Gland surgery最新文献

Background and objective: Prostate cancer (PCa) management and outcomes are dependent on risk stratification. Indolent disease is often managed with active surveillance, whereas clinically significant PCa (CSPCa) necessitates prompt intervention due to its aggressive potential. Although transrectal ultrasound (TRUS) is central to diagnosis and biopsy guidance, its limited resolution and high interobserver variability complicate accurate risk assessment. Artificial intelligence (AI) offers a promising solution to these limitations. This review evaluates the current landscape of TRUS-based AI models for three critical objectives: PCa detection, CSPCa identification, and risk stratification.

Methods: We systematically searched the PubMed and Web of Science databases for peer-reviewed, original English-language articles published from 1999 to 2026.

Key content and findings: TRUS-based AI models have advanced significantly, achieving area under the curve (AUC) values of 0.78-0.96 for PCa detection and 0.85-0.90 for CSPCa identification, particularly when leveraging three-dimensional (3D) architectures or multiparametric fusion (e.g., elastography or contrast enhancement). Performance is robust for binary risk stratification (e.g., low-intermediate vs. high-risk). However, a critical gap remains: no existing AI model has successfully predicted the full spectrum of the five-tier International Society of Urological Pathology (ISUP) Grade Group (GG) stratification using TRUS imaging alone. Key barriers to clinical translation include challenges in precise lesion localization, the complexity of annotating risk-stratified labels, and the predominance of single-center retrospective datasets.

Conclusions: TRUS-based AI demonstrates high accuracy for PCa detection and CSPCa identification, particularly with 3D architectures or multiparametric fusion. However, the inability to predict the full five-tier ISUP GG stratification represents a major unmet need. Future research should prioritize standardized multicenter data collection and advanced algorithms to address localization challenges and enable precise risk stratification, thereby facilitating clinical translation.

Background: Breast cancer (BC) is one of the most prevalent malignancies among women worldwide, with heterogeneous outcomes necessitating individualized prognostic assessment. Existing models often rely on specialized biomarkers, limiting their accessibility in routine practice. This study aimed to develop and internally validate a prognostic nomogram based on readily available clinical indicators to predict overall survival (OS) in BC patients.

Methods: In this retrospective study, 217 BC patients diagnosed between 2012 and 2015 at The First Affiliated Hospital of Soochow University and The 904th Hospital of the Joint Logistics Support Force of the People's Liberation Army were enrolled. The cohort was randomly split into training and internal validation sets. Prognostic factors were selected using least absolute shrinkage and selection operator (LASSO) regression, followed by univariate and multivariate Cox regression analyses. A nomogram was constructed based on significant predictors from the training set. Its discriminative ability and calibration were evaluated using Harrell's concordance index (C-index), calibration curves, and time-dependent area under the curve (AUC).

Results: Six clinical indicators-hypertension, American Joint Committee on Cancer (AJCC) stage, metastasis, Ki-67 status, endocrine therapy, and red blood cell (RBC) count-were identified as independent prognostic factors and incorporated into the nomogram. The model demonstrated excellent discrimination, with a C-index of 0.898. In the training cohort, the AUCs for predicting 1-, 3-, and 5-year OS were 0.93, 0.89, and 0.93, respectively; corresponding values in the validation cohort were 0.98, 0.86, and 0.85. Calibration curves indicated good agreement between predicted and observed survival probabilities.

Conclusions: We developed and validated a novel nomogram based on clinical indicators for predicting OS for BC, which showed good application prospect. This model has the potential to help in clinical decision-making and evaluating patient outcomes.

Background: Despite meeting guideline-based criteria for surgery, older adults with primary hyperparathyroidism (PHPT) undergo parathyroidectomy at lower rates. We aimed to evaluate age-specific differences in PHPT diagnosis, time to surgery, and surgical indications among patients offered parathyroidectomy.

Methods: Retrospective cohort study of adults with sporadic PHPT who underwent parathyroidectomy between 1/1/2017 and 12/31/2022 at a tertiary academic center was performed. Surgical indications were determined using the 2016 American Association of Endocrine Surgeons (AAES) and Fourth International Workshop guidelines. Complete preoperative evaluation was defined as documentation of corrected serum calcium, parathyroid hormone (PTH), 25-hydroxy vitamin D, estimated glomerular filtration rate (eGFR), bone imaging/dual-energy X-ray absorptiometry (DXA), and 24-hour urine calcium.

Results: Among 266 patients (median age 63.2 years; 74.8% female), 145 (54.5%) were <65 years (median 54.9 years) and 121 (45.5%) were ≥65 years (median 71.4 years). Time from first calcium elevation to PTH testing was similar between groups. However, the median time from biochemical diagnosis to surgery was significantly longer in older adults (14.5 vs. 7.53 months, P<0.05). Patients ≥65 years were more likely to undergo surgery for bone disease (31.4% vs. 20.0%, P<0.05), have eGFR <60 mL/min/1.73 m² (43.8% vs. 13.1%, P<0.001), and less likely to have nephrolithiasis (29.8% vs. 43.3%, P<0.05). Only 32.3% of all patients received a complete preoperative evaluation, with no difference by age group (P=0.80).

Conclusions: Older adults experienced longer delays to parathyroidectomy despite comparable rates of guideline-based evaluation. They were more likely to present with bone complications and decreased renal function, highlighting the need for earlier identification and referral to mitigate long-term morbidity.

Background: Reoperation for recurrent thyroid cancer (TC) presents unique challenges, necessitating exploration of optimal surgical approaches for improved outcomes. Therefore, this study aimed to compare the lateral intermuscular approach (LIA) between the sternohyoid and sternothyroid muscles with the standard cervical white line approach (SCWLA) in reoperations for recurrent TC.

Methods: In the single-center retrospective cohort study, a total of 102 patients with recurrent TC undergoing reoperation were included and, according to the intraoperatively selected surgical approach, were divided into a SCWLA group (n=51) and a LIA between the sternohyoid and sternothyroid muscles group (n=51). Thyroid exposure, surgical parameters, and postoperative complications were evaluated.

Results: The LIA group demonstrated significantly better thyroid exposure across multiple anatomical regions, providing a wider surgical field, clearer visualization of key structures, and facilitating safer dissection, along with shorter operative and hospitalization period and reduced intraoperative blood loss compared with the SCWLA group. Postoperative complications were also less frequent in the LIA group.

Conclusions: Implementing the sternohyoid and sternothyroid LIA in reoperations for recurrent TC offers improved local structure exposure, decreased trauma, faster recovery, and reduced postoperative complications.

Background: Breast nodules are a common clinical finding in women, and their association with metabolic syndrome (MetS) remains unclear. This study aimed to investigate the independent relevant factors for breast nodules, with a focus on MetS.

Methods: We analyzed health examination data from 667 women in 2024, with 300 participants (150 with breast nodules and 150 without) randomly selected for analysis. Data included medical history, metabolic parameters, psychological evaluations, and breast ultrasound reports [breast imaging reporting and data system, Breast Imaging Reporting and Data System (BI-RADS) classification].

Results: The prevalence of breast nodules was 65.97% (440/667). Women with breast nodules exhibited a significantly higher average height (160.89±5.65 vs. 158.92±5.96 cm, P=0.005) and higher very low-density lipoprotein cholesterol (VLDL-C) level (0.069 vs. 0.064 mmol/L, P=0.03) compared to those without nodules. The breast nodule group also had higher rates of MetS (17.33% vs. 6.67%, P=0.007), diabetes (13.33% vs. 5.33%, P=0.03), hyperlipidemia (39.33% vs. 27.33%, P=0.04), and high symptom burden of anxiety/depression (19 vs. 9 cases, P=0.02). After correction, MetS [false discovery rate (FDR)-adjusted P=0.04] and height (FDR-adjusted P=0.03) still showed significant statistical differences between the group with breast nodules and the group without breast nodules.

Conclusions: Multivariate regression analysis identified MetS [odds ratio (OR) =3.453; 95% confidence interval (CI): 1.569-7.601] and height (OR =1.060 per 1 cm increase, 95% CI: 1.018-1.103) as independent relevant factors. These findings suggest that metabolic health interventions may play an important role in breast nodules.

Background: Breast cancer is the most common malignant tumor in women worldwide, and surgery remains its primary treatment. Endoscopic-assisted breast surgery has gained widespread attention in recent years for its minimally invasive and aesthetic advantages, yet its safety remains controversial. This study aims to provide a comprehensive bibliometric overview of endoscopic surgery for breast cancer, elucidating its development trends, research patterns, and emerging hotspots.

Methods: Based on the Web of Science (WoS) database (1999-2024), we searched and screened relevant English literature. Tools such as R, Bibliometrix, VOSviewer, and CiteSpace were used to conduct metrological and visualization analyses of countries, institutions, authors, journals, and keywords.

Results: A total of 230 documents were included. China, Japan, and the United States were the major research countries, with China leading in publication volume and international collaboration. Changhua Christian Hospital in Taiwan, China was the most active institution, and scholars such as Lai, Hung-Wen were the most prolific and highly cited. Core journals included Annals of Surgical Oncology. The analysis of highly cited literature and keywords shows that research hotspots have shifted from early focuses on axillary lymph node dissection and breast ductoscopy to nipple-sparing mastectomy (NSM) and breast reconstruction. Current research is mainly focused on key technologies such as endoscopic and robot-assisted breast reconstruction.

Conclusions: In the future, the oncologic safety and long-term aesthetic results of endoscopic surgery will become an important research direction.

Background and objective: Autologous breast reconstruction most commonly utilizes free tissue transfer to create a natural-appearing and aesthetically pleasing breast. A critical component of flap-based reconstruction is the selection of recipient vessels, yet the optimal choice, exposure, and technical utilization can vary. This study reviews the different options for recipient vessel selection along with the critical factors that influence decision-making and surgical technique in these cases.

Methods: A literature review of PubMed/MEDLINE databases was performed from inception to June 2025 to identify recipient vessels utilized in autologous breast reconstruction. Key words included "recipient vessels", "breast reconstruction", "autologous reconstruction", and "microsurgery". Original and review articles in English were included. Studies were analyzed for discussion of indications, advantages, and drawbacks of one or more recipient options.

Key content and findings: A multitude of factors influence decision-making in recipient selection and technique including flap choice, mastectomy type, prior operations and surgeon preference. Internal mammary (IM) vessels are the first-line choice. Internal mammary perforators (IMPs) have been explored to reduce morbidity but lack reliability. Thoracodorsal (TD) vessels and other axillary selections can be utilized in appropriately selected patients, typically as second-line options.

Conclusions: Advancements in reconstructive techniques have changed the landscape for optimal recipient vessel selection from TD vessels to IM vessels. Options for free flap breast reconstruction continue to evolve toward improving aesthetic outcomes, increasing efficiency, and minimizing recipient site morbidity. Currently, IMP techniques are the forefront of continued innovation, but alternative recipient vessels may be appropriate in select individuals after considering patient factors and surgeon experience.

Background: With the development and new technological knowledge, such as surgical techniques that accompany the consolidated open surgical procedures, minimally invasive strategies have also emerged for thyroid surgery. Among these, we can cite the transoral endoscopic vestibular approach known as TOETVA. Recurrences and metastases of differentiated thyroid cancer frequently manifest in the lymph nodes, lungs, bones, and liver. Although the primary implantation of cancer cells causing these recurrences and metastases is considered an uncommon event, it can nonetheless occur in specific instances. This can be a serious complication for patients, as these recurrences and metastases can be difficult to detect and treat effectively. Early identification and appropriate management of these cases are crucial for improving patient outcomes.

Case description: We present a case of a 55-year-old male patient with recurring muscular and subcutaneous recurrence that developed five years after the initial left thyroidectomy performed via a TOETVA. The patient therefore required a second surgical procedure of completion thyroidectomy, central lymph node dissection (level 6 and 7), and removal of nodes in subcutaneous tissue and muscle.

Conclusions: Tumor biology, local environment, technical issues, surgical skills, and the correct management and handling of neoplastic nodules represent crucial clinical pitfalls and important factors that can contribute to local recurrence and malignant cellular implantation following a TOETVA for thyroid surgery.