Journal of Investigative Surgery最新文献

Background: Abdominal aortic aneurysm (AAA) is a progressive vascular disorder that enlarges irreversibly and may ultimately rupture. Mendelian randomization (MR) provides a powerful approach to uncover biomarkers. We aimed to identify plasma proteins linked to AAA and evaluate their diagnostic potential.

Methods: We performed a proteome-wide MR analysis using genetic instruments for 2,940 plasma proteins from the UK Biobank Pharma Proteomics Project (UKB-PPP). Summary statistics for AAA were obtained from the Finnish R9 GWAS, comprising 4,083 cases and 420,324 controls.

Results: Eleven proteins showed significant causal associations with AAA risk (FDR < 0.05): seven positively and four negatively associated, highlighting their potential as diagnostic markers.

Conclusion: This study provides the first proteome-wide MR evidence linking plasma proteins to AAA, offering candidate biomarkers for diagnosis. As a hypothesis-generating work, further experimental and clinical validation is warranted.

Background: Laparoscopic cholecystectomy (LC) is performed by surgeons from various specialties and remains central to minimally invasive surgical training. This study assessed whether surgeon subspecialty affects patient outcomes and explored aspects of LC education.

Methods: This population-based study included 46,700 LCs performed between 2020 and 2023, using data from the Swedish Registry for Gallstone Surgery (GallRiks). Surgeons were categorized as resident surgeons (RS), attending surgeons (AS), upper gastrointestinal/hepatopancreatobiliary surgeons (UGIS), acute care surgeons (ACS), or alternate subspecialty surgeons (ASS). Primary outcomes were 30-day adverse events (AE), bile duct injuries (BDI), and operative time (OT). Educational activity and subgroup analyses for elective and acute cholecystitis cases were evaluated.

Results: AE rates were higher for ACS (9.6%; OR 1.22, 95% CI 1.07-1.40) and AS (7.9%; OR 1.17, 95% CI 1.06-1.19) compared to UGIS (6.9%) but without increased BDI rates. RS demonstrated similar AE rates (6.1%) but lower BDI rates in elective cases (0.08%). OT was 24-33 min shorter for UGIS than for other surgeon types. Educational activity prolonged OT by 12 min (OR 1.06; 95% CI 1.05-1.08).

Discussion: Higher AE rates among ACS and AS likely reflect more complex cases. LC performed by RS appears equally safe and efficient, provided appropriate supervision is available.

Objective: This review aims to systematically assess and compare the efficacy, complication rates, and procedural characteristics of percutaneous interlaminar endoscopic discectomy (PIED), percutaneous transforaminal endoscopic discectomy (PTED), and unilateral biportal endoscopy (UBE) in the management of lateral recess stenosis (LRS).

Methods: A systematic search was conducted across six databases from inception to March 2025 to identify studies on endoscopic lumbar decompression for LRS. Primary outcomes were pain reduction (VAS) and functional improvement (ODI); secondary outcomes were perioperative metrics, complication rates, and patient satisfaction. Narrative synthesis was applied due to heterogeneity. Study quality was assessed using the Cochrane Risk of Bias Tool, ROBINS-I, and the Downs and Black checklist.

Results: Thirty-six studies involving 2341 patients with 6-60 months of follow-up were included. PIED achieved VAS reductions of 3-5 points and ODI reductions of 40-60%, but with higher complication rates, including dural tears (3-6%) and reoperation rates (5-9.7%). UBE produced VAS improvements of 5-7 points and ODI reductions of 50-70%, with satisfaction >92%, though operative times were longer (48-91 min) and dural tears occurred in 3-6%. PTED showed consistent pain relief (VAS 6-8 to 1-2) and ODI reductions >50%, with satisfaction 85-95%, short operative times (5-30 min), and low complication and reoperation rates (<5%). Overall study quality ranged from low to moderate risk of bias.

Conclusions: PIED, PTED, and UBE all provide effective decompression for LRS. PTED demonstrates the most consistent balance of symptom improvement, safety, and efficiency, while each technique offers distinct advantages for individualized patient selection.

Background: Ischemic preconditioning of parathyroid glands (IPCP) is biologically plausible but clinical evidence is limited. In this single-center randomized trial (ChiCTR2000039788), we compared IPCP versus control during total thyroidectomy with central neck dissection.

Methods: A total of 135 patients with differentiated thyroid carcinoma were analyzed (IPCP, n = 67; control, n = 68). IPCP consists of three cycles of 60-second occlusion followed by 60-second reperfusion of the ipsilateral superior and inferior thyroid arteries. The baseline characteristics, postoperative hypoparathyroidism (hypoPTH) and hypocalcemia, early parathyroid function recovery (PFR), and surgical complications, were compared between groups.

Results: The incidence of postoperative hypoPTH and protracted hypoPTH was not significantly different between the IPCP and control groups (50.8% vs 41.2%, p = 0.265; 6.0% vs 14.7%, p = 0.096). An exploratory analysis showed a higher rate of early PFR in the IPCP group (88.2% vs 64.3%; p = 0.025). The incidence of postoperative hypocalcemia was similar between groups (79.1% vs 82.4%; p = 0.632). Fewer inadvertent parathyroidectomy occurred in the IPCP group, though this difference was not statistically significant (4.5% vs 8.8%; p = 0.505). Other surgical complications were comparable.

Conclusions: IPCP did not reduce postoperative hypoPTH in this randomized trial. Earlier PFR is exploratory and warrants further investigation in adequately powered trials.

Background: Antiviral therapies for hepatitis B or C virus may be associated with reduced risk of tumor recurrence and mortality of patients with hepatocellular carcinoma (HCC) undergoing curative treatments, compared to untreated patients. Previous studies comparing survival outcomes between percutaneous radiofrequency ablation (RFA) and liver resection (LR) for treating patients with very early-stage HCC did not evaluate the effects of antiviral treatments on survival outcome. Our study aimed to clarify this issue.

Methods: From 2011 to 2021, 265 patients undergoing LR and 269 patients undergoing RFA for very early-stage HCC (i.e., a single tumor ≤2 cm without macrovascular invasion or extrahepatic metastasis, with Eastern Cooperative Oncology Group performance status = 0 and Child-Pugh class A liver disease) were included in this retrospective study. Survival analysis was performed using the Kaplan - Meier method after propensity score matching (PSM).

Results: After 1:1 PSM (n = 205 in both groups), the survival benefit of LR was significantly higher than that of RFA (five-year OS: 85% vs. 73%; p = 0.004; five-year RFS: 64% vs. 45%; p < 0.001).

Conclusions: For patients with very early-stage HCC, LR was associated with superior OS and RFS compared to RFA.

Background: The advantages of postoperative adjuvant chemotherapy (ACT) for gastric cancer patients with pT1N + M0 staging have been a subject of debate. This study aims to assess whether ACT can enhance the overall survival (OS) of postoperative pT1N + M0 gastric cancer patients when compared to surgery alone.

Methods: A total of 329 postoperative patients with pT1N + M0 gastric cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2015). Patients were stratified into surgery-alone and surgery-plus-chemotherapy groups. Multivariate Cox regression identified prognostic factors, followed by subgroup analyses stratified by clinical characteristics.

Results: This study included 329 patients, of whom 80 received postoperative ACT and 249 underwent surgery alone. Multivariate analysis revealed that race, tumor primary site, differentiation grade, clinical stage, N stage, and ACT were independent prognostic factors for OS. Subgroup analysis demonstrated that the survival benefit of ACT was more pronounced in Asian/Pacific Islander (API) patients (hazard ratio [HR], 0.320; 95% confidence interval [CI], 0.140-0.732; P for interaction = 0.028) and in those with N1 stage (HR, 0.447; 95% CI, 0.272-0.737; P for interaction = 0.022).

Conclusion: ACT was associated with a survival benefit versus surgery-alone in pT1N + M0 gastric cancer, especially among API patients or those with N1 stage.

Background: Idiopathic retroperitoneal fibrosis (IRPF) is a rare fibroinflammatory condition that is challenging to distinguish from retroperitoneal malignancies based solely on imaging. We evaluated laparoscopic ultrasound-guided biopsy for diagnosing IRPF.

Methods: We retrospectively analyzed 12 patients with suspected retroperitoneal fibrosis who underwent laparoscopic ultrasound-guided biopsy. The surgical technique involved systematic laparoscopic exploration, intraoperative ultrasound to delineate the mass and its relation to great vessels, and targeted biopsy.

Results: Preoperative imaging suggested retroperitoneal masses in all 12 patients but failed to provide a definitive diagnosis in any case. Laparoscopic biopsy was successfully performed in all patients without conversion to laparotomy. Pathological examination confirmed IRPF in 11 patients and retroperitoneal adenocarcinoma in one. The procedure was safe, with minimal blood loss (20.4 ± 14.8 mL) and a short operative time (68.3 ± 19.0 min). All IRPF patients were treated with a combination of prednisone, tamoxifen, and mycophenolate mofetil, leading to significant lesion regression on follow-up imaging (median 37.9 months).

Conclusions: Laparoscopic ultrasound-guided biopsy is a safe and highly effective diagnostic procedure for IRPF. It provides definitive pathological diagnosis to guide appropriate therapy and should be considered when percutaneous biopsy is not feasible.

Background: This retrospective study compared the perioperative outcomes of vaginal natural orifice transluminal endoscopic surgery (V-NOTES) and total laparoscopic hysterectomy (TLH).

Materials and methods: This analysis included 62 patients: 32 underwent V-NOTES and 30 underwent TLH. Patients with a body mass index (BMI) >30, a history of endometriosis, multiple cesarean sections, or a uterine size >12 week were excluded. Perioperative data-including visual analog scale (VAS) scores, analgesia use, mobilization time, hospitalization duration, and hemoglobin deficit-were compared using independent sample t tests and Mann-Whitney U tests.

Results: There were no significant differences in BMI, number of pregnancies, or operative time (p > 0.05). VAS scores at 6 and 24 h were significantly lower in the V-NOTES group (p < 0.001). Patients in the V-NOTES group required less analgesia, had shorter mobilization and hospitalization periods, and returned to daily activities sooner (p < 0.001). However, the hemoglobin deficit was higher in the V-NOTES group (1.85 g/dl vs. 0.7 g/dl, p < 0.001). The neutrophil-to-lymphocyte ratio (NLR) was lower in the V-NOTES group (p = 0.013), whereas the platelet-to-lymphocyte ratio (PLR) and mean platelet volume (MPV) did not differ significantly between the two groups.

Conclusion: V-NOTES offers advantages such as reduced postoperative pain and faster recovery compared to TLH. The higher hemoglobin deficit observed with V-NOTES may be related to the surgeon's experience. Further randomized studies are warranted to validate these findings and define appropriate patient selection criteria.

Aim: Acute mesenteric ischemia (AMeI) is a mortal intestinal emergency with vascular origin. Mortality and morbidity can be prevented by early diagnosis and prompt intervention. In this study, an AMeI rat model was established to investigate the efficacy of immunophenotyping to reveal a biomarker of AMeI.

Material and methods: Twenty-one adult female Sprague-Dawley rats were divided into three groups. In the Sham group (Group 1), after laparotomy, the superior mesenteric artery (SMA) was found, and no further intervention was performed. In the ischemia-reperfusion group (Group 2), SMA was occluded only for 45 min whereas in Group 3(ischemia group), SMA was permanently occluded. Peripheral blood mononuclear cells were quantified for T cell subsets using flow cytometry.

Results: Regarding hematological biomarkers, only mean platelet volume (MPV) values in Group 3 were significantly higher compared to Group 2 (p = 0.0134). Platelet lymphocyte ratio values and D dimer levels were higher in Group 3 compared to the sham Group (p = 0.0219, p = 0.0012; respectively). No statistically significant difference was detected between groups considering the subtypes of lymphocytes surface antigens. However, in the correlation matrix analysis, significant correlations were observed between Chiu histopathological stage of ileum mucosa and CD45+ and CD4 + CD8 + [Spearman r = 0.571 (95% CI: 0.172-0.809) p = 0.0068 and Spearman r = 0.4908 (95% CI: 0.061-0.767) p = 0.0239]. Likewise, a positive linear correlation was found between MPV, D-dimer and Chiu score [Spearman r = 0.5155 (95% CI: 0.094 - 0.780; p = 0.0168) and r = 0.7828 (95% CI: 0.520 - 0.910; p < 0.0001), respectively].

Conclusion: Blood levels of CD45+ and CD4 + CD8+ were proved to be higher in study groups. Remarkable positive linear correlation with histopathological changes may also play a predictive role to investigate the role of these markers in larger samples.

Background: Despite advancements in surgical techniques, coronary artery bypass grafting (CABG) for patients with recent acute myocardial infarction (AMI) remains associated with relatively high mortality. Risk prediction in these patients is essential. The aim of this study was to develop a nomogram model to predict the early postoperative mortality in patients undergoing surgical revascularization for AMI based on preoperative clinical features.

Method: We retrospectively analyzed the clinical data of 332 consecutive patients who underwent CABG for AMI at our center from January 2018 to December 2024. Independent predictors for early postoperative death were identified by using univariate and multivariate logistic regression models. A nomogram prediction model was developed based on all independent predictors. Discriminative ability, calibration, and clinical utility of the model were evaluated. Internal validation was performed utilizing the bootstrapping method.

Results: The nomogram model incorporated seven independent predictors: preoperative cardiac arrest, previous history of myocardial infarction(MI), left ventricular ejection fraction (LVEF) <50%, MI-to-CABG interval ≤ 3d, age > 75 years, serum albumin < 35g/L and serum creatinine > 2.0 mg/dL. The model achieved good discrimination with an area under the receiver operating characteristic curve (AUC) of 0.905 (95% CI: 0.832-0.978), and showed well-fitted calibration curves with Hosmer-Lemeshow test results (χ² = 3.437, p = 0.944). Decision curve analysis indicated that the model can provide greater clinical net benefits compared to "operate-all" or "operate-none" strategies in a wide range of threshold probability.

Conclusions: The novel nomogram model combining seven preoperative clinical predictors can provide an accurate preoperative estimation of early postoperative death for AMI patients undergoing surgical revascularization, with satisfactory discrimination and calibration.