Langenbeck's Archives of Surgery最新文献

Introduction: Duct-to-mucosa pancreaticojejunostomy (PJ) is a widely accepted. However, it is difficult to implement during laparoscopic surgery, particularly for a small main pancreatic duct (MPD). We attempted to perform PJ without suturing the main pancreatic duct (WSMPD) and examined its safety and feasibility.

Materials and methods: We retrospectively reviewed 126 patients who underwent laparoscopic pancreaticoduodenectomy (LPD) between 2019 and 2024. Among them, 64 patients underwent Blumgart PJ and 62 underwent WSMPD PJ. The patients' demographics and short-term clinical safety were examined.

Results: After 1:1 PSM, the WSMPD group had significantly shorter operation and PJ durations and higher biochemical leakage than those in the Blumgart group. However, no significant differences were observed in other postoperative complications between the groups. Furthermore, the operation and PJ durations were shorter in the WSMPD group than in the Blumgart group, regardless of the MPD size (> 3 mm or ≤ 3 mm). In the Blumgart group, patients with MPD ≤ 3 mm had longer PJ duration and hospital stay as well as higher hospital expenses, incidence of B + C grade pancreatic fistula, and incidence of abdominal infection than those with MPD > 3 mm. In the WSMPD group, no significant differences were observed among the patients.

Conclusions: WSMPD PJ is a safe, effective, and easy-to-perform method that simplifies LPD procedures. It is particularly suitable for cases involving small MPDs.

Introduction: Investigating the role of posterior retroperitoneoscopic adrenalectomy (PRA) for the treatment of adrenocortical cancer (ACC).

Methods: Between January 2010 and December 2024, 28 patients (9 men, 19 female) with am mean age of 51.5 ± 19.5 years (range: 1.6-82.3) underwent PRA for primary ACC. Tumor sizes ranged between 3 and 15 cm (mean: 7.3 cm). Hormonal hypersecretion was found in 12 patients. Surgeries were performed in a standardized 3-port technique in prone position. Follow-up (mean: 37.9 months) data could be obtained for 26 patients.

Results: There were 12 right and 16 left adrenalectomies. The mean operating time was 159.2 ± 100.9 min (range: 35-340 min). Seven conversions occurred (25%): five to an open approach and two to a laparoscopic approach. One patient with Cushing's syndrome died because of multiple organ failure in the postoperative period (4%). The mean follow-up time was 38.8 ± 35.3 months. Patients with stage I disease demonstrated a 5-year overall survival rate of 100%, whereas patients with stage II and III disease had 3-years survival rates of 64% and 50%, respectively.

Conclusions: The posterior retroperitoneoscopic approach appears feasible in patient with confirmed or suspected ACC and can be proposed in selected cases.

Objective: Papillary thyroid cancer (PTC) is the most common malignancy of the thyroid gland. This study aimed to evaluate the potential biomarker effect of ABO blood group and Rhesus factor in PTC.

Methods: In this retrospective study, data from patients who underwent thyroid surgery at our center were analyzed. Patients operated for benign thyroid disease (Group I, n = 955) and those operated for PTC (Group II, n = 656) were included. Demographic data, histopathological characteristics of thyroid nodules, ABO blood group, and Rhesus factor were evaluated, and statistical analyses were performed.

Results: No significant difference was found in ABO blood group distribution between Group I and Group II (p = 0.340). Similarly, Rhesus factor showed no statistically significant association with PTC (p = 0.579). The nodule diameter was significantly smaller in the malignant group (p < 0.001). Preoperative Free T3, TSH, and thyroglobulin levels differed significantly between the two groups (p < 0.001). No statistically significant relationship was observed between ABO blood groups and histopathological characteristics, including extrathyroidal extension, lymphatic invasion, vascular invasion, and capsular invasion.

Conclusion: ABO blood group and Rhesus factor do not appear to be independent biomarkers in papillary thyroid cancer. Our study presents findings that do not support a relationship between ABO blood group, Rhesus factor, and PTC. However, further studies with larger patient cohorts are needed to reach more definitive conclusions.

Purpose: The appropriate surgical approach for colon cancer (CC) in nonagenarian patients remains a subject of clinical debate. This study aimed to compare the short-term outcomes of laparoscopic (Lap) versus open (Open) surgery in patients aged ≥ 90 years with resectable colon cancer.

Methods: This multi-institutional retrospective cohort study included oldest-old patientswith pathological Stage II/III CC who underwent elective surgery at 15 hospitals between 2011 and 2022. Patients with rectal cancer, Stage 0/I/IV disease, or emergency surgery were excluded. To address selection bias, inverse-probability-weighted regression adjustment and stabilized inverse probability of treatment weighting (sIPTW) were applied. The primary outcome was postoperative complications; secondary outcomes included overall survival (OS).

Results: Median age was 92 years in both groups. Before adjustment, the Lap group had a higher proportion of female patients (p = 0.038) and lower ASA scores (p = 0.01). Laparoscopic surgery was associated with a significantly longer operative time (220 vs. 171 min, p = 0.046) but less intraoperative blood loss (10 vs. 78 mL, p < 0.01). Postoperative complication rates were comparable (Lap: 31.8%, Open: 33.8%), while the Lap group had a significantly shorter hospital stay (13 vs. 17 days, p < 0.01). D3 lymph node dissection was more frequently performed in the Lap group (p < 0.01). After sIPTW, overall survival did not differ significantly between groups (p = 0.61).

Conclusion: Both laparoscopic and open surgery are feasible options for selected nonagenarians with colon cancer. Laparoscopic surgery may offer benefits in terms of reduced blood loss and shorter hospitalization, despite longer operative times. Careful patient selection considering frailty and comorbidities is essential in determining the most appropriate surgical approach.

Purpose: Although robotic liver resection (RLR) has gained popularity worldwide, limited liver resection remains the mainstay of RLR. This study aimed to investigate the effect of parameters, including liver transection depth (LTD), on surgical difficulty in limited RLR compared with limited laparoscopic liver resection (LLR).

Methods: This retrospective study included 105 patients who underwent limited RLR (n = 56) or LLR (n = 49) at our institution between January 2018 and December 2024. After comparing outcomes of RLR and LLR, multivariate analyses were performed to examine effect of LTD on surgical difficulty (defined as prolonged operative time). Moreover, outcomes stratified by LTD cut-off values were compared between the groups.

Results: Median LTD was similar between groups (RLR vs. LLR: 2.6 vs. 2.6 cm, P = 0.77). LTD was significantly correlated with operative time for both procedures (RLR, R² = 0.07, P = 0.042; LLR, R² = 0.08, P = 0.046). Multivariate analyses demonstrated that LLR (odds ratio, 6.9; P < 0.001) and LTD (odds ratio, 2.0; P = 0.004) were significant risk factors of surgical difficulty. Among patients with deeper LTD (> 2.5 cm), the RLR group had significantly shorter operative time (145 vs. 231 min, P < 0.001), less blood loss (nil vs. 100 mL, P = 0.006), and a higher rate of textbook outcomes (76.7% vs. 42.3%, P = 0.01).

Conclusion: This study investigated impact of LTD on surgical outcomes in patients who underwent limited RLR compared to those who underwent limited LLR. LTD may be a useful parameter for estimating surgical difficulty in limited RLR. Moreover, robotic surgery may be favorable for deeper and limited liver resections.

Objective: This study explored the effects of enhanced recovery after surgery (ERAS) nursing combined with early enteral nutrition support on postoperative gastrointestinal function in patients undergoing radical gastrectomy for gastric cancer.

Methods: Ninety-six patients were randomly assigned to either an experimental group, which received ERAS nursing plus early enteral nutrition, or a routine group, which received conventional perioperative nursing with standard nutritional support. Postoperative gastrointestinal recovery, intraoperative indicators, nutritional markers [transferrin (TRF), albumin (ALB), prealbumin (PAB)], immune indicators [CD3+, CD4+, CD8+, CD4+/CD8+, IgA, IgM, IgG], quality of life (EORTC QLQ-C30), and complication rates were compared between the two groups.

Results: The experimental group showed significantly shorter times to first flatus (2.45 vs. 3.84 days), first bowel movement (3.39 vs. 5.61 days), and hospital stay (8.75 vs. 12.50 days) than the routine group (P < 0.05). On postoperative day 7, TRF, ALB, PAB, CD3+, CD4+, CD4+/CD8+, IgA, IgM, and IgG levels were significantly higher in the experimental group than in the routine group (P < 0.05). The experimental group also achieved higher quality-of-life scores across somatic, role, cognitive, social, emotional, and global health domains, and had a lower complication rate compared to the routine group (6.25% vs. 31.25%) (P < 0.05).

Conclusion: ERAS nursing combined with early enteral nutrition accelerates gastrointestinal recovery, enhances nutritional and immune status, improves quality of life, and reduces postoperative complications in patients undergoing radical gastrectomy for gastric cancer.

Purpose: The combined burden of vascular resections and pancreas-specific complications may preclude or delay adjuvant chemotherapy and impair survival. We evaluated the effect of complications on adjuvant therapy delivery and survival after upfront pancreatectomy with venous resection (PVR).

Methods: Patients undergoing upfront PVR were retrieved from a prospectively maintained database at two high-volume Institutions. The incidence and severity of complications were correlated with administration of adjuvant chemotherapy and overall survival.

Results: Overall, 280 patients underwent upfront PVR. 75% (N = 210) underwent pancreatoduodenectomy (PD), 15% (N = 41) distal pancreatectomy (DP), and 10% (N = 29) total pancreatectomy (TP). Major morbidity occurred in 34% (N = 96), with 4% (N = 12) 90-day mortality. Overall rates of POPF, PPH, and DGE were 22%, 15%, and 18%, respectively. Mortality was higher in Type IV venous resections (14%, p = 0.028). DP was associated with higher morbidity but similar mortality compared to PD and TP. The only factor independently associated with adjuvant chemotherapy delivery, administered in 196 (70%), was ASA score < 3 (p = 0.003). Factors independently associated to worse OS were age > 75 years, TP, pT > 2, pN2, and lack of adjuvant chemotherapy delivery.

Conclusions: Upfront PVR has an acceptable risk profile and oncologic outcomes when adjuvant chemotherapy is administered. Survival and the delivery of adjuvant therapy do not appear to be negatively affected by complications.

Purpose: The study aimed to determine whether adjuvant chemotherapy after colorectal cancer resection is associated with an increased risk of developing incisional hernia (IH).

Methods: All patients undergoing elective curative resection of stage I-III colon adenocarcinoma between 2014 and 2017 at Copenhagen University Hospital - North Zealand were registered in a local database prospectively. This study collected additional data from patients' electronic health records (EHR) on chemotherapy and incision placement. The follow-up computed tomography scans were retrospectively reassessed by two trained surgeons for incisional hernia for up to five years. Patients were stratified into two groups: those receiving adjuvant chemotherapy (study group) and those not receiving it (control group). The primary outcome was CT-verified IH.

Results: Of 451 patients, 303 were included in the final analysis, with 108 in the chemotherapy group and 195 in the control group. The study found that the unadjusted risk of IH was 28.9% (95% CI: 20.4-37.4) in the chemotherapy group and 21.1% (95% CI: 15.4-26.9) in the control group with an absolute risk difference of 7.7% (95% CI: -2.3-17.9, p = 0.13). After inverse probability of treatment weighting, the absolute risk difference was 5.6% (95% CI: -4.2-15.6), p = 0.26).

Conclusions: Adjuvant chemotherapy after colon cancer resection does not seem to be associated with a significantly higher risk of IH.

Trial registration: Danish Patient Safety Authority (#31-1522-51).

Purpose: Studies reporting intraoperative complications during gastrectomy for gastric cancer or their effect on short- and long-term outcomes are rare. Our aim was to examine the effect of major intraoperative complications to incidence of major postoperative complications and long-term survival after gastrectomy for gastric cancer.

Methods: This population-based, nationwide, and retrospective cohort study reports intraoperative complications and examines the effect of major intraoperative complications to incidence of major postoperative complications and mortality after gastrectomy for gastric cancer in Finland in 2005-2016.

Results: Total or partial gastrectomy was performed to 2,184 patients eligible for this study. A total of 552 (25.3%) intra-operative complications occurred in 483 patients. Major intraoperative complication occurred to 69 patients (3.2%) and major postoperative complication occurred to 374 patients (17.1%). The occurrence of major intraoperative complications was not associated to the risk of postoperative major complications in the crude (OR 1.13, CI 0.61-2.08) or in the adjusted analysis (OR 1.18, CI 0.62-2.27), compared to patients without major intraoperative complications. Major intraoperative complications were not associated to higher 90-day mortality (HR 1.76, 95% CI 0.81-3.82) or higher 5-year mortality (HR 1.09, 95% CI 0.79-1.52) compared to patients without major intraoperative complications.

Conclusion: Intraoperative complications during gastric cancer surgery are common but mainly not life-threatening and can be managed with relatively low sequelae. Major intraoperative complications did not increase the risk of major postoperative complications and were not associated to higher 90-day, or 5-year mortality compared to patients without major intraoperative complications after gastric cancer surgery.