Langenbeck's Archives of Surgery最新文献

This systematic review synthesizes current evidence on robotic transanal minimally invasive surgery (TAMIS) for rectal neoplasms, analyzing data from 26 clinical studies (2011-2024) involving 1,284 patients. The findings demonstrate robust short-term oncologic outcomes, including an 89.1% R0 resection rate for malignant lesions and an 8.3% local recurrence rate at a median follow-up of 28 months. Technical advancements, particularly the development of single-port robotic systems, have yielded significant improvements in procedural efficiency, reducing operative time by 22% while enhancing surgical ergonomics. Comparative analyses reveal advantages over conventional endoscopic TAMIS, including lower conversion rates (4% vs. 12%) and superior maneuverability in confined spaces. However, the review identifies persistent knowledge gaps regarding long-term survival outcomes and cost-effectiveness that require further investigation through prospective trials. The current evidence supports selective use of robotic TAMIS in specialized centers for carefully selected cases, particularly early-stage adenocarcinomas and complex benign lesions, while highlighting the need for standardized training protocols and economic evaluations.

Purpose: A German transplant center recently published a prognostic model predicting graft function one year after deceased donor kidney transplantation (KTx) relying on pre-transplant variables. The aim of this study is to externally validate this model.

Methods: We retrospectively analyzed clinical data from deceased donor KTx recipients undergoing transplantation between January 2007 and December 2023 at University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen. Receiver operating characteristics (ROC) curves were analyzed to validate the prognostic model based on donor age, donor serum creatinine, recipient body mass index, re-transplantation > 2nd KTx, and cold ischemia time. Glomerular filtration rates were categorized using the Kidney Disease: Improving Global Outcomes (KDIGO) categories G1 - G5.

Results: A total of 494 kidney transplantations were performed at our institution, 350 (70.9%) thereof from donation after brain death. The median one-year estimated glomerular filtration rate (eGFR) was 42 [12-94] mL/min/1.73 m². A validation for all eGFR categories was only possible with recalibration of the constant and coefficients of the original model, whereas without recalibration it could only be validated for KDIGO G2 and G4. Unfavourable recipient/donor-pairings with eGFR categories G4 and G5 one year after KTx could be predicted with an area under the ROC curve (AUC) > 0.700 in the validation and the original study cohort.

Conclusion: We successfully validated the prognostic model for prediction of eGFR categories G4 and G5, which is of high clinical importance to identify outcomes with marginal graft function one year after KTx, thereby facilitating the avoidance of futile recipient/donor-pairings during allocation.

Background: Varicose veins of the lower limbs, particularly involving the great saphenous vein (GSV), are a common vascular condition often requiring intervention. Conventional surgeries entail higher morbidity and prolonged recovery. To minimize complications while ensuring efficacy, a novel hybrid technique -Endovenous Chemical Ablation and Trendelenburg's operation (eCAT) -was developed. This study aimed to evaluate the efficacy and safety of the eCAT operation for treating GSV varicosities.

Methods: A single-arm open-label interventional study was conducted on 500 patients with primary lower limb varicose veins (2014-2021). The eCAT procedure, developed by Walied Khereba at Al-Azhar University (New Damietta), combined Trendelenburg's operation with polidocanol foam sclerotherapy under local anaesthesia. The primary outcome was GSV ablation efficacy at 1 week, 3 months, and 1 year. Secondary outcomes included postoperative complications, pain reduction, and factors influencing success.

Results: GSV ablation succeeded in all cases (100%). At 1 week, 88% of veins were fully occluded and 12% partially; at 3 months, full occlusion decreased to 76%, then improved to 88% at 1 year. Postoperative complications included oedema (30%), hyperpigmentation (20%), and residual varicosities (40%), all resolved by 1 year. Median pain scores decreased from 4 (IQR: 1) preoperatively to 2 (IQR: 1) at 1 week and 1 (IQR: 0) at both 3 months and 1 year (P = 0.001). Age, gender, and standing occupation significantly impacted early surgical success.

Conclusion: The eCAT is a safe, effective, and minimally invasive procedure for GSV varicosities treatment, achieving durable clinical outcomes with minimal complications and significant pain reduction.