Langenbeck's Archives of Surgery最新文献

Purpose: This study aimed to compare the impact of argon plasma coagulation (APC) and electrosurgical knife (EK) in sealing the hepatic transection surface of patients undergoing curative resection for hepatocellular carcinoma (HCC).

Methods: This single-center retrospective study was performed in the department of hepatobiliary and pancreatic surgery of 900th Hospital at the Joint Logistics Support Force of the Chinese People's Liberation Army between January 2013 and January 2018. 319 patients who underwent surgery for hepatocellular carcinoma were analysed ; and categorized into the two groups according to usage of argon plasma coagulation and the electrosurgical monopolar knife as secondary hemostatic surgical instruments. After 1:1 propensity score matching analysis, differences between two groups were assessed in terms of postoperative clinical outcomes. Multivariate logistic regression analysis was performed to identify independent factors associated with postoperative complications.

Results: After propensity score matching analysis, the group in which argon plasma coagulation was used for secondary hemostasis had a significantly lower postoperative complication rate compared to the group that used electrosurgical monopolar knife (p:0.033).A lower rate of complications graded according to Clavien-Dindo classification (grade III-V) was also seen in APC group (p:0.030). Moreover, the APC group had significantly less seen complications of bile leakage (p:0.015), ascites (p:0.011), and intra-abdominal infection (p:0.030). Multivariate analysis revealed the use of APC as an independent factor effective on postoperative complications (OR: 0.42, 95% CI: 0.21-0.84).

Conclusion: The use of APC during curative resection of HCC decreased the incidence of postoperative complications in comparison with EK.

Purpose: Ventral hernias are frequently encountered in general surgery. In recent years, minimally invasive techniques, including the Extended View Totally Extraperitoneal Repair (eTEP), have gained popularity. Meta-analyses suggest that eTEP may offer both intraoperative and postoperative advantages over alternative approaches. This retrospective study aimed to evaluate intra- and postoperative complications, length of hospital stay, and the potential association between American Society of Anesthesiologists (ASA) Physical Status Classification and complication rates in patients who underwent eTEP. The findings may inform preoperative risk stratification and surgical planning based on ASA score.

Methods: A monocentric, retrospective study of 95 patients who underwent eTEP for ventral hernia repair between January 2019 and December 2021 was conducted. Descriptive statistics and binary logistic regression analyses were performed to explore the association between the ASA score and perioperative complications.

Results: Intraoperative complications occurred in 2.1% (n = 2), and postoperative complications were observed in 7.4% (n = 7). The median length of hospital stay was three days (IQR = 1). Logistic regression analysis did not identify a statistically significant association between the ASA score and the occurrence of either intra- or postoperative complications. Nonetheless, all observed complications arose in patients with ASA scores of ≥ II.

Conclusion: eTEP repair was associated with a low complication rate and short hospitalization. While ASA classification was not a statistically significant predictor of perioperative complications in this cohort, the absence of complications in ASA I patients suggests potential relevance. These findings highlight the need for larger, prospective studies to further evaluate the role of ASA classification in risk assessment for eTEP procedures.

Objective: It was to compare perioperative outcomes between transperitoneal (TLNU) and retroperitoneal (RLNU) approaches for laparoscopic nephroureterectomy in UTUC.

Methods: Literature pertaining to "TLNU", "RLNU", and "upper-tract urothelial carcinoma (UTUC)" was systematically retrieved from databases, covering the period from January 2000 to July 2024. Quality and risk of bias were assessed utilizing Cochrane Handbook, and extracted basic information and outcome data. Meta-analysis (MA) was conducted utilizing Review Manager 5.3.

Results: The study included a total of 11 articles. The analysis revealed no significant differences between the RLNU and TLNU groups in terms of surgical duration (mean difference (MD) = 2.83, 95% confidence interval (CI): -29.40 to 35.07, Z = 0.17, P = 0.86 > 0.05), time to bowel function recovery (MD = -0.28, 95% CI: -0.81 to 0.25, Z = 1.03, P = 0.30 > 0.05), length of hospital stay (MD = 0.70, 95% CI: -0.51 to 1.91, Z = 1.14, P = 0.26 > 0.05), incidence of complications (MD = 1.02, 95% CI: 0.43 to 2.41, Z = 0.05, P = 0.96 > 0.05), recurrence rate (MD = 1.25, 95% CI: 0.94 to 1.66, Z = 1.55, P = 0.12 > 0.05), and overall survival (OS) rate (MD = 1.07, 95% CI: 0.98 to 1.18, Z = 1.49, P = 0.14 > 0.05). However, a significant difference was observed in intraoperative blood loss (BL) between the RLNU and TLNU groups (MD = 6.78, 95% CI: 2.44 to 11.13, Z = 3.06, P = 0.002 < 0.05).

Conclusion: Perioperative outcomes between RLNU and TLNU show significant differences in operative time, bowel recovery, hospital stay, complications, recurrence, and OS. However, RLNU had significantly higher intraoperative blood loss (P < 0.05), though its clinical relevance remains uncertain. This analysis focused on perioperative metrics; long-term oncologic efficacy requires further investigation.

Background: Surgeons may experience technical complexity and negative outcomes related to robotic liver surgery (RLS) in obese patients. However, evidence regarding the impact of obesity on perioperative outcomes in RLS is limited.

Methods: A retrospective analysis was performed on patients who underwent RLS between 2019 and 2024. Obesity was defined as a BMI ≥ 30 kg/m², and postoperative complication rate and risk factors were evaluated for complications. Short-term perioperative outcomes were compared using propensity score matching (PSM) analysis at a 1:1 ratio.

Results: A total of 205 RLS procedures were performed at a high-volume hepatopancreatobiliary (HPB) center in Denmark. After 1:1 propensity score matching, 41 patients in each group were included. In the obese group, the rate of comorbid diabetes (p = 0.037) and the rate of steatosis (p = 0.035) were significantly higher in the obese group; standard liver volumes were also significantly larger (p < 0.001). There was no significant difference in the rate of major complications or the rate of all complications between the two groups. In multivariate binary logistic regression analysis using the nine factors selected in univariate analysis, only the IWATE criteria (≥ 7) showed a nearly significant p-value [p = 0.056], potentially suggesting an association with major postoperative complications.

Conclusions: The results of our single-center experience demonstrated that RLS in patients with a BMI of 30 or more did not impact postoperative surgical complications or other short-term outcomes. Therefore, RLS appears safe and feasible for obese patients in experienced centers.

Introduction: Chronic sigmoid diverticulitis is the most common benign cause of sigmoid-bladder fistulas (SBF) and sigmoid-vaginal fistulas (SVF). This multicenter retrospective comparative study analyzed the perioperative and postoperative outcomes between laparoscopic and open surgical procedures.

Methods: The study included 101 patients from four German hospitals who underwent elective sigmoid resection for SBF, SVF, or combined fistulas between January 2010 and July 2024. Patient data were retrospectively analyzed, comparing outcomes based on the surgical approach.

Results: Of the 101 patients, 70 (69.3%) had a sigmoid-bladder fistula, 29 (28.7%) had a sigmoid-vaginal fistula, and 2 (2%) had a combined fistula. Fifty-seven patients (56.4%) underwent open surgery, while 44 (43.6%) had laparoscopic surgery. The median hospital stay was significantly shorter in the laparoscopic group (11 days vs. 16 days, p = 0.016). The laparoscopic group also showed earlier removal of drains (4 days vs. 5.5 days, p = 0.044), shorter intensive care unit (ICU) stays (0.5 days vs. 1.5 days, p = 0.026) and earlier return of bowel function (3 days vs. 5 days, p < 0.001). No significant differences were observed in anastomotic leakage rates (1 in the laparoscopic group vs. 7 in the open group, p = 0.066), mortality rates (1 in the laparoscopic group vs. 4 in the open group, p = 0.384), wound infection rates (7 in the laparoscopic group vs. 15 in the open group, p = 0.234) and operating time (206 min in the laparoscopic group vs. 159 min in the open group p = 0.133).

Conclusion: Laparoscopic procedures, if technical possible, potentially demonstrate superior postoperative outcomes compared to open surgery for the treatment of fistulizing sigmoid diverticulitis in several parameters without increasing risk or operating time.

Background: Machine learning has emerged as a promising tool for survival prediction in various diseases; however, its application and external validation in real-world gastric cancer populations remain limited.

Methods: Clinical data of patients diagnosed with gastric cancer between 2000 and 2018 were obtained from the SEER database, supplemented with data from two Chinese medical centers (2005-2018). Three feature selection methods and four modeling algorithms-including Cox, RSF, CoxBoost, and Deepsurv_Cox-were employed to construct prediction models for overall survival (OS) and cancer-specific survival (CSS). Model performance was evaluated using the concordance index (C-index), integrated Brier score (IBS), and mean area under the curve (AUC). The two best-performing base models were subsequently integrated into a stacked model and compared against the traditional TNM staging system using decision curve analysis (DCA) and time-dependent ROC curves at 3, 5, and 10 years.

Results: A total of 21,559 patients from the SEER database and 3,805 patients from two Chinese centers were included. In independent testing, the integrated model achieved a C-index/IBS/mean AUC of 0.693/0.158/0.829 for OS and 0.719/0.171/0.819 for CSS. For 3-, 5-, and 10-year survival prediction, the AUCs were 0.705/0.747/0.851 for OS and 0.734/0.779/0.830 for CSS, outperforming the TNM staging system across all metrics. Superior calibration and clinical utility of the integrated model were further confirmed by calibration curves and DCA.

Conclusion: The integrated machine learning model outperformed both traditional TNM staging and deep learning approaches, offering improved predictive accuracy for survival outcomes in patients with gastric cancer.

Background: Longstanding Overt Ventriculomegaly in Adults (LOVA) and Obstructive Hydrocephalus (o-HCP) is the abnormal accumulation of cerebrospinal fluid (CSF), leading to increased intracranial pressure, and associated neurological symptoms. Endoscopic Third Ventriculostomy (ETV) is a minimally invasive surgical treatment for these conditions. ETV has demonstrated effectiveness in pediatric populations, its efficacy in adult patients remains ambigous. This systematic review and meta-analysis aims to evaluate the outcomes of ETV in adult patients with LOVA and o-HCP.

Methods: A systematic review along with meta-analysis were carried out following the PRISMA guidelines. Studies were identified through PubMed, Cochrane, Scopus, and CINAHL databases using relevant MeSH terms and BOOLEAN operators. The inclusion criteria followed the PICO model, focusing on adult patients (> 18 years) undergoing ETV. Data on postoperative complications, symptom improvement, and successful treatment outcomes were extracted. Statistical analysis, including sensitivity analyses, was performed using R Studio, with odds ratios (OR) and heterogeneity (I²) calculated. The Newcastle-Ottawa Scale was employed to assess for risk of bias.

Results: A total of 8 studies comprising 200 patients were included. The overall odds ratio for successful treatment following ETV was 4.59 (95% CI: 2.74-7.67) with moderate heterogeneity (I² = 53%). Sensitivity analysis reduced the heterogeneity to 0%, increasing the OR to 5.56 (95% CI: 3.80-8.13). Significant improvements were noted in specific symptoms, including headache (OR 9.47, 95% CI: 4.31-20.81, I² = 0%), balance (OR 10.78, 95% CI: 4.00-29.03, I² = 35%), and memory (OR 6.64, 95% CI: 1.38-31.86, I² = 61%). A low risk of bias was observed across all studies included.

Conclusions: ETV is an effective treatment for patients with LOVA and o-HCP, demonstrating significant symptom improvement and a high success rate. Low heterogenicity of outcomes with robust findings confirmed sensitivity analyses. However, patient-specific factors, such as age and duration of symptoms, should be considered for ETV.