Langenbeck's Archives of Surgery最新文献

Purpose: Diarrhea after pancreatic surgery is gaining growing importance since extended pancreatic resections have been increasingly performed. The aim of this study was to determine the incidence of diarrhea after pancreatic surgery with a special focus on the extent of resection and subgroups at higher risk for diarrhea.

Methods: Retrospectively collected data of all consecutive patients undergoing pancreatic surgery between 01/2021 and 11/2023 were analyzed. Information on bowel movements was prospectively documented. Diarrhea was defined as > 3 bowel movements per day for at least 72 h despite pancreatic enzyme replacement and in the absence of laxatives or prokinetics. Extended resections were differentiated according to the type of vascular resection and arterial divestment. Clinicopathological characteristics and outcomes were compared among these groups and risk factors for diarrhea were identified.

Results: A total of 320 patients were included. Following any type of pancreatectomy, 71/320 (22.2%) patients developed diarrhea. The incidence of diarrhea after partial pancreatoduodenectomy, distal pancreatectomy and total pancreatectomy was 26.6%, 11.5% and 35.3%, respectively (p = 0.004). Arterial divestment/resection and venous resection were significantly associated with an increased risk for postoperative diarrhea in 87% (OR = 31.14; 95%-CI: 8.77, 170.08; p < 0.001) and 52.2% of patients (OR = 5.14; 95%-CI: 2.51, 10.52; p < 0.001), respectively. Postoperative diarrhea was significantly associated with a prolonged length of hospital stay (19 vs. 13 days; 95%-CI: 3.00, 7.00; p < 0.001).

Conclusion: Diarrhea after pancreatic resection is a common postoperative complication affecting especially patients undergoing extended resections with vascular resections and arterial divestment. Diarrhea significantly impairs postoperative recovery leading to a prolonged hospital stay.

Purpose: Postoperative pancreatic fistula is a common and serious complication after pancreaticoduodenectomy that significantly impairs patient recovery and prognosis. Despite extensive research, the field lacks systematic bibliometric visualization analyses, which hinders comprehensive understanding of its research landscape, evolutionary trends and key advancements. This study aims to address this gap by systematically analyzing relevant literature to clarify global research patterns and emerging directions.

Methods: A bibliometric analysis was conducted on literature regarding postoperative pancreatic fistula after pancreaticoduodenectomy published from January 2006 to December 2024. Data were retrieved from Web of Science Core Collection and Scopus databases. After removing duplicates, filtering by document type, language and time, and assessing eligibility, 4295 records were included. VOSviewer and Microsoft Excel were used to analyze publication trends, collaboration networks, core author contributions, keyword clustering and co-citation networks.

Results: The number of publications increased steadily with original research articles dominating. Japan the United States China Italy and Germany were the top contributing countries while England had the highest average citation rate per article. University of Verona, Universiteit van Amsterdam, and Heidelberg University were key contributing institutions. Core research themes included postoperative pancreatic fistula classification and definition, risk factors, preventive measures, and surgical technique comparison.

Conclusion: This study comprehensively maps the global research landscape and trends of postoperative pancreatic fistula after pancreaticoduodenectomy. The findings provide valuable insights for identifying research hotspots and guiding future studies, thereby promoting standardized and systematic advancement in this field.

Background: This cohort study investigated the efficacy of minimally invasive plate osteosynthesis combined with an enhanced recovery after surgery in the treatment of proximal humeral fractures (PHF).

Methods: This retrospective study examined 72 patients with PHF treated from March 2019 to June 2021. All patients were divided into two groups: a control group undergoing minimally invasive plate osteosynthesis (MIPO) and a study group receiving MIPO combined with an enhanced recovery after surgery (ERAS). Outcomes compared included operative time, intraoperative blood loss, hospital length of stay, time to first feeding, time to first flatus, and time to initial mobilization, postoperative pain (VAS), functional recovery (Barthel index), and fracture healing rates. The impact of ERAS on MIPO outcomes in patients with PHF was then analyzed.

Results: The study group demonstrated superior healing outcomes compared to the control group (P < 0.05). Post-treatment pain, significantly decreased in both groups, with the study group exhibiting lower scores (P < 0.05). After treatment, the Constant-Murley score of the study group was higher than the control group at one week, three months, and six months after operation (P < 0.05). Hospital stays were significantly shorter in the study group, as were times to first feeding, flatus, mobilization, and fracture healing (P < 0.05). After treatment, Barthel index scores improved in both groups, with the study group achieving higher scores at final evaluation. Conversely, the study group reported lower scores in physical, social, and cognitive health function (P < 0.05) indicating a greater degree of quality-of-life.

Conclusion: This study showed that combining minimally invasive plate osteosynthesis (MIPO) with an Enhanced Recovery after Surgery (ERAS) protocol yields better outcomes for proximal humeral fractures than MIPO alone. Wider adoption of ERAS-enhanced MIPO can optimize perioperative care and support longer-term function in PHF patients.

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: 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.

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: 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.