Surgical Endoscopy And Other Interventional Techniques最新文献

Background: Neoadjuvant chemoradiotherapy (NCRT) followed by surgery is the standard treatment for locally advanced esophageal squamous cell carcinoma (ESCC). Pathological complete response (pCR) is a key prognostic indicator, yet clinical outcomes and recurrence patterns in ESCC patients achieving pCR warrant further investigation.

Methods: We retrospectively analyzed patients with cT2-4aN0-3 ESCC who underwent NCRT followed by esophagectomy between 2014 and 2022. Patients were stratified into pCR (ypT0N0) and non-pCR groups. Survival and recurrence outcomes were assessed using Kaplan-Meier and Cox regression analyses.

Results: Among 136 patients (mean age 59.1 ± 7.2 years, 90.4% male), 39 (28.7%) achieved pCR. With a median follow-up of 30 months, the 5-year overall survival (OS) rate was 81.6% in the pCR group versus 39.2% in the non-pCR group (p < 0.001), and the 5-year disease-free survival (DFS) rate was 70.1 vs. 31.0%, respectively (p < 0.001). Recurrence occurred in 26.3% of pCR patients, significantly lower than the 65.9% in non-pCR patients (p < 0.001). Multivariate analysis identified pCR as an independent favorable prognostic factor for OS (HR 0.351, 95% CI 0.121-0.980, p = 0.040) and ypTNM stage for both OS (HR 1.516, 95% CI 1.114-2.063, p = 0.006) and DFS (HR 1.733, 95% CI 1.381-2.174, p = 0.001).

Conclusion: Achieving pCR after NCRT is associated with significantly improved survival in ESCC patients. However, recurrence still occurs in a notable proportion of pCR patients, underscoring the need for further risk stratification and exploration of adjuvant strategies even in this favorable response group.

Background: Professor Alberto Montori (1933-2021) was a Professor Emeritus and a pioneering figure in Italian and international digestive endoscopy and minimally invasive surgery.

Methods: This manuscript summarizes Professor Montori's clinical and academic career, highlighting his impact on therapeutic endoscopy, surgical innovation, and mentorship.

Results: Professor Montori promoted endoscopic and minimally invasive approaches early in his career and helped establish structured training in surgical endoscopy. His Digestive Endoscopy Centre became a national reference center; by 1979, it was the only center in Rome performing ERCP and endoscopic papillo-sphincterotomy for biliary disease. He authored more than 446 publications and held major international leadership roles, including within UEGF, ESGE, and EAES, while also fostering international academic exchange and humanitarian surgical programs. Beyond his academic achievements, he was a devoted husband and father, and an exceptional mentor to multiple generations of students, surgical residents and attending surgeons.

Conclusions: Professor Montori's legacy endures through the surgeons he trained and the lasting integration of therapeutic endoscopy and minimally invasive principles into modern digestive surgery. He will be deeply missed by his family and by those of us who were privileged to know him and share time with him.

Background: Robotic liver surgery has gradually increased within the realm of minimally invasive hepatobiliary surgery; nevertheless, worldwide adoption rates, educational systems, and thought processes are various.

Materials and methods: An online worldwide survey was devised to collect data from hepatobiliary surgeons with experience or interests in robotic liver surgery. The design explores the use of robotic platforms, adoption rate, learning opportunities, learning curves, procedural options based on complexity, safety in perioperative phases, and limiting factors. Descriptive statistics are used to analyze the collected responses.

Results: The da Vinci platform is the most commonly used, while the new systems are still in the early adoption stages. Variability of use patterns has been identified. Structured learning, including simulation, proctoring, and learning at a second console, has been identified as essential to ensure safe adoption. The learning curve is a multi-step process that is dependent on procedure type, inherent surgical skills, and prior training. The laparoscopic, robotic, and open methods are considered to be relatively similar in low-complexity resections, while robotic, open, or a combination of robotic or open would be preferred for directing posterosuperior, major hepatectomy, as well as reconstruction cases, respectively.

Conclusion: Robotic liver surgery is gradually being adopted within the realm of hepatobiliary surgery, but has been unevenly distributed. Uniform models of training, organizational structure, and equal availability of systems are essential factors that define how such systems are expanded.

Background and study aims: Afferent limb syndrome (ALS) is a rare condition resulting in a mechanical obstruction in the afferent loop after surgical gastrointestinal (GI) reconstruction. Endoscopic ultrasound (EUS)-guided gastrojejunostomy (GJ) or jejunojejunostomy (JJ) is increasing in clinical practice. Therefore, the aim of this systematic review with meta-analysis is to evaluate the efficacy and safety of EUS-GJ or EUS-JJ for ALS.

Patients and methods: The most important medical databases were systematically searched through May 2025. The primary outcome was technical success of EUS-GJ/JJ for ALS. Secondary outcomes were clinical success, safety, and recurrence rate. A random-effects model was used to pool the results. Heterogeneity was expressed as inconsistency index (I²) and explored through subgroup analyses.

Results: 9 studies (all retrospective) involving 188 patients were included in the analysis. The weighted mean age was 65.38(± 10.57) years and the etiology of the ALS was mostly malignant. Technical success was 96.3% (CI95% 93.2-99.4%, I² = 0%). Clinical success was 95% (CI95% 91.2-98.7%, I² = 0%) and adverse events (AEs) rate was 6.9% (CI95% 2.9-11.1%, I² = 0%). Recurrence rate was 16.6% (CI95% 7.7-25.4%, I² = 43.79%). Subgroup analyses showed differences in the recurrence rate between the use of a fully covered self-expandable metal stent (FCSEMS) (35.9% [CI95% 20.3-51.6%, I² = 0%]) and a lumen-apposing metal stent (LAMS)(10.4% [CI95% 4-16.8%, I² = 0%], p = 0.003). Follow-up ranged from a median of 96.5 to 185 days.

Conclusions: EUS-guided GI anastomosis is an effective treatment for ALS, showing high technical and clinical success rates and a low incidence of AEs. The use of LAMS over FCSEMS seems to reduce the recurrence rate, suggesting the routine use of LAMS in the case of EUS-guided GI anastomosis for treating ALS.

Background: Robotic-assisted cholecystectomy has gained popularity due to its purported advantages over the traditional laparoscopic technique. However, studies to date have not consistently demonstrated improved patient outcomes. Concerns regarding increased costs, particularly when the platform's clinical benefit is unclear, have limited its adoption. To our knowledge, there has been no study focusing on the role of robotic technique in interval cholecystectomy, which may present greater technical challenges, and the advantages offered by robotic technology may lead to improved outcomes.

Methods: In this retrospective study, we identified patients undergoing cholecystectomy at least one month after either percutaneous or endoscopic drainage of the gallbladder for acute cholecystitis at a single tertiary center between August 2018 and February 2025. Medical records were reviewed to collect patient outcomes for comparison between procedures initiated as robotic-assisted versus laparoscopic-assisted.

Results: A total of 215 patients, with a mean age of 67 years (± 16), underwent interval cholecystectomy after a median of 102 days (interquartile range (IQR): 85-148 days). Initial therapy for acute cholecystitis was either percutaneous drainage (n = 135, 63%) or endoscopic transcystic duct drainage (n = 80, 37%) of the gallbladder. Interval cholecystectomy was initiated laparoscopically in 177 cases, while 38 surgeries were robotically assisted. Conversion to open cholecystectomy occurred significantly more frequently in the laparoscopic group (33 cases, 19%) compared to the robotic group (0 cases, p < 0.01). Estimated blood loss was also higher in the laparoscopic group (67 ± 74 ml vs 30 ± 25 ml, p < 0.01). Robotic surgeries lasted longer (185 ± 71 vs 155 ± 65 min, p = 0.02).

Conclusions: In our retrospective review, robotic-assisted interval cholecystectomy is associated with a lower risk of conversion to open surgery, reduced estimated blood loss, and longer operative times when compared to the laparoscopic approach.

Objective: With the growing adoption and implementation of vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES), structured hands-on simulation practice is essential for the training of gynecologists and residents. This study compares the performance of validated surgical tasks using a conventional multiport laparoscopy box and a single-port vNOTES box. Additionally, participants' experiences and task load for each training modality were evaluated.

Design, setting and participants: This multi-center, prospective comparative study included three groups: medical students and inexperienced gynecological residents (n = 15), gynecological residents (n = 15), and gynecologists (n = 15). Participants performed four validated laparoscopic skill tests on both the conventional laparoscopy box and the vNOTES box. For each task and box, total task time, number of errors, and total scores were recorded. Questionnaires regarding baseline characteristics, preferred box for hand-eye coordination, depth perception, and instrument handling, as well as task load (NASA Task Load Index scores) for both boxes were evaluated.

Results: A total of 45 participants were included, 35 females (77.8%) and 10 males (22.2%), with a mean age of 34.2 years (SD 11.1). Across all four tasks, the use of the vNOTES box was associated with less favorable scores in terms of task time, error rates, and total scores compared to the conventional laparoscopy box. In addition, the laparoscopy box was favored for depth perception (86.7%), hand-eye coordination (91.1%) and instrument usage (97.8%). The vNOTES box was associated with higher scores across all NASA Task Load Index domains, indicating it was more demanding overall.

Conclusion: This study demonstrates that performing standardized surgical tasks using the vNOTES technique is significantly more challenging than with conventional laparoscopy, resulting in higher task load and inferior performance across all experience levels. These findings underline the need for tailored training, as existing laparoscopic skills do not directly translate to vNOTES proficiency. Future research should develop and validate vNOTES simulation exercises.

Introduction: Endorectal ultrasound (EUS) is an essential tool for local staging of rectal neoplasia; however, its diagnostic accuracy in distinguishing non-invasive from invasive lesions before transanal endoscopic microsurgery (TEM) remains a matter of debate.

Methods: A retrospective analysis of 1,000 consecutive EUS examinations performed before TEM between 1993 and 2025 was conducted using a prospectively maintained database. EUS levels (0-3) were correlated with the final histopathological outcome. Lesions were categorised as non-invasive (LGD, HGD, Tis) or invasive (pT1-pT3). Diagnostic metrics-sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy-were calculated overall and across three chronological periods. Separate analyses were performed for post-neoadjuvant (ypT03) and post-endoscopic resection groups.

Results: Among 883 evaluable EUS studies for the primary analysis (non-invasive vs invasive pT1-pT3), overall sensitivity was 86.4%, specificity 64.9%, PPV 81.5%, NPV 72.7%, and accuracy 78.7%. All indices improved over time, with accuracy rising from 62.9% in early cases to 73.9% in the most recent period. In the post-neoadjuvant group (n = 47), sensitivity remained high (89.7%), but specificity was low (33.3%), likely due to overstaging related to fibrosis. In the post-endoscopic resection group (n = 70), the apparent accuracy was 44.3%, suggesting a high rate of false-positive invasion predictions.

Conclusions: EUS before TEM shows good overall accuracy and excellent reliability for excluding deep invasion, with progressive improvement over the past 3 decades. While overstaging remains a limitation in post-treatment and non-dysplastic lesions, EUS continues to play a pivotal role in selecting candidates for organ-preserving rectal surgery. In post-endoscopic resection scars and post-neoadjuvant rectum, EUS findings should be interpreted cautiously and integrated with MRI/endoscopic morphology.

Background: Numerous studies have confirmed that the NOSES has significant short-term prognostic benefits in the treatment of CRC. However, there is still an obvious gap in the systematic assessment of the psychological status of patients in the perioperative period, such as anxiety and depression. Our study aims to compare the quality of life and psychological functions, as well as the short-term surgical outcomes in patients undergoing NOSES and conventional laparoscopic surgery.

Methods: This prospective study included patients diagnosed with CRC who underwent radical resection between January 2021 and August 2024 at Sechenov University and Harbin Medical University. Patients were segregated into NOSES group and CL group based on case-match method. Quality of life was assessed using the Short-Form 36 Health Survey (SF-36), Beck Depression Inventory (BDI) and Spielberger State-Trait Anxiety Inventory (STAI) preoperative, predischarge, postoperative 3 months and postoperative 6 months.

Results: A total of 92 patients (46 in the NOSES group and 46 in the CL group) were included. The NOSES group showed faster gastrointestinal recovery and subsequently shorter hospital stays than the CL group. Postoperative pain scores were significantly lower in the NOSES group on the first, third and fifth postoperative days. At three months postoperatively, role function, physical pain, vitality, emotional state and mental health were better in the NOSES group than in the CL group. In addition, patients in the NOSES group had better role function, physical pain, vitality, social function, emotional state and mental health than patients in the CL group. As for postoperative anxiety and depression, patients in the NOSES group were significantly better than patients in the CL group before discharge, three months after surgery and six months after surgery.

Conclusion: NOSES improves quality of life and reduces postoperative anxiety and depression, helping patients to recover. At the same time, the short-term outcomes were comparable to CL.

Background: The importance of transitioning care from pediatric to adult practitioners is an often overlooked aspect of chronic disease. The benefits of a planned transition in health care are that patients will learn valuable life-long lessons on healthcare maintenance, when and how to seek medical attention for new issues that may arise, and improvements on their overall well-being. The purpose of this SAGES White Paper was to summarize the available knowledge for several pediatric surgical conditions to aid in transition of care for this patient population.

Methods: The members of the SAGES Pediatric Surgery Committee elected to produce this White Paper. The group chose to focus on several important gastrointestinal diseases that may require lifelong care: tracheoesophageal fistula, duodenal atresia, anorectal malformations, childhood obesity, and gastrointestinal malignancies. For each disease process a summary of long term issues facing these patients, stakeholders involved, and follow up recommendations if required were identified.

Results: Each disease process has its own unique set of long-term issues as well as multidisciplinary stakeholders and need for follow-up. However, individualized care is needed based on each patient's unique needs. To facilitate consistent transfer of care standardization is needed for surgical diseases. Key aspects of standardization include identifying a multidisciplinary team, working towards consistent quality improvement, and implementation of policy guided processes with individual treatment plans.

Conclusion: Continued work in standardizing transition of care is required for optimal treatment of this complex patient population.

Background: Postpancreatectomy hemorrhage (PPH) remains the most lethal complication following pancreaticoduodenectomy. Patients who develop clinically relevant postoperative pancreatic fistula (CR-POPF) are at particularly high risk. A preoperative model tailored to CR-POPF patients is needed to enable early risk stratification and targeted perioperative strategies.

Methods: We conducted a retrospective multicenter case-control study across five high-volume pancreatic centers from 2010 to 2024. Consecutive patients who underwent minimally invasive pancreaticoduodenectomy (MIPD) and subsequently developed CR-POPF were included and split into a derivation (n = 304) and an external validation cohort (n = 187). Variables were screened using least absolute shrinkage and selection operator (LASSO) and entered multivariable logistic regression. Model performance was assessed by receiver operating characteristic analysis, calibration analysis, Brier score, Hosmer-Lemeshow test and decision-curve analysis. A nomogram and individualized risk formula were constructed to facilitate bedside application.

Results: Late PPH occurred in 25.6% (78/304) of the derivation cohort and 21.4% (40/187) of the validation cohort. Four independent indicators were identified: Tumor abutment of artery (odds ratio [OR] 10.32; 95% confidence interval [CI] 2.67-39.93; P < 0.01), receipt of preoperative neoadjuvant chemotherapy (OR 8.28; 95% CI 2.41-28.44; P < 0.01), Naples prognostic score > 2 (OR 17.88; 95% CI 6.74-47.42; P < 0.01), and Tumor size > 3 cm (OR 9.19; 95% CI 3.64-23.15; P < 0.01). Discrimination was excellent (AUC 0.952 derivation; 0.925 validation) with good calibration and low prediction error (Brier 0.067). A Youden-derived cutoff (0.192) separated risk groups with clear incidence gradients in validation (low vs high risk: 5.0% vs 68.8%).

Conclusion: This four-variable, preoperative LASSO-logistic model offers a reliable tool for predicting late PPH among CR-POPF patients after MIPD. Early identification of high-risk individuals may enable targeted perioperative strategies and improved outcomes.