Updates in Surgery最新文献

While laparoscopic common bile duct exploration with primary duct closure (LCBDE + PDC) has been considered a feasible and safe treatment for cholecystocholedocholithiasis, uncertainties remain regarding its effectiveness and safety in patients with mild-to-moderate calculus-associated acute cholangitis. Therefore, this study aims to investigate the safety and efficacy of LCBDE + PDC specifically in patients with mild-to-moderate acute cholangitis (AC). Patients with cholecystocholedocholithiasis who underwent LCBDE + PDC treatment at our hospital between July 2020 and September 2022 were included. The patients were divided into two groups based on the presence of cholangitis: acute cholangitis (AC group) and non-acute cholangitis (non-AC group). A total of 136 patients underwent LCBDE + PDC treatment, with 65 in the AC group and 71 in the non-AC group. No deaths occurred after surgery in either group. The AC group had longer drainage tube retention time (5 (4-7) days vs. 4 (3-5) days, P < 0.001), postoperative hospital stay (8 (6-9) days vs. 6 (5-7) days, P < 0.001), and total hospital stay (12 (9.5-15) days vs. 10 (8-13) days, P < 0.001) compared to the non-AC group. However, there were no significant differences between the two groups in terms of operation time, estimated blood loss, and the rate of using holmium laser lithotripsy. The incidence of postoperative complications was similar between the two groups. Our study demonstrates that LCBDE + PDC is a safe and feasible treatment for patients with mild-to-moderate calculus-associated acute cholangitis who meet the criteria for primary duct closure.

Malignancy risk calculation models were developed using the clinical and radiological features. It was aimed to compare pulmonary nodule risk calculation models and evaluate their effectiveness and applicability for the Turkish population. Between 2014 and 2019, 351 patients who were operated on for pulmonary nodules were evaluated with the following data: age, gender, smoking history, family history of lung cancer, extrapulmonary malignancy and granulomatous disease, nodule diameter, attenuation character, side, localization, spiculation, nodule count, presence of pulmonary emphysema, FDG uptake in PET/CT of the nodule, and definitive pathology data. Malignancy risk scores were calculated using the equations of the Brock, Mayo, and Herder models. The results were evaluated statistically. The mean age of the 351 patients (236 men, 115 women) was 57.84 ± 10.87 (range 14-79) years, and 226 malignant and 125 benign nodules were observed. Significant correlations were found between malignancy and age (p < 0.001), nodule diameter (p < 0.001), gender (p < 0.009), speculation (p < 0.001), emphysema (p < 0.05), FDG uptake (p < 0.001). All three models were found effective in the differentiation (p < 0.001). The ideal threshold value was determined for the Brock (19.5%), Mayo (23.1%), and Herder (56%) models. All models were effective for nodules of > 10 mm, but none of them were for 0-10 mm. Brock was effective in ground-glass nodules (p = 0.02) and all models were effective for semi-solid and solid nodules. None of the groups could provide AUC values as high as those achieved in the original studies. This suggests the need to optimize models and malignancy risk thresholds for Turkish population.

Gastric signet ring cell carcinoma (GSRC) is a rare malignancy without a commonly acknowledged prognostic assessment and treatment system. This study aimed to determine the optimal cut-off value of tumor size (TS), and construct a prognostic nomogram in combination with other independent prognostic factors (PFs) to predict 3 year and 5 year overall survival (OS) in GSRC patients. From the Surveillance, Epidemiology, and End Results (SEER) database, this study collected 4744 patients diagnosed with GSRC. These patients were randomized into a training cohort (n = 2320,) and a validation cohort (n = 1142). A restricted cubic spline (RCS) was used to determine the cut-off value for TS, and univariate and multivariate Cox regression analyses were performed in the training cohort to identified significant predictors. A prognostic nomogram was constructed to predict OS at 3 and 5 years. Concordance index (C index), receiver operating characteristics curve (ROC curve), area under curve (AUC), and calibration curve were used to test the predictive accuracy of the model. A non-linear relationship was observed between TS and the risk of OS in GSRC, with TS thresholds at 4.4 cm and 9.6 cm. Survival was significantly lower in GSRC patients with TS > 4.4 cm. Age, marriage, chemotherapy, surgery, TS, SEER stage, regional lymph node status, and total number were independent predictors of OS. The C index in the training cohort was 0.748, and the AUC values for both 3- and 5-year OS were higher than 0.80. Similar results were observed in the validation cohort. In addition, the calibration curves showed good agreement between the predicted 3 year and 5 year OS and the actual OS. TS is a key prognostic factor for patients with GSRC, and patients with a TS of 4.4-9.6 cm and > 9.6 cm may have a poorer prognosis than those with a TS of < 4.4 cm. The TS-stratified nomogram we constructed and validated has favorable accuracy and calibration precision, and may be helpful in predicting the survival rate of patients.

Flexible sigmoidoscopy has emerged as a vital tool for the purpose of assessing colorectal anastomoses: a procedure that can play a crucial role in reducing postoperative complications. The present technical note aims at describing a comprehensive strategy for the perioperative evaluation of colorectal anastomoses integrity. An endoscopic grading system is utilized to categorize findings, ensuring consistency and external validity. Postoperative flexible sigmoidoscopy can evaluate anastomotic integrity using a classification system, thereby facilitating informed decision-making and enabling targeted local treatment options. Additionally, flexible sigmoidoscopy can be carried out post-discharge from the hospital for further assessment of late-onset anastomotic leakage. While a consensus on the utility of flexible sigmoidoscopy is yet to be established, its potential to improve surgical decision-making is evident.

This systematic review and meta-analysis evaluated changes in circulating irisin levels after bariatric surgery. A systematic search was performed across Embase, Scopus, PubMed, and Web of Science for this study. The meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) V4 software. The overall effect size was depicted through a random-effects meta-analysis and the leave-one-out method. The meta-analysis, which included 13 studies with a total of 407 participants, showed a statistically non-significant reduction in circulating irisin levels following bariatric surgery (SMD:  - 0.089, 95% CI  - 0.281, 0.102, 95% PI:  - 0.790, 0.611, p = 0.360; I²:70.56). Our research found no significant change in irisin levels after bariatric surgery. Moreover, these findings were not associated with the type of surgery or the duration of follow-up.

Conventional benign tumor excision leaves scars on the skin surface of the breast, which is unacceptable for young patients. The feasibility and clinical results of endoscopic resection of benign breast tumors through a single axillary incision via an inflatable method were evaluated.

Methods: Clinicopathological data from 62 patients who underwent this procedure from June 2022 to July 2023 were retrospectively collected. The surgical success rate, number of tumors excised, operative time, intraoperative conditions, postoperative complications, and clinical outcomes were analyzed.

Results: A total of 144 benign tumors were resected, and the surgical success rate was 100% (62/62). The time required to resect tumors located in the inner quadrant with larger diameters was shorter than the time to resect tumors located in the outer quadrant with smaller tumors. Sixty-two patients experienced reduced intraoperative bleeding and did not experience skin burns, incision infections, or poor healing. However, all patients experienced varying degrees of subcutaneous emphysema during the postoperative period. Fourteen patients experienced minor local effusions, and 3 patients experienced mild upper limb dysfunction, which resolved within one month. During the six-month follow-up period, there were no cases of tumor recurrence or new tumors. The ABNSW score was above 14 points, and patient satisfaction was high.

Conclusion: Endoscopic resection of benign breast tumors through a single incision in the axilla via the inflatable method could quickly remove lesions larger than 3.0 cm. This method also results in hidden scars and good cosmetic effects on the shape of the breast. This is a new and effective treatment for benign breast tumors.

Trial registration: This retrospective study was registered in the National Medical Research Registry filing system ( https://www.medicalresearch.org.cn ) (No. MR-44-22-007981) and recorded in the Medical Research Division of our hospital (No. NYXJS-22-021).

Malignant pleural effusion (MPE) is a complication of malignancy. Treatment of MPE is based on predicted outcome. The aim of this study was to compare the performance characteristics of LENT, PROMISE, RECLS, AL and pNLR scores for prediction of mortality in lung cancer patients who have MPE. Patients who were diagnosed with MPE that was associated with underlying lung cancer between January 2010 and December 2019 were included and analyzed retrospectively in a single center. Outcomes considered were 30-day, 6 months, and 1-year mortality. A total of 180 patients were examined. For 30-day mortality, the areas under the ROC curves (AUC) (95% CI) were: LENT 0.83 (0.76-0.87), RECLS 0.71 (0.63-0.77), and PROMISE 0.70 (0.17-0.38). For 6-month and 1-year mortality the order of these AUCs was similar. Cox regression showed that none of the scores were significantly associated with 30-day mortality, but LENT and RECLS were significantly associated with 6-month and 1-year mortality. Comparison of - 2log likelihood ratios showed that LENT score was more, strongly associated with 6-month mortality than PROMISE (p = 0.001) or RECLS (p = 0.02). LENT score was also more strongly associated with 1-year mortality than PROMISE (p = 0.001) but there was no difference between LENT and RECLS score (p = 0.64). We observed that the LENT score was more predictive than the other scores in mortality in patients who have lung cancer and MPE. The LENT and RECLS scores have similar performance characteristics for prediction of 1-year mortality in these patients.

Compared to donations after brain death, donations after circulatory death present a series of difficulties: the acquisition of the family's consent, the need for qualified personnel and specific resources, death assessment, assessment of the organ, and graft care (pre- and post-transplant). These are all time-related factors that negatively impact the organ, resulting in increased tubular, glomerular, and vascular damage. The evaluation of the organ, as per today's standards, requires three hours for the preparation and processing of formalin-fixed paraffin-embedded (FFPE) samples. An alternative to this is the use of the extemporaneous frozen biopsy. However, frozen samples are considered a second choice in the decision-making process. This retrospective study investigates the reliability of the frozen samples in identifying a series of morphological alterations compared to the more accepted results from FFPE samples. Additionally, two important clinical data, terminal serum creatinine levels and warm ischemia time, were correlated to the presence of some morphological alterations in an attempt to find effective and fast strategies to predict the kidney transplant outcome.

To explore the frequency and predictive factors of erectile dysfunction diagnosis after colorectal cancer surgery. The Surveillance, Epidemiology, and End Results-Medicare database was used to identify a national sample of men undergoing surgery for colorectal cancer from 2004 to 2015. Men aged > 65 years with any index surgery within 1 year of diagnosis of colorectal cancer were included. Men with a history of prior erectile dysfunction, metastatic cancer, or genitourinary cancer prior to their index procedure were excluded. The primary outcome was a new diagnosis of erectile dysfunction within 2 years of the index procedure. A total of 28,248 men aged > 65 years who underwent colorectal cancer surgery were identified. The rates of erectile dysfunction diagnosis 2 years after surgery were 3.6% for hemicolectomy, 5.3% for low anterior resection, and 6.4% for abdominoperineal resection. On multivariable analysis, low anterior resection (HR: 1.27, 95%CI 1.08 to 1.51, p < 0.01) and abdominoperineal resection (HR: 1.49, 95%CI 1.14 - 1.93, p < 0.01) were independently associated with increased risk of erectile dysfunction compared to hemicolectomy. Minimally invasive surgery was independently associated with an increased risk of erectile dysfunction compared to open surgery (HR: 1.44, 95% CI 1.25-1.65, p < 0.001). Compared to hemicolectomy, men treated with low anterior resection and abdominoperineal resection have a higher risk of being diagnosed with erectile dysfunction within 2 years of treatment. The absolute rate of erectile dysfunction diagnosis was low compared to rates reported in prior controlled trials, suggesting that patients are underdiagnosed in real-world settings.