Journal of Visceral Surgery最新文献

Background: Colorectal cancer (CRC) ranks as the third most diagnosed cancer worldwide and the second leading cause of cancer-related death. Although relatively rare, brain metastases from CRC (BMCRC) have been linked to poor prognosis and reduced survival rates. The incidence of BMCRC is increasing, possibly because of improved diagnostic techniques and prolonged patient survival due to advances in systemic treatments.

Methods: A systematic literature review was conducted following PRISMA guidelines, utilizing databases such as PubMed, Embase, and the Cochrane Library. Eligible studies included original research articles related to BMCRC published in English from January 2000 to June 2025. Two independent reviewers screened and extracted data on study characteristics, treatment modalities, outcomes, and risk factors.

Key findings: BMCRC is less common than liver and lung metastases, but its incidence is increasing. Risk factors include molecular subtype (particularly KRAS mutation), location of the primary (rectal or right-sided) and the presence of lung or liver metastases. Symptoms are often nonspecific and include neurological deficits and headaches. Systematic brain scans are not currently recommended but may be suggested for patients with risk factors. Treatments are not standardized and include neurosurgery, radiotherapy (stereotactic radiosurgery [SRS] and whole-brain radiotherapy [WBRT]) and systemic therapies (chemotherapy, targeted therapies and immunotherapy). Surgical resection remains the treatment of choice when possible.

Conclusion: BMCRC is challenging because of its rarity and complex management. Recent advances in systemic therapies and diagnostic techniques have improved patient outcomes. Future research should focus on novel therapeutic approaches and biomarker validation to enhance early detection and personalize treatment strategies.

Peritoneal metastases originating from colorectal cancer (CRPM) and gastric cancer (GCPT) occur frequently (metachronous in 15 to 40% of patients) and are most often diagnosed at an advanced stage because symptoms are sparse at the initial stages of disease. Abdominal-pelvic computed tomography with or without arterial and portal phase evaluation is essential for the diagnosis of recurrence or peritoneal involvement. However, exploration of the peritoneal cavity by laparoscopy can confirm the diagnosis and provide histological evidence. It is crucial to distinguish between palliative and potentially curative treatments; the latter based on complete resection of disease, the feasibility of which depends on technical, oncological and physiological criteria. The treatment of CRPM and GCPM is based on systemic chemotherapy (associated with or without targeted therapy) potentially combined with complete cytoreductive surgery (CRS) in selected patients and performed in expert centers. The survival benefit of CRS in patients with CRPM has been validated with a median survival of 41 months (PRODIGE 7). Regarding the addition of hyperthermic intraperitoneal chemotherapy (HIPEC) to CRS, mitomycin C is the preferred drug used and a phase-3 randomized trial comparing CRS plus HIPEC to mitomycin C versus CRS alone, is underway in Spain. Regarding GCPM, survival results after CRS, after CRS plus HIPEC, or after systemic chemotherapy alone, remain disappointing. The goal of CONVERGENCE, an international trial (starting soon in France), will be to evaluate the benefit of CRS in these patients. The prognosis of colorectal and gastric peritoneal disease (PD) has improved substantially in recent decades, thanks to better knowledge of these entities, managed surgically and oncologically in expert reference centers. The potential benefits of HIPEC in combination with CRS are under evaluation in randomized trials.

Background: Assessing intraoperative workload is essential for understanding performance variability, preventing errors, and supporting occupational well-being. The Surgery Task Load Index (SURG-TLX) offers greater contextual relevance for surgery than general tools such as the NASA-TLX, but no validated French version has been available.

Objective: To translate the SURG-TLX into French and evaluate its psychometric properties in a real-world operating-room setting.

Methods: Twenty operating-room professionals each rated two distinct procedures (Time 1, T1; Time 2, T2), yielding 40 evaluations. After each operation, participants completed the French SURG-TLX, the NASA-TLX, and a 1-10 perceived difficulty rating. Analyses included descriptive statistics, Pearson correlations (convergent/construct validity), paired t-tests, Bland-Altman plots, intraclass correlation coefficient (ICC[3,k]) for test-retest reliability, and linear mixed-effects models with participant as a random intercept.

Results: Mean weighted SURG-TLX scores indicated moderate workload (T1: 9.28±4.27; T2: 8.37±2.98 on a 0-40 scale). Convergent validity was supported by strong correlations with NASA-TLX (T1: r=0.67, P<0.001; T2: r=0.81, P<0.001). Construct validity was confirmed by the association with perceived difficulty across all procedures (r=0.69, P<0.001). The paired comparison showed no T1-T2 difference (t(19)=0.94, P=0.36, d=0.21). Test-retest reliability was moderate (ICC[3,k]=0.48; 95% CI -0.12-0.76). In mixed-effects models, perceived difficulty predicted SURG-TLX (β=1.20±0.22, P<0.001), whereas time and demographics were non-significant.

Conclusion: The French SURG-TLX shows solid preliminary validity, moderate temporal reliability, and sensitivity to task complexity in real surgical practice.

We present the case of a direct inguinal hernia located at the lateral aspect of the inguinal orifice. This hernia protruded through the posterior wall of the inguinal canal; the (pseudo-)hernia sac was lateral to the inferior epigastric vessels, but medial to the spermatic vessels, and its tip could eventually bulge through the external inguinal ring. Deploying a large prosthetic mesh via the laparoscopic approach can prevent the risk of recurrence in the case of multiple and atypical orifices.

Aim: Digestive surgery is known to be a surgical specialty with high workload, through training program for residents and lot of emergent procedures during night shift. The term "black cloud" referred to nurses, attending physicians and residents who seem to have a heavier workload during on-call shifts relative to their peers. The scientific literature is controversial about the reality of this concept. The aim was to determine if the "black cloud" concept really exists in digestive surgery.

Methods: All the emergent surgeries (under general and local anaesthesia) performed in one department of digestive surgery in a tertiary referral centre (Timone Hospital, Marseille, France) were prospectively included during 6 months.

Results: During the study period, 423 emergent digestive procedures were performed in one tertiary referral centre, by 9 surgeons and 8 residents. The mean number of interventions was similar between surgeons (P=0.4). Regarding the surgeon degree, the mean number of emergent procedures was similar between attending surgeons and senior residents (2.3±1.5 vs 2.4±1.6, P=0.49). There was no significant difference between digestive surgery residents and those from urology and gynaecology training program in terms of mean number of emergent procedures (2.2±1.5 vs 2.4±1.6, P=0.4). The emergent procedures performed during the day were significantly different between weekdays (P=0.03), with a lower number of procedures performed on Sunday: 0.9±0.9 [range, 0-3].

Conclusion: We did not identify a real "black cloud" in our digestive surgery department. We only reported that there were less emergencies procedures during the day of Sunday.

The objective of this narrative review of the literature was to discuss the original concept and ongoing validation of predictive scores for intraoperative or postoperative morbi-mortality, and their overall utility in scheduled visceral surgery. The development and validation of a predictive score for morbi-mortality is carried out by means of a well-defined process encompassing internal and external validation according to temporality, geographical location or domain (patient population and/or type of surgery), and the clinical impact of application of the score. Bibliographic analysis has shown that very few existing studies possess the required methodological qualities. Detailed individual analysis of the different scores, not including nutritional scores, showed that the ASA-PS score is easy to use but yields only moderate performance, that the SORT score (six variables) is more powerfully discriminatory than the POSSUM score, that the POSPOM score has not been validated in visceral surgery, that the ACS-NSQIP score cannot be utilized in Europe and, finally, that the Charlson index is not sufficiently discriminatory in the short term. If specific types of surgery are taken into consideration, none of these scores have received formal external validation. In conclusion, the SORT score has been the most validated, and the ASA-PS score is widely used in current practice. The role of artificial intelligence in the form of machine learning remains to be defined.