Scandinavian Journal of Surgery最新文献

Background and aims: Evidence suggests that female surgeons achieve comparable or even more favorable outcomes than male surgeons. It is currently unclear what factors contribute to these potential differences. Possible explanations might be differences in personality traits, communication style, attitude, and risk-taking behavior. This cross-sectional study aimed to examine disparities in personality traits between male and female general surgeons in Sweden.

Methods: The research was conducted as a cross-sectional study of personality traits. Between August 29, 2022, and December 15, 2023, Swedish specialists in general surgery were invited to participate in an online survey. The survey, assessed with the Big Five Inventory, collected information on self-reported surgeon gender, years in practice, employment data, and differences in personality traits.

Results: The analysis encompassed responses from 223 Swedish general surgeons: 121 (54%) males and 102 (46%) females. In contrast to female surgeons, male surgeons were older and had longer surgical experience. A higher proportion of male surgeons were employed in rural hospitals. Higher mean scores were observed in all personality traits among female surgeons. The adjusted analysis showed significantly higher scores for conscientiousness (p < 0.001), extraversion (p < 0.001), agreeableness (p = 0.006), and neuroticism (p < 0.001); however, no such change was observed for openness.

Conclusion: This cross-sectional study demonstrates that Swedish female and male surgeons differ in personality traits. The implications of these results could lead to a deeper understanding of the variations in surgical outcomes based on the gender of the surgeon.

Background and aims: Managing infrainguinal vascular graft infections (VGI) in bypass reconstruction is complex. Although an autologous vein is the preferred graft material, alternative conduits are required when autologous veins are unavailable. This study aimed to compare the efficacy of cryopreserved arterial homografts and biosynthetic glutaraldehydemodifiedovine collagen grafts (Omniflow II) for the treatment of infrainguinal VGI.

Methods: The study was retrospective across two centers and included patients with infrainguinal VGI treated with cryopreserved arterial homografts or Omniflow II grafts between 2009 and 2019. Freedom from reinfection, primary patency rates, amputation-free survival, and overall survival were analyzed using 5-year Kaplan-Meier estimates.

Results: Overall, 63 patients with infrainguinal VGI were treated with either Omniflow II grafts (n = 34) or cryopreserved arterial homografts (n = 29). At 5 years, freedom from reinfection was 97.1% for Omniflow II grafts and 93.1% for cryopreserved arterial homografts (p = .4). Primary patency was 50% for Omniflow II grafts and 55.2% for the cryopreserved arterial homografts (p = .5). Amputation-free survival was 52.9% for Omniflow II grafts and 55.2% for cryopreserved arterial homografts (p = .7). No graft degeneration or graft ruptures were observed during the follow-up.

Conclusions: This study suggests that biosynthetic grafts are viable and accessible alternatives for traditional graft materials, offering similar efficacy and ease of use. Although autologous vein grafts remain the gold standard for VGI management, biosynthetic grafts may serve as a viable alternatives to cryopreserved arterial homografts in the treatment of infrainguinal VGIs.

Background and aims: The majority of neurogenic thoracic outlet syndrome (NTOS) surgery still involves removal of the first rib. A rib-sparing procedure has also been found to give a good result, but no meta-analysis has been published about this procedure. Also, from a financial point of view, it is important to know what kind of results have been obtained in the treatment of NTOS with rib-sparing surgery. Our opinion is that first-rib resection (FRR) surgeries, which contain more complications and require a longer recovery time, are performed too often these days, if the same result is achieved with rib-sparing surgery.

Methods: We accomplished a systematic review and meta-analysis to find out the outcome of rib-sparing NTOS surgery, collecting studies on rib-sparing supraclavicular scalenotomy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using appropriate databases.

Results: Of 1354 studies, 18 studies met our inclusion criteria. The mean study sample size was 58, and the mean patient age at surgery was 35.8 years. All studies reported long-term outcomes, with the mean follow-up time of 49 months. All reported fewer patient complaints after surgical TOS treatment. In our meta-analysis, improvement to Derkash's excellent/good classifications was achieved in 71% (95% confidence interval (CI) = 64.4% to 76.4%, I² = 73.0%). The heterogeneity noted in the systematic review showed no significant moderation by gender, age, or follow-up time. The studies included had a low risk of publication bias, with most failing to use validated evaluation methods.

Conclusion: According to this analysis, the rib-sparing surgical treatment of NTOS is beneficial to most patients and relatively safe. Still, future studies should accommodate validated thoracic outlet scales.Type of study / level of evidence:Therapeutic IV.

Background and objective: Breast cancer liver and lung metastases are common and associated with poor prognosis. Personalized medical treatment of advanced breast cancer, based on established predictive factors, has improved survival during the last decades. In contrast, there is no consensus regarding indications for surgery. The aim of this narrative review is to summarize the current knowledge on the outcome of surgical treatments for breast cancer liver and lung metastases.

Method: A narrative review of existing evidence for diagnosis and treatment of breast cancer liver and lung metastases.

Results: There are no randomized trials to evaluate surgery as an adjunct to medical treatment. In this review, data are reported from case-control studies and meta-analyses on surgery for liver and lung metastases. Selected patients have an improved survival after surgery compared to those who only received medical treatment. The survival benefit is, however, uncertain when adjusting for prognostic factors, and prospective trials are warranted. Anecdotal cases have long-term survival and surgery is safe.

Conclusion: Surgery for breast cancer liver and lung metastases may be considered in selected cases within prospective studies.

Background: There is controversy regarding which is the best reconstruction technique after the pancreatoduodenectomy. Currently, there are no studies comparing the three most frequent reconstruction techniques: Whipple + Roux-en-Y gastrojejunostomy (WRYGJ), pyloric-preserving + Billroth II (PPBII), and Whipple + BII (WBII).

Methods: Between 2012 and March 2023, 246 patients underwent pancreaticoduodenectomy with the following type of reconstruction techniques: (1) WRYGJ: 40 patients; (2) PPBII: 118 patients; and (3) WBII: 88 patients. A retrospective comparative study among these groups was performed.

Results: No significant differences were found among the groups regarding duration of the surgery, the blood volume transfused, or caliber of the Wirsung duct. The size and types of tumors, the degree of differentiation and tumor invasion of the peripancreatic tissue, vascular and neural structures, and lymph nodes were similar among the groups. The rate of R0 resection was lower in WBII (62.5% [55/88]) than in WRYGJ (75% [30/40]) and PPBII (72% [85/118]), but statistically insignificant among the groups (p = 0.232). The incidences of relevant B/C postoperative pancreatic fistula (POPF) were similar among the groups: 7.5% (7/40) in WRYGJ, 17% (20/118) in PPBI, and 26.2% (23/88) in WBII (p = 0.292). In addition, the incidence of B/C delayed gastric emptying (DGE) was higher in WBII (27.3% [24/88]) than in WRYGJ (20% [8/40]) and PPBII (19.5% [23/118]) but statistically insignificance among the groups (p = 0.381). The incidence of medical and surgical complications, intensive care unit and hospital stays, morbimortality at 90 days, and 5-year survival were similar among the groups. Multivariate analysis revealed that POPF grade B/C was a risk factor for DGE grade B/C (odds ratio (OR) = 9.903, 95% confidence interval (CI) = 4.829-20.310; p < 0.001), and a <3-mm Wirsung duct was a risk factor for POPF (OR = 3.604, 95% CI = 1.791-7.254; p < 0.001).

Conclusion: No technique was superior to the others. Only relevant POPF B/C was a risk factor for DGE B/C, and <3 mm Wirsung for a POPF.

Frailty is a common phenomenon in older adult population and associated with an elevated risk of adverse health outcomes. Recent studies have demonstrated that patients with frailty undergoing surgery had a significantly higher morbidity and mortality compared to those without frailty. This is particularly important in patients with cancer because the prevalence of frailty is persistently high across a spectrum of primary cancers. Identifying frailty in oncological patients undergoing surgery may provide an important preoperative intervention opportunity to mitigate operative risks. In this review, we provide an overview of frailty and its association with other geriatric syndromes. We will also review the impact of frailty on postoperative outcomes focusing on the field of surgical oncology. We then describe currently available tools to objectively measure frailty to provide clinicians with various practical tools that may be adopted in their clinical practice. Finally, we will describe potential interventional programs, including the recently introduced Geriatric Surgery Verification program by the American College of Surgeons, that may be institutionally adopted to mitigate postoperative complications and improve meeting patient-centered goals in the frail patient population.

Lymphedema occurs when the lymphatic system is malformed, leaking or is damaged by infection or cancer treatment. Enlarged extremities due to extensive fluid retention and adipose tissue deposition, recurrent cellulitis, and the requirement for hard-to-wear compression garments lead to impaired limb function and decreased quality of life. This narrative review aims to elucidate classification, diagnostic tools, and conservative management strategies leading the path to patient selection for microsurgical reconstructive procedures or volume reduction procedures. The surgical approaches include reconstructive procedures such as lymphaticovenous anastomosis (LVA) and lymph node transfer and reductive procedures, mainly liposuction and occasionally excisional surgery. Comparing the efficacy of lymphedema surgeries is fully dependent on standardized and reproducible outcome measures. A growing body of knowledge has evolved pointing to the benefits of reconstructive microsurgery of the lymphatic system with or without surgical volume reduction. Tissue engineering and stem cell research leads the way for new approaches. However, several questions remain emphasizing the research needs. Ongoing multicentre trials aiming to elucidate the efficacy and accessibility of surgical treatments for this condition are on their way.

Adrenal glands can host metastases from various malignancies. While surgical resection offers potential benefits in solitary- or oligometastatic cases, many patients have systemic disease unsuitable for surgery when adrenal metastases are diagnosed. Most adrenal metastases originate from malignancies in the lungs, kidneys, or liver. This review explores diagnostic and treatment strategies for adrenal metastases including data from a single center. In particular, it is shown that surgical resection of metastases from colorectal cancer to the adrenals may offer a potential survival benefit. Personalized treatment plans and further research are critical for improving outcomes for patients with adrenal metastases.