Surgery open science最新文献_第6页

Outcomes of simultaneous resection for colorectal liver metastases: A nationwide cohort study (2005–2022) 同时切除结直肠肝转移的结果：一项全国队列研究（2005-2022）

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-08-05 DOI: 10.1016/j.sopen.2025.07.008

J.H. Angelsen , S. Yaqub , T.A. Hegvik , L.S. Nymo , T. Veen , V.J. Dagenborg , E.A. Bringeland

Introduction

The optimal treatment strategy for synchronous colorectal liver metastases (CRLM) has been a topic for ongoing debate. We present a national cohort containing simultaneous resections of the primary tumour and CRLM, with emphasis on postoperative complications, and survival.

Method

This population-based national cohort study included consecutive patients who underwent simultaneous resections in Norway between 2005 and 2022. Postoperative complications (Accordion Severity Grading System – ASGS) and overall survival (OS) were analysed in relation to the extent of liver resection and location of the primary tumour.

Results

A total of 193 patients underwent simultaneous resection of the primary tumour and liver metastases. Postoperative complications graded as ASGS ≥3 occurred in 48 (24.9 %) while 23 (11.9 %) patients developed ASGS ≥4 complications. Anastomotic leakage was observed in 9 (4.7 %) patients. Among 18 (9.3 %) patients undergoing major liver resections, 10 (55.6 %) and seven (38.9 %) patients experienced ASGS ≥3 and ASGS ≥4 complications, respectively. Major liver resection was an independent predictor for ASGS ≥3, (RR: 2.40; p = 0.002). The 30- and 90-day mortality rates were 0.5 % (n = 1) and 2.1 % (n = 4), respectively. Median, 5- and 10-year OS were 4.8 years, 46.7 % and 35.6 %, respectively. In a multivariable analysis both an increasing number of liver metastases and ASGS ≥4 complications were independently associated with inferior OS.

Conclusions

Simultaneous resection for synchronous CRLM was a safe option, particularly in minor liver resections. Major liver resections were associated with increased risk of severe complications and inferior OS.

同步性结直肠肝转移（CRLM）的最佳治疗策略一直是一个争论不休的话题。我们提出了一个包含原发肿瘤和CRLM同时切除的国家队列，重点是术后并发症和生存率。方法：这项以人群为基础的国家队列研究纳入了2005年至2022年间在挪威接受同期切除术的连续患者。分析术后并发症（Accordion严重性分级系统- ASGS）和总生存期（OS）与肝脏切除程度和原发肿瘤位置的关系。结果193例患者同时行原发肿瘤和肝转移灶切除术。术后出现ASGS≥3级并发症48例（24.9%），ASGS≥4级并发症23例（11.9%）。吻合口瘘9例（4.7%）。18例（9.3%）大肝切除术患者中，ASGS≥3例（55.6%）和ASGS≥4例（38.9%）并发症发生率分别为10例（55.6%）和7例（38.9%）。肝大切除是ASGS≥3的独立预测因子（RR: 2.40; p = 0.002）。30天和90天的死亡率分别为0.5% （n = 1）和2.1% （n = 4）。中位、5年和10年OS分别为4.8年、46.7%和35.6%。在一项多变量分析中，肝转移数量的增加和ASGS≥4的并发症与较差的OS独立相关。结论同步CRLM的同时切除是一种安全的选择，特别是在小范围的肝切除中。大肝切除术与严重并发症和不良OS的风险增加有关。

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引用次数: 0

Call for participation in a multicenter study: Intraoperative blood loss – Towards a standardized and objective recording method 呼吁参与一项多中心研究：术中失血——迈向标准化和客观的记录方法

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-08-05 DOI: 10.1016/j.sopen.2025.07.007

Emelie Nébel, Lätitia Dennin, Johannes Klose, Ulrich Ronellenfitsch, Jörg Kleeff, Artur Rebelo

引用次数: 0

S-EMR: A first experience with stalked endoscopic mucosal resection in thick and high-risk pedunculated polyps S-EMR：在厚和高风险带蒂息肉的内镜下粘膜切除的第一次经验

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-07-31 DOI: 10.1016/j.sopen.2025.07.005

Mojgan Forootan , Alessandro Repici , Mohsen Rajabnia , Ali Jahanian , Mahsa Mohammadi , Mohammad Reza Zali , Hamidreza Bolhasani

Background

Post-polypectomy bleeding (PPB) is a relatively common event after polypectomy of large polyps using conventional methods, and the likelihood of malignant tissue remaining remains. The aim of this study was to investigate the efficacy of stalked endoscopic mucosal resection (S-EMR) as a potential solution to PPB in large pedunculated and semi-pedunculated colonic polyps and to reduce the need for repeat endoscopic intervention and surgery for malignant polyps.

Methods

This prospective, single-arm, open-label study was conducted on patients in whom screening colonoscopy was indicated. All patients who were found to have pedunculated and semi-pedunculated polyps (Paris class Ip and Ips) with a thick stalk (>10 mm), a polyp head ≥20 mm in size, giant polyps leading to bowel obstruction, or large polyps with JNET type 2B or type3 were included in this study. These polyps were treated with S-EMR method, instead of conventional current methods like utilizing endoloops and clips in the base of stalks: Lift-and-cut technique after formation of adequate submucosal cushion in the base of the pedicle and subsequent prophylactic cauterization of the underlying blood vessels. After the procedure, patients were monitored for vital signs and symptoms of immediate complications for 6 h post-procedure and up to 48 h after discharge.

Results

A total of 48 patients were included in the study. The mean age of the patients was 62.24 years and 41.6 % of them were male. Ten patients had pedunculated and 38 patients had semi-pedunculated polyps. The most common localization of polyps was sigmoid (45.8 %). After S-EMR, no patient had early or late PPB. Four large semi-pedunculated polyps were diagnosed as adenocarcinoma. All had clear margins and no signs of neoplastic submucosal invasion on histologic evaluation.

Conclusion

S-EMR is a safe method for removing thick-stalked, giant, high-risk, and malignant, pedunculated, and semi-pedunculated polyps. It may reduce the risk of PPB and assist in achieving clear margins in malignant polyps.

背景：息肉切除术后出血（PPB）是采用常规方法切除大息肉后相对常见的事件，并且仍然存在恶性组织残留的可能性。本研究的目的是探讨跟踪内镜粘膜切除术（S-EMR）作为大带蒂和半带蒂结肠息肉PPB的潜在解决方案的有效性，并减少恶性息肉的重复内镜干预和手术的需要。方法这项前瞻性、单臂、开放标签的研究是在需要结肠镜筛查的患者中进行的。所有发现有带梗和半带梗息肉（Paris类Ip和Ips），息肉柄粗（10mm），息肉头≥20mm，巨大息肉导致肠梗阻，或JNET型2B或3型大息肉的患者均纳入本研究。这些息肉采用S-EMR方法治疗，而不是传统的现有方法，如利用柄基部的内环和夹子，在蒂基部形成足够的粘膜下缓冲后，采用提切技术，随后预防性烧灼下血管。术后6小时和出院后48小时监测患者的生命体征和立即并发症的症状。结果共纳入48例患者。患者平均年龄62.24岁，男性占41.6%。10例为带梗息肉，38例为半带梗息肉。息肉最常见的定位是乙状结肠（45.8%）。S-EMR后，无患者出现早期或晚期PPB。4个大的半带蒂息肉被诊断为腺癌。所有病例均有清晰的边缘，组织学评价无肿瘤粘膜下浸润征象。结论s - emr是一种安全的切除厚茎、巨大、高危、恶性、带梗和半带梗息肉的方法。它可以降低PPB的风险，并有助于在恶性息肉中获得清晰的边缘。

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引用次数: 0

Feasibility of intraluminal oxygen delivery after minimally invasive esophagus resection 微创食管切除术后腔内供氧的可行性

IF 1.7 Q3 SURGERY

Surgery open science

Pub Date : 2025-07-30 DOI: 10.1016/j.sopen.2025.07.004

Douwe van der Steen MSc , Anne M. Leferink PhD , Frederieke A. Dijkstra MD , Boudewijn van Etten MD, PhD , Eric Keus MD, PhD , Rutger J. Spruit MD , Roy J.J. Verhage MD, PhD , Jeroen J. Kolkman MD , Jan Willem Haveman MD, PhD

Introduction

Anastomotic leakage (AL) is a severe complication after esophagectomy. Intraluminal oxygen delivery at the anastomosis site might improve the viability of the tissue and thereby reduce the incidence of AL. We present a feasibility study of intraluminal oxygen delivery after esophagectomy.

Methods

Eighteen patients scheduled for robot-assisted minimally invasive esophagectomy with an intrathoracic anastomosis were selected to receive an additional manometry catheter for intraluminal oxygen delivery at the anastomosis site. The primary endpoint was the feasibility of placing the catheter in the correct position and staying in situ for five days postoperatively. Intraluminal pressure was monitored during oxygen delivery at flow rates of 0 (control group), 1, 2, or 4 ml/min. Patients were questioned on the comfort of the catheter.

Results

In two patients, intraoperative placement of the catheter was unsuccessful. Two others replaced these patients according to the study protocol. 16 patients were analyzed. In five patients, the catheter was accidentally removed before the end of the study. The primary endpoint was successful in 11/16 patients (69 %). Intraluminal pressure in the 1 ml/min group did not differ from the control group. Intraluminal pressure in the 2 ml/min group increased substantially compared to the control group. Patients reported comfort rates that decreased over time.

Conclusion

This study shows that it is feasible to administer intraluminal oxygen in the first five days after esophagectomy and that a flow rate of 1 ml/min is not associated with increased intraluminal pressure. Future studies are required to study the effectiveness of intraluminal oxygen delivery in preventing AL.

吻合口漏是食管切除术后的严重并发症。吻合口腔内供氧可提高组织活力，从而减少AL的发生率。我们提出了食管切除术后腔内供氧的可行性研究。方法选择18例行机器人辅助微创食管切除术胸内吻合的患者，在吻合处附加测压导管供氧。主要终点是将导管放置在正确位置的可行性，并在术后5天内保持原位。以0（对照组）、1、2或4 ml/min的流速给氧时监测腔内压力。病人被询问导管的舒适度。结果2例患者术中置管不成功。根据研究方案，另外两名患者代替了这些患者。对16例患者进行分析。在五名患者中，导管在研究结束前被意外取出。主要终点有11/16（69%）患者成功。1 ml/min组的腔内压与对照组无差异。与对照组相比，2 ml/min组的腔内压显著升高。患者报告的舒适率随着时间的推移而下降。结论食管切除术后5天内给予腔内氧是可行的，1 ml/min的流速与腔内压力升高无关。需要进一步研究腔内供氧在预防AL中的有效性。

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引用次数: 0

Cost comparison of laparoscopic versus open surgery for common procedures in Rwandan teaching hospitals 卢旺达教学医院常见手术的腹腔镜与开放手术的成本比较

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-07-08 DOI: 10.1016/j.sopen.2025.07.001

King Kayondo , Martin Nyundo , Miguel Gasakure , Janvière Mutamuliza , Leon Ngeruka , Regis Hitimana , Julien Gashegu , Annie Robert

Objective

This study evaluates the economic and clinical impacts of minimally invasive surgery (MIS) compared to open surgery (Open S) for four common procedures—appendectomy, cholecystectomy, hernia repair, and ovarian cystectomy—at two major teaching hospitals in Rwanda, RMRTH and CHUK. The aim is to assess direct costs, hospital stays, complications, and recovery times for MIS versus Open S and to explore the role of health insurance in MIS accessibility.

Methods

A retrospective analysis was conducted on data from 206 patients treated between 2019 and 2022, with 100 undergoing Open S and 106 receiving MIS. Data included direct costs, hospital stay lengths, post-operative complications, and recovery times. The study also examined the correlation between MIS utilization and health insurance.

Results

The average patient age was 41.7 years, with nearly equal gender distribution (52.4 % male, 47.6 % female). Most patients (79.1 %) had Community-Based Health Insurance coverage. Laparoscopic cholecystectomy showed significant economic advantages, with shorter stays, fewer complications, and faster recovery (p < 0.02). MIS for hernia repair offered quicker recovery but incurred higher costs. For appendectomy and ovarian cystectomy, there was no significant cost difference between MIS and Open S. A strong positive correlation was found between MIS adoption rates and health insurance, supporting improved access.

Conclusion

MIS in Rwanda shows promise for economic savings, better patient outcomes, and expanded access through insurance. However, challenges like high consumable costs and limited expertise need to be addressed to fully optimize MIS benefits in Rwanda's healthcare system.

目的：本研究在卢旺达RMRTH和CHUK两家主要教学医院对四种常见手术（阑尾切除术、胆囊切除术、疝修补术和卵巢膀胱切除术）进行了微创手术（MIS）与开放手术（open S）的经济和临床影响进行了比较。目的是评估MIS与Open S的直接成本、住院时间、并发症和恢复时间，并探讨健康保险在MIS可及性中的作用。方法回顾性分析2019 - 2022年206例患者的数据，其中100例接受Open S治疗，106例接受MIS治疗。数据包括直接费用、住院时间、术后并发症和恢复时间。该研究还调查了信息管理系统使用与健康保险之间的相关性。结果患者平均年龄为41.7岁，性别分布基本均匀（男性52.4%，女性47.6%）。大多数患者（79.1%）享有社区医疗保险。腹腔镜胆囊切除术具有显著的经济优势，住院时间短，并发症少，恢复快(p <；0.02)。MIS疝气修补术恢复较快，但费用较高。对于阑尾切除术和卵巢囊肿切除术，MIS和Open s之间没有显著的成本差异，发现MIS采用率与健康保险之间存在强正相关，支持改善获取。结论卢旺达的信息管理系统有望节省经济，改善患者治疗效果，并通过保险扩大获取范围。然而，需要解决消耗品成本高和专业知识有限等挑战，以充分优化卢旺达医疗保健系统中的管理信息系统效益。

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引用次数: 0

Outcomes and costs in splenectomy after failed splenic arterial embolization for blunt splenic injury 钝性脾损伤脾动脉栓塞失败后脾切除术的结果和费用

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-07-02 DOI: 10.1016/j.sopen.2025.06.011

Nam Yong Cho BS , Bill Kwon MD , Esteban Aguayo MD , Zeyu Liu BS , Areti Tillou MD , Peyman Benharash MD

Background

Splenic injury (BSI) is present in nearly 45 % of abdominal blunt trauma cases in the US and splenic artery embolization (SAE) has been increasingly utilized to manage BSI in recent years. However, SAE failure necessitating delayed splenectomy remains a critical concern with significant implications for patient outcomes and healthcare resource utilization.

Methods

We conducted a retrospective cohort study utilizing the 2016–2021 Nationwide Readmissions Database. Adult patients (≥18 years) with BSI undergoing SAE or splenectomy were included. Early embolization was defined as SAE within 48 h of admission. Failure of SAE (FE) was defined as splenectomy following unsuccessful SAE during the index hospitalization or within 30 days post-discharge. Multivariable regression models were developed to assess the association of FE with in-hospital mortality, length of stay (LOS), and costs.

Results

Of 44,750 included patients, 17,921 (40.0 %) underwent SAE as an initial operative approach. Rates of failed embolization remained stable over the study period (2016: 8.1 % vs 2021: 9.4 %, nptrend = 0.86), as did mortality following FE (2016: 1.9 % vs 2021: 1.3 %, nptrend = 0.05). After risk adjustment, early embolization was associated with reduced odds of FE (AOR 0.78, 95%CI 0.64–0.95). FE was associated with significantly increased odds of mortality (AOR 2.52, 95 % CI 1.86–3.41), prolonged LOS by 4.8 days (95 % CI 4.0–5.5), and increased hospitalization costs by $27,600 (95 % CI $24,400-30,900).

Conclusions

Despite growing SAE utilization, its failure rate remains stable with FE being associated with inferior clinical and financial outcomes. Improve patient selection, increased availability of embolization and providing early embolization in select cases may enhance SAE outcomes.

背景：在美国，近45%的腹部钝性创伤病例存在脾损伤（BSI），近年来脾动脉栓塞（SAE）越来越多地用于治疗BSI。然而，SAE失败需要延迟脾切除术仍然是一个关键问题，对患者预后和医疗资源利用具有重要影响。方法利用2016-2021年全国再入院数据库进行回顾性队列研究。包括接受SAE或脾切除术的成年BSI患者（≥18岁）。早期栓塞定义为入院48小时内的SAE。脾切除术失败（FE）定义为在住院期间或出院后30天内脾切除术失败。建立了多变量回归模型来评估FE与住院死亡率、住院时间（LOS）和费用的关系。结果在纳入的44,750例患者中，17,921例（40.0%）接受了SAE作为初始手术入路。在研究期间，栓塞失败率保持稳定（2016年：8.1%，2021年：9.4%,nptrend = 0.86），栓塞后死亡率也保持稳定（2016年：1.9%，2021年：1.3%,nptrend = 0.05）。风险调整后，早期栓塞与FE发生率降低相关（AOR 0.78, 95%CI 0.64-0.95）。FE与死亡率显著增加（AOR 2.52, 95% CI 1.86-3.41）、生存期延长4.8天（95% CI 4.0-5.5）以及住院费用增加27,600美元（95% CI 24,400-30,900美元）相关。结论：尽管SAE的应用越来越多，但其失败率保持稳定，FE与较差的临床和财务结果相关。改善患者选择，增加栓塞的可用性，并在选定的病例中提供早期栓塞可能会提高SAE的预后。

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引用次数: 0

Utilizing the Leap Motion Controller for skill tracking in surgical training: solving line-of-sight issues 利用Leap运动控制器进行手术训练中的技能跟踪：解决视线问题

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-25 DOI: 10.1016/j.sopen.2025.06.009

V.E.E. Kleinrensink , R.H.M. Goossens , J.F. Lange , L.W. Kranenburg , G.J. Kleinrensink

Background

Minimally invasive surgery (MIS) requires mastery of complex skills, for which diverse training methods have been developed. While some methods focus on precise instrument tracking and others on realistic practice scenarios, combining these aspects leads to increased costs and impractical setups.

The Leap Motion Controller (LMC) is a cost-effective device offering precise motion tracking, but previous studies found its utility in surgical training is limited by line-of-sight issues. This study aims to address this challenge.

Methods

A novel interface was developed for use of LMC for tracking MIS instruments during practice. To resolve the line-of-sight problem, the traditional enclosed working area was replaced with a single vertical barrier concealing the task while allowing the LMC to maintain a clear horizontal view of the instrument. Performance metrics included time to task completion and total path length of the instrument. Twenty-eight medical students participated, performing 40 consecutive trials each.

Results

The LMC provided precise tracking, effectively resolving line-of-sight issues. Participants improved significantly, with task completion time decreasing from 61 s (SD = 40) to 19 s (SD = 8) and path length from 2390 mm (SD = 2569) to 574 mm (SD = 348). Performance plateaued after 20 trials, with reduced variance for all outcomes.

Conclusions

The study successfully leveraged the LMC for tracking surgical instruments, overcoming previous limitations. The setup enables real-time monitoring, continuous movement tracking, and tactile interaction with physical objects. Its affordability and simplicity make it a promising tool for traditional and home-based MIS training, especially in resource-limited settings.

背景微创手术（MIS）需要掌握复杂的技能，为此已经开发了多种培训方法。虽然一些方法侧重于精确的仪器跟踪，而另一些方法则侧重于现实的实践场景，但将这些方面结合起来会导致成本增加和不切实际的设置。Leap运动控制器（LMC）是一种具有成本效益的设备，提供精确的运动跟踪，但先前的研究发现，它在外科训练中的应用受到视线问题的限制。本研究旨在解决这一挑战。方法开发了一种新的界面，使LMC能够在实际操作中跟踪MIS仪器。为了解决视线问题，传统的封闭工作区域被单一的垂直屏障所取代，同时允许LMC保持仪器的清晰水平视野。性能指标包括完成任务的时间和仪器的总路径长度。28名医学生参与其中，每人连续进行40次试验。结果LMC提供了精确的跟踪，有效地解决了视线问题。参与者显著改善，任务完成时间从61秒（SD = 40）减少到19秒（SD = 8），路径长度从2390毫米（SD = 2569）减少到574毫米（SD = 348）。20次试验后表现趋于平稳，所有结果的方差均减小。结论：该研究成功地利用LMC跟踪手术器械，克服了以往的局限性。该装置可实现实时监控、连续运动跟踪以及与物理对象的触觉交互。它的可负担性和简单性使其成为传统和家庭管理信息系统培训的一个很有前途的工具，特别是在资源有限的情况下。

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引用次数: 0

Chronic inflammation following hernia repair and cancer risk: A nationwide study 疝气修复后的慢性炎症与癌症风险：一项全国性研究

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-25 DOI: 10.1016/j.sopen.2025.06.004

Malene Broholm MD, PhD , Ismail Gögenur MD, DMSc , Lau Caspar Thygesen Cand.Scient.san.publ, PhD , Frederik Helgstrand MD, PhD

Purpose

Implantation of mesh in patients undergoing hernia surgery or prolonged inflammation due to postoperative complication may be associated with increased risk of cancer.

We aim to test whether implementation of mesh or complicated postoperative course with readmittance was associated with increased risk of cancer.

Methods

This register-based nationwide observational cohort study included 48,392 and 127,756 patients undergoing ventral and inguinal hernia surgery, respectively, during 1996–2004, with follow-up until Dec. 2014. In total, 16,909 patients undergoing ventral hernia repair with mesh, and 31,483 undergoing sutured repair, as well as 106,342 patients undergoing inguinal hernia repair with mesh and 21,414 undergoing sutured repair were included. Patients were matched with a reference cohort from the general Danish population and were followed in the Danish Cancer Registry.

Results

For ventral hernia surgery, there was a significant association between mesh repair and risk of cancers, [(vs general population), HR 1.09 (95%CI, 1.00–1.18)]. Thirty-day readmission after mesh and sutured repair was associated with developing cancer [HR 1.15 (0.99–1.34) and 1.14 (1.00–1.31), respectively]. However, the association for suture repair (HR 1.14) did not reach statistical significance (p = 0.055). For inguinal hernia surgery, mesh repair was not associated with increased risk of cancer [(vs. general population), HR 1.00 (95%CI, 0.97–1.02)]. For both mesh and sutured repair, there was an increased risk for developing cancer after 30-day readmission, [HR 1.21 (1.12–1.31) and 1.24 (1.07–1.43), respectively].

Conclusion

Patients undergoing ventral hernia repair with mesh and patients readmitted after inguinal or ventral hernia repair may have higher risk of developing cancer than the general population.

These exploratory findings do not establish causality, but the association warrants further investigations in other populations.

目的疝手术或术后并发症引起的长期炎症患者植入补片可能会增加患癌风险。我们的目的是测试是否实施补片或复杂的术后再接纳过程与癌症风险增加有关。方法：这项基于登记的全国观察队列研究纳入了1996-2004年间分别接受腹疝和腹股沟疝手术的48,392和127,756例患者，随访至2014年12月。共纳入腹侧疝补片修补术16909例，缝合修补术31483例，腹股沟疝补片修补术106342例，缝合修补术21414例。患者与来自丹麦普通人群的参考队列相匹配，并在丹麦癌症登记处进行随访。结果对于腹疝手术，补片修复与癌症风险之间存在显著关联[（与一般人群相比），HR 1.09 (95%CI, 1.00-1.18)]。补片和缝合修复后30天再入院与发生癌症相关[HR分别为1.15（0.99-1.34）和1.14(1.00-1.31)]。但缝线修复相关性（HR 1.14）无统计学意义（p = 0.055）。对于腹股沟疝手术，补片修复与癌症风险增加无关[（与一般人群相比），相对危险度1.00 (95%CI, 0.97-1.02)]。对于补片和缝合修复，30天再入院后发生癌症的风险增加，[HR分别为1.21（1.12-1.31）和1.24(1.07-1.43)]。结论腹股沟疝修补术及腹股沟疝修补术或腹股沟疝修补术后再入院的患者发生肿瘤的风险高于一般人群。这些探索性的发现并没有建立因果关系，但这种联系值得在其他人群中进一步调查。

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引用次数: 0

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-20 DOI: 10.1016/j.sopen.2025.06.008

Anna Ekström , Victoria Fomichov , Bergthor Björnsson , Carina Wennerholm , Per Sandström , Jenny Drott

Purpose

Patients with cancer in the liver, pancreas, or bile ducts often experience stressful situations. These patients frequently perceive a variety of symptoms that affect their health both before and after surgery. This study aimed to investigate the health-related quality of life of patients undergoing hepato-pancreato-biliary cancer surgery and to compare pre- and postoperative patient-reported outcomes.

Method

A prospective study was conducted using a consecutive sampling procedure. The inclusion criteria were patients aged over 18 years with malignant tumours in the liver, bile ducts, or pancreas, who were treated with curative cancer surgery.

Results

Of the 77 included patients, 50.6 % were men, and 55.8 % were 70 years or older. The results are based on 154 completed EQ-5D-5L questionnaires, analyzed preoperatively and postoperatively. The overall mobility and anxiety dimensions did not change between the pre- and postoperative assessments. The overall self-care dimension increased over time (p = 0.001), as did the usual activities and pain dimensions (p < 0.001). More men reported no problems with mobility one month postoperatively. Our results showed that patients undergoing HPB cancer surgery had a lower overall health-related quality of life postoperatively, with significant differences in the dimensions of pain, activity, and self-care.

Conclusions

Clinically significant results include no changes in mobility and anxiety between the pre- and postoperative assessments. Men reported higher rates of no problems with mobility postoperatively. The differences in mobility between women and men are important clinical findings, suggesting the need for more attention to support patients for equitable and safe postoperative cancer care.

目的肝癌、胰腺癌或胆管癌患者经常经历压力状态。这些患者在手术前后经常会出现各种影响其健康的症状。本研究旨在调查接受肝-胰-胆道癌手术患者的健康相关生活质量，并比较患者报告的术前和术后结局。方法采用连续抽样方法进行前瞻性研究。纳入标准是年龄在18岁以上的肝脏、胆管或胰腺恶性肿瘤患者，他们接受了治愈性癌症手术治疗。结果纳入的77例患者中，50.6%为男性，55.8%为70岁及以上。结果基于154份完整的EQ-5D-5L问卷，并在术前和术后进行分析。总体活动能力和焦虑维度在术前和术后评估之间没有变化。整体自我照顾维度随时间增加（p = 0.001），日常活动和疼痛维度也是如此(p <；0.001)。更多的男性报告术后一个月没有活动障碍。我们的研究结果显示，接受HPB癌症手术的患者术后总体健康相关生活质量较低，在疼痛、活动和自我护理方面存在显著差异。结论：在术前和术后评估中，具有临床意义的结果包括活动能力和焦虑没有变化。男性报告术后活动能力无问题的比例更高。女性和男性在移动性上的差异是重要的临床发现，表明需要更多的关注来支持患者公平和安全的癌症术后护理。

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引用次数: 0

Indications, sub-types and complications of surgically treated thyroid disease in Africa: A systematic review and meta-analysis 非洲手术治疗甲状腺疾病的适应症、亚型和并发症：系统回顾和荟萃分析

IF 1.4 Q3 SURGERY

Surgery open science

Pub Date : 2025-06-18 DOI: 10.1016/j.sopen.2025.06.006

Bekalu Getachew , Mekbeb Afework , Girmaye Tamrat

Objectives

Thyroidectomy is a surgical procedure that reduces or removes the thyroid gland the aim of this systematic review and meta-analysis was to assess the pooled prevalence and sub-types of thyroidectomy and characterize its postoperative complications in some low and middle income African countries.

Methods

The studies were identified through an exhaustive search of reputable databases Twenty-two studies were selected based on the inclusion and exclusion criteria. Data were extracted using a standardized and pre-tested data extraction checklist, and the analysis was done using STATA version 14 statistical software. Heterogeneity was assessed using I² statistics.

Result

Toxic goiters were the most common indication for thyroidectomy accounting for 46.62 % of cases. Cosmetic reasons (41.07 %) and suspicion of malignancy (11.30 %) were the other common indications. Regarding surgical procedures, sub-total thyroidectomy (39.27 %) was the predominant surgical procedure, followed by lobectomy and isthmusectomy (34.88 %) and near-total thyroidectomy (34.77 %) respectively. The pooled prevalence of postoperative complications following thyroidectomy was 26.6 % [95%CI, 18.3–34.89]. Hypoparathyroidism (8.49 %) was the most common complication, followed by recurrent laryngeal nerve injury (7.96 %) and dysphonia (7.28 %).

Conclusion

A toxic goiter was the most common indication for thyroidectomy. The pooled prevalence of postoperative complications was comparably higher than international figures. Hypoparathyroidism was the predominant postoperative complication.

甲状腺切除术是一种减少或切除甲状腺的外科手术。本系统综述和荟萃分析的目的是评估一些中低收入非洲国家甲状腺切除术的总患病率和亚型，并描述其术后并发症。方法通过对知名数据库的全面检索，根据纳入和排除标准筛选出22项研究。使用标准化和预测试的数据提取清单提取数据，并使用STATA version 14统计软件进行分析。采用I2统计量评估异质性。结果中毒性甲状腺肿是甲状腺切除术最常见的指征，占46.62%。美容原因（41.07%）和怀疑恶性肿瘤（11.30%）是其他常见的适应症。手术方式以甲状腺次全切除术（39.27%）为主，其次为肺叶切除术、峡部切除术（34.88%）和近甲状腺全切除术（34.77%）。甲状腺切除术后并发症的总发生率为26.6% [95%CI, 18.3-34.89]。最常见的并发症是甲状旁腺功能减退（8.49%），其次是喉返神经损伤（7.96%）和发音障碍（7.28%）。结论中毒性甲状腺肿是甲状腺切除术最常见的指征。术后并发症的总发生率相对高于国际数据。甲状旁腺功能减退是主要的术后并发症。

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