Annals of Surgical Treatment and Research最新文献

Purpose: Single-port robotic platforms represent an emerging approach in head and neck surgery, yet their comparative effectiveness against traditional multiport systems remains unclear.

Methods: A systematic review of PubMed, Scopus, Cochrane CENTRAL, and ClinicalTrials.gov was conducted from inception to January 17, 2025. From 93 potentially relevant articles, 5 retrospective comparative studies met the inclusion criteria, comprising 1,000 patients (single-port, 453; multiport, 547). Random-effects meta-analysis was performed for operative parameters.

Results: Single-port surgery demonstrated shorter docking times (pooled effect size, -1.05; 95% confidence interval [CI], -1.47 to -0.64) with moderate heterogeneity (I² = 74.27%). Console times showed no significant difference between approaches (effect size, -0.05; 95% CI, -0.35 to 0.25). Total operative times, reported in 2 studies, indicated modest reductions with the single-port approach (295 ± 92 minutes vs. 315 ± 101 minutes; 101.9 ± 23.6 minutes vs. 114.9 ± 32.8 minutes). Major complication rates were comparable (single-port, 1.8%-9.7%; multiport, 2.7%-4.3%). Negative margin rates favored single-port procedures (57%-100% vs. 48%-92.6%).

Conclusion: This systematic review suggests that single-port robotic surgery offers advantages in docking time while maintaining comparable safety profiles to multiport approaches in head and neck procedures. However, the quality of evidence remains low due to the observational nature of available studies and heterogeneity in outcome reporting.

Purpose: This study was performed to analyze whether adjuvant radiotherapy (RT) can improve the survival outcome for pathological node-negative (ypN0) breast cancer patients who underwent surgery after neoadjuvant chemotherapy (NAC).

Methods: In this meta-analysis, we reviewed papers related to adjuvant RT in ypN0 patients after NAC published between January 2010 and November 2024 using PubMed, EMBASE via Elsevier, Cochrane Library with keywords: "breast neoplasms," "neoadjuvant therapy," and "radiotherapy." The effectiveness of post-mastectomy RT (PMRT) after mastectomy and regional nodal irradiation (RNI) after breast-conserving surgery (BCS) was evaluated. The end point of this study was overall survival (OS).

Results: We selected 11 retrospective papers for this meta-analysis out of 4,164 English full-text articles. There were 7 PMRT-related and 5 RNI-related papers (1 duplicated) for final analysis. Overall, PMRT in ypN0 patients improved OS (hazard ratio [HR], 0.862; 95% confidence interval [CI], 0.766-0.972; P = 0.015) after mastectomy. Moreover, OS (HR, 0.774; 95% CI, 0.600-0.999; P = 0.049) was also improved by RNI for ypN0 patients after BCS.

Conclusion: For patients with ypN0 breast cancer who have undergone NAC and surgery, PMRT positively affected the survival outcome of patients. Therefore, it is necessary to undergo adjuvant RT to improve survival for ypN0 breast cancer patients.

Purpose: Endophytic gastric subepithelial tumors (SETs), especially those near the gastroesophageal junction (GEJ), present challenges in localization and resection. This study aimed to compare the outcomes of single-incision intragastric wedge resection (SIWR) and conventional multiport laparoscopic wedge resection (CWR) for endophytic gastric SETs, including a subgroup analysis of tumors located near the GEJ.

Methods: This retrospective, single-center study included 124 patients who underwent laparoscopic wedge resection for endophytic gastric SETs between January 2016 and December 2024. Operative and postoperative outcomes were compared between the SIWR (n = 23) and CWR (n = 101) groups. Subgroup analysis was performed for tumors located within 2 cm of the GEJ.

Results: The mean tumor size was smaller in the SIWR group than in the CWR group (2.03 ± 0.97 cm vs. 2.57 ± 1.14 cm, P = 0.038). The SIWR group showed a longer postoperative hospital stay (6.30 ± 6.55 days vs. 4.89 ± 1.29 days, P = 0.045) and a higher complication rate (21.7% vs. 4%, P = 0.003), but a shorter time to oral intake (1.43 ± 0.95 days vs. 1.98 ± 0.98 days, P = 0.016). In the GEJ subgroup, SIWR was more commonly performed and showed a shorter time to oral intake without increasing early complications. Late complications were observed only in the CWR group.

Conclusion: Both CWR and SIWR are feasible approaches for endophytic gastric SETs. SIWR may be preferable in selecting GEJ-proximal cases but requires cautious application due to its higher complication rate.

Purpose: Various materials and techniques have been explored to prevent anastomotic leakage (AL). Polyglycolic acid (PGA) sheets and cyanoacrylate (CA) glue have been investigated for their potential in wound healing and fistula closure. This study aims to assess the feasibility of PGA-CA complex (PCC) to prevent AL by developing a major leakage model in rats.

Methods: After the creation of the major leakage model in the jejunum of rat, the leakage site was treated with each material individually and in combination. Rats were categorized into the control, CA, PGA, and PCC groups.

Results: A total of 40 rats were included, with one animal from the CA and PGA groups having expired. Gross intra-abdominal conditions showed no significant difference between the groups. Median intraluminal bursting pressure was 120.0 (range, 102.5-138.0) in the CA group and 138.0 (range, 127.0-147.0) in the PCC group (P = 0.286). Pathologic evaluation revealed fibroblast activation was significantly different in the PCC group (P = 0.025).

Conclusion: No significant differences were observed in the macroscopic intra-abdominal findings or intraluminal bursting pressure between the groups. The only difference in PCC group was enhanced fibroblast activation at moderate levels compare to the control group. Further research is warranted to optimize material combinations and validate efficacy in larger preclinical and clinical settings.

Purpose: The quality of kidneys from deceased donors is critical for successful kidney transplantation. Due to donor shortages, expanded criteria donors are increasingly used, raising concerns about posttransplant outcomes. This study evaluated the predictive value of donor aortoiliac calcification on graft outcomes to improve donor assessment and transplant planning.

Methods: This retrospective study analyzed pretransplant non-contrast CT scans to classify donor aortoiliac calcification as non-to-mild or moderate-to-severe (MTS). Donor and recipient characteristics, time-zero biopsy findings, and graft outcomes were compared using chi-square tests and logistic regression.

Results: MTS donors were significantly older (58.2 ± 5.2 years vs. 49.7 ± 12.8 years, P = 0.002), had more diabetes mellitus (50.0% vs. 10.0%, P = 0.004), and higher Kidney Donor Profile Index (KDPI) scores (79.0 ± 15.2 vs. 59.4 ± 25.1, P = 0.001). Tubular atrophy (TA) was more frequent in the MTS group (81.8% vs. 46.7%, P = 0.022). Logistic regression showed donor diabetes mellitus (β = 0.496, P = 0.001) and Banff TA (β = 0.431, P = 0.003) were significant predictors of calcification.

Conclusion: Aortoiliac calcification in deceased donors is associated with older donor age, higher KDPI scores, and increased incidences of diabetes mellitus and TA. Although it correlated with donor-related risk factors known to influence graft outcomes, it did not independently predict graft function or survival. Therefore, its role in donor selection appears limited and warrants further validation through larger prospective studies.

Purpose: The primary objective of this study was to evaluate long-term outcomes in patients who underwent endovascular treatments for type II endoleaks (T2ELs) following endovascular aneurysm repair (EVAR).

Methods: This single-center, retrospective study included patients who developed early T2EL after EVAR for abdominal aortic aneurysm. Patients were divided into those who did and did not receive intervention for T2EL. Study outcomes included 10-year overall survival (OS), open conversion-free survival, and T2EL regression rates without open conversion.

Results: Of the 385 patients who underwent EVAR between January 2006 and December 2016, 65 (16.9%) had early T2EL. Of these, 22 (33.8%) underwent T2EL intervention and 43 (66.2%) were treated conservatively. Eight (12.3%) of the 65 patients required open conversion, with no significant difference in open conversion-free survival between the two groups (P = 0.080). T2EL regression occurred in 16 of 62 patients (25.8%), with no difference in T2EL closure rates between the groups (P = 0.755). Analysis of the 31 patients with sac growth showed no significant between-group differences in 10-year OS, open conversion-free survival, and T2EL regression rates, regardless of T2EL intervention. Cox regression analysis identified that the development of other types of endoleak was the only risk factor for open conversion.

Conclusion: Interventions for T2EL did not improve OS rates, reduce open conversion rates, or increase T2EL closure rates, even in patients with sac growth. This study suggests that current T2EL interventions are not sufficiently effective, emphasizing the need to detect the development of other types of endoleak that may lead to rupture.

Purpose: Deep vein thrombosis (DVT) contributes significantly to the mortality and morbidity of patients with and without cancer. Non-vitamin K antagonist oral anticoagulants (NOACs) and endovascular interventions have been included in the guidelines for special populations, such as those with cancer-associated DVT. This study aimed to evaluate the long-term outcomes of pharmacomechanical thrombectomy (PMT) compared to NOAC therapy in patients with iliofemoral DVT, and to perform an exploratory subgroup analysis of cancer-associated cases.

Methods: This study included 126 patients who received only medical therapy (n = 66) and PMT (n = 60) for iliofemoral DVT. Of the patients who underwent PMT, 13 had cancer-associated DVT; 10 of them were in the NOAC group. All patients included in this study were retrospectively analyzed after 6 months and 1 year. The Villalta scale was used to measure the severity of post-thrombotic syndrome.

Results: Villalta scores 1 year after DVT onset showed a strong positive correlation with those 6 months after DVT onset (ρ = 0.803, P < 0.001). Cancer-associated DVT patients (n = 13) who underwent PMT showed superior 1-year Villalta scores than did cancer patients (n = 10) who received NOAC treatment (Villalta score,12 vs. 8). This difference was similar to that observed in the non-cancer-associated population who underwent PMT (Villalta score,11 vs. 8).

Conclusion: Acute proximal DVT, regardless of malignancy induction, can be treated with endovascular interventions along with medical therapies. The evolution and development of endovascular treatments for DVT can improve the declining quality of life among patients with cancer-associated DVT.

Purpose: Lumbar hernia repair presents unique surgical challenges due to its rarity and complex anatomical location. This study aimed to compare 3 minimally invasive surgical approaches for lumbar hernia repair: conventional laparoscopy, robotic surgery, and articulating laparoscopy.

Methods: Three patients diagnosed with lumbar hernia underwent repair via the transabdominal preperitoneal approach using different minimally invasive techniques. Each patient was treated with one of 3 approaches: conventional laparoscopy, robotic surgery, or articulating laparoscopic instruments. Clinical outcomes, operative details, and costs were analyzed.

Results: Each technique demonstrated distinct advantages: conventional laparoscopy offered familiarity, robotic surgery provided enhanced visualization and maneuverability, while articulating instruments presented a cost-effective alternative with improved range of motion.

Conclusion: Multiple minimally invasive approaches for lumbar hernia repair are feasible, each with unique benefits, allowing surgeons to choose based on resource availability and expertise.

Purpose: This study aimed to investigate the potential prognostic value of fibrinogen-to-albumin ratio (FAR) in patients with neuroblastoma (NB).

Methods: We conducted a retrospective cohort study with 257 patients with NB included as the training group, and 78 patients included as the validation group. The associations between NB and clinicopathological categorical variables based on FAR were assessed. Survival time and the corresponding survival curve were analyzed using the Kaplan-Meier survival analysis. Univariate and multivariate Cox proportional hazard regression models were utilized to identify potential prognostic factors. A prognostic nomogram was constructed. The predictive performance of the nomogram was evaluated using calibration curves.

Results: Based on the receiver operating characteristic analysis, the optimal cutoff value for FAR was found to be 0.0734. Both univariate and multivariate models demonstrated that FAR is a potential prognostic factor for overall survival in NB patients. Furthermore, the development of a nomogram based on the identified potential prognostic factors was predictive of the 3- and 5-year overall survival probabilities in both the training group and the validation group.

Conclusion: FAR, a routinely performed test known for its simplicity, objectivity, and cost-effectiveness, has emerged as a promising prognostic factor in NB. Its potential applicability in clinical practice holds great promise.