Annals of Surgical Treatment and Research最新文献

Purpose: Ischemia and reperfusion (I/R) can cause significant functional impairments in cells and tissues depending on the duration of ischemia. To date, many alternative treatments have been utilized to address this damage. We aimed to research the protective efficacy of taxifolin (Tax), a natural antioxidant, against liver I/R injury in terms of biochemical, histopathologic, and immunohistochemical parameters.

Methods: The rats utilized in our study were randomly chosen and divided into four equal groups. Group 1 (n = 7), sham group received 1 mL saline orally; group 2 (n = 7), Tax group; Group 3 (n = 7), I/R group; group 4 (n = 7), Tax + I/R group as designated. The entire study was performed under general anesthesia with protection of animal welfare. Malondialdehyde (MDA) and interleukin-6 (IL-6) were analyzed from blood samples. Proapoptotic (B-cell lymphoma 2 [Bcl-2]-associated X protein [Bax]) and antiapoptotic (Bcl-2) amendments in cells were reviewed.

Results: MDA grades were lower in the Tax+I/R group compared to the I/R group. Likewise, IL-6 grades were lower in the Tax + I/R group, histologic examinations showed that Bax proteins were less expressed in the Tax + IR group, and Bcl-2 proteins were intensely expressed in the Tax group.

Conclusion: Taxifolin applied before liver I/R demonstrated favorable effects on inflammation, oxidative stress, and proapoptotic changes.

Purpose: Papillary thyroid carcinoma (PTC) is the most prevalent endocrine malignancy, and the global incidence has been steadily increasing over the years. Although PTC generally exhibits favorable prognosis, a subset of patients experiences aggressive progression and increased mortality. Current prognostic approaches, reliant on clinic-pathological factors, have limitations, underscoring the need for innovative biomarkers. MicroRNAs (miRs) have emerged as promising candidates due to their roles in cellular processes and cancer progression. Among them, the present study investigated the role of miR-18b in PTC, exploring its potential as a prognostic biomarker.

Methods: Utilizing PTC cell lines (TPC1, K1), we examined miR-18b expression and its regulatory effects. The present study used web-based tools to predict the target of miR-18b and to investigate the prognostic impact of miR-18b on thyroid cancer.

Results: Through a series of cell proliferation, invasion assay, gap closure, and colony formation assays, we identified that miR-18b suppresses PTC aggressiveness. Dual-luciferase assays confirmed that miR-18b directly targeted the 3'-untranslated region of CDK2 and suppressed the expression of CDK2. In addition, miR-18b significantly attenuates the interaction between cyclin A or cyclin E with cyclin-dependent kinase 2 according to co-immunoprecipitation assay. Western blotting of cell cycle proteins and flow cytometry revealed miR-18b-induced cell cycle arrest and apoptosis.

Conclusion: Our findings underscore miR-18b's potential as a biomarker for predicting the prognosis of PTC and suggest that it functions through direct regulation of CDK2, influencing cell cycle dynamics. This study not only enhances our understanding of miR-18b in thyroid cancer but also highlights its potential in refining prognostic evaluations and therapeutic strategies.

Purpose: Laparoscopic cholecystectomy is the standard surgical procedure for benign gallbladder disease. However, the analysis of risk factors for complications, including serious complications such as bile duct injury (BDI), has been largely overlooked. This study aimed to collect standardized prospective data from multiple centers and to develop a predictive model for laparoscopic cholecystectomy complications.

Methods: This study included 2,514 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease at 18 academic institutes in Korea. Fifty-six preoperative and intraoperative variables were analyzed as risk factors for adverse postoperative outcomes, including overall complications. A surgical risk calculator was developed using a multivariate logistic regression analysis.

Results: Of the 2,514 patients, 62 (2.5%) experienced surgery-related complications, including BDI in 17 (0.7%). Various factors such as sex, age, smoking, emergency operation, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, preoperative endoscopic common bile duct stone removal, therapeutic antibiotics usage, American Society of Anesthesiologists physical status classification, and acute cholecystitis were found to be associated with postoperative adverse outcomes. Based on these variables, a surgical risk calculator was developed for overall complications, systemic complications, surgery-related complications, BDI, and delayed discharge, with the area under the curve values of 0.733, 0.775, 0.697, 0.857, and 0.833, respectively.

Conclusion: This study developed a surgical risk calculator using standardized variables from a multi-institutional prospective database to predict adverse outcomes after laparoscopic cholecystectomy. This tool can be used for risk stratification prior to cholecystectomy.

The Hemodialysis Reliable Outflow (HeRO) graft (Merit Medical Systems, Inc.), first approved by the U.S. Food and Drug Administration in 2008, provides an alternative vascular access option for patients with end-stage kidney disease who have exhausted upper extremity arteriovenous (AV) access. The first HeRO graft procedure was performed in South Korea in December 2023. Herein, we describe HeRO graft application in 2 complex vascular access scenarios: (1) establishing a new access pathway for a catheter-dependent patient with bilateral central venous occlusions and (2) bypassing recurrent central venous stenotic lesions to restore the function of a mature AV fistula. Given the potential risks, including thrombosis or infection, careful preoperative planning and meticulous patient selection are essential for optimizing HeRO graft outcomes. Further research is necessary to evaluate the long-term efficacy and complication profile of this technique.

Purpose: Robotic adrenalectomy was developed to address the limitations of laparoscopic adrenalectomy and enhance the visualization, dexterity, and control of surgeons performing this beneficial minimally invasive technique. This study compared the clinical and perioperative outcomes of lateral transperitoneal adrenalectomy using da Vinci SP and Xi robotic systems (Intuitive Surgical).

Methods: We retrospectively analyzed 84 patients who underwent robotic adrenalectomies at a single institution between January 2019 and July 2024. Sixty-two and 22 patients were treated with da Vinci Xi and SP systems, respectively.

Results: No significant differences in patient demographics, tumor size, or postoperative hospital stay between the 2 groups were observed. The SP system demonstrated significantly shorter operative times for right-sided adrenalectomy (81.0 ± 17.1 minutes vs. 113.3 ± 26.2 minutes, P < 0.001), whereas no significant differences were observed in overall operative time (104.9 ± 28.2 minutes for Xi vs. 93.5 ± 23.2 minutes for SP, P = 0.094) or left adrenalectomy (99.9 ± 28.4 minutes for Xi vs. 104.0 ± 23.0 minutes for SP, P = 0.253).

Conclusion: The da Vinci Xi and SP systems are both effective for robotic adrenalectomy, with the SP system showing particular advantages in right-sided procedures.

Purpose: Chemo-port insertion is performed by a radiologist or surgeon in an interventional radiology (IR) suite or an operating room (OR). The complication rate is approximately 3%-4%. However, there is still a lack of data for comparison when it is performed in different conditions such as IR suite and OR.

Methods: This study is for the safety of adult cancer patients after chemo-port implantation by comparing postoperative complication types and rates in different places. Among 375 patients who underwent chemo-port implantation, 203 patients underwent chemo-port implantation by radiologists in an IR suite, and 172 patients underwent the procedure by general surgeons in an OR. In both groups, early and late mortality were investigated. Early and late complication types and rates were also compared, and our study results were compared to the literature.

Results: Patients' characteristics showed no differences. Mortality after the procedure was 39 in OR vs. 72 in IR (P < 0.01). Early mortality at 7 days was 1 in IR, no patient in OR (P = 0.36). Catheter problems did not show a statistical difference in these 2 groups (1.16% vs. 0.49%, P = 0.47). Venous thrombosis happened in 4 and 7 (2.33% vs. 3.45%, P = 0.13), and the central line bloodstream infection was in 5 patients and 6 patients (2.91% vs.. 2.96%, P = 0.98), respectively. Skin problems were 6 and 7 (3.49% vs. 3.45%, P = 0.98). Port site infection happened in 6 patients in each group (3.49% vs. 2.96%, P = 0.77).

Conclusion: Chemo-port implantation can be performed in OR or IR without difference in complication rates.

Purpose: This study assesses preoperative prognostic factors in intrahepatic cholangiocarcinoma (ICC) to improve risk assessment and inform clinical decisions, focusing on the role of lymph node dissection (LND).

Methods: We conducted a retrospective analysis of 234 patients who underwent surgery for ICC at a single institution between 2010 and 2019. Prognostic factors affecting overall survival (OS) were identified through univariate and multivariable logistic regression analyses. Patients were categorized into high-, intermediate-, and low-risk groups based on the number of adverse prognostic factors. Survival curves were compared between the groups that underwent LND and those that did not within each risk category.

Results: Of the 234 patients, 138 (59.0%) underwent LND, and 96 (41.0%) did not (non-LND). Significant prognostic factors included preoperative elevation of CEA (>5 ng/mL), CA 19-9 (>37 U/mL), tumor multiplicity, tumor size >5 cm, and extrahepatic invasion. These factors were associated with adverse OS (hazard ratio ranging from 1.69 to 2.54). High-risk patients had significantly lower median OS compared to intermediate and low-risk groups in both LND and non-LND cohorts, but no significant difference in median OS between LND and non-LND groups within each risk category was observed.

Conclusion: Preoperative prognostic factors such as CEA, CA 19-9, tumor size, and multiplicity are vital for assessing patient risk in ICC. These factors guide clinical decision-making and emphasize the need for targeted treatment strategies, including the consideration of LND, particularly in high-risk patients. The study underscores the importance of these prognostic indicators in enhancing treatment outcomes.

Purpose: This study aimed to compare clinical outcomes between thoracoscopic surgery (TR) and open surgery (OR) for esophageal atresia with distal tracheoesophageal fistula (EA with distal TEF) and to evaluate the feasibility of TR.

Methods: We retrospectively analyzed the clinical data of 42 patients who underwent primary surgery for EA with distal TEF from January 2012 to December 2020. We compared the OR and TR groups based on patient characteristics, intraoperative outcomes, and early and late postoperative outcomes.

Results: The TR group had longer operation times and a higher risk for intraoperative hypoxic events. Anastomosis leakage and stricture tended to occur more frequently in the TR group, although not statistically significant. The TR group required a significantly higher number of esophageal balloon dilatations (P = 0.006).

Conclusion: Successful TR for EA with distal TEF requires advanced anesthesia and efforts to overcome the learning curve of surgical skill with limited thoracoscopic instruments for neonates. Despite challenges, TR is considered a feasible method for EA with distal TEF patients when performed by experienced pediatric surgeons with appropriate anesthesia support.

Purpose: Total mesorectal excision (TME) without lateral pelvic lymph node (LPN) dissection (LPND) is feasible in patients with mid/low rectal cancer showing a reduction in LPN size to ≤5 mm following neoadjuvant chemoradiotherapy (nCRT). We aimed to evaluate the clinical outcomes of selective LPNDs based on these criteria.

Methods: Patients with mid/low rectal cancer and LPNs >5 mm before nCRT were included and classified based on nCRT response (post-nCRT LPN size ≤5 mm [responsive] vs. >5 mm [persistent]) and surgical procedure (TME alone vs. TME + LPND). In the responsive group, LPND was selectively performed only if morphologic predictors of LPN metastasis were present. Clinical outcomes were analyzed across subgroups.

Results: Of 122 patients, 82 were in the responsive group. Within this group, 61 underwent TME alone and 21 underwent TME + LPND. No locoregional recurrence was observed in either subgroup of the responsive group, with similar systemic metastasis rates (13.1% vs. 14.3%, P > 0.99). The TME alone subgroup showed significantly smaller post-nCRT LPN sizes (1.7 ± 2.1 mm vs. 3.9 ± 1.8 mm, P < 0.001) and lower ycN positivity rates (31.1% vs. 71.4%, P = 0.001).

Conclusion: Selective LPND based on post-nCRT LPN size ≤5 mm and the absence of morphologic predictors of metastasis may serve as a feasible option for managing mid/low rectal cancer with enlarged LPNs, thereby optimizing local control and reducing unnecessary surgeries.

Purpose: Pancreas transplantation (PT) is a definitive treatment for diabetes mellitus (DM), restoring endogenous insulin secretion and improving glycemic control. Despite its efficacy, PT is less common in South Korea compared to Western nations. This study aims to report the clinical outcomes of PT over 2 decades at a single center, focusing on surgical techniques, complications, and graft survival.

Methods: A retrospective analysis of 69 PT recipients at Seoul National University Hospital between January 2002 and December 2023 was conducted. Data on recipient and donor demographics, surgical details, immunosuppressive regimens, and graft outcomes were collected. Graft survival was evaluated using Kaplan-Meier analysis, with subgroup comparisons using the log-rank test. Graft failure was defined as graft removal, PT re-registration, insulin dependence exceeding 0.5 units/kg/day for more than 90 days, or patient death.

Results: Among the 69 recipients, 50 (72.5%) had type 1 DM, and 18 (26.1%) had type 2 DM. Simultaneous pancreas-kidney (SPK) transplantations comprised 84.1% (n = 58), and pancreas-after-kidney (PAK) transplantations accounted for 10.1%. The 1-year and 5-year death-censored pancreas graft survival rates were 92.7% and 89.6%, respectively, with no significant difference between SPK and PAK (P = 0.330). Graft failure occurred in 10 patients, primarily due to pancreatitis and rejection. Donor-related factors, particularly anoxic brain injury, were significantly associated with lower graft survival (P = 0.045).

Conclusion: PT outcomes in this cohort align with international standards, emphasizing the importance of donor selection and tailored immunosuppression. Expanding PT indications to include selective type 2 DM patients could benefit South Korea's PT programs with adequate resource allocation.