Annali italiani di chirurgia最新文献

Aim: This study aimed to identify key ultrasound (US) characteristics that differentiate complicated acute appendicitis (CAA) from non-complicated acute appendicitis (NCAA) and to develop and validate a US-based predictive model for preoperative diagnosis.

Methods: A retrospective analysis was conducted on 178 patients with surgically confirmed acute appendicitis between June 2022 and May 2025. All patients underwent a standardized preoperative US examination. Clinical and sonographic variables were compared between the CAA (n = 63) and NCAA (n = 115) groups. Least Absolute Shrinkage and Selection Operator (LASSO) regression was used for variable selection, followed by multivariable logistic regression to construct a predictive model. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).

Results: Compared to the NCAA group, the CAA group had significantly older age, longer symptom duration, higher white blood cell (WBC), and higher neutrophil percentage (NE%) (p < 0.05). Significant US-based predictors included greater appendiceal outer diameter (AOD), increased periappendiceal inflammatory fat thickness (PIFT), and higher incidences of periappendiceal fluid collection (PAFC), marginal indistinctness (MI), and altered bowel peristalsis (ABP). The final model identified eight independent predictors: age, symptom duration, WBC, NE%, PIFT, PAFC, MI, and ABP. The nomogram showed excellent discrimination (AUC = 0.890), good calibration (Hosmer-Lemeshow test, p = 0.108), and sustained performance during internal validation (AUC = 0.902). DCA confirmed high clinical utility.

Conclusions: The proposed US-based nomogram provides an accurate, non-invasive tool for preoperative differentiation of CAA from NCAA, potentially aiding in risk stratification and treatment decision-making.

Aim: This study aimed to construct a risk stratification model for prostate cancer (PCa) ultrasound imaging data and machine learning algorithms, with the goal of providing an effective tool for early diagnosis, personalized treatment, and clinical decision-making.

Methods: A total of 211 histopathologically confirmed PCa patients were retrospectively enrolled and categorized into low-risk (n = 65), intermediate-risk (n = 55), and high-risk (n = 91) groups based on prostate-specific antigen levels, Gleason scores, and clinical T stage. From ultrasound images, 135 quantitative radiomic features-including morphological, texture, and edge descriptors-were extracted using the PyRadiomics toolkit. Feature dimensionality was reduced using the Pearson correlation coefficient (PCC), followed by recursive feature elimination (RFE) with 10-fold nested cross-validation to select the most informative features. Three machine learning algorithms-support vector machine (SVM), random forest (RF), and logistic regression (LR)-were trained and evaluated. Model performance was assessed using accuracy, sensitivity, specificity, and area under the curve (AUC).

Results: The RF model achieved the best performance in both training and test cohorts, with AUCs of 0.87 and 0.86, and accuracies of 90% and 88%, respectively. DeLong's test confirmed that RF significantly outperformed SVM (p = 0.016) and LR (p = 0.004) in AUC comparison. The RF model also demonstrated robust predictive ability across risk subgroups: in the high-risk group, it achieved an AUC of 0.89, accuracy of 89%, sensitivity of 88%, and specificity of 90%; in the intermediate- and low-risk groups, AUCs were 0.86 and 0.81, respectively. Feature importance analysis revealed that wavelet-transformed Gray Level Dependence Matrix (GLDM) texture features, particularly DependenceEntropy and DependenceVariance, were the most predictive, highlighting the value of intratumoral textural heterogeneity in risk classification.

Conclusions: The RF-based ultrasound radiomics model enables accurate stratification of PCa risk, with remarkable performance in identifying high-risk patients.

Aim: This study aims to construct an intensive care unit (ICU) pre-experience pattern for patients undergoing lung cancer surgery and their family members, to provide a novel mechanism of communication between healthcare professionals and patients that may improve treatment adherence and satisfaction with hospitalisation.

Methods: Initially, an item pool was created for pre-experienced ICUs through a comprehensive literature review, prior qualitative research, and expert panel discussions, resulting in 146 items. Inputs from experts were sought through Delphi surveys to construct an ICU pre-experience pattern for patients undergoing lung cancer surgery and their family members. The Delphi study included 22 multidisciplinary experts from intensive care, nursing management, clinical medicine, and social psychology. Subsequent rounds of consultation were guided by consistency in the findings of the consultation. Two rounds of consultations were performed using 5-point Likert scales to assess importance and feasibility. Consensus criteria included a mean score of ≥3.5 and a coefficient of variation (CV) of ≤0.25.

Results: A total of 146 items, including 5 primary, 29 secondary, and 112 tertiary items, were incorporated in the final pattern. These included items structured around 5 critical time phases: '24 hours preceding ICU admission', 'Postoperative ICU admission before anaesthesia emergence', 'Postoperative ICU admission after anaesthesia emergence', 'First postoperative day/transfer day', and 'Following ICU discharge'. Key dimensions include the objectives of ICU admission, description of ICU personnel and environment, psychological preparation, clinical procedures, and post-ICU care. Two rounds of expert consultations yielded a 100% recovery rate (RR). An acceptable level of consensus was achieved, with mean importance and feasibility scores ranging from 4.41 to 5.00 in Round 2, and a CV below 0.25 for all items. The high authority coefficients (Cr) (0.84 and 0.83) confirm a trend toward higher expert consensus on the clinical relevance and practical applicability of the developed pattern.

Conclusions: This study developed an ICU pre-experience pattern for patients undergoing lung cancer surgery and their family members. This pattern provides a theoretical framework and a potential approach that may help alleviate anxiety and enhance treatment adherence.

Aim: This study aims to evaluate the predictive performance of preoperative blood lipid profiles combined with thyroid ultrasound features for postoperative nausea and vomiting (PONV) after thyroid lobectomy, and to develop a nomogram for individualized risk assessment.

Methods: This retrospective study included 269 patients who underwent thyroid lobectomy for nodular thyroid disease at the People's Hospital of Pingyang between January 2022 and December 2024. Study participants were divided into non-PONV (n = 102) and PONV (n = 167) groups. Preoperative clinical details, thyroid ultrasound parameters, and lipid profiles were compared between the two groups. Statistically significant variables (p < 0.05) from the univariate analysis were included in the multivariate logistic regression to identify independent risk predictors. A nomogram was constructed and internally validated using bootstrap resamples (1000 iterations).

Results: Multivariate analysis identified Apfel score, thyroid volume, maximum nodule diameter, presence of diffuse changes, total cholesterol (TC), high-density lipoprotein cholesterol (HDL), and low-density lipoprotein cholesterol (LDL) as independent risk predictors of PONV. The nomogram showed favorable discriminative performance with an area under the receiver operating characteristic curve of 0.804 (95% CI: 0.749-0.859) and a bias-corrected area under the curve (AUC) of 0.794 (95% CI: 0.737-0.850) after bootstrap validation. Additionally, the model demonstrated favorable calibration and superior clinical utility, as assessed using the decision curve analysis.

Conclusions: Multivariate analysis identified that preoperative blood lipid profiles and thyroid ultrasound features are independently associated with PONV. Incorporating these indicators along with established clinical risk factors into a nomogram enables accurate individualized prediction and may support targeted prophylactic interventions.

Aim: Surgical smoke generated during electrosurgery contains various toxic substances, including carbon monoxide (CO), hydrogen sulfide (H₂S), formaldehyde (HCHO), total volatile organic compounds (TVOC), and particulate matter 2.5 (PM2.5), which pose a significant health threat to both surgical staff and patients. This study investigates the effectiveness of a novel gas-liquid drainage tube in removing surgical smoke and improving the safety of the surgical environment.

Methods: A gas detector and an air quality monitor were used to measure the concentrations of CO, carbon dioxide (CO₂), PM2.5, HCHO, TVOC, and H₂S in the rat model during electrosurgery. Animals were divided into two groups (n = 3 each): an experimental group employing a novel gas-liquid drainage tube and a control group using a traditional drainage tube. Measurements were taken at various time points (1, 5, 10, 15, 30, 60, and 120 min) and fixed distances from the surgical site (0, 10, 30, 50, 100, and 150 cm). Additionally, the effectiveness of the drainage tube in maintaining surgical field clarity during the procedure was evaluated using an image subtraction algorithm.

Results: Compared to the control group, the novel gas-liquid drainage tube significantly reduced the concentrations of CO, CO₂, PM2.5, HCHO, TVOC, and H₂S in the experimental group (p < 0.05). Furthermore, the drainage tube effectively reduced hazards and cleared smoke, thus improving the clarity of the surgical field.

Conclusions: This device effectively reduces the concentration of harmful gases and particulate matter generated during electrosurgical procedures. These findings suggest that it may contribute to creating a cleaner, safer surgical environment.

Colorectal cancer, currently the third most common malignancy worldwide, can be significantly reduced through early detection and endoscopic resection of polyps. This review discusses the main classifications of colonic lesions and the most effective evidence-based technologies for their detection, characterization, and management. A practical roadmap for risk stratification and a management algorithm are proposed, based on the latest recommendations from the European and American Societies of Gastrointestinal Endoscopy. By combining clinical experience with a critical analysis of key studies from the past decade, this article provides practical tools to enhance optical diagnosis and guide therapeutic decisions, minimizing the need for surgical interventions. This review serves as an essential resource for clinicians, offering practical guidance for effective and individualized management of colorectal lesions, thereby enhancing cancer prevention and optimizing healthcare resource utilization.

Aim: Conventional femoral artery cannulation with retrograde perfusion may increase the incidence of cerebral embolism in treating Stanford type A aortic dissection (STAAD). This study aimed to compare the neuroprotective effect of combined axillary-femoral artery cannulation utilizing an antegrade-retrograde perfusion strategy with femoral artery single cannulation in STAAD surgery.

Methods: This was a two-center, retrospective cohort study including 120 patients who underwent STAAD surgery between January 2021 and January 2025. Among them, 63 patients received combined axillary-femoral artery cannulation (double arterial cannulation group, DAC group), while 57 patients underwent conventional femoral artery single cannulation (single arterial cannulation group, SAC group). Perioperative parameters, neurological outcomes, including incidences of permanent/transient neurological dysfunction (PND/TND), delirium and coma duration, modified Rankin Scale (mRS) score, and Montreal Cognitive Assessment (MoCA) score, were evaluated. Serum biomarkers of brain injury, including neuron-specific enolase (NSE) and S100 calcium-binding protein B (S100B) protein levels, as well as postoperative general complications, were also analyzed.

Results: There was no significant difference in the key perioperative time parameters between the two groups (p > 0.05). Regarding neuroprotection, the DAC group exhibited superior outcomes, with significantly lower incidences of PND and TND, and shorter coma and delirium durations (p < 0.05). The DAC group also achieved better mRS and MoCA scores at 30 and 90 days postoperatively (p < 0.001). Peak postoperative levels of NSE and S100B were significantly lower in the DAC group (p < 0.001). Multivariate linear regression analyses revealed that the DAC strategy was an independent protective factor associated with improved neurological function (mRS), enhanced cognitive performance (MoCA), lower brain injury biomarker levels (NSE and S100B), and reduced coma and delirium durations (p < 0.001). There was no significant difference in the overall incidence of postoperative general complications between the two groups (p > 0.05). However, the incidence of postoperative limb ischemia was significantly lower in the DAC group (p < 0.05).

Conclusions: Compared with conventional femoral artery single cannulation, combined axillary-femoral artery cannulation provides superior and independent cerebral protection during STAAD surgery. This approach reduces permanent and transient neurological deficits, mitigates early brain injury, enhances neurological and cognitive recovery, and lowers the incidence of postoperative limb ischemia. It holds promise as a safe and effective cerebral protective perfusion strategy in STAAD surgical management.

Aim: This study aimed to perform a rigorous comparison of perioperative and functional outcomes between the 3D laparoscopic Toupet (270° posterior partial fundoplication) vs. Nissen (360° total fundoplication) for hiatal hernia (HH) repair in gastroesophageal reflux disease (GERD) patients.

Methods: This retrospective cohort study included 103 patients with HH and GERD who underwent surgery between January 2020 and May 2024. Patients were divided into two groups based on surgical technique: the Toupet group (n = 53) and the Nissen group (n = 50). Outcomes included surgical metrics, pre/postoperative high-resolution manometry, 24-hour pH-impedance, gastroesophageal reflux disease symptom questionnaire (GERD-Q) and gastroesophageal reflux disease health-related quality of life (GERD-HRQL) scores, and complications. Multivariable regression adjusted for baseline differences.

Results: The Toupet group demonstrated significantly shorter time to first postoperative oral intake (p = 0.012) and hospital stays (p = 0.023) compared to the Nissen group. At 6 months postoperatively, both groups showed significant increases in minimum lower esophageal sphincter (LES) resting pressure and respiratory mean values, along with decreases in reflux-related parameters and ineffective swallowing ratio (p < 0.001). Intergroup comparison revealed that the Toupet group had lower minimum LES resting pressure, respiratory mean LES pressure, and ineffective swallowing ratio, but higher 24-hour reflux episodes, percentage acid exposure time, and mean DeMeester scores than the Nissen group (p < 0.001). At 1 year postoperatively, both groups exhibited significant improvements in GERD-Q and GERD-HRQL scores (p < 0.001), with no intergroup differences observed (p > 0.05). The Toupet group had significantly lower overall complication rates (p = 0.031) and a lower incidence of dysphagia than the Nissen group (p = 0.019). Multivariable regression analyses confirmed that the Toupet procedure was an independent predictor for shorter time to first postoperative oral intake (p = 0.015), shorter hospital stays (p = 0.017), and lower overall complication rates (p = 0.020).

Conclusions: In summary, when performed with 3D laparoscopy, Toupet and Nissen fundoplication show distinct and meaningful clinical profiles. Nissen fundoplication is the preferred option for achieving maximal anti-reflux efficacy in patients with normal esophageal motility, whereas Toupet fundoplication is preferred for minimizing postoperative dysphagia and enhancing rapid recovery, particularly in cases with impaired or borderline motility.

Aim: This study compared the standard loop electrosurgical excision procedure (LEEP) with an enhanced technique incorporating intraoperative ultrasound guidance and individualized marking for high-risk human papillomavirus (HPV)-associated cervical lesions. The primary focus was on their differential impact on stress injuries incurred during the perioperative period. Furthermore, secondary outcomes included surgical precision, modulation of local immune microenvironment, and clinical endpoints, such as complications, HPV clearance, and recurrence.

Methods: This retrospective cohort study included high-risk HPV-induced cervical intraepithelial neoplasia (CIN) II-III patients (n = 122) who were treated between January 2022 and March 2024. Patients were divided into two groups: an observation group (n = 58), which received intraoperative ultrasound-guided LEEP with individualized marking, and a control group (n = 64), which received conventional LEEP. The outcome measures evaluated were (1) perioperative stress hormones and inflammatory markers, (2) surgical parameters (intraoperative blood loss, margin positivity, and cervical canal adhesion rates), (3) postoperative complications (infection, bleeding, and cervical canal stenosis), and (4) HPV clearance and recurrence rates.

Results: Postoperative stress and the levels of inflammatory markers were significantly reduced in the observation group compared to the conventional group (p < 0.05). However, the observation group demonstrated significant improvement, including reduced intraoperative bleeding, fewer positive margins, and increased HPV clearance rates (p < 0.05). Regarding postoperative complications, the observation group exhibited a significant reduction in acute infection and Cervical canal adhesion rates compared with the control group (p < 0.05). Finally, postoperative Visual Analogue Scale (VAS) and Hospital Anxiety and Depression Scale-anxiety (HADS-A) scores were lower in the observation group than in the control group (p < 0.05).

Conclusions: The use of intraoperative ultrasound-guided LEEP with individualized marking is associated with attenuated perioperative stress responses and a more preserved immune microenvironment. This, in turn, improves HPV clearance rates and diminishes postoperative complication risks.