Annali italiani di chirurgia最新文献

Aim: To explore the predictive performance of magnetic resonance imaging (MRI) combined with serum carbohydrate antigen 19-9 (CA19-9) for the efficacy of transarterial chemoembolization (TACE) treatment in patients with primary liver cancer.

Methods: In this retrospective study, a total of 174 patients with primary liver cancer who underwent TACE treatment at Hangzhou Xixi Hospital between January 2022 and January 2025 were selected as the study subjects. The patients were divided into an effective group and an ineffective group according to the treatment efficacy at 3 months postoperatively, and the clinical data of the two groups were compared. Multifactorial logistic regression analysis was conducted to identify factors affecting patient efficacy, and a predictive model was constructed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of MRI combined with serum CA19-9 and the model.

Results: Among the 174 patients, 50 cases achieved complete remission (CR) (28.74%), 29 cases attained partial remission (PR) (16.67%), 58 cases had stable disease (SD) (33.33%), and 37 cases experienced disease progression (PD) (21.26%). The results of multifactorial logistic regression analysis showed that low tumor differentiation, continuous multi-nodular tumor margins, incomplete tumor capsule, higher ALT levels, and high CA19-9 were risk factors for compromised efficacy of TACE treatment in patients with primary liver cancer (p < 0.05), while tumor tissue necrosis was a protective factor (p = 0.001). The area under the curves (AUCs) of MRI, CA19-9, MRI combined with CA19-9, and the model were 0.883, 0.772, 0.904, and 0.958, respectively; the sensitivities were 79.84%, 70.18%, 86.95%, and 89.96%, respectively; and the specificities were 82.69%, 67.88%, 84.02%, and 91.05%, respectively.

Conclusions: MRI demonstrates promising utility in predicting the efficacy of TACE treatment in patients with primary liver cancer, with its predictive performance enhanced by the combination with serum CA19-9.

Aim: Lentigo maligna (LM) is the commonest melanoma in situ variant and frequently arises on chronically sun-exposed facial skin, where subclinical radial spread and background actinic melanocytic atypia complicate both surgical clearance and histological interpretation. The aim of this study is to appraise contemporary surgical options for LM and their oncological outcomes, focusing on conventional wide local excision (WLE), Mohs micrographic surgery (MMS), Paraffin embedded margin-controlled ("slow Mohs") techniques and staged excision (SE).

Methods: A comprehensive search of PubMed and Web of Science (January 2015-January 2025) retrieved retrospective cohorts, systematic reviews and meta-analyses that detailed technique, margin policy and outcomes for LM or lentigo maligna melanoma (LMM). Forty-six studies met prespecified criteria and were synthesised qualitatively.

Results: WLE remains the most widely performed procedure but showed the greatest heterogeneity in practice. Initial clinical margins of 5 mm often required histological extensions to 7-12 mm to secure clearance; under WLE, residual disease rates reached 16.7% and recurrences ranged from 5.7% to 27.3%. In contrast, MMS, especially when using immunohistochemistry, achieved recurrence rates between 0-3% with ≥5 years of follow-up. Slow Mohs and staged excision provided intermediate recurrence control (0-5.7%) while preserving tissue but were limited by procedural variability and delayed reconstruction. Although one retrospective study reported improved disease-specific survival with MMS, most studies showed no significant differences in melanoma-specific or overall survival across surgical techniques. Limited long-term follow-up and inconsistent statistical reporting (e.g., confidence intervals) were common.

Conclusions: Margin-controlled approaches (MMS, slow Mohs, SE) afford superior local control to WLE and are preferable for lesions on cosmetically or functionally critical sites. Because survival appears equivalent, the choice of technique should be guided by anatomical location, lesion size, available expertise, patient characteristics and preferences as well as cost-effectiveness and available resources. Well-designed prospective trials with standardised protocols are essential to refine margin recommendations and compare long-term outcomes.

Aim: To construct and validate a risk prediction model for intraoperatively acquired pressure injury (IAPI) in total knee arthroplasty (TKA), thereby improving the accuracy of early diagnosis and intervention.

Methods: This retrospective study included 546 patients who underwent elective total knee arthroplasty at Chengdu 363 Hospital Affiliated to Southwest Medical University and Chengfei Hospital. According to predefined inclusion and exclusion criteria, 278 cases from Chengdu 363 Hospital Affiliated to Southwest Medical University between January 2022 and December 2023 were used as the training set, while 118 cases from 2024 served as the internal validation set; 150 cases from Chengfei Hospital in 2024 were used as the external validation set. Feature variables were screened using multivariable logistic regression and Lasso regression analyses. Sensitivity, specificity, accuracy, F1-score (F1), and area under the curve (AUC) were used to evaluate discriminative performance. External validation was performed using AUC to evaluate generalizability. The optimal model was further interpreted by the Shapley additive explanation (SHAP) method to identify key risk factors.

Results: Among the four machine learning algorithms tested, the gradient boosting decision tree (GBDT) model demonstrated the best discriminative performance (AUC 0.867, sensitivity 0.725, specificity 0.836, accuracy 0.788, and F1 value 0.747). The five most influential variables associated with IAPI risk were body mass index (BMI), Braden score, age, American Society of Anesthesiologists (ASA) classification, and surgical duration.

Conclusions: The GBDT-based prediction model, combined with the SHAP interpretation, effectively identifies risk factors for intraoperative IAPI in TKA. This model provides strong support for early clinical intervention and contributes to improving the outcomes of IAPI care.

Aim: Transanal opening of the intersphincteric space (TROPIS) is a minimally invasive surgical treatment for anal fistula that not only eliminates the source of infection but also protects anal function to the greatest extent. This systematic review and meta-analysis aims to evaluate the efficacy of TROPIS in the treatment of anal fistula.

Methods: We searched PubMed, EMBASE, Web of Science, and the Cochrane Library for information on TROPIS surgery for anal fistulas performed between the inception of each database and 1 November 2024. We used the single-arm studies for analysis, with a total of 918 subjects and a follow-up period ranging from 3 months to 36 months. The analysis focused on the cure rate of different types of anal fistula, postoperative bleeding, infection, and adverse reactions.

Results: This systematic review included six single-arm studies involving a total of 918 patients with anal fistula who underwent TROPIS surgery, with follow-up durations ranging from 3 to 36 months. Among the included studies, all were classified as high quality (score ≥7). This study demonstrated an 80% success rate for the initial operation (95% confidence interval (CI): 0.77-0.83), as well as an 80% success rate specifically for high fistulas (95% CI: 0.77-0.83). The success rate for second operations was 73% (95% CI: 0.47-0.99). For patients with high fistulas who underwent a second procedure, the success rate was 78% (95% CI: 0.40-1.00). The cure rate for anal fistulas accompanied by abscesses was 88%, while the cure rate for anal fistulas without abscesses is the same. For horseshoe fistulas, the cure rate was 87%, whereas it was 88% for non-horseshoe fistulas. The overall cure rate in this study was 88% (95% CI: 0.86-0.90). The rate of intraoperative bleeding was 3%, the postoperative infection rate was 5%, and the overall incidence of adverse reactions was 3%.

Conclusions: This study demonstrates that TROPIS holds significant potential in the treatment of anal fistulas, particularly for high fistulas, fistulas with associated abscesses, and horseshoe-shaped fistulas, whilst exhibiting a relatively low incidence of incontinence.

Aim: Patients undergoing scar revision surgery have high expectations for both aesthetic restoration and functional recovery, with postoperative pain management and scar prevention being key factors that influence the quality of rehabilitation. This study, through a retrospective analysis, examined the impact of comprehensive postoperative incisional analgesia and scar-prevention intervention on rehabilitation outcomes in patients undergoing scar revision surgery, aiming to provide evidence for optimizing clinical postoperative management strategies.

Methods: A retrospective analysis was conducted using the clinical data of 170 patients who underwent scar revision surgery in our hospital between March 2022 and August 2024. Based on the intervention approach, patients were assigned to a comprehensive intervention group (n = 90) and a control group (n = 80). Both groups received standardized optimal wound care, including layered suturing of incisions and routine dressing changes every 3 days, until suture removal. The comprehensive intervention group received multimodal analgesia combined with a comprehensive scar-management protocol, while the control group received routine analgesia combined with a basic scar-management plan. Visual Analog Scale (VAS) scores, Vancouver Scar Scale (VSS) scores, and complication rates were compared between the two groups.

Results: Preoperative baseline characteristics showed no significant differences between the two groups (p > 0.05). Postoperative VAS scores in the comprehensive intervention group were significantly lower than those in the control group (p < 0.001). Furthermore, the total VSS score in the comprehensive intervention group was significantly superior to that in the control group (p < 0.001). Regarding complications, the overall complication rate in the comprehensive intervention group (25.56%) was significantly lower than in the control group (51.25%) (p < 0.01). Subgroup analyses based on scar type (hypertrophic vs. keloid) demonstrated consistent benefits of the intervention, with no significant interaction observed (p > 0.05).

Conclusions: Comprehensive postoperative analgesia and scar-prevention intervention can effectively alleviate postoperative pain, improve scar appearance, and enhance rehabilitation among patients undergoing scar revision surgery, indicating that such an approach is suitable for clinical application.

Aim: This study aimed to compare the efficacy and safety of ultrasound-guided percutaneous balloon dilatational tracheotomy (US-PDT) versus surgical tracheotomy (ST) in patients with acute respiratory failure (ARF).

Methods: In this retrospective cohort study, 278 patients with ARF were enrolled from January 2022 to January 2025. These patients were divided into the US-PDT group (n = 135) and the ST group (n = 143) based on the surgical method used. Perioperative indicators, procedural success rates, inflammatory markers, hospitalization outcomes, and complications were systematically compared between the two groups.

Results: The US-PDT group demonstrated superior outcomes across all measures. It was associated with a significantly shorter procedure time, smaller incision length, reduced intraoperative blood loss, and shorter duration of mechanical ventilation (all p < 0.001). The US-PDT group also showed a higher single-attempt procedural success rate, alongside a lower accidental extubation rate (all p < 0.001). Postoperative inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and procalcitonin [PCT]) were significantly lower in the US-PDT group (p < 0.001). Furthermore, the US-PDT group experienced reduced ventilator-associated pneumonia (VAP) incidence, higher weaning success, shorter intensive care unit (ICU) and hospital stays, and lower ICU and overall mortality (all p < 0.05). Complication rates were also significantly lower in the US-PDT group (p < 0.05).

Conclusions: US-PDT is a more efficient, safer, and less invasive alternative to ST for ARF patients, resulting in better clinical outcomes, reduced inflammation, fewer complications, and improved survival rates.