Annali italiani di chirurgia最新文献

Aim: Goitre is a multifactorial disease whose development is influenced by both genetic and environmental factors. The literature presents no univocal definition of retrosternal goitre. There are more than ten different definitions, making actual classification non-homogeneous. There is no clear consensus concerning the proportion of the gland that must be located in a retrosternal position, nor the depth to which it must descend into the thoracic cavity to be classified as a retrosternal goitre. The therapeutic choice depends on the size of the goitre, the symptomatology, the patient's age, and other patient characteristics. A multidisciplinary evaluation is essential to choosing the best therapeutic approach. Most retrosternal goitres can be safely resected through a cervical approach; however, up to 2% of cases may require a combined cervicothoracic approach. The purpose of this study is to analyze the different surgical approaches used in cases of cervico-mediastinal goitre with real sinking into the thorax, which required a joint surgical procedure with surgeons from the thoracic surgery unit.

Case presentation: From June 2022 to February 2024, 449 patients underwent surgery for thyroid disease at the general surgery unit of the University Hospital of Parma. Of these patients, we analysed the cases of cervico-mediastinal goitre with real sinking into the thorax, which required a joint surgical procedure with colleagues from the thoracic surgery unit due to the goitre's size and location. We identified a series of 5 cases of thoracic goitre, for an incidence rate of 1.1% of the treated patients. In all 5 cases, there was preoperative tracheal compression or dislocation. Of our cases, we found that 2 patients were treated with Kocher cervicotomy, 2 were treated with cervicotomy associated with thoracoscopy (in 1 case, a concomitant mini-thoracotomy at the IV intercostal space was performed), and 1 was treated with cervicotomy associated with manubriotomy. In 2 cases, total thyroidectomy was performed; in 2 cases, two-stage thyroidectomy was performed; and in 1 case, left lobectomy was performed.

Results: Although thoracic goitre is a low-incidence disease, the risks and complications are significantly higher than those of cervical thyroidectomy. Preoperative imaging enables the evaluation of morphology, extension, relationships, and vascularisation, which facilitates preoperative multidisciplinary planning of surgical procedures. Advances in surgical techniques reduce procedure invasiveness by using minimally invasive techniques, which in turn reduce the impact of surgical access, perioperative complications, hospitalisation times, and postoperative recovery.

Conclusions: In our experience, a multidisciplinary approach-in particular, collaboration with thoracic surgeons-is fundamental to improving surgical outcomes.

Aim: To evaluate the clinical efficacy and functional outcomes of autologous tendon grafting in reconstructing Rockwood type III-V acromioclavicular (AC) joint dislocations, and to compare its performance with conventional titanium fixation.

Methods: A total of 276 patients who underwent AC joint reconstruction between January 2019 and March 2024 were retrospectively analyzed. Following propensity score matching (PSM), 87 patients were included in the autologous tendon and titanium fixation groups. Primary outcome measures comprised radiographic parameters (acromioclavicular distance [ACD], coracoclavicular distance [CCD], magnetic resonance imaging [MRI] signal intensity), functional scores (Constant-Murley, University of California at Los Angeles [UCLA] shoulder score, visual analog scale [VAS]), biomechanical indices (horizontal motion displacement [HMD], range of motion [ROM] loss ratio, CCD maintenance rate), and complication rates. Prognostic factors were identified using Cox proportional hazards and logistic regression models. An extreme gradient boosting (XGBoost)-based machine learning model was constructed to predict postoperative functional recovery.

Results: After matching, no significant differences in baseline characteristics were observed between groups (n = 87 each). Compared with the titanium group, autologous tendon grafting achieved significantly superior joint stability (ACD, CCD, HMD, ROM loss) and radiological outcomes (tendon signal intensity, bone remodeling score) (all p < 0.01). It was also associated with a lower incidence of redislocation and implant-related failures (p < 0.05). Cox regression identified four independent prognostic factors, including surgical technique, Rockwood classification, preoperative CCD, and ROM limitation. A multivariable risk scoring system demonstrated high predictive accuracy for recurrence at 12 months (area under the curve [AUC] = 0.91). Logistic regression revealed that titanium fixation, Rockwood type V, older age, and impaired bone healing capacity were significant risk factors for complications. The XGBoost model highlighted surgical technique and tissue quality as key predictors of functional recovery, though its external generalizability warrants further validation.

Conclusions: Compared to conventional titanium-based fixation, autologous tendon graft reconstruction yields superior joint stability, improved radiographic outcomes, and better functional scores within 12 months postoperatively, suggesting more favorable early clinical efficacy and biomechanical restoration.

Aim: The optimal surgical strategy for clinical stage IA non-small cell lung cancer (NSCLC) remains under active investigation. This study aimed to compare the perioperative outcomes, functional preservation, and short-term oncologic results between individualized segmentectomy and standard lobectomy.

Methods: This retrospective cohort study included 205 patients with histologically confirmed clinical stage IA (T1a-cN0M0) NSCLC who underwent surgery at Changzhou Cancer Hospital between January 2017 and June 2023. According to the type of surgical procedure, patients were classified into the individualized segmentectomy group or the standard lobectomy group. Perioperative variables, postoperative complications (graded by Clavien-Dindo classification), pulmonary function recovery (forced expiratory volume in one second (FEV1), diffusing capacity of the lung for carbon monoxide (DLCO)), pain scores (visual analog scale (VAS)), quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30)), and 2-year recurrence rates were analyzed between these two groups.

Results: A total of 205 NSCLC patients were analyzed in this study (segmentectomy: n = 101; lobectomy: n = 104). Compared with the lobectomy group, the segmentectomy group showed significantly reduced intraoperative blood loss, lower drainage volume, earlier chest tube removal, and a shorter length of hospital stay (p < 0.05). Compared with the lobectomy group, the segmentectomy group had significantly lower early postoperative pain scores and significantly higher quality of life scores (p < 0.05). Pulmonary function was better preserved in the segmentectomy group at both 1 and 3 months postoperatively (p < 0.05). However, no significant difference was observed in the 2-year tumor recurrence rate between the two study groups (p > 0.05).

Conclusions: Individualized segmentectomy offers perioperative and functional advantages over standard lobectomy in patients with early-stage NSCLC, without compromising short-term oncologic safety. These findings support its application as a lung parenchyma-sparing surgical option in appropriately selected patients.

Aim: This study evaluates the impact of a responsibility system management model in patients undergoing internal fixation for pelvic fractures, by examining the incidence of deep vein thrombosis (DVT) and postoperative pelvic functional recovery.

Methods: This retrospective observational study included 145 patients who underwent internal fixation for pelvic fractures at Ganzhou People's Hospital between January 2022 and October 2024. Based on the nursing model, patients were categorized into a responsibility care group (n = 70), which received responsibility system management nursing care and a conventional care group (n = 75), which was managed through conventional postoperative care. The incidence of postoperative lower extremity DVT was compared between the two groups. Furthermore, pelvic function was assessed using the Majeed Pelvic Score and pain levels were evaluated using the Visual Analogue Scale (VAS). Additional parameters assessed were postoperative recovery, compliance with mechanical prophylaxis, and nursing satisfaction.

Results: The responsibility system management care group demonstrated a significantly lower incidence of postoperative lower extremity DVT compared to the conventional care group (p < 0.05). Furthermore, the responsibility care group had significantly higher postoperative Majeed functional scores, lower VAS pain scores (p < 0.05), better overall recovery, longer duration of mechanical prophylaxis use, and higher nursing satisfaction (p < 0.05).

Conclusions: The responsibility system management nursing model was significantly associated with a lower risk of early DVT and better short-term pelvic functional recovery during hospitalization. This model represents a promising postoperative management strategy; however, its long-term efficacy and generalizability require further validation through multicenter prospective studies with extended follow-up.

Aim: Intrahepatic bile duct stones (IHBDS) are characterized by a high postoperative recurrence rate. Their pathophysiological core lies in a vicious cycle of bile stasis, infection, and inflammation. Inflammatory responses play a crucial role in the onset, progression, and recurrence of IHBDS. This study aimed to evaluate the predictive performance of the preoperative systemic inflammation response index (SIRI) for postoperative recurrence in patients with IHBDS.

Methods: This retrospective study analyzed 152 patients with IHBDS who underwent surgical resection between January 2018 and December 2024. Data, including demographic characteristics, comorbidities, and preoperative laboratory parameters, were collected. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values for the systemic immune-inflammation index (SII), SIRI, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR). Furthermore, multivariate logistic regression analysis was performed to identify independent risk factors for postoperative recurrence.

Results: ROC analysis demonstrated that SIRI had superior predictive performance compared with SII, NLR, MLR, and PLR, with an area under the curve (AUC) of 0.756 (95% confidence interval [CI]: 0.671-0.842). Multivariate analysis identified prior IHBDS-related surgical history (odds ratio [OR] = 3.06, 95% CI: 1.28-7.34, p = 0.012), preoperative SIRI (OR = 1.81, 95% CI: 1.21-2.72, p = 0.004), and total bilirubin level (OR = 1.07, 95% CI: 1.02-1.13, p = 0.011) as independent risk factors for postoperative recurrence.

Conclusions: Preoperative SIRI is a novel, independent, and readily detectable biomarker for predicting postoperative recurrence in patients with IHBDS. When combined with a history of prior biliary surgery and total bilirubin levels, SIRI can aid in risk stratification and guide surgical planning and postoperative management.

Aim: Distal radius fractures (DRFs) are among the most common traumatic injuries. Reduction of dorsoulnar fragments combined with volar locking plate fixation yields satisfactory outcomes. However, conventional fluoroscopy-guided techniques present inherent limitations in accuracy. This study aimed to evaluate the feasibility and efficacy of ultrasound-guided reduction of dorsoulnar fragment (DUF) combined with volar locking plate fixation for DRFs.

Methods: This retrospective study included 116 patients with DRFs who underwent reduction of dorsoulnar fragments combined with volar locking plate fixation at our hospital between January 2022 and January 2024. Patients were allocated into two groups based on the intraoperative guidance technique: the observation group (n = 54, ultrasound-guided) and the control group (n = 62, X-ray-guided). Surgical indicators, healing progress, and outcome measures were assessed, including wrist function (Gartland-Werley score), range of motion (dorsiflexion, volar flexion, supination, pronation), radiological parameters (volar tilt, radial inclination, radial height), Visual Analog Scale (VAS) score, Modified Mayo Wrist Score (MMWS), grip strength, and complications.

Results: Baseline characteristics and all preoperative outcome metrics (Gartland-Werley score, range of motion, radiological parameters, VAS score, MMWS, grip strength) showed no significant differences between the two groups (p > 0.05). The observation group demonstrated significantly shorter operation time, less intraoperative blood loss, and reduced hospital stay compared to the control group (p < 0.05). No significant difference in fracture healing time was observed (p > 0.05). Postoperatively, both groups exhibited significant reductions in Gartland-Werley scores (p < 0.001), with lower scores in the observation group (p < 0.001). Dorsiflexion, volar flexion, pronation, and supination angles significantly improved in both groups (p < 0.001); the observation group demonstrated larger dorsiflexion, pronation and supination angles (p < 0.001), but no intergroup difference was observed in volar flexion (p > 0.05). The radiological outcomes improved significantly in both groups postoperatively (p < 0.001). The observation group achieved superior volar tilt and radial height (p < 0.001), while radial inclination showed no significant difference (p > 0.05). The complication rate was significantly lower in the observation group than in the control group (p < 0.05).

Conclusions: Ultrasound-guided reduction of dorsoulnar fragments combined with volar locking plate fixation significantly enhanced postoperative wrist function, anatomical alignment, and reduced complication rates compared to conventional X-ray guidance. These findings suggest that intraoperative ultrasound is a valuable adjunct for dorsoulnar fragment (DUF) reduction in DRF fixation, contributing to great

Aim: To investigate the impact of femoral offset (FO) reconstruction on postoperative hip function recovery and complication rates following total hip arthroplasty (THA) via the posterolateral approach.

Methods: A retrospective analysis was performed on 146 patients who underwent primary unilateral THA between January 2019 and April 2024. Patients were divided into two groups based on whether the postoperative FO difference (≤4 mm vs. >4 mm): the reconstruction group (n = 92) and the control group (n = 54). Baseline characteristics, radiographic parameters, postoperative functional outcomes (Harris Hip Score (HHS), visual analogue scale (VAS) for pain, and gait parameters), complications, and prosthesis failure cases were compared between the groups, accompanied by a representative case analysis.

Results: No significant differences were observed in baseline data between the two groups (p > 0.05). Compared with the control group, the postoperative FO in the reconstruction group was significantly closer to that of the contralateral healthy side (p < 0.05). There were no significant differences in acetabular prosthesis parameters between the two groups (p > 0.05). However, the femoral stem neck-shaft angle in the control group was significantly smaller than in the reconstruction group (p < 0.05). At all postoperative time points, the reconstruction group demonstrated superior outcomes in HHS, VAS, and gait parameters than the control group (p < 0.05). The incidence of complications was significantly lower in the reconstruction group than that in the control group (p < 0.05), whereas no significant difference was found in prosthesis revision rates (p > 0.05). Representative cases indicated that patients who failed to achieve FO reconstruction criteria were more susceptible to postoperative dislocation.

Conclusions: Precise femoral offset reconstruction contributes to improved postoperative hip function and a reduced risk of complications in THA.

Aim: Pneumothorax is a prevalent thoracic disorder, with management strategies primarily consisting of conservative treatment and minimally invasive surgery. However, their long-term efficacy remains controversial. This study conducted a systematic review and meta-analysis to compare clinical outcomes between these two approaches.

Methods: A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and non-randomized controlled trials published between 1 January 2000 and 31 January 2025. Studies comparing total complications, recurrence rate during hospitalization, and overall recurrence rate between treatment groups were included. Fixed- or random-effects models were applied for meta-analysis. Begg's test was applied to assess publication bias, and sensitivity analysis was performed to evaluate model robustness.

Results: A total of nine studies were included in the meta-analysis. Compared to conservative treatment, video-assisted thoracoscopic surgery (VATS) significantly reduced the recurrence rate during hospitalization [odds ratio (OR) = 0.23, 95% CI (0.12-0.43), p < 0.00001] and the overall recurrence rate [OR = 0.16, 95% CI (0.08-0.31), p < 0.00001]. However, no statistically significant difference was found between the groups in terms of complication rate (p = 0.79). Additionally, Begg's test confirmed no significant publication bias (p > 0.05). Subgroup analysis indicated that pneumothorax type may contribute to the observed heterogeneity.

Conclusions: VATS reduces both the short-term recurrence rate during hospitalization and the overall recurrence rate in patients with pneumothorax, offering a clinical advantage in preventing early relapse. Individualized treatment strategies tailored to patient characteristics and pneumothorax type remain essential. Additional high-quality studies are needed to clarify its long-term efficacy.