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Jiménez-Romero C, de Juan Lerma A, Marcacuzco Quinto A, Caso Maestro O, Alonso Murillo L, Rioja Conde P, Justo Alonso I. Risk factors for delayed gastric emptying after pancreatoduodenectomy: a 10-year retrospective study. Ann Med 2025; 57:2453076. [PMID: 39817563 PMCID: PMC11740295 DOI: 10.1080/07853890.2025.2453076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2024] [Revised: 12/06/2024] [Accepted: 12/20/2024] [Indexed: 01/18/2025] Open
Abstract
BACKGROUND Delayed gastric emptying (DGE) is a frequent complication of pancreatoduodenectomy (PD) and is associated with prolonged hospital stay, readmission, increased hospital costs and decreased quality of life. However, the pathophysiology of DGE remains unclear. METHODS This is a retrospective study of patients who underwent PD for pancreatic or periampullary tumours. All these patients were operated between January 2012 and February 2023. The patients were divided into four groups according to the development of DGE after PD: No DGE, DGE grade A, DGE grade B and DGE grade C. The groups were compared in terms of outcomes and complications. We also analysed the preoperative and perioperative risk factors for DGE development. RESULTS Between January 2012 and February 2023, a total of 250 patients underwent PD. These patients were divided into four groups: No DGE (n = 152); DGE grade A (n = 42); DGE grade B (n = 45); and DGE grade C (n = 11). The incidence of the postoperative pancreatic fistulas (POPFs) grade B/C was significantly higher in the DGE grade C group (p < .001), and the rates of post-pancreatectomy haemorrhage (p = .004) and reoperation (p < .001) were significantly higher in the DGE grade B/C groups. A significantly higher rate of grade III-IV Clavien-Dindo complications (p < .001), longer intensive care unit (p < .001) and longer hospital stays (p < .001) were observed in the DGE grade C group; and 90-day mortality (p < .001) and morbidity (p < .001) were significantly higher in the DGE grade B/C groups. Multivariate analysis demonstrated that the POPF grade B/C was a risk factor of DGE grade B/C (OR: 9.147; 95%CI: 4.125-20.281; p < .001). CONCLUSIONS POPF B/C is a risk factor for grade B/C DGE. Prevention of surgical complications and early treatment could contribute to the decreased incidence of DGE.
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Affiliation(s)
- Carlos Jiménez-Romero
- Department of Surgery, Faculty of Medicine, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - Agustín de Juan Lerma
- Department of Surgery, Faculty of Medicine, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - Alberto Marcacuzco Quinto
- Department of Surgery, Faculty of Medicine, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - Oscar Caso Maestro
- Department of Surgery, Faculty of Medicine, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - Laura Alonso Murillo
- Department of Surgery, Faculty of Medicine, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - Paula Rioja Conde
- Department of Surgery, Faculty of Medicine, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
| | - Iago Justo Alonso
- Department of Surgery, Faculty of Medicine, Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Instituto de Investigación (imas12), Complutense University, Madrid, Spain
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Hecht CJ, Burkhart RJ, Nedder VJ, Acuña AJ, Porto JR, Gurd DP, Rosneck JT, Kamath AF. Concomitant hip arthroscopy and periacetabular osteotomy: Systematic review and meta-analysis of contemporary outcomes, survivorship, and complications with comparison to isolated periacetabular osteotomy. J Orthop 2025; 69:1-9. [PMID: 40099314 PMCID: PMC11910352 DOI: 10.1016/j.jor.2024.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Accepted: 10/30/2024] [Indexed: 03/19/2025] Open
Abstract
Objective To evaluate outcomes, survivorship, and complication rates among patients who underwent concomitant periacetabular osteotomy (PAO) and hip arthroscopy and compare them to patients undergoing isolated PAO. Design Systematic review and meta-analysis. Setting Medline, EBSCO host, and Google Scholar databases were searched to identify all studies describing concomitant PAO and HA through May 9, 2023 (PROSPERO study protocol registration: CRD42023426191). Patients Patients who underwent concomitant PAO and hip arthroscopy compared to patients who underwent isolated PAO. Interventions Randomized controlled trials and cohort studies reporting clinical outcomes after concomitant PAO and hip arthroscopy. Main outcome measures Patient-reported outcome measures (PROMs), radiographic outcomes, range of motion scores, complications, re-operations, and survivorship. Results Thirteen studies reporting on a total of 697 patients (726 hips) were included. Significant improvements in PROMs and radiographic measures were demonstrated for most included studies. Pooled analyses demonstrated significant improvements in post-operative modified Harris Hip Score (mHHS) (mean difference (MD): 26.97, 95%CI: 30.19 to -23.75; p < 0.00001) and lateral-center edge angle (LCEA; MD: 13.94, 95%CI: 16.95 to -10.93; p < 0.0001) values. Patients undergoing combined procedures experienced 136 complications for 690 hips (19.71 %) with 29 (21.32 %) classified as major. There were 27 re-operations for 614 hips (4.40 %), and post-operative survivorship estimated at minimum 85 % after 3.5 years follow-up. However, for most outcome measures, there were no differences between concomitant procedures and isolated PAO. Conclusions Based on the available literature, patients undergoing concomitant PAO and hip arthroscopy experience excellent outcomes. However, there is limited evidence to indicate that performing both procedures result in different outcomes compared to PAO alone.
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Affiliation(s)
- Christian J. Hecht
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Robert J. Burkhart
- Department of Orthopaedic Surgery, University Hospitals, Cleveland, OH, 44106, USA
| | - Victoria J. Nedder
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Alexander J. Acuña
- Department of Orthopaedics, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Joshua R. Porto
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - David P. Gurd
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - James T. Rosneck
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
| | - Atul F. Kamath
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, 44195, USA
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Yu Y, Yamauchi S, Kaji S, Yube Y, Nasu M, Yoshimoto Y, Cheng M, Ozaki A, Watanabe T, Orita H, Ecoff K, Nojiri S, Mine S, Wu YY, Fukunaga T. Predictive model and prognostic insights into duodenal stump fistula following radical gastrectomy with Roux-en-Y reconstruction for gastric cancer. World J Gastrointest Surg 2025; 17:104333. [DOI: 10.4240/wjgs.v17.i6.104333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 03/24/2025] [Accepted: 04/29/2025] [Indexed: 05/30/2025] Open
Abstract
BACKGROUND Duodenal stump fistula (DSF) is a rare yet serious complication following gastric cancer surgery. The risk factors associated with DSF, as well as the predictive models, remain insufficiently elucidated.
AIM To identify DSF risk factors following radical gastrectomy with Roux-en-Y anastomosis, develop a predictive model, and evaluate impact on prognosis.
METHODS This retrospective cohort study was conducted on patients undergoing radical gastrectomy with Roux-en-Y anastomosis for gastric cancer at Juntendo University from 2015 to 2021 (n = 325). Univariate and multivariate analyses were performed to identify the risk factors associated with DSF. Based on the independent risk factors, a predictive nomogram was developed and subsequently evaluated using receiver operating characteristic curve analysis. Kaplan-Meier survival curves were utilized to assess the impact of DSF on overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS).
RESULTS Among the 325 patients analyzed, DSF was observed in 7 (2.2%) cases. No DSF was observed in 110 patients where the duodenal stump suturing fixation technique to the jejunal wall was used. Multivariate analysis confirmed that age [odds ratio (OR) = 1.17, P = 0.015] and obstructive ventilatory failure (OVF) (OR = 14.03, P = 0.001) were independent risk factors for DSF. The predictive nomogram was constructed based on age and OVF, which exhibited strong performance (area under the curve = 0.90, 95% confidence interval: 0.82-0.99). Kaplan-Meier analysis revealed a statistically significant reduction in CSS for patients with DSF, whereas no significant differences were observed in OS or DFS.
CONCLUSION Age and OVF are independent risk factors for DSF, which worsens CSS. A nomogram predicts DSF accurately, and innovative surgical techniques may reduce its occurrence.
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Affiliation(s)
- Yang Yu
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
- Gastrointestinal Cancer Center, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Suguru Yamauchi
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
- Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, United States
| | - Sanae Kaji
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
| | - Yukinori Yube
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
| | - Motomi Nasu
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
| | - Yutaro Yoshimoto
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
| | - Ming Cheng
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Asako Ozaki
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
| | - Takehiro Watanabe
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
| | - Hajime Orita
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
| | - Kaitlyn Ecoff
- Department of Surgery, Johns Hopkins University, Baltimore, MD 21287, United States
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo 113-8421, Japan
| | - Shinji Mine
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
| | - Yong-You Wu
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu Province, China
| | - Tetsu Fukunaga
- Department of Esophageal and Gastroenterological Surgery, Juntendo University, Tokyo 113-8431, Japan
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Jiménez-Romero C, Marcacuzco-Quinto A, Caso-Maestro O, Alonso L, Fernández-Fernández C, Justo I. Comparison of three reconstruction techniques performed after pancreaticoduodenectomy: Using external, internal, or no stent. World J Gastrointest Surg 2025; 17:104652. [DOI: 10.4240/wjgs.v17.i6.104652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2024] [Revised: 03/13/2025] [Accepted: 05/06/2025] [Indexed: 05/30/2025] Open
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) is the most frequent cause of morbimortality after pancreaticoduodenectomy, but the best technique to use to prevent its development is unclear. The choice of drainage method external duct stent (EDS), internal duct stent (IDS), or non-ductal stent (NDS) is also controversial.
AIM To compare the three groups (EDS, IDS and NDS), analyzing the patient characteristics, perioperative examinations and survival.
METHODS Patients who underwent pancreaticoduodenectomy and pancreaticojejunostomy between 2012 and 2020, were divided into the EDS, IDS and NDS groups.
RESULTS Of the 244 patients included, 129 were in the EDS group, 71 in the IDS group, and 44 in the NDS group. Except for preoperative pancreatitis in the NDS patients, comorbidities were similar among the groups. Patients in the NDS group had a high caliber of the Wirsung duct and frequently presented with a hard pancreas (P < 0.001). A lower rate of grade C POPF was observed in the EDS (1.6%) compared to the NDS (9.1%) and IDS group (14.1%) (P = 0.009). The groups showed similar findings for delayed gastric emptying, postoperative hemorrhage, reoperation, and 5-year survivals. Ninety-day mortality rate was significantly higher in the IDS group (5.6%) compared to the EDS (1.6%) and NDS (4.5%) groups (P = 0.046). Multivariate analysis showed that the use of EDS was a protective factor for grade B/C POPF (P = 0.034), and 90-day mortality (P = 0.018). Additionally, a Wirsung duct diameter < 3 mm was the only risk factor for grade B/C POPF (P = 0.001), and 90-day mortality (P = 0.031).
CONCLUSION The use of the EDS was a protective factor for grade B/C POPF and 90-day mortality, and the Wirsung duct < 3 mm was a risk factor for grade B/C POPF and 90-day mortality.
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Affiliation(s)
- Carlos Jiménez-Romero
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, “12 de Octubre” University Hospital, Madrid 28041, Spain
| | - Alejandro Marcacuzco-Quinto
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Department of Surgery, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital, Madrid 28045, Spain
| | - Oscar Caso-Maestro
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, “12 de Octubre” University Hospital, Madrid 28041, Spain
| | - Laura Alonso
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Department of Surgery, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital, Madrid 28045, Spain
| | - Clara Fernández-Fernández
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, “12 de Octubre” University Hospital, Madrid 28041, Spain
| | - Iago Justo
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Department of Surgery, “12 de Octubre” University Hospital, Instituto de Investigación Sanitaria Hospital, Madrid 28045, Spain
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Tulahong A, Zhu DL, Liu C, Jiang TM, Zhang RQ, Tuergan T, Aji T, Shao YM. Simultaneous combined surgery for hepatic-renal double organ alveolar or cystic echinococcosis: A retrospective study. World J Gastrointest Surg 2025; 17:105007. [DOI: 10.4240/wjgs.v17.i6.105007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Revised: 03/19/2025] [Accepted: 03/20/2025] [Indexed: 05/30/2025] Open
Abstract
BACKGROUND Alveolar and cystic echinococcoses are lethal zoonotic diseases caused by Echinococcus multilocularis and Echinococcus granulosus infections, leading to alveolar echinococcosis (AE) or cystic echinococcosis (CE), respectively. No study has hitherto reported effective treatment approaches for AE or CE with concurrent hepatorenal involvement.
AIM To investigate the feasibility and efficacy of simultaneous combined surgery (SCS) as a comprehensive treatment approach for patients with hepatorenal echinococcosis.
METHODS Clinical datasets of hepatorenal AE (n = 10) and CE (n = 11) patients were retrospectively collected and systematically analyzed. The SCS approach was introduced, and surgical outcomes, complications, and prognoses were documented in detail.
RESULTS The SCS approach incorporated hybridized techniques, including partial hepatectomy, partial or total nephrectomy, ex vivo liver resection and autotransplantation, and total or subtotal cystectomy with endocystectomy. Radical SCS was achieved in 100% of AE patients and 63.6% of CE patients. All surgeries were completed without intraoperative complications. The short-term complication rate was 28.6% (Clavien-Dindo classification: AE-1 IIIb, 3 IIIa; CE-2 II), while the long-term complication rate was 4.8% (Clavien-Dindo classification: AE-1 IIIb). Patients were followed up for a median of 37 months (AE: 6-81 months; CE: 34-123 months), with no reported deaths or disease relapses.
CONCLUSION CS appears to be a feasible and effective treatment method for patients with hepatorenal involvement of AE or CE. It fulfills the management criteria for advanced AE or CE cases, aiming to maximize patient benefits.
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Affiliation(s)
- Alimu Tulahong
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Da-Long Zhu
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Chang Liu
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Tie-Min Jiang
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Rui-Qing Zhang
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Tuerganaili Aji
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Ying-Mei Shao
- Department of Hepatobiliary and Echinococcosis Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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Pascale MM, Frongillo F, Vasta P, Massimiani G, Nure E, Agnes S. Significance of the neutrophil-to-lymphocyte ratio and the platelet-to-lymphocyte ratio as prognostic predictors after liver transplantation. World J Transplant 2025; 15. [DOI: 10.5500/wjt.v15.i2.100157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 12/20/2024] [Accepted: 01/21/2025] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND
The use of biomarkers, such as the neutrophil-to-lymphocyte ratio (NLR) and the neutrophil-to-platelet ratio (NPR), has shown promise in evaluating early outcomes after medical, interventional, and surgical treatments. NLR has emerged as an indicator of systemic inflammation and physiological stress. NPR has emerged as a potential indicator of inflammation and thrombotic risk in the context of surgical and radiological procedures.
AIM
To analyze the correlation of NLR and NPR with the development of post-liver transplantation (LT) early complications after stratification for hepatocellular carcinoma diagnosis.
METHODS
Consecutive patients undergone LT between January 2019 and December 2023 were enrolled. Data regarding the concentration of hemoglobin and the differential leukocyte count on postoperative days (POD) 0, 1, 3, and 5 were collected.
RESULTS
The dataset included 161 consecutive patients undergone LT. Clavien-Dindo IV-V complications had a good correlation with NLR POD 1 (P = 0.05), NLR POD 3 (P < 0.001), NLR POD 7 (P < 0.001), NPR POD 3 (P < 0.001). In addition, the NPR ratio on POD 3 correlated with the onset of 30-day hemorrhage (P = 0.009). Finally, 30-day mortality had a significant association with the NLR POD 1 (P = 0.03) and with NLR POD 7 (P = 0.004), while NPR had a significant correlation with 30-day mortality in NPR POD 7 (P = 0.004).
CONCLUSION
The analysis of NLR and NPR are strictly correlated with Clavien-Dindo IV-V complications and 30-day post-LT death.
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Affiliation(s)
- Marco Maria Pascale
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Francesco Frongillo
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Pierangelo Vasta
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Giuseppe Massimiani
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Erida Nure
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Salvatore Agnes
- General Surgery and Liver Transplantation Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
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Park Y, Hwang DW, Lee JH, Song KB, Jun E, Lee W, Sung MK, Kim SC. Oncological outcomes of palliative minimally invasive distal pancreatectomy for unexpected metastatic pancreatic ductal adenocarcinoma: A single-center experience. Surgery 2025; 182:109331. [PMID: 40138876 DOI: 10.1016/j.surg.2025.109331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 02/19/2025] [Accepted: 02/20/2025] [Indexed: 03/29/2025]
Abstract
BACKGROUND The benefits of palliative minimally invasive distal pancreatectomy for patients with unexpectedly metastatic pancreatic ductal adenocarcinoma have not been previously studied. This retrospective study compared the outcomes of palliative minimally invasive distal pancreatectomy with those of minimally invasive biopsy in these patients. METHODS We reviewed the records of 46 patients with unexpected metastasis of left-sided pancreatic ductal adenocarcinoma that were discovered during surgery between 2005 and 2019. Nineteen patients underwent palliative resection (minimally invasive distal pancreatectomy group), whereas 27 patients underwent only minimally invasive biopsy (minimally invasive biopsy group). Demographic, clinical, and operative data, as well as survival rates, were compared between the 2 groups. RESULTS Major complications (Clavien-Dindo grade ≥3) were comparable between the 2 groups (11.8% vs 5.6%; P = .603). Postoperative chemotherapy was administered to 84.2% of the minimally invasive distal pancreatectomy group and 77.8% of the minimally invasive biopsy group (P = .716). The minimally invasive distal pancreatectomy group had a higher completion rate of first-line palliative chemotherapy (42.9% vs 8.7%; P = .007) and a higher 2-year survival rate (36.8% vs 18.8%; P = .004). In multivariate analysis, survival was associated with completion of first-line chemotherapy (hazard ratio: 2.962; P = .003) and maintenance chemotherapy for over 12 months (hazard ratio: 2.339; P = .010). Gastric outlet obstruction was less prevalent in the minimally invasive distal pancreatectomy group (5.3% vs 25.9%, P = .037). CONCLUSION Palliative minimally invasive distal pancreatectomy may improve survival and facilitate the continuation of chemotherapy in selected patients with unexpected metastatic pancreatic ductal adenocarcinoma. However, the small sample size and potential selection bias limit the generalizability of these findings. Larger, prospective, multicenter studies are needed to confirm the role of minimally invasive distal pancreatectomy and to establish optimal management strategies for these patients.
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Affiliation(s)
- Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eunsung Jun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Convergence Medicine, Asan Institute for Life Sciences, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Republic of Korea
| | - Woohyung Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Kyu Sung
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, BK21 Project, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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Hoshino N, Hisamori S, Kanaya S, Hosogi H, Manaka D, Kinjo Y, Matsuo K, Sakaguchi M, Kondo M, Nakanishi Y, Yamamoto M, Tanaka E, Toda K, Abe H, Nishigori T, Tsunoda S, Obama K. Efficacy and safety of polyglycolic acid sheets for prevention of intra-abdominal infectious complications following minimally invasive surgery for gastric cancer: A prospective, multicenter, single-arm clinical trial. Surg Oncol 2025; 60:102224. [PMID: 40203474 DOI: 10.1016/j.suronc.2025.102224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2024] [Revised: 03/22/2025] [Accepted: 04/03/2025] [Indexed: 04/11/2025]
Abstract
BACKGROUND Serious intra-abdominal infectious complications are common after gastric cancer surgery, including anastomotic leakage, pancreatic fistula, and intra-abdominal abscess. Although polyglycolic acid sheets are often used to reinforce soft tissue and prevent postoperative complications in various types of surgery, including gastric cancer surgery, their effectiveness has not yet been fully demonstrated. METHODS Patients with gastric cancer and no distant metastasis undergoing minimally invasive distal or total gastrectomy at Kyoto University Hospital or its 9 affiliated facilities between March 2022 and December 2023 were enrolled. The primary outcome was incidence of Clavien-Dindo (CD) grade ≥ III intra-abdominal infectious complications, including anastomotic leakage, pancreatic fistula, and intra-abdominal abscess. Secondary outcomes were incidence of overall complications (CD grade ≥ III), pancreatic fistula (CD grade ≥ III), or anastomotic leakage (CD grade ≥ III). RESULTS In total, 210 patients were included. Distal gastrectomy was performed in 186 cases (88.6 %) and total gastrectomy in 24 (11.4 %). No cases required conversion to laparotomy. The incidence of CD grade III intra-abdominal infectious complications was 1.4 % (90 % confidence interval 0.6-3.5), below the pre-defined limit of 7.0 %. The rate of CD grade ≥ III overall complications was 4.3 %, that of CD grade ≥ III pancreatic fistula was 1.0 %, and that of CD grade ≥ III anastomotic leakage was 0.5 %. The polyglycolic acid sheet was not associated with any serious complications or abnormal laboratory values. CONCLUSION Polyglycolic acid sheets were safe and effective in preventing serious intra-abdominal infectious complications after minimally invasive surgery for gastric cancer. TRIAL REGISTRY NUMBER: jRCTs052210188.
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Affiliation(s)
- Nobuaki Hoshino
- Department of Surgery, Kyoto University Graduate School of Medicine, Japan
| | - Shigeo Hisamori
- Department of Surgery, Kyoto University Graduate School of Medicine, Japan.
| | | | | | - Dai Manaka
- Department of Surgery, Kyoto Katsura Hospital, Japan
| | - Yosuke Kinjo
- Department of Surgery, National Hospital Organization Himeji Medical Center, Japan
| | | | | | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Japan
| | - Yasutaka Nakanishi
- Department of Surgery, National Hospital Organization Kyoto Medical Center, Japan
| | | | - Eiji Tanaka
- Department of Surgery, Kitano Hospital, Japan
| | - Kosuke Toda
- Department of Surgery, Shiga General Hospital, Japan
| | - Hiroyasu Abe
- Department of Regulatory Science and Pharmaceutical Informatics, School of Pharmaceutical Sciences, Wakayama Medical University, Japan
| | - Tatsuto Nishigori
- Department of Surgery, Kyoto University Graduate School of Medicine, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Kyoto University Graduate School of Medicine, Japan
| | - Kazutaka Obama
- Department of Surgery, Kyoto University Graduate School of Medicine, Japan
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9
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Nezasa M, Kawase M, Washino S, Nishino T, Fukushima H, Iwatani K, Miyagawa T, Shimbo M, Yamasaki T, Ohba K, Miki J, Ishida K, Koie T. Efficacy of Neoadjuvant Hormonal Therapy for High-Risk Prostate Cancer Undergoing Robot-Assisted Radical Prostatectomy: A Retrospective Multicenter Study Using Propensity Score-Matched Analysis in Japan. Clin Genitourin Cancer 2025; 23:102346. [PMID: 40306091 DOI: 10.1016/j.clgc.2025.102346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2025] [Revised: 03/25/2025] [Accepted: 03/29/2025] [Indexed: 05/02/2025]
Abstract
INTRODUCTION The potential improvement in oncological outcomes of robot-assisted radical prostatectomy (RARP) with neoadjuvant androgen deprivation therapy (ADT) in patients with prostate cancer (PCa) who had high-risk or very-high risk disease (HR/VHR-PCa) remains controversial. This study evaluated the impact of neoadjuvant hormone therapy (NHT) on biochemical recurrence (BCR) following RARP. MATERIALS AND METHODS A total of 1,203 patients with HR/VHR-PCa who underwent RARP at 6 centers in Japan were included. Patients were categorized into 2 groups: those who underwent RARP alone (RARP-alone group) and those who underwent RARP following NHT (NHT group). The primary endpoint was biochemical recurrence-free survival (BRFS) after RARP. RESULTS A total of 976 patients were analyzed, including 140 patients in each group after propensity score matching. At a median follow-up of 47 months, BCR was observed in 40.7% of patients in the RARP-alone group and 31.4% in the NHT group (P = .106). BRFS rates did not significantly differ between the 2 groups (P = .671). The RARP-alone group tended to have slightly longer operative times and more positive surgical margins than the NHT group. CONCLUSION This study suggests that NHT does not improve BRFS in patients with HR/VHR-PCa undergoing RARP. Further research is necessary to develop more effective neoadjuvant regimens for this patient population.
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Affiliation(s)
- Minori Nezasa
- Department of Urology, Matsunami General Hospital, Gifu, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takato Nishino
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Hajime Fukushima
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takeshi Yamasaki
- Department of Urology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Kojiro Ohba
- Department of Urology and Renal Transplantation, Nagasaki University Hospital, Nagasaki, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Kashiwa Hospital, Kashiwa, Japan
| | | | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan.
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10
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Wang M, Xie X, Lin J, Shen Z, Zou E, Wang Y, Liang X, Chen G, Yu H. Preoperative blood and CT-image nutritional indicators in short-term outcomes and machine learning survival framework of intrahepatic cholangiocarcinoma. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109654. [PMID: 40009922 DOI: 10.1016/j.ejso.2025.109654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2024] [Revised: 01/23/2025] [Accepted: 01/29/2025] [Indexed: 02/28/2025]
Abstract
BACKGROUND&AIMS Intrahepatic cholangiocarcinoma (iCCA) is aggressive with limited treatment and poor prognosis. Preoperative nutritional status assessment is crucial for predicting outcomes in patients. This study aimed to compare the predictive capabilities of preoperative blood like albumin-bilirubin (ALBI), controlling nutritional status (CONUT), prognostic nutritional index (PNI) and CT-imaging nutritional indicators like skeletal muscle index (SMI), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), visceral to subcutaneous adipose tissue ratio (VSR) in iCCA patients undergoing curative hepatectomy. METHODS 290 iCCA patients from two centers were studied. Preoperative blood and CT-imaging nutritional indicators were evaluated. Short-term outcomes like complications, early recurrence (ER) and very early recurrence (VER), and overall survival (OS) as long-term outcome were assessed. Six machine learning (ML) models, including Gradient Boosting (GB) survival analysis, were developed to predict OS. RESULTS Preoperative blood nutritional indicators significantly associated with postoperative complications. CT-imaging nutritional indicators show insignificant associations with short-term outcomes. All preoperative nutritional indicators were not effective in predicting early tumor recurrence. For long-term outcomes, ALBI, CONUT, PNI, SMI, and VSR were significantly associated with OS. Six ML survival models demonstrated strong and stable performance. GB model showed the best predictive performance (C-index: 0.755 in training cohorts, 0.714 in validation cohorts). Time-dependent ROC, calibration, and decision curve analysis confirmed its clinical value. CONCLUSION Preoperative ALBI, CONUT, and PNI scores significantly correlated with complications but not ER. Four Image Nutritional Indicators were ineffective in evaluating short-term outcomes. Six ML models were developed based on nutritional and clinicopathological variables to predict iCCA prognosis.
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Affiliation(s)
- Mingxun Wang
- Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
| | - Xiaozai Xie
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
| | - Jiacheng Lin
- Medical Insurance and Pricing Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
| | - Zefeng Shen
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang Province, China.
| | - Enguang Zou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
| | - Yi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
| | - Xiao Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang Province, China.
| | - Gang Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China; Zhejiang-Germany Interdisciplinary Joint Laboratory of Hepatobiliary-Pancreatic Tumor and Bioengineering, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
| | - Haitao Yu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China; Zhejiang-Germany Interdisciplinary Joint Laboratory of Hepatobiliary-Pancreatic Tumor and Bioengineering, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang Province, China.
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11
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Li J, Qin M, Tang Y, Dan J, Chen H, Chen H, Huang J, Yang Y, Wang T, Li Y, Chen M, Ju W, Wang D, Guo Z, Tan H, He X, Zhao Q. Simplified ischemia-free liver transplantation by providing alternating flow of the portal vein and hepatic artery: Applicability, efficiency, and safety. Liver Transpl 2025; 31:737-749. [PMID: 39641582 DOI: 10.1097/lvt.0000000000000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2024] [Accepted: 11/15/2024] [Indexed: 12/07/2024]
Abstract
Conventional ischemia-free liver transplantation (CIFLT) represents a pioneering procedure that circumvents ischemia-reperfusion injury to livers throughout the transplant procedure. However, its complexity has limited its widespread adoption. This study introduced a simplified ischemia-free liver transplantation (SIFLT) technique by providing an alternating flow of the portal vein and hepatic artery, demonstrating its efficacy and safety. In this retrospective study, 32 patients who received SIFLT and 32 who received CIFLT were included between January 2021 and January 2024. The intraoperative and postoperative outcomes were collected and elevated. Patients who underwent SIFLT had a shorter anhepatic phase (44.0±2.4 vs. 51.6±2.4 min, p =0.03), along with a comparatively reduced intraoperative blood loss compared to those who underwent CIFLT. Furthermore, the SIFLT group exhibited significantly lower peak AST levels within postoperative 7 days (413.1±62.6 vs. 707.5±110.7 U/L, p =0.02). The incidence of early allograft dysfunction, primary nonfunction, and transplant-related complications were similar across both groups. There were no significant differences in the number of Clavien-Dindo classification of surgical complications and comprehensive complication index at 3 months after transplantation. Kaplan-Meier analysis confirmed similar patient and graft survival rates. The subgroup analysis of extended criteria donor demonstrated that SIFLT can effectively reduce anhepatic phase and intraoperative blood loss and can achieve a clinical prognosis similar to CIFLT. Additionally, histological analysis revealed that both groups demonstrated well-preserved livers and bile ducts. The SIFLT simplifies the intricate surgical procedure while ensuring the protection of livers from ischemia-reperfusion injury. This technique holds promise for enabling patients to achieve clinical outcomes comparable to those of CIFLT.
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Affiliation(s)
- Jiahao Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Meiting Qin
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yunhua Tang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Jia Dan
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Honghui Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Huadi Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Jinbo Huang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yongqi Yang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Tielong Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Yefu Li
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Maogen Chen
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Weiqiang Ju
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Dongping Wang
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Zhiyong Guo
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Haidong Tan
- Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
| | - Qiang Zhao
- Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China
- Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, China
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Manzia TM, Sensi B, Gentileschi P, Quaranta C, Toti L, Baiocchi L, Dauri M, Angelico R, Tisone G. Safety and efficacy of simultaneous liver transplantation and sleeve gastrectomy in morbid obese patients with end-stage liver disease: The LT-SG study. Liver Transpl 2025; 31:770-780. [PMID: 39451118 DOI: 10.1097/lvt.0000000000000522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 09/30/2024] [Indexed: 10/26/2024]
Abstract
In obese patients, metabolic dysfunction-associated steatotic liver disease is becoming a leading etiology of end-stage liver disease and HCC. Simultaneous liver transplantation and sleeve gastrectomy (LT-SG) have been proposed in the United States, but the safety and efficacy of the procedure have not been widely explored in Europe. Between January 2016 and December 2022, morbidly obese patients listed for liver transplantation at Tor Vergata University were enrolled in the LT-SG study. Primary outcomes were (1) safety expressed as 30- and 90-day overall survival and (2) major postoperative complications (Clavien-Dindo >IIIa). The secondary outcome was efficacy expressed as a 3-year %excess body mass index (BMI) loss. Eleven patients were enrolled in the study. The median BMI at transplantation was 42 (IQR 38-48). Indications of LT-SG were HCC (63.6%) and cirrhosis (36.4%). In 54% of cases, donors had high-risk characteristics (eurotransplant donor risk index >1.6). The 30- and 90-day overall survival were 63.6% and 54.5%, respectively. All deaths occurred in patients with P-SOFT >15 or in patients who had at least 3 of the following characteristics: >60 years, BMI >45, metabolic syndrome, MELD >25 or eurotransplant donor risk index >1.6. The 6 months, 1, 2, and 3 years %excess BMI loss was 73%, 60%, 50%, and 43%, respectively. LT-SG is a complex procedure that may carry excess risk in an unselected population. It should be considered only in highly selected patients. Standard donors are recommended, and prioritization of severely obese patients on the waiting list should be considered.
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Affiliation(s)
- Tommaso Maria Manzia
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Bruno Sensi
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Gentileschi
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
- Department of Surgery, Bariatric and Metabolic Surgery Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Claudia Quaranta
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Luca Toti
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Leonardo Baiocchi
- Department of Medical Sciences, Hepatology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Mario Dauri
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Roberta Angelico
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
| | - Giuseppe Tisone
- Department of Surgical Science, HPB and Transplant Unit, University of Rome Tor Vergata, Rome, Italy
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13
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Johnston HE, Mayr HL, Andelkovic M, Takefala TG, Chen Y, Thrift AP, Macdonald GA, Hickman IJ. Comparing the performance of 3 sarcopenia definitions for predicting adverse events prior to liver transplant. Hepatol Commun 2025; 9:e0701. [PMID: 40434634 PMCID: PMC12122176 DOI: 10.1097/hc9.0000000000000701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 03/06/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Sarcopenia is a syndrome of severe muscle wasting, associated with adverse outcomes related to liver transplantation (LT). There are several approaches used to identify sarcopenia. We aimed to investigate the prevalence of sarcopenia using 3 different criteria and determine how these performed in relation to clinical outcomes. METHODS The cohort study included 237 adults with cirrhosis referred for LT. Sarcopenia was identified using (1) CT-defined; and the (2) original and (3) updated European Working Group on Sarcopenia in Older People criteria (EWGSOP1 and 2). Logistic regression was used to estimate OR and 95% CI for the relationships between sarcopenia and receiving an LT, unplanned admissions pre-LT, surgical complications, and length of stay for the LT admission. Fine-Gray competing risk analysis explored the impact of sarcopenia on receiving an LT and unplanned admissions. The AUC determined the predictive utility of the criteria. RESULTS The prevalence of CT-defined sarcopenia (52%) was more than twice and 4-fold that of EWGSOP1-defined (22%) and EWGSOP2-defined (11%) sarcopenia, respectively. No criteria demonstrated a significant association with time to LT nor the time to unplanned admissions pre-LT. Similarly, none of the 3 criteria had superior predictive utility for the clinical outcomes for unplanned hospital admissions pre-LT of receiving an LT, with all 3 criteria having identical moderate AUCs for unplanned admissions (0.70) and similar weak AUCs (≤0.55) for the likelihood of receiving an LT. CONCLUSIONS Sarcopenia in patients undergoing LT evaluation is prevalent. EWGSOP criteria appear to offer no advantage over CT-only criteria in identifying patients at increased risk of adverse LT outcomes. Bedside measures of muscle function may be of benefit in tracking the effectiveness of interventions targeting sarcopenia.
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Affiliation(s)
- Heidi E. Johnston
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Queensland Liver Transplant Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Hannah L. Mayr
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Melita Andelkovic
- Princess Alexandra Hospital, Queensland Liver Transplant Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Tahnie G. Takefala
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Princess Alexandra Hospital, Queensland Liver Transplant Service, Brisbane, Queensland, Australia
| | - Yanyan Chen
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas, USA
| | - Graeme A. Macdonald
- Princess Alexandra Hospital, Queensland Liver Transplant Service, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology & Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ingrid J. Hickman
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- ULTRA Team, The University of Queensland Clinical Trial Capability, Brisbane, Queensland, Australia
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14
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Blackman B, Dworsky-Fried J, Cohen D, Slawaska-Eng D, Gyemi L, Simunovic N, Peterson D, Ayeni OR, de Sa D. Surgical management of first-time patellar dislocations in paediatric patients may lower rates of redislocation compared to conservative management: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2025; 33:2156-2166. [PMID: 39474842 DOI: 10.1002/ksa.12524] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/16/2024] [Accepted: 10/17/2024] [Indexed: 05/27/2025]
Abstract
PURPOSE The purpose of this study is to assess whether early surgical intervention for first-time patellar dislocations in paediatric patients is superior to conservative management. We hypothesized that surgical intervention would lead to lower redislocation rates compared to conservative treatment. METHODS Three online databases (PubMed, MEDLINE and EMBASE) were searched from inception to 14 March 2024 to identify studies investigating the management options for acute first-time patellar dislocations in paediatric patients. Data pertaining to patient demographics, patient management, redislocation rates and Kujala scores, evaluating function, were abstracted. Weighted means and meta-analyses were conducted to compare rates of redislocation, as well as Kujala scores. The quality of included studies was assessed using the methodological index for non-randomized studies criteria for non-randomized studies and the ROB2 tool for randomized controlled trials (RCTs). RESULTS A total of 11 studies and 761 patients were included in this review. The weighted mean post-operative combined rates of redislocation in the surgical group was 25.1%, compared to 46.4% in the conservative group at a mean follow-up of 53.2 months (12-168). The relative risk (RR) of redislocation was 0.82 (95% confidence interval [CI]: 0.65-1.04, I2 = 0%, p = 0.11), favouring surgery compared to conservative management. A subgroup meta-analysis of two recent RCTs with 110 patients demonstrated an RR of redislocation of 0.53 (95% CI: 0.31-0.91, I2 = 0%, p = 0.02), favouring surgery. Kujala scores among three comparative studies showed a mean difference of -2.7 (95% CI: -6.1 to 0.68, I2 = 0%, p = 0.12), favouring conservative treatment. The weighted mean redislocation rate in 131 patients undergoing medial patellofemoral ligament reconstruction (MPFLR) was 3.1%, compared to 39.4% in 203 patients undergoing other surgical procedures, such as lateral release and medial imbrication, Roux-Goldwaith and MPFL repair. Furthermore, the conservative groups experienced a complication rate of 0.9% compared to 2.9% across the surgical groups. CONCLUSION Surgical management for first-time patellar dislocations in a paediatric population, particularly MPFLR, may be more beneficial in lowering redislocation rates than conservative management. No significant differences in Kujala scores were found. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Joshua Dworsky-Fried
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dan Cohen
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lauren Gyemi
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Devin Peterson
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Olufemi R Ayeni
- School of Medicine, University of Limerick, Limerick, Ireland
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Darren de Sa
- Division of Orthopedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
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15
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Renda I, Manon N, Blot C, Dinu M, Bautrant E, Serboli G, Joinau-Zoulovits F, Merlot B, Roman H, Petraglia F, Lévêque C. Impact of laparoscopic pudendal nerve decompression on quality of life in patients suffering from pudendal neuralgia caused by entrapment syndrome. J Gynecol Obstet Hum Reprod 2025; 54:102963. [PMID: 40294820 DOI: 10.1016/j.jogoh.2025.102963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2025] [Accepted: 04/25/2025] [Indexed: 04/30/2025]
Abstract
BACKGROUND Pudendal neuralgia caused by entrapment syndrome (PNE) is an underdiagnosed condition with severe quality of life (QoL) impact. In cases unresponsive to medical treatment, a minimally invasive surgical approach, such as laparoscopic surgery, is preferred, particularly in patients presenting central sensitisation (CS) and myofascial syndrome (MS). Although the procedure has proven to be safe and feasible, limited studies examinate its impact on QoL. OBJECTIVES This retrospective observational study was conducted at the Résilience Center, Axium Clinic, Aix-en-Provence, France, with the objective to assess QoL improvement and pain relief in PNE patients treated with laparoscopic pudendal neurolysis, focusing on those with CS. Secondary objectives included assessing the occurrence of surgical complications and improvements in urinary, intestinal and sexual functions. METHODS The study involved 147 patients operated from January 2018 to June 2023. The patients' status was evaluated using validated surveys at the preoperative consultation, at 4-6 weeks, 6-12 months and 3 years post-surgery for those operated up to 2020. RESULTS The laparoscopic approach resulted safe and effective, showing significant improvements in VAS score (χ2:132.4,df=3,p < 0.001), QoL (χ2:133,df=3,p < 0.001), urinary (χ2:26.3,df=3,p < 0.001), intestinal (χ2:26.3,df=3,p < 0.001), and sexual functions (χ2:8.5,df=3,p < 0.001). MS and CS patients demonstrated diminished improvement scores. The implementation of a multidisciplinary approach significantly improved outcomes within these subgroups. A preoperative VAS score >8 was a significant risk factor for surgical failure (OR 19.2 for PGI, 14.2 for QoL, p < 0.001). CONCLUSION A multidisciplinary approach aimed at reducing VAS score below 8 before surgery is recommended to optimize outcomes, particularly in CS patients.
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Affiliation(s)
- Irene Renda
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre Résilience, Bastide d'AXIUM, 31 avenue de Lattre de Tassigny, Aix-en-Provence 13090, France; Obstetrics and Gynaecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy.
| | - Nathalie Manon
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre Résilience, Bastide d'AXIUM, 31 avenue de Lattre de Tassigny, Aix-en-Provence 13090, France
| | - Christophe Blot
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre Résilience, Bastide d'AXIUM, 31 avenue de Lattre de Tassigny, Aix-en-Provence 13090, France
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, Florence 50134, Italy
| | - Eric Bautrant
- Pelvi-Perineal Surgery and Rehabilitation Department, Medical Center L'Avancée, Clinique Axium, 31-33 Avenue du Marechal de Lattre de Tassigny, Aix en Provence 13090, France
| | - Giacomo Serboli
- Obstetrics and Gynaecology Department, Des Escartons Hospital, 24 Av. Adrien Daurelle, Briançon 05100, France
| | - Felicia Joinau-Zoulovits
- Department of Obstetrics and Gynecology, Centre Hospitalier Général de Saint-Denis, 2 Rue du Dr Delafontaine, Saint-Denis 93200, France
| | - Benjamin Merlot
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, 91 Rue de Rivière, Bordeaux 33000, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo)-Middle East Clinic, Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Horace Roman
- Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo), Clinique Tivoli-Ducos, 91 Rue de Rivière, Bordeaux 33000, France; Franco-European Multidisciplinary Endometriosis Institute (IFEMEndo)-Middle East Clinic, Burjeel Medical City, Abu Dhabi, United Arab Emirates
| | - Felice Petraglia
- Obstetrics and Gynaecology, Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy
| | - Christine Lévêque
- Pelvi-Perineal Surgery and Rehabilitation Department, Private Medical Centre Résilience, Bastide d'AXIUM, 31 avenue de Lattre de Tassigny, Aix-en-Provence 13090, France
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Yanagisawa T, Tatematsu N, Asano S, Horiuchi M, Migitaka S, Yasuda S, Itatsu K, Kubota T, Sugiura H. Perioperative decline in isometric knee extension force is a predictor of unplanned readmission within 1 year in patients with colorectal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109673. [PMID: 40009920 DOI: 10.1016/j.ejso.2025.109673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 01/07/2025] [Accepted: 02/01/2025] [Indexed: 02/28/2025]
Abstract
INTRODUCTION Exploring the relationship between perioperative physical function and unplanned readmission (UR) in patients with colorectal cancer (CRC) can aid in rehabilitation interventions. In this study, we aimed to determine whether perioperative physical function is associated with UR within 1 year in patients with CRC. MATERIALS AND METHODS This retrospective cohort study included 155 consecutive patients with CRC who underwent surgery. The outcome was UR within 1 year. Physical function was evaluated through isometric knee extension force (IKEF) and 6-min walk distance. Additionally, the decline ratio of physical function was calculated using the following formula: the decline ratio (%) = ([before discharge - before surgery]/before surgery) × 100. The propensity score-matching strategy was used to adjust for confounders in the relationship between perioperative physical function and UR. Subsequently, the association between perioperative physical function and UR was assessed using the log-lank test and Cox proportional hazards model analysis. RESULTS Of 155 patients, 120 were included in the analysis. A significant difference in the decline ratio of IKEF was observed between patients with and without UR (p = 0.007). After propensity score-matching, 52 patients were matched. In matched patients, the decline in IKEF (decline ratio of IKEF ≤ -18.8 %) was significantly correlated with UR in the log-rank test (p = 0.003) and Cox proportional hazards model analysis (hazard ratio, 9.26; 95 % confidence interval, 1.15, 74.12; p = 0.035). CONCLUSION A decline in IKEF was associated with UR within 1 year in patients with CRC.
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Affiliation(s)
- Takuya Yanagisawa
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan; Faculty of Rehabilitation and Care, Seijoh University, 2-172 Fukinodai, Tokai, Aichi, 476-8588, Japan.
| | - Noriatsu Tatematsu
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan.
| | - Shiho Asano
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan; Department of Rehabilitation, Toyohashi Municipal Hospital, 50 Hachikennishi Aotake-cho, Toyohashi, Aichi, 441-8570, Japan.
| | - Mioko Horiuchi
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Saki Migitaka
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Shotaro Yasuda
- Department of Rehabilitation, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Keita Itatsu
- Department of Surgery, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Tomoyuki Kubota
- Department of Breast Surgery, Kamiiida Daiichi General Hospital, 2-70 Kamiiida-kitamachi, Kita-ku, Nagoya, Aichi, 462-0802, Japan.
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, 1-1-20 Daiko-minami, Higashi-ku, Nagoya, Aichi, 461-8673, Japan.
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Tran KL, Chen A, Yang D, Kwon JJY, Sabiq F, Fels S, Hodgson A, Durham JS, Prisman E. Geometric Study and Clinical Case Series for Mandible Reconstruction With a Single-Piece Scapular Free Flap. Head Neck 2025; 47:1584-1592. [PMID: 39831388 DOI: 10.1002/hed.28063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 11/04/2024] [Accepted: 12/29/2024] [Indexed: 01/22/2025] Open
Abstract
BACKGROUND Virtual surgical planning (VSP) with simple cutting templates could help surgeons preoperatively plan scapula reconstructions in the vertical and horizontal orientations. METHODS Virtually, eight defects were created in ten healthy mandibles and reconstructed with the subject-specific scapula vertically and horizontally. In the clinical series, 15 single-piece scapula mandible reconstructions planned with in-house VSP and guided with simple templates were compared with 15 freehand reconstructions. RESULTS Virtually, the vertical placement outperformed the horizontal placement in dice score (DSC) and Hausdorff-95 for all but one defect. Clinically, the VSP cohort had shorter operative time (386.6 ± 111.6 min vs. 268.9 ± 50.6 min, p = 0.002), fewer tracheostomies (73% vs. 15%, p = 0.002), lower length of hospital stay (16.6 ± 13.5 days vs. 12.2 ± 8.1 days, p = 0.319), and higher complete/partial union to a non-significant degree (78% vs. 100%, p = 0.471). CONCLUSION A single-piece scapula free flap is a versatile option for mandibular reconstruction. VSP has time and cost savings potential and quality of life impact that should be further investigated.
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Affiliation(s)
- Khanh Linh Tran
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Chen
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Yang
- Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jamie Jae Young Kwon
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Farahna Sabiq
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sidney Fels
- Department of Electrical and Computer Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Antony Hodgson
- Department of Mechanical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - James Scott Durham
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Chen L, Yuan S, Xu Q, Cui M, Li P, Liu W, Lin C, Chen W, Chen H, Hu Y, Dai M. Outcomes evaluation of robotic versus laparoscopic pancreaticoduodenectomy: a propensity score matching and learning curve analysis. Surg Endosc 2025; 39:3681-3690. [PMID: 40307469 DOI: 10.1007/s00464-025-11684-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Accepted: 03/14/2025] [Indexed: 05/02/2025]
Abstract
BACKGROUND Limited research has been conducted on the short-term outcomes comparing laparoscopic pancreaticoduodenectomy (LPD) and robotic pancreaticoduodenectomy (RPD), particularly in the post-learning curve stage. This study aims to investigate surgical efficacy and provide clinical practices for selecting suitable techniques between LPD and RPD. METHODS A retrospective study was conducted on consecutive patients who underwent RPD and LPD between April 2016 and December 2023. Baseline characteristics, pathological information, and perioperative data were analyzed. Propensity score matching (PSM) analysis was performed to ensure the comparability of important factors between the groups. RESULTS A total of 277 patients were enrolled in the study, of which 145 underwent RPD. Following PSM, 116 patients were included in each group and baseline characteristics were well matched. The RPD group demonstrated a lower conversion rate to laparotomy (5.2% vs. 18.1%, p = 0.002), reduced blood loss (350 vs. 500 ml, p = 0.031), and a higher rate of R0 resection (91.4% vs. 80.7%, p < 0.05) compared to the laparoscopic group. The incidence of B2-Grade postoperative pancreatic fistula (B2-POPF) was also lower in the RPD group compared to the LPD group (4.3% vs. 11.2%, p = 0.037). Among patients in the post-learning curve stage, perioperative outcomes were similar between the two groups. CONCLUSION RPD offered several advantages over LPD, including lower rates of conversion to open and blood loss, higher rates of R0 resection, and improved POPF outcomes. Other perioperative outcomes were comparable between the two groups. Both techniques appeared feasible and safe in experienced surgeons, though RPD was preferred in complex cases.
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Affiliation(s)
- Lixin Chen
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Shuai Yuan
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Qiang Xu
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Ming Cui
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Pengyu Li
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Wenjing Liu
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Chen Lin
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Weijie Chen
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Haomin Chen
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Ya Hu
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China
| | - Menghua Dai
- Department of General Surgery, Peking Union Medical College and Chinese Academy of Medical Sciences, Peking Union Medical College Hospital (PUMCH), No. 1, Shuai Fu Yuan, Beijing, China.
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De Rose AM, Taliente F, Panettieri E, Moschetta G, Belia F, Ardito F, Giuliante F. Evolving surgical techniques for hepatolithiasis: A retrospective analysis of 164 liver resections at a Western center. Surgery 2025; 182:109330. [PMID: 40179530 DOI: 10.1016/j.surg.2025.109330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2024] [Revised: 02/10/2025] [Accepted: 02/18/2025] [Indexed: 04/05/2025]
Abstract
OBJECTIVE To assess the outcomes of liver resection for primary intrahepatic lithiasis in a Western population, emphasizing the evolution of surgical techniques, including minimally invasive surgery, and their impact on patient outcomes. METHODS We performed a retrospective analysis of 164 patients who underwent liver resection for primary intrahepatic lithiasis at the Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. Data included demographics, surgical techniques, complications, and long-term outcomes. Minimally invasive surgery was introduced and progressively adopted, and its outcomes were compared with open surgery using propensity score matching. This represents the largest Western dataset on liver resection for primary intrahepatic lithiasis published to date. RESULTS Liver resections were predominantly unilateral (96%) and commonly targeted the left liver (65%). Minimally invasive surgery use increased to 60% in the most recent period, showing reduced morbidity and shorter hospital stays compared with open surgery. Postoperative complications included bile fistula (16%) and septic events (30%). Independent risk factors for bile fistula were previous cholangitis (odds ratio, 4.7; P = .006) and major hepatectomy (odds ratio, 7.8; P = .002). Septic complications were associated with previous cholangitis (odds ratio, 2.3; P = .026), bilateral lithiasis (odds ratio, 4.0; P = .010), and major hepatectomy (odds ratio, 3.5; P = .003), with minimally invasive surgery providing a protective effect (odds ratio, 0.34; P = .028). Long-term follow-up revealed a 20% recurrence rate, linked to incomplete intraoperative stone clearance (hazard ratio, 2.645; P = .019) and biliary fistula (hazard ratio, 2.799; P = .016). Cholangiocarcinoma occurred in 6.6%, underscoring the need for surveillance. CONCLUSION Liver resection is an effective, curative treatment for primary intrahepatic lithiasis in Western populations. Minimally invasive surgery advancements significantly improve short-term outcomes, bridging the East-West gap in primary intrahepatic lithiasis management and highlighting the importance of individualized surgical approaches.
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Affiliation(s)
- Agostino Maria De Rose
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Taliente
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Elena Panettieri
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Moschetta
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Belia
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Ardito
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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Waterloos M, Lumen N, Ockrim JL, Falcone M, Kose O, Shenfeld OZ, Vetterlein MW, Greenwell TJ. Diagnostics, reconstructive approaches, and outcomes in female urethroplasty patients. BJU Int 2025; 135:1025-1030. [PMID: 40078036 DOI: 10.1111/bju.16701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2025]
Abstract
OBJECTIVES To gain further understanding of current outcomes regarding urethroplasty for female urethral stricture disease. METHODS The European Association of Urology Section of Genitourinary Reconstructive Surgeons formed the Female Reconstruction Group to enhance multicentric collaboration, and to generate more evidence on the most effective treatment options for female patients with recurrent urethral stricture. Patients were eligible for inclusion if they had a urethral stricture and had undergone one of three reconstructive procedures, namely ventral onlay flap (VOFU), ventral onlay graft (VOGU) or dorsal onlay graft (DOGU) urethroplasty. Outcomes of specific interest were stricture-free survival and prognostic factors. RESULTS Of a total of 165 included patients, the surgical techniques were VOFU, VOGU, DOGU in 17, 115 and 33 patients, respectively. The median follow-up was 29 months. The 2-year stricture-free survival rate was 73%, 86% and 80% in respectively the VOFU, VOGU and DOGU groups, with no significant difference between the groups. Prior radiotherapy (P = 0.015) was identified as an independent predictor for stricture recurrence. CONCLUSION Female urethroplasty is a safe treatment option with excellent patency rates. Mid-term stricture-free survival rate after different types of urethroplasty is encouraging in females.
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Affiliation(s)
- Marjan Waterloos
- Department of Urology, AZ Maria Middelares Gent, Ghent, Belgium
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | | | - Marco Falcone
- Department of Urology, Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
| | - Osman Kose
- Department of Urology, Sakarya University, Sakarya, Turkey
| | - Ofer Z Shenfeld
- Department of Reconstructive and Functional Urology, Shaare Zedek Medical Center, Jerusalem, Israel
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21
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Cerrato C, Antoniou V, Somani BK. Prostatic stents: a systematic review and analysis of functional outcomes and complication rate. Prostate Cancer Prostatic Dis 2025; 28:318-327. [PMID: 39516581 DOI: 10.1038/s41391-024-00915-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 10/20/2024] [Accepted: 10/23/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND This review aims to identify and summarize the current literature on the use of prostatic stents or nitinol devices as minimally invasive techniques for the management of lower urinary tract symptoms (LUTS) resulting from benign prostatic hyperplasia (BPH). METHODS A comprehensive search of the literature was conducted until October 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023474884). RESULTS Thirty-eight articles were included (2618 patients). Generally, the risk of bias was deemed as high or very high. The most frequently investigated stents were the UroLume, followed by the Memokath/Memotherm. The mean age was 72.01 ± 5.6 years, with a mean prostate volume of 48.27 ± 12.8 cc and a mean urethral length of 40.53 ± 9.16 mm. Surgeries were usually performed under local anesthesia. The rates of catheter-free status and complications were 85.2% and 30.83%, respectively. The primary complications included urinary tract infections (17.2%), followed by calcifications (12.6%), irritative symptoms (12.2%), and acute urinary retention (10.4%). During a follow-up period of 12 months, the failure rate intended as stent removal or repositioning was 14.8%. The International Prostate Symptom Score (IPSS) showed an overall improvement of 9.85 points. The mean improvement in maximum flow rate and post-void residual volume were 6.62 ml/sec and 147 ml, respectively. CONCLUSIONS Prostatic stents remain an efficient choice for addressing obstructive symptoms from BPH, offering the advantage of being performed under local anaesthesia, relieving symptoms with good functional outcomes and a low incidence of major complications. Prospective studies are needed to corroborate these results.
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Affiliation(s)
- Clara Cerrato
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Vaki Antoniou
- University Hospital Southampton NHS Trust, Southampton, UK
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22
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Ben Zvi A, Dagan A, Freund MR, Yellinek S, Ben-Haim M, Boaz E. Remnant Gallbladder Cholecystitis After Subtotal Cholecystectomy: Management and Outcome. Am Surg 2025; 91:1006-1009. [PMID: 40156588 DOI: 10.1177/00031348251328493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2025]
Abstract
BackgroundSubtotal cholecystectomy (STC) is a viable alternative for challenging cases of severely acute or chronic inflammation of the gallbladder. However, despite its advantages, patients undergoing STC still face the risk of developing symptomatic gallstones in the remnant gallbladder. In such cases, redo resection of the gallbladder remnant is required, posing some technical challenges. In this report, we share our experience in diagnosing and surgical management of remnant gallbladder cholecystitis.MethodsA retrospective study of all patients admitted to a tertiary care hospital with symptoms directly linked to gallbladder remnant stones from 2018 to 2023 was performed.ResultsSix patients were admitted with symptoms directly linked to gallbladder remnant stones. The median age at presentation was 50 years (IQR 25-75), with median interval between the index surgery and the current presentation of 9.5 months (IQR 3-90). The presentation varied and included stump cholecystitis, cholangitis, Mirizzi syndrome, and liver abscess. All 6 patients underwent laparoscopic redo cholecystectomy, with 1 conversion to open surgery and without major complications. Symptoms resolved in all patients.ConclusionsSymptomatic gallstone disease in remnant gallbladder is rare and requires redo cholecystectomy. According to our limited series, laparoscopic redo cholecystectomy may be feasible and safe.
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Affiliation(s)
- Aviv Ben Zvi
- Department of General Surgery, Sha'are Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Amir Dagan
- Department of General Surgery, Sha'are Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael R Freund
- Department of General Surgery, Sha'are Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shlomo Yellinek
- Department of General Surgery, Sha'are Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Menahem Ben-Haim
- Department of General Surgery, Sha'are Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Elad Boaz
- Department of General Surgery, Sha'are Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Klemm J, Dahlem R, Hartmann M, von Deimling M, Schulz RJ, Klemm D, Janisch F, Shariat SF, Fisch M, Vetterlein MW. Perioperative morbidity of open retroperitoneal lymph node dissection for testicular germ cell tumors: an in-depth single center analysis according to European Association of Urology guidelines of complication reporting and a scoping literature review. Surg Oncol 2025; 60:102228. [PMID: 40378498 DOI: 10.1016/j.suronc.2025.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2025] [Revised: 04/23/2025] [Accepted: 05/08/2025] [Indexed: 05/19/2025]
Abstract
INTRODUCTION Retroperitoneal lymph node dissection (RPLND) is crucial in managing metastatic germ cell tumors (GCTs), particularly post-chemotherapy. Given the long-term survival of these patients, perioperative morbidity is a significant concern. However, data on RPLND morbidity using predefined reporting standards are scarce. This study aims to address this gap by utilizing updated European Association of Urology (EAU) guidelines for standardized complication reporting. PATIENTS AND METHODS A retrospective analysis was conducted on patients who underwent RPLND for GCTs between 2010 and 2022. 30-day complications were extracted from digital charts using a predefined procedure-specific catalog. Complications were graded using the Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI) was calculated for each patient. RESULTS Sixty-nine men underwent RPLND at a median age of 32 years (IQR 25-38). Chemotherapy was administered to 64 patients (93 %), with 48 (70 %) having negative tumor markers. Median tumor diameter was 52 mm (IQR 35-83), and median operative time was 197 min (IQR 128-262). Unilateral template removal was performed in 55 patients (80 %). A total of 157 complications were reported in 66 patients (96 %), with anemia (33 %) and gastrointestinal issues (24 %) being the most common. Five patients (7.2 %) had "major" complications (CDC grade ≥ IIIa), and the median CCI was 12 (IQR 9-23). Using the CCI, the proportion of patients with a "major" complication burden increased to 14 %, compared to 8.5 % by CDC alone. The primary limitation of this study is its retrospective design and the limited 30-day follow-up period. CONCLUSION Most patients experience postoperative complications after RPLND, though severe complications are rare. These findings could improve patient counseling when discussing testicular cancer therapy options.
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Affiliation(s)
- Jakob Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Hartmann
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus von Deimling
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert J Schulz
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - David Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Janisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, United States; Department of Urology, University of Texas Southwestern, Dallas, TX, United States; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; Department of Urology, Semmelweis University, Budapest, Hungary; Research Center for Evidence Medicine, Department of Urology, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Vimalathas P, Gordon EJ, Nieuwsma JA, Meador K, Geevarghese SK. From Moral Injury Vulnerability to Protective Equity: The Voyage Every Surgeon Must Take. Ann Surg 2025; 281:903-905. [PMID: 39692009 DOI: 10.1097/sla.0000000000006607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2024]
Abstract
OBJECTIVE To examine the relationship between moral injury and surgical practice, further explore the concept of protective equity, and understand its role in mitigating the impact of morally injurious events throughout a surgical career. BACKGROUND Moral injury in health care settings has evolved from Jonathan Shay's original definition, modified by Brett Litz and others, to encompass the psychological impact of adverse patient outcomes on medical practitioners. Early career surgeons may be particularly susceptible to moral injury, yet the factors influencing this vulnerability remain poorly understood. METHODS An analysis of existing literature on moral injury in health care, combined with an examination of surgical career trajectories and outcome reporting was conducted. The concepts of protective equity and vulnerability are introduced, defined, and theoretically extrapolated across a surgical career. RESULTS Evidence suggests that surgical complications significantly contribute to moral injury, particularly among early-career surgeons. We propose a model wherein protective equity accumulates over a surgical career, whereas vulnerability follows an M-shaped curve with peaks in early and late careers. CONCLUSIONS Early career surgeons face a precarious imbalance of low protective equity and high vulnerability, especially immediately posttraining. Strategies to address this dynamic include providing: specific education when onboarding faculty, and longitudinal peer support by senior, trained surgeons.
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Affiliation(s)
- Praveen Vimalathas
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Elisa J Gordon
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
- Center for Biomedical Ethics and Society, Vanderbilt University Medical, Nashville, TN
| | - Jason A Nieuwsma
- Integrative Mental Health, Veterans Health Administration
- Department of Psychiatry, University of North Carolina, Chapel Hill
| | - Keith Meador
- Center for Biomedical Ethics and Society, Vanderbilt University Medical, Nashville, TN
- Integrative Mental Health, Veterans Health Administration
- Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN
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Castrillo A, García-Martínez L, Laín A, Giné C, Díaz-Hervás M, López M. Percutaneous Endoscopic Gastrostomy with T-Fasteners versus "Pull Technique": Analysis of Complications. Eur J Pediatr Surg 2025; 35:201-207. [PMID: 38848755 DOI: 10.1055/a-2340-9475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
INTRODUCTION The T-fasteners gastrostomy (T-PEG) has become increasingly popular over recent years as an alternative to the "pull-technique" gastrostomy (P-PEG). This study aimed to compare P-PEG and T-PEG complications. MATERIALS AND METHODS A retrospective observational study of pediatric patients who underwent percutaneous endoscopic gastrostomy (PEG) placement. P-PEG was performed using the standard Ponsky technique and was replaced after 6 months by a balloon gastrostomy under sedation. T-PEG was performed using three percutaneous T-fasteners (that allow a primary insertion of a balloon gastrostomy). The balloon was replaced by a new one after 6 months without sedation. Complications were recorded. RESULTS In total, 146 patients underwent PEG placement, 70 P-PEG and 76 T-PEG. The mean follow-up was 3.9 years (standard deviation = 9.6). Age, weight, and associated comorbidities were comparable (p > 0.05). The overall complications were 17 (24.2%) in the P-PEG group and 16 (21.0%) in the T-PEG group (p > 0.05). P-PEG was associated with more sedation for button replacement (97 vs. 2.6% [p < 0.05]). P-PEG was associated with more early tube dislodgement during the first replacement (7.2 vs. 1.4% [p = 0.092]). Two of the five dislodged gastrostomies in the P-PEG group underwent laparotomy due to peritonitis, whereas the only dislodged gastrostomy in the T-PEG group was solved endoscopically. Altogether, P-PEG was associated with more complications that required urgent endoscopy, laparotomy, or laparoscopy (18.6 vs. 6.6% [p < 0.05]). CONCLUSIONS P-PEG was associated with more sedation, complications during first button replacement, and complications requiring urgent endoscopy, laparotomy, or laparoscopy compared with T-PEG.
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Affiliation(s)
- Alejandra Castrillo
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Laura García-Martínez
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ana Laín
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos Giné
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - María Díaz-Hervás
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Manuel López
- Department of Pediatric Surgery and Urology, Vall d'Hebron University Hospital, Barcelona, Spain
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Morel A, Ouamri Y, Ségaux L, Zaidan L, Moryoussef M, Mulé S, Champy C, Reizine E, Ingels A, Luciani A, Grimbert P, Canouï‐Poitrine F, Matignon M, Pigneur F, Stehlé T. Myosteatosis as a New Risk Factor of Surgical Complications in Kidney Transplant Recipients: A Retrospective Study. J Cachexia Sarcopenia Muscle 2025; 16:e13746. [PMID: 40304205 PMCID: PMC12041939 DOI: 10.1002/jcsm.13746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 12/09/2024] [Accepted: 01/30/2025] [Indexed: 05/02/2025] Open
Abstract
BACKGROUND Computed tomography (CT) scan-defined myosteatosis is a common feature in ESKD patients receiving kidney transplantation (KT) and is associated with mortality after KT. We aimed to explore the impact of myosteatosis and other CT scan based morphometric data on the occurrence of early surgical complications after KT. METHODS We retrospectively measured on an unenhanced cross-sectional CT scan taken at the middle of the third lumbar vertebra performed within the previous year or at the time of KT: surface muscle index (total lumbar cross-sectional muscle area [CSMA] divided by height squared), subcutaneaous adipose tissue index, visceral adipose tissue index and muscle density (MD: mean CT attenuation of CSMA). Vessel to skin distance was the distance between iliac vein and skin. Myosteatosis was defined as MD below age- and sex-specific normal values. Logistic regression models were constructed to identify predictive factor of 90 days postoperative surgical complications with Clavien-Dindo score greater than or equal to 2, CD ≥ 2). RESULTS Among the N = 200 patients, 61.5% were male with a mean age of 54.8 (± 13.8) years and a mean BMI of 25.1 (± 4.4) kg/m2. Sixty patients (30%) developed at least one postoperative complication (CD ≥ 2) in the first 3 months after KT. In two different multivariate analyses, MD (aOR: 0.95 for one Hounsfield unit increase, 95% CI: 0.91-0.99, p = 0.028) and myosteatosis status (aOR: 4.64, 95% CI: 2.18-9.90, p < 0.0001) were the only independent risk factors for postsurgical complication. CONCLUSIONS Myosteatosis is independently associated with the occurrence of CD ≥ 2 postoperative complication within 90 days of surgery.
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Affiliation(s)
- Antoine Morel
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo‐Universitaire “Innovative therapy for immune disorders”CréteilFrance
| | - Yaniss Ouamri
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri‐Mondor, Service d’Imagerie MédicaleCréteilFrance
| | - Lauriane Ségaux
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Groupe Hospitalier Henri‐Mondor/Albert Chenevier, Clinical Epidemiology and Ageing Unit (CEpiA)CréteilFrance
| | - Louai Zaidan
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri‐Mondor, Service d’Imagerie MédicaleCréteilFrance
| | - Michael Moryoussef
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo‐Universitaire “Innovative therapy for immune disorders”CréteilFrance
| | - Sébastien Mulé
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri‐Mondor, Service d’Imagerie MédicaleCréteilFrance
| | - Cécile Maud Champy
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique‐Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri Mondor, Service d’Urologie, Groupe Hospitalier Henri‐Mondor/Albert ChenevierCréteilFrance
| | - Edouard Reizine
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri‐Mondor, Service d’Imagerie MédicaleCréteilFrance
| | - Alexandre Ingels
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique‐Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri Mondor, Service d’Urologie, Groupe Hospitalier Henri‐Mondor/Albert ChenevierCréteilFrance
| | - Alain Luciani
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri‐Mondor, Service d’Imagerie MédicaleCréteilFrance
| | - Philippe Grimbert
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo‐Universitaire “Innovative therapy for immune disorders”CréteilFrance
| | - Florence Canouï‐Poitrine
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Groupe Hospitalier Henri‐Mondor/Albert Chenevier, Clinical Epidemiology and Ageing Unit (CEpiA)CréteilFrance
| | - Marie Matignon
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo‐Universitaire “Innovative therapy for immune disorders”CréteilFrance
| | - Frédéric Pigneur
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri‐Mondor, Service d’Imagerie MédicaleCréteilFrance
| | - Thomas Stehlé
- Université Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Mondor de Recherche Biomédicale (IMRB)CréteilFrance
- Assistance Publique des Hôpitaux de Paris (AP‐HP)Hôpitaux Universitaires Henri Mondor, Service de Néphrologie et Transplantation, Fédération Hospitalo‐Universitaire “Innovative therapy for immune disorders”CréteilFrance
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Hai ZX, Zhao JN, Liu XR, Qu SP, Lv Q, Wang CY. Effects of Planned Stoma Before Neoadjuvant Chemoradiation in Patients With Endoscopically Obstructing Colorectal Cancer. Am Surg 2025; 91:978-983. [PMID: 40114325 DOI: 10.1177/00031348251329482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025]
Abstract
PurposeIn order to investigate whether colorectal cancer (CRC) patients with endoscopic obstruction benefited from a planned stoma before neoadjuvant chemoradiation (nCRT).MethodsPatients who were diagnosed with CRC with endoscopic obstruction at a single clinical center from January 2017 to April 2022 were retrospectively collected. Baseline characteristics and short-term and long-term outcomes were compared between the stoma group and the no stoma group. Statistical analysis was performed using SPSS (version 22.0) software.ResultsA total of 51 CRC patients with endoscopic obstruction were included in this study. Eleven (21.6%) patients received a planned stoma before nCRT, and 40 (78.4%) patients were treated with immediate nCRT. The mean time from diagnosis to nCRT was 30.6 days for the stoma group and 11.9 days for the no stoma group. There was a significant delay in the initiation of nCRT in the stoma group (P < 0.05). In terms of complications, there was a statistical difference between the stoma group and the no stoma group (P < 0.05). Planned stoma before nCRT did not affect survival for patients with endoscopically obstructing CRC (P > 0.05).ConclusionA planned stoma caused delay in nCRT; the no stoma group was more likely to develop perforation or obstruction of the tumor during nCRT. A comprehensive assessment might be needed to determine whether a planned stoma was necessary in CRC patients with endoscopic obstruction.
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Affiliation(s)
- Zhan-Xiang Hai
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun-Nan Zhao
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xu-Rui Liu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shu-Pei Qu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Quan Lv
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chun-Yi Wang
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tomi Y, Kinoshita T, Yura M, Sakamoto N, Fujita T, Tokunaga M, Kinugasa Y. Accuracy of the preoperative estimation of esophageal invasion length of adenocarcinoma of the esophagogastric junction and its discrepancy with the pathological measurement. Surg Today 2025; 55:768-777. [PMID: 39499292 DOI: 10.1007/s00595-024-02955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 10/07/2024] [Indexed: 11/07/2024]
Abstract
PURPOSE The incidence of esophagogastric junction (EGJ) adenocarcinoma has increased worldwide. As the EGJ is located at the boundary between the thoracic and abdominal cavities, the optimal surgical approach is a subject of debate and estimation of the esophageal invasion length (EIL) is an important factor in its selection. METHODS Data from our in-house database were extracted for consecutive patients with Siewert type I, II and III EGJ adenocarcinoma (EIL ≤ 4 cm), who underwent transhiatal or transthoracic surgical resection between 2010 and 2016. The clinical records of these patients were reviewed and the accuracy of EIL estimation and its discrepancy with the pathological measurement were analyzed. RESULTS A total of 82 patients were included in the final analysis. We established that EIL was underestimated in 49 of these patients (59.8%). The mean-distance discrepancy between the preoperative and pathological diagnosis of EIL in the underestimation group was 7.0 mm. Multivariate analysis revealed that submucosal cancer spread was an independent risk factor for underestimation (P < 0.01). The mean length of submucosal cancer spread was longer for undifferentiated histologic type EGJ adenocarcinomas. (P < 0.01). CONCLUSIONS The EIL was underestimated in approximately 60% of EGJ adenocarcinomas requiring surgical treatment. Thus, careful management is necessary, especially for EGJ adenocarcinoma of the undifferentiated histologic type.
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Affiliation(s)
- Yoshiaki Tomi
- Department of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kahiwanoha, Kashiwa, 277-8577, Japan
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
- Department of Surgery, Tojun Hospital, 4-3-4 Hitotsuya, Adachi, Tokyo, 121-0075, Japan
| | - Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kahiwanoha, Kashiwa, 277-8577, Japan.
| | - Masahiro Yura
- Department of Gastric Surgery, National Cancer Center Hospital East, 6-5-1 Kahiwanoha, Kashiwa, 277-8577, Japan
| | - Naoya Sakamoto
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center East, Kashiwa, Japan
| | - Takeo Fujita
- Department of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
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Dohmen S, Recker F, Ivanova Y, Strunk HM, Tonguc T, Ramig O, Thudium M, Stader JM, Conrad R, Essler M, Egger EK, Mustea A, Gortchev GA, Dimitrov D, Marinova M. Ultrasound-guided high-intensity focused ultrasound for symptomatic uterine fibroids: clinical outcome of two European centers. Eur Radiol 2025; 35:3638-3648. [PMID: 39613955 PMCID: PMC12081518 DOI: 10.1007/s00330-024-11230-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 09/10/2024] [Accepted: 10/19/2024] [Indexed: 12/01/2024]
Abstract
OBJECTIVES The aim of this study is to assess the clinical outcome and mid-term efficacy of ultrasound-guided high-intensity focused ultrasound (USgHIFU) as a treatment for symptomatic uterine fibroids at two major European HIFU centers. MATERIALS AND METHODS This bi-center longitudinal clinical study involved the treatment of 100 patients with symptomatic uterine fibroids using USgHIFU (n = 59 in Germany, n = 41 in Bulgaria). Clinical outcomes were evaluated at 6 weeks, 6 months, and 1 year follow-up utilizing the uterine fibroid symptoms-quality of life questionnaire for fibroid-related symptoms and health-related quality of life as well as MRI imaging for determining the fibroid volume. RESULTS The mean fibroid volume reduction rate was 33.2 ± 22.9%, 51.3 ± 24.2%, and 59.1 ± 28.0% at 6 weeks, 6 months, and 1 year, respectively (each p < 0.001). The mean symptom severity score decreased from 43.9 ± 18.8 at baseline to 35.4 ± 18.2 at 6 weeks, 31.1 ± 20.0 at 6 months, and 23.1 ± 14.0 at 1 year (each p < 0.001). The mean QOL score improved from 56.5 ± 23.4 at baseline to 65.4 ± 22.2 at 6 weeks, 72.5 ± 19.5 at 6 months, and 79.4 ± 15.3 at 1 year (each p < 0.001). No major complications were observed, though two patients experienced temporary sciatic nerve irritation following the procedure. Four patients had pregnancies and deliveries without any complications after USgHIFU therapy. CONCLUSION To our knowledge, this is the first longitudinal study conducted in two major European HIFU centers that reveals the clinical efficacy of USgHIFU ablation on symptomatic uterine fibroids. Our results confirm that USgHIFU is a non-invasive approach with a low risk of complications, offering an innovative treatment option for affected women. KEY POINTS Question To evaluate mid-term clinical efficacy and safety of US-guided high-intensity focused ultrasound (HIFU) for treating symptomatic uterine fibroids and patient outcomes across two European centers. Findings US-guided HIFU treatment resulted in significant fibroid volume reduction (up to 59.1% after 1 year) improving symptoms and quality of life with no major complications. Clinical relevance This prospective longitudinal study provides preliminary data assessing mid-term efficacy and clinical outcomes of ultrasound-guided HIFU. It is shown to be a low-risk, non-invasive treatment option for symptomatic uterine fibroids that reduces fibroid size and improves patients' quality of life.
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Affiliation(s)
- Sara Dohmen
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
- Department of Rаdiology, University Hospital Bonn, Bonn, Germany
| | - Florian Recker
- Department of Gynaecology and Gynaecological Oncology, University Hospital Bonn, Bonn, Germany
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Yoana Ivanova
- St. Marina University Hospital, Medical University Pleven, Pleven, Bulgaria
| | | | - Tolga Tonguc
- Department of Rаdiology, University Hospital Bonn, Bonn, Germany
| | - Olga Ramig
- Department of Rаdiology, University Hospital Bonn, Bonn, Germany
| | - Marcus Thudium
- Department of Anesthesiology, University Hospital Bonn, Bonn, Germany
| | - Judith M Stader
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Muenster, Muenster, Germany
| | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Eva-Katharina Egger
- Department of Gynaecology and Gynaecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Alexander Mustea
- Department of Gynaecology and Gynaecological Oncology, University Hospital Bonn, Bonn, Germany
| | - Grigor A Gortchev
- St. Marina University Hospital, Medical University Pleven, Pleven, Bulgaria
| | - Dobromir Dimitrov
- Department of Surgical Propedeutics/HIFU Center University Hospital St. Marina, Medical University Peleven, Pleven, Bulgaria
| | - Milka Marinova
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany.
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Toppenberg AGL, Plaat RE, Schwandt LQ. Transoral Robotic Surgery in Chronic Lingual Tonsillitis: An Observational Cohort Study. Head Neck 2025; 47:1665-1673. [PMID: 39840439 PMCID: PMC12068535 DOI: 10.1002/hed.28074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 12/05/2024] [Accepted: 01/06/2025] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND Chronic lingual tonsillitis (CLT) entails persistent inflammation of the lingual tonsils (LT), presenting in recurrent infections, throat discomfort, dyspnea, dysphagia, and LT hypertrophy. METHODS A retrospective observational study at a nonacademic general hospital described outcomes of CLT patients undergoing base of tongue (BOT) reduction via transoral robotic surgery (TORS). Primary outcomes were changes in patient-reported quality of swallowing and life and were assessed at baseline, 3, 6, and 12 months post-TORS. Secondary outcomes were tonsillitis complaints, LT Friedman grade, and postoperative complications. RESULTS Thirty-three patients were included, 5 patients were lost to follow-up at 6 and 12 months. Improved swallowing experience and enhanced quality of life were observed. Tonsillitis scores decreased significantly (mean 7.8 to 1.65 p < 0.001). LT Friedman grade reduced, with 69.7% achieving grade 0 at 12-months follow-up. Two patients experienced postoperative bleeding. CONCLUSIONS TORS appears effective and safe for treating CLT improving swallowing, and overall quality of life for patients and reducing tonsillitis complaints.
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Affiliation(s)
- Alexandra G. L. Toppenberg
- Department of Otorhinolaryngology – Head and Neck SurgeryFrisius Medical Center, LeeuwardenLeeuwardenThe Netherlands
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Robert E. Plaat
- Department of Otorhinolaryngology – Head and Neck SurgeryFrisius Medical Center, LeeuwardenLeeuwardenThe Netherlands
| | - Leonora Q. Schwandt
- Department of Otorhinolaryngology – Head and Neck SurgeryFrisius Medical Center, LeeuwardenLeeuwardenThe Netherlands
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Zhao Y, Jiang Z, Guo T, Cao M, Zeng J, Zheng R, Sun Y, Yuan G, Li N, Shen G, Lv Q, Ma L, Zhang Y, Zhao H, Li J, Wu L. Secondary Cytoreductive Surgery for Ovarian Cancer With Second Platinum-Sensitive Recurrence: A Multicentre Retrospective Cohort Study. BJOG 2025; 132 Suppl 4:36-44. [PMID: 40275748 DOI: 10.1111/1471-0528.18184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2024] [Accepted: 04/08/2025] [Indexed: 04/26/2025]
Abstract
OBJECTIVE To compare survival outcomes between patients with ovarian cancer with platinum-sensitive recurrence (PSR) who underwent secondary cytoreductive surgery (SCS) at the first recurrence and those who underwent SCS at the second recurrence. DESIGN Multicentre cohort study. SETTING Data were retrospectively collected from five hospitals in China. POPULATION Patients with ovarian cancer who underwent SCS at either the first or second PSR. METHODS Overall survival (OS) and time to second progression (PFS2), calculated from the time of recurrence to the next progression following SCS, were compared between the groups. Postsurgical complications were categorised according to the Clavien-Dindo classification system. MAIN OUTCOME MEASURES OS, PFS2, and postsurgical complications. RESULTS Among the 231 patients included, 175 underwent SCS at the first PSR (Group 1) while 56 underwent SCS at the second PSR (Group 2). Complete resection was achieved in 84.0% of patients in Group 1 and 78.6% in Group 2. Postsurgical complication rates were similar between the groups. The median OS was not reached in Group 1, whereas Group 2 had a median OS of 77.3 months. Patients who underwent SCS at the second PSR had an OS comparable to that of those who underwent SCS at the first PSR. Multivariate analyses revealed that complete resection (hazard ratio [HR] = 0.120, p = 0.002) and optimal resection (HR = 0.228, p = 0.046) were independently associated with improved survival. CONCLUSIONS SCS is a safe and effective treatment for patients with platinum-sensitive recurrent ovarian cancer, regardless of whether it is performed at the first or second recurrence.
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Affiliation(s)
- Yuxi Zhao
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhihao Jiang
- State Key Laboratory of Oncology in South China, Department of Gynecology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Tao Guo
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meiting Cao
- Department of Gynecologic Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jia Zeng
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Gynecology, The First Hospital of China Medical University, Shenyang, China
| | - Rongshou Zheng
- Office of National Central Cancer Registry, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yangchun Sun
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Gynecology, The First Hospital of China Medical University, Shenyang, China
| | - Guangwen Yuan
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guihua Shen
- Department of Obstetrics and Gynecology, National Center of Gerontology/Beijing Hospital, Beijing, China
| | - Qiubo Lv
- Department of Obstetrics and Gynecology, National Center of Gerontology/Beijing Hospital, Beijing, China
| | - Linlin Ma
- Department of Obstetrics and Gynecology, National Center of Gerontology/Beijing Hospital, Beijing, China
| | - Yi Zhang
- Department of Gynecology, The First Hospital of China Medical University, Shenyang, China
| | - Hongwei Zhao
- Department of Gynecologic Oncology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China
| | - Jundong Li
- State Key Laboratory of Oncology in South China, Department of Gynecology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Lingying Wu
- Department of Gynecologic Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Chan AHY, Zhao Y, Tan HL, Chua DW, Ng KYY, Lee SY, Lee JJX, Tai D, Goh BKP, Koh YX. Clinical Outcomes of Neoadjuvant Therapy Versus Upfront Surgery in Resectable Pancreatic Cancer: Systematic Review and Meta-analysis of Latest Randomized Controlled Trials. Ann Surg Oncol 2025; 32:4094-4107. [PMID: 39987384 DOI: 10.1245/s10434-024-16674-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 11/23/2024] [Indexed: 02/24/2025]
Abstract
BACKGROUND Survival and surgical benefits of neoadjuvant treatments (NAT) in resectable pancreatic cancer (RPC) remains unclear. The role of NAT in providing additional benefits to reduce biological aggressiveness and recurrence is worth elucidating. We assessed the latest randomized controlled trials (RCTs). METHODS A systematic review and meta-analysis was performed including trials published from inception to February 2024 to evaluate survival, surgical, and short-term oncological benefits with RCTs for RPC, comparing NAT with upfront surgery. RESULTS Eight RCTs with 982 patients were analyzed. RPC treated with NAT conferred better median disease-free survival (DFS) compared to upfront surgery (HR = 0.66, p = 0.01) with a significantly improved R0 resection (RR = 1.20, p = 0.04) and pN0 rate (RR = 1.68, p < 0.001). These benefits did not translate into overall survival benefits (HR = 0.81, p = 0.06). Postoperative major morbidity and mortality did not differ significantly between treatment approaches. No significant difference was noted in resection rate (RR = 0.95, p = 0.21). However, a significantly lower surgical exploration rate was exhibited in the NAT group (RR = 0.84, p = 0.007). CONCLUSION NAT conferred better DFS with significantly improved R0 resection rate and pN0 rate compared with upfront surgery. Our findings highlight the potential benefits of NAT in enhancing survival, surgical, and short-term oncological outcomes without increasing postoperative risks.
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Affiliation(s)
- Anna Ho Yin Chan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
| | - Yun Zhao
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Darren Weiquan Chua
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
| | - Kennedy Yao Yi Ng
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Suat Ying Lee
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Joycelyn Jie Xin Lee
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - David Tai
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Brian Kim Poh Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Ye Xin Koh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore, Singapore.
- Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
- Division of Surgical Oncology, National Cancer Centre Singapore, Singapore, Singapore.
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Choi YJ, Jeon SM, Yu S, Jo HS, Kim DS, Yu YD. Initial experience of robotic-assisted pancreaticoduodenectomy using the da Vinci SP system. Surg Endosc 2025; 39:4017-4025. [PMID: 40263137 DOI: 10.1007/s00464-025-11695-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 03/30/2025] [Indexed: 04/24/2025]
Abstract
BACKGROUND In the era of robotic surgery, pancreatoduodenectomy (PD) has been performed with the Xi system. Recently, the advent of the SP system has allowed more minimally invasive surgery with reduced ports. We have applied the SP system to perform PD. We aimed to report our initial experience of robotic-assisted PD using the da Vinci single-port (SP) system to demonstrate the safety and feasibility of this platform. METHODS We retrospectively reviewed patients who underwent robotic-assisted pylorus-preserving pancreaticoduodenectomy (PPPD) between 2021 and 2023 at a single center. Robotic PPPD was performed using the da Vinci SP system with either four or two additional ports, utilizing a laparoscopic hybrid technique. RESULTS Of the 14 patients, six underwent the SP + 4 ports approach, and eight underwent the SP + 2 ports approach. The mean patient age was 60.2 years, and the mean body mass index was 22.5 ± 2.3 kg/m2. The mean operative time was 444.29 ± 59.6 min, with an estimated intraoperative blood loss of < 500 ml in all cases. There were two cases of postoperative pancreatic fistula and one case of bile leak. CONCLUSION Robot-assisted PPPD using the da Vinci SP system is safe and feasible, with acceptable perioperative outcomes. We also report a successful SP + 2 port PPPD. Owing to the unique structure of the da Vinci SP system, our method has the potential to reduce the number of trocar sites and provide a gateway for better, minimally invasive surgeries. However, further reports assessing the experience are essential to establish its wide clinical practice.
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Affiliation(s)
- Yoo Jin Choi
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, 73 Goryeodae-Ro Seongbuk-Gu, Seoul, 02841, Korea
| | - Su Min Jeon
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, 73 Goryeodae-Ro Seongbuk-Gu, Seoul, 02841, Korea
| | - Sehyeon Yu
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, 73 Goryeodae-Ro Seongbuk-Gu, Seoul, 02841, Korea
| | - Hye-Sung Jo
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, 73 Goryeodae-Ro Seongbuk-Gu, Seoul, 02841, Korea
| | - Dong-Sik Kim
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, 73 Goryeodae-Ro Seongbuk-Gu, Seoul, 02841, Korea
| | - Young-Dong Yu
- Department of Surgery, Division of HBP Surgery & Liver Transplantation, Korea University College of Medicine, 73 Goryeodae-Ro Seongbuk-Gu, Seoul, 02841, Korea.
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Li X, Li Q, Yang F, Gao E, Lin L, Li Y, Hu X, Song X, Duan L. Survival Outcomes of Neoadjuvant Therapy Followed by Sleeve Lobectomy in Non-Small Cell Lung Cancer. Ann Thorac Surg 2025; 119:1185-1195. [PMID: 39426557 DOI: 10.1016/j.athoracsur.2024.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 09/04/2024] [Accepted: 09/23/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND This study was carried out to evaluate the impact of neoadjuvant therapy on long-term survival of patients with non-small cell lung cancer undergoing sleeve lobectomy. METHODS A total of 613 patients were retrospectively analyzed, including 124 who received neoadjuvant therapy. A 1:2 propensity score matching method was adopted to create a balanced cohort including 110 with neoadjuvant therapy and 169 without neoadjuvant therapy. Survival was estimated by the Kaplan-Meier method and compared with the log-rank test and Cox proportional hazards models. RESULTS Neoadjuvant therapy was associated with improved 3-year disease-free survival (DFS; 73.6% vs 54.4%; P < .001) and overall survival (OS; 80.9% vs 63.9%; P = .002) compared with patients without neoadjuvant therapy. Moreover, neoadjuvant chemoimmunotherapy significantly improved 3-year DFS (85.3% vs 54.4%; P = .001) and OS (88.2% vs 63.9%; P = .006), whereas chemotherapy alone did not show a significant effect. Multivariable Cox regression analysis revealed neoadjuvant therapy to be an independent predictor of improved DFS and OS, whereas pathologic N2 stage was independently associated with poorer DFS and OS. Furthermore, subgroup analysis in the neoadjuvant arm revealed that pathologic N2 stage is an independent risk factor for DFS (hazard ratio, 3.830; 95% CI, 1.687-8.694; P = .001), and achieving major pathologic response is an independent predictor for better OS (hazard ratio, 0.120; 95% CI, 0.015-0.933; P = .043). CONCLUSIONS Neoadjuvant therapy before sleeve lobectomy significantly increased DFS and OS in locally advanced non-small cell lung cancer. Sleeve lobectomy is advisable after neoadjuvant therapy, especially following chemoimmunotherapy.
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Affiliation(s)
- Xiang Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Fujun Yang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Erji Gao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lei Lin
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yaqiang Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuefei Hu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiao Song
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang Duan
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
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Ram S, Lavie M, Assouline A, Gilboa I, Yacobi LM, Ariel G, Michaan N, Grisaru D, Laskov I. Identifying risk factors for postoperative complications following staging surgery for endometrial cancer. J Gynecol Obstet Hum Reprod 2025; 54:102949. [PMID: 40185228 DOI: 10.1016/j.jogoh.2025.102949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2025] [Revised: 03/17/2025] [Accepted: 03/30/2025] [Indexed: 04/07/2025]
Abstract
INTRODUCTION Endometrial cancer is the most prevalent gynecologic malignancy, with increasing incidence primarily due to aging, obesity, and diabetes. Surgical staging, a gold standard treatment involving total hysterectomy with bilateral salpingo-oophorectomy and sentinel lymph node biopsy, presents various postoperative complications influencing patient outcomes and healthcare costs. This study aims to identify risk factors associated with short term postoperative complications following staging surgery for endometrial cancer. METHODS A retrospective cohort study conducted at a single university-affiliated medical center from January 2016 to December 2022. Data were extracted from electronic medical records, including patient demographics and comorbidities, surgical data including intraoperative complications, tumor histology and surgical outcomes. A composite adverse post operative outcome was defined, including need for post-operative blood transfusion, antibiotic treatment, Intensive care unit (ICU) admission, prolonged hospitalization, and 30-day readmission rates. RESULTS Among 495 patients, 34.3 % experienced at least one postoperative complication. Significant factors associated with complications included age over 65, ASA score >2, pathologic grade 3 tumours, and non-minimally invasive surgical approaches. Prolonged operative time (>75th percentile) and intraoperative complications also correlated with increased risk. Conversely, higher preoperative haemoglobin levels were protective against complications. CONCLUSION The findings emphasize the importance of recognizing risk factors such as advanced age, elevated ASA scores, and specific tumor characteristics to enhance preoperative assessments and surgical planning. By tailoring surgical approaches and optimizing patient preparation, healthcare providers may improve postoperative outcomes and reduce complications for patients undergoing staging surgery for endometrial cancer.
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Affiliation(s)
- Shai Ram
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Lavie
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - Anna Assouline
- Department of Statistics and Data Science, Hebrew University, Jerusalem, Israel
| | - Itamar Gilboa
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Lihie Maltz Yacobi
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gal Ariel
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Nadav Michaan
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Grisaru
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ido Laskov
- Lis Hospital for Women, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Jensen SAMS, Lauridsen SV, Fonnes S, Rosenberg J, Tønnesen H. Effect of tailored, intensive prehabilitation for risky lifestyles before ventral hernia repair on postoperative outcomes, health, and costs - study protocol for a randomised controlled trial (STRONG-Hernia). PLoS One 2025; 20:e0324002. [PMID: 40435308 PMCID: PMC12118980 DOI: 10.1371/journal.pone.0324002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2025] [Accepted: 04/14/2025] [Indexed: 06/01/2025] Open
Abstract
BACKGROUND A substantial untapped potential for risk reduction may be fulfilled by applying intensive lifestyle interventions targeting the co-existing risky lifestyle factors Smoking, Nutrition (both malnutrition and obesity), risky Alcohol intake, and Physical inactivity (SNAP) before surgery. This trial will compare the effect of combined and individually tailored prehabilitation with standard care on postoperative outcomes, health, and cost-effectiveness in short and long term in participants undergoing ventral hernia repair. An interview study will be nested within the randomised trial. METHODS The study is a multicenter, parallel-group, superiority randomised clinical trial. A total of 400 adult participants undergoing ventral hernia repair with ≥1 SNAP factor will be allocated to the individually tailored STRONG programme or standard care. The STRONG programme is initiated at least four weeks prior to surgery and consists of six sessions. It is delivered as one session a week, approximately, and includes patient education, motivational, and pharmaceutical supports. The primary outcome is postoperative complications requiring treatment within 30 days. Secondary outcomes address other surgical outcomes, changes in lifestyle, health, and cost-effectiveness. Follow-up takes place after 6 weeks (the end of intervention), at surgery, and 30 days, 90 days, and 6 months after surgery, respectively. Long-term data on health and costs will be obtained from nationwide registries after two years. Eligible trial participants will be invited to a semi-structured interview study at baseline. Their reflections on the STRONG programme and the choice of participating in the trial or not will be explored. DISCUSSION Many patients have multiple SNAP factors adding to the risk of complications related to surgery. As these are modifiable, prehabilitation may be an area with great potential for risk reduction. Nevertheless, no well-acknowledged and evidence-based strategies exist in the preoperative period. The STRONG programme is tailored specifically to the individual patient's preidentified needs including up to all five common risky SNAP factors and may tap into the large unused potential for risk reduction. Overall, the study will add important new knowledge on the effect of individually tailored prehabilitation on complications and other important outcomes in elective surgery, and also clarify if this intervention will have long-lasting implications. TRIAL REGISTRATION www.clinicaltrials.gov (NCT06611462).
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Affiliation(s)
- Sofie Anne-Marie Skovbo Jensen
- WHO-CC/Clinical Health Promotion Centre, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Surgery, Centre for Perioperative Optimization, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Susanne Vahr Lauridsen
- WHO-CC/Clinical Health Promotion Centre, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Surgery, Centre for Perioperative Optimization, University of Copenhagen, Herlev Hospital, Herlev, Denmark
- Department of Urology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Siv Fonnes
- Department of Surgery, Centre for Perioperative Optimization, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Jacob Rosenberg
- Department of Surgery, Centre for Perioperative Optimization, University of Copenhagen, Herlev Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne Tønnesen
- WHO-CC/Clinical Health Promotion Centre, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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Wang Z, Xing Q, Gao X, Qiu M, Zhang L. A comparative study of transurethral 450 nm DiLVP and 1470 nm DiLEP in the treatment of benign prostatic hyperplasia. Lasers Med Sci 2025; 40:246. [PMID: 40434506 PMCID: PMC12119703 DOI: 10.1007/s10103-025-04502-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 05/22/2025] [Indexed: 05/29/2025]
Abstract
To compare the clinical effects of 450 nm diode laser vaporisation of the prostate (450 nm DiLVP) and 1470 nm diode laser enucleation of the prostate (1470 nm DiLEP) in the surgical treatment of benign prostate hyperplasia (BPH). BPH patients who were treated with 450 nm DiLVP or 1470 nm DiLEP in the Department of Urology of Jinan Central Hospital from November in 2021 to November in 2023 were selected for retrospective analysis. The assessment indexes included: (1) Preoperative general information; (2) Perioperative indicators; (3) Postoperative follow-up indicators(followed up at 1 and 3 months after surgery). A total of 128 BPH patients were included in the study, 63 in the experimental group with 450 nm DiLVP and 65 in the control group with 1470 nm DiLEP. There was no significant difference in the baseline information between the two groups (P > 0.05). Compared with the 1470 nm DiLEP group, the operation time, the laser energy consumption and bladder irrigation time were significantly reduced in the 450 nm DiLVP group (P < 0.001). At 3 months postoperatively, Qmax relief was significant in the 1470 nm DiLEP group (P = 0.023). (1) Perioperatively, compared with the 1470 nm DiLEP, 450 nm DiLVP has shorter operation time, irrigation time, and laser energy consumption; (2)Postoperative follow-up: 450 nm DiLVP and 1470 nm DiLEP have similar efficacy in improving BPH symptoms; 1470 nm DiLEP may have greater impact on max urinary flow rate in long-tem follow-up, which needs further verification.
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Affiliation(s)
- Zhichao Wang
- The Fourth Affiliated Hospital of Soochow University, Medical Center of Soochow University, Suzhou Dushu Lake Hospital, Suzhou, China.
- Jinan Central Hospital, Shandong University, Jinan, China.
| | - Qingfei Xing
- Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xinghua Gao
- Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Mengzhen Qiu
- Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Longyang Zhang
- Jinan Central Hospital, Shandong University, Jinan, China.
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Okazoe Y, Yanagimoto H, Tsugawa D, Akita M, Mizumoto T, Yoshida T, So S, Ishida J, Urade T, Nanno Y, Fukushima K, Gon H, Komatsu S, Asari S, Toyama H, Kido M, Fukumoto T. Using the comprehensive complication index to assess the impact of Global Leadership Initiative on Malnutrition (GLIM)-defined malnutrition on postoperative complications after resection for biliary tract cancer. Surg Today 2025:10.1007/s00595-025-03051-9. [PMID: 40423807 DOI: 10.1007/s00595-025-03051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 03/25/2025] [Indexed: 05/28/2025]
Abstract
PURPOSE The Global Leadership Initiative on Malnutrition (GLIM) criteria, proposed in 2018, provide universal diagnostic standards for malnutrition, a known risk factor for postoperative complications in patients with various cancers. However, its impact on surgery for biliary tract cancer (BTC) remains unclear. This study evaluates the relationship between GLIM-defined malnutrition and postoperative complications after resection for BTC. METHODS The subjects of this retrospective study were patients who underwent pancreaticoduodenectomy or major hepatectomy with extrahepatic bile duct resection for BTC between January, 2013 and December, 2021. The comprehensive complication index (CCI), an indicator of postoperative complications, was calculated based on the total number and severity of postoperative complications. RESULTS GLIM-defined malnutrition was diagnosed in143 (71.1%) of the total 201 patients. The median CCI was significantly higher in the GLIM-defined malnutrition group than in the non-malnutrition group (37.2 vs. 28.3; P < 0.001). Multivariate logistic regression analysis revealed that GLIM-defined malnutrition (odds ratio 2.87 [95% confidence interval 1.38-5.96], P = 0.005) and intraoperative blood loss > 1,000 mL (odds ratio 3.77 [95% confidence interval 1.06-13.47], P = 0.041) were independent predictors of high morbidity (CCI ≥ 37.1). CONCLUSION Preoperative GLIM-defined malnutrition was closely associated with increased postoperative complications in patients who underwent resection for BTC.
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Affiliation(s)
- Yuki Okazoe
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Hiroaki Yanagimoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan.
| | - Daisuke Tsugawa
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Masayuki Akita
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Takuya Mizumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Toshihiko Yoshida
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Shinichi So
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Jun Ishida
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Takeshi Urade
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Yoshihide Nanno
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Kenji Fukushima
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Hidetoshi Gon
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Shohei Komatsu
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Sadaki Asari
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Masahiro Kido
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-Cho, Chuo-Ku, Kobe City, Hyogo, 650-0017, Japan
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Mattia A, Lorenzo C, Mirko P, Paolo G, Marco F. Reliability of suprapubic pedicled phalloplasty to address genital gender-affirming surgery in transgender men: A single-center cohort analysis. Andrology 2025. [PMID: 40424205 DOI: 10.1111/andr.70074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 05/13/2025] [Accepted: 05/19/2025] [Indexed: 05/29/2025]
Abstract
BACKGROUND Over the years, numerous techniques have been used to address genital gender-affirming surgery (GGAS) in transgender men. Among the proposed surgical options to address TPC in transgender men, suprapubic pedicled phalloplasty (SPP) has rarely been considered in the current scientific literature. OBJECTIVES The aim of the study is to report the surgical outcomes of the first step of suprapubic pedicled phalloplasty (SPP)-with or without urethral lengthening (UL)-evaluating possible risk factors affecting the incidence of complications. METHODS The study was conducted as a retrospective, single-center analysis at a regional tertiary referral center. Between April 2006 and August 2024, 40 transgender men underwent GGAS at our center. GGAS was conducted as a multistage procedure, consisting of (1) SPP (2) eventual radial artery-based forearm free-flap urethroplasty, (3) glans sculpting, join-up, vaginectomy and scrotoplasty, and (4) penile prosthesis implantation. Surgery time, intra- and postoperative complications, and hospital stay were selected as variables for surgical outcomes. RESULTS The median operative time was 130 min (111-158 min). Partial necrosis of the phallus was detected in 4 cases (10.5%) it was easily managed through a minor outpatient procedure. The median length loss after debridement was 1.3 cm (0.5-2 cm), without significant impact on the final length. A total loss of the neophallus occurred in a single case (2.5%) and required a staged salvage TPC. In the present series, only 14 patients (35%) opted for urethral reconstruction: 8 (20%) required a perineostomy, 4 (10%) underwent radial artery urethroplasty (RAU), while the remaining 5% required an additional metoidioplasty with urethral lengthening, ensuring that the clitoris was not incorporated into the neophallus during penile construction. Univariate and multivariate analyses failed to highlight any possible risk factors influencing the incidence of postoperative complications. The lack of a comparison group or randomization, the limited follow-up, and the absence of patient-reported outcome analysis are the main limitations of our study. CONCLUSION Our evidence suggests that SPP is a reliable and technically accessible option for GGAS in transgender men, particularly when microsurgery is contraindicated. The technique offers the advantage of accommodating the patient's needs for urethral lengthening, simplifying the surgical process, and reducing operative times. While vascular complications may occur relatively frequently, they are mostly minor and can be managed with simple outpatient procedures.
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Affiliation(s)
- Anfosso Mattia
- Center for Reproductive Medicine and Andrology/Clinical and Surgical Andrology, University Hospital of Münster, Münster, Germany
| | - Cirigliano Lorenzo
- Urology Clinic - A.O.U. "Cittàdella Salute e della Scienza"- Molinette Hospital, University of Turin, Turin, Italy
| | - Preto Mirko
- Urology Clinic - A.O.U. "Cittàdella Salute e della Scienza"- Molinette Hospital, University of Turin, Turin, Italy
| | - Gontero Paolo
- Urology Clinic - A.O.U. "Cittàdella Salute e della Scienza"- Molinette Hospital, University of Turin, Turin, Italy
| | - Falcone Marco
- Urology Clinic - A.O.U. "Cittàdella Salute e della Scienza"- Molinette Hospital, University of Turin, Turin, Italy
- Neurourology Clinic - A.O.U. "Città della Salute e della Scienza" - Unità Spinale Unipolare, Turin, Italy
- Urology Department, Medical Faculty, Biruni University, Istanbul, Turkey
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Hatanaka T, Kakizaki S, Hiraoka A, Tada T, Kariyama K, Itobayashi E, Tsuji K, Ishikawa T, Toyoda H, Koshiyama Y, Naganuma A, Kanayama Y, Tanaka K, Tada F, Ohama H, Nouso K, Nakamura S, Kumada T, Real‐life Practice Experts for HCC (RELPEC) Study Group. Comparison of Surgical Resection and Radiofrequency Ablation for Early-Stage HCC Patients With Child-Pugh Class B. J Gastroenterol Hepatol 2025. [PMID: 40420725 DOI: 10.1111/jgh.17025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2025] [Revised: 05/03/2025] [Accepted: 05/18/2025] [Indexed: 05/28/2025]
Abstract
AIM The aim of this study is to compare the clinical outcomes of surgical resection (SR) and radiofrequency ablation (RFA) in patients with early-stage hepatocellular carcinoma (HCC) and Child-Pugh Class B liver function. METHODS Among 7210 treatment-naïve HCC patients in our group between 2000 and 2021, this retrospective study included 41 and 456 patients who underwent SR and RFA, respectively. All included patients had Child-Pugh Class B liver function, an Eastern Cooperative Oncology Group (ECOG) performance status of ≤ 2, and early-stage HCC (≤ 3 nodules, ≤ 3 cm in diameter). To adjust for baseline imbalances between the two groups, we applied inverse probability of treatment weighting (IPTW) analysis. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier survival analysis and Cox regression models. RESULTS Before IPTW analysis, significant differences were observed between the SR and RFA groups in Child-Pugh scores (p = 0.003), total bilirubin levels (p = 0.04), prothrombin time (p = 0.003), and the presence of ascites (p = 0.01), all of which were more favorable in the SR group. The SR group also had fewer tumors (p = 0.03) and larger tumor diameters (p = 0.002) compared to the RFA group. In the entire cohort, there were no significant differences in RFS between the two groups (p = 0.6). After IPTW analysis, the differences remained statistically nonsignificant (p = 0.4). Regarding OS, the difference was not observed between the two groups in the entire cohort (p = 0.5) and in the IPTW cohort (p = 0.9). CONCLUSION RFA appears to be as effective as SR in patients with early-stage HCC with the liver function of Child-Pugh Class B.
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Affiliation(s)
- Takeshi Hatanaka
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Satoru Kakizaki
- Department of Clinical Research, NHO Takasaki General Medical Center, Takasaki, Japan
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Toshifumi Tada
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuya Kariyama
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | - Ei Itobayashi
- Department of Gastroenterology, Asahi General Hospital, Asahi, Japan
| | - Kunihiko Tsuji
- Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yuichi Koshiyama
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Atsushi Naganuma
- Department of Gastroenterology, NHO Takasaki General Medical Center, Takasaki, Japan
| | - Yuki Kanayama
- Department of Gastroenterology, Gunma Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Kazunari Tanaka
- Center of Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Fujimasa Tada
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hideko Ohama
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Kazuhiro Nouso
- Department of Gastroenterology, Okayama City Hospital, Okayama, Japan
| | - Shinichiro Nakamura
- Department of Internal Medicine, Japanese Red Cross Society Himeji Hospital, Himeji, Japan
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Cassaro F, Impellizzeri P, Montalto AS, D'Antoni S, Bagnara V, Romeo C, Arena S. Comparative Outcomes of Laparoscopic, Retroperitoneoscopic, and One-Trocar-Assisted-Pyeloplasty in Pediatric Ureteropelvic Junction Obstruction: A Scoping Review of Literature. J Laparoendosc Adv Surg Tech A 2025. [PMID: 40420547 DOI: 10.1089/lap.2025.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2025] Open
Abstract
Introduction: Ureteropelvic junction obstruction (UPJO) is a common condition in pediatric urology, with various surgical techniques employed for treatment, including laparoscopic pyeloplasty (LP), retroperitoneoscopic pyeloplasty (RP), and One-Trocar-Assisted-Pyeloplasty (OTAP). This review compares intraoperative and postoperative complications, recurrence rates, and outcomes among these methods. Materials and Methods: A scoping review of the literature from 2000 to 2024 was conducted, analyzing studies on LP, RP, and OTAP in pediatric UPJO patients. We included studies in English and excluded those involving other surgical techniques and mixed adult-pediatric cases. Data extracted from eligible studies included the number of cases, patient age, operative time, complications, recurrence rates, and conversion to open surgery. Results: A review of 81 studies involving 3549 pediatric patients compared three surgical techniques: LP (2719 patients), RP (399 patients), and OTAP (476 patients). OTAP had the highest rates of minor intraoperative complications (8%) and conversions to open surgery (7.6%). LP and RP showed lower intraoperative complication rates (1.8% and 4.3%) and conversion rates (0.81% and 4.24%). Postoperative complications and recurrence rates were similar across all techniques, with OTAP having the fewest minor postoperative complications (0.8%) and the shortest surgical times (111.5 minutes). Conclusions: LP, RP, and OTAP are all effective treatments for pediatric UPJO, with comparable success rates and low recurrence rates. OTAP offers fewer minor postoperative complications in confront of LP and faster surgical times but has a higher conversion rate. LP and RP are more suitable for older patients, whereas OTAP seems to be more appropriate for younger patients.
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Affiliation(s)
- Fabiola Cassaro
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Pietro Impellizzeri
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Angela Simona Montalto
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Santi D'Antoni
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Vincenzo Bagnara
- Paediatric Surgery Unit, Polyclinic G.B. Morgagni, Catania, Italy
| | - Carmelo Romeo
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
| | - Salvatore Arena
- Unit of Pediatric Surgery, Department of Human Pathology of Adult and Childhood "Gaetano Barresi", University of Messina, Messina, Italy
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Mazzola M, Zironda A, Giani A, Bellomo C, Bernasconi DP, Calcagno P, Paterno M, Ferrari G. Biodegradable internal stent versus no stent for patients at increased risk of pancreatic fistula after pancreaticoduodenectomy: a single-center propensity score matching analysis. Updates Surg 2025:10.1007/s13304-025-02252-8. [PMID: 40418425 DOI: 10.1007/s13304-025-02252-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2025] [Accepted: 05/07/2025] [Indexed: 05/27/2025]
Abstract
Postoperative pancreatic fistula (POPF) is considered the main trigger for further dangerous sequelae following pancreaticoduodenectomy (PD). This study compared the short-term postoperative results of patients at increased risk of POPF undergoing pancreaticojejunal (PJ) anastomosis with and without internal biodegradable stent. Data from a prospectively collected database of patients undergoing PD at increased risk of POPF (ISGPS type B, C, D) between January 2017 and June 2023 were retrieved and analyzed, comparing the postoperative outcomes of those with and without an internal biodegradable stent, using a propensity score matching analysis. In the study period, 183 patients were selected. After matching, a total of 59 with stent (SG) and 59 without (NSG) were compared. The overall POPF rate was 21.2%. No difference was seen between the groups regarding POPF and other postoperative outcomes. A higher rate of biochemical leakage in the SG (53.1% vs 31.9%, p 0.033) was found among patients in the type D class of risk. The present study showed no significant difference in terms of 90-day overall, severe and pancreas-specific postoperative complications among patients at increased risk of POPF who received PJ anastomosis with and without internal biodegradable stent.
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Affiliation(s)
- Michele Mazzola
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
| | - Andrea Zironda
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Alessandro Giani
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Carlotta Bellomo
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Davide Paolo Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre-B4, School of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Advanced Training Research and Development, Piazza Ospedale Maggiore, 3, ASST Grande Ospedale Metropolitano Niguarda, 20162, Milan, Italy
| | - Pietro Calcagno
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Michele Paterno
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Giovanni Ferrari
- Division of Minimally-Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy
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Eltyeb HA, Mohamedahmed AYY, Mills GA, Khan J. Left colectomy for diverticular disease: systematic review and meta-analysis comparing robotic and laparoscopic resections. Tech Coloproctol 2025; 29:121. [PMID: 40413682 DOI: 10.1007/s10151-025-03155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/05/2025] [Indexed: 05/27/2025]
Abstract
BACKGROUND Around 50% of people aged 60 years and above are affected by diverticular disease, and 25% of these individuals will require surgical intervention. Our objective is to compare the results of left colonic resection for sigmoid diverticular disease using both robotic and laparoscopic approaches. Our primary aim is to conduct a meta-analysis while investigating the rates of conversion to open surgery, stoma and complications between the two methods. METHODOLOGY A systematic review was conducted following the PRISMA guidelines. A meta-analysis was performed using RevMan Version 5.4 software. The random-effect model was employed to pool dichotomous outcomes and estimate risk and odds ratios (OR). RESULTS Eight studies were thought to fulfil the eligibility criteria: 1892 patients (49.2%) had robotic surgery, and 1952 patients (50.84%) underwent a laparoscopic approach. There were fewer conversions to open surgery in the robotic group when compared to the laparoscopic group (P < 0.00001), a lower rate of postoperative ileus (P = 0.005), shorter length of stay (mean difference (MD) 0.18 P = 0.003) and fewer morbidities (P = 0.002). There were similar rates of stoma formation (4.7%, P = 1.00), anastomotic leak (2.6%, P = 0.85) and mortality (0.3% vs 0.2%, P = 0.59). The operative time was shorter in the robotic approach, although the difference was not significant (P = 0.47). CONCLUSION Robotic surgery is feasible for diverticular disease compared to laparoscopic left colectomy. Our study observed a reduction in the conversion to open rate, reduced morbidity, and less ileus while demonstrating similar rates of stoma formation, anastomotic leak, and mortality. However, more high-quality research needs to be conducted to investigate this further. The study is registered in Prospero (reg # CRD42023440509).
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Affiliation(s)
- H A Eltyeb
- Department of General Surgery, Queen Elizabeth Hospital, Queen Elizabeth Ave, Gateshead, NE9 6SX, UK.
- Faculty of Science, University of Portsmouth, St Michael's Building, Portsmouth, PO1 2DT, UK.
| | - A Y Y Mohamedahmed
- University Hospitals of Derby and Burton, Uttoxeter Road Derby Derbyshire, Burton on Trent, DE22 3NE, UK
| | - G A Mills
- Faculty of Science, University of Portsmouth, St Michael's Building, Portsmouth, PO1 2DT, UK
| | - J Khan
- Faculty of Science, University of Portsmouth, St Michael's Building, Portsmouth, PO1 2DT, UK
- Portsmouth Hospitals University NHS Trust, Southwick Hill Road Cosham, Portsmouth, PO6 3LY, UK
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Studer AM, Krebs J, Brambs C, Christmann-Schmid C. The Learning Curve for Laparoscopic Sacrocolpopexy Based on Dissection Skills if Structured Teaching and Standardized Surgery are Applied. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2025; 16:917-925. [PMID: 40438225 PMCID: PMC12118485 DOI: 10.2147/amep.s513699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2025] [Accepted: 05/08/2025] [Indexed: 06/01/2025]
Abstract
Purpose Teaching is an important but time- and resource-consuming process. Therefore, it is important to optimize and structure it effectively. The aim of this study was to evaluate if dry-lab suture and knotting training lead to stable theater performance. Consequently, the learning curve is supposed to be ascribed to only on-patient trainable skills like tissue preparation. Patients and Methods To test this hypothesis, a structured training and stepwise surgical program were implemented to perform laparoscopic sacrocolpopexy (SCP) for urogynecological fellows adapting existing literature.The program was structured and recorded as following: dry-lab training weekly for knotting and suturing skills, assisting 20 SCP, stepwise overtaking defined steps under supervision including preparation of the dissecting planes anteriorly, posteriorly and at the level of the promontory, mesh fixation and retroperitoneal closure. All women opting for sacrocolpopexy as pelvic organ prolapse repair and being treated by one designated fellow were included without any specific selection. The only exclusion criterium was repeat sacrocolpopexy. Results Within 45 procedures, the fellow reached a plateau of 80 minutes surgical time for SCP (excluding port-entry/-closure or concomitant interventions like hysterectomy or adnexectomy), with a complication rate of 11.1%. A high subjective and objective success rate was reported post-operatively. Differences in overall time were clearly correlated with overall dissection time. Conclusion We demonstrated that a stepwise, structured, and standardized intraoperative surgical program facilitated safe and efficient laparoscopic SCP performance in the analyzed situation. Off-patient trainable skills like suturing and knotting led to consistent mesh fixation times from the start of the qualification process and variation arose due to in situ learnable factors.
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Affiliation(s)
| | - Jörg Krebs
- Neuro-Urology Research Group, Swiss Paraplegics Research, Nottwil, Switzerland
| | - Christine Brambs
- Department of Urogynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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Bandini M, Joshi P, Bafna S, Yepes C, Alrefaey A, Longoni M, Montorsi F, Kulkarni S. Establishing the role of single-stage preputial spiral graft urethroplasty for panurethral stricture. BJU Int 2025. [PMID: 40411315 DOI: 10.1111/bju.16796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2025]
Abstract
OBJECTIVE To assess whether single-stage preputial spiral graft urethroplasty (PSGU) minimises panurethral stricture (PUS) recurrence, which often result from traditional multiple grafting for anterior urethral strictures exceeding 10 cm. PATIENTS AND METHODS We prospectively collected 114 patients with PUS treated with single-stage PSGU across five centres in India, Colombia, Egypt, and Italy since May 2021. Preoperative assessment included physical examination, medical history, uroflowmetry, International Prostate Symptom Score (IPSS), five-item International Index of Erectile Function (IIEF-5), and urethrography. Intraoperative urethroscopy assessed stricture length and severity. Follow-up included uroflowmetry and patient-reported outcomes. Treatment success was defined as a maximum urinary flow rate (Qmax) >10 mL/s without symptoms. Outcomes were compared between teaching and fellows' institutions. RESULTS The median stricture length was 16 cm, with instrumentation as the most frequent aetiology (64.0%). The median (interquartile range [IQR]) operative time was 134 (123-142) min. Postoperative complications rate was 23.0%, mostly Clavien-Dindo Grade I. At a median (IQR) follow-up of 16 (7-24) months, the median Qmax significantly increased from 4.5 preoperatively to 24 mL/s postoperatively (P < 0.001), while the median IPSS decreased by 24.3 points (P < 0.001) and the median IIEF-5 score remained stable. Stricture recurrence occurred in 11 (9.6%) patients. No significant differences in patency/complications were found between teaching and fellows' institutions. Key PSGU limitations are intact prepuce and absence of active lichen sclerosus. CONCLUSIONS A single-stage PSGU effectively manages PUS, showing comparable outcomes across institutions with varying experience levels. This technique is ready for broader adoption in clinical practice, pending further studies to confirm its long-term efficacy.
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Affiliation(s)
- Marco Bandini
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Pankaj Joshi
- Department of Urology, Kulkarni Reconstructive Urology Center, Pune, India
| | - Sandeep Bafna
- Department of Genitourinary Surgery, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | | | - Ahmed Alrefaey
- Department of Urology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Mattia Longoni
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS Ospedale San Raffaele, Milan, Italy
| | - Sanjay Kulkarni
- Department of Urology, Kulkarni Reconstructive Urology Center, Pune, India
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Collin H, Huang B, Siriwardana A, Harris C, Stevenson A, Navaratnam A, Esler R, Roberts MJ. Simultaneous robotic-assisted prostatectomy and rectal resection: a systematic review. J Robot Surg 2025; 19:229. [PMID: 40407946 PMCID: PMC12102092 DOI: 10.1007/s11701-025-02395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Accepted: 05/09/2025] [Indexed: 05/26/2025]
Abstract
Prostate cancer (PC) and rectal cancer (RC) are common and can require complex management, especially when presenting synchronously or with invasive characteristics. Robotic surgery has emerged as a viable option for managing these challenging cases; however, the outcomes are yet to be summarised or compared to traditional approaches. This systematic review aims to evaluate the feasibility, oncological outcomes, and functional results of simultaneous robotic-assisted resections of the prostate and rectum. Following prior protocol registration (PROSPERO: CRD42023449872) and according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, we conducted a systematic search across multiple databases, selecting studies that involved simultaneous bladder-sparing robotic-assisted prostatectomy and rectal resection. The Joanna Briggs Institute tool was used for risk of bias assessment. Data on patient demographics, treatment details, post-operative course, and functional and oncological outcomes were extracted and analysed. From 1357 identified records, 25 studies met our inclusion criteria resulting in 45 cases/patients. The median patient age was 62 years. Diverse treatment backgrounds and outcome definitions were recorded. Median operative time was 548 min and median estimated blood loss was 450 mL. The overall complication rate was 44.4%, with major complications (Clavien-Dindo III) occurring in 17.8% of cases. Surgical margins were negative in 92.6% of cases. Continence recovery occurred for most (78.6%) of the cases reporting on urinary function. Simultaneous robotic-assisted prostatectomy and rectal resection appears to be a feasible, safe and oncologically effective approach with satisfactory oncological and functional outcomes for managing patients with synchronous or invasive PC and RC.
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Affiliation(s)
- Harry Collin
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.
| | - Benjamin Huang
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Amila Siriwardana
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Craig Harris
- Department of Colorectal Surgery, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Andrew Stevenson
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Colorectal Surgery, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Anojan Navaratnam
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Rachel Esler
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Matthew J Roberts
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
- University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia
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Cui LL, Zhang L, Liu S, Zhu Q, Xue FS. Dexmedetomidine Cannot Attenuate Liver Injury and Improve Outcomes Following Laparoscopic Living Donor Hepatectomy: A Randomised Controlled Trial. Drug Des Devel Ther 2025; 19:4263-4274. [PMID: 40420947 PMCID: PMC12105671 DOI: 10.2147/dddt.s524343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2025] [Accepted: 05/15/2025] [Indexed: 05/28/2025] Open
Abstract
Purpose To determine the effects of intraoperative dexmedetomidine (DEX) administration on postoperative ischaemia/reperfusion injury (HIRI) and clinical outcomes of patients undergoing the laparoscopic living donor hepatectomy (LLDH). Patients and Methods Fifty-five patients who underwent the LLDH were randomly assigned to the DEX or control group. The DEX group received an intravenous infusion of DEX with an bolus dose of 1 µg/kg for 15 min before anaesthesia induction, followed by a continuous infusion at a rate of 0.4 µg/kg/h until the portal branch was disconnected. The control group was given an intravenous infusion of 0.9% saline at same volume and rate. The primary outcome was peak serum aspartate aminotransferase (AST) level during the first 72 h postoperatively. The secondary outcomes included other variables of postoperative liver and kidney function, intraoperative hemodynamic changes, postoperative recovery outcomes and the occurrence of complications. Results The peak serum AST level during the first 72 h postoperatively was not significantly different between groups (DEX vs control: 288 [194-466] vs 324 [194-437] IU/L; difference, -1.2 IU/L; 95% CI, -86.9 to 88.0; P=0.973). The intraoperative mean artery pressure was not significantly different, but intraoperative heart rate was significantly decreased in the DEX group. There were no significant differences between groups in other secondary outcomes. Conclusion This study demonstrates that intraoperative DEX administration at the studied dosage regimens cannot attenuate postoperative HIRI and does not improve clinical outcomes in patients undergoing the LLDH. Clinical Trial Registration www.chictr.org.cn, ChiCTR2000040629.
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Affiliation(s)
- Ling-Li Cui
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Liang Zhang
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Shen Liu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qian Zhu
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Fu-Shan Xue
- Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital, Fuzhou, People’s Republic of China
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48
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Hartung FO, Egen L, Breuer L, Gruene B, Netsch C, Becker B, Wenk M, Herrmann J. [Holmium Laser Enucleation of the Prostate (HoLEP) Compared to Robot-Assisted Simple Prostatectomy (RASP): A Propensity Score Matched Analysis]. Aktuelle Urol 2025. [PMID: 40398491 DOI: 10.1055/a-2577-3748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2025]
Abstract
This study investigates and compares the clinical safety and efficiency of Holmium Laser Enucleation of the Prostate (HoLEP) and robot-assisted transvesical enucleation of the prostate (RASP) for the treatment of benign prostatic hyperplasia (BPH) with large prostate volumes in a tertiary care centre. Perioperative data were collected from 39 patients who underwent RASP at our centre between 2015 and 2021. Propensity score matching was performed based on prostate volume, patient age, and body mass index (BMI), comparing these patients with 721 individuals treated with HoLEP at our clinic. An analysis was performed of preoperative parameters, including prostate volume, age, BMI, PSA level, IPSS score, and IIEF score, as well as intra- and postoperative parameters, including operative time, resected tissue weight, postoperative catheterization duration, length of hospital stay, haemoglobin decrease, transfusion rate, postoperative urinary retention, Clavien-Dindo classification (CDC), and the Comprehensive Complication Index (CCI). A statistically significant advantage was observed in favour of HoLEP regarding operative time (114.5 vs. 153.5 minutes; p<0.001), catheterization duration (2.6 vs. 7.4 days; p<0.001), and length of hospital stay (2.9 vs. 8.8 days; p<0.001). No statistically significant difference was found in terms of haemoglobin decrease or transfusion rate. The overall complication rate was lower in the HoLEP group, but the difference did not reach statistical significance (p=0.051). However, regarding the severity of complications, a statistically significant disadvantage for RASP was observed based on the CDC (p=0.027), while the CCI did not show a statistically significant difference between the cohorts (p=0.098). Both HoLEP and RASP proved to be effective and safe for the treatment of BPH with large prostate volumes. Compared to RASP, HoLEP demonstrated advantages in terms of catheterization duration and length of hospital stay. No statistically significant differences were observed regarding the overall complication rate.
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Affiliation(s)
| | - Luisa Egen
- Universitätsklinikum Mannheim, Klinik für Urologie und Urochirurgie, Mannheim, Germany
| | - Linus Breuer
- Universitätsklinikum Mannheim, Klinik für Urologie und Urochirurgie, Mannheim, Germany
| | - Britta Gruene
- Universitätsklinikum Mannheim, Klinik für Urologie und Urochirurgie, Mannheim, Germany
| | | | - Benedikt Becker
- Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Maren Wenk
- Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Jonas Herrmann
- Vivantes Auguste-Viktoria-Klinikum, Urologisches Laserzentrum Berlin, Berlin, Germany
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49
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Aoyama R, Tsunoda S, Okamura R, Yamashita Y, Hata H, Kinjo Y, Miki A, Kanaya S, Yamamoto M, Matsuo K, Manaka D, Tanaka E, Kawada H, Kondo M, Itami A, Kan T, Kadokawa Y, Ito T, Hirai K, Hosogi H, Nishigori T, Hisamori S, Hoshino N, Obama K. Subtotal Gastrectomy for Clinical Stage I Remnant Gastric Cancer. World J Surg 2025. [PMID: 40396982 DOI: 10.1002/wjs.12638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 04/24/2025] [Accepted: 04/28/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND Subtotal gastrectomy (SG) is a surgical option for early remnant gastric cancer (RGC). However, reports evaluating the feasibility and oncological safety of SG for RGC are limited. Here, we aimed to evaluate the short- and long-term outcomes of SG for RGC. METHODS We conducted a multi-institutional retrospective cohort study and compared the outcomes between SG and completion gastrectomy (CG) of patients with clinical stage I RGC. The short- and long-term outcomes, body weight change, and serum albumin level at 1 year postoperatively were evaluated. RESULTS Twenty-two and 202 patients in the SG and CG groups, respectively, were included in the analysis. The risk ratios (95% confidence interval [CI]) were 0.90 (0.27, 2.22) and 0.51 (0.33, 2.47) for the overall and severe complications, respectively. No anastomotic leakage was observed in the SG group, while 6.4% of the CG group had anastomotic leakage (p = 0.62). The 3-year relapse-free survival rates were 79.8% and 78.8% in the SG and CG groups, respectively (hazard ratio [95% CI], 0.87 [0.31, 2.40]; p = 0.80). The median body weight changes at 1 year postoperatively from the preoperative level were significantly less in the SG group (96.4% and 90.4% in the SG and CG groups, respectively; p = 0.021), and the median serum albumin changes at 1 year postoperatively were + 0.01 and -0.04 g/dL, respectively (p = 0.551). CONCLUSION SG might be one of the potential options for clinical stage I RGC, if the proximal margin is secured.
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Affiliation(s)
- Ryuhei Aoyama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Ryosuke Okamura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Yoshito Yamashita
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Hiroaki Hata
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, National Hospital Organization, Kyoto Medical Center, Kyoto, Japan
| | - Yosuke Kinjo
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Gastroenterological Surgery and Oncology, Himeji Medical Center, Himeji, Japan
| | - Akira Miki
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Toyooka Hospital, Toyooka, Japan
| | - Seiichiro Kanaya
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Michihiro Yamamoto
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Shiga General Hospital, Moriyama, Japan
| | - Koichi Matsuo
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Dai Manaka
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Eiji Tanaka
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Kitano Hospital, Osaka, Japan
| | - Hironori Kawada
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masato Kondo
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Atsushi Itami
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Kobe City Nishi-Kobe Medical Center, Kobe, Japan
| | - Takatsugu Kan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Kobe City Medical Center West Hospital, Kobe, Japan
| | - Yoshio Kadokawa
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Gastrointestinal Surgery, Tenri Hospital, Tenri, Japan
| | - Tetsuo Ito
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Gastroenterological Surgery, Osaka Saiseikai-Noe Hospital, Osaka, Japan
| | - Kenjiro Hirai
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Otsu City Hospital, Otsu, Japan
| | - Hisahiro Hosogi
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
- Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Tatsuto Nishigori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Nobuaki Hoshino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Kyoto Esophageal and Gastric Surgery Study Group, Kyoto, Japan
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50
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Il Kim Y, Park IJ, Ro JS, Lee JL, Kim CW, Yoon YS, Lim SB, Yu CS, Lee Y, Tak YW, Chung S, Kim KW, Ko Y, Yun SC, Jo MW, Lee JW. A randomized controlled trial of a digital lifestyle intervention involving postoperative patients with colorectal cancer. NPJ Digit Med 2025; 8:296. [PMID: 40394118 PMCID: PMC12092578 DOI: 10.1038/s41746-025-01716-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2024] [Accepted: 05/11/2025] [Indexed: 05/22/2025] Open
Abstract
Few studies have investigated quality of life (QoL) improvements in patients with colorectal cancer or the benefits of digital healthcare interventions. This randomized controlled trial assessed the impact of mobile applications on postoperative QoL in patients scheduled for curative surgery for colorectal cancer. Patients were randomized into three intervention groups (each using a different mobile application for postoperative lifestyle management) and a control group. QoL was evaluated using the European Quality of Life-5 Dimensions (EQ-5D), with physical and metabolic parameters and fat/muscle areas measured preoperatively, and every six months postoperatively. At six months, no significant differences in the EQ-5D scores from baseline were observed across groups. Intervention Group C showed a significant increase in skeletal muscle area compared to the control group (P = 0.046). Overall, mobile application use had a minimal effect on postoperative health-related QoL, warranting further research on their efficacy and compliance rates. Trial registration: CRIS.nih.go.kr: KCT0005447. Registration date: June 23, 2020.
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Affiliation(s)
- Young Il Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Jun-Soo Ro
- Department of Preventive Medicine & Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jong Lyul Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Wook Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sik Yoon
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok-Byung Lim
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Division of Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yura Lee
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yae Won Tak
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seockhoon Chung
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yousun Ko
- Biomedical Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Sung-Cheol Yun
- Division of Epidemiology and Biostatics, Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Won Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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