Surgical recurrence, defined as the need for reoperation at the anastomotic site, remains a critical challenge in Crohn’s disease (CD) management. This study aimed to identify clinical and molecular risk factors associated with time to surgical recurrence and develop a validated nomogram for individualized risk stratification. 280 patients were included in this study. Integrin αvβ6 expression was quantified via immunohistochemistry in resection specimens using a validated semiquantitative scoring system. Univariate and multivariable Cox regression analysis were used to identify the variables associated with time to surgical recurrence. A nomogram was then constructed based on the above risk factors. Over a median post-resection follow-up of 71.4 months, surgical recurrence occurred in 32 patients (11.4
Postoperative complications after distal pancreatectomy (DP), notably clinically relevant postoperative pancreatic fistula (CR-POPF) and peripancreatic fluid collections, drive morbidity. Existing scores rely on intraoperative variables and do not capture individual inflammatory responses. We evaluated whether preoperative, postoperative, and perioperative changes in routine inflammatory indices predict complications. Single-center retrospective cohort of patients undergoing DP for pancreatic malignancy (2010–2024). Pre- and postoperative inflammatory indices were derived from complete blood counts: neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI). Associations with outcomes were assessed using Firth’s penalized logistic regression and time-to-event analyses. Of 568 patients, 198 met inclusion criteria. Postoperative fluid collection occurred in 71 (35.9
Anastomotic leakage (AL) remains one of the most feared complications after rectal surgery for cancer, with stable incidence rates despite advances in surgical technique and perioperative care. Multiple anastomotic reinforcement strategies have been proposed, yet evidence remains heterogeneous and no clear consensus exists regarding their routine use. A structured expert position panel process was conducted. Eleven clinical scenarios based on AL risk factors and twenty thematic items addressing indications, devices, timing, contraindications, surgical approach, stoma use, costs, and expected outcomes were developed. A panel of experts evaluated each statement using a five-point Likert scale through a two-round process. Consensus was assessed using median scores and interquartile ranges (IQR). Consensus was not reached for most individual or combined preoperative risk factors. Most reinforcement techniques did not receive clear endorsement because of inconsistent and heterogeneous evidence. Strong agreement emerged regarding the central role of intraoperative assessment: tissue perfusion, mechanical tension, tissue quality, and unexpected technical difficulty were identified as key determinants. The panel agreed that reinforcement may still be appropriate in the presence of a diverting stoma, as diversion reduces clinical severity but does not prevent leakage or long-term sequelae. Surgical approach and material cost were not considered influent factors. This position statement highlights the lack of robust evidence supporting routine, indication-driven, or device-specific anastomotic reinforcement in rectal cancer surgery. The main shared recommendation was to base reinforcement on intraoperative surgical judgment, including tissue perfusion, tension, tissue quality, and unexpected technical difficulty.Keywords: anastomotic leakage, rectal cancer surgery, anastomotic reinforcement.
This proof-of-concept study describes a novel “no-knots” pancreatojejunostomy technique designed to minimize parenchymal injury by avoiding knot-tying on the pancreatic capsule. Instead of knot-tying, the method uses interrupted sutures anchored with clips to redistribute traction forces evenly along the pancreatic surface. Between January 2024 and July 2025, 40 consecutive pancreatoduodenectomies were performed using this approach. The pancreatic anastomosis was completed in all patients without technical failure. Four patients (10
Despite advances in hernia repair techniques, high recurrence rates remain a major challenge; studies report rates as high as 31.2
Achalasia is a rare oesophageal motility disorder, and minimally invasive Heller–Dor (HD) surgery remains the gold standard surgical treatment for type I and II disease. Mucosal injury is a relevant intraoperative risk during laparoscopic Heller–Dor (LHD) myotomy. Real-time assessment of mucosal integrity remains challenging. This study aimed to evaluate whether the intraoperative use of Indocyanine Green (ICG) fluorescence during this surgery could reliably assess mucosal integrity and potentially reduce the need for intra- and postoperative additional diagnostic tests. In this prospective pilot randomized study, patients undergoing LHD for type I–II achalasia were randomly assigned (1:1) to intraoperative ICG fluorescence assessment or standard intraoperative evaluation with endoscopy and postoperative contrast radiography. The primary outcome was intraoperative detection of mucosal leaks. Secondary outcomes included operative time, intraoperative and postoperative complications, length of stay, postoperative pain, inflammatory markers, dietary progression and 12-month follow-up (ClinicalTrials.gov Identifier: NCT07181070). Seventy-one patients were included (37 ICG, 34 standard). No significant differences were observed between groups in intraoperative or postoperative complications, postoperative recovery, or inflammatory markers. Operative time was significantly shorter in the ICG group compared with the standard group (median 95 [90–95] vs. 105 [95–110] minutes; p = 0.04). Intraoperative ICG fluorescence is safe and feasible, providing real-time visualization of mucosal integrity during LHD surgery. This technique may represent a valuable adjunct to standard practice, optimizing surgical efficiency and resource utilization. Larger studies are needed to confirm these findings.
To evaluate the outcomes of robotic bariatric surgery in our center, including sleeve gastrectomy (SG) and one-anastomosis gastric bypass (OAGB), focusing on operative time, perioperative complications, and length of hospital stay. A retrospective review identified 100 consecutive patients who underwent robotic bariatric surgery between February 2024 and September 2025. Of these, 78 underwent SG and 22 underwent OAGB. Baseline data included age, sex, body mass index (BMI), and obesity-related comorbidities. Operative time, docking time, perioperative complications, and length of hospital stay were analyzed. The mean patient age was 37 ± 8 years, with a mean BMI of 44.7 ± 5.4 kg/m². Comorbidities included diabetes mellitus in 11 patients, obstructive sleep apnea syndrome in 6, and hypertension in 35. All 100 procedures (78 Robotic Sleeve Gastrectomy, R-SG, and 22 Robotic one-anastomosis gastric bypass, R-OAGB) were completed successfully without conversion. The median total operative time was 87 min for R-SG and 96 min for R-OAGB. A significant reduction in the mean operative time for the entire cohort was observed, dropping from 166.36 min during the initial phase (Feb–Aug 2024) to a steady state of 91 min in the final period (Apr–Sep 2025). Mean docking time also improved, stabilizing at 7.4 min. Overall 30-day morbidity was 8
Extralevator abdominoperineal excision (ELAPE) was introduced to improve oncological quality in low rectal cancer surgery by reducing circumferential resection margin (CRM) positivity and intraoperative specimen perforation (IOP) compared with standard abdominoperineal resection (s-APR). However, its impact on long-term survival remains unclear. This study aimed to compare s-APR and ELAPE in terms of surgical quality parameters and their effects on disease-free survival (DFS) and overall survival (OS). This retrospective single-center study included 203 patients with non-metastatic distal rectal adenocarcinoma (0–5 cm from the anal verge) who underwent APR between 2001 and 2020. Patients treated between 2001 and 2009 underwent s-APR (n = 109), whereas those treated between 2010 and 2020 underwent ELAPE (n = 94). Demographic, clinicopathological, and survival data were analyzed. Survival outcomes were evaluated using Kaplan–Meier analysis and compared between groups using the log-rank test. CRM positivity was significantly lower in the ELAPE group compared with the s-APR group (13.8
Intraductal papillary neoplasm of the bile duct (IPNB) is a rare premalignant biliary tumor characterized by papillary growth and mucin production with variable presentations and outcomes. Here, we discuss our early experience in managing this rare disease at a tertiary care centre. This observational retrospective study included patients with IPNB who underwent surgery from January 2020 to December 2025. Pre- and Peri-operative details were recorded, and outcomes were analysed. Ten cases were grouped into Intrahepatic mass forming (n = 3), Extrahepatic mass forming (n = 4), and Intrahepatic cystic IPNB (n = 3). Based on the location, formal anatomical liver resection was done for six patients (Right hepatectomy-3, central hepatectomy-2, and segmentectomy-1), en bloc extra-hepatic bile duct excision for two patients, and enucleation and pancreatoduodenectomy for one patient each. The median (IQR) operative time was 450 (180–600) minutes, and blood loss was 375 mL (200–1800 mL). The median hospital stay was 6 days (4–40). Two patients had Clavien Dindo Grade 3 or more complications with one perioperative mortality (1/10). The final histopathology was suggestive of IPNB with invasive carcinoma in four patients (40
Robotic thyroid surgery (RTS) has gained popularity due to its minimal invasiveness and improved cosmetic outcomes. However, complications like hypoparathyroidism, bleeding, and infection can occur before surgeons’ learning curve completion. The purpose of present research is to develop and validate a predictive model for complications in RTS prior to their learning curve completion. We retrospectively analyzed data from 236 cases accepted RTS at our institution from Jan 2020 to Dec 2022. The data of included cases were classified into training set (n = 165) and validation set (n = 71). Data on clinical characteristics, surgical details, and postoperative outcomes were collected. Several regression analysis models were applied to identify independent factors of complications. A nomogram was constructed and validated using the training and validation sets. The overall complication rate was 29.24
Diverticular disease is one of the most common gastrointestinal disorders and minimally invasive surgery is currently considered the standard of care for the elective treatment. This retrospective, single-center, observational study included patients undergoing elective surgery for diverticular disease between January 2020 and December 2024. Patients were stratified into laparoscopic group (LG) and robotic-assisted group (RG). Baseline characteristics, intraoperative and early postoperative outcomes, complications, recurrence, functional outcomes and postoperative quality of life (Qol) were compared. The RG showed reduced intraoperative blood loss, lower conversion rates, and faster postoperative bowel recovery. No statistically significant differences were observed in postoperative complications, stoma rate, recurrence, long-term functional outcomes, or quality of life. Both laparoscopic and robotic-assisted approaches are safe and effective for elective left-sided colectomy in diverticular disease. Robotic surgery may provide technical advantages that could translate into clinical benefits, particularly in complex inflammatory conditions such as diverticular disease.
Academic envy, particularly its malicious form, constitutes a silent epidemic that destabilizes medical faculty through counterproductive work behaviours and diminished psychological well-being. This review addresses the “zero-sum” culture inherent in competitive medical hierarchies by proposing Strategic Vulnerability as an institutional intervention. Strategic Vulnerability advocates structured sharing of navigated professional struggles by senior faculty. This is a mentoring strategy promoting competent humility, psychological safety, and benign rather than malicious envy. The proposed “Scars Success Initiative” provides a practical framework designed specifically for medical faculty development through structured mentorship sessions, Second Victim seminars, and longitudinal evaluation of organizational climate.
The study aimed to develop and validate a radiomics-based predictive model for differentiating minimally invasive adenocarcinoma (MIA) from stage I invasive non-mucinous adenocarcinoma (INMA) in lesions dominated by ground-glass opacity (GGO) with a consolidation-to-tumor ratio (CTR) < 0.5. Patients pathologically diagnosed with MIA or stage I INMA (predominantly presenting as GGO with CTR < 0.5) at the Affiliated Nantong Hospital of Shanghai University between January 2021 and December 2022 were enrolled. All eligible patients were randomly divided into a training cohort and a validation cohort at a ratio of 8:2. Regions of interest (ROIs) were manually delineated using 3D Slicer software. A radiomics signature and a nomogram predictive model were constructed using Least Absolute Shrinkage and Selection Operator (LASSO) regression, univariate, and multivariate logistic regression analyses. The predictive performance of the model was internally validated using the validation cohort. A total of 153 (MIA, 74; INMA, 79) patients were divided into training (n = 122) and validation (n = 31) cohorts. Baseline clinical characteristics were well balanced between the two cohorts (P > 0.05). Fifteen features significantly associated with the study endpoint were selected via LASSO regression. The radiomics signature exhibited favorable discriminative ability, with area under the curve (AUC) values of 0.844 (training cohort) and 0.871 (validation cohort). The nomogram model achieved Harrell’s concordance index (C-index) values of 0.864 (95
T1 colorectal cancer presents a management challenge because a minority of lesions harbour lymph node metastasis (LNM), while T1N-positive disease may demonstrate favourable survival compared with some locally advanced node-negative tumours. This narrative review examines determinants of nodal metastasis in T1 colorectal cancer and considers how these features may inform risk-adapted management. This narrative review was conducted across two databases (MEDLINE and Embase), prioritising studies that used standardised definitions, including International Tumour Budding Consensus Conference (ITBCC) criteria for tumour budding and D2-40 or elastin staining for lymphovascular invasion. The most consistent predictors of lymph node metastasis are lymphovascular invasion and high-grade tumour budding, with poor differentiation and submucosal invasion depth adding to risk. Non-granular pseudo-depressed lateral spreading tumours and depressed lesions appear to signal covert submucosal invasion, indirectly increasing nodal risk. Evidence for tumour site, sex, molecular subtype, and lymphatic vessel distribution remains inconsistent or exploratory. Survival for T1N-positive disease is generally favourable compared with high-risk stage II disease, although comparisons are confounded by nodal burden, stage migration, treatment era, and adjuvant chemotherapy. A structured pathology report incorporating lymphovascular invasion, tumour budding, grade, depth, margin status, and morphology may support balanced decisions regarding completion surgery and adjuvant therapy while avoiding overtreatment.
Large language models are increasingly being used in academic and scientific writing, but their reliability in medical literature generation remains uncertain. In particular, concerns persist regarding factual accuracy, reference validity, originality, and the overall academic quality of AI-assisted manuscripts. This study aimed to systematically evaluate the capacity of ChatGPT-5.5 to generate a scientific narrative review on sleeve gastrectomy using structured prompting and objective assessment criteria. ChatGPT-5.5 was instructed to generate a narrative review on long-term metabolic improvement and weight loss outcomes after sleeve gastrectomy using a structured prompt framework. The generated manuscript was independently evaluated by two general surgeons with expertise in bariatric and metabolic surgery. Assessment domains included scientific accuracy, reference validity, plagiarism screening, narrative review quality using the Scale for the Assessment of Narrative Review Articles (SANRA), and academic quality using a structured peer-review rubric. The model generated a structured nine-section review outline and a complete narrative review manuscript. Overall, 85 statements were identified and evaluated. Of the 40 cited statements, 38 were factually correct and 2 were factually incorrect. The remaining 45 uncited statements were also considered factually correct, although 16 were classified as requiring supporting references. Reference verification revealed that 16 of 33 references (48.48
