This study aimed to evaluate whether indocyanine green (ICG) fluorescence navigation is independently associated with lymph node yield during open total gastrectomy with systematic D2 lymphadenectomy after adjustment for baseline clinical covariates. This single-center retrospective–prospective comparative study included 102 patients undergoing open total gastrectomy, D2 lymphadenectomy, and Roux-en‑Y reconstruction. A historical non-ICG cohort operated between 2016 and 2020 (n = 76) was compared with a prospective ICG cohort operated between 2023 and 2025 (n = 26). Indocyanine green (0.625 mg/ml) was injected endoscopically 12–24 h before surgery into four quadrants around the tumor. Multivariable linear regression with heteroscedasticity-consistent (HC3) standard errors adjusted for age, sex, body mass index (BMI), ASA class, neoadjuvant chemotherapy, and clinical T stage. Mean lymph node yield was higher in the ICG cohort (26.8 ± 4.9 vs. 18.1 ± 5.2; p < 0.001). After multivariable adjustment, ICG navigation remained independently associated with a higher lymph node yield (adjusted β = 8.79 nodes; 95
Gallbladder cancer (GBC) is a highly aggressive malignancy with a poor prognosis and varied global incidence. Despite surgical resection being the primary treatment, optimal approaches remain heterogeneous and debated due to limited high-quality evidence. This study aims to validate current surgical recommendations in a European real-world cohort. We retrospectively analyzed data from 150 GBC patients who underwent surgery at the University Hospital of Essen, Germany (2008–2023). Patient and tumor characteristics (UICC/TNM stage, incidental diagnosis, surgical approach), perioperative outcomes (mortality, morbidity, length of hospital stay), and overall survival (OS) were recorded. Congruence with established surgical recommendations was assessed, and its impact on OS analyzed using multivariate regression. Our cohort, predominantly female (60
Anal fissure is a common anorectal condition causing severe pain, sphincter hypertonia, and reduced quality of life. Pharmacological therapies are commonly used as first-line nonsurgical interventions, but comparative effectiveness and adverse events remain inconsistent. We conducted a systematic review following the PRISMA guidelines to evaluate pharmacological treatments for anal fissure. PubMed, Scopus, and Web of Science were searched for clinical trials and quasi-experimental studies published 2000–2025. Interventions included topical nitroglycerin (GTN), calcium channel blockers (diltiazem, nifedipine), and botulinum toxin. Outcomes were healing rates, pain reduction, internal anal sphincter pressure changes, recurrence, and adverse effects. Eighteen eligible studies involving 1254 patients were included. Healing rates with topical GTN ranged from 55 to 78
Hepatic flexure (HF) and splenic flexure (SF) tumors are uncommon and anatomically complex tumors. Their management is largely extrapolated from right- and left-sided colon cancer paradigms. Despite distinct vascular and lymphatic anatomy, whether these flexure locations differ in terms of oncologic outcomes after resection remains unclear. Patients with surgically treated HF or SF adenocarcinoma (2010–2017) were identified from the SEER database. Multivariable Cox models evaluated associations between location and survival, adjusting for demographic, pathological, and treatment factors. Stage-stratified and treatment-specific analyses were performed. Among 4898 patients (3368 HF; 1530 SF), flexure location was not independently associated with overall survival (OS; p = 0.163). However, SF tumors demonstrated improved cancer-specific survival (CSS) after adjustment (hazard ratio [HR] 0.84; p = 0.0065). This association was confined to advanced disease, with significant differences in stage III (HR 0.76; p = 0.0018) and stage IV tumors (HR 0.79; p = 0.0113), and no difference in stage I–II. Advanced disease was more common among SF tumors. Chemotherapy was associated with reduced mortality across flexure locations, with a significant CSS advantage for SF tumors (HR 0.84; p = 0.0265). Advanced stage remained the dominant prognostic factor. Tumors > 5 cm were associated with worse OS and CSS, while examination of ≥ 12 lymph nodes was independently protective. Hepatic flexure and splenic flexure cancers demonstrate comparable OS. However, SF tumors exhibit a CSS advantage in advanced disease. Established oncologic factors remain the primary drivers of prognosis, while location may selectively influence cancer-specific mortality.
Billroth II (B-II) anastomosis is widely used after distal gastrectomy but is associated with bile reflux and alkaline gastritis. Billroth II with Braun anastomosis (B-B) may reduce these risks, but the evidence is controversial. We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library up to November 2025 for comparative studies (RCTs or cohorts) comparing B‑II vs. B‑B in distal gastrectomy for gastric cancer. Outcomes included perioperative parameters, short-term complications, 1‑year endoscopic findings, and long-term complications. Meta-analysis was performed using random-/fixed-effects models. Eight studies (2892 patients; 1366 B‑II, 1526 B‑B) were included. While B‑B had longer operative time (WMD: 22.01; P = 0.003), it was associated with shorter gastric tube removal (WMD: −0.46; P < 0.00001) and earlier flatus (WMD: -0.36; P = 0.02). No significant differences were found in terms of blood loss, hospital stay, overall complications, bleeding, anastomotic leakage, obstruction, pulmonary infection, or bile reflux. However, B‑B significantly reduced grade III–IV gastritis at 1 year (RR: 0.29; P = 0.0001). Dumping syndrome and gallstones showed no differences. Adding Braun anastomosis to Billroth II facilitates early recovery and reduces moderate-to-severe reflux gastritis without increasing complications. It appears safe and effective as an adjunct, but high-quality RCTs with long-term follow-up are needed to confirm its comprehensive value.
