Background: To synthesize current evidence and the structured expert perspectives presented during a dedicated session on pancreatic ductal adenocarcinoma, focusing on the transition from anatomical to biological definitions of resectability, neoadjuvant therapy, minimally invasive and artery-first surgery, postoperative pancreatic fistula, and perioperative optimization. Methods: This narrative review was developed according to the standardized artificial intelligence-assisted, clinician-supervised methodology described by Molteni et al. The review is based on the complete audiovisual recording and original presentations of the Pancreatic Surgery session held during the 44th National Congress of the Italian Association of Hospital Surgeons (ACOI), Palermo, Italy (24–27 May 2026), and integrates the expert discussion with contemporary peer-reviewed evidence from randomized controlled trials, meta-analyses, and observational studies. No patient data were collected. Results: Biological characteristics emerged as the principal determinant of outcome, while margin-negative (R0) resection remained the main modifiable surgical objective. Resectability is evolving from a purely anatomical concept toward an integrated anatomical, biological, and physiological assessment. Evidence on neoadjuvant therapy for resectable disease remains heterogeneous but supports its role as a tool for biological selection. Minimally invasive distal pancreatectomy is well established, whereas minimally invasive pancreatoduodenectomy requires high procedural volumes and structured training. Postoperative pancreatic fistula is managed through risk stratification and early diagnosis rather than a single superior preventive strategy. Prehabilitation and enhanced recovery reduce postoperative morbidity without demonstrated mortality benefit. Conclusions: Contemporary management of pancreatic ductal adenocarcinoma integrates biological selection, individualized surgical decision-making, technical standardization in high-volume centers, and an explicit distinction between beneficial and futile surgery.
Background: Thoracic surgery is evolving through minimally invasive technologies, robotic platforms, multimodal oncological treatments, and integration between surgery, systemic therapies, and molecular characterization. Contemporary decision-making balances oncological radicality, functional preservation, technical feasibility, and multidisciplinary management. Methods: This narrative review derives from the Thoracic Surgery session of the 44th National Congress of the Italian Association of Hospital Surgeons (ACOI), Palermo, Italy (24–27 May 2026). It followed the standardized artificial intelligence-assisted, clinician-supervised methodology described by Molteni et al. The complete audiovisual recording and original presentations constituted the primary source material. Individual clinical cases and selected electronic presentations were excluded. Results: Endoscopic treatment remains the preferred first-line approach for benign airway disease, whereas tracheal resection is reserved for selected patients. Pleuro-parenchymal infections, empyema, chest-wall reconstruction, and thoracic emergencies require individualized multidisciplinary management. Complete thymectomy achieving R0 resection remains the fundamental oncological principle, while minimally invasive and robotic approaches are appropriate only if oncological radicality is preserved. Functional esophageal surgery emphasizes physiological assessment and tailored minimally invasive treatment. In thoracic oncology, perioperative immune checkpoint inhibition is reshaping treatment paradigms, and resectability increasingly incorporates pathological response, circulating tumor DNA, and tumor biology alongside anatomical criteria. The optimal extent of pulmonary resection in early-stage lung cancer remains under investigation. Conclusions: Contemporary thoracic surgery is defined by multidisciplinary decision-making, individualized patient selection, preservation of oncological radicality, and concentration of complex procedures in high-volume centers. Integration of surgery, systemic therapies, molecular biomarkers, and immunotherapy is redefining resectability as a dynamic biological concept rather than a purely anatomical condition.
Background: Carcinoma of the left colonic (splenic) flexure remains challenging because of its watershed vascular territory, marked arterial and lymphatic variability, and proximity to adjacent organs, making the optimal extent of resection controversial. The availability of multiple robotic platforms has further transformed the technological landscape of colorectal surgery. Methods: This narrative review integrates peer-reviewed evidence identified through PubMed/MEDLINE with the scientific content presented during the “Re.Live Experience” session of the 44th National Congress of the Italian Association of Hospital Surgeons (ACOI). The session included a comparison of robotic platforms, conventional laparoscopy, and three relive robotic resections. The manuscript followed a previously described artificial intelligence–assisted, clinician-supervised methodology. Results: Current evidence supports minimally invasive surgery and suggests that segmental colectomy is appropriate for selected splenic flexure cancers, with oncological outcomes comparable to more extended resections. However, the optimal extent of lymphadenectomy and the specific role of complete mesocolic excision and central vascular ligation remain incompletely defined. Given the variability of arterial supply and lymphatic drainage, accurate tumor localization and individualized preoperative vascular mapping are central to surgical planning. Robotic platforms differ in architecture, ergonomics, docking, and instrumentation, but current evidence does not establish the superiority of any specific platform. Conclusions: Successful splenic flexure surgery depends primarily on individualized anatomical and vascular planning, sound oncological principles, appropriate extent of resection, structured training, and procedural standardization rather than on the specific robotic platform used.
Littoral cell angioma is a rare primary vascular neoplasm of the spleen. Spontaneous atraumatic splenic rupture is an exceptionally uncommon presentation and may result in life-threatening hemorrhage. We report the case of a 54-year-old woman with a homozygous factor V Leiden mutation who presented with acute abdominal pain and progressive anemia in the absence of trauma. Contrast-enhanced computed tomography demonstrated massive hemoperitoneum and splenic rupture without evidence of a focal splenic lesion. Owing to hemodynamic deterioration, emergency splenectomy was performed. Histopathological and immunohistochemical examination confirmed the diagnosis of littoral cell angioma. Owing to the rarity of this condition and the nonspecific radiological findings, diagnosis is frequently established only after splenectomy. Prompt recognition and urgent surgical treatment remain essential to achieve favorable outcomes.
Background: Although often regarded as “minor surgery,” ambulatory and day surgery have evolved into strategic domains of contemporary surgical care where organizational efficiency, technological innovation, and workforce sustainability converge. Within the emerging paradigm of the “5.0 hospital,” these settings provide an ideal environment for integrating robotics, artificial intelligence, telemedicine, and data-driven clinical governance into resilient and sustainable healthcare systems. Methods: This narrative review re-elaborates the scientific content presented during the joint ACOI (Italian Society of Hospital Surgeons)–SICADS (Italian Society of Ambulatory and Day Surgery) session, “Beyond Surgery. The Professionals of the Future: New Organisational Models, Digitalisation of Surgical Pathways, and New Competencies,” held at the 44th ACOI National Congress (Palermo, Italy, 24–27 May 2026). The complete session transcript served as the primary source and was synthesized according to the standardized editorial methodology described by Molteni et al. Results: The session followed the surgical pathway from national clinical governance to hospital management, departmental organization, operating-room practice, early-career surgical training, and healthcare networks. Across all topics, a consistent message emerged: technological innovation creates value only when embedded within organized, data-driven systems. Two cross-cutting themes unified the discussion: structured data as the foundation of clinical governance and workforce sustainability. Conclusions: Ambulatory and day surgery should be regarded as strategic, high-volume public surgery. Their future depends not on technology alone but on its integration into organized, data-driven, and sustainable healthcare systems capable of improving quality of care while supporting the next generation of surgeons.
