UNASSIGNED: There are no standard guidelines regarding the number and size of chest tubes that should be selected after thoracic surgery. This study aimed to evaluate the effects of adopting a drainage strategy with bi-pigtail catheters (BPCs) on patients undergoing lobectomy by uniportal video-assisted thoracic surgery (VATS).
UNASSIGNED: A retrospective study was performed of patients undergoing uniportal lobectomy at the Department of Thoracic Surgery of the Cancer Hospital of Dalian University of Technology between August 2021 and August 2022. The patients were divided into the following two groups according to the drainage strategy adopted: (I) a traditional chest tube (TCT) group; and (II) a BPC group. The outcomes measured included postoperative complications, as measured by the Clavien-Dindo method, and the visual analogue scale (VAS) pain scores of the patients after surgery.
UNASSIGNED: In total, 868 patients underwent lung resection during the study period, after exclusion, the data of 470 patients who underwent uniport lobectomy were reviewed (235 in the TCT group, and 235 in the BPC group). There were no statistically significant differences between the two groups in terms of baseline data (P>0.05). The incidence of postoperative complications (7.7% vs. 19.1%) and postoperative VAS pain scores at 7-24 hours (3.3±1.0 vs. 3.7±1.5) and 25-48 hours (3.1±0.8 vs. 3.6±1.5) were significantly lower in the BPC group than the TCT group (all P<0.001). Additionally, the postoperative length of stay (4.6±1.5 vs. 5.4±4.5 days) and the collapse rate of the residual lung (19.2%±9.1% vs. 20.9%±9.6%) of the BPC group were better than those of the TCT group (P<0.05). The results of univariable and multivariable analyses showed that a drainage strategy with a TCT was an independent risk factor for decreased postoperative complications, and reduced moderate or severe pain scores at 7-24 and 25-48 hours after surgery.
UNASSIGNED: Our drainage strategy with BPCs decreased the incidence of postoperative complications and alleviated the postoperative pain of patients undergoing lobectomy by uniportal VATS and is safe and feasible.

UNASSIGNED: This study aimed to provide a comprehensive overview of the complications unique to ureteral reconstruction in adults, emphasizing their presentation, diagnosis, and management in the treatment of ureteral structure disease.
UNASSIGNED: This review involves an in-depth analysis of existing literature and case studies pertaining to ureteral reconstruction, with a focus on examining the range of complications that can arise post-surgery. Special attention is given to the presentation of each complication, the diagnostic process involved, and the subsequent management strategies.
UNASSIGNED: Ureteral reconstruction can treat ureteral stricture disease with low morbidity; however, complications, although uncommon, can have severe consequences. The most notable complications include urinary extravasation, stricture recurrence, urinary tract infections, compartment syndrome, symptomatic vesicoureteral reflux, and Boari flap necrosis. Each complication presents unique diagnostic challenges and requires specific management approaches.
UNASSIGNED: Ureteral reconstruction is a highly effective treatment for ureteral stricture disease. Having a strong understanding of the potential complications that patients may experience following ureteral reconstruction is not only critical to adequately counsel patients but also facilitate prompt diagnosis and management of complications when they arise.

OBJECTIVE: The purpose of this review article is to provide a contemporary overview of benign uretero-enteric anastomotic stricture (UAS) management and outcomes.
RESULTS: In this article, we will review the most recent studies investigating UAS and evaluate etiology, potential risk factors, presentation, diagnosis, and management options, along with personal insight gained from our experience with managing this challenging reconstructive complication. Benign UAS is a relatively common long-term complication of intestinal urinary diversion, affecting approximately 1 in 10 patients. It is thought to be caused by ureteral tissue ischemia and fibrosis at the anastomotic site. Risk factors appear to include any that increase the likelihood of leak or ischemia; it is not clear if anastomotic approach impacts risk for stricture as well. Management options are varied and include endourologic, open, and robotic approaches. Endoscopic approaches may be less morbid but are considerably less effective than reconstruction performed after a period of ureteral rest.

BACKGROUND: Although sublobar resection (wedge resection [Wed] or segmentectomy [Seg]) has become a standard operative procedure for clinical stages IA1 and IA2 non-small cell lung cancer (NSCLC) in Japan, the impact of this procedure on the prognosis and postoperative complications in real-world clinical practice is unknown.
METHODS: This study retrospectively analyzed risk factors for a poor prognosis and postoperative complications of 470 patients with clinical stage ≤ IA2 NSCLC who underwent surgery from 2012 to 2021.
RESULTS: Among the patients with a consolidation-to-tumor ratio (CTR) higher than 0.5, the 5-year relapse-free survival (RFS) rate was significantly lower in the Wed group (72.1%) than in the Seg (85.8%) and Lob (86.8%) groups (p < 0.01), but the difference between the Seg and Lob groups was not significant. Among patients with a CTR of 0.5 or lower, the 5-year RFS rate did not differ significantly among the three groups. Multivariable analysis of RFS showed that the prognosis was significantly worse in the Wed group than in the Lob group (hazard ratio, 2.83; p < 0.01), but the difference between the Wed and Seg groups or the between Seg and Lob groups was not significant. Multivariable analysis of postoperative complications showed a significantly lower risk in the Wed group than in the Seg group (odds ratio, 0.31; p < 0.01).
CONCLUSIONS: Seg could become the standard operative procedure for clinical stages IA1 and IA2 NSCLC patients. Wed is suggested to be an option for patients with a CTR of 0.5 or lower and has the advantage of avoiding postoperative complications.

Splenic artery aneurysm (SAA) is the most common visceral artery aneurysm and can lead to severe outcomes if ruptured. This report presents the case of a 71-year-old female who experienced a sudden and severe gastrointestinal hemorrhage 19 years after undergoing pancreaticoduodenectomy for pancreatic head cancer. The patient arrived at the hospital with signs of shock, and imaging revealed an SAA rupture with associated gastric perforation. Emergency treatment involved endovascular techniques, which stabilized the patient and controlled the bleeding. This case highlights the importance of rapid diagnosis and the effectiveness of endovascular therapy in managing SAA rupture, particularly in patients with complex surgical histories.

UNASSIGNED: The combination of neoadjuvant immunotherapy and chemotherapy (NICT) has become a common treatment regimen for locally advanced gastric cancer (LAGC). However, the safety and efficacy of radical gastrectomy following NICT (NICT-G) remain controversial. This study aimed to analyze the risk factors influencing postoperative complications (POCs) after NICT-G. Additionally, it aimed to construct a nomogram to provide a clinical reference for predicting POCs.
UNASSIGNED: This study included 177 patients who received NICT-G at the Chinese PLA General Hospital First Medical Center from January 2020 to January 2024. Univariable and multivariable logistic regression models were used to evaluate the risk factors influencing POCs, and a nomogram model was constructed. To evaluate the discrimination and accuracy of the nomogram model, the area under the receiver operating characteristic curve (AUC) and the calibration curve were measured.
UNASSIGNED: In 177 patients who received NICT-G, the pathological complete response and major pathological response rates were 15.8% and 45.2%, respectively, whereas the rates of the overall and severe treatment-related adverse events were 71.8% and 15.8%, respectively. In addition, 43 (24.3%) patients developed overall POCs (Clavien-Dindo classification ≥ II). Univariable and multivariable logistic analyses showed that age ≥70 years, greater estimated blood loss, platelet/lymphocyte ratio (PLR) ≤196, neutrophil/lymphocyte ratio (NLR) >1.33, non-R0 resection, and body mass index (BMI) < 18.5 kg/m2 were independent risk factors for overall POCs (p < 0.05). The nomogram model developed using the abovementioned variables showed that the AUC (95% confidence interval [CI]) was 0.808 (95% CI): 0.731-0.885 in predicting the POC risk. The calibration curves showed that the prediction curve of the nomogram was a good fit for the actual POCs (Hosmer-Lemeshow test: χ2 = 5.76, P = 0.451).
UNASSIGNED: The independent risk factors for overall POCs in the NICT-G were age ≥ 70 years, greater estimated blood loss, PLR ≤ 196, NLR > 1.33, non-R0 resection, and BMI < 18.5 kg/m2. The nomogram model developed based on the abovementioned indicators showed better accuracy in predicting the POC risk.

BACKGROUND: This study aimed to assess the impact of peritoneal drainage and its type on prognosis, encompassing postoperative recovery and complications, in pediatric patients (≤ 16 years old) following appendectomy based on the grade of appendicitis.
METHODS: In this retrospective study, we analyzed pediatric patients (≤ 16 years old) with appendicitis who met the inclusion and exclusion criteria in our center from January 2017 to January 2024 and classified them into grade I-V based on the grade of appendicitis, with V representing the most serious cases. The patients were grouped according to drainage status and type. The main clinical outcomes included postoperative rehabilitation indexes such as time to resume a soft diet, time to remove the drain, duration of postoperative antibiotic use and length of hospitalization (LOH), as well as postoperative complications including intra-abdominal abscess (IAA), ileus and wound infection (WI), and readmission within 30 days after surgery.
RESULTS: A total of 385 pediatric patients with appendicitis were included in the study and divided into No-drainage (ND) group (n = 74), Passive drainage (PD) group (n = 246) and Active drainage (AD) group (n = 65) according to drainage status and type. Compared to the other two groups, the ND group had a significantly shorter time to resume a soft diet, duration of postoperative antibiotic use and LOH, and these differences were statistically significant. Similar findings were observed in grade I patients too (P < 0.05). In all cases examined here, the AD group had a significantly shorter time for drain removal compared to the PD group (3.04 [1-12] vs 2.74 [1-15], P = 0.049); this difference was also evident among grade I patients (2.80 [1-6] vs 2.47 [1-9], P = 0.019). Furthermore, within the same grade, only in grade IV did the AD group exhibit a shorter duration of postoperative antibiotic use compared to the PD group (4.75 [4-5] vs 8.33 [5-15], P = 0.009). Additionally, the LOH in the AD group was longer than that in the PD group (8.00 [4-13] vs 4.75 [4-5], P = 0.025). Among all cases, the ND group exhibited significantly lower incidences of overall complications and WI compared to the other two groups (P < 0.05). Additionally, the incidence of IAA in the ND group was significantly lower than that in the PD group (0% vs 5.3%, P = 0.008 < 0.0167). Furthermore, although there were no statistically significant differences in the incidence of overall complications, IAA, ileus, and WI between the PD and AD groups during grade ≥ II analysis (P > 0.05), a higher readmission rate within 30 days was observed in the PD group compared to the AD group; however, these differences were not statistically significant (P > 0.05). Moreover, multivariate analysis revealed that a higher grade of appendicitis was associated with an increased risk of overall complications and IAA as well as a longer duration of postoperative antibiotic use and LOH.
CONCLUSIONS: The appendicitis grade is a crucial indicator for predicting postoperative IAA and LOH. In patients with grade I appendicitis, peritoneal drainage, even if active drainage, is not recommended; For patients with grade ≥ II appendicitis, active drainage may be more effective than passive drainage in reducing the duration of postoperative antibiotic use and LOH.

OBJECTIVE: Postoperative delirium (POD) is one of the most frequent complications after surgery which is closely associated with many adverse outcomes, including high mortality and low quality of life. This study aims to carry out a bibliometric analysis of POD and its risk factors from 2012 to 2022 to reveal the research status and hot spots.
METHODS: This study is a bibliometric and visualized analysis.
METHODS: Relevant publications between 2012 and 2022 were extracted from the Web of Science Core Collection database. CiteSpace software (v6.1. R2, Drexel University), VOSviewer software (v1.6.18, Leiden University), and the Online Analysis Platform of Literature Metrology were used to analyze research attributes. These publications were used to analyze research attributes, including countries, journals, institutions, authors, keywords, and burst detection, to predict trends and hot spots.
RESULTS: We included a total of 1,324 related documents from 2012 to 2022. The literature on POD has increased significantly since 2016. The United States and Harvard University were the leading literature publishing country (436/1324, 32.9%) and institution (112/1324, 8.5%). Anesthesia and Analgesia was the most frequently published journal. Keywords analysis with VOSviewer revealed that the keywords could be divided into five clusters, including anesthesia techniques, cardiac surgery, risk factors, intraoperative anesthesia monitoring, and postoperative cognitive dysfunction. We included a total of 198 POD risk factors documents, and the literature on POD risk factors increased. The People\'s Republic of China and Harvard University were the leading literature publishing country (53/198, 26.8%) and institution (12/198, 6.1%). Elderly, hip surgery, frailty, postoperative pain, cardiac surgery, dementia, and depression are keywords that are risk factors for POD.
CONCLUSIONS: The number of literature on POD in the field of anesthesia has increased significantly. Risk factors and anesthesia techniques are still key areas of research. Encephalogram, the use of sedatives, and perioperative nursing may be the new research focus. Older adults, hip fractures, cardiac surgery, liver transplants, dementia, and depression are hot words in the field of POD risk factors.

OBJECTIVE: This research aimed to clarify the metastatic patterns of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma and to investigate appropriate strategies for lymph node dissection.
METHODS: Patients with thoracic esophageal squamous cell carcinoma receiving esophagectomy from December 2020 to April 2024 were retrospectively analyzed. Risk factors for subcarinal, right and left recurrent laryngeal nerve lymph nodes metastasis were determined by chi-square test and multivariate logistic regression analysis. We visualized the metastasis rates of these specific lymph nodes based on the different clinicopathological characteristics. Correlation between subcarinal, right and left recurrent laryngeal lymph nodes metastasis and postoperative complications were also analyzed.
RESULTS: A total of 503 thoracic esophageal squamous carcinoma patients who underwent esophagectomy were enrolled. The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes were 10.3%, 10.3%, and 10.9%, respectively. The lymphovascular invasion status and tumor location were the significant predictors for subcarinal and right recurrent laryngeal nerve lymph nodes metastasis, respectively (P < 0.001 and P = 0.013). For left recurrent laryngeal nerve lymph node metastasis, younger age (P = 0.020) and presence of lymphovascular invasion (P = 0.009) were significant risk factors. Additionally, pulmonary infection is the most frequent postoperative complication in patients with dissection of subcarinal, right and left recurrent laryngeal lymph nodes. There was no significant difference in the incidence of anastomotic leakage (P = 0.872), pulmonary infection (P = 0.139), chylothorax (P = 0.702), and hoarseness (P = 0.179) between the subcarinal lymph node dissection cohort and the reservation cohort. The incidence of hoarseness significantly increased in both right (P = 0.042) and left (P = 0.010) recurrent laryngeal nerve lymph nodes dissection cohorts compared by the reservation cohorts, with incidence rates of 5.9% and 6.7%, respectively.
CONCLUSIONS: The metastasis rates of subcarinal, right and left recurrent laryngeal nerve lymph nodes in thoracic esophageal squamous cell carcinoma were all over 10%. The dissection of subcarinal lymph nodes does not increase postoperative complications risk, while recurrent laryngeal nerve lymph nodes dissection significantly increases the incidence of hoarseness. Thus, lymph node dissection of subcarinal lymph nodes should be conducted routinely, while recurrent laryngeal nerve lymph nodes dissection may be selectively performed in specific patients.