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Topic Review
Appropriate Antibiotic Therapy for Intra-Abdominal Infections
Adequately controlling the source of infection and prescribing appropriately antibiotic therapy are the cornerstones of the management of patients with intra-abdominal infections (IAIs). Correctly classifying patients with IAIs is crucial to assessing the severity of their clinical condition and deciding the strategy of the treatment, including a correct empiric antibiotic therapy. Best practices in prescribing antibiotics may impact patient outcomes and the cost of treatment, as well as the risk of “opportunistic” infections such as Clostridioides difficile infection and the development and spread of antimicrobial resistance.
  • 450
  • 26 Oct 2022
Topic Review
C-Arm-Free Minimally Invasive Technique for Spinal Surgery
C-arm-free MIS techniques can offer significantly reduced rates of postoperative complications such as inadequate decompression, blood loss, and instrumentation misplacement. Another advantageous long-term aspect is the notably diminished exposure to radiation, which is known to cause malignant changes. 
  • 448
  • 19 Oct 2023
Topic Review
Antibiotic Cement and Spine Surgery
Antibiotic bone cement (ABC) is an effective tool for the prophylaxis and treatment of osteomyelitis due to the controlled, sustained release of local antibiotics. ABC has been proven to be effective in the orthopedic fields of arthroplasty and extremity trauma, but the adoption of ABC in spine surgery is limited. The characteristics of ABC make it an optimal solution for treating vertebral osteomyelitis (VO), a serious complication following spine surgery, typically caused by bacterial and sometimes fungal and parasitic pathogens.
  • 447
  • 24 Jun 2022
Topic Review
Relevance of Digitalization in Spine Surgery
Machine learning is a subset of artificial intelligence and refers to computer techniques that allow complex tasks to be solved in a reproducible and standardized way. Healthcare systems worldwide generate vast amounts of data from many different sources. Although of high complexity for a human being, it is essential to determine the patterns and minor variations in the genomic, radiological, laboratory, or clinical data that reliably differentiate phenotypes or allow high predictive accuracy in health-related tasks. Convolutional neural networks (CNN) are increasingly applied to image data for various tasks. Its use for non-imaging data becomes feasible through different modern machine learning techniques, converting non-imaging data into images before inputting them into the CNN model. Considering also that healthcare providers do not solely use one data modality for their decisions, this approach opens the door for multi-input/mixed data models which use a combination of patient information, such as genomic, radiological, and clinical data, to train a hybrid deep learning model. Thus, this reflects the main characteristic of artificial intelligence: simulating natural human behavior. 
  • 443
  • 16 May 2022
Topic Review
Frontline Extended Surgery
Surgery is the only curative treatment for localized disease in retroperitoneal sarcoma (RPS). Frontline extended surgery, or compartmental surgery, is a surgical strategy consisting of resecting the tumor together with adjacent organs, with the aim of minimizing marginality. 
  • 439
  • 08 Sep 2022
Topic Review
AI for Preoperative Measurements in Total Knee Arthroplasty
Total knee arthroplasty (TKA) is widely used in clinical practice as an effective treatment for end-stage knee joint lesions. It can effectively correct joint deformities, relieve painful symptoms, and improve joint function. The reconstruction of lower extremity joint lines and soft tissue balance are important factors related to the durability of the implant; therefore, it is especially important to measure the joint lines and associated angles before TKA. 
  • 438
  • 15 Mar 2023
Topic Review
Defect Coverage after Forequarter Amputation
Autologous fillet flaps are a common reconstructive option for large defects after forequarter amputation (FQA) due to advanced local malignancy or trauma. FQA predominantly was a consequence of local malignancy. For vascular supply, the brachial artery was predominantly anastomosed to the subclavian artery and the brachial or cephalic vein to the subclavian or external jugular vein. 
  • 437
  • 01 Jul 2022
Topic Review
Minimally Invasive Approach for Multiple Hepatocellular Carcinoma
The best therapy for patients with multiple hepatocellular carcinoma (HCC) within the Milan Criteria is liver transplantation (LT). Unluckily, LT cannot be offered to all the patients. For the intermediate staged multiple HCC trans-arterial chemoembolization (TACE) still remains the treatment of choice. However, a growing body of evidence is showing better outcomes after surgery than TACE. Trans-arterial radioembolization and stereotaxic body radiation therapy can also play an important role in this setting. Furthermore, the role of minimally invasive liver surgery (MILS) for patients with multiple HCC is still debated.
  • 435
  • 27 Dec 2022
Topic Review
Roles of CAFs in the TME of PDAC
Pancreatic ductal adenocarcinoma (PDAC) is one of the most malignant digestive tumors, characterized by a low rate of early diagnosis, strong invasiveness, and early metastasis. The abundant stromal cells, dense extracellular matrix, and lack of blood supply in PDAC limit the penetration of chemotherapeutic drugs, resulting in poor efficacy of the current treatment regimens. Cancer-associated fibroblasts (CAFs) are the major stromal cells in the tumor microenvironment. Tumor cells can secrete exosomes to promote the generation of activated CAFs, meanwhile exosomes secreted by CAFs help promote tumor progression. 
  • 433
  • 02 Sep 2022
Topic Review
Necessity of Cardiothoracic Surgical Critical Care Medicine Training
Cardiothoracic surgical critical care medicine is practiced by a diverse group of physicians including surgeons, anesthesiologists, pulmonologists, and cardiologists. With a wide array of specialties involved, the training of cardiothoracic surgical intensivists lacks standardization, creating significant variation in practice. Additionally, it results in siloed physicians who are less likely to collaborate and advocate for the cardiothoracic surgical critical care subspeciality. Moreover, the current model creates credentialing dilemmas, as experienced by some cardiothoracic surgeons. 
  • 428
  • 01 Jan 2023
Topic Review
Sarcopenia and Pancreatic Fistula after Pancreatic Surgery
Postoperative pancreatic fistula (POPF) is one of the most critical complications after pancreatic surgery. The relationship between sarcopenia and outcomes following this type of surgery is debated. There is increasing evidence that sarcopenia should be considered in the preoperative risk assessment and treatment decision making in patients undergoing pancreatic surgery.
  • 427
  • 25 Jul 2022
Topic Review
Mesothelioma Surgery
Mesothelioma is an aggressive disease arising from parietal pleura. Surgery is a valuable option in the frame of a multimodality treatment. Several surgical approaches have been standardized with the aim of a macroscopic complete resection; these often require homolateral diaphragm and pericardial resection and reconstruction. Extrapleural pneumonectomy (EPP) and extended pleurectomy decortication (EPD) have been recognized as radical surgical procedures. Nevertheless, both operations are technically challenging and associated with a significant rate of peri-operative morbidity and non-negligible mortality. The diaphragmatic and pericardial reconstruction technique is mandatory to avoid respiratory impairment and to reduce post-operative complications like gastric and cardiac herniation. Moreover, in the case of localized chest wall recurrence, surgery might be considered a valuable therapeutical option for highly selected and fit patients. All the technical aspects of the resection and reconstruction of the diaphragm, pericardium, and chest wall are described as well as the possible use of new minimally invasive techniques. In addition, the choice of different prosthetic materials, considering the most recent innovations in the field, are discussed.
  • 423
  • 25 Jun 2021
Topic Review
Leaping the Boundaries in LLR for Hepatocellular Carcinoma
Recent advances in surgical techniques and perioperative management lead to a redefinition of the actual frontiers of Laparoscopic Liver Resection (LLR) by including patients with more advanced disease. Nonetheless, because of both underlying liver conditions and technical difficulty, LLR for Hepatocellular Carcinoma (HCC) is still considered as a challenging procedure. Specific concerns exist about LLR in cirrhotic patients, posterosuperior segments, giant and multiple tumors, as well as repeat resections.
  • 421
  • 05 May 2022
Topic Review
Biomarkers and Therapeutic Targets for Melanoma
Malignant melanoma is one of the most common cancers in the world. In the disease’s early stages, treatment involves surgery, in advanced stages however, treatment options were once scarce. There has been a paradigm shift in advanced melanoma treatment with the introduction of immunotherapy and targeted therapies. Understanding the molecular pathways and their pathologic counterparts helped identifying specific biomarkers that lead to the development of specific targeted therapies.
  • 421
  • 25 Oct 2022
Topic Review
Autologous Breast Reconstruction versus Implant-Based Breast Reconstruction
The autologous method for breast reconstruction has been determined by researchers throughout the field as providing comparable benefits and positive long-term outcomes with more natural results compared to implant-based breast reconstruction which can often result in firmer, less natural breast mounds and increase the risks associated with foreign material in the body. The traditional method of using the abdomen, thigh, or gluteus region as a donor site has been a suitable, if not preferred, option for patients undergoing unilateral or bilateral non-implant-based reconstruction. By utilizing the rectus abdominus, latissimus dorsi, transverse or diagonal upper gracilis, gluteal, or any other appropriate muscle flap with transposable vasculature, surgeons are able to recreate a warm, soft, and natural breast mound in the place of removed breast tissue and skin that may be necessary for patients with locally involved breast cancer.
  • 417
  • 27 Jun 2023
Topic Review
Precision Medicine for Hepatocellular Carcinoma
Hepatocellular carcinoma (HCC) is one of the major malignant diseases worldwide, characterized by growing incidence and high mortality rates despite apparent improvements in surveillance programs, diagnostic and treatment procedures, molecular therapies, and numerous research initiatives. Most HCCs occur in patients with liver cirrhosis, and the competing mortality risks from the tumor and the cirrhosis should be considered. Presently, previously identified risk factors, such as hepatitis virus infection, hepatic inflammation and fibrosis, and metabolic syndrome, may be used as chemoprevention targets. The application of precision medicine for HCC management challenges the one-size-fits-all concept; moreover, patients should no longer be treated entirely according to the histology of their tumor but based on molecular targets specific to their tumor biology. Next-generation sequencing emphasizes HCC molecular heterogeneity and aids our comprehension of possible vulnerabilities that can be exploited. 
  • 414
  • 05 May 2022
Topic Review
Human Acellular Dermal Matrix in Reconstructive Surgery
Reconstructive surgery often confronts large tissue defects. This creates a need to look for materials that are immunogenic but offer the possibility of tissue filling. ADM—acellular dermal matrix—is a biological collagen matrix without immunogenicity, which is more commonly used in surgical treatment. Reconstructive surgery is still searching for various biocompatible materials that can be widely used in surgery. The available materials have their advantages and disadvantages.
  • 414
  • 28 Jan 2023
Topic Review
Local Aggressive Treatment in Oligometastatic NSCLC
In oligometastatic NSCLC, the treatment of all tumor sites should be technically feasible with tolerable toxicity. It was thus proposed that oligometastatic NSCLC should include five or fewer metastases in three or fewer organs. Notably, the primary tumor and an involvement of mediastinal lymph nodes are excluded as a metastatic site, while pulmonary or pleural metastases are counted as a metastatic site. Patients with diffuse serosal metastases (meningeal, pericardial, pleural, or peritoneal) or bone marrow involvement are as well excluded from the definition of oligometastatic NSCLC, for they cannot be treated with radical intent. In general, most (oligo) metastases of NSCLC are found in the brain (35.5%), followed by the contralateral lung (33.6%), the adrenal glands (10%), bones (8.5%), and the liver (2.4%). One-fourth of all patients with metastatic non-small cell lung cancer presents with a limited number of metastases and relatively low systemic tumor burden. This oligometastatic state with limited systemic tumor burden may be associated with remarkably improved overall and progression-free survival if both primary tumor and metastases are treated radically combined with systemic therapy. This local aggressive therapy (LAT) requires a multidisciplinary approach including medical oncologists, radiation therapists, and thoracic surgeons.
  • 405
  • 06 Jan 2022
Topic Review
Riedel’s Thyroiditis
Riedel’s thyroiditis (RT), being strongly connected with positive antibodies against the thyroid, has been traditionally regarded as a particular type of autoimmune thyroiditis. RT was assimilated into the larger spectrum of immunoglobulin IgG4-related disease (IgG4-RD) and, recently (in 2021), a proposal was released to designate a particular framework, namely, IgG4-related thyroid disease (IgG4-RTD) with four underlying entities: IgG4-mediated RT, IgG4-associated Hashimoto’s thyroiditis (and its fibrotic variant), and IgG4-related Graves’s disease.
  • 405
  • 13 Jun 2023
Topic Review
Radiation Therapy in Non-Melanoma Skin Cancer Treatment
Non-melanoma skin cancer (NMSC) is the most common malignancy in the United States. While surgery is considered as the main treatment modality for both cutaneous basal cell carcinoma (cBCC) and cutaneous squamous cell carcinoma (cSCC), radiotherapy plays an important role in the treatment of NMSC, both in the adjuvant setting for cases considered high-risk for recurrence, and in the definitive setting, when surgery is not feasible or desired by the patient. 
  • 404
  • 26 May 2023
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