Contemporary Surgical Trends and Management

Dear Colleagues,

Although the beginnings of surgery date back to antiquity, the daily rapid development of new technologies and research, which even leads to personalized medicine, improves care in this area. However, more knowledge is needed among experts worldwide about new advances. This Special Issue provides space for surgeons and related professionals who wish to remain updated on new contemporary surgical trends.

This Special Issue aims to present articles that bring new knowledge related to the field of surgery, especially in the part related to the use of new biomarkers, prognostic factors, sophisticated imaging methods, the newest surgical techniques, minimally invasive surgery, robotic surgery, and transplant surgery.

Staying updated with the latest knowledge is essential to every clinician and researcher in providing the best management for the well-being of patients.

Surgeons and related professionals are invited to contribute manuscripts to this Special Issue. Contributions can be original articles (prospective/retrospective studies), experimental studies, narrative reviews, systemic reviews and meta-analyses, or new diagnostics or surgical techniques.

We look forward to receiving your contributions.

Dr. Marko Bašković
Dr. Zenon Pogorelić
Guest Editors

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• surgery
• pediatric surgery
• urology
• biomarkers and prognostic factors
• surgical infections
• surgical techniques
• minimally invasive surgery
• robotic surgery
• transplant surgery

Title: Validation of prognostic scores in predicting tumor recurrence of gastrointestinal tumor patients: Friend or foe?
Authors: Robert Karitnig1*, Michael Thalhammer1*, Nora Jahn2, Christos Vlachos1, Andreas Bogner1, Sandro Hasenhütl, Tim Eichler1, Mo El-Mahrouk1, Andri Lederer1, Antonia Geisler1, Robert Sucher1, Hans Michael
Affiliation: 1 Department of General, Visceral-and Transplant Surgery, Medical University of Graz, Graz, Austria 2 Department for Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
Abstract: Background: Gastrointestinal stromal tumors (GIST) – the most common mesenchymal tumors of the gastrointestinal (GI) tract - carry a potential risk of malignancy, and the treatment of GIST varies for different risk levels. There are several known prognostic features to predict recurrence in GISTs include tumor mitotic rate, size, and location, yet one common feature of primary GISTs for which prognostic significance and potential malignancy is unknown, is mucosal ulceration. This study aims to investigate the prognostic significance as well as discrimination, validation and calibration of these prognostic models to predict recurrence of GIST after surgery. Materials and methods: A retrospective analysis was conducted including 199 patients at a tertiary university center with documented diagnosis of GIST undergoing surgery between 2000 and 2020. Ulceration was confirmed by documentation in endoscopic and histopathologic reports. Demographic, clinicopathological and outcome data were analyzed for assessing prognostic significance of GIST recurrence prediction. Validation, discrimination and performance of prognostic models for GIST recurrence prediction was assessed by using the area under the receiver operating characteristic curve (AUC), for checking calibration Hosmer-Lemshow-test was used. Results: Of the 195 included patients in this study, 87 GIST (44%) patients demonstrated mucosal ulceration of the primary tumor. Mucosal ulceration in GISTs is associated with GI bleeding, mitotic rate, tumor size, and incidental finding (all p < 0.01). After a median follow-up of 72.2 +/- 23.4 months patients with ulcerated GISTs experienced higher rates of tumor progression. In multivariate analysis, ulceration of GISTs was specifically highly associated with disease progression (p < 0.01) and progression-free survival (hazard ratio (HR) 2.5 [95%CI: 1.3-4.9], p < 0.01). With regard to discrimination and performance, the AUC for recurrence prediction were 0.83 (95% CI 0.75-0.89; p = 0.013) and 0.63 (95% CI 0.53–0.72; 0.12) for mucosal ulceration and risk score model, respectively. The Hosmer-Lemeshow test was insignificant for mucosal ulceration (p = 0.39, chi square 2.1) and significant for risk score model (p = 0.04; chi square 5.1). Conclusions: Mucosal ulceration in GISTs is associated with GI bleeding, mitotic rate, and tumor size. Overall, ulceration in GISTs is associated with elevated risk of tumor progression and is an independent prognostic factor. In multivariate analysis, ulceration in GIST remains an independent risk factor for disease progression. Furthermore, the prognostic factor mucosal ulceration showed both good performance/discrimination and calibration for predicting recurrence in GIST patients.