The development of incisional hernias (IH) is an uncommon but complex outcome following pancreatic surgery, especially through the open approaches. The etiology of this complication is multifactorial and can be related to the patient and to the surgical technique. We aimed to perform a systematic review and meta-analysis assessing the risk factors for development of IH following pancreatic surgery. Pubmed, Cochrane, and EMBASE databases were systematically searched from inception to September 2024. Observational studies and randomized controlled trials assessing patients > 18 years old undergoing pancreatic surgery and reporting data on incidence and risk factors for IH were selected. Outcomes were mean age, mean body mass index (BMI), diabetes mellitus, female and male gender, active smoking, and surgical site infections (SSI). We used RStudio for statistical analysis. 686 records were reviewed, and 7 observational retrospective studies were included, totaling 3,391 patients. The incidence of IH in the pooled analysis was 368 (10.8%), and after performing a proportional meta-analysis, we found that 12.5 per 100 (95% CI 7.1, 20.9) patients undergoing pancreatic surgery develop IH. Our pooled analysis found that older patients (MD 2.7 years; 95% CI 0.5, 4.8; p = 0.014) and patients with higher BMI (MD 1.8; 95% CI 0.9, 2.7; p < 0.001) present higher risk of developing IH. Female and male gender, active smoking, diabetes mellitus, and SSI were not significant risk factors for IH after pancreatic surgery. Our study showed that patients with older age and higher weight present a significantly higher risk of developing IH after pancreatic surgery. Considering pancreatic surgery is frequently carried out in emergent conditions, sometimes due to malignant causes, the preoperative optimization to reduce weight before surgery is not always a possible alternative. On the other hand, surgeons must consider the possibility of optimizing the patient in terms of weight loss if feasible, to reduce morbidity after the procedure.

Colorectal cancer liver metastasis remains a significant challenge, with systemic inflammation and liver fibrosis emerging as key prognostic factors. This study evaluates the individual and combined prognostic significance of the Systemic Inflammation Index and Fibrosis-4 index in CRLM patients undergoing curative liver resection after neoadjuvant chemotherapy. A retrospective cohort of 255 CRLM patients was stratified into high/low SII and FIB-4 groups based on median values. SII and FIB-4 were calculated using preoperative laboratory data. Primary outcomes included overall survival (OS) and disease-free survival (DFS), with secondary outcomes assessing postoperative complications and recurrence. Kaplan-Meier analysis and Cox regression were used for survival analysis. Higher SII levels were associated with worse DFS (HR = 0.67, p = 0.028). Similarly, higher FIB-4 levels correlated with increased recurrence rates (p = 0.03) and poorer DFS (HR = 0.69, p = 0.047). For Overall Survival (OS), no significant difference was observed between the High SII and Low SII groups, nor between the High FIB-4 and Low FIB-4 groups. The Low FIB-4 & Low SII group showed significantly better DFS (HR = 0.47, p = 0.048). In terms of postoperative outcomes, the FIB-4 Low group had more transfusions and incision infections. Additionally, the SII High group had higher recurrence rates and more R1 resections (p = 0.045). SII and FIB-4 are valuable biomarkers for predicting DFS and recurrence in CRLM patients. Their combined use enhances risk stratification, offering a comprehensive approach to guide personalized treatment strategies. Future studies should explore targeted therapies to modulate inflammation and fibrosis, improving outcomes for high-risk patients.

ERAS programmes are widely used in colorectal surgery, but the impact of overall pathway compliance on outcomes in elderly colorectal cancer patients and the mechanisms linking compliance to recovery are unclear. We retrospectively analysed 206 elderly patients (median age 72years) who underwent elective colorectal cancer resection within an ERAS pathway (2020-2023). Overall ERAS compliance was classified as high (≥ 70%, n = 114) or low (< 70%, n = 92). Outcomes included major complications (Clavien-Dindo III-V), length of stay (LOS), Comprehensive Complication Index (CCI), time to first flatus/defecation, readmission, mortality, and hospital costs. Subgroup analyses and structural equation modelling (SEM) assessed direct and indirect pathways between compliance and outcomes. High compliance was associated with fewer major complications (16.7% vs 29.3%, P = 0.048), lower CCI (18.6 ± 9.5 vs 22.1 ± 10.4, P = 0.014), and shorter LOS (8.2 ± 2.6 vs 10.1 ± 3.1days, P = 0.003). Gastrointestinal recovery was faster (flatus 2.3 ± 0.8 vs 2.9 ± 1.0days; defecation 3.8 ± 1.1 vs 4.5 ± 1.2days; both P < 0.001), and costs were lower (64.8 ± 15.2 vs 72.5 ± 18.1 × 103 RMB, P = 0.003). Readmission and 30-day mortality were low and similar between groups. SEM indicated that higher compliance directly reduced complications, CCI, and LOS, and indirectly reduced 30-day readmission via complications and LOS. In elderly colorectal cancer surgery, higher ERAS compliance is associated with lower morbidity, faster recovery, shorter LOS, and lower costs without increased short-term readmission or mortality, supporting efforts to monitor and improve adherence.

Breast surgery is a cornerstone of breast cancer (BC) treatment and has distinctive features that distinguish it from other subspecialties within general surgery. BC management requires multidisciplinary competencies, with specialized training and dedicated care shown to improve patient outcomes. Breast surgery training should become a critical priority within residency programs. We conducted a cross-sectional survey during the 2025 Italian Society of Breast Surgeon (ANISC) annual meeting, to explore the opinions of breast surgery consultants and residentsregarding the current state of breast surgery training, as well as future perspectives for its improvement. A total of 126 participants (77% consultants, 23% residents) completed the survey. Most of the participants (49.2%) worked in medium-volume Breast Units and had > 10 years of clinical practice (45.2%). Overall, 67.5% of respondents judged their training only partially satisfactory, while 23.8% were completely dissatisfied. The majority (58.7%) supported a hybrid model with three years of general surgery followed by two years exclusively dedicated to breast surgery. Most respondents endorsed mandatory training periods in complementary specialties (79.4%) and rotations in peripheral Breast Units (69.8%). Notably, 88.1% favored the development of a vertical breast surgeon profile, capable of independently managing both oncologic and reconstructive procedures. This is the first national survey exploring breast care professionals’ perspectives on surgical training in Italy. Only 8.7% considered the current system adequate to meet clinical needs. The strong demand for structured and specialized programs, together with the recognition of a vertical breast surgeon figure, highlights the urgent need to redefine breast surgery training pathway.

Pancreatic and periampullary cancers are among the most challenging malignancies. Centralization of care and multidisciplinary management have been associated with improved outcomes. In 2024,the Italian Ministry of Health established a national Steering Committee with the objective of defining a centralized model for the management of pancreatic and periampullary diseases and identifying the minimum requirements for referral centers across Italy. The Steering Committee met every four weeks through plenary and focused working groups. Using data from the National Agency for Regional Health Services and the National Outcome Program, all ICD-9 codes related to pancreatic, periampullary, and distal biliary diseases were analyzed. Criteria were developed according to international recommendations and structured into a Hub-and-Spoke network model. Pancreas Units(Hub centers) were defined as hospitals providing 24/7 multidisciplinary expertise, advanced diagnostic and interventional capabilities, and a minimum surgical volume of ≥ 30 pancreatic resections per year with 90-day mortality < 10% (target < 5% within 3 years). Spoke centers were required to adhere to standardized diagnostic–therapeutic pathways and participate in multidisciplinary team meetings, without performing pancreatic surgery. Based on catchment area analyses, one Hub center per 700,000–1,200,000 inhabitants was recommended. Additional requirements included structured multidisciplinary processes, standardized diagnostic pathways, and integration with national research and training networks. This national model provides a comprehensive framework for centralizing pancreatic and periampullary diseases care. By defining minimum standards, enhancing multidisciplinary coordination, and concentrating complex procedures in high-performance centers, this initiative aims to improve outcomes, reduce regional disparities, and create a sustainable national Pancreas Unit network.

Table 1 Respondents' baseline characteristics N (%) Which surgical specialty are you specialized in?ENT 4 (2.1)General surgery 180 (93.8)General surgery, ENT 5 (2.6)General surgery, thoracic surgery 3 (1.6)How long have you been working as a surgeon in your field?I'm in residency 9 (4.7) < 5 years 18 (9.4)5-10 years 47 (24.5) > 10 years 118 (61.5)