Surgery最新文献

{"title":"The utility of cosyntropin stimulation test in the assessment of adrenal function after unilateral adrenalectomy.","authors":"Dogukan Akkus, Edip Memisoglu, Kamran Huseynli, Arturan Ibrahimli, Rafael Perez-Soto, Pratibha Rao, Riccardo Correa, Eren Berber","doi":"10.1016/j.surg.2026.110585","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110585","url":null,"abstract":"<p><strong>Background: </strong>There are scant data in the literature regarding assessment of adrenal function after unilateral adrenalectomy. Most research has involved patients with mild autonomous cortisol secretion, with recommendations to use the cosyntropin stimulation test and basal cortisol to diagnose secondary adrenal insufficiency. Our aim was to investigate the utility of the cosyntropin stimulation test in the assessment of adrenal function after unilateral adrenalectomy.</p><p><strong>Methods: </strong>This was a retrospective institutional review board-approved study of patients who underwent unilateral adrenalectomy between 2010 and 2025, followed by basal morning cortisol and a cosyntropin stimulation test on postoperative day 1. The relationship between postoperative day 1 cortisol and the cosyntropin stimulation test was investigated.</p><p><strong>Results: </strong>There were 179 patients with mild autonomous cortisol secretion and 119 with non-cortisol-secreting tumors. The cosyntropin stimulation test was normal when postoperative day 1 cortisol was >10 μg/dL in both groups. When postoperative day 1 cortisol was less than 5 mg/dL, the cosyntropin stimulation test was abnormal in 75% of patients in the mild autonomous cortisol secretion group and in 27% in the non-cortisol-secreting tumor group. When postoperative day 1 cortisol was 5-10 mg/dL, the cosyntropin stimulation test was abnormal in 38% of patients in the mild autonomous cortisol secretion group and 12% in the non-cortisol-secreting tumor group.</p><p><strong>Conclusion: </strong>Routine postoperative day 1 morning cortisol followed by a selective cosyntropin stimulation test may enable a patient-custom assessment of adrenal insufficiency and minimize unnecessary steroid replacement after unilateral adrenalectomy. The most practical use of the cosyntropin stimulation test seems to be in patients with postoperative day 1 cortisol levels between 5 and 10 mg/dL.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110585"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Avoiding the sternum: Perioperative outcomes of hybrid cervical and robotic-assisted thoracoscopic resection versus sternotomy for substernal goiters.","authors":"Niranjna Swaminathan, Mehmet Kostek, Rongzhi Wang, Rachael Caretti, Peter J Abraham, Andrea Gillis, Sophie Dream, Brenessa Lindeman, Herbert Chen","doi":"10.1016/j.surg.2026.110603","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110603","url":null,"abstract":"<p><strong>Background: </strong>Substernal goiters occasionally require sternotomy for safe resection. Hybrid cervical and robotic-assisted thoracoscopic surgery offers a less invasive alternative, though it is underutilized in the United States. We report one of the largest United States series comparing hybrid and sternotomy approaches.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of 7,370 thyroidectomies performed at a single tertiary academic center between 2012 and 2023. Patients with substernal goiters extending below the sternal notch on preoperative computed tomography imaging were identified. Thoracic surgical assistance was involved when mediastinal mobilization was anticipated based on preoperative imaging and multidisciplinary evaluation. Patients requiring thoracic involvement were categorized into 3 operative groups: hybrid cervical thyroidectomy with robotic-assisted thoracoscopic surgery, sternotomy, or cervical thyroidectomy with deep mediastinal dissection. Perioperative outcomes, including operative time, blood loss, chest tube use, intensive care unit admission, length of stay, and postoperative complications, were compared between hybrid and sternotomy groups. Complications included hypocalcemia, recurrent laryngeal nerve injury, and voice changes. Continuous and categorical variables were compared using appropriate parametric and nonparametric statistical tests.</p><p><strong>Results: </strong>Among 34 patients requiring thoracic surgical assistance, 16 underwent hybrid cervical thyroidectomy with robotic-assisted thoracoscopic surgery, and 13 underwent sternotomy. Baseline demographics were similar between groups, including age (62 ± 13 vs 58 ± 10 years), female sex (56% vs 46%), and body mass index (33.7 ± 7.4 vs 32.1 ± 8.7). Racial distribution within the hybrid and sternotomy groups was 37.5% vs 76.9% Black and 62.5% vs 23.1% White, respectively. Preoperative symptoms were comparable between groups. Operative outcomes favored the hybrid approach, including shorter operative time (3.2 vs 5.0 hours, P < .001), lower estimated blood loss (180 [120-250] vs 344 [200-533], P < .001), shorter hospital stay (2 vs 4 days, P < .001), and fewer chest tubes (25% vs 92%, P < .001). Intensive care unit admission occurred less frequently in the hybrid group (13% vs 29%). Rates of hypocalcemia (14%), hoarseness (29%), and recurrent laryngeal nerve injury (7%) were similar between groups. Intraoperative complications and perioperative mortality occurred only in the sternotomy group (15%).</p><p><strong>Conclusion: </strong>Hybrid cervical thyroidectomy with robotic-assisted thoracoscopic surgery mobilization was associated with improved perioperative outcomes compared with sternotomy and may represent a safe minimally invasive alternative for select patients with substernal goiters requiring thoracic access.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110603"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiometabolic benefits after adrenalectomy for mild autonomous cortisol secretion.","authors":"Alexis Korman, Joy Done, Arden Stromnes, Carolyn Seib, Namrata Gumaste, Sapir Nachum, Kepal Patel, Rachel Liou, Jason Prescott, John Allendorf, Wen Shen, Insoo Suh","doi":"10.1016/j.surg.2026.110600","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110600","url":null,"abstract":"<p><strong>Background: </strong>Mild autonomous cortisol secretion causes substantial cardiometabolic morbidity, yet evidence for benefits following adrenalectomy remains mixed. Prior studies are limited by small sample sizes and heterogeneous definitions. This study evaluates the metabolic impact of adrenalectomy compared with nonoperative management in mild autonomous cortisol secretion using standardized biochemical criteria from the Epic Cosmos database.</p><p><strong>Methods: </strong>Mild autonomous cortisol secretion was defined biochemically using dexamethasone suppression test cortisol 1.8-10 μg/dL, dexamethasone, and adrenocorticotropic hormone levels. Surgical patients underwent unilateral adrenalectomy with biochemical resolution of hypercortisolism. Inverse probability of treatment weighting was performed, adjusting for demographics, baseline cardiometabolic parameters, dexamethasone suppression test cortisol level, and glucagon-like peptide-1 receptor agonist use. The starting time point was the adrenalectomy date or, for nonoperative patients, the dexamethasone suppression test date plus the median time to surgery. Follow-up outcomes (A1C, lipid profile, body mass index, and blood pressure) were assessed for categorical improvement at last follow-up within 3 years using a weighted logistic regression model.</p><p><strong>Results: </strong>From 2018 to 2025, 395 patients met inclusion criteria (54 surgical, 341 nonoperative). Surgical patients had a higher adjusted likelihood of categorical improvements in A1C (25.6% vs 9.5%, odds ratio, 3.30; P = .002), total cholesterol (14.6% vs 3.9%, odds ratio, 4.25; P = .004), and body mass index (24.9% vs 12.1%, odds ratio, 2.42; P = .018). There were no differences in blood pressure between groups (28.4% vs 26.7%, odds ratio, 1.09; P = .803).</p><p><strong>Conclusion: </strong>This is the largest cohort study to date evaluating metabolic outcomes after surgery for mild autonomous cortisol secretion. Adrenalectomy was associated with categorical improvement in A1C, body mass index, and total cholesterol, supporting more widespread consideration for selective operative management.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110600"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hazards of delay: Impact of parathyroidectomy timing on outcomes in secondary hyperparathyroidism of renal origin.","authors":"Raj Roy, Rachael Caretti, Niranjna Swaminathan, Julia Kasmirski, Azeem Izhar, Daniel Gomez Carrillo, Hameeda Arain, Peter Abraham, Brenessa Lindeman, Andrea Gillis, Orlando M Gutierrez, Herbert Chen, Sophie Dream","doi":"10.1016/j.surg.2026.110591","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110591","url":null,"abstract":"<p><strong>Background: </strong>Surgical management is recommended in patients with secondary hyperparathyroidism when parathyroid hormone levels exceed 9 times the normal, and medical management has failed to control parathyroid hormone levels or associated complications. We aimed to examine the impact of the timing of parathyroidectomy on clinical outcomes in patients with secondary hyperparathyroidism and parathyroid hormone exceeding 9 times the normal.</p><p><strong>Methods: </strong>In this retrospective cohort study using the TriNetX database, we included adults with a parathyroid hormone level of ≥600 pg/mL with concurrent stage 5 chronic kidney disease or an estimated glomerular filtration rate of ≤15 mL/min/1.73 m² who underwent parathyroidectomy. Patients with prior kidney transplants were excluded. Parathyroidectomy timing was classified as early (≤2 years) or delayed (>2 years) from the index parathyroid hormone elevation. Cohorts were propensity score matched based on demographics, Charlson comorbidities, body mass index, laboratory values, dialysis dependence, and medication use. A secondary matched analysis compared outcomes in kidney transplant recipients undergoing parathyroidectomy before versus after transplantation. Outcomes measured were fatigue, hypercalcemia, osteoporosis, and cardiovascular complications after the index event.</p><p><strong>Results: </strong>A total of 1,413 patients underwent parathyroidectomy without prior kidney transplant. Of these, 916 (64.8%) underwent early and 497 (35.2%) underwent delayed parathyroidectomy. Kidney transplant occurred in 15.8% of early and 35.8% of delayed patients at median intervals of 1.8 and 3.9 years. After matching at the index parathyroid hormone elevation (n = 730), the mean age was 44 years, with 50% female and 43% Black. Delayed parathyroidectomy was associated with a higher risk of malaise and fatigue (hazard ratio = 1.5; P = .02), osteoporosis (hazard ratio = 1.63; P = .04), and hypercalcemia (hazard ratio = 1.42; P = .01). Cardiovascular complications were significantly more frequent in the delayed group. In a secondary analysis of kidney transplant recipients (n = 1,054), parathyroidectomy performed after transplantation was associated with a 2.6-fold increased hazard of graft failure.</p><p><strong>Conclusions: </strong>In patients with secondary hyperparathyroidism undergoing parathyroidectomy, early surgery performed at a parathyroid hormone level of 9 times the normal may mitigate the risk of complications.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110591"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adrenalectomy for adrenocortical carcinoma: A national assessment of trends in the utilization of the robotic approach.","authors":"Dhruv J Patel, Alexa J Hughes, Signe M Braafladt, Alexandria D McDow, C Corbin Frye, Ryan J Ellis, Karl Y Bilimoria, Anthony D Yang","doi":"10.1016/j.surg.2026.110601","DOIUrl":"10.1016/j.surg.2026.110601","url":null,"abstract":"<p><strong>Background: </strong>Current operative guidelines recommend open adrenalectomy for adrenocortical carcinoma. Despite this recommendation, minimally invasive approaches have been adopted. We hypothesize that minimally invasive adrenalectomy for adrenocortical carcinoma has increased over time, driven by robotic-assisted approaches, and has not compromised oncologic outcomes.</p><p><strong>Methods: </strong>A retrospective review of patients undergoing surgical resection of adrenocortical carcinoma from the National Cancer Database was performed. Separate multivariable logistic regression models were built to compare factors associated with robotic surgery relative to open and laparoscopic approaches. Survival was assessed using Kaplan-Meier curves and Cox regression analysis.</p><p><strong>Results: </strong>Of 2,481 patients who underwent adrenalectomy for adrenocortical carcinoma from 2010 to 2022, 1,618 (65.2%) underwent open adrenalectomy, 555 (22.4%) underwent laparoscopic adrenalectomy, and 308 (11.9%) underwent robotic adrenalectomy. The proportion of robotic cases increased from 2010 (4.5%) to 2022 (20.7%). Patients who underwent resection after 2018 had a higher probability of undergoing a robotic adrenalectomy compared with open adrenalectomy (odds ratio, 1.76; 95% confidence interval [CI], 1.23-2.52; P = .002) and a higher likelihood of undergoing a robotic adrenalectomy compared with laparoscopic adrenalectomy (odds ratio, 2.49; 95% CI, 1.71-3.62; P < .001). There were no differences in margin positivity by approach: robotic adrenalectomy versus open adrenalectomy (odds ratio, 0.79; 95% CI, 0.50-1.23; P = .291) and robotic adrenalectomy versus laparoscopic adrenalectomy (odds ratio, 0.65; 95% CI, 0.40-1.05; P = .081). Five-year overall survival rates by surgical approach were open adrenalectomy = 48%, laparoscopic adrenalectomy = 51%, and robotic adrenalectomy = 55% (P = .063). Cox regression revealed that surgical approach was not associated with survival (robotic adrenalectomy versus open adrenalectomy [hazard ratio, 1.13; 95% CI, 0.82-1.55; P = .510]).</p><p><strong>Conclusion: </strong>Minimally invasive surgery, specifically the robotic approach, for adrenocortical carcinoma has increased over the past decade with no associated compromise in oncologic efficacy.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110601"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluate or ignore: National variation in the evaluation of adrenal lesions in over 250,000 patients.","authors":"Jessica K Hall, Joshua John Horns, Samantha Saperstein, Rupam Das, Kennedy E Jensen, Lauren Slattery, Shaidy Moronta, Carrie E Cunningham, Fiemu Nwariaku, Jessica L McMullin","doi":"10.1016/j.surg.2026.110588","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110588","url":null,"abstract":"<p><strong>Background: </strong>Adrenal lesions are commonly found on abdominal imaging obtained for unrelated indications. Available data on the incidence, evaluation, and management of adrenal incidentalomas are primarily based on single-institution retrospective studies that may not be nationally representative. Our aim was to evaluate national rates and predictors of guideline-concordant adrenal lesion follow-up using a large, well-established national claims database (Merative MarketScan).</p><p><strong>Methods: </strong>Using the MarketScan database, we identified a national cohort of patients >18 years old with adrenal lesions discovered on imaging. Outcomes of interest included biochemical workup, repeat imaging, and surgical intervention. We performed descriptive, comparative, and multivariable analyses to determine the rates and predictors of guideline-concordant workup and assessed geographic trends.</p><p><strong>Results: </strong>Among 251,705 patients with adrenal masses, only 3% received complete biochemical workup. Only 19% received any biochemical testing, 61% underwent follow-up imaging, and 2% ultimately underwent adrenalectomy. On multivariable analysis, hypertension, private insurance, and female sex were significant predictors of receiving adrenal biochemical workup. Older age and a prior cancer diagnosis were associated with lower rates of biochemical workup. Patients located in the Northeast and Western regions of the United States were more likely to undergo biochemical workup.</p><p><strong>Conclusion: </strong>National rates of guideline-concordant evaluation for patients with adrenal incidentalomas are low. Patient comorbidities, region of residence, and insurance status influenced rates of follow-up. Targeted interventions for high-risk patients and efforts to address regional disparities may help improve national adherence to guideline-recommended evaluation.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110588"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Before the incision: How thyroid surgeons foster patient trust preoperatively.","authors":"Sarah Lund, Steven Xie, Gurjit Sandhu, Catherine Jensen, Elizabeth Bacon, Hunter J Underwood, David T Hughes, Susan C Pitt","doi":"10.1016/j.surg.2026.110592","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110592","url":null,"abstract":"<p><strong>Background: </strong>Patient trust in physicians is crucial but has declined over time. Understanding what language surgeons use to build trust may guide educational strategies to better prepare surgical trainees. This study aimed to identify trust-building language used by surgery attendings during preoperative counseling for thyroidectomy.</p><p><strong>Methods: </strong>This qualitative study was conducted with patients referred for thyroidectomy, their surgeons, and trainees. Preoperative clinic visits were audio-recorded and transcribed verbatim. An inductive thematic analysis was performed, focused on trust-building language.</p><p><strong>Results: </strong>Across 3 academic centers, transcripts from 44 patients seen by 14 surgeons (6 otolaryngologists and 8 endocrine surgeons) and 14 surgical trainees (5 medical students, 7 surgical residents, and 2 fellows) were analyzed. Six types of trust-building approaches were identified. To build trust, attendings: (1) practiced bidirectional and closed-loop communication, (2) built a personal connection with patients, (3) demonstrated expertise, (4) acknowledged the uncertainty inherent to workup and/or management, (5) respected patient agency in decision-making, and (6) streamlined the care process. Surgical trainees modeled their attending's trust-building language, tending to rely predominantly on bidirectional/closed-loop communication skills and developing a personal connection with patients.</p><p><strong>Conclusion: </strong>These results demonstrate several discrete trust-building approaches that attending surgeons used to build trust when counseling patients and inform a model for teaching trust building to trainees. While trainees already model some of these approaches, more advanced skills were not observed, identifying specific trust-building approaches as a focus for formal training.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110592"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149075979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone-modifying agents may alter biochemical presentation and operative findings in primary hyperparathyroidism.","authors":"Abigail C Chmiel, Genesys Giraldo, Caroline Jones, Meredith Freeman, Naga M Yalla, William E Gillanders, John A Olson, Taylor C Brown","doi":"10.1016/j.surg.2026.110587","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110587","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperparathyroidism is closely linked to bone metabolism, leading to increased bone resorption and osteoporosis. Bone-modifying agents are commonly used to mitigate bone loss by altering calcium metabolism; however, their effect on the biochemical and operative presentation of primary hyperparathyroidism has not been well characterized. This study evaluates the association between bone-modifying agent use, biochemical markers, and operative findings among patients with primary hyperparathyroidism.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients who underwent parathyroidectomy for primary hyperparathyroidism between 2019 and 2025 at a single tertiary referral center. A history of bone-modifying agent use and bone disease was assessed. Descriptive statistics and univariate analyses were performed to evaluate associations between bone-modifying agent use and the biochemical and operative phenotypes of primary hyperparathyroidism.</p><p><strong>Results: </strong>A total of 899 patients met inclusion criteria, of whom 187 (20.8%) had a history of bone-modifying agent use. Patients with bone-modifying agent use were more likely to be female (P < .001), White (P < .001), and older on average (70 vs 60 years, P < .001). Mean serum calcium levels (10.5 vs 10.9 mg/dL, P < .001) and mean parathyroid hormone levels (99.5 vs 119.7 pg/mL, P < .001) were lower among bone-modifying agent users. Multigland disease was more frequent in bone-modifying agent users (43% vs 32%, P = .03) as was bilateral neck exploration (54% vs 45%, P = .033).</p><p><strong>Conclusion: </strong>In patients undergoing parathyroidectomy for primary hyperparathyroidism, the use of bone-modifying agents is associated with a distinct biochemical profile and a higher prevalence of multigland disease. A more nuanced understanding of the relationship between bone-modifying agents and the pathophysiology and surgical presentation of primary hyperparathyroidism could inform preoperative planning and guide individualized evaluation strategies in this patient population.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110587"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149064274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between genotype and long-term risk of reintervention and distant metastases in patients with multiple endocrine neoplasia type 1-associated duodenopancreatic neuroendocrine tumors.","authors":"Omair A Shariq, Sutton Julsrud, Geoffrey B Thompson, Thorvardur R Halfdanarson, Trenton R Foster, Benzon M Dy, William F Young, Travis J McKenzie, Melanie L Lyden","doi":"10.1016/j.surg.2026.110586","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110586","url":null,"abstract":"<p><strong>Background: </strong>Duodenal and pancreatic neuroendocrine tumors are the leading cause of mortality in multiple endocrine neoplasia type 1, due to distant metastasis. Although surgery is the cornerstone of management, patients may require reintervention for disease progression or hormone-related morbidity. The clinical and genetic determinants of reintervention and long-term oncologic outcomes after index duodenal and pancreatic neuroendocrine tumor surgery in multiple endocrine neoplasia type 1 remain unclear.</p><p><strong>Methods: </strong>We retrospectively analyzed patients with genetically confirmed multiple endocrine neoplasia type 1 and duodenal and pancreatic neuroendocrine tumors evaluated at our institution from 1985 to 2024. Reintervention was defined as any subsequent surgical or locoregional therapy. Kaplan-Meier methods and multivariable Cox proportional hazards models were used to evaluate predictors of reintervention-free survival and distant metastasis-free survival, focusing on truncating versus nontruncating MEN1 variants.</p><p><strong>Results: </strong>Among 153 patients with multiple endocrine neoplasia type 1, 94 (61%) underwent surgical resection for duodenal and pancreatic neuroendocrine tumors at a median age of 40 (interquartile range, 28-49) years. After a median follow-up of 16.4 years, 25 patients (27%) required reintervention, with 45 total procedures performed. Truncating multiple endocrine neoplasia type 1 variants were significantly more common among patients undergoing reintervention (88.0% vs 63.8%; P = .024). On multivariable analysis, truncating genotype was independently associated with reintervention (hazard ratio, 3.82; 95% confidence interval, 1.25-16.68; P = .036). Among 84 patients without metastases at surgery, 24 (28.6%) developed distant metastases during follow-up; truncating genotype independently predicted shorter distant metastasis-free survival (hazard ratio, 5.55; 95% confidence interval, 1.56-35.40; P = .024). Notably, 37.5% of patients who developed metastases had a largest resected tumor ≤2 cm.</p><p><strong>Conclusion: </strong>Over a quarter of patients undergoing surgery for multiple endocrine neoplasia type 1-associated duodenal and pancreatic neuroendocrine tumors require reintervention for progressive disease, and truncating MEN1 variants confer a nearly 4-fold higher risk of reintervention and >5-fold higher risk of distant metastatic progression during follow-up. Our findings underscore the limitations of size-based surgical algorithms and suggest that germline genotype may provide complementary prognostic information to refine postoperative risk stratification and surveillance strategies.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110586"},"PeriodicalIF":3.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149128619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating technical variations and outcomes in indocyanine green-guided lymph node mapping for colorectal cancer.","authors":"Sara Saeidishahri, Lillian Wagner, Sameh Hany Emile, Steven D Wexner","doi":"10.1016/j.surg.2026.110576","DOIUrl":"https://doi.org/10.1016/j.surg.2026.110576","url":null,"abstract":"<p><strong>Background: </strong>Indocyanine green is a fluorescent dye used in a wide range of specialties, including colorectal surgery. Although indocyanine green fluorescence imaging has been well established for assessing colorectal anastomotic perfusion, its role in lymph node mapping in colorectal cancer remains unclear. This narrative review aimed to provide an overview of the mechanism of action of indocyanine green-fluorescence imaging and its role in lymph node mapping in colorectal cancer.</p><p><strong>Methods: </strong>PubMed/MEDLINE was searched through July 2026 for studies evaluating the use of indocyanine green-fluorescence imaging for lymphatic mapping and lymph node identification in colorectal cancer. Findings were narratively summarized.</p><p><strong>Results: </strong>Indocyanine green-fluorescence imaging may improve visualization of lymphatic drainage and support a more complete lymphadenectomy. Meta-analyses have reported pooled lymph node detection rates of 91% and 86.8%, with substantial variation by tumor location, disease stage, and mapping technique, with generally lower detection rates in rectal than in colon cancer. Pooled sensitivities of 63%, 64.3%, and 71% were reported, corresponding to false-negative rates of 37%, 35.7%, and 29%, respectively. Although indocyanine green-fluorescence imaging was associated with an increased lymph node harvest and occasionally modified resection strategy, data on long-term survival remain limited and inconsistent. Heterogeneity in indocyanine green dose and concentration, injection route and timing, imaging platforms, and outcome definitions limits comparison across studies.</p><p><strong>Conclusion: </strong>Indocyanine green-fluorescence imaging might be a valuable tool for intraoperative lymphatic mapping and enhancing lymphadenectomy; however, substantial methodologic heterogeneity precludes definitive conclusions regarding its diagnostic accuracy for nodal metastatic status. Standardized protocols and high-quality prospective studies are needed to define its optimal role and long-term oncologic impact.</p>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":" ","pages":"110576"},"PeriodicalIF":3.2,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}