Annals of surgery open : perspectives of surgical history, education, and clinical approaches最新文献

{"title":"Understanding How Surgeons Improve the Quality of Breast Cancer Surgery Using the Theoretical Domains Framework.","authors":"Doris Goubran, Iresha Ratnayake, Pamela Hebbard, Caroline Park, Maziar Fazel Darbandi, Kathleen Decker, Megan Delisle","doi":"10.1097/AS9.0000000000000585","DOIUrl":"10.1097/AS9.0000000000000585","url":null,"abstract":"<p><strong>Objective: </strong>To understand how surgeons improve the quality of breast cancer surgery.</p><p><strong>Background: </strong>Between 2007 and 2021, breast cancer surgeons in Manitoba, Canada, participated in national initiatives to build a local capacity for quality improvement (QI) in cancer surgery. Key aspects of these initiatives include audit and feedback reports using data from synoptic operative reports and communities of practice. Surgeon engagement in breast cancer surgery QI in Manitoba has not been evaluated since the initiatives were concluded in 2021.</p><p><strong>Methods: </strong>We conducted 60-minute virtual semi-structured qualitative interviews with surgeons who performed breast cancer surgery in Manitoba, Canada, between 2021 and 2024. The interviews were guided by the theoretical domain framework. The thematic analyses were performed by 2 independent researchers.</p><p><strong>Results: </strong>Twelve surgeons were interviewed. Surgeons were motivated to ensure timely care close to home, with excellent oncological, surgical, and aesthetic outcomes. They felt capable of monitoring and improving their surgical quality by tracking their own metrics, collaborating with multidisciplinary colleagues, engaging in continuous professional development, and advocating for improvement. Audit and feedback reports were not perceived to improve the quality of surgery. They felt limited opportunities to sustain improvement strategies. Resource constraints and leadership support within the healthcare system were major barriers to achieving their ideal quality of care.</p><p><strong>Conclusion: </strong>Surgeons performing breast cancer surgery in Manitoba were motivated and capable of improving the quality of breast cancer surgery. However, they perceive limited opportunities and barriers within the healthcare systems to doing so. Future research will provide information on broader contextual factors affecting breast cancer surgery QI.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e585"},"PeriodicalIF":0.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Paired Kidney Analysis of Simultaneous Heart-Kidney Transplantation and Kidney Transplantation After Heart Transplantation.","authors":"Kenji Okumura, Suguru Ohira, Ryosuke Misawa, Seigo Nishida, Steven Lansman, Abhay Dhand","doi":"10.1097/AS9.0000000000000582","DOIUrl":"10.1097/AS9.0000000000000582","url":null,"abstract":"<p><strong>Objective: </strong>To assess the outcomes of a pair of kidneys from a single donor used for simultaneous heart-kidney transplantation (SHKT) or kidney after heart transplantation (KAH).</p><p><strong>Background: </strong>An Increase in kidney dysfunction among heart transplant candidates has led to an increased need for SHKT and KAH. The risk of early kidney graft loss and mortality is higher in SHKT compared with kidney-alone recipients.</p><p><strong>Methods: </strong>Among adult kidney transplant recipients from Oct 2014 to Oct 2022, outcomes were compared between paired kidney-alone <i>vs</i> SHKT and kidney-alone <i>vs</i> KAH. Paired kidney models were used to mitigate differences among donor risk factors. Differential graft years were calculated using restricted mean survival analysis.</p><p><strong>Results: </strong>A total of 1220 pairs of kidney-alone and SHKT recipients and 441 pairs of kidney-alone and KAH recipients were identified. Among the paired donor kidneys, graft survival was significantly lower in SHKT recipients compared with kidney-alone recipients at 1-year post-transplant (96.1% <i>vs</i> 89.3%; <i>P</i> < 0.001) and at 3-year post-transplant (83.9% <i>vs</i> 78.8%; <i>P</i> < 0.001). This resulted in lower mean graft years [SHKT (3.98 years, standard error = 0.06) <i>vs</i> kidney-alone (4.55 years, standard error = 0.04); <i>P</i> < 0.001] and an additional loss of 57 kidney graft years per 100 transplants (<i>P</i> < 0.01) during the study period. There was no difference in graft survival of paired kidneys in kidney-alone <i>vs</i> KAH recipients with additional loss of 17 kidney graft years per 100 transplants (<i>P</i> = 0.20).</p><p><strong>Conclusions: </strong>Optimal recipient selection for kidney after heart transplant under the new safety-net policy may help mitigate the significant risk of kidney graft failure among SHKT recipients.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e582"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Dissected Lymph Node Count and Positive Lymph Node Ratio Following Esophagectomy on Long-Term Outcomes in Esophageal Cancer: A Systematic Review and Meta-Analysis.","authors":"Eisuke Booka, Hiroya Takeuchi, Yuki Sakai, Ryoma Haneda, Wataru Soneda, Tomohiro Murakami, Tomohiro Matsumoto, Yoshifumi Morita, Hirotoshi Kikuchi, Yoshihiro Hiramatsu, Mark K Ferguson","doi":"10.1097/AS9.0000000000000587","DOIUrl":"10.1097/AS9.0000000000000587","url":null,"abstract":"<p><strong>Objective: </strong>This meta-analysis evaluated how the number of lymph nodes dissected (LND) and the positive lymph node ratio (LNR) following esophagectomy influence long-term outcomes in esophageal cancer.</p><p><strong>Background: </strong>Esophagectomy is a critical treatment for esophageal cancer, but the optimal extent of lymphadenectomy remains debated, especially in the era of modern neoadjuvant protocols.</p><p><strong>Methods: </strong>A systematic electronic search of Embase, Medline, and the Cochrane Library was performed for studies published between 2000 and 2024. Included studies assess overall survival (OS) in patients with esophageal cancer undergoing esophagectomy with lymphadenectomy, comparing groups with high and low LND and LNR. A subset analysis examined outcomes in patients receiving neoadjuvant therapy.</p><p><strong>Results: </strong>In total, 18 and 19 articles were included in the LND and LNR meta-analyses, respectively. High LND and low LNR were associated with improved OS [LND: hazard ratio (HR) = 0.75, 95% confidence interval (CI) = 0.67-0.85, <i>P</i> < 0.01; LNR: HR = 0.39, 95% CI = 0.33-0.47, <i>P</i> < 0.001]. Subset analysis revealed that these survival benefits persisted in patients who received neoadjuvant therapy (LND: HR = 0.56, 95% CI = 0.34-0.93, <i>P</i> = 0.01; LNR: HR = 0.24, 95% CI = 0.15-0.39, <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>These findings highlight the prognostic importance of high LND and low LNR in improving OS following esophagectomy, regardless of neoadjuvant therapy. Extensive lymphadenectomy may enhance survival, and LNR provides a valuable prognostic tool for guiding postoperative treatment decisions.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e587"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immersive Virtual Reality for Postoperative Pain Among Older Adults: A Scoping Review.","authors":"Christina Keny, Bhagvat Maheta, Karl Lorenz, Marcia M Russell, Heather Leutwyler, Laura M Wagner, Victoria Tang, Linda Park","doi":"10.1097/AS9.0000000000000583","DOIUrl":"10.1097/AS9.0000000000000583","url":null,"abstract":"<p><strong>Objective: </strong>The aim is to map out and describe, through a scoping review, the current evidence on immersive virtual reality (IVR) for postoperative pain management in surgical older adults.</p><p><strong>Background: </strong>Managing postoperative pain in older adults through pharmacological interventions poses inherent complexity and risk to the patient. There is a growing interest in nonpharmacological interventions, including IVR, to address postoperative pain in older adults. However, IVR use for postoperative pain across a spectrum of surgical procedures remains largely unknown in the older adult demographic.</p><p><strong>Methods: </strong>A comprehensive literature search of 5 databases was conducted through April 2024. Inclusion criteria were: (1) mean/median age greater than 65; (2) patients underwent surgical procedures; (3) the intervention group received IVR before, during, or after surgery; and (4) numerical postoperative pain scores were collected. Study titles/abstracts underwent initial screening against inclusion/exclusion criteria, followed by full-text screening. A narrative report was compiled with the identified studies.</p><p><strong>Results: </strong>This scoping review yielded 10 studies. Three main findings emerged: (1) IVR for postoperative pain occurred predominantly in total joint replacement surgery; (2) while over half of the studies in this review indicated that IVR could improve postoperative pain management, weak to moderate study designs and small sample sizes limited the ability to draw firm conclusions about IVR use in older adults; and (3) there was significant heterogeneity in IVR administration and program content offered.</p><p><strong>Conclusions: </strong>Despite common misconceptions that older adults are averse to new technology, this scoping review suggests that IVR for postoperative pain in older surgical adults holds potential as an acceptable and feasible intervention. This review highlights the need for more rigorous randomized clinical trials on IVR efficacy in older adults across a more diverse spectrum of surgical procedures and older adult subgroups (eg, underrepresented minority groups or those with physical/cognitive limitations).</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e583"},"PeriodicalIF":0.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185076/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation and Implication of Case Volume Variation in Level 1 and 2 Trauma Centers.","authors":"Patrick L Johnson, Bryant W Oliphant, Jonathan E Williams, Cody L Mullens, Raymond A Jean, Anne H Cain-Nielsen, John W Scott, Mark R Hemmila","doi":"10.1097/AS9.0000000000000589","DOIUrl":"10.1097/AS9.0000000000000589","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate variation in case volume and procedural volume across level 1 and 2 U.S. trauma centers.</p><p><strong>Background: </strong>When trauma center distribution does not fit regional needs, the longstanding volume-outcomes relationship in trauma care is at risk. Case volume variability has important implications for trauma center distribution, patient outcomes, and clinical skills maintenance.</p><p><strong>Methods: </strong>We placed trauma centers into quintiles based on average annual patient volume meeting American College of Surgery Trauma Quality Improvement Program (ACS TQIP) inclusion criteria from 2017 to 2021. Patient characteristics and procedures performed were evaluated across case volume and trauma center verification levels. We evaluated the relationship between procedural volume and case volume by examining the number of interventions performed as a proportion of patients with a potential indication.</p><p><strong>Results: </strong>We identified 1,902,005 patients among 228 level 1 and 288 level 2 trauma centers. A fourfold difference in ACS TQIP qualifying patient volume was present between the highest and lowest quintile level 1 and 2 trauma centers (1888 ± 481 vs 484 ± 109, 966 ± 223 vs 224 ± 70). The lowest quintile centers performed very low volumes of essential trauma procedures including hemorrhage control (22 per year) and pelvic fracture operations (10 per year). Low-volume trauma centers performed proportionally fewer procedures, including hemorrhage control procedures for patients presenting with tachycardia and hypotension (25.9 vs 31.8%, <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Trauma center case volume varies widely, with 1-in-5 level 1 trauma centers averaging <2 hemorrhage control procedures per month. Furthermore, low-volume centers perform proportionally fewer procedures suggesting unexplained variation in practice patterns.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e589"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Survey of Surgical Chairs to Investigate the Role of Diversity, Equity, and Inclusion Vice Chairs in Departments of Surgery.","authors":"Katya Kaplow, Grace Keegan, Suhani S Patel, Jasmine Akhtar, Karen B Vanterpool, Carolyn Sidoti, Allan B Massie, Robert A Montgomery, Dorry L Segev, Macey L Levan, Kathie-Ann Joseph","doi":"10.1097/AS9.0000000000000586","DOIUrl":"10.1097/AS9.0000000000000586","url":null,"abstract":"<p><strong>Objective: </strong>The aim is to identify surgical department chairs' perspectives on the role of Vice Chairs for Diversity, Equity, and Inclusion (DEI VCs).</p><p><strong>Background: </strong>The role of DEI VCs has become increasingly common in departments of surgery. However, the role remains ill-defined, and most who hold the position are the first to serve their department in this capacity.</p><p><strong>Methods: </strong>A 27-item online survey was administered in September 2023 to department chairs across US-based academic general surgery departments who reported having a DEI VC instated in the department. The survey assessed (1) the role, purpose, responsibilities, and value of the DEI VC, (2) resources allotted to DEI VCs, (3) demographic characteristics of both surgical chairs and DEI VCs, and (4) recommendations to increase the impact of the position within the department.</p><p><strong>Results: </strong>The survey sample consisted of 22 surgical chairs; White (73%) and men (68%). Twenty (91%) agreed that the DEI VC enhances their ability to fulfill their mission to diversity, equity, and inclusion, but only 12 (57%) said that the DEI VC was given an annual budget. Surgical chairs reported that increasing resources, integrating the position across other departments, and defining measures to evaluate success would increase the impact of DEI VCs.</p><p><strong>Conclusions: </strong>Surgical chairs with a DEI VC find value in the position and provide a range of resources to support the role. These results should be used as evidence for establishing and funding DEI VCs across US-based academic general surgery departments.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e586"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of New-Onset Diabetes in Patients Undergoing Pancreatic Surgery and the Association of Glucose Dysregulation With Complications in Pancreatic Cancer.","authors":"Martyn Stott, Irena Stefanova, Lucy Oldfield, Anthony Evans, James Birch-Ford, Rohith Rao, William Greenhalf, Christopher Halloran, Eithne Costello","doi":"10.1097/AS9.0000000000000584","DOIUrl":"10.1097/AS9.0000000000000584","url":null,"abstract":"<p><strong>Objective: </strong>To determine the prevalence of new-onset diabetes (NOD) in individuals undergoing pancreatic surgery and to explore the implications of glycaemic status on clinicopathological features and outcomes for patients with pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Introduction: </strong>PDAC is characterized by a high prevalence of NOD. The prevalence of NOD in individuals undergoing pancreatic surgery for other diseases is less well-documented.</p><p><strong>Methods: </strong>A retrospective analysis of 483 individuals undergoing pancreatic surgery between 2016 and 2020 was undertaken. For patients with PDAC, associations between glycaemic status and tumor size, cancer stage, grade, postoperative complications, and outcomes were assessed.</p><p><strong>Results: </strong>Diabetes status was determined for 433 patients. The prevalence of preoperative NOD was higher in PDAC (34.9%; 58/166) compared to ampullary adenocarcinoma (6.3%; 3/48; <i>P</i> < 0.001), cholangiocarcinoma (5.6%; 2/36; <i>P</i> < 0.001), and intraductal papillary mucinous neoplasms (8.9%; 4/45; <i>P</i> = 0.005), but was similar to chronic pancreatitis (30%; 9/30; <i>P</i> = 0.909). For 22/58 (37.9%) PDAC patients with NOD, diabetes was undiagnosed until preoperative testing. In individuals undergoing pancreaticoduodenectomy, delayed gastric emptying (DGE) was more frequently associated with glucose dysregulation than with normoglycaemia (32.8% vs 8.3%; <i>P</i> = 0.004), while overall postoperative pancreatic fistula (POPF) was less frequently associated with glucose dysregulation than with normoglycaemia (4.7% vs 19.4%; <i>P</i> = 0.02).</p><p><strong>Conclusions: </strong>In contrast to PDAC, NOD was infrequently observed in other pancreatic/periampullary tumors. Of clinical importance, in more than one-third of PDAC patients, NOD was undiagnosed until preoperative assessment. Preoperative glucose dysregulation correlated with an increased rate of DGE and a reduced rate of POPF in pancreaticoduodenectomy.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e584"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Flush Model: A Novel Framework to Manage Surgeons' Mental Fatigue and Cognitive Load.","authors":"Pierrick Laulan, Matthieu L G Fernandez, Emeric Abet, Jérôme Dimet, Ulrike Rimmele","doi":"10.1097/AS9.0000000000000581","DOIUrl":"10.1097/AS9.0000000000000581","url":null,"abstract":"<p><strong>Background: </strong>Mental fatigue significantly impairs surgeons' cognitive performance, compromising patient safety. However, surgical practice lacks an integrated framework to understand and mitigate this cognitive strain effectively.</p><p><strong>Conceptual model: </strong>We propose adapting the Flush model, initially developed for endurance sports, to surgical settings. This model conceptualizes mental fatigue through a dynamic analogy of a water tank composed of 4 main components: perceived fatigue (ballcock), fatigue accumulation (filling rate), fatigue recovery (drain rate), and a safety margin (security reserve). We detail how intrinsic cognitive load, extraneous stressors, physiological and psychological factors, and circadian influences collectively drive mental fatigue accumulation.</p><p><strong>Clinical implications: </strong>The Flush model clarifies how mental fatigue fluctuates during surgical procedures and highlights practical recovery methods such as brief mindfulness interventions, microbreaks, cognitive offloading, and ergonomics adjustments. It emphasizes maintaining a cognitive safety reserve to safeguard against errors during critical surgical phases, providing surgeons with actionable strategies to manage fatigue in real time.</p><p><strong>Future directions: </strong>We recommend empirical validation through real-time monitoring using physiological measures (eg, heart-rate variability, pupillometry) coupled with subjective assessments (eg, NASA Task Load Index, Surgery Task Load Index). Integrating Flush principles into surgical training, simulation programs, and institutional policies could foster a culture prioritizing cognitive performance and patient safety.</p><p><strong>Conclusions: </strong>The Flush model provides a comprehensive, intuitive framework for understanding and addressing surgeons' mental fatigue. Its implementation promises to enhance cognitive resilience, reduce surgical errors, and improve both patient outcomes and surgeon well-being.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e581"},"PeriodicalIF":0.0,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Open-Label, Noninferiority, Phase 3, Multicenter, Controlled Trial to Compare Laparoscopic Surgery With Open Surgery for Symptomatic, Noncurable Stage IV Colorectal Cancer (JCOG1107).","authors":"Tomonori Akagi, Masafumi Inomata, Ryo Kanzaka, Hiroshi Katayama, Haruhiko Fukuda, Akio Shiomi, Masaaki Ito, Jun Watanabe, Kohei Murata, Yasumitsu Hirano, Manabu Shimomura, Shunsuke Tsukamoto, Tetsuya Hamaguchi, Seigo Kitano, Yukihide Kanemitsu","doi":"10.1097/AS9.0000000000000580","DOIUrl":"10.1097/AS9.0000000000000580","url":null,"abstract":"<p><strong>Objective: </strong>To confirm noninferiority of laparoscopic (LAP) to open surgery (OP) for progression-free survival (PFS) of patients with non-curable stage IV colorectal cancer (CRC).</p><p><strong>Background: </strong>Benefits of LAP versus OP are suggested, but long-term survival following LAP for symptomatic, noncurable CRC remains unclear.</p><p><strong>Methods: </strong>In this open-label, multicenter, randomized controlled trial, only accredited surgeons from 42 Japanese institutions participated. Eligibility criteria included pathologically proven adenocarcinoma or adenosquamous carcinoma; primary tumor anywhere in the colon causing bowel stenosis and/or bleeding; and at least 1 to 3 noncurable factors. Patients received mFOLFOX6+bevacizumab or CapeOX+bevacizumab postoperatively and were randomly assigned 1:1 to the OP or LAP group. The primary endpoint was PFS, with noninferiority margin for the hazard ratio (HR) set at 1.38.</p><p><strong>Results: </strong>Between January 2013 and January 2021, 195 patients were randomized (OP, n = 95, LAP, n = 100). Ninety-two patients received OP and 98 LAP, with 82 OP and 86 LAP patients receiving postoperative chemotherapy. Median PFS was 9.7 months (95% CI = 8.7-11.3) for OP and 10.4 months (9.1-12.4) for LAP. Noninferiority of LAP was confirmed [HR = 1.02; 91.4% CI = 0.79-1.32 (<1.38), <i>P</i> for noninferiority = 0.021]. Median overall survival was 23.9 months (95% CI = 18.6-29.4) for OP and 25.4 months (19.4-29.0) for LAP (HR = 0.99; 95% CI, 0.72-1.36). In-hospital mortality was 1.1% (OP) and 0% (LAP). Postoperative complications (Grade 2-4) included ileus (OP = 12.0%; LAP = 5.1%), wound infection (OP = 2.2%; LAP = 2.0%), and anastomotic leakage (OP = 0%; LAP = 2.0%).</p><p><strong>Conclusions: </strong>LAP appears to be an acceptable standard treatment for symptomatic, noncurable stage IV CRC.</p><p><strong>Trial registration: </strong>UMIN-CTR, number UMIN000009715.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e580"},"PeriodicalIF":0.0,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicthor: AI-Powered Predictive Risk Model for 30-Day Mortality and 30-Day Complications in Patients Undergoing Thoracic Surgery for Lung Cancer.","authors":"Xavier Durand, Julien Hédou, Grégoire Bellan, Pascal-Alexandre Thomas, Pierre-Benoît Pages, Xavier-Benoît D'Journo, Laurent Brouchet, Caroline Rivera, Pierre-Emmanuel Falcoz, André Gillibert, Jean-Marc Baste","doi":"10.1097/AS9.0000000000000578","DOIUrl":"10.1097/AS9.0000000000000578","url":null,"abstract":"<p><strong>Objective: </strong>To assess the predictive performance of Predicthor, an artificial intelligence model, for 30-day mortality and complications following major pulmonary resections.</p><p><strong>Background: </strong>The significance of predicting postoperative complications in thoracic surgery lies in the impact on patient outcomes and the efficient allocation of healthcare resources. The longstanding use of the Thoracoscore for over 15 years in hospital settings emphasizes the opportune moment for an update, leveraging new artificial intelligence methodologies to enhance predictive precision and relevance.</p><p><strong>Methods: </strong>The EPITHOR French population-based database linked to the National Institute of Statistics and Economic Studies database has been queried from January 1, 2016, through December 31, 2022, on 6 selected hospital centers (Rouen, Dijon and Toulouse CHUs, Strasbourg CHRU, Centre Hospitalier Général de Bayonne, and Assitance Publique des Hopitaux de Marseille) with curated data collection. A total of 6508 patients who have undergone primary lung cancer surgery via lobectomy or bilobectomy, aged over 18 years, and with anAmerican Society of Anesthesiologists (ASA) physical status classification system score under 4, were selected. In a retrospective analysis using a 3-dataset scheme (training cohort, internal and external validation on 118 other centers), we assessed the predictive performance of Predicthor for 30-day complications and mortality following major pulmonary resections.</p><p><strong>Results: </strong>Postoperative complications occurred in 17.6% of patients, with 4.6% experiencing complications of Clavien-Dindo grade III or higher. Overall mortality was 0.6%. Predicthor excelled in predicting 30-day mortality with an area under the curve of 0.81 (95% CI = 0.79-0.83; <i>P</i> < 1E-16), surpassing the Thoracoscore at 0.72 (95% CI = 0.70-0.75; <i>P</i> < 1E-16). Predicthor identified 9 key variables, including age, comorbidity scores, tumor characteristics, forced expiratory volume (FEV1), and dyspnea. They were utilized for predicting Comprehensive Complication Index (Pearson-r: 0.23; 95% CI = 0.22-0.24; <i>P</i> < 1E-16) and complications with Clavien-Dindo ≥III (area under the curve: 0.68; 95% CI = 0.68-0.69; <i>P</i> < 1E-16).</p><p><strong>Conclusions: </strong>Predicthor's predictive performance for 30-day mortality and complications highlighted its potential as a valuable tool in clinical decision-making. The study's methodology and comprehensive dataset contribute to its relevance in using machine learning on large available databases for shaping thoracic surgery practices and patient management.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 2","pages":"e578"},"PeriodicalIF":0.0,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12185074/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}