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

{"title":"Necessary Elements of Intraoperative Cholangiogram: A Call for Synoptic Reporting.","authors":"Maggie E Bosley, Jennifer M Moffett, Eleah D Porter, Irving A Jorge, Matthew B Bloom, Lucas P Neff","doi":"10.1097/AS9.0000000000000599","DOIUrl":"10.1097/AS9.0000000000000599","url":null,"abstract":"","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e599"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132543","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":"Use and Outcomes of Medication for Opioid Use Disorder Among Patients With Opioid Use Disorder Undergoing Surgery.","authors":"Alicia H Li, Yongmei Huang, Silvia S Martins, Yukio Suzuki, Jennifer S Ferris, Xiao Xu, Dawn L Hershman, Jason D Wright","doi":"10.1097/AS9.0000000000000598","DOIUrl":"10.1097/AS9.0000000000000598","url":null,"abstract":"<p><strong>Objective: </strong>We examined patterns of use of perioperative medication for opioid use disorder (MOUD) in patients undergoing surgical procedures and assessed the association between MOUD use and perioperative opioid use and postsurgical adverse events.</p><p><strong>Background: </strong>Optimal management of patients with opioid use disorder (OUD) undergoing surgery is unknown.</p><p><strong>Methods: </strong>We identified patients who underwent major and minor surgery from 2016 to 2021 in the MarketScan Database. Patients were classified into OUD and non-OUD groups (opioid-naïve, intermittent use, and chronic use). Among patients with OUD, preoperative MOUD (buprenorphine, methadone) use was noted. Outcomes were compared between patients with and without OUD and among OUD patients who used or did not use MOUD.</p><p><strong>Results: </strong>Of 917,754 surgical patients, 1.6% had OUD, 63.7% were opioid-naïve, 27.8% were intermittent opioid users, and 6.8% were chronic opioid users. Among OUD patients, 27.6% were current MOUD users before surgery. Compared to opioid-naïve patients, patients with OUD had higher rates of persistent perioperative opioid use (42.2% vs. 8.2%), higher rates of emergency department (ED) visits (21.7% vs. 6.9%), and higher rates of readmissions (6.6% vs. 2.2%) within 30 days following surgery (all <i>P</i> < 0.05). Among patients with OUD, current MOUD use was associated with lower perioperative opioid use compared with no MOUD (53.7% vs. 82.9%), lower persistent postoperative opioid use (13.8% vs. 56.7%), lower rates of ED visits (18.3% vs. 22.3%), and lower readmission rates (4.8% vs. 7.2%) (all <i>P</i> < 0.05), compared to untreated OUD patients.</p><p><strong>Conclusions: </strong>Among patients with OUD undergoing surgery, preoperative current MOUD is associated with reduced postoperative opioid use, and fewer ED visits and readmissions compared to patients who had a diagnosis of OUD but were untreated.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e598"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132745","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 Cost-effectiveness Analysis of Antibiotic Prophylaxis versus No Antibiotic Prophylaxis for Postoperative Infectious Complications for Hand-assisted Laparoscopic Donor Nephrectomy.","authors":"Yasmin Baker, Martin Diamond, Jay Priyadarshi, Akram Nazir, Binjal Benny","doi":"10.1097/AS9.0000000000000592","DOIUrl":"10.1097/AS9.0000000000000592","url":null,"abstract":"<p><strong>Objectives: </strong>Individuals who volunteer to undergo hand-assisted laparoscopic donor nephrectomy (HALDN) to help those needing renal transplants, face postoperative infection complications (POICs) risks for no corresponding clinical benefit. Prophylactic antibiotics often control POIC risk; however, there is no clear consensus on their use in HALDN. Considering the incidence of POICs, National Health Service (NHS) resource constraints, and antimicrobial stewardship priorities, a cost-effectiveness analysis (CEA) was conducted to evaluate the economic impact of prophylactic antibiotic use in HALDN.</p><p><strong>Methods: </strong>A CEA was conducted using data from the UK multicenter, double-blinded, randomized controlled POWAR (Prophylaxis of Wound Infections-antibiotics in Renal Donation) trial. The primary outcome was the cost per POIC avoided within 30 days post-HALDN. Effectiveness was defined as the absence of POICs. The incremental cost-effectiveness ratio (ICER) was calculated in British pounds. Four sensitivity analyses examined variability in drug costs, length of stay, POIC severity, and cost thresholds.</p><p><strong>Results: </strong>The ICER for antibiotic prophylaxis compared with no prophylaxis was -£4,709.71, indicating that prophylaxis was cost-saving. Sensitivity analyses under all 4 scenarios confirmed the robustness of this cost-saving finding under varying assumptions.</p><p><strong>Conclusion: </strong>Antibiotic prophylaxis in HALDN is a cost-saving intervention. These findings support the need to review UK guidelines for antibiotic use in living donor renal transplant surgery, specifically regarding prophylactic measures for donors. Further clarification on whether HALDN should be classified as a 'clean' or 'clean-contaminated' procedure may enhance consistency in national practice and inform evidence-based antibiotic stewardship and policy aligned with NHS goals for safe and sustainable surgical care.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e592"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132876","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 Perioperative Hemoglobin A1c Levels on Survival Outcomes of Patients With Pancreatic Cancer: A Retrospective Study.","authors":"Hidemasa Kubo, Katsuhisa Ohgi, Shimpei Otsuka, Yuta Okawa, Ryo Ashida, Mihoko Yamada, Yoshiyasu Kato, Hideyuki Dei, Katsuhiko Uesaka, Akifumi Notsu, Teiichi Sugiura","doi":"10.1097/AS9.0000000000000597","DOIUrl":"10.1097/AS9.0000000000000597","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to clarify the association between perioperative hemoglobin A1c (HbA1c) levels and survival outcomes in pancreatic cancer (PC) patients.</p><p><strong>Background: </strong>Diabetes mellitus is frequently associated with PC and may affect survival outcomes.</p><p><strong>Methods: </strong>We retrospectively analyzed 569 patients who underwent pancreatectomy for PC with available preoperative HbA1c (HbA1c-pre) data (2002-2018). A subgroup analysis included 318 patients with HbA1c measured 1 year postsurgery (HbA1c-1Y).</p><p><strong>Results: </strong>Optimal cutoff values were 9.0 for HbA1c-pre and 10.0 for HbA1c-1Y. Patients with HbA1c-pre ≥9.0 had worse relapse-free survival (RFS; median, 11.8 vs. 16.3 months, <i>P</i> = 0.002) and overall survival (OS; median, 20.3 vs. 32.9 months, <i>P</i> < 0.001) than those with HbA1c-pre <9.0. Multivariate analysis identified HbA1c-pre ≥9.0 as an independent prognostic factor for RFS (hazard ratio: 1.39, <i>P</i> = 0.029) and OS (hazard ratio: 1.51, <i>P</i> = 0.010). Patients with HbA1c-1Y ≥10.0 had worse RFS (median, 11.3 vs. 25.0 months, <i>P</i> < 0.001) and OS (median, 22.2 vs. 52.8 months, <i>P</i> = 0.002) than those with HbA1c-1Y <10.0. HbA1c-1Y ≥10.0 was associated with distal pancreatectomy (DP) and recurrence within 1-year postsurgery. HbA1c levels decreased after pancreatoduodenectomy (PD; HbA1c-pre 6.4 vs. HbA1c-1Y 6.0, <i>P</i> < 0.001), although HbA1c levels were increased after DP (6.5 vs. 7.0, <i>P</i> = 0.041). Patients with HbA1c-1Y ≥10.0 had poor survival outcomes regardless of the surgical procedure (DP: RFS, <i>P</i> < 0.001; OS, <i>P</i> = 0.006) (PD: RFS, <i>P</i> = 0.006; OS, <i>P</i> = 0.001).</p><p><strong>Conclusions: </strong>HbA1c-pre ≥9.0 and HbA1c-1Y ≥10.0 were prognostic factors in PC. Postoperative follow-up for diabetes mellitus is important, particularly following DP.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e597"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132930","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":"Bibliometric Analysis of Surgical Articles Using Bayesian Statistics.","authors":"Zhenyu Li, Aliya Izumi, Dominique Vervoort, Kuan Liu, Stephen E Fremes","doi":"10.1097/AS9.0000000000000594","DOIUrl":"10.1097/AS9.0000000000000594","url":null,"abstract":"<p><strong>Objectives: </strong>The study aims to investigate the landscape and trends in the use of Bayesian statistics in surgical papers published in high-impact journals over the past 2 decades, determine the characteristics of these papers, and assess the quality of Bayesian analysis reporting.</p><p><strong>Background: </strong>Observational and clinical trials have traditionally employed frequentist approaches. Bayesian framework enables the incorporation of prior evidence, flexible modeling of uncertainty, and returns a direct probabilistic summary of the estimates of interest that can provide valuable insight. However, their use in high-impact surgical research remains underexplored.</p><p><strong>Methods: </strong>Surgical articles from high-impact surgical and medical journals indexed in Web of Science and PubMed were retrieved for the period from January 2000 to August 2024. Data extraction covered bibliometrics and content details. The Reporting of Bayes Used in Clinical Studies scale (ROBUST) was used to assess Bayesian reporting quality.</p><p><strong>Results: </strong>A total of 120 articles were analyzed. The use of Bayesian statistics in surgical research has increased over time (compounded annual growth rate: 12.3%). General surgery (N = 39, 32.5%) and cardiothoracic surgery (N = 20, 16.7%) were the most represented specialties. The most common study designs were retrospective cohort studies (N = 50, 41.7%), meta-analyses (N = 38, 31.7%), and randomized trials (N = 19, 15.8%). Regression-based methods were the most frequently used (N = 51, 42.5%). The average ROBUST score was 4.1 ± 1.6 out of 7, with 54.0% (N = 54) of studies specifying priors and 29.0% (N = 29) justifying them.</p><p><strong>Conclusions: </strong>Bayesian statistics is increasingly incorporated into surgical research, predominantly observational studies and meta-analyses. However, improvements in the quality and standardization of Bayesian reporting are needed to enhance transparency and reproducibility.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e594"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132913","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":"One-year stoma-free survival of ileoanal pouches for UC in European centers: The MIRACLE project.","authors":"Tycho B Moojen, Eva Visser, Maud A Reijntjes, Johan F Lange, Gabriele Bislenghi, Michele Carvello, Janindra Warusavitarne, Roel Hompes, Laurents P S Stassen, Omar D Faiz, Antonino Spinelli, André D'Hoore, Willem A Bemelman","doi":"10.1097/AS9.0000000000000596","DOIUrl":"10.1097/AS9.0000000000000596","url":null,"abstract":"<p><strong>Objective and background: </strong>Restorative proctocolectomy with ileal pouch-anal anastomosis is the standard surgical procedure for patients with refractory ulcerative colitis. The aim of this study was to evaluate intermediate-term stoma-free rates after ileoanal pouch surgery and current practice in various European centers.</p><p><strong>Methods: </strong>In this multicenter retrospective cohort study, we included patients ≥18 years with ulcerative colitis or unclassified inflammatory bowel disease undergoing primary ileoanal pouch construction between 2016 and 2021 in 4 high-volume (>10 pouch procedures annually) and 2 low-volume European centers. The primary outcome was an intermediate-term stoma-free rate (absence of ileostomy > 1-year postpouch). Secondary outcomes included perioperative practice, predictive factors for intermediate-term stoma-free status, and anastomotic leakage management.</p><p><strong>Results: </strong>In total, 411 patients were included [43% female, median age 40.0 years (IQR, 29.0-52.0)]. Intermediate-term stoma-free rate was 92.2% (378/410 patients), with a variance of 13.0% between centers (<i>P</i> = 0.045). The majority were modified 2-stage (55.5%) or 3-stage (34.5%) procedures. Close rectal dissection (CRD) was performed in 64.6% and transanal minimally invasive surgery proctectomy in 71.8%. Predictive factors for intermediate-term stoma-free status were CRD [odds ratio (OR) = 3.0; 95% confidence interval (CI) = 1.4-6.4; <i>P</i> = 0.01], and high-volume center (OR = 3.7; 95% CI = 1.1-12.5; <i>P</i> = 0.03). In the 56 (13.6%) patients with anastomotic leakage, early diagnosis, and treatment (≤21 days postpouch) were associated with intermediate-term stoma-free status (95.5% vs 41.7%; <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>This study showed that >90% of ileoanal pouch patients are stoma-free more than 1 year after surgery with substantial variance between centers. Centralization of pouch procedures, implementation of CRD proctectomy, and early diagnosis and treatment of anastomotic leakages could further improve results.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e596"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453384/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132587","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":"Full Robotic Whole Graft Liver Transplantation: A Novel Approach.","authors":"Mehdi El Amrani, Florian Pecquenard, Anne Bignon, Caroline Petit, Emmanuel Boleslawski, Sebastien Dharancy, Gilles Lebuffe, Stephanie Truant, Guillaume Millet","doi":"10.1097/AS9.0000000000000595","DOIUrl":"10.1097/AS9.0000000000000595","url":null,"abstract":"","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e595"},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132948","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":"Association Among Fragmented Trauma Care, Mortality, and Major Complications: Optimizing Care for the Injured Beyond the Initial Hospitalization.","authors":"Benjamin K Wang, Allen Green, Cheryl K Zogg, Lakshika Tennakoon, David A Spain, Jeff Choi","doi":"10.1097/AS9.0000000000000591","DOIUrl":"10.1097/AS9.0000000000000591","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to characterize the nationwide burden of fragmented care among adult trauma patients and evaluate associations between readmission to index versus nonindex hospital and mortality, major complications, and other outcomes during readmission.</p><p><strong>Background: </strong>Fragmented care from readmission to a nonindex hospital has been associated with worse outcomes across multiple disciplines. The nonelective nature of traumatic injury and the high prevalence of social vulnerability risk factors renders trauma patients at high risk of fragmented care.</p><p><strong>Methods: </strong>In this retrospective observational cohort study using the 2019 and 2020 National Readmissions Database, we identified the rate of fragmented care among adult trauma patients who experience a 90-day readmission and the most prevalent principal readmission diagnoses. Multivariable regression analysis using least absolute shrinkage and selector regression and 10-fold cross-validation identified risk factors for readmission to nonindex hospitals and the associations between readmission to nonindex hospitals and outcomes.</p><p><strong>Results: </strong>Among 906,531 injured adult patients, 108,246 (11.9%) experienced 90-day readmission after discharge from initial hospitalization. Twenty-eight percent (n = 30,153) were readmitted to a nonindex hospital. Septicemia was the most common principal readmission diagnosis, and urinary tract infections and pneumonia were the most common concomitant infectious diagnoses. Compared with patients readmitted to their index hospital, those readmitted to a nonindex hospital had 11% higher adjusted odds of mortality [OR (95% confidence interval {CI}): 1.11 (1.02-1.21)] and 12% higher adjusted odds of major complications [OR (95% CI): 1.12 (1.07-1.17)].</p><p><strong>Conclusions: </strong>Ninety-day readmissions are not uncommon among adult trauma patients, and many experience fragmented care. Fragmented care is associated with higher odds of mortality and major complications during readmission. There is an urgent need to identify modifiable risk factors for readmission during the index injury hospitalization and develop strategies to prevent readmission and the consequences of fragmented care.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e591"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132864","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":"Firearm Injuries: Unveiling the Unmatched Healthcare Burden and Costs.","authors":"Colleen P Nofi, Emma Cornell, Bailey K Roberts, Rafael Klein-Cloud, Thevaa Chandereng, Arjun Sondhi, Codruta Chiuzan, Chethan Sathya","doi":"10.1097/AS9.0000000000000590","DOIUrl":"10.1097/AS9.0000000000000590","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate hospital resource utilization in the treatment of firearm-related injuries compared to other penetrating and blunt traumas.</p><p><strong>Background: </strong>Trauma is a leading cause of morbidity and mortality in the United States, with firearm injuries becoming the leading cause of pediatric death as of 2020. Despite the known mortality, the burden of inpatient healthcare for initially nonfatal firearm injuries is poorly understood.</p><p><strong>Methods: </strong>A retrospective cohort study of the National Inpatient Sample was performed. The study population included patients with firearm injuries, penetrating traumas, and blunt traumas from 2017 to 2021. Primary interventions assessed included surgical procedures performed during hospitalization, and the outcomes evaluated were costs, length of stay, and mortality. Comparisons were made between the 3 injury groups (firearm, penetrating trauma, and blunt trauma) across these key variables.</p><p><strong>Results: </strong>Among 10,653,446 patients identified, 243,295 (2.3%) had a firearm injury, 287,110 (2.7%) had a penetrating injury, and 10,123,041 (95%) had blunt trauma. Patients sustaining firearm injuries required more resuscitative interventions and major surgical procedures, such as pericardiotomy, chest tube placement, exploratory thoracotomy, and laparotomy. The mean length of inpatient stay was longer for firearm injuries (7.8 days) compared with penetrating (5.7 days) and blunt trauma (6.0 days, <i>P</i> < 0.001). Inpatient death rates were higher for firearm injuries (6.5%) compared with penetrating (0.6%) and blunt trauma (2.8%, <i>P</i> < 0.001). Total hospital costs were higher for firearm injuries ($30,529) compared with penetrating ($12,243) and blunt trauma ($18,333, <i>P</i> < 0.001). Firearm injuries remained a significant predictor of higher hospital costs, even after adjusting for other factors (adjusted incidence rate ratio 1.256; <i>P</i> < 0.001).</p><p><strong>Conclusions: </strong>Although firearm injuries account for only a proportion of total trauma cases, they are associated with higher inpatient resource utilization, as measured by interventions and hospital costs. These findings highlight the need for focused prevention efforts and resource allocation to address unique challenges posed by firearm injuries.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e590"},"PeriodicalIF":0.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453340/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132896","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":"Tailored-Surgery for Locally Advanced Rectal Cancer Based on 3D Mathematical Reconstruction Surgical Planner: Prospective Multicenter Study.","authors":"Álvaro García-Granero, Sebastián Jeri-McFarlane, Gianluca Pellino, Aina Ochogavía-Seguí, Jorge Sancho-Muriel, Marco Antonio Martínez-Ortega, Isabel Amengual-Antich, Blas Flor-Lorente, Francisco Giner-Segura, Nuria Gomez-Romeu, Ramon Farrés-Coll, Margarita Gamundí-Cuesta, Francisco Xavier Gonzalez-Argenté","doi":"10.1097/AS9.0000000000000588","DOIUrl":"10.1097/AS9.0000000000000588","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility of a 3D image processing and reconstruction system (3D-IPR) based on pelvic magnetic resonance imaging (MRI) for surgical planning of locally advanced rectal cancer (LARC) and recurrent pelvic rectal cancer (PRCR).</p><p><strong>Background: </strong>Achieving R0 resection is critical for prognosis in LARC and PRCR, but 2D imaging often limits precise surgical planning in complex pelvic anatomy. 3D reconstruction may enhance visualization and decision-making.</p><p><strong>Methods: </strong>In this prospective feasibility multicenter study, 37 patients with LARC or PRCR and threatened circumferential resection margins on MRI underwent surgical planning using 3D-IPR. This tool provides information on tumor localization, infiltration volume, and precise spatial relationships with adjacent structures. Outcomes included surgeon satisfaction, changes in surgical approach, and perioperative results.</p><p><strong>Results: </strong>A total of 56.7% of cases were primary rectal cancer and 43.2% were recurrent cancer. Satisfaction percentage of 3D-IPR to select the best surgical route was 100%. Minimally invasive techniques were employed in 40% of the surgeries. In 37.8% of cases, it was considered that the 3D-IPR changed the decision on the surgical attitude with respect to the neighboring organ with suspicion of infiltration. R0 resection was achieved in 75.7% of cases, with no perioperative mortality and a severe complication rate of 27%.</p><p><strong>Conclusions: </strong>A surgical planner based on 3D reconstruction using mathematical algorithms from pelvic MRI is feasible for performing tailored surgery for locally advanced rectal cancers and pelvic recurrence. Further research will show if this new tool reduces the morbidity and mortality rates, increasing the probability of R0 surgery, and increasing survival.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 3","pages":"e588"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132723","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}