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

{"title":"The Effects of Intersphincteric Space Dissection Approaches on Low Rectal Cancer Outcomes: A Multicenter Retrospective Study in China.","authors":"Yiwen Zang, Bin Zhang, Xing Liu, Baoxiang Chen, Linfeng Gao, Minwei Zhou, Xiaodong Gu, Zhenyang Li, Yiming Zhou, Bo Tang, Congqing Jiang, Guoxian Guan, Jianhua Ding, Jianbin Xiang","doi":"10.1097/AS9.0000000000000550","DOIUrl":"10.1097/AS9.0000000000000550","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effects of 2 intersphincteric space (ISS) dissection approaches for intersphincteric resection (ISR) on perioperative safety, oncological prognosis, and anal function.</p><p><strong>Background: </strong>The dissection of ISS is a crucial aspect of ISR, yet the outcomes associated with various ISS dissection approaches remain uncertain.</p><p><strong>Methods: </strong>Data were retrospectively collected from 314 patients with rectal cancer who underwent ISR at 5 Chinese tertiary referral medical institutions from January 2015 to December 2020. ISS dissection was performed using 1 of the 2 avenues: the complete transabdominal approach (CTA) and the transabdominal-perineal transanal approach (TPTA). The primary endpoints were 3-year overall survival (OS) and disease-free survival (DFS) rates. The secondary endpoints were postoperative anal function assessed by questionnaires. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to match the clinicopathological characteristics of patients from both cohorts.</p><p><strong>Results: </strong>After PSM, 140 patients were successfully matched in the CTA and TPTA groups. There were no statistically significant differences between the groups in terms of perioperative complication rates, 3-year OS/DFS, and Wexner incontinence scores within 3 years after ileostomy reversal surgery (<i>P</i> > 0.05). However, the CTA group demonstrated less surgical time and superior low anterior resection syndrome (LARS) scores compared with the TPTA group (<i>P</i> < 0.05). Similar outcomes were observed after conducting IPTW adjustment.</p><p><strong>Conclusions: </strong>CTA and TPTA showed similar efficacy regarding perioperative safety and oncological outcomes. However, the CTA approach demonstrated a clear superiority in the LARS score.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e550"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712352","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":"\"Detect Anemia Preoperatively\": A Scoping Review of Recommendations.","authors":"Katja Schneider, Diana Sauer, Lorenz Wolf, Arnulf G Willms","doi":"10.1097/AS9.0000000000000551","DOIUrl":"10.1097/AS9.0000000000000551","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anemia significantly impacts patient outcomes, prompting increasing global implementation of patient blood management (PBM) measures. Timely diagnosis and differentiation of preoperative anemia are crucial components of PBM to maximize its effectiveness. Despite this, comprehensive implementation remains inconsistent. This scoping review aims to give an overview of recommendations regarding preoperative anemia management to detect gaps in knowledge and emerging ideas.</p><p><strong>Methods: </strong>A scoping review, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, investigated preoperative anemia detection, focusing on patient population, timing, extent, and process of investigations. PubMed and ScienceDirect were searched for English and German articles published in the last 5 years, supplemented by manual selection. Pediatric and obstetric recommendations were excluded. Results were synthesized based on key questions.</p><p><strong>Results: </strong>Four hundred sixty-five articles were screened, and 80 met the inclusion criteria, including 25 clinical practice guidelines. Most (n = 62) suggested \"detect and correct\" anemia without further specification. The rest advised conducting investigations early, ideally up to 30 days before major procedures with expected blood loss >500 mL. Recommended tests include blood counts, various iron parameters, folic acid/vitamin B12, inflammation markers, and renal, hepatic, and thyroid function tests. Ten articles described detailed algorithms. Other key recommendations included using reticulocyte hemoglobin, point-of-care Hb measurements, and automated laboratory algorithms. The underlying quality of scientific evidence is heterogeneous.</p><p><strong>Conclusions: </strong>International recommendations on the detection of preoperative anemia are heterogeneous and often generic. Automated algorithms could make a significant contribution to practicability. While practice-oriented guidelines, especially by surgical societies, could promote standardized and efficient implementation, further research is needed to improve the quality of underlying scientific evidence.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e551"},"PeriodicalIF":0.0,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712333","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 Value of Blood T Cell Frequencies for Risk Prediction of Postoperative Complications in Pancreatic Cancer Surgery.","authors":"Loreen Natusch, Max Heiduk, Anna Klimova, Carolin Beer, Tido Willms, David Digomann, Charlotte Reiche, Daniela E Aust, Sebastian Hempel, Florian Oehme, Marius Distler, Jürgen Weitz, Adrian M Seifert, Lena Seifert","doi":"10.1097/AS9.0000000000000545","DOIUrl":"10.1097/AS9.0000000000000545","url":null,"abstract":"<p><strong>Objective: </strong>To quantify and characterize preoperative blood T cells in patients with pancreatic ductal adenocarcinoma (PDAC), who underwent tumor resection, and to determine their relevance as biomarkers for postoperative pancreas-specific complications.</p><p><strong>Background: </strong>Pancreas-specific complications after pancreatic surgery are associated with a high morbidity and mortality, which both deprive patients of adjuvant chemotherapy. Noninvasive biomarkers for risk prediction of postoperative complications are missing, and the role of blood T cells for preoperative risk stratification is unknown.</p><p><strong>Methods: </strong>The preoperative frequency of blood T cell subsets was analyzed for 73 patients with PDAC, who underwent proximal pancreatectomy. Patients were screened for postoperative complications such as pancreatic fistula, postpancreatectomy hemorrhage, and postpancreatectomy acute pancreatitis. The frequency of CD8⁺, conventional CD4⁺, and regulatory T cells, as well as the differentiation state of each T cell subset in the peripheral blood of patients with PDAC, was analyzed.</p><p><strong>Results: </strong>Of 73 patients with PDAC, 19.2% developed pancreas-specific complications. The occurrence of postoperative complications was independent of the type of resection performed (Whipple procedure vs pylorus-preserving pancreaticoduodenectomy). Neither the frequency of CD8⁺, conventional CD4⁺, and regulatory T cells nor the state of T cell differentiation in the peripheral blood was associated with postoperative pancreas-specific complications. Notably, a significantly lower preoperative bilirubin serum level was observed in patients, who developed postpancreatectomy hemorrhage after proximal pancreatectomy (<i>P</i> =0.001).</p><p><strong>Conclusions: </strong>A low preoperative bilirubin serum level was associated with a higher risk for postpancreatectomy hemorrhage after proximal pancreatectomy. However, the preoperative blood T cell frequency does not predict postoperative pancreas-specific complications.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e545"},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712355","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":"Intraoperative Cholangiogram Interpretation for Laparoscopic Transcystic Bile Duct Exploration: Is Concurrence Possible?","authors":"Jennifer Turco, Matthew Pugliese, Anand Trivedi, Oscar Aldridge, Laurence Webber, Mohammed Ballal","doi":"10.1097/AS9.0000000000000543","DOIUrl":"10.1097/AS9.0000000000000543","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic transcystic bile duct exploration (LTCBDE) represents a secure and efficacious approach for managing common bile duct (CBD) stones, particularly in patients concurrently undergoing laparoscopic cholecystectomy (LC). The decision to proceed with LTCBDE hinges on real-time assessment of the intraoperative cholangiogram (IOC), which is highly operator-dependent and poorly interpreted. No established criteria exist to guide the evaluation of IOCs for LTCBDE. This study aims to ascertain the concordance among surgeons, experienced in LTCBDE, on critical aspects of IOC interpretation.</p><p><strong>Methods: </strong>A retrospective collection of IOC images of 40 patients who underwent LC, IOC, and LTCBDE at a tertiary university hospital between 2017 and 2018 was undertaken. Two hepato-pancreato-biliary (HPB) and 2 acute care surgery (ACS) specialists independently reviewed the images. They were tasked with assessing IOC features hypothesized to influence duct exploration and stone extraction complexity, along with overall suitability for LTCBDE based exclusively on the IOC images. Agreement percentages were calculated and Kappa inter-rater reliability statistics were assessed.</p><p><strong>Results: </strong>The overall agreement percentages concerning IOC features ranged between 52.5% and 82.5% with agreements surpassing 75% deemed robust. Maximum agreement was achieved in the interpretation of cystic duct morphology, whether straight or characterized by spiral valves. The concurrence for amenability of LTCBDE also demonstrated substantial accord among surgeons (ACS: 92.5%, HPB: 95%, total: 87.5%). Consistently high agreement was evident within specialty groups.</p><p><strong>Conclusions: </strong>Anatomical attributes displayed superior agreement levels, as opposed to variables necessitating measurements. We recommend the development of a structured approach for the interpretation of IOC to facilitate surgical education in LTCBDE.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e543"},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712270","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":"Development and Validation of a Machine Learning Prediction Model for Textbook Outcome in Liver Surgery: Results From a Multicenter, International Cohort.","authors":"Jane Wang, Amir Ashraf Ganjouei, Taizo Hibi, Nuria Lluis, Camilla Gomes, Fernanda Romero-Hernandez, Han Yin, Lucia Calthorpe, Yukiyasu Okamura, Yuta Abe, Shogo Tanaka, Minoru Tanabe, Zeniche Morise, Horacio Asbun, David Geller, Mohammed Abu Hilal, Mohamed Adam, Adnan Alseidi","doi":"10.1097/AS9.0000000000000539","DOIUrl":"10.1097/AS9.0000000000000539","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to (1) develop a machine learning (ML) model that predicts the textbook outcome in liver surgery (TOLS) using preoperative variables and (2) validate the TOLS criteria by determining whether TOLS is associated with long-term survival after hepatectomy.</p><p><strong>Background: </strong>Textbook outcome is a composite measure that combines several favorable outcomes into a single metric and represents the optimal postoperative course. Recently, an expert panel of surgeons proposed a Delphi consensus-based definition of TOLS.</p><p><strong>Methods: </strong>Adult patients who underwent hepatectomies were identified from a multicenter, international cohort (2010-2022). After data preprocessing and train-test splitting (80:20), 4 models for predicting TOLS were trained and tested. Following model optimization, the performance of the models was evaluated using receiver operating characteristic curves, and a web-based calculator was developed. In addition, a multivariable Cox proportional hazards analysis was conducted to determine the association between TOLS and overall survival (OS).</p><p><strong>Results: </strong>A total of 2059 patients were included, with 62.8% meeting the criteria for TOLS. The XGBoost model, which had the best performance with an area under the curve of 0.73, was chosen for the web-based calculator. The most predictive variables for having TOLS were a minimally invasive approach, fewer lesions, lower Charlson Comorbidity Index, lower preoperative creatinine levels, and smaller lesions. In the multivariable analysis, having TOLS was associated with improved OS (hazard ratio = 0.82, <i>P</i> = 0.015).</p><p><strong>Conclusions: </strong>Our ML model can predict TOLS with acceptable discrimination. We validated the TOLS criteria by demonstrating a significant association with improved OS, thus supporting their use in informing patient care.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e539"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710644","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 Sensitive Circulating Tumor DNA Monitoring on CT Scan Intervals During Postoperative Colorectal Cancer Surveillance.","authors":"Tomoko Sasaki, Takeshi Iwaya, Mizunori Yaegashi, Masashi Idogawa, Hayato Hiraki, Masakazu Abe, Yuka Koizumi, Noriyuki Sasaki, Akiko Yashima-Abo, Ryosuke Fujisawa, Fumitaka Endo, Shoichiro Tange, Koki Otsuka, Akira Sasaki, Mari Masuda, Masashi Fujita, Hidewaki Nakagawa, Fumiaki Takahashi, Yasushi Sasaki, Takashi Tokino, Satoshi S Nishizuka","doi":"10.1097/AS9.0000000000000549","DOIUrl":"10.1097/AS9.0000000000000549","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated whether digital polymerase chain reaction (dPCR)-based circulating tumor DNA (ctDNA) monitoring can allow longer intervals between computed tomography (CT) scans during postoperative surveillance of colorectal cancer (CRC).</p><p><strong>Background: </strong>Practical guidelines still recommend intensive postoperative surveillance of CRC using periodical CT scans and serum carcinoembryonic antigen testing.</p><p><strong>Methods: </strong>The longitudinal dynamics of ctDNA for 52 patients with CRC as measured by dPCR using probes targeting 87 individual tumor-specific mutations (1-5 per patient) were compared with results from conventional (ie, clinical) surveillance using serum tumor markers and CT.</p><p><strong>Results: </strong>A total of 382 CT procedures were carried out for the patient cohort (3.3/year per patient) and the median lead time from ctDNA relapse to clinical relapse was 182 days (range, 0-376 days). If the CT interval was annual, potential delays in the detection of clinical relapse would have occurred for 7 of the 10 patients who experienced clinical relapse (9 of 13 events), with a median delay of 164 days (range, 0-267 days). If annual CT surveillance was performed together with ctDNA monitoring, 218 (57.1%) CTs would not have been needed to detect the first clinical relapse. In addition, the ctDNA monitoring would have provided a lead time of 339 days for detection of clinical relapse (range, 42-533 days).</p><p><strong>Conclusions: </strong>Our findings suggest that the ctDNA monitoring as part of postoperative surveillance and clinical relapse detection for patients with CRC could allow the CT interval to be lengthened.</p><p><strong>Trial registration: </strong>This trial was registered with University Hospital Medical Information Network Clinical Trial Registry (UMIN000045114).</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e549"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712138","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":"Rates of Minimally Invasive Surgery After Introduction of Robotic-Assisted Surgery for Common General Surgery Operations.","authors":"Zhi Ven Fong, Elizabeth Wall-Wieler, Shaneeta Johnson, Richard Culbertson, Brian Mitzman","doi":"10.1097/AS9.0000000000000546","DOIUrl":"10.1097/AS9.0000000000000546","url":null,"abstract":"<p><strong>Importance: </strong>Many patients who would benefit from minimally invasive surgery (MIS) have open surgery; robotic-assisted surgery (RAS) addresses some of the limitations of laparoscopic surgery and could increase rates of MIS across different patient populations.</p><p><strong>Objective: </strong>To determine whether the introduction of RAS increases MIS rates and whether increases are seen across different patient populations undergoing common general surgery procedures.</p><p><strong>Design: </strong>A retrospective cohort study was performed to compare rates of MIS in the year before and after the index date for hospitals that did and did not introduce RAS. Generalized estimating equation regression models were used to compare rates in MIS over time.</p><p><strong>Setting: </strong>PINC AI Healthcare Database, an all-payor discharge database of hospitals in the United States.</p><p><strong>Participants: </strong>Hospitals that performed cholecystectomy, inguinal hernia repair, ventral hernia repair, and colorectal resection from 2016 to 2022.</p><p><strong>Exposure: </strong>RAS hospitals performing at least 1 common general surgery procedure using RAS.</p><p><strong>Main outcome and measure: </strong>The primary analysis examined rates of MIS, defined as the rate of common general surgeries that were minimally invasive (laparoscopic or RAS) in a hospital. The secondary analysis examined MIS rates for common general surgeries, across age, sex, race, ethnicity, and payor.</p><p><strong>Results: </strong>Of 408 hospitals included in the study, 153 (38%) introduced RAS for common general surgeries. The relative MIS rate for hospitals that introduced RAS compared with hospitals that did not went from 1.08 (95% confidence interval [CI], 1.02-1.14; <i>P</i> < 0.01) before the index date to 1.15 (95% CI, 1.09-1.22; <i>P</i> < 0.01) after the index date (<i>P</i> _interaction < 0.01), indicating a larger increase in MIS rates among hospitals introducing RAS. MIS rates increased significantly more in hospitals that introduced RAS across patient age, sex, ethnicity, race, and payor compared with hospitals that did not introduce RAS.</p><p><strong>Conclusions and relevance: </strong>Hospitals that introduced RAS for common general surgery procedures were associated with an increase in MIS rates across different patient populations compared with hospitals that did not introduce RAS.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e546"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712312","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":"Development of Multiservice Machine Learning Models to Predict Postsurgical Length of Stay and Discharge Disposition at the Time of Case Posting.","authors":"Hamed Zaribafzadeh, T Clark Howell, Wendy L Webster, Christopher J Vail, Allan D Kirk, Peter J Allen, Ricardo Henao, Daniel M Buckland","doi":"10.1097/AS9.0000000000000547","DOIUrl":"10.1097/AS9.0000000000000547","url":null,"abstract":"<p><strong>Objective: </strong>Develop machine learning (ML) models to predict postsurgical length of stay (LOS) and discharge disposition (DD) for multiple services with only the data available at the time of case posting.</p><p><strong>Background: </strong>Surgeries are scheduled largely based on operating room resource availability with little attention to downstream resource availability such as inpatient bed availability and the care needs after hospitalization. Predicting postsurgical LOS and DD at the time of case posting could support resource allocation and earlier discharge planning.</p><p><strong>Methods: </strong>This retrospective study included 63,574 adult patients undergoing elective inpatient surgery at a large academic health system. We used surgical case data available at the time of case posting and created gradient-boosting decision tree classification models to predict LOS as short (≤1 day), medium (2-4 days), and prolonged stays (≥5 days) and DD as home versus nonhome.</p><p><strong>Results: </strong>The LOS model achieved an area under the receiver operating characteristic curve (AUC) of 0.81. Adding relative value unit and historical LOS through the similarity cascade increased the accuracy of short and prolonged LOS prediction by 9.0% and 3.9% to 72.9% and 74%, respectively, compared with a model without these features (<i>P</i> = 0.001). The DD model had an AUC of 0.88 for home versus nonhome prediction.</p><p><strong>Conclusions: </strong>We developed ML models to predict, at the time of case posting, the postsurgical LOS and DD for adult elective inpatient cases across multiple services. These models could support case scheduling, resource allocation, optimal bed utilization, earlier discharge planning, and preventing case cancelation due to bed unavailability.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e547"},"PeriodicalIF":0.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712156","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":"Surgical Approach and Variation in Long-Term Survival Following Colorectal Cancer Surgery Using Instrumental Variable Analysis.","authors":"Cody Lendon Mullens, Sarah Sheskey, Edward C Norton, Jyothi R Thumma, Hari Nathan, Scott E Regenbogen, Kyle H Sheetz","doi":"10.1097/AS9.0000000000000538","DOIUrl":"10.1097/AS9.0000000000000538","url":null,"abstract":"<p><strong>Objective: </strong>The study aimed to determine whether increased use of minimally invasive surgical approaches, compared with open, improves long-term survival after colon and rectal cancer resections.</p><p><strong>Background: </strong>Existing prospective and observational data comparing surgical approach for colon and rectal cancer are limited by selection bias, necessitating better approaches for causal inference to understand the relationship between surgical approach and long-term survival.</p><p><strong>Methods: </strong>We included colon and rectal cancer patients who underwent colon or rectal resection from the American College of Surgeons National Cancer Database between 2011 and 2018. Using an instrumental variable (IV) approach, we accounted for measured and unmeasured differences between patients undergoing colon or rectal cancer resection based on operative approach - robotic, laparoscopic, or open. The IV used in this study was rate of robotic-assisted colon and rectal cancer surgery within 81 different hospital regions based on US Census region and rurality during the 12 months before each patient's operation. Proportional hazard modeling was used to estimate risk-adjusted mortality rates.</p><p><strong>Results: </strong>There were 326,406 colon and 96,979 rectal cancer patients included in this study. The risk-adjusted 5-year cumulative incidence of mortality for colon and rectal cancer was highest for patients who underwent open approaches (35.73 [95% confidence interval {CI}: 35.37-36.1] and 39.27 [95% CI: 28.44-30.13], respectively), compared with lower mortality for those undergoing laparoscopic (28.91 [95% CI: 28.55-29.27] and 22.93 [95% CI: 22.11-23.78], respectively) and robotic approaches (26.39 [95% CI: 24.51-28.42] and 19.77 [95% CI: 17.32-22.43], respectively). Growth in utilization of minimally invasive approaches outpaced improvements in long-term survival.</p><p><strong>Conclusions: </strong>Patients undergoing minimally invasive surgical approaches for colon and rectal cancer had improved long-term survival. However, long-term survival changes did not correlate with the large expansion of minimally invasive approaches, which suggests that growing these approaches is not a viable strategy to improve long-term patient outcomes.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e538"},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712331","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":"Race and Sex Disparities in Metabolic/Bariatric Surgery over 20 Years: A Cohort Study.","authors":"Benjamin Grobman, Liyun He, Zhou Lan, Abdelrahman Nimeri, Caroline Apovian, Alexander Turchin","doi":"10.1097/AS9.0000000000000540","DOIUrl":"10.1097/AS9.0000000000000540","url":null,"abstract":"<p><strong>Objectives: </strong>To determine how rates of discussion of metabolic and bariatric surgery (MBS) between patients with class 2 obesity and higher and their healthcare providers as well as subsequent progression to MBS have varied by race and sex over the last 20 years.</p><p><strong>Background: </strong>Obesity is a growing public health crisis. MBS remains the most effective treatment for long-term management of obesity.</p><p><strong>Methods: </strong>Retrospective cohort study of electronic health records from a large tertiary academic health system using a previously validated natural language processing algorithm. The primary outcomes were discussion of MBS between eligible patients and providers and progression to surgery. Multivariable logistic regression was used to determine the association between sociodemographic factors, time, and discussion and receipt of MBS.</p><p><strong>Results: </strong>Among 122,487 patients included in the analysis, 11,094 (9.1%) patients discussed MBS with their providers. Of these, 1348 (12.2%) progressed to MBS. Between 2000 and 2020 the annual fraction of patients who had a discussion of MBS with their providers rose from 3.2% to 10.0% (<i>P</i> < 0.001). Black people were equally likely to discuss MBS with providers as non-Black people (9.5 vs 9.0%, <i>P</i> = 0.09) but were less likely to progress to MBS (8.4 vs 12.6%, <i>P</i> < 0.001). These disparities in progression narrowed over the study period (<i>P</i> = 0.044). Men were less likely than women to both discuss (8.1% vs 9.6%, <i>P</i> < 0.001) and receive MBS (7.6% vs 14.6%, <i>P</i> < 0.001), and these disparities increased over the study period.</p><p><strong>Conclusions: </strong>Interventions to reduce racial disparities in utilization of MBS should focus on progression from discussion to MBS. Interventions to increase the uptake of MBS among men are required across the care cascade.</p>","PeriodicalId":72231,"journal":{"name":"Annals of surgery open : perspectives of surgical history, education, and clinical approaches","volume":"6 1","pages":"e540"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712310","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}