Annals of surgery最新文献

{"title":"Local Regrowth After Neoadjuvant Chemoradiotherapy and Active Surveillance for Esophageal Cancer: An Analysis of Surgical Specimens From the SANO Trial.","authors":"Sanjiv S G Gangaram Panday, Lindsey Oudijk, Sjoerd M Lagarde, Bianca Mostert, A Stijn L P Crobach, Ilse Diederen, Heleen Doornewaard, Karen E Hamoen, Liudmila L Kodach, Ineke van Lijnschoten, Judith Nieken, Chella S van der Post, Robert Riedl, Arjan van Tilburg, Manon C W Spaander, J Jan B van Lanschot, Michail Doukas, Bas P L Wijnhoven","doi":"10.1097/SLA.0000000000007179","DOIUrl":"10.1097/SLA.0000000000007179","url":null,"abstract":"<p><strong>Objective: </strong>To assess pattern of regrowth after neoadjuvant chemoradiotherapy (nCRT) for esophageal cancer. This may inform optimization of response evaluations and explore the possibility for endoscopic treatment of cancer regrowth.</p><p><strong>Summary background data: </strong>Active surveillance is a treatment approach for patients with locally advanced esophageal cancer but the timely detection of regrowth remains challenging.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted in patients with complete clinical response 3 months after nCRT who underwent active surveillance. Patients with cancer regrowth that underwent surgery were included. Resection specimens were reviewed by 2 pathologists. The primary outcome was the anatomic layer(s) of regrowth within the esophageal wall.</p><p><strong>Results: </strong>In total, 75 resection specimens were available 6-36 months after nCRT. Cancer cells were seen in the mucosal layer in 68 of 75 (91%) patients. In 4/75 (5%) patients the tumor was confined to the mucosa. In 13/75 patients (17%), tumor was seen in the mucosa and submucosa but 4 patients also had lymph node involvement. Overall, tumor was present in the submucosa in 88%, proper muscle layer in 71%, and surrounding stroma in 61% of specimens. The majority of regrowth occurred in all layers and this pattern did not change over time.</p><p><strong>Conclusions: </strong>Detected regrowth after nCRT predominantly involves the mucosa and submucosa in the majority of patients and its temporal regrowth pattern support endoscopy as a diagnostic tool. Given the risk of undetected nodal disease and the current limitations of staging after nCRT, surgery remains the recommended treatment for regrowth.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"964-970"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Out-of-Hours Liver Transplantation on Outcomes: A Swedish National Study.","authors":"Mathias V A Vidgren, Rose Matin, Samuel A E Lundgren, Antonio Romano, Amanda L M Habermann, Malin E Aram, Sebastian P Forssten, William F D Bennet, Gabriel C Oniscu","doi":"10.1097/SLA.0000000000007185","DOIUrl":"10.1097/SLA.0000000000007185","url":null,"abstract":"<p><strong>Objectives: </strong>This national, multicenter retrospective study of 764 adult liver transplantations (LT) in Sweden (2019-2023) employed a data-driven approach to identify the out-of-hours (OOH) high-risk window and evaluate its impact on patient outcomes and health care costs.</p><p><strong>Summary background data: </strong>LT logistics often necessitate OOH surgery, but the evidence for an impact on outcomes remains conflicting, partly due to arbitrary window definitions.</p><p><strong>Methods: </strong>Using the mathematical principle of permutations and linear regression analysis of 1-hour start-time intervals across 552 temporal windows, we identified the period with the greatest impact on the primary endpoint: the 3-month Comprehensive Complication Index (CCI). Secondary outcomes included intensive care unit length of stay, Clavien-Dindo complications, reoperations, patient and graft survival, and health care costs.</p><p><strong>Results: </strong>The 17:00 to 05:59 window was identified as having the greatest negative impact on CCI. After adjusting for covariates, procedures initiated during this timeframe were associated with significantly higher CCI (β=7.41, 95% CI: 4.27-10.56, P <0.01), increased Clavien-Dindo IIIb and IV complications, 1.16 days longer intensive care unit stay and a higher risk of LT-related reoperations (odds ratio: 1.61, 95% CI: 1.11-2.36). One-year graft and patient survival were comparable between groups. Health care costs were 169.629 SEK (€15,500) higher per patient operated OOH, during the 3-month follow-up.</p><p><strong>Conclusion: </strong>This data-driven analysis identified a high-risk OOH window beginning earlier than previously reported (17:00 vs. traditional nighttime definitions). LT starting in this interval is associated with significantly increased morbidity and health care costs. Further studies are needed to evaluate mitigating strategies to enable daytime transplantation.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1035-1041"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life After Robotic Living Donor Hepatectomy: A 1-Year Prospective Analysis of Donor and Recipient Determinants.","authors":"Dimitri A Raptis, Mamdouh Alenazi, Maha Assubayii, Yasser Elsheikh, Yasir Alnemary, Bandar Aljudaibi, Saleh A Alqahtani, Dieter C Broering","doi":"10.1097/SLA.0000000000007184","DOIUrl":"10.1097/SLA.0000000000007184","url":null,"abstract":"<p><strong>Introduction: </strong>Living liver donation is a major operation performed without direct medical benefit to the donor. Prospective data on longitudinal donor-reported outcomes after minimally invasive donor hepatectomy remain limited, particularly for robotic approaches offered without donor selection.</p><p><strong>Methods: </strong>This prospective observational cohort study included all consecutive living liver donors undergoing robotic donor hepatectomy between April 2024 and March 2025. The robotic approach was offered to all donors without preselection. Donors completed the Short Form-36 (SF-36), Body Image Scale (BIS), and Beck Depression Inventory (BDI) questionnaires preoperatively and at 3, 6, and 12 months post-donation. Longitudinal changes relative to baseline were assessed using Wilcoxon signed-rank tests. Associations with donor demographics, perioperative variables, and recipient disease severity were evaluated using Spearman correlation and nonparametric group comparisons.</p><p><strong>Results: </strong>A total of 214 donors were analyzed (mean age 36.4 y, 54% male). Physical Functioning, Role-Physical, Bodily Pain, and General Health declined at 3 months but recovered and returned to baseline by 12 months. Emotional Well-Being and Energy/Fatigue improved beyond baseline by 6 months and remained elevated at 12 months. Body image disturbance and depressive symptoms remained low throughout follow-up. Older donor age was modestly associated with better psychosocial outcomes. Donor complications and early recipient mortality were associated with transient reductions in selected domains without sustained impact. No consistent associations were observed with graft type, donor-recipient relationship, or recipient disease severity.</p><p><strong>Conclusions: </strong>Robotic living donor hepatectomy is associated with excellent physical and psychosocial recovery during the first postoperative year, supporting its donor-centered benefits.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1002-1008"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Anastomotic Leak After Esophagectomy on Long-term Survival in the Modern Era of Management (ALES Study): A Multicenter Cohort Study.","authors":"Lorenzo Giorgi, Nadia Guidozzi, Riadh Salem, Wing K Chou, Stijn Vanstraelen, Helena Gielen, Johnny Moons, Philippe Nafteux, Femke E Lammes, Jelle P Ruurda, Richard van Hillegersberg, Alban Todesco, Xavier Benoit D'Journo, Alice Collizzolli, Barbara Ajazi, Simone Giacopuzzi, Maria Bencivenga, Sam Alhayo, Ella Seabourne, Ewen A Griffiths, Aram Abu Hejleh, Lars M Schiffmann, Christiane J Bruns, Giovanni Maria Garbarino, Andrea Pansa, Silvia Basato, Ophélie Bacoeur-Ouzillou, Caroline Gronnier, Sofie P G Henckens, Suzanne S Gisbertz, Rakesh Ahmed, Nithiesh Loganathan, Jessie A Elliott, Kirsty Cole, Youssef Ibrahim, Chanakya Anand, Philip H Pucher, Martin Skogar, Jakob Hedberg, Eloise Bonnin, Julie Veziant, Guillaume Piessen, Agnese Carresi, Francesco Puccetti, Silvia Battaglia, Riccardo Rosati, Fahad Murad, Fredrik Klevebro, Magnus Nilsson, Grard A P Nieuwenhuijzen, Lars van de Sanden, Misha Luyer, Rita Alfieri, Carlo Castoro, Mark I van Berge Henegouwen, Sheraz R Markar","doi":"10.1097/SLA.0000000000007190","DOIUrl":"10.1097/SLA.0000000000007190","url":null,"abstract":"<p><strong>Objective: </strong>To determine the impact of severity of esophageal anastomotic leak (AL), standardized by ECCG grading, on long-term survival within a contemporary multicenter cohort.</p><p><strong>Summary background data: </strong>Historical evidence suggesting AL is associated with increased recurrence and poor survival is limited by heterogeneous definitions and outdated management. This study utilizes the standardized ECCG definition to evaluate the prognostic significance of AL severity under modern perioperative protocols and endoscopic rescue strategies.</p><p><strong>Methods: </strong>An international multicenter cohort across 17 high-volume European centers. Adult patients with esophageal or junctional cancer treated with neoadjuvant CROSS or FLOT, followed by esophagectomy were included (2018-2023).</p><p><strong>Results: </strong>Out of 2905 patients, 425 (14.6%) developed an AL. AL was associated with a nearly two-fold increase in pulmonary complications (46.8% vs. 26.7%; P <0.001). AL requiring surgical reintervention (type III) was associated with an increased 30- and 90-days mortality rate (7.3% vs. 2.7% and 12.3% vs. 4%, P <0.001) and a significant reduction in median overall survival versus the no leak group (33.9 vs. 69.3; months P <0.001). After multivariable adjustment, type III AL was associated with a greater likelihood of death (HR 1.51; 95% CI: 1.04-2.18; P =0.029). A lower rate of adjuvant therapy administration (33.9% vs. 43.3%; P =0.004) was observe for AL patients. No significant survival deficits were observed for leaks treated conservatively or with no-surgical intervention.</p><p><strong>Conclusions: </strong>AL requiring surgical reintervention was associated with impaired survival. This relationship identifies a high-risk clinical profile and represents a critical target for future research into strategies for clinical stabilization and risk mitigation.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"978-984"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Xenotransplantation: The Next Surgical Revolution for Acute Liver Failure?","authors":"Léo Bühler, Xiaowei Hu, Kefeng Dou, Shaoping Deng, Antonio Pinna, Pierre-Alain Clavien","doi":"10.1097/SLA.0000000000007186","DOIUrl":"10.1097/SLA.0000000000007186","url":null,"abstract":"<p><strong>Objective: </strong>To review the current state of liver xenotransplantation and evaluate emerging strategies using genetically modified porcine organs for the management of acute liver failure.</p><p><strong>Background: </strong>The shortage of donor organs continues to limit transplantation, with substantial waitlist mortality, especially in acute liver failure. Progress in the last decades has been driven by advances in gene editing and immunomodulation, allowing for clinical solid-organ xenotransplantation trials since 2021, with early kidney and heart experiences demonstrating feasibility. Liver xenotransplantation might be more challenging because of the liver's metabolic, synthetic, and hemodynamic roles.</p><p><strong>Methods: </strong>This review summarizes the development of liver xenotransplantation and focuses on modern approaches using genetically modified pigs. We discuss 2 main liver-directed strategies: extracorporeal liver support using ex vivo perfusion of whole porcine livers and the transplantation of genetically engineered porcine liver for patients with acute liver failure. Practical aspects of organ preservation, transportation, and application of long-term machine perfusion are also discussed.</p><p><strong>Results: </strong>Recent first clinical applications of genetically modified porcine liver as auxiliary transplants or associated with extracorporeal circulation systems demonstrated preserved function for several days to weeks without evidence of acute rejection, both in deceased and living recipients. These trials suggest technical feasibility and short-term physiological efficacy, while exposing unresolved challenges related to coagulopathy and immunologic injury.</p><p><strong>Conclusions: </strong>Liver xenotransplantation using genetically modified porcine organs has progressed from experimental concept to early clinical application. Current evidence supports its potential role as a bridging strategy for acute liver failure, although further refinement is needed for broader clinical adoption.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"879-887"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expanding Indications of Nonvascularized Rectus Fascia as a Cross-Disciplinary Allograft: A Prospective Single-Center Study.","authors":"Laurens J Ceulemans, Ewout Muylle, Gert De Hertogh, Andrea Zajacova, Marina G M C Mori da Cunha, Steffi De Pelsmaeker, Ina Benoy, Antoine Dubois, Thomas Douchy, Daphne Hompes, Albert Wolthuis, Diethard Monbaliu, Philippe Nafteux, Paul De Leyn, André D Hoore, Jacques Pirenne, Nele Van De Winkel","doi":"10.1097/SLA.0000000000007194","DOIUrl":"10.1097/SLA.0000000000007194","url":null,"abstract":"<p><strong>Objective: </strong>To report the expanding application of nonvascularized rectus fascia allotransplantation (NVRF-alloTx) in solid organ transplant (SOT) and non-SOT patients and evaluate its effectiveness, integration, and immunologic response in complex abdominal and thoracic reconstruction.</p><p><strong>Summary background data: </strong>Synthetic and biological meshes are limited by infection risk, long-term failure, donor-site morbidity, and high cost. NVRF-alloTx, first applied in intestinal/multivisceral-Tx with a 5.9% herniation rate, offers a simple and promising alternative for challenging defects.</p><p><strong>Methods: </strong>This prospective single-center study included all consecutive patients undergoing NVRF-alloTx (2020-2025). Patients were divided into 2 groups: (1) reconstruction in SOT patients (simultaneous or elective closure post-SOT) and (2) reconstruction in non-SOT patients, without immunosuppression. NVRF-allografts were procured from deceased donors, preserved at 2°C, and implanted without HLA-matching. Primary endpoints were successful closure, graft failure, and functional outcome. Clinical and radiologic follow-up was performed, with HLA donor-specific antibody (HLA-DSA) testing and histology whenever available.</p><p><strong>Results: </strong>Forty-seven NVRF-Tx procedures were performed in 41 patients using grafts from 48 deceased donors: group 1 (n=17) and group 2 (n=24). In 2 patients (4.9%), the graft did not integrate due to pancreatic leakage and vasopressor therapy. Others resulted in successful functional outcomes. Histology (n=5) showed graft integration through host fibrotic remodeling with neovascularization evident from 1 month after implantation. (De novo) HLA-DSA developed more frequently in non-SOT NVRF recipients than in SOT NVRF recipients.</p><p><strong>Conclusions: </strong>NVRF-alloTx is a versatile and effective reconstructive option for complex defects in SOT and non-SOT patients, providing an alternative to conventional meshes in challenging clinical scenarios.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"888-897"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Near-infrared Autofluorescence Probe Versus Visual Identification for Parathyroid Detection and Functional Preservation During Total Thyroidectomy: A Randomized Controlled Trial.","authors":"Marcin Barczyński, Agnieszka Pac, Karolina Krakowska, Katarzyna Kłodziejska, Mateusz Dworak, Aleksander Konturek","doi":"10.1097/SLA.0000000000007180","DOIUrl":"10.1097/SLA.0000000000007180","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether PTeye-guided identification increases the number of parathyroid glands (PGs) preserved in situ and reduces hypoparathyroidism compared with visual identification alone.</p><p><strong>Background: </strong>Injury or inadvertent removal of PGs during thyroidectomy is the main cause of postoperative hypoparathyroidism. Reliance on visual inspection makes intraoperative PG identification difficult. Probe-based near-infrared autofluorescence (NIRAF) systems such as PTeye provide real-time, tissue-specific feedback that may enhance PG detection and preservation.</p><p><strong>Methods: </strong>In this single-center, prospective, randomized trial, patients undergoing first-time total thyroidectomy were allocated to PTeye-assisted or visual PG identification. Procedures were performed by 2 senior and 3 junior surgeons. The primary outcome was the number of PGs identified. Secondary outcomes included inadvertent parathyroidectomy, autotransplantation, and transient and last follow-up hypoparathyroidism.</p><p><strong>Results: </strong>Among 154 randomized patients (77 per group; mean age 53.4±14.3 y; 84.4% female), PTeye increased the mean number of PGs identified (3.81 vs. 2.73; P <0.001) and the proportion with 3-4 PGs preserved in situ (98.7% vs. 87.0%; P =0.004). Inadvertent parathyroidectomy was less frequent with PTeye (5.2% vs. 20.8%; P =0.004). Junior surgeons performed more autotransplantations than senior surgeons when using PTeye (33.3% vs. 10.5%; P =0.015). Female sex ( P =0.047), ≤2 PGs preserved ( P =0.008), and autotransplantation ( P =0.010) predicted low postoperative day-1 parathormone serum level. Among junior surgeons, transient hypoparathyroidism was lower with PTeye (20.5% vs. 55.2%; P <0.001), with no difference among senior surgeons. Permanent hypoparathyroidism rates were similar between groups.</p><p><strong>Conclusions: </strong>PTeye-guided NIRAF improves PG identification and in situ preservation and reduces transient hypoparathyroidism, particularly for junior surgeons, without affecting permanent hypoparathyroidism.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"907-913"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary Rehabilitation Following Upper Gastrointestinal Cancer Surgery (RESTORE II): A Definitive Randomized Controlled Trial.","authors":"Linda M O'Neill, Emily Smyth, Neil Kearney, Grainne Sheill, Louise Brennan, Sophie Grehan, Sanela Begic, Fiona Murphy, Ciara Tansey, Niamh Flanagan, Mikel Egaña, Ricardo Segurado, Marie Galligan, Jinbo Zhao, Ciaran M Fairman, Claire M Timon, Suzanne L Doyle, Deirdre Connolly, Jacintha O'Sullivan, John V Reynolds, Juliette Hussey, Emer M Guinan","doi":"10.1097/SLA.0000000000007189","DOIUrl":"10.1097/SLA.0000000000007189","url":null,"abstract":"<p><strong>Objective: </strong>RESTORE II compared in an RCT the impact of a 12-week multidisciplinary rehabilitation program versus standard care (SC) on cardiorespiratory fitness and physical function in patients postupper gastrointestinal (UGI) oncologic surgery.</p><p><strong>Summary of background data: </strong>The value of multidisciplinary cancer rehabilitation in UGI cancer survivorship is unclear, with limited high-quality data.</p><p><strong>Methods: </strong>Disease-free patients, ≥3 months post-UGI cancer resection were randomized to SC or RESTORE (physiotherapy-led aerobic and resistance exercise, dietary counselling, and psychosocial support). The primary endpoint was cardiorespiratory fitness (VO 2 peak). Secondary endpoints included body composition (anthropometry and bioimpedance analysis), muscle strength (hand grip strength and leg-press 1-repetition maximum), functional performance (Short Physical Performance Battery), physical activity (accelerometery), and health-related quality of life (EORTC-QLQ-C30). Assessments were conducted at baseline (T0), postintervention (T1), and 3-month follow-up (T2).</p><p><strong>Results: </strong>Eighty-eight participants were randomized to SC (n=44) or RESTORE (n=44). Median age was 67.5 (range: 43-86) years, n=60 (68.2%) male, and median time postsurgery was 33 (range: 3.5-145) months. VO₂peak remained stable in the SC group. Estimated interaction effects for time × group indicate that the mean increases in VO₂peak were greater for RESTORE relative to SC from baseline to T1, by a mean of 1.5 mL/min/kg (95% CI: 0.52-2.48; P -value=0.003), and from baseline to T2 by a mean of 1.23 mL/min/kg (95% CI: 0.18-2.27; P -value=0.02). Secondary endpoints remained stable across treatment arms with no significant differences observed.</p><p><strong>Conclusion: </strong>RESTORE II provides Level I evidence that cardiorespiratory fitness can be targeted and improved in survivors of UGI cancer surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"898-906"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Auxiliary Partial Orthotopic Liver Transplantation in Children Under 10 Years Old With Fulminant Hepatic Failure: A Multicenter Experience.","authors":"Sho Fujiwara, Sergio Assia-Zamora, Miriam Cortes-Cerisuelo, Wayel Jassem, Peter Liou, Gennaro Selvaggi, Jennifer Garcia, Mercedes Martinez, Nathaly Llore, Jason Hawksworth, Antonio D Pinna, Anil Dhawan, Nigel Heaton, Tomoaki Kato","doi":"10.1097/SLA.0000000000007198","DOIUrl":"10.1097/SLA.0000000000007198","url":null,"abstract":"<p><strong>Background and aims: </strong>Auxiliary partial orthotopic liver transplantation (APOLT) for fulminant hepatic failure (FHF) allows potential withdrawal of lifelong immunosuppression (ISP) following native liver regeneration, which may be advantageous in young children with high regenerative capacity. Despite these potential benefits, APOLT has been rarely used, and long-term outcomes in children under 10 years remain unclear. This study aimed to evaluate perioperative safety, long-term outcomes, and native liver regeneration rates in children under 10 years undergoing APOLT for FHF at major centers in the UK and the USA.</p><p><strong>Materials and methods: </strong>We conducted a multicenter international retrospective study using data from King's College Hospital, Columbia University, and the University of Miami. Children under 10 years with FHF who underwent APOLT between 1996 and 2025 were included.</p><p><strong>Results: </strong>Forty-two patients were analyzed. Median age was 3.2 years (interquartile range, 1.69 to 5.89), and 59.5% were males. Etiologies included idiopathic (n = 19), autoimmune hepatitis (n = 8), and adenovirus (n = 7). Left lateral segment grafts were used in 83.3%. No perioperative mortality occurred within 90 days. Perioperative morbidity included hepatic artery thrombosis (7.1%), portal vein thrombosis (4.8%), biliary strictures (7.1%), and bile leaks (2.4%). Median follow-up was 11.1 years (interquartile range, 6.74 to 15.7), with a 25-year overall survival of 97.6%. Native liver regeneration was confirmed in 95.0% (38/40) with successful withdrawal from ISP. Four patients (9.5%) required retransplantation; in 2 of them, APOLT was repeated. Finally, 40 patients underwent APOLT, and 80% are off ISP and 76.2% in the intention-to-treat analysis.</p><p><strong>Conclusion: </strong>APOLT is a safe and effective treatment for patients under 10 years old with FHF, providing excellent long-term survival and a high rate of native liver regeneration.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1050-1056"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex- and Age-specific Outcomes After Ruptured Abdominal Aortic Aneurysm Repair: A Nationwide Cohort Study.","authors":"Mathijs J Biemond, Jan van Schaik, Jaap F Hamming, Jorg L de Bruin, Jeroen J W M Brouwers, Mark Dirven, Gabor Gäbel, Joost A van Herwaarden, Vincent Jongkind, Jon S Matsumura, Barend M E Mees, Abbey Schepers, Jean-Paul P M de Vries, Joost R van der Vorst, Jan H N Lindeman","doi":"10.1097/SLA.0000000000007191","DOIUrl":"10.1097/SLA.0000000000007191","url":null,"abstract":"<p><strong>Background: </strong>Ruptured abdominal aortic aneurysm (RAAA) remains a medical catastrophe. Although early outcomes improved, contemporary data integrating early and long-term survival, and postdischarge care needs across sex- and age groups is limited.</p><p><strong>Methods: </strong>This nationwide cohort included Dutch RAAA repairs between 2014 and 2023. Dutch Surgical Aneurysm Audit data were linked to Statistics Netherlands registries. Outcomes included 90-day mortality, long-term survival, and postdischarge care.</p><p><strong>Results: </strong>Of the 3642 patients, 15.2% were women, who were older (76.3 vs. 74.0 y) and more often required open repair (61.4% vs. 54.0%). Ninety-day mortality increased with age and was higher in women (39.1% vs. 29.1%), but female sex was not independently associated with early mortality after adjustment.Among 90-day survivors, absolute long-term survival was similar, but relative survival was lower in women (5-year relative survival 68.0% vs. 78.3%). Women were less often discharged home (42.4% vs. 56.7%) and more frequently required early homecare (47.7% vs. 34.7%). Reinterventions were more common after EVAR than open repair and occurred less frequently in women.</p><p><strong>Conclusion: </strong>In this nationwide linked audit-registry analysis, outcomes after RAAA repair improved substantially, despite lower estimated in-hospital turndown rates than in earlier eras. The higher early mortality in women WAS reflected by differences in age, presentation severity, and repair type - possibly reflecting less favorable aneurysm anatomy. Female sex also associated with an increased long-term excess mortality and greater postdischarge dependency. These findings indicate that optimization of care for women with a RAAA is not confined to perioperative mortality, but extends across the entire care pathway.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"943-949"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}