Annals of surgery最新文献

{"title":"The Surveillance Strategy for Intraductal Pancreatic Mucinous Neoplasms: Criteria for Discontinuation.","authors":"Mari-Claire McGuigan, Rafaella Hadjicosti, Andrew J Cameron, Maria Coats, David Chang, Euan J Dickson, David Holroyd, Colin J McKay, Nigel B Jamieson","doi":"10.1097/SLA.0000000000006580","DOIUrl":"10.1097/SLA.0000000000006580","url":null,"abstract":"<p><strong>Objective: </strong>To review the surveillance of IPMN, the risk of pancreatic cancer and the cost of surveillance.</p><p><strong>Background: </strong>The increasing IPMN prevalence and low pancreatic cancer associated with IPMN question the necessity and cost-effectiveness of surveillance. Guidelines favour a 'watch and wait' approach, lacking clarity on stopping surveillance. This study aims to identify patients with pancreatic cancer risk equivalent to their age group, create guidelines for stopping surveillance and reduce NHS costs.</p><p><strong>Methods: </strong>Retrospective analysis of IPMN patients on surveillance in the WoS. Clinicopathological data were collected. Endpoints included pancreatic cancer development and surveillance pathway cost estimation. Age-matched controls were used for comparison using standardised incidence ratios (SIRs) for pancreatic cancer.</p><p><strong>Results: </strong>Of 746 patients, 27 (3.62%) were resected. 3 (0.402%) developed pancreatic cancer and 44 (5.90%) developed worrisome features/ high-risk stigmata after a median surveillance of 48 (IQR 48) months. 221 (29.6%) had a stable cyst for at least 5 years and their SIR was 1.56 (95% CI 0.04-8.71). Patients ≥75 years with stable cysts for ≥5 years, SIR was 1.71 (95% CI 0.03-3.42). Patients ≥65 years with stable cysts of <15 mm for ≥5 years and patients with stable cysts of <10 mm for ≥5 years, had SIRs of 0. The cost of surveillance was £6,330.36 ($8,105.65) per resected patient and £2,032.78 ($2,602.85) per non-resected patient.</p><p><strong>Conclusion: </strong>Patients with stable IPMNs have similar pancreatic cancer risk as the general population. Surveillance discontinuation can be considered after 5 years in a cohort of patients, saving £106,211.19 ($136,020.42) per year.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557042","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":"Artificial Intelligence Assisted Surgical Scene Recognition: A Comparative Study Amongst Healthcare Professionals.","authors":"Simon C Williams, Jinfan Zhou, William R Muirhead, Danyal Z Khan, Chan Hee Koh, Razna Ahmed, Jonathan P Funnell, John G Hanrahan, Alshaymaa Mortada Ali, Shankhaneel Ghosh, Tarık Sarıdoğan, Alexandra Valetopoulou, Patrick Grover, Danail Stoyanov, Mary Murphy, Evangelos B Mazomenos, Hani J Marcus","doi":"10.1097/SLA.0000000000006577","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006577","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to compare the ability of a deep-learning platform (the MACSSwin-T model) with healthcare professionals in detecting cerebral aneurysms from operative videos. Secondly, we aimed to compare the neurosurgical team's ability to detect cerebral aneurysms with and without AI-assistance.</p><p><strong>Background: </strong>Modern microscopic surgery enables the capture of operative video data on an unforeseen scale. Advances in computer vision, a branch of artificial intelligence (AI), have enabled automated analysis of operative video. These advances are likely to benefit clinicians, healthcare systems, and patients alike, yet such benefits are yet to be realised.</p><p><strong>Methods: </strong>In a cross-sectional comparative study, neurosurgeons, anaesthetists, and operating room (OR) nurses, all at varying stages of training and experience, reviewed still frames of aneurysm clipping operations and labelled frames as \"aneurysm not in frame\" or \"aneurysm in frame\". Frames then underwent analysis by the AI platform. A second round of data collection was performed whereby the neurosurgical team had AI-assistance. Accuracy of aneurysm detection was calculated for human only, AI only, and AI-assisted human groups.</p><p><strong>Results: </strong>5,154 individual frame reviews were collated from 338 healthcare professionals. Healthcare professionals correctly labelled 70% of frames without AI assistance, compared to 78% with AI-assistance (OR 1.77, P<0.001). Neurosurgical Attendings showed the greatest improvement, from 77% to 92% correct predictions with AI-assistance (OR 4.24, P=0.003).</p><p><strong>Conclusion: </strong>AI-assisted human performance surpassed both human and AI alone. Notably, across healthcare professionals surveyed, frame accuracy improved across all subspecialties and experience levels, particularly among the most experienced healthcare professionals. These results challenge the prevailing notion that AI primarily benefits junior clinicians, highlighting its crucial role throughout the surgical hierarchy as an essential component of modern surgical practice.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142543241","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":"Machine Perfusion or Straight to Transplant? Predictive Value of Flavin Mononucleotide Levels in Flush Solution of Human Liver Allograft.","authors":"Khaled Ali,Beatrice Cazzaniga,Qiang Liu,Yuki Miyazaki,Munkhbold Tuul,Roma Raj,Ahmed Hussein,Chase Wehrle,Mingyi Zhang,Esteban Calderon,Jiro Kusakabe,Kumaran Shanmugarajah,Glenn Wakam,Mazhar Khalil,Alejandro Pita,Federico Aucejo,Choon David Kwon Md,Jaekun Kim,Masato Fujiki,Charles Miller,Cristiano Quintini,Andrea Schlegel,Koji Hashimoto","doi":"10.1097/sla.0000000000006576","DOIUrl":"https://doi.org/10.1097/sla.0000000000006576","url":null,"abstract":"OBJECTIVEThis study examined the predictive value of Flavin Mononucleotide (FMN) levels in the flush solution used during cold storage of donor livers on outcomes post-transplantation.BACKGROUNDStatic cold storage for liver grafts induces hypoxia with subsequent impaired mitochondrial function and Flavin Mononucleotide (FMN) release upon reperfusion.METHODSThis study enrolled 62 recipients who received whole liver grafts from donation after brain death (n=50) and circulatory death donors (n=12) between June 2022 and July 2023. FMN concentrations were measured in flush solutions on the back-table. ROC-curve analysis identified an FMN level cut-off for graft survival. Post-transplant outcomes were examined according to FMN levels.RESULTSFMN level was significantly associated with graft survival, with an area-under-the-curve (AUC) of 0.858 (95%CI: 0.754-0.963, P<0.001), outperforming the donor risk index (AUC 0.571, 95%CI: 0.227-0.915, P=0.686). The study cohort was divided into low-FMN (<37.5 ng/mL, n=40) and high-FMN groups (≥37.5 ng/mL, n=22). The low-FMN group had superior one-year graft survival compared with the high-FMN group (100% vs. 77%, P=0.003). Levels of transaminases within 7 days post-transplant were significantly higher in the high-FMN group (P=0.003). The high-FMN group developed acute rejections (41% vs. 15%, P=0.023) and early allograft dysfunction (50% vs. 20%, P=0.014) more frequently. Median comprehensive complication index in the high-FMN group was significantly higher (54 [interquartile range, 40-78] vs. 42 [interquartile range, 28-52], P=0.017).CONCLUSIONThe FMN level measured in donor livers' cold storage flush solution is a valid biomarker to predict post-transplant outcomes. Liver grafts with high FMN levels may benefit from machine perfusion to improve outcomes.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142490515","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 Paradox of Hope in Surgery for Advanced Gastrointestinal Malignancy - How Do We Define Futility?","authors":"Kilian G M Brown,David J Coker,Michael J Solomon,Cherry E Koh,Kate Mahon,Daniel Steffens","doi":"10.1097/sla.0000000000006575","DOIUrl":"https://doi.org/10.1097/sla.0000000000006575","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":9.0,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488281","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":"Sneaking Islets Into the Liver During Ex-vivo Normothermic Preservation - A Cunning Strategy to Avoid Ischemia and IBMIR.","authors":"A M James Shapiro","doi":"10.1097/SLA.0000000000006573","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006573","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456551","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":"Clinical and Financial Validation of the International Study Group for Pancreatic Surgery (ISGPS) Definition of Post-Pancreatectomy Acute Pancreatitis (PPAP): International Multicenter Prospective Study.","authors":"Elisa Bannone, Alice Cattelani, Gaetano Corvino, Alessio Marchetti, Valentina Andreasi, Francesca Fermi, Stefano Partelli, Nicolò Pecorelli, Domenico Tamburrino, Alessandro Esposito, Giuseppe Malleo, Manish Bhandare, Kaival Gundavda, Kuirong Jiang, Zipeng Lu, Jie Yin, Harish Lavu, Rosa Klotz, Daniela Merz, Christoph Michalski, Ulla Klaiber, Marco Montorsi, Gennaro Nappo, Naoki Ikenaga, Pasquale Scornamiglio, Bodil Andersson, Fraser Jeffery, Daniel Halloran, Robert Padbury, Ajith K Siriwardena, Savio George Barreto, Luca Gianotti, Attila Oláh, Christopher M Halloran, Saxon Connor, Roland Andersson, Jakob R Izbicki, Masafumi Nakamura, Alessandro Zerbi, Mohammad Abu Hilal, Martin Loos, Charles J Yeo, Yi Miao, Massimo Falconi, Christos Dervenis, John P Neoptolemos, Markus W Büchler, Marc G Besselink, Cristina Ferrone, Thilo Hackert, Roberto Salvia, Shailesh V Shrikhande, Oliver Strobel, Jens Werner, Christopher L Wolfgang, Giovanni Marchegiani","doi":"10.1097/SLA.0000000000006569","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006569","url":null,"abstract":"<p><strong>Objective: </strong>To validate the ISGPS definition and grading system of PPAP after pancreatoduodenectomy (PD).</p><p><strong>Summary background data: </strong>In 2022, the International Study Group for Pancreatic Surgery (ISGPS) defined post-pancreatectomy acute pancreatitis (PPAP) and recommended a prospective validation of its diagnostic criteria and grading system.</p><p><strong>Methods: </strong>This was a prospective, international, multicenter study including patients undergoing PD at 17 referral pancreatic centers across Europe, Asia, Oceania, and the United States. PPAP diagnosis required the following three parameters: (1) postoperative serum hyperamylasemia /hyperlipasemia (POH) persisting on postoperative days 1 and 2, (2) radiologic alterations consistent with PPAP, and (3) a clinically relevant deterioration in the patient's condition. To validate the grading system, clinical and economic parameters were analyzed across all grades.</p><p><strong>Results: </strong>Among 2902 patients undergoing PD, 7.5% (n=218) developed PPAP (6.3% grade B and 1.2% grade C). POH occurred in 24.1% of patients. Hospital stay was associated with PPAP grades (No POH/PPAP 10 days (IQR 7-17) days, grade B 22 days (IQR 15-34) days, and grade C 43 days (IQR 27-54) days; P<0.001), as well as intensive care unit admission (No POH/PPAP 5.4%, grade B 12.6%, grade C 82.9%; P<0.010), and hospital readmission rates (No POH/PPAP 7.3%, grade B 16.1%, grade C 18.5%; P<0.05). Costs of grade B and C PPAP were 2 and 11 times greater than uncomplicated clinical course, resp. (P<0.001).</p><p><strong>Conclusions: </strong>This first prospective, international validation study of the ISGPS definition and grading system for PPAP highlighted the relevant clinical and financial implications of this condition. These results stress the importance of routine screening for PPAP in patients undergoing PD.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456548","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 COMPARE Study: Comparing Perioperative Outcomes of Oncologic Minimally Invasive Laparoscopic, Da Vinci Robotic, and Open Procedures: A Systematic Review and meta-analysis of The Evidence.","authors":"Rocco Ricciardi, Usha Seshadri-Kreaden, Ana Yankovsky, Douglas Dahl, Hugh Auchincloss, Neera M Patel, April E Hebert, Valena Wright","doi":"10.1097/SLA.0000000000006572","DOIUrl":"10.1097/SLA.0000000000006572","url":null,"abstract":"<p><strong>Objective: </strong>To assess 30-day outcomes of da Vinci robotic-assisted (dV-RAS) versus laparoscopic/thoracoscopic (lap/VATS) or open oncologic surgery.</p><p><strong>Summary background data: </strong>Complex procedures in deep/narrow spaces especially benefit from dV-RAS. Prior procedure-specific comparisons are not generalizable.</p><p><strong>Methods: </strong>PubMed, Scopus and EMBASE were systematically searched (latest: 11/17/2023) following PRISMA and PROSPERO (Reg#CRD42023466759). Randomized, prospective, and database studies were pooled as odds ratios (OR) or mean differences (MD) in R using fixed-effect or random-effects (heterogeneity significant). ROBINS-I/RoB 2 were used to assess bias.</p><p><strong>Results: </strong>Of 56,314 unique references over 12 years from 22 countries, 230 studies (34 randomized, 74 prospective, 122 database) comparing dV-RAS to lap/VATS or open surgery across 7 procedures, 4 specialties, representing 1,194,559 dV-RAS; 1,095,936 lap/VATS and 1,625,320 open cases were included. Operative time for dV-RAS was longer than lap/VATS (MD:17.73min [9.80,25.67], P <0.01) and open surgery (MD:40.92min [28.83,53.00], P <0.01), whereas hospital stay was shorter (lap/VATS MD:-0.51d [-0.64,-0.38], P <0.01; open MD:-1.85d [-2.09,-1.62], P <0.01) and blood loss was less versus open (MD:-293.44ml [-359.53,-227.35]). There were fewer dV-RAS conversions (OR:0.44 [0.40,0.49], P <0.01), transfusions (OR:0.79 [0.72,0.88], P <0.01), postoperative complications (OR:0.90 [0.84,0.96], P <0.01), readmissions (OR:0.91 [0.83,0.99], P =0.04), and deaths (OR:0.86 [0.81,0.92], P <0.01) versus lap/VATS, and fewer transfusions (OR:0.25 [0.21,0.30], P <0.01), postoperative complications (OR:0.56 [0.52,0.61], P <0.01), readmissions (OR:0.71 [0.63,0.81], P <0.01), reoperations (OR:0.89 [0.81,0.97], P <0.01), and deaths (OR:0.54 [0.47,0.63], P <0.01) versus open surgery. Blood loss (MD:-12.26mL [-29.44,4.91], P =0.16) and reoperations (OR:1.03 [0.95,1.11], P =0.48) were similar for dV-RAS and lap/VATS. There was significant heterogeneity.</p><p><strong>Conclusions: </strong>Da Vinci -RAS confers benefits across oncological procedures and study designs. These results provide clinical evidence to multi-specialty-care decision-makers considering dV-RAS.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456553","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":"Prospective Multicenter Comprehensive Survey on Male Sexual Dysfunction following Laparoscopic, Robotic, and Transanal Approaches for Rectal Cancer (the LANDMARC Study).","authors":"Masakatsu Numata, Tomohiro Yamaguchi, Akio Shiomi, Ryo Inada, Manabu Shiozawa, Keisuke Kazama, Masanori Hotchi, Daisuke Yamamoto, Suguru Hasegawa, Masashi Miguchi, Shinobu Ohnuma, Kay Uehara, Koji Munakata, Yusuke Kinugasa, Hisanaga Horie, Shigeki Yamaguchi, Teppei Takeshima, Koya Hida, Tomonori Akagi, Hiroyasu Kagawa, Shunsuke Oyamada, Yasushi Rino, Yoshiharu Sakai, Masahiko Watanabe, Takeshi Naitoh","doi":"10.1097/SLA.0000000000006574","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006574","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the incidence of male sexual dysfunction (SD) including erectile dysfunction (ErD) and ejaculatory dysfunction (EjD) after minimally invasive rectal cancer surgery.</p><p><strong>Background: </strong>Male SD significantly affects post-rectal cancer surgery quality of life (QOL). Current assessments using the International Index of Erectile Function-5 are unsuitable for patients with reduced postoperative sexual activity, because it assumes sexual intercourse. This study addresses this gap using the Erection Hardness Score (EHS) and custom ejaculatory questionnaires.</p><p><strong>Methods: </strong>This prospective multicenter open-label phase II trial enrolled 399 patients who underwent laparoscopic (Lap), robotic (Ro), or transanal (Ta) rectal cancer surgery. EHS and custom ejaculatory questionnaires assessed ErD, EjD, and potency impairment at 3, 6, and 12 months postoperatively. The rates were assessed in the full analysis set and compared between the Lap and Ro groups after propensity score matching.</p><p><strong>Results: </strong>At 12 months, the overall incidences of ErD and EjD were 34.7% and 29.8%, respectively. The Ro group showed a significantly lower EjD rate (25.0%) than the Lap group (40.9%), with no significant difference in ErD. Potency impairment was lower in the Ro group at 6 months (32.7% vs. 22.3%) and 12 months (29.0% vs. 17.8%) postoperatively. The Ta group showed relatively high ErD and EjD at 3 months, with some recovery at 12 months.</p><p><strong>Conclusions: </strong>Minimally invasive rectal cancer surgery commonly results in ErD, EjD, and potency impairment. Robotic surgery provides lower EjD rates and less potency impairment. Comprehensive sexual function assessments are essential to inform patients and improve QOL outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456549","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":"Telesurgery a Systematic Literature Review and Future Directions.","authors":"Sumeet Kumar Reddy, Shady Saikali, Ahmed Gamal, Marcio Covas Moschovas, Travis Rogers, Mischa Dohler, Jacques Marescaux, Vipul Patel","doi":"10.1097/SLA.0000000000006570","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006570","url":null,"abstract":"<p><strong>Objective: </strong>To undertake a systematic review of the medical literature on telesurgery, with a key focus on identifying the key technical and non-technical themes searched in medical articles and to analyze gaps in the current knowledge base on telesurgery.</p><p><strong>Background: </strong>It has now been over two decades since the first successful case of telesurgery and since this time there have been significant technological and telecommunications advancements.</p><p><strong>Methods: </strong>A systematic review of the literature was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Details of the protocol for this systematic review were registered on PROSPERO (CRD42024511530).</p><p><strong>Results: </strong>In total, 102 unique references which were allocated into five categories; technical, cybersecurity, ethical, financial, regulatory considerations to discuss key themes. The vast majority of references were related to technical considerations which have demonstrated the feasibility of telesurgery. The non-technical considerations have a paucity of literature and a lack of guidance on telesurgery which appears to still be the major barriers to telesurgery.</p><p><strong>Conclusions: </strong>Telesurgery presents many interdisciplinary challenges, encompassing both important technical and non-technical (such as cybersecurity, ethical, financial, and regulatory) considerations. Further research, collaboration between stakeholders, collaborative community of experts, and the development of comprehensive consensus frameworks are essential steps toward the widespread adoption of telesurgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456552","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 Status of Liver Margin in Perihilar Cholangiocarcinoma: A Multicenter Study.","authors":"Shuo Jin, Ming-Yu Lin, Can-Hong Xiang, Zhi-Peng Liu, Si-Yuan Wang, Nan Jiang, Li Li, Si-Qiao Shan, Jian-Ping Zeng, Hai-Xin Yin, Tao Zhang, Chang-Zhen Yang, Dong-Liang Yang, Hu Zhou, Zhi-Yu Chen, Jia-Hong Dong","doi":"10.1097/SLA.0000000000006571","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006571","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the prevalence and distribution of carcinoma in the liver margin (LM) of resected perihilar cholangiocarcinoma (pCCA) and establish a method for LM examination.</p><p><strong>Background: </strong>LM is the largest margin in resected pCCA with undefined status and assessment method.</p><p><strong>Methods: </strong>227 pCCA cases underwent major hepatectomy were divided into a discovery cohort (n=101) assessed using serial whole-mount digital large sections (WDLS) combined with small sections, and a control cohort (n=126) assessed using only small sections.</p><p><strong>Results: </strong>The LM R1 resection rate was 38.6% (39/101) in the discovery cohort and 5.6% (7/126) in the control cohort. WDLS identified more LM R1 cases compared to the small section in the discovery cohort (38.6% vs. 5.9%, P<0.001). R0 patients in the discovery cohort had better overall survival and recurrence-free survival than those in the control cohort (both P<0.05). Additionally, 95% of carcinoma was found within 20 mm of the proximal ductal margin (DM). A proximal DM distance of<5 mm was an independent risk factor for LM R1 resection. Patients with which are more likely to experience R1 compared to those with ≥ 5 mm (P<0.001).</p><p><strong>Conclusions: </strong>Positive LM was the significant cause for R1 resection of pCCA and the utilization of WDLS improved the diagnostic accuracy of LM. An examination methodology was established, highlighting the necessity of examining LM within a 20 mm radius around the proximal DM, especially in patients with a proximal DM of<5 mm.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":null,"pages":null},"PeriodicalIF":7.5,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142456554","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}