Annals of surgery最新文献

{"title":"Ten-year Results After Primary Gastric Bypass: Real-world Data from A Swedish Nationwide Registry.","authors":"Magnus Sundbom,Erik Näslund,Johan Ottosson,Torsten Olbers,Suzanne Hedberg,Jeff Wennerlund,Anna Laurenius,Erik Stenberg","doi":"10.1097/sla.0000000000006743","DOIUrl":"https://doi.org/10.1097/sla.0000000000006743","url":null,"abstract":"OBJECTIVETo determine the 10-year outcomes regarding weight loss and remission of obesity-related diseases after primary Roux-en-Y gastric bypass (RYGB), when performed in routine clinical care.SUMMARY OF BACKGROUND DATALong-term results of metabolic bariatric surgery (MBS) are important, as the number of patients needing help with this chronic condition is increasing globally. However, results from larger nation-wide studies are lacking.METHODSCohort study of RYGB-patients from the Scandinavian Obesity Surgery Registry (SOReg), a national Swedish quality registry of MBS. Supplementary data was obtained from the Prescribed Drug Register (pharmacological therapy) and the National Diabetes Register (clinical data). Weight loss, complete remission of comorbidities (defined as no pharmacological therapy and normal laboratory values), and associations for new-onset disease were studied.RESULTS29,578 individuals (mean age 41.0±11.0 y, 75.6% females) had a RYGB in Sweden 2007-2012. At ten years, mean body weight was reduced from 112.7 kg to 91.4 kg, corresponding to a total body weight loss of 24.6%. A significant complete remission rate persisted in type 2 diabetes (29.7%), hypertension (15.1%) and dyslipidemia (8.8%), while the use of antidepressants increased by 38.6%, P<0.001 for all. The use of continuous positive airway pressure for sleep apnea decreased from 9.8% to 4.1%. New-onset disease was in general associated to age, low weight loss and presence of other comorbidities.CONCLUSIONSAt ten years, patients undergoing primary RYGB in Sweden demonstrate lasting weight loss and substantial remission of obesity-related diseases. RYGB is a valuable treatment option in the long-term for patients with severe obesity.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"67 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889327","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":"Management of Bile Leak Post Minimally Invasive Subtotal Cholecystectomy: A Review.","authors":"Shirley X Deng,Brittany Greene,Christopher Habbel,Lev Bubis,Melanie E Tsang,Shiva Jayaraman","doi":"10.1097/sla.0000000000006744","DOIUrl":"https://doi.org/10.1097/sla.0000000000006744","url":null,"abstract":"OBJECTIVEMinimally invasive subtotal cholecystectomy is safe alternative to minimally invasive cholecystectomy that prevents bile duct injury. Nonetheless, it is associated with higher rates of other complications, namely post-operative bile leak and symptomatic remnant cholelithiasis.SUMMARY BACKGROUND DATABile leak presents as biloma requiring drainage and subsequently high bilious drain output. It is more strongly associated with fenestrating subtotal cholecystectomy. Fortunately, the majority are self-limited and do not require endoscopic intervention. Symptomatic remnant cholelithiasis presents as recurrent gallstone disease post-operative cholecystectomy.METHODSIn this paper, we review available literature on these two complications and share our institutional algorithm on the management of bile leak.RESULTSOur approach to bile leak advocates for intra-operative drain placement, early characterization of the leak, watchful waiting, the use of sinogram, and reserving ERCP and stenting for high-grade leaks or refractory cases. Symptomatic remnant cholelithiasis is more strongly associated with reconstituting subtotal cholecystectomy, particularly in cases where the gallbladder stump is long or stones are not completely evacuated from the remnant. This complication should be treated with completion cholecystectomy when possible, but can also be managed with gallbladder-preserving choleystolithomy in patients with aberrant biliary anatomy and/or significant comorbidities. Completion cholecystectomy is a technically challenging operation that benefits from hepatopancreaticbiliary expertise and intra-operative adjuncts such as near-infrared fluorescent cholangiography or intra-operative cholangiogram.CONCLUSIONSMinimally invasive subtotal cholecystectomy effectively prevents bile duct injury but at the expense of increased post-operative morbidity; it is a bailout strategy that should be used judiciously.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"149 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889323","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 BARIREF Study: BARIatric Surgery Complications in Patients with Prior REFlux Surgery in a Large National Cohort.","authors":"Francesco Abboretti,Styliani Mantziari,Damien Bouriez,Caroline Gronnier,Andrea Lazzati","doi":"10.1097/sla.0000000000006742","DOIUrl":"https://doi.org/10.1097/sla.0000000000006742","url":null,"abstract":"OBJECTIVETo assess the outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in patients with prior fundoplication.SUMMARY BACKGROUND DATAObesity and gastroesophageal reflux disease (GERD) often coexist, posing clinical challenges. Fundoplication is the standard treatment for GERD refractory to medical therapy. Managing obesity after fundoplication is complex and while RYGB is preferred for addressing both obesity and GERD, its use post-fundoplication requires further evaluation.METHODSRetrospective analysis of a national French database of patients undergoing RYGB and SG between 2013 and 2023. Patients were grouped according to prior fundoplication (PriorF) or no fundoplication (NoF). Baseline demographics and 90-day postoperative outcomes were assessed. Univariate and multivariate analyses identified risk factors; 1:5 matching was applied based on sex, age, body mass index, comorbidities, surgery year, procedure type and center volume.RESULTSAmong 372,464 patients, 337 (0.1%) had prior fundoplication. PriorF patients had higher rates of severe postoperative complications (Dindo ≥IIIa: 8.9% vs. 3.7%, P < 0.001), longer hospital stays (4.5 ± 4.9 vs. 3.7 ± 2.9 d, P < 0.001), and higher readmission rates (17.8% vs. 10.6%, P < 0.001). Multivariate analysis for RYGB showed no significant association between prior fundoplication and complications (OR 1.71, 95% CI 1.00-2.74, P=0.051). Prior fundoplication was independently associated with increased complications after SG (OR 2.54, 95% CI 1.37-4.32, P < 0.001).CONCLUSIONSPrior fundoplication increased postoperative complications after SG but not after RYGB. RYGB appears to be the safer bariatric procedure in patients with prior fundoplication.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"123 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889226","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":"Frailty and Survival for Diagnoses Feasibly Managed Operatively or Nonoperatively.","authors":"Emily Mosher,Hasan Nassereldine,Jeffrey C McKibben,Jason Johanning,Shipra Arya,Nader N Massarweh,Rupen Shah,Myrick Shinall,Paula Shireman,Patrick R Varley,Elizabeth L George,Ada Youk,Leah Backhus,Alaina J Brown,Neil Christie,Rajeev Dhupar,Nicole Donnellan,Nicholas John Giori,Matthew R Goede,Richard Guido,Joon Lee,Jennifer L Griffin Miller,Justin C Siebler,Daniel A Tonetti,Scott A Vincent,Katherine M Reitz,Daniel E Hall","doi":"10.1097/sla.0000000000006739","DOIUrl":"https://doi.org/10.1097/sla.0000000000006739","url":null,"abstract":"OBJECTIVECompare outcomes, stratified by frailty, of patients with eight common conditions with plausible operative and nonoperative management strategies.SUMMARY BACKGROUND DATAA surgical pause, evaluating potential adverse outcomes among frail patients, improves postoperative outcomes; however, the outcomes among patients opting for nonoperative management are unknown.METHODSIn an observational cohort study across a multi-hospital healthcare system including adults presenting to outpatient surgical clinics (2016-2023) for evaluation of eight conditions feasibly managed operatively or nonoperatively as defined by modified Delphi consensus. In a landmarked analysis, we compared 2-year survival by management strategies across frailty categories (robust, normal, frail, very frail) as defined by the Risk Analysis Index (RAI). Secondarily we compared 365-day hospital free days (HFD-365), postoperative length of stay, and discharge disposition.RESULTSAmong 49,169 patients (mean±SD age, 60.4±14.6 y; 54.6% female), operative management was associated with lower observed and adjusted mortality (1.3% vs 2.5%; aHR=0.55 [95% CI, 0.47-0.66], P<0.0001) overall and among all frailty categories expect the very frail (8.1% vs 12.1%, P=0.1). Additionally, operative management was associated with fewer HFD-365 again overall which was specifically prominent among the very frail (median 365 [IQR, 358-365] vs 361 days [IQR, 357-363], P<0.0001). Postoperatively, frailty portended more protracted recoveries with greater postoperative lengths of stay (1.7±2.6 vs 1.2±2.1) days, P<0.0001) and fewer discharges home (370 [85.1%] vs 5,087 [91.8%], P<0.0001; odds ratio=2.0 [95%CI 1.5-2.6]).CONCLUSIONSConsidering the protracted postoperative recovery of very frail patients, nonoperative management might be the preferred treatment option for those presenting with these eight clinical conditions.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"7 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889208","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":"Estimation of Risk-Adjusted Outcomes for Non-Infectious Postoperative Complications using Interpretable Machine Learning and Electronic Health Record Data.","authors":"Christina M Stuart,Yizhou Fei,Kathryn L Colborn,Yaxu Zhuang,William G Henderson,Adam R Dyas,Michael R Bronsert,Robert A Meguid","doi":"10.1097/sla.0000000000006737","DOIUrl":"https://doi.org/10.1097/sla.0000000000006737","url":null,"abstract":"OBJECTIVETo compare statistical models applied to electronic health record (EHR) data to predict and identify non-infectious postoperative complications. The models have been published and are part of the Automated Surveillance of Postoperative Infections (ASPIN) project, which has expanded to include non-infectious complications.SUMMARY OF BACKGROUND DATAPostoperative complications occur in 15% of nonemergent inpatient surgeries. Most reporting of postoperative complications relies on manual chart abstraction.METHODSPreoperative and postoperative probabilities of non-infectious complications for patients from 5 large hospitals in Colorado were estimated using ASPIN models that were developed using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) gold standard outcomes. Observed:expected (O:E) ratios were estimated by dividing the sum of the postoperative probabilities by the sum of the preoperative probabilities. O:E ratios were compared between local ACS-NSQIP patients using ACS-NSQIP data, local ACS-NSQIP patients using EHR data, and all patients undergoing operations in the study period using EHR data.RESULTSO:E ratios for 9 non-infectious postoperative complications were estimated. Comparison of the O:E ratios of ACS-NSQIP patients using ACS-NSQIP data vs. EHR data showed overlapping confidence intervals in 44 (98%) of 45 comparisons (5 hospitals x 9 outcomes) and agreement in outlier status for 35 (78%).CONCLUSIONSRisk-adjusted postoperative outcomes estimated using machine learning on EHR data were similar to those produced by manual chart review. These models could be used to augment manual chart review to guide surgical quality improvement.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"16 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857419","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":"Intermittent Inflow Occlusion in Robotic Right Donor Hepatectomy: A Randomised Controlled Trial.","authors":"Rahul D Kunju,Christi Titus Varghese,Krishnanunni Nair,Shweta Mallick,Binoj Sivasankara Pillai Thankamony Amma,Ramachandran N Menon,Dinesh Balakrishnan,Unnikrishnan Gopalakrishnan,Sudheer Ov,S Sudhindran","doi":"10.1097/sla.0000000000006733","DOIUrl":"https://doi.org/10.1097/sla.0000000000006733","url":null,"abstract":"OBJECTIVETo assess the safety and efficacy of intermittent inflow occlusion (IIO) during robotic right donor hepatectomy (RDH) for adult living donor liver transplantation.SUMMARY BACKGROUND DATAAlthough evidence supports minimally invasive donor hepatectomy, its adoption by surgeons remains limited. Key challenges include bleeding during parenchymal transection and prolonged warm ischemia during graft extraction, resulting in morbidity in both the donor and recipient.METHODSBetween April 2022 and June 2023, out of 123 donors suitable for RDH, 113 were randomised to undergo robotic RDH with (n=56) or without (n=57) IIO. The primary endpoint was the blood loss during robotic RDH. The secondary end points included peak levels of bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), INR and complications in donors and recipients. Additionally, peak lactate levels and the need for blood transfusion were assessed in donors.RESULTSThe mean duration of IIO was 42.48±11.21 minutes .Blood loss during parenchymal transection (235 (186.25 - 375) vs. 295 (235 - 475),P=0.006) and total blood loss (275 (212.5 - 430) vs. 330 (272.5- 520),P=0.018) were significantly lower among donors in the IIO arm. In recipients belonging to IIO arm, peak ALT (P=0.032) and INR (P=0.012) were significantly low. Although statistically similar, the peak AST (P=0.064) and acute kidney injury (1,P=0.061) in the IIO arm among recipients were also less. Other perioperative outcomes including complications in donors/recipients and overall mortality in recipients remained comparable.CONCLUSIONIIO during robotic RDH is safe. It led to reduced blood loss among donors and improved graft parameters in recipients during the immediate postoperative period.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"108 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857420","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":"Comprehensive Review of the Management of Patients with Acute Cholecystitis Who Are Ineligible for Surgery.","authors":"Todd H Baron,Irving Jorge,Ali Husnain,Petros Constantino Benias,Bradley N Reames,Ashok Bhanushali,Salvatore Docimo,Matthew Bloom,Riad Salem,Patrick Murphy,Harjit Singh,Shyam Varadarajulu,Ahsun Riaz","doi":"10.1097/sla.0000000000006741","DOIUrl":"https://doi.org/10.1097/sla.0000000000006741","url":null,"abstract":"OBJECTIVEReview the current literature for available treatments for acute cholecystitis (AC) in non-surgical candidates and provide guidelines for the management of these patients.BACKGROUNDCholecystectomy is the gold standard treatment modality for AC. A considerable number of patients who are not eligible for surgery are managed by percutaneous and endoscopic techniques. There is recent data regarding endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) and emerging percutaneous approaches to address cholelithiasis and remove drains.METHODSAn expert panel of surgeons, gastroenterologists, and interventional radiologists reviewed the current literature and provided recommendations for AC management in non-surgical candidates. Recommendations were based on relevant evidence, with quality and strength assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.RESULTSPercutaneous cholecystostomy (PC) is advised for patients ineligible for lumen-apposing metal stent (LAMS) or with reversible conditions, aiming to bridge to cholecystectomy. The optimal timing of cholecystectomy after PC remains unclear. In cases where surgery is not feasible, potential definitive treatments such as percutaneous cholecysto-lithotripsy/lithectomy and cholecystoduodenal stenting should be considered. For calculous AC, EUS-GBD with LAMS is recommended as a therapy for never-surgical candidates if they are eligible for monitored anesthesia care or general anesthesia and there is institutional expertise and minimal intervening ascites.CONCLUSIONSThe management of AC in non-surgical candidates remains a challenge, with institutional protocols varying based on physician preferences and expertise. The proposed protocol integrates percutaneous and endoscopic approaches and emphasizes the need for multidisciplinary collaboration. Further research is required to evaluate these evolving management techniques, as the current literature is limited.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"35 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857417","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":"Out of Sequence Allocation in Liver Transplantation: A Poorly Used Tool to Improve Organ Utilization.","authors":"Chase J Wehrle,Abby Gross,Sangeeta Satish,Kumaran Shanmugarajah,Toshihiro Nakayama,Christina M Fleischer,Kyle Sheetz,Federico Aucejo,Kazunari Sasaki,David Ch Kwon,Masato Fujiki,Antonio D Pinna,Charles Miller,Koji Hashimoto,Andrea Schlegel,Glenn K Wakam","doi":"10.1097/sla.0000000000006738","DOIUrl":"https://doi.org/10.1097/sla.0000000000006738","url":null,"abstract":"SIGNIFICANCEWe evaluated the impact of OOS on organ utilization and also what factors impact the decision to employ OOS.BACKGROUNDDeceased donor liver allocation typically follows a ranked match-run of potential recipients. Organ procurement organizations (OPOs) may deviate from liver transplant standardized allocation using \"out-of-sequence\" (OOS) matches.METHODSAll eligible donors from the Scientific Registry of Transplant Recipients (SRTR) (1/1/2013-8/31/2023) were identified and merged with associated match-runs in the Potential Transplant Recipient (PTR) data. OOS offers were defined as bypass codes (861-863; 760-765). Hierarchical mixed-effects models with eligible donors nested in OPOs assessed OOS-practices versus organ utilization, controlling for liver graft risk with the Discard Risk Index (DSRI) by risk quintile, blood type, and year.RESULTSOOS were more common each progressive year. Neither TC's (R2<0.01) nor OPO's (R2<0.01) OOS-rate correlated with increased utilization. OOS was not associated with improved utilization (OR=1.11, 95%CI=0.90-1.38). Increasing graft risk in DBD&DCD grafts was associated with reduced utilization. Introducing OOS-allocation interaction terms improved utilization for DCD's of all risk levels but only improved utilization for DSRI 5th-Quintile DBD's. 38% of utilization was explained by graft factors versus 5% by TC-&OPO-variability (Conditional-R2=0.431, Marginal-R2=0.380). High-risk DCD grafts in DSRI 3rd-5th-Quintiles were not more likely to be allocated through OOS despite these grafts demonstrating improved utilization with this approach. Only 15% of variation in OOS-allocation was explained by graft factors versus 23% by TC-and OPO-variability (Conditional R2=0.388, Marginal R2=0.154).CONCLUSIONSOOS improves utilization in high-risk grafts, but graft risk is not correlated with their actual use. This highlights utility in OOS, but also that this practice is currently incorrectly used.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"138 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143857418","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":"Hospital Configurations Leading to Successful Implementation of Enhanced Recovery Programs.","authors":"Reiping Huang,Sarah L Remer,Leandra K Knapp,Mark E Cohen,Michael A Rosen,Bruce L Hall,Elizabeth C Wick,Clifford Y Ko","doi":"10.1097/sla.0000000000006731","DOIUrl":"https://doi.org/10.1097/sla.0000000000006731","url":null,"abstract":"OBJECTIVEThis study explains successful implementation of hospital enhanced recovery programs (ERPs) through unique configurations of contextual and implementation conditions.SUMMARY BACKGROUND DATADespite proven benefits in improving surgical outcomes, ERPs are often ineffectively implemented in hospitals, possibly due to the complex ways in which the interventions, local environment contexts, and implementation processes intertwine.METHODSUsing coincidence analysis, a mathematical method for analyzing configurations, we identified sufficient and necessary conditions for ERP implementation success in a national surgical collaborative. Success (high improvement) was defined as being among the 25% of hospitals with the greatest improvement in ERP adherence rate over time. Explanatory conditions included implementation resources in five domains (knowledge of evidence supporting interventions, leadership support, team skills and cohesion, stakeholder buy-in, and appropriate workload and time), organizational readiness to change, and hospital characteristics (teaching status, bed size, surgical volume, and socioeconomic status (SES) of patient populations). Prevalence-adjusted (PA) consistency and contrapositive (PAC) coverage, measures of data fit, were used in model selection adjusting for outcome prevalence.RESULTSOf the 86 hospitals, 26 (30.2%) successfully implemented ERP. Three scenarios collectively explained success for >70% of the hospitals (PA consistency=0.719, PAC coverage=0.752): Low-SES hospitals ready to change despite lacking team skills and cohesion during implementation; hospitals with low surgical volume which were ready to change and had strong staff buy-in; and high-volume hospitals that lacked leadership support but had appropriate workload and sufficient time for implementation rollout.CONCLUSIONSSuccessful ERP implementation varied by local context and relied on organizational readiness to change, strong staff buy-in, appropriate workload and sufficient time.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"34 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841006","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":"Carbohydrate Antigen 19-9 Delta Function for Survival Prediction in Borderline Pancreatic Cancer. A PANC-PALS Consortium International Multicenter Derivation and Validation Study.","authors":"Jonathan Garnier,Alessio Marchetti,Brady Campbell,Paul C M Andel,Marie-Sophie Alfano,Camila Hidalgo Salinas,Eddy Traversari,Joseph R Habib,Gabriella Lionetto,Anaïs Palen,Jacques Ewald,Kelly Lafaro,Daniel Brock Hewitt,Richard A Burkhart,Salvatore Paiella,Greg D Sacks,Guiseppe Malleo,Christopher L Wolfgang,Roberto Salvia,Jin He,Olivier Turrini,Ammar A Javed","doi":"10.1097/sla.0000000000006735","DOIUrl":"https://doi.org/10.1097/sla.0000000000006735","url":null,"abstract":"OBJECTIVETo establish a novel method for evaluating carbohydrate antigen 19-9 (CA19-9) during neoadjuvant therapy (NAT) and assess its role in predicting overall (OS) and disease-free (DFS) survival in borderline resectable pancreatic adenocarcinoma (BR-PC).SUMMARY BACKGROUND DATAStatic CA19-9 values or percentage changes often fail to capture therapeutic responses in patients with BR-PC undergoing NAT. Improved evaluation methods are essential for guiding the treatment.METHODSThis was a retrospective multicenter study of patients who underwent BR-PC surgery. Two parameters were developed: slope coefficient (SC, change in CA19-9 divided by therapy duration) and mean δf (mδf, calculated as the sum of CA19-9 values over therapy intervals divided by the number of 15-day periods). The main objective was to correlate mδf with OS thresholds derived using a maximally selected log-rank statistic and validated in independent cohorts.RESULTSOverall, 991 patients (median age 65 [59-71] years; 49% male) were included. The thresholds for mδf were defined as U.mL-1. month-1 (negative SC) and U.mL-1. month-1 (positive SC). Patients with mδf below these thresholds had significantly better prognoses, with hazard ratios (HR) for OS (95% CI) of 0.6 (0.4-0.8; P<0.01) and 0.4 (0.2-0.9; P=0.04) for negative and positive SC, respectively. Both thresholds were validated for mOS, with 29 vs 22 months (P=0.015) and 32 vs 16 months (P=0.0034) for negative and positive SC, respectively. Similarly, the mDFS was 13 vs 10 months (P=0.011) and 12 vs 7 months (P=0.0018), respectively.CONCLUSIONThis CA19-9 evaluation approach accurately predicts survival outcomes, offering a valuable tool for optimizing treatment strategies. An mδf calculator is available at https://www.pancpals.com/tools.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"37 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143841260","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}