Annals of surgery最新文献

{"title":"Preoperative Exercise to Improve Fitness in Patients Undergoing Complex Surgery for Cancer of the Lung or Esophagus (PRE-HIIT): A Randomized Controlled Trial.","authors":"Emily Smyth, Linda M O'Neill, Neil Kearney, Grainne Sheill, Louise Brennan, Sarah Wade, Sophie Grehan, Sanela Begic, Mikel Egaña, Ronan Ryan, Gerard J Fitzmaurice, Ross T Murphy, Myles McKittrick, Suzanne L Doyle, Cathal Walsh, Narayanasamy Ravi, Claire L Donohoe, John V Reynolds, Juliette Hussey, Emer M Guinan","doi":"10.1097/SLA.0000000000006882","DOIUrl":"10.1097/SLA.0000000000006882","url":null,"abstract":"<p><strong>Objective: </strong>This randomized controlled trial (RCT) compared the impact of high-intensity interval training (HIIT) versus standard care (SC) on preoperative cardiopulmonary fitness in patients before esophageal or lung cancer surgery.</p><p><strong>Background: </strong>Exercise prehabilitation aims to optimise preoperative condition and attenuate postoperative risks. Although intuitive, defining the optimal training parameters to impact physiologically before surgery with attendant clinical benefit remains challenging.</p><p><strong>Methods: </strong>Utilising a parallel, 2-armed RCT design, n=79 participants [(mean age (SD): 64 (9.3) years, 67% males] scheduled for curative resection for lung (50.6%) or esophageal (49.6%) cancer with ≥2-weeks preoperative lead-in, were recruited and randomised to HIIT (n=41) or SC (n=38). HIIT was completed on an electronically braked cycle ergometer consisting of 30 minutes of 15-second intervals at 100% peak power output alternating with 15-second active recovery for 5 days/week. The SC arm was offered moderate-intensity exercises 2 to 3 days/week. The primary outcome was peak oxygen consumption (VO 2 peak), measured by cardiopulmonary exercise testing. Secondary outcomes included lower limb strength and physical functioning.</p><p><strong>Results: </strong>Baseline cardiopulmonary fitness was predominantly very poor [n=75 (95%)]. Adjusting for baseline in a linear model, VO 2 peak increased significantly ( P =0.05) in the HIIT group versus SC (6.6% between-group difference). HIIT increased VO 2 peak from 18.7 (5.0) to 21.7 (5.7) ml/kg/min, whereas with SC it remained unchanged at 19.6 (5.4) to 20.1 (5.7) ml/kg/min from pre-intervention to post-intervention. Sit-to-stand scores were significantly ( P =0.02) improved with HIIT.</p><p><strong>Conclusions: </strong>HIIT is effective for eliciting meaningful gains in preoperative fitness in a deconditioned cohort within short timeframes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"690-698"},"PeriodicalIF":6.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144788105","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":"Is Standardized Right Hemicolectomy with D2 Lymphadenectomy Enough to Limit Local Recurrence in Adenocarcinoma of the Right Colon?","authors":"Giovanni Taffurelli,Isacco Montroni,Federico Ghignone,Francesca Sivieri,Davide Zattoni,Giacomo Frascaroli,Federico Mazzotti,Giampaolo Ugolini","doi":"10.1097/sla.0000000000006958","DOIUrl":"https://doi.org/10.1097/sla.0000000000006958","url":null,"abstract":"OBJECTIVETo identify tumor-related and pathological predictors of local recurrence (LR) following laparoscopic right hemicolectomy with standardized complete mesocolic excision (CME) and D2 lymphadenectomy for stage I-III right-sided colon cancer, and to delineate distinct patterns of local versus distant recurrence.SUMMARY BACKGROUND DATAWhile CME with central vascular ligation is advocated to improve oncologic outcomes in colon cancer, its true impact remains controversial. Most evidence focuses on surgical technique and nodal yield, often underestimating the role of tumor biology. Moreover, standard survival analyses fail to adequately account for competing events, potentially skewing recurrence estimates.METHODSWe retrospectively analyzed 400 consecutive patients who underwent laparoscopic right hemicolectomy with CME and D2 lymphadenectomy between 2017 and 2024. Recurrence patterns were evaluated using Fine-Gray competing risk models to identify independent predictors of local and distant relapse.RESULTSWith a median follow-up of 39 months, LR occurred in only 2.5% of patients, whereas 9% developed distant metastases. Among all variables, only the presence of a tumor in the proximal transverse colon was independently associated with a higher LR risk (subdistribution hazard ratio[sHR] 5.3; P=0.016). Perineural invasion (sHR 2.74; P=0.019) and advanced nodal stage (sHR 5.59; P<0.001) significantly predicted distant relapse.CONCLUSIONSStandardized CME with D2 lymphadenectomy ensures excellent local control in right-sided colon cancer. However, proximal transverse colon tumors exhibit a unique pattern of LR. Incorporating tumor location and pathological risk factors into surgical planning could support a more personalized, biology-driven approach to colorectal cancer treatment.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"21 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277239","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":"Age-specific Increase in Vasopressin-induced Coronary Microvascular Contractile Response in Patients Undergoing Cardiac Surgery.","authors":"Debolina Banerjee, Sharif A Sabe, William G Cioffi, Thomas J Miner, Neel R Sodha, M Ruhul Abid, Jun Feng, Frank W Sellke","doi":"10.1097/SLA.0000000000006797","DOIUrl":"10.1097/SLA.0000000000006797","url":null,"abstract":"<p><strong>Objectives: </strong>To assess changes in coronary microvascular vasomotor and myogenic function in older patients (age ≥65) undergoing cardioplegic arrest and cardiopulmonary bypass (CP/CPB) that may portend worse outcomes.</p><p><strong>Background: </strong>Elderly patients are being increasingly referred for cardiac operations requiring CP/CPB, but consistently have worse outcomes. Levels of circulating vasopressin and vasopressin receptor activity are enhanced with age. Effects of vasopressin on coronary microcirculation are controversial: animal studies showing increased microvascular vasoconstriction and decreased coronary blood flow, but vasopressin deficiency leading to vasoplegic shock postoperatively has been widely reported. We investigated the effects of age and CP/CPB on coronary arteriolar vasomotor and myogenic reactivity.</p><p><strong>Methods: </strong>Viable coronary microvessels (<200  m) were harvested from human atrial samples collected pre- and post-CP/CPB from a subset of 101 enrolled patients. Ex vivo microvascular myogenic tone and vasomotor responses to vasopressin, adenosine diphosphate, and sodium nitroprusside were assessed using video microscopy. RNA deep-sequencing and immunoblotting were used to quantify gene and protein expression, respectively.</p><p><strong>Results: </strong>Vasopressin-induced coronary microvascular response was increased in older patients (age ≥65) at baseline. CP/CPB further enhanced contractile response to vasopressin in resistance arterioles while blunting nitric oxide-mediated vasodilatory responses. Gene and protein expression relevant to vasopressin signaling varied with age and following surgery. Age and vasopressin-induced contractile response predicted cardiac index.</p><p><strong>Conclusions: </strong>Older patients exhibited more pronounced coronary microvascular contractile response to vasopressin. CP/CPB was associated with further increased coronary microvascular contractile response accompanied by decreased vasodilatory capacity from baseline, potentially predisposing these patients to myocardial malperfusion and worse outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"541-552"},"PeriodicalIF":6.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144309445","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":"Impact of Merging two high-volume Centers on Patient Outcome: 1000 Consecutive Pancreatoduodenectomies.","authors":"Ingmar F Rompen,Julia E Menso,Ewout Ingwersen,Freek Daams,Joris I Erdmann,Sebastiaan Festen,Rutger-Jan Swijnenburg,Babs M Zonderhuis,Otto M van Delden,Martijn R Meijerink,Rogier P Voermans,Roy L J van Wanrooij,Hanneke J W Wilmink,Esmee Beers-Vural,Wing C Lam,Rosanna G van Langen,Annuska Schoorlemmer,André L A Sterk,Geert Kazemier,Olivier R Busch,Marc G Besselink, ","doi":"10.1097/sla.0000000000006953","DOIUrl":"https://doi.org/10.1097/sla.0000000000006953","url":null,"abstract":"AIMTo assess the impact of a merger of two high-volume centers for pancreatic surgery.BACKGROUNDPancreatoduodenectomy (PD) has one of the strongest volume-outcome relationships in surgery. Allegedly, this relationship plateaus beyond annual center volumes of 40-50 PD. If so, merging two high-volume centers would not lead to improvement in patient outcome but data are lacking.METHODSRetrospective study assessing the merger of two high-volume university medical centers on outcome of PD using data from the prospective and mandatory Dutch Pancreatic Cancer Audit (DPCA) (August 2017-March 2025). On May 31, 2021, the multidisciplinary pancreatic surgery services of both centers were concentrated on one location including implementing several surgical and structural changes in patient and complication management. Outcomes of 500 consecutive patients undergoing PD pre-merger were compared with 500 consecutive patients post-merger.RESULTSOverall, 1000 patients undergoing PD were included. Pre-merger, the average annual center volumes were 42 and 87 PD, post-merger this was 133. The use of robot-assisted PD increased post-merger (16% to 36%, P<0.001). Post-merger, the complication-related in-hospital/30-day mortality decreased (2.0% to 0.4%, P=0.020), as did the rates of failure-to-rescue (4.9% to 1.1%, P=0.040), major morbidity (Clavien-Dindo ≥3, 41% to 35%, P=0.037), postoperative pancreatic fistula grade C (2.4% to 0.8% (P=0.044), and post-pancreatectomy hemorrhage grade B/C (8.0% to 4.6%, P=0.027). Outcomes improved for both centers.CONCLUSIONThe merger of two high-volume centers for pancreatic surgery was associated with improved major morbidity, failure-to-rescue, and complication-related mortality following PD. This improvement, attributed to both improved patient management and increased surgical volume, highlights the potential for improving patient outcome.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"31 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194518","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":"A Frozen Elephant Trunk Technique to Reduce Circulatory Arrest Time in Hybrid Aortic Arch for Acute Aortic Dissection: Early and Midterm Outcomes in a Multicentric Cohort of 153 Patients.","authors":"Guillaume Guimbretière,Aurelien Vallée,Charles-Henri David,Yohann Foucher,Stéphane Kermen,Olivier Fouquet,Maroua Eid,Thibaut Schoell,Sébastien Gonthier,Bleri Celmeta,Thierry Bourguignon,Julien Guihaire,Jean-Christian Roussel,Eric Braunberger,Nicolas Bonnet,Mehrdad Ghoreishi,Thomas Sénage","doi":"10.1097/sla.0000000000006933","DOIUrl":"https://doi.org/10.1097/sla.0000000000006933","url":null,"abstract":"OBJECTIVEThis study compared the results of the conventional Frozen Elephant Trunk (FET) technique with those of a new approach for the treatment of Acute Aortic Dissection (AAD).SUMMARY BACKGROUND DATAFrozen Elephant Trunk has revolutionized the treatment of extensive aortic pathologies. Hypothermic circulatory arrest is a recommendation for its implementation but remains the greatest burden. Our approach for the FET (Simplified Delivery-FET) procedure allows distal suturing in normothermia with a shorter circulatory arrest time.METHODSThis was a non-randomized, multicenter, retrospective study of all patients who underwent total arch replacement for AAD using either the normothermia (SD-FET) or conventional FET (control) techniques. The primary endpoints were in-hospital mortality, stroke, and spinal cord injury.RESULTSOne hundred and fifty-three patients were included (n=90 SD-FET; n=63 control FET). Overall, in-hospital mortality was 13.3% (n=20), 10.3% (n=9) in the SD-FET group and 27.5% (n=11) in the control FET group (P=0.206). There were no differences in the rates of postoperative stroke and spinal cord injury. SD-FET was protective for combined outcome (death and/or neurological event) with a corresponding population-average percentage of events of 17.8% (5.3-27.7) in the SD-FET group versus 30.7% (16.5-52.8) in the FET group. The Kaplan-Meier showed a survival rate at 12 and 24 months of 87% in the SD-FET group versus 83% in the FET group and 86% in the SD-FET group versus 80% FET (P=0.625), respectively.CONCLUSIONSThe SD-FET technique allows hybrid arch surgery to be performed without cooling and is associated with a lower incidence of the combined criteria of death and/or neurological events.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"27 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145194464","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":"Molecular Residual Disease and Recurrence in Rectal Cancer Patients Undergoing Upfront Surgery: A Prospective Cohort Study.","authors":"Koji Ando,Atsushi Hamabe,Yoshiaki Nakamura,Jun Watanabe,Keiji Hirata,Kozo Kataoka,Masaaki Miyo,Kentaro Kato,Naoya Akazawa,Yoshinori Kagawa,Mitsuru Yokota,Kentaro Yamazaki,Saori Mishima,Hiroki Yukami,Daisuke Kotani,Hideaki Bando,George Laliotis,Shruti Sharma,Charuta C Palsuledesai,Matthew Rabinowitz,Adham Jurdi,Minetta C Liu,Alexey Aleshin,Hiroya Taniguchi,Ichiro Takemasa,Takeshi Kato,Takayuki Yoshino,Eiji Oki","doi":"10.1097/sla.0000000000006948","DOIUrl":"https://doi.org/10.1097/sla.0000000000006948","url":null,"abstract":"OBJECTIVETo evaluate the prognostic utility of postoperative circulating tumor DNA (ctDNA) for recurrence and treatment response in patients with rectal cancer undergoing upfront surgery.SUMMARY BACKGROUND DATActDNA-based molecular residual disease (MRD) testing shows promise in colorectal cancer, but its role in patients with rectal cancer not receiving neoadjuvant therapy is unclear. This study evaluates whether postoperative ctDNA predicts disease-free survival (DFS) and guides adjuvant chemotherapy (ACT) decisions.METHODSWe analyzed ctDNA from patients with stage II-III rectal cancer (N=250) enrolled in the GALAXY study, multi-center registry in Japan. A clinically validated, personalized, tumor-informed 16-plex PCR-NGS assay (SignateraTM) was used to detect and quantify ctDNA. The primary outcome was DFS, defined as time from landmark to recurrence, death, or latest radiological assessment.RESULTSIn the MRD window (2-10 wks post-surgery, before ACT), 14.2% (35/246) of patients were ctDNA-positive and had significantly shorter DFS (HR: 9.96, 95% CI: 5.76-17.2, P<0.0001). Among patients who were ctDNA-positive in the MRD window, a significant benefit from ACT was observed (HR: 0.28, 95% CI: 0.09-0.89, P=0.031), whereas no benefit was seen in ctDNA-negative patients (HR: 0.59, 95% CI: 0.26-1.35, P=0.211). When analyzing ctDNA dynamics from MRD window to 6-months post-surgery, recurrence risk was higher in patients who converted from ctDNA-negative to positive (HR: 8.22, 95% CI: 1.86-36.32, P=0.0055) and who remained ctDNA-positive (HR: 45.48, 95% CI: 14.31-144.57, P<0.0001) compared to serially ctDNA-negative patients.CONCLUSIONSPostoperative ctDNA status is a robust biomarker predicting recurrence risk and ACT benefit in patients with rectal cancer undergoing upfront surgery.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"18 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140364","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":"Implementation of Comprehensive Surgical Guidelines for Hepatoblastoma: Analysis of the Children's Oncology Group AHEP0731 Phase III Trial.","authors":"Zachary J Kastenberg,Sanjeev A Vasudevan,Lucy Dolmadjian,Max R Langham,Jin Piao,Gregory M Tiao,Stephen P Dunn,Eugene D McGahren,Alexander J Towbin,M Beth McCarville,Marcio H Malogolowkin,Wayne L Furman,Patrick A Thompson,Milton J Finegold,Sarangarajan Ranganathan,Dolores Lopez-Terrada,Mark Krailo,Carlos Rodriguez-Galindo,Allison F O'Neill,Howard M Katzenstein,Christopher B Weldon,Rebecka L Meyers","doi":"10.1097/sla.0000000000006951","DOIUrl":"https://doi.org/10.1097/sla.0000000000006951","url":null,"abstract":"OBJECTIVETo evaluate the impact of surgical guidelines on the management of children with hepatoblastoma.BACKGROUNDThe Children's Oncology Group study AHEP0731 was the first pediatric cooperative group trial to propose guidelines for the surgical management of children with hepatoblastoma.METHODSAHEP0731 enrolled children with hepatoblastoma between 2009 and 2018. Surgical guidelines were based upon radiographic extent of disease (PRETEXT, POST-TEXT). Planned non-real-time central review of imaging was completed at diagnosis and after two, four, and six cycles of chemotherapy to determine guideline adherence. Resection rate, event-free survival (EFS), overall survival (OS), and complications were compared between guideline adherent and nonadherent groups.RESULTSOf 226 enrolled patients, 221 were evaluable of whom 205 (93%) underwent definitive surgical resection. Guideline adherence for protocol recommended timing of resection was 65% (133/205). The nonadherent group included 44/205 (21%) patients who underwent early resection and 28/205 (14%) patients who underwent late resection or late transplantation. Eighty-five patients met criteria for early referral to a liver transplant center, of whom 55 (65%) were referred within the recommended timeframe. Twelve patients received liver transplants outside of surgical guidelines. There were no significant differences in EFS, OS, or complication rates between adherent and nonadherent groups.CONCLUSIONSImplementation of surgical guidelines, in combination with effective chemotherapy and radiologic staging, produced a higher rate of definitive tumor resection compared to historical trials. Nonadherence with surgical guidelines resulted in liver transplantation in some patients for whom partial hepatectomy might have been an option.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"41 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134095","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":"Operating or Building Capacity? Rethinking International Surgical Missions.","authors":"Javier Arredondo Montero","doi":"10.1097/sla.0000000000006956","DOIUrl":"https://doi.org/10.1097/sla.0000000000006956","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"25 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134098","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":"Anticoagulation Practice and Risk of Portal Vein Thrombosis Following Pancreaticoduodenectomy or Total Pancreatectomy with Venous Resection: An International Multicentre Cohort Study.","authors":"Peter L Labib,Siobhan C McKay,Stéphanie F Perrodin,Louisa Bolm,Omar A Mownah,Ruben Bellotti,Jane McClements,Asma Sultana,James Ra Skipworth,Anita Balakrishnan,Manuel Durán,Dimitrios Moris,James A Milburn,Gökalp K Kurtoğlu,Nicola De'Liguori Carino,Ismael Domínguez-Rosado,Sanjay Pandanaboyana,Jacob Ghotbi,Giovanni Marchegiani,Tejinderjit S Athwal,Stefan Stättner,Dimitrios D Karavias,Bilal Al-Sarireh,Paul D Morris,Saxon Connor,Asif Halimi,Carl-Stephan Leonhardt,Russell Hodgson,Jaswinder S Samra,Anubhav Mittal,Oliver M Fisher,Christopher Sh Lim,Simon W Banting,Jonathan Koea,Osamu Yoshino,Michael A Silva,Ricky H Bhogal,Daniel Croagh,David J Cavallucci,Benjamin Pt Loveday,Declan Fj Dunne,Somaiah Aroori,Brian R Davidson,Keith J Roberts, ","doi":"10.1097/sla.0000000000006954","DOIUrl":"https://doi.org/10.1097/sla.0000000000006954","url":null,"abstract":"OBJECTIVEAssess anticoagulation practice and portal vein thrombosis (PVT) risk following pancreaticoduodenectomy (PD) or total pancreatectomy (TP) with venous resection (VR).BACKGROUNDRetrospective studies suggest an increased risk of PVT following PD/TP with VR. However, anticoagulation practice is variable and its efficacy at preventing PVT is unknown.METHODSThis multicentre cohort study (Europe, USA, Mexico, Turkey, Australia, New Zealand) included consecutive patients undergoing PD/TP with VR between 2018-2022. A 1:1 age and sex matched cohort undergoing PD/TP without VR was also collected to assess PVT risk without VR.RESULTSAmong 972 patients who underwent PD/TP with VR, 259 (26.6%) received inpatient therapeutic anticoagulation and 242 (25.0%) were discharged on therapeutic anticoagulation. Thirty-day, 90-day and one-year PVT risk following VR was 5.1%, 7.3%, and 11.6%, versus 1.0%, 1.3% and 2.6% in patients without VR (P<0.001). Predictors of 90-day PVT included prior history of venous thromboembolism (odds ratio [OR] 2.67), VR type (OR 2.29, 6.28, 6.90 and 23.75 for type 1-4 VR, P<0.001) and graft material (OR 0.78, 0.94, 5.28, 4.90 and 5.99 for peritoneal, autologous vein, cadaveric vein, bovine and synthetic grafts, P<0.001). Postoperative therapeutic anticoagulation reduced 30-day PVT risk (OR 0.06, P<0.001), but not 90-day (OR 0.06, P=0.075) or >90-day PVT risk (OR 1.23, P=0.466). The strongest predictor of >90-day PVT was cancer recurrence (OR 3.96, P<0.001).CONCLUSIONSVR increases PVT risk following PD/TP, with technical factors influencing <90-day PVT and cancer-related factors influencing >90-day PVT. The benefits of early postoperative anticoagulation in preventing PVT post-VR remain unclear.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"81 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134097","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":"How She was Born.","authors":"Caitlin J Cain-Trivette","doi":"10.1097/SLA.0000000000006955","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006955","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136329","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}