Annals of surgery最新文献

{"title":"Normothermic Liver Machine Perfusion At a Large European Center -Real World Outcomes Following 238 Applications.","authors":"Felix J Krendl,Benno Cardini,Margot Fodor,Jessica Singh,Florian Ponholzer,Franka Messner,Annemarie Weissenbacher,Thomas Resch,Manuel Maglione,Christian Margreiter,Stephan Eschertzhuber,Christian Irsara,Andrea Griesmacher,Harald Schennach,Robert Breitkopf,Lisa Schlosser,Heinz Zoller,Herbert Tilg,Rupert Oberhuber,Stefan Schneeberger","doi":"10.1097/sla.0000000000006634","DOIUrl":"https://doi.org/10.1097/sla.0000000000006634","url":null,"abstract":"OBJECTIVETo report outcomes from routine clinical practice of liver transplantation (LT) following normothermic liver machine perfusion (NLMP) and compare to LT after static cold storage (SCS).BACKGROUNDNLMP is emerging as a clinical routine in LT as has recently received renewed attention, however outcomes outside of clinical trials are lacking.METHODSAll adult LT between February 2018 and January 2023 were included. Comprehensive viability assessment was applied during NLMP. Outcomes were compared between NLMP and SCS recipients, as well as benchmark and non-benchmark cases.RESULTSOf the 332 LT included, 174 underwent NLMP and 158 were transplanted following SCS. Sixty-seven organs were accepted and transplanted only under the premise of NLMP. One-year graft survival for SCS and NLMP recipients was 83.8% vs. 81.3% and 93.4% for benchmark cases in the overall cohort. Total preservation time had no influence on graft survival in the NLMP group but was associated with inferior 1-year graft survival in the SCS group. NLMP usage increased significantly over the duration of the study period, as did the median total preservation time. With increasing NLMP use and longer preservation times, nighttime surgery decreased significantly from 41.9% to 4.2%.CONCLUSIONSProlonged preservation times ease logistics and enable daytime surgery. The possibility of NLMP offers to expand liver transplantation without negatively affecting outcomes.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"62 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991674","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":"Feasibility of Pure Laparoscopic Donor Right Hepatectomy Compared to Open Donor Right Hepatectomy: A Large Single-Center Cohort Study.","authors":"Sang-Hoon Kim,Ki-Hun Kim,Young-In Yoon,Woo-Hyoung Kang,Sang-Kyung Lee,Shin Hwang,Chul-Soo Ahn,Deok-Bog Moon,Tae-Yong Ha,Gi-Won Song,Dong-Hwan Jung,Gil-Chun Park,Ji Hoon Kim,Eun-Kyoung Jwa,Byeong-Gon Na,Sung Min Kim,Rak-Kyun Oh,I-Ji Jeong,Hyo Jung Ko,Minha Choi,Dae Hyeon Won,Ji Hoon Kang,Sung-Gyu Lee","doi":"10.1097/sla.0000000000006633","DOIUrl":"https://doi.org/10.1097/sla.0000000000006633","url":null,"abstract":"OBJECTIVEThis study aimed to compare morbidity of living donors and recipients after pure laparoscopic donor right hepatectomy (PLDRH) and open donor right hepatectomy (ODRH).BACKGROUNDDonor and recipient morbidity have not been sufficiently reported in large-scale comparisons of PLDRH and ODRH.METHODSThis retrospective study reviewed 3348 donors who underwent PLDRH (n=329) and ODRH (n=3019) and their corresponding recipients (n=3348) between January 2014 and August 2023. Donor complications and recipient biliary complications within 90 days were evaluated before and after 1:3 propensity score mathcing (PSM). Multivariate logistic regression analyses identified significant risk factors for donor major and biliary complications, as well as recipient bile leakage and biliary stricture.RESULTSFor donors, PLDRH had fewer overall complications than ODRH (0.9% vs. 3.7%, P=0.009), with no significant differences in major (Clavien-Dindo III/IV) complications (P=0.057) and biliary complications (P=0.067), despite the absence of biliary complications in PLDRH. However, PLDRH showed longer warm ischemic time and operation time, and higher peak aspartate aminotransferase and alanine aminotransferase levels compared to ODRH in donors (P<0.001). These results remained consistent after PSM. Recipient biliary complications were comparable between PLDRH and ODRH, both before (P=0.806) and after PSM (P=0.149). Multiple portal veins were significant donor risk foctor for major (P=0.022), and biliary complications (P=0.001). Separated multiple bile ducts were common significant recipient risk factor for bile leakage (P=0.007) and biliary stricture (P=0.022).CONCLUSIONSPLDRH could become the standard for donor right hepatectomy with careful consideration of portal and biliary variations for donor and recipient safety.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"26 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991679","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":"Pancreatic Fistula and Intraabdominal Fluid Collections after Distal Pancreatectomy: Incidence, Implications, and Natural History.","authors":"Thakerng Pitakteerabundit,Peter J Fagenholz,Casey M Luckhurst,Shravya Srinivas Rao,Avinash Kambadakone,Andrew L Warshaw,Keith D Lillemoe,Motaz Qadan,Carlos Fernandez-Del Castillo","doi":"10.1097/sla.0000000000006635","DOIUrl":"https://doi.org/10.1097/sla.0000000000006635","url":null,"abstract":"OBJECTIVETo investigate the incidence and management of pancreatic fistula and fluid collections (FC) after distal pancreatectomy (DP).SUMMARY BACKGROUND DATAPancreatic fistula and FC are common after DP. The relationship between pancreatic fistula, FC, and surgical drain placement remains unclear.METHODSWe retrospectively reviewed patients who underwent DP at a single institution between June 2000 and August 2023.RESULTS1,212 patients were reviewed. Amongst them, 300 (24.9%) developed a biochemical leak, and 162 (13.4%) developed a postoperative pancreatic fistula (POPF). Of the 949 patients who had at least one postoperative cross-sectional imaging, 500 (52.7%) had a FC. Most FCs were asymptomatic (68%); however, when associated with POPF, the majority (n=121, 89%) became symptomatic and required treatment. Patients with POPF were significantly more likely to develop FC (OR 9.49), whereas biochemical leakage did not significantly increase this risk. Surgical drains did not significantly decrease the likelihood of FC (52% vs. 66%, P=0.06), but did increase POPF (13.9% vs. 4.7%, P<0.001) and the need for intervention for FC (33.6% vs. 12.9%, P=0.019).CONCLUSIONSFC develop in over half of the patients undergoing DP, with approximately one-fourth of these cases associated with POPF. In most instances, FC remain asymptomatic; however, when linked to POPF, they are nine times more likely to become symptomatic and require therapeutic intervention. Although surgical drain placement may not contribute to FC, it was associated with a higher rate of POPF.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"80 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991673","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":"Prolonged Preservation of up to 24h at 10°C does not Impact Outcomes after Lung Transplantation.","authors":"Konrad Hoetzenecker,Aadil Ali,Jose Campo-Cañaveral de la Cruz,Stefan Schwarz,Silvana Crowley Carrasco,Alexandra Romero Roman,Mohammed Aladaileh,Alberto Benazzo,Peter Jaksch,Elliott Wakeam,Meghan Aversa,Shaf Keshavjee,Marcelo Cypel","doi":"10.1097/sla.0000000000006632","DOIUrl":"https://doi.org/10.1097/sla.0000000000006632","url":null,"abstract":"OBJECTIVETo determine the impact of prolonged storage of donor lungs at 10°C of up to 24h on outcome after lung transplantation.BACKGROUNDAn increasing body of evidence suggests 10°C as the optimal storage temperature for donor lungs. A recent study showed that cold ischemic times can be safely expanded to >12h when lungs are stored at 10°C. However, it is currently unknown how long donor lungs can be preserved before they deteriorate in function.METHODSPatients who received a donor lung stored at 10°C between 11/2020 and 06/2023 at the lung transplant programs of Toronto, Vienna and Madrid were included in this retrospective analysis. After excluding EVLP-cases, recipients were grouped based on the total preservation times of their donor organs (<12h: n=48; 12-18h: n=109; ≥18h: n=24). 372 recipients who had received an organ stored on-ice during the study period served as a control group.RESULTSLength of lung preservation ranged from 2h 27min to 29h 33min (mean 14h 06min). Despite these prolonged preservation times, early postoperative outcomes were excellent. Median length of mechanical ventilation did not differ between the three study groups (<12h: 41h [IQR 24-109]; 12-18h: 56h [IQR 24-143] and ≥18h: 59h [IQR 28-108]; P=0.493). ICU length of stay (6 d [4-14]; 8 d [4-23]; 8 d [5-32]) and hospital length of stay (32 d [20-48]; 29 d [20-50]; 26 d [17-50]) were also similar. Furthermore, length of donor organ preservation had no impact on patient survival (log rank P=0.413).CONCLUSIONSProlonged static preservation of donor lungs at 10°C for up to 24 hours is safe and does not impair short-intermediate outcomes after lung transplantation.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"98 2 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988726","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":"Perspectives, Experiences, and Opportunities of Academic Surgeons in the Era of Healthcare Corporatization.","authors":"Sara Sakowitz, Syed Shahyan Bakhtiyar, Nicholas S Sienna, Saad Mallick, Konmal Ali, Peyman Benharash, Richard Jolly, Timothy R Donahue","doi":"10.1097/SLA.0000000000006630","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006630","url":null,"abstract":"<p><strong>Objective: </strong>To characterize contemporary surgeons' viewpoints and perspectives on the academic mission during healthcare corporatization.</p><p><strong>Summary background data: </strong>Academic surgery, traditionally driven by the tripartite missions of excellence in clinical care, scientific research, and education, faces increasing challenges from a corporatized healthcare environment. While previous studies have addressed the financial aspects of corporatization, a comprehensive evaluation of academic surgeons' attitudes and experiences remains lacking.</p><p><strong>Methods: </strong>An online survey was distributed to a national sample of academic surgical department chairs and program directors assessing their views, perspectives, and experiences with healthcare corporatization. We also analyzed trends in National Institutes of Health (NIH) funding and abstract submissions to the Academic Surgical Congress.</p><p><strong>Results: </strong>Of 105 respondents, 72.9% believe corporatization negatively impacts academic surgery. Among program directors, 79.1% feel corporatization prioritizes clinical productivity over research and teaching. Similarly, 82.8% of department chairs report their faculty often must prioritize clinical duties over other academic responsibilities.Qualitative analysis reveals that surgeons perceive corporatization as a significant barrier to achieving their goals. Many feel that profit has become \"king,\" reducing their roles to \"cogs in a wheel.\"While overall NIH funding increased, the proportion awarded to surgical departments remained largely unchanged from 2006 to 2023 (2.7% vs. 2.8%, P=0.94). Additionally, the proportion of basic science abstracts submitted to the Academic Surgical Congress declined by 37.9%.</p><p><strong>Conclusions: </strong>Corporatization has had a profound impact on surgeons' perceptions of their roles, responsibilities, and autonomy. Surgical departments must take intentional steps to preserve the multidimensional mission of the academic surgeon.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982547","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":"Performance of an Algorithm Grading Surgery-Related Adverse Events According to the Clavien-Dindo Classification.","authors":"Lisen Båverud Olsson, Dennis Parkan, Annika Sjövall, Pontus Nauclér, Suzanne D van der Werff, Christian Buchli","doi":"10.1097/SLA.0000000000006629","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006629","url":null,"abstract":"<p><strong>Objective: </strong>To assess performance of an algorithm for automated grading of surgery-related adverse events (AEs) according to Clavien-Dindo (C-D) classification.</p><p><strong>Summary background data: </strong>Surgery-related AEs are common, lead to increased morbidity for patients, and raise healthcare costs. Resource-intensive manual chart review is still standard and to our knowledge algorithms using electronic health record (EHR) data to grade AEs according to C-D classification have not been explored.</p><p><strong>Method: </strong>The algorithm was developed in a research database containing all EHR data of Karolinska University Hospital Stockholm and returns a C-D grade for each AE within 30 days. This raw score was used to grade postoperative recovery of 1,379 elective colorectal procedures according to C-D classification and Comprehensive Complication Index® (CCI). Agreement with manual annotation of colorectal surgeon (gold standard) and research nurse (current practice) was assessed in a random sample of 399 procedures.</p><p><strong>Results: </strong>For the C-D classification, kappa was 0.77 (95%CI 0.71-0.84) for algorithm vs surgeon and 0.74 (95%CI 0.67-0.82) for algorithm vs nurse. The kappa value increased to 0.89 (95%CI 0.84-0.95) after correction of misclassified annotations of surgeon. The intraclass correlation for CCI between algorithm and surgeon was 0.89 (95%CI 0.87-0.91) after correction and 0.76 (95%CI 0.71-0.80) for algorithm vs nurse.</p><p><strong>Conclusion: </strong>The performance of the algorithm motivates in our opinion implementation to real-time data under continuous scientific evaluation of the impact on AEs in different types of surgery. In the future, local EHR data could be used to enhance risk prediction with machine learning techniques.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982546","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":"Recurrence Patterns and Management after Pleurectomy Decortication for Pleural Mesothelioma.","authors":"Juuso Paajanen, William G Richards, Yue Xie, Emanuele Mazzola, Kristina Sidopoulos, John Kuckelman, Ritu R Gill, Raphael Bueno","doi":"10.1097/SLA.0000000000006627","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006627","url":null,"abstract":"<p><strong>Objective: </strong>We hypothesize that recurrence following pleurectomy decortication (PD) is primarily local. We explored factors associated with tumor recurrence patterns, disease-free interval (DFI), and post-recurrence survival (PRS).</p><p><strong>Summary background data: </strong>Tumor recurrence is a major barrier for long-term survival after pleural mesothelioma (PM) surgery.</p><p><strong>Methods: </strong>All patients who underwent PD between 1998 and 2022 were identified. Patients with diffuse PM who achieved macroscopic complete resection and had sufficient information on tumor relapse were included. Postoperative scans were reviewed to determine the timing and sites of the first recurrence.</p><p><strong>Results: </strong>A total of 436 patients had tumor recurrence during follow-up. Local recurrences occurred most frequently (N=370, 85%) and represented the only recurrence site in 29% (N=129) of cases. Patients with sarcomatoid tumors relapsed earlier than other subtypes (P=0.003) with more frequent distant spread compared to other subtypes (P<0.001). Multivariable analysis revealed that age (P=0.015), preoperative tumor volume (P<0.001), epithelioid histology (P<0.001), intraoperative chemotherapy (P<0.001), and TNM stage IV (P=0.003) were associated with DFI. Similarly, age (P=0.042), performance status (P<0.001), epithelioid histology (P<0.001), intraoperative chemotherapy (P<0.001), TNM stages III and IV (P=0.003 and 0.010 respectively), type of surgery (P=0.019), and number of recurrent lesions (P=0.024) were associated with PRS. Recurrence surgery (HR 0.46, 95% CI 0.29-0.74) and chemotherapy (HR 0.69, 95% CI 0.54-0.92) were independently associated with PRS in patients with distant with or without local recurrences.</p><p><strong>Conclusions: </strong>PM is frequently associated with local recurrence. Repeat surgical resection is feasible and can achieve good local control in selected cases.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982548","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":"Does Parathyroid Autotransplantation Prevent Hypoparathyroidism after Thyroid Surgery?","authors":"Julia Adriana Kasmirski, Ashba Allahwasaya, Christopher Wu, Zhixing Song, Ramsha Akhund, Sanjana Balachandra, M Chandler McLeod, Andrea Gillis, Jessica Fazendin, Brenessa Lindeman, Herbert Chen","doi":"10.1097/SLA.0000000000006631","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006631","url":null,"abstract":"<p><strong>Objective: </strong>To assess the impact of parathyroid gland autotransplantation on the restoration of parathyroid function in patients who are hypoparathyroid after thyroidectomy.</p><p><strong>Background data: </strong>Hypoparathyroidism post-thyroidectomy arises when all parathyroid glands are devascularized or injured. Autotransplantation of compromised parathyroids aims to preserve their function and prevent permanent hypoparathyroidism. Despite routine use, comprehensive evidence on the efficacy of parathyroid autotransplantation remains limited.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 549 patients who underwent total or completion thyroidectomy from December 2015 to June 2023. Surgical outcomes of patients with and without parathyroid autotransplantation were compared. A subgroup analysis included patients with post-anesthesia care unit (PACU) parathyroid hormone (PTH) levels below 10 units. Statistical analyses included the Chi-squared test and multivariable analysis.</p><p><strong>Results: </strong>Of the 549 patients, 152 (27.7%) had parathyroid autotransplantation and 397 (72.3%) did not. The groups were similar in demographics and underlying thyroid etiologies. No significant difference was found in intraoperative parathyroid identification rates (P=0.25). Postoperatively, autotransplanted patients had a higher incidence of transient symptomatic hypocalcemia at 2 weeks (38.0% vs. 19.3%, P<0.001). Multivariable regression showed a higher frequency of postoperative transient hypocalcemia with autotransplantation (IRR=1.90, 95% CI: 1.42-2.54, P<0.001). Among patients with PACU PTH<10 units, recovery rates of parathyroid function were similar between treatment groups (82.2% vs. 82.5%, P=0.46). Long-term follow-up showed comparable low incidence of parathyroid insufficiency in both groups (5.3% vs. 3.8%, P=0.46).</p><p><strong>Conclusions: </strong>Parathyroid autotransplantation does not enhance recovery in hypoparathyroid patient's post-thyroidectomy and does not significantly alter outcomes among patients with PACU PTH<10 .</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982545","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":"Association between Deficient MSH2/MSH6 vs MLH1/PMS2 Status and Survival Rates in Localized Colorectal Cancer: A Nationwide Cohort Study.","authors":"Tobias Freyberg Justesen, Adile Orhan, Andreas Weinberger Rosen, Mikail Gögenur, Peter-Martin Krarup, Camilla Qvortrup, Ismail Gögenur","doi":"10.1097/SLA.0000000000006628","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006628","url":null,"abstract":"<p><strong>Objective: </strong>This study investigated the association between loss of MSH2/MSH6 versus loss of MLH1/PMS2 expression and overall survival and disease-free survival in patients with localized colorectal cancer.</p><p><strong>Background: </strong>The risk of developing colorectal cancer varies depending on the expression of mismatch repair proteins. However, it is unknown if the prognosis differs accordingly.</p><p><strong>Methods: </strong>In this retrospective study, we included a Danish cohort of patients who underwent surgery for colorectal cancer between 2009 and 2020. The Danish Colorectal Cancer Group database was used to identify patients, and patient-level data were extracted from six registries. Subsequently, patients with proficient mismatch repair status, with metastatic disease, who underwent emergency surgery, or who received neoadjuvant therapy were excluded. Patients were then propensity score matched in a 1:1 ratio.</p><p><strong>Results: </strong>A total of 3,625 patients with localized deficient mismatch repair colorectal cancer were included in the study. Patients had a median age of 75 years and a median follow-up of 4.3 years. Before matching, the MSH2/MSH6 versus MLH1/PMS2 groups differed in age, gender, and comorbidities. After matching, 556 patients were included and loss of MSH2/MSH6 was significantly associated with better overall survival (hazard ratio 0.60; 95% CI, 0.37-0.94); however, not disease-free survival (hazard ratio 0.84; 95% CI, 0.54-1.30).</p><p><strong>Conclusions: </strong>In patients with localized deficient mismatch repair colorectal cancer who underwent surgery, a significant association was found between loss of MSH2/MSH6 versus loss of MLH1/PMS2 expression and overall survival. Thus, these patients may be a target for a differentiated follow-up strategy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142976786","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":"Optimal Timing and Approaches for First Tangential Excision in Patients with ≥70% TBSA Burns: Insights from a Retrospective Cohort of a Mass Casualty Incident.","authors":"Runzhi Huang, Yuntao Yao, Sujie Xie, Junqiang Li, Wei Zhang, Yifan Liu, Shuyuan Xian, Hanlin Sun, Guosheng Wu, Heng He, Linhui Li, Xinru Wu, Yuanan Li, Haoyu Zhang, Bingnan Lu, Jiajie Zhou, Yibin Zhou, Dayuan Xu, Zhaofan Xia, Shizhao Ji","doi":"10.1097/SLA.0000000000006626","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006626","url":null,"abstract":"<p><strong>Objective: </strong>We aim to determine the optimal timing and approaches for first tangential excision of severely burned patients ≥70% total body surface area (TBSA).</p><p><strong>Background: </strong>Early tangential excision is the gold-standard surgical therapy for full-thickness burns. However, there are debates about its optimal timing and approaches for severely burned patients ≥70%TBSA.</p><p><strong>Materials and methods: </strong>This study included 185 patients in the Kunshan factory explosion. We focused on surgical timing, surgical area, and main wound covering method for first tangential excision. We determined the optimal cut-off values for surgical timing and area using R language \"surv_cutpoint\" and \"surv_categorize\" functions, and utilized the Kaplan-Meier survival analysis to investigate their influences on patients' overall survival. Then, we utilized multi-variate Cox regression analysis to identify independent factors, and performed subgroup analyses to find confounding factors. Finally, we employed a 10-year single-center cohort of 144 patients with burn injury ≥70% TBSA for external validation.</p><p><strong>Results: </strong>Performing first tangential excision in >3 days (hazard ratio=2.37, 95% confidence interval=1.05-5.40, P =0.039) and surgical area > 48% TBSA (hazard ratio=2.41, 95% confidence interval=1.46-4.00, P <0.001) were independent risk factors in the Kunshan cohort for overall survival of patients ≥70% TBSA, and were associated with higher rate of complications. Subgroup analysis revealed that the timing and TBSA of first tangential excision were influenced by several treatment and complications factors (hemodynamic status and types of hospitals). Main wound covering methods was a significant confounding factor. Patients with more autograft showed better overall survival than those with more extensive use of temporary skin substitutes in the Kaplan-Meier survival analysis ( P <0.001). However, main wound covering methods influenced by the severity of injury, availability of autologous skin source, as well as the medical resources. Additionally, external validation demonstrated consistent results and acceptable calibration.</p><p><strong>Conclusion: </strong>This study identified the optimal timing and approaches for first tangential excision, validating them as independent prognostic factors for patients with ≥70% TBSA. However, considering the various confounding factors, treatment for each patient should be tailored.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142969367","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}