Annals of surgery最新文献

{"title":"Toward Competency Based Medical Education: A Plea to Synergize Frameworks and Tools.","authors":"Brigitte K Smith,Holly Caretta-Weyer,Adnan Alseidi","doi":"10.1097/sla.0000000000006729","DOIUrl":"https://doi.org/10.1097/sla.0000000000006729","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"39 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822618","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":"Attitudes toward Sustainability among Surgeons at Ten Academic Hospitals in the United States: Are we Ready, Willing, and Incentivized to Change?","authors":"Tejas S Sathe,Jaeyun Jane Wang,Kaiyi Wang,Thomas A Sorrentino,Ava Yap,Amir Ashraf Ganjouei,Patricia O'Sullivan,Garrett R Roll,Seema Gandhi,Hanmin Lee,Adnan Alseidi,","doi":"10.1097/sla.0000000000006728","DOIUrl":"https://doi.org/10.1097/sla.0000000000006728","url":null,"abstract":"OBJECTIVEGiven the outsized contribution of surgical care to the carbon footprint of the health sector, we aim to understand attitudes towards sustainability among academic surgeons in the United States (U.S.).SUMMARY BACKGROUND DATAThe healthcare sector accounts for 8.5% of United States (U.S.) greenhouse gas emissions-of which one third come from surgical care. Though prior studies suggested that surgeons are aware of operating room waste and interested in improving sustainability, they were not nationally representative and did not ask about specific changes surgeons were willing to make or what incentives would promote such changes. In this study, we aim to ascertain a more granular understanding of surgeons' views on sustainability in a representative sample of U.S. academic surgeons.METHODSWe surveyed surgeons at ten academic surgery programs representing all U.S. geographic regions. The survey contained questions on general attitudes towards sustainability, willingness to make sustainable changes, and the degree to which certain incentives would motivate change. Surgeons rated questions on Likert scales, and we calculated the proportion of respondents who indicated strongly positive responses.RESULTSOverall, 247 out of 523 surgeons (47%) responded to the survey. Similar majorities of respondents felt that the problem of operating room waste was critical (n=155, 63%) and were motivated to improve the sustainability of their practices (n=160, 65%). Five respondents (2%) felt their institution put effort into sustainability education. Most respondents (n=243, 98%) were willing to make at least one of the sustainable practice changes in our survey, with the greatest number willing to reduce items on their preference cards following periodic review (n=227, 92%). Respondents were more motivated by personal cash incentives than non-cash or departmental incentives. Using factor analysis, we derived five factors from survey responses: (1) general attitudes, (2) education, (3) willingness, (4) responsiveness to personal cash incentives, and (5) responsiveness to other incentives.CONCLUSIONSSurgeons understand that operating room waste is a problem and most say they are willing to make individual changes to improve operating room sustainability. However, a majority would be motivated to improve sustainability by personal cash incentives which are rarely implemented. Additional work will be needed to operationalize surgeons' positive views on sustainability into practice changes that meaningfully impact climate change.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"75 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822620","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":"Randomized Controlled Trial - Perioperative Telemonitoring of Patient Generated Health Data in Gastrointestinal Oncologic (GI) Surgery: Assessing Outcomes.","authors":"Kelly M Mahuron,Patricia Esslin,Virginia Sun,Oluwatimilehin Okunowo,Darrell Fan,Andreas M Kaiser,I Benjamin Paz,Mustafa Raoof,Aaron Lewis,Kurt A Melstrom,Lily I Lai,Yanghee Woo,Gagandeep Singh,Yuman Fong,Laleh G Melstrom","doi":"10.1097/sla.0000000000006724","DOIUrl":"https://doi.org/10.1097/sla.0000000000006724","url":null,"abstract":"OBJECTIVETo determine whether perioperative monitoring with nursing triage intervention is feasible and improves surgical outcomes and recovery.BACKGROUNDThere are increased demands for outpatient recovery after complex gastrointestinal oncologic surgery with simultaneous expectations of improving quality of life and expedited functional recovery. Telemonitoring is a proposed mechanism to achieve these goals.METHODSThis prospective randomized controlled trial was conducted at a single institution from October 2021 to July 2023, and follow-up was completed in August 2023. Adult patients undergoing gastrointestinal oncologic surgery were randomized to either the telemonitoring intervention arm or the enhanced usual care control arm. Patient-generated health data (PGHD) and electronic patient-reported outcomes (ePROs) were assessed at discharge, 2 days, 7 days, 14 days, and 30 days post-discharge. The telemonitoring intervention arm additionally received nursing triage support when PGHD deviated from defined thresholds.RESULTS129 participants (median [IQR] age, 53 [47-65]; 43% female) were randomized. 50 (39%) lived >50 miles from the medical center. Overall attrition was 12%, and there were no differences in feasibility, retention, or acceptability between arms. Postoperative complications and readmission rates were similar between arms. The intervention arm reported significantly lower MD Anderson Symptom Inventory (MDASI) interference with activity and symptom severity scores at multiple time points compared to the control arm (P<0.05).CONCLUSIONSThis trial demonstrates that perioperative telemonitoring is feasible and acceptable. Improved ePROs in the intervention arm suggests that nursing triage intervention may help augment postoperative recovery.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"25 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822622","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":"Associations of Patient Age, Tumor Nephrectomy Weight, and Tumor Diameter with Event-Free and Overall Survival in Stage I or II Favorable Histology Wilms Tumor: A Pooled Analysis of Children's Oncology Group Studies AREN0532 and AREN03B2.","authors":"Lindsay A Renfro,Kelly L Vallance,Ian C Tfirn,Nicholas Evageliou,Daniel J Benedetti,Robert C Shamberger,Peter F Ehrlich,Nicholas G Cost,Jennifer H Aldrink,Ann Schechter,Amy Treece,Lauren N Parsons,Amy L Walz,Kathryn S Sutton,Amy E Armstrong,Conrad V Fernandez,Jeffrey S Dome,James I Geller,Elizabeth A Mullen,","doi":"10.1097/sla.0000000000006726","DOIUrl":"https://doi.org/10.1097/sla.0000000000006726","url":null,"abstract":"OBJECTIVETo evaluate age, TNW, or tumor diameter (TD) as continuous prognostic variables for outcomes in early stage FHWT after accounting for biology and treatment.SUMMARY OF BACKGROUND DATAPatient age (< 2 vs. ≥ 2 years) and tumor nephrectomy weight (TNW; < 550g vs. ≥ 550 grams) have been used to risk stratify children with stage I favorable histology Wilms tumor (FHWT) on Children's Oncology Group (COG) studies and select patients for omission of chemotherapy.METHODSIncluded patients had stage I or II FHWT per central review and were treated with nephrectomy only, EE4A, or DD4A on COG trials. Restricted cubic splines models were used to estimate the stage-specific effects of age, TNW, and TD on event-free survival (EFS) and overall survival (OS), accounting for treatment and biology.RESULTSIn pooled analyses of 775 stage I and 936 stage II patients, age was not significantly associated with EFS or OS for stage I or II patients after accounting for adverse biology that is more prevalent with older age. Greater TNW and larger TD were associated with increased risk of relapse in stage I and increased risk of death in stage II, but not when restricted to patients less than 4 years old.CONCLUSIONSAge, TNW, and TD are each prognostic for EFS or OS in some cohorts of patients with stage I or II FHWT. However, after accounting for adverse biology that becomes more prevalent at older ages, these factors are no longer independently prognostic. The next COG FHWT study will implement and validate these findings.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"10 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822624","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":"Automatic Generation of Liver Virtual Models with Artificial Intelligence: Application to Liver Resection Complexity Prediction.","authors":"Omar Ali,Alexandre Bône,Caterina Accardo,Belkacem Acidi,Amaury Facque,Paul Valleur,Chady Salloum,Marc-Michel Rohe,Irene Vignon-Clementel,Eric Vibert,","doi":"10.1097/sla.0000000000006722","DOIUrl":"https://doi.org/10.1097/sla.0000000000006722","url":null,"abstract":"OBJECTIVEThe clinical aim of this work is to predict intraoperative LRC from preoperative CT scans only.SUMMARY OF BACKGROUND DATALiver resection (LR) is the most prevalent curative treatment for primary liver cancer, yet overall mortality/morbidity rates remain elevated. The conventional definition and classification of LR complexity (LRC) lack inclusion of the disease-induced 3D anatomical surgery complexity.METHODS3D models of the organ, tumors and blood vessels were generated from Deep Learning models trained on patients CT scans. The surgeons' expertise on which anatomical factors lead to LRC was translated into a new anatomical frame of reference around the Hepatic Central Zone (HCZ). A fully automatic pipeline to generate the HCZ and quantify the tumors position relative to it was assessed. An AI model was then trained to predict LRC from a patient cohort for whom LRC was annotated at the end of each surgery. The AI-prediction was finally compared to prediction of surgeons that only saw the patient preoperative CT scan.RESULTSThe 3D reconstructions are successfully evaluated on benchmark datasets. The HCZ is accurately generated for a variety of atypical vascular anatomies (dice score 82±4.6%). The automatic pipeline is successfully run on a 145 HCC patient cohort. The predicted LRC outperforms the surgeons' individual and combined anticipated complexities (accuracy and AUC scores: 79.4±3.4% and 85.1±3.2% respectively).CONCLUSIONThis automatic digital tool accurately predicts intraoperative LRC and paves the way for an innovative oncology surgery planning. This tool could help orient patients towards appropriate medical centers depending on the predicted LRC level.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"249 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822625","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":"An Alternative to \"Checkmark Credentialling\" for Effective Physician Benchmarking and Professional Improvement.","authors":"Thoralf M Sundt, John B Herman, Michael Jellinek","doi":"10.1097/SLA.0000000000006725","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006725","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810039","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":"Use of an Intraoperative Head, Neck, and Back Support Exoskeleton on Surgeons' Pain and Posture.","authors":"Joseph Y Kim, Hamid Norasi, Stephen D Cassivi, Dalliah M Black, M Susan Hallbeck","doi":"10.1097/SLA.0000000000006723","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006723","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the effectiveness of an intraoperative exoskeleton that supports surgeons' heads, necks, and backs to reduce neck discomfort.</p><p><strong>Summary background data: </strong>Surgeons are at a considerable risk of developing neck pain and related injuries. Passive exoskeletons are a potential intervention to support surgeons' body parts and alleviate strain and discomfort.</p><p><strong>Methods: </strong>The NekSpineTM (a passive neck exoskeleton) was trialed on twelve surgeons (seven male, five female) across six specialties. Each surgeon performed four surgical procedures, two with the NekSpineTM (exoskeleton) and two without (baseline). Exoskeleton and baseline surgeries were paired primarily by surgical procedure and secondarily by duration. Surgeons completed surveys that included the NASA-TLX and usability questions before and after surgical procedures to evaluate body part discomfort, overall fatigue, workload, and potential disruptions to the surgical workflow. Surgeons also wore inertial measurement units (IMUs) to objectively record their upper arms, neck, and torso postures.</p><p><strong>Results: </strong>Use of the exoskeleton yielded significant decreases in discomfort in the neck, left shoulder, right shoulder, and left arm. Reductions in percent surgical duration in Risk 4 (extreme risk postures) coupled with increases spent in Risk 2 (moderate risk postures) for the neck and torso were noted. Surgeons reported overall favorable usability results with the exoskeleton not interfering with the surgical workflow, and most stated that they would use the exoskeleton again.</p><p><strong>Conclusions: </strong>The NekSpineTM is a promising intervention to alleviate surgeons' neck discomfort and improve their neck and torso postures.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810081","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 #HOPE4LIVER single-arm Pivotal Trial for Histotripsy of Primary and Metastatic Liver Tumors: 1-year Update of Clinical Outcomes.","authors":"Timothy J Ziemlewicz, Jeffrey J Critchfield, Mishal Mendiratta-Lala, Philipp Wiggermann, Maciej Pech, Xavier Serres-Créixams, Meghan Lubner, Tze Min Wah, Peter Littler, Clifford R Davis, Govindarajan Narayanan, Sarah B White, Osman Ahmed, Zach S Collins, Neehar D Parikh, Mathis Planert, Maximilian Thormann, Guido Torzilli, Luigi A Solbiati, Clifford S Cho","doi":"10.1097/SLA.0000000000006720","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006720","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the 1-year clinical outcomes of patients enrolled in the #HOPE4LIVER trial of hepatic histotripsy.</p><p><strong>Summary background data: </strong>Histotripsy is a novel non-invasive, non-thermal focused ultrasound therapy that liquefies tissue at the focal point of the transducer. Following diagnostic ultrasound targeting, an automated treatment is performed via a robotic arm to treat a user-defined volume of tissue.</p><p><strong>Methods: </strong>Forty-seven patients were enrolled at 14 sites in the United States and Europe. Included patients were ineligible for or had opted out of standard therapies. Tumor control was evaluated via a core laboratory with a primary assessment at each time point and a post hoc assessment performed following completion of each time point to allow for a learning curve of interpreting imaging findings of this novel therapy. Overall survival and freedom from local tumor progression were evaluated via the Kaplan-Meier method.</p><p><strong>Results: </strong>Nineteen patients with hepatocellular carcinoma and 28 with metastatic disease were enrolled, of whom 89.5% (17/19) and 96.4% (27/28) had multifocal hepatic tumors at the time of treatment. Fifty-two tumors were treated. The 1-year local control rate was 63.4% using the primary assessment method and 90% using the post hoc method. There were six serious adverse device-related effects within 30 days of treatment. Only one non-serious adverse device-related effect was observed after 30 days of treatment. Overall survival at 1-year was 73.3% for patients with HCC and 48.6% for patients with metastatic disease.</p><p><strong>Conclusions: </strong>Histotripsy results in local control of liver tumors at 1-year that is consistent with current locoregional therapies. The safety profile is favorable, and survival at 1 year is comparable with other therapies for similar disease stages.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810041","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":"Efficacy of Neoadjuvant Therapy and the Prognostic Significance of Serum Carcinoembryonic Antigen Level in Patients with Localized Pancreatic Adenocarcinoma with Non-elevated Carbohydrate Antigen 19-9 Levels.","authors":"Guoliang Qiao, Xiang Li, Marwa Mohamed, Louisa Bolm, Qian Zhu, Carlos Fernandez Del-Castillo, Qi Zhang, Yiwen Chen, Zhiyong Yang, Keith D Lillemoe, Xueli Bai, Motaz Qadan, Tingbo Liang","doi":"10.1097/SLA.0000000000006719","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006719","url":null,"abstract":"<p><strong>Objective: </strong>This study evaluated the effect of neoadjuvant therapy (NAT) and the prognostic significance of carcinoembryonic antigen (CEA) levels in patients with non-elevated serum carbohydrate antigen (CA) 19-9 levels.</p><p><strong>Summary background data: </strong>The impact of NAT followed by surgical resection on oncologic outcomes in patients with localized pancreatic ductal adenocarcinoma (PDAC) remains unclear.</p><p><strong>Methods: </strong>This retrospective and propensity-score matched (PSM) study included primary and validation cohorts from four centers. Propensity scores were estimated using multivariable logistic regression and survival curves were generated using the Kaplan-Meier method and analyzed using the log-rank test. overall survival (OS) and recurrence-free survival (RFS) were compared and univariable and multivariable Cox proportional hazards regression model were applied.</p><p><strong>Results: </strong>Among 251 patients with PDAC with non-elevated CA 19-9 levels, 67 received NAT followed by surgical resection, and 184 underwent upfront surgery. Following PSM, NAT significantly improved OS (39.87 vs. 18.86 months, P=0.0175) and RFS (25.67 vs. 12.83 months, P=0.0197) compared to upfront surgery. These results validated in an independent external cohort. In the primary cohort after PSM, elevated CEA was associated with worse OS and RFS compared to non-elevated CEA (median OS: 18.86 months vs. 42.39 months, P=0.0014, and median RFS: 17.40 months vs. 28.60 months, P=0.0020). Furthermore, after adjusting for competing risk factors, elevated CEA was identified as an independent factor associated with both OS (hazard ratio (HR): 1.751, 95%CI: 1.087-2.821; P=0.021) and RFS (HR: 1.637, 95%CI: 1.046-2.561; P=0.031). These results were validated in an independent external cohort.</p><p><strong>Conclusion: </strong>NAT followed by surgical resection improves outcomes in patients with PDAC with non-elevated CA 19-9 levels. Elevated CEA levels were associated with adverse prognostic effects on both OS and RFS. These findings support the need for further evaluation of patients with non-elevated CA 19-9 levels and serum CEA levels in prospective settings.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802212","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":"Reduction of Central Venous Pressure in Elective Robotic and Laparoscopic Liver Resection: The PRESSURE Trial - A Randomized Clinical Study.","authors":"Patrick Téoule, Niccolo Dunker, Johanna Debatin, Dorothée Sturm, Svetlana Hetjens, Valentin Walter, Erik Rasbach, Christoph Reissfelder, Emrullah Birgin, Nuh N Rahbari","doi":"10.1097/SLA.0000000000006721","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006721","url":null,"abstract":"<p><strong>Objective: </strong>To compare perioperative outcomes in patients undergoing minimally invasive liver surgery (MILR) with or without central venous pressure (CVP) reduction (≤5 mmHg).</p><p><strong>Background: </strong>Reduction CVP during parenchymal transection is widely accepted in open hepatectomy to reduce intraoperative blood loss, as a major predictor of postoperative outcomes. However, the effect of CVP reduction on blood loss in MILR remains unclear.</p><p><strong>Methods: </strong>Randomized controlled, double-blinded trial. Patients undergoing elective MILR between August 2020 and April 2023 were equally randomized to either no CVP reduction (No CVP reduction group) or CVP reduction by anesthesiological interventions (CVP reduction group). The remaining perioperative care was kept identical between groups. The primary endpoint was total intraoperative blood loss.</p><p><strong>Results: </strong>In total 120 patients were randomized and 112 were analyzed. Baseline characteristics did not differ between groups. Total intraoperative blood loss in MILR was equivalent between groups (No CVP reduction: 280 mL (120-560) versus CVP reduction: 360 mL (150-640); P=0.30), despite higher CVP values during resection in the No CVP reduction group (9.3 mmHg±4.2 versus 3.2 mmHg±2.2; P<0.001). Similarly, there was no difference in blood loss during parenchymal transection between the No CVP reduction (220 mL; 80-400) and the CVP reduction group (240 mL;110-560) (P=0.39). Postoperative 90-day mortality (No CVP reduction: n=3, 5% versus CVP reduction: n=2, 4%; P=0.68) and total morbidity rates (No CVP reduction: n=10, 18% versus CVP reduction: n=11, 20%; P=0.77) were comparable. Intraoperative hemodynamic instability was less frequent in the No CVP reduction group (n=7, 12% versus CVP reduction group: n=16, 30%; P=0.03).</p><p><strong>Conclusions: </strong>MILR without CVP reduction during liver transection is safe and is not associated with increased intraoperative blood loss. Moreover, a no-CVP-reduction strategy might prevent potential adverse effects of fluid restriction in MILR, such as hemodynamic instability.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802213","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}