Annals of surgery最新文献

{"title":"Prospective Evaluation of Circulating Tumor DNA Using Next-generation Sequencing as a Biomarker During Neoadjuvant Chemotherapy in Localized Pancreatic Cancer.","authors":"Dhavan Shah, Amy Wells, Madison Cox, Kevin Dawravoo, John Abad, Arlene D'Souza, Grace Suh, Robert Bayer, Sohail Chaudhry, Qiang Zhang, Massimo Cristofanilli, David Bentrem, Akhil Chawla","doi":"10.1097/SLA.0000000000006209","DOIUrl":"10.1097/SLA.0000000000006209","url":null,"abstract":"<p><strong>Objective: </strong>In this prospective study, we aim to characterize the prognostic value of circulating tumor DNA (ctDNA) by next-generation sequencing (NGS) in patients undergoing neoadjuvant chemotherapy (NAC) for pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Background: </strong>ctDNA is a promising blood-based biomarker that is prognostic in several malignancies. Detection of ctDNA by NGS may provide insights regarding the mutational profiles in PDAC to help guide clinical decisions for patients in a potentially curative setting. However, the utility of ctDNA as a biomarker in localized PDAC remains unclear.</p><p><strong>Methods: </strong>Patients with localized PDAC were enrolled in a prospective study at Northwestern Medicine between October 2020 and October 2022. Blood samples were collected to perform targeted tumor-agnostic NGS utilizing the Tempus x|F 105 gene panel at 3 timepoints: pretherapy (at diagnosis), post-NAC, and after local therapy, including surgery. The relationship between ctDNA detection and CA19-9 and the prognostic significance of ctDNA detection were analyzed.</p><p><strong>Results: </strong>Fifty-six patients were included in the analysis. ctDNA was detectable in 48% at diagnosis, 33% post-NAC, and 41% after local therapy. After completion of NAC, patients with detectable ctDNA had higher CA19-9 levels versus those without (78.4 vs 30.0; P =0.02). The presence of baseline ctDNA was associated with a CA19-9 response; those without ctDNA had a significant CA19-9 response following NAC (109.0 vs 31.5 U/mL; P =0.01), while those with ctDNA present at diagnosis did not (198.1 vs 113.8 U/mL; P =0.77). In patients treated with NAC, the presence of KRAS ctDNA at diagnosis was associated with and independently predicted worse progression-free survival.</p><p><strong>Conclusions: </strong>This report demonstrates the prognostic value of ctDNA analysis with NGS in localized PDAC. NGS ctDNA is a biomarker of treatment response to NAC. KRAS ctDNA at diagnosis independently predicts worse survival in patients treated with NAC.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"997-1005"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11263501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Entrustable Professional Activities in Postgraduate General Surgery Training: A Scoping Review.","authors":"Daniel Nel, Eduard Jonas, Vanessa Burch, Lydia Cairncross, Amy Nel, Adnan Alseidi, Brian George, Olle Ten Cate","doi":"10.1097/SLA.0000000000006400","DOIUrl":"10.1097/SLA.0000000000006400","url":null,"abstract":"<p><strong>Objective: </strong>To provide an overview of the current use of Entrustable Professional Activities (EPAs) in postgraduate general surgery training internationally.</p><p><strong>Background: </strong>Entrustable Professional Activities (EPAs) were introduced to connect clinical competencies and the professional activities to be entrusted to trainees on graduation. The popularity of EPAs as a framework for assessment is growing globally, including in general surgery. Anecdotally, there appears to be substantial variation in how they are implemented, yet a formal comparison of their use in postgraduate general surgery training is lacking.</p><p><strong>Methods: </strong>A scoping review was performed based on the original 5-stage approach described by Arksey and O'Malley with the addition of protocol-specific items from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR).</p><p><strong>Results: </strong>Twenty-nine published and grey literature sources were included in the review. Entrustable Professional Activity use in postgraduate general surgery training was identified in 11 unique contexts, including from North America, South America, Europe, Asia, Africa, and Australia. There were substantial differences in the scope and number of EPAs, tools used for EPA assessment, and how EPAs were sequenced through training. Despite the wide variation, 8 distinct EPAs were common to the majority (>80%) of countries. Several articles described findings of EPA use in postgraduate general surgery training, allowing the identification of multiple barriers and facilitators to integration.</p><p><strong>Conclusions: </strong>This review provides guidance for certification and regulatory bodies, program directors, and institutions with ambitions to implement EPAs for assessment and curricular design. In settings where EPAs are already used, the data may facilitate the refinement of programs and strategies.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"960-967"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141330248","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":"Evaluation of Short and Long-term Outcomes After Resection in Patients With Locally Advanced Versus (Borderline) Resectable Pancreatic Cancer.","authors":"Lilly J H Brada, Thijs J Schouten, Lois A Daamen, Leonard W F Seelen, Marieke S Walma, Ronald van Dam, Ignace H de Hingh, Mike S L Liem, Vincent E de Meijer, Gijs A Patijn, Sebastiaan Festen, Martijn W J Stommel, Koop Bosscha, Marc G Besselink, Hjalmar C van Santvoort, Izaak Quintus Molenaar","doi":"10.1097/SLA.0000000000006289","DOIUrl":"10.1097/SLA.0000000000006289","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate short and long-term outcomes after pancreatectomy in patients with locally advanced pancreatic cancer (LAPC) compared with patients with (borderline) resectable pancreatic cancer [(B)RPC].</p><p><strong>Background: </strong>Selected patients diagnosed with LAPC are increasingly undergoing resection after induction chemotherapy. To evaluate the benefit of this treatment approach, it is helpful to compare outcomes in resected patients with primary LAPC to outcomes in resected patients with primary (B)RPC.</p><p><strong>Methods: </strong>Two prospectively maintained nationwide databases were used for this study. Patients with (B)RPC undergoing upfront tumor resection and patients with resected LAPC after induction therapy were included. Outcomes were postoperative pancreas-specific complications, 90-day mortality, pathologic outcomes, disease-free interval, and overall survival.</p><p><strong>Results: </strong>Overall, 879 patients were included; 103 with LAPC (12%) and 776 with (B)RPC (88%). Patients with LAPC had a lower World Health Organization performance score and ageadjusted Charlson Comorbidity Index. Postoperative pancreas-specific complications were comparable between groups, except delayed gastric emptying grade C, which occurred more often in patients with LAPC (9% vs 3%, P = 0.03). Ninety-day mortality was comparable. About half of the patients in both groups [54% in LAPC vs 48% in (B)RPC, P = 0.21] had a radical resection (R0). Disease-free interval was 13 months in both groups ( P = 0.12) and overall survival from the date of diagnosis was 24 months in patients with LAPC and 19 months in patients with (B)RPC ( P = 0.34).</p><p><strong>Conclusions: </strong>In our nationwide prospective databases, pancreas-specific complications, mortality, and survival in patients with LAPC after pancreatectomy are comparable with those undergoing resection for (B)RPC. These outcomes suggest that postoperative morbidity and mortality after tumor resection in carefully selected patients with LAPC are acceptable.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1026-1031"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334474","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":"Objective Assessment of Cognitive Workload in Surgery: A Systematic Review.","authors":"Aws Almukhtar, Virginia Caddick, Ravi Naik, Mary Goble, George Mylonas, Ara Darzi, Felipe Orihuela-Espina, Daniel R Leff","doi":"10.1097/SLA.0000000000006370","DOIUrl":"10.1097/SLA.0000000000006370","url":null,"abstract":"<p><strong>Objective: </strong>To systematically review technologies that objectively measure cognitive workload (CWL) in surgery, assessing their psychometric and methodological characteristics.</p><p><strong>Background: </strong>Surgical tasks involving concurrent clinical decision-making and the safe application of technical and non-technical skills require a substantial cognitive demand and resource utilization. Cognitive overload leads to impaired clinical decision-making and performance decline. Assessing CWL could enable interventions to alleviate burden and improve patient safety.</p><p><strong>Methods: </strong>Ovid MEDLINE, OVID Embase, the Cochrane Library, and IEEE Xplore databases were searched from inception to August 2023. Full-text, peer-reviewed original studies in a population of surgeons, anesthesiologists or interventional radiologists were considered, with no publication date constraints. Study population, task paradigm, stressor, cognitive load theory (CLT) domain, objective and subjective parameters, statistical analysis, and results were extracted. Studies were assessed for (1) definition of CWL; (2) details of the clinical task paradigm; and (3) objective CWL assessment tool. Assessment tools were evaluated using psychometric and methodological characteristics.</p><p><strong>Results: </strong>A total of 10,790 studies were identified; 9004 were screened; 269 full studies were assessed for eligibility, of which 67 met inclusion criteria. The most widely used assessment modalities were autonomic (32 eye studies and 24 cardiac). Intrinsic workload (eg, task complexity) and germane workload (effect of training or expertize) were the most prevalent designs investigated. CWL was not defined in 30 of 67 studies (44.8%). Sensitivity was greatest for neurophysiological instruments (100% EEG, 80% fNIRS); and across modalities accuracy increased with multisensor recordings. Specificity was limited to cardiac and ocular metrics, and was found to be suboptimal (50% and 66.67%). Cardiac sensors were the least intrusive, with 54.2% of studies conducted in naturalistic clinical environments (higher ecological validity).</p><p><strong>Conclusions: </strong>Physiological metrics provide an accessible, objective assessment of CWL, but dependence on autonomic function negates selectivity and diagnosticity. Neurophysiological measures demonstrate favorable sensitivity, directly measuring brain activation as a correlate of cognitive state. Lacking an objective gold standard at present, we recommend the concurrent use of multimodal objective sensors and subjective tools for cross-validation. A theoretical and technical framework for objective assessment of CWL is required to overcome the heterogeneity of methodological reporting, data processing, and analysis.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"942-951"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12061381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141282803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Genomic Landscape of Adenocarcinomas Across the Gastroesophageal Junction: Moving on From the Siewert Classification.","authors":"Masaya Nakauchi, Henry S Walch, Samuel Nussenzweig, Rebecca Carr, Elvira Vos, Michael F Berger, Nikolaus Schultz, Yelena Janjigian, Abraham Wu, Laura Tang, Pari Shah, David R Jones, Dan Coit, Vivian E Strong, Daniela Molena, Smita Sihag","doi":"10.1097/SLA.0000000000006363","DOIUrl":"10.1097/SLA.0000000000006363","url":null,"abstract":"<p><strong>Objective: </strong>To investigate how the Siewert classification of gastroesophageal junction adenocarcinomas correlates with genomic profiles.</p><p><strong>Background: </strong>Current staging and treatment guidelines recommend that tumors with an epicenter <2 cm into the gastric cardia be treated as esophageal cancers, whereas tumors with an epicenter >2 cm into the cardia be staged and treated as gastric cancers. To date, however, few studies have compared the genomic profiles of the 3 Siewert classification groups to validate this distinction.</p><p><strong>Methods: </strong>Using targeted tumor sequencing data on patients with adenocarcinoma of the gastroesophageal junction previously treated with surgery at our institution, we compared genomic features across Siewert classification groups.</p><p><strong>Results: </strong>A total of 350 patients were included: 121 had Siewert type I, 170 type II, and 59 type III. Comparisons by Siewert location revealed that Siewert types I and II were primarily characterized as the chromosomal instability molecular subtype and displayed Barrett metaplasia and p53 and cell cycle pathway dysregulation. Siewert type III tumors, by contrast, were more heterogeneous, including higher proportions of microsatellite instability and genomically stable tumors, and more frequently displayed ARID1A and somatic CDH1 alterations, signet ring cell features, and poor differentiation. Overall, Siewert type I and II tumors demonstrated greater genomic overlap with lower esophageal tumors, whereas Siewert type III tumors shared genomic features with gastric tumors.</p><p><strong>Conclusions: </strong>Overall, our results support recent updates in treatment and staging guidelines. Ultimately, however, molecular rather than anatomic classification may prove more valuable in determining staging, treatment, and prognosis.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"989-996"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621229/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141260754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving Epidemiology of Increasing Trauma Deaths in the United States (2000-2020).","authors":"Peter Rhee, John B Holcomb, Bardiya Zangbar","doi":"10.1097/SLA.0000000000006668","DOIUrl":"10.1097/SLA.0000000000006668","url":null,"abstract":"<p><strong>Objective: </strong>To utilize the US consus data available every 10 years to show the trauma death rates and how it has changed over 20 years.</p><p><strong>Background: </strong>Over the past 2 decades, the epidemiology of trauma has shifted significantly, driven primarily by demographic changes. The aim of our study was to illustrate the changing landscape of trauma mortality rates and compare them with other leading causes of death.</p><p><strong>Methods: </strong>We performed a cross-sectional study from 2000 to 2020, using data from the Centers for Disease Control and Prevention and Web-based Injury Statistics Query and Reporting System. Trauma deaths were defined according to the World Health Organization classification, encompassing unintentional injuries, homicides, and suicides. Mortality rates were calculated per 100,000 using U.S. census data.</p><p><strong>Results: </strong>The analysis revealed a 91% increase in trauma mortality from 2000 to 2020, rising to 268,926 deaths-far surpassing the 17.8% population growth. A trimodal distribution of trauma deaths persisted, with age peaks shifting to 30 to 35, 55 to 59, and above 70 years by 2020. Causes of death shifted with increases in firearm, poisoning, and fall, while motor vehicle mortality rates declined. By 2020, trauma was the leading cause of death up to age 50. Trauma remained the leading cause of cumulative deaths up to age 67 and the primary contributor to years of life lost. Death rates from cancer and heart disease showed a declining trend.</p><p><strong>Conclusions: </strong>Trauma has become the leading cause of death up to age 50 and remains a primary contributor to years of life lost. The largest increase in trauma deaths was noted among baby boomers and millennials. As death rates from cancer and heart disease decline, it is essential to reprioritize and reallocate resources to address the evolving trauma epidemiology in an aging and expanding U.S. population.</p><p><strong>Level of evidence: </strong>Level III-retrospective study.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"976-981"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389617","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":"Defining the Role of Social Vulnerability in the Treatment and Survival of Localized Colon Cancer: A Retrospective Cohort Study.","authors":"Jennie Meier, Gilbert Murimwa, Mithin Nehrubabu, Adam Yopp, Lisa DiMartino, Amit G Singal, Herbert J Zeh, Patricio Polanco","doi":"10.1097/SLA.0000000000006282","DOIUrl":"10.1097/SLA.0000000000006282","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether variations in the Social Vulnerability Index (SVI) are associated with disparities in colon cancer surgery and mortality.</p><p><strong>Background: </strong>Colon cancer mortality is influenced by health care access, which is affected by individual and community-level factors. Prior studies have not used the SVI to compare surgical access and survival in localized colon cancer patients. Further, it is unclear whether those >65 years are more vulnerable to variations in SVI.</p><p><strong>Methods: </strong>We queried the Texas and California Cancer Registries from 2004 to 2017 to identify patients with localized colonic adenocarcinoma and categorized patients into <65 and ≥65 years. Our outcomes were survival and access to surgical intervention. The independent variable was census tract SVI, with higher scores indicating more social vulnerability. We used multivariable logistic regression and Cox proportional hazards for analysis.</p><p><strong>Results: </strong>We included 73,923 patients with a mean age of 68.6 years (SD: 13.0), mean SVI of 47.2 (SD: 27.6), and 51.1% males. After adjustment, increasing SVI was associated with reduced odds of undergoing surgery (odds ratio: 0.996; 95% CI: 0.995-0.997; P < 0.0001) and increased mortality (hazard ratio: 1.002; 95% CI: 1.001-1.002; P < 0.0001). Patients <65 years were more sensitive to variation in SVI.</p><p><strong>Conclusions: </strong>Increased social vulnerability was associated with reduced odds of receiving surgery for early-stage colon cancer, as well as increased mortality. These findings amplify the need for policy changes at the local, state, and federal levels to address community-level vulnerability to improve access to surgical care and reduce mortality.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1055-1062"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11436472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracellular Vesicle- MDM2 -DNA as a Potential Liquid Biopsy Biomarker for Disease Identification in Retroperitoneal Liposarcoma.","authors":"Federica Calore, Lucia Casadei, Patricia D Sarchet, Paolo Fadda, Giovanni Nigita, Kevin R Coombes, Luciano Cascione, Fernanda Costas C de Faria, Sayumi Tahara, O Hans Iwenofu, Raphael E Pollock, Valerie P Grignol","doi":"10.1097/SLA.0000000000006345","DOIUrl":"10.1097/SLA.0000000000006345","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to assess the levels of MDM2 -DNA within extracellular vesicles (EVs) isolated from the serum of retroperitoneal liposarcoma (RLS) patients versus healthy donors, as well as within the same patients at the time of surgery versus postoperative surveillance visits. To determine whether EV- MDM2 may serve as a possible first-ever biomarker of liposarcoma recurrence.</p><p><strong>Background: </strong>A hallmark of well-differentiated and dedifferentiated (WD/DD) retroperitoneal liposarcoma is elevated MDM2 due to genome amplification, with recurrence rates of >50% even after complete resection. Imaging technologies frequently cannot resolve recurrent WD/DD-RLS versus postoperative scarring. Early detection of recurrent lesions, for which biomarkers are lacking, would guide surveillance and treatment decisions.</p><p><strong>Methods: </strong>WD/DD-RLS serum samples were collected both at the time of surgery and during follow-up visits from 42 patients, along with sera from healthy donors (n=14). EVs were isolated, DNA purified, and MDM2 -DNA levels determined through q-PCR analysis. Nonparametric tests were employed to compare EV- MDM2 DNA levels from patients versus the control group, as well as the time of surgery versus postsurgery conditions.</p><p><strong>Results: </strong>EV -MDM2 levels were significantly higher in WD/DD-RLS than controls ( P =0.00085). Moreover, EV- MDM2 levels were remarkably decreased in WD/DD-RLS patients after resection ( P =0.00036), reaching values comparable to control group ( P =0.124). During postoperative surveillance, significant increases of EV- MDM2 were observed in some patients, correlating with computed tomography scan evidence of recurrent or persistent postresection disease.</p><p><strong>Conclusions: </strong>Serum EV- MDM2 may serve as a potential biomarker of early recurrent or postoperatively persistent WD/DD-RLS, a disease currently lacking such determinants.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1048-1054"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11579277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141074820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MEsh FIxation STudy in Laparoendoscopic Repair of M3 Inguinal Hernias: Multicenter, Double-blind, Randomized Controlled Trial-MEFISTO Trial.","authors":"Mateusz Zamkowski, Maciej Ś Mietański, Paula Franczak, Dominik Górski, Jacek Grabias, Michał Janik, Aleksander Król, Kryspin Mitura, Olaf Mędraś, Łukasz Nawacki, Michał Romańczuk, Przemysław Rymkiewicz, Sławomir Saluk, Przemysław Sroczyński, Leszek Sułkowski, Dominik Wieczorek, Marcin Włodarczyk","doi":"10.1097/SLA.0000000000006669","DOIUrl":"10.1097/SLA.0000000000006669","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of non-fixation versus fixation of meshes in laparoendoscopic repair of M3 inguinal hernias in terms of recurrence, postoperative pain, and surgical complications.</p><p><strong>Background: </strong>International guidelines recommend mesh fixation for large M3 inguinal hernias during laparoendoscopic repairs due to high recurrence rates. However, emerging experimental and registry data suggest that anatomically shaped, rigid, and three-dimensional (3D) meshes may maintain stability without fixation. This study aimed to address this knowledge gap through a multicenter randomized controlled trial.</p><p><strong>Methods: </strong>The MEsh FIxation STudy trial is a prospective, multicenter, double-blind, randomized controlled trial conducted in 12 surgical centers. A total of 204 patients with M3 inguinal hernias were randomized into 2 groups: a \"non-fixation\" group using 3D, rigid, anatomic meshes. \"Fixation\" group using flat lightweight meshes fixed with tissue adhesive. The primary outcome was the recurrence rate at 12 months. The secondary outcomes included postoperative pain (Visual Analog Scale) and surgical site occurrence. Data were analyzed using appropriate statistical methods for noninferiority studies.</p><p><strong>Results: </strong>The recurrence rate at 12 months was 3.1% and 2.1% in the non-fixation and fixation groups respectively ( P = 0.6847). No differences were observed in pain at discharge, 7 to 10 days postsurgery, or 12 months postsurgery. No significant differences were found in surgical complications or operative times between groups.</p><p><strong>Conclusions: </strong>Non-fixation of 3D meshes is noninferior to fixation of flat lightweight meshes for M3 inguinal hernia repair. These findings support the potential revision of international hernia management guidelines to incorporate non-fixation approaches with appropriate mesh types.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"921-927"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143405177","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":"Outcomes of Visceral Arterial Interposition Graft Reconstruction for Locally Advanced Pancreatic Cancer.","authors":"Jennifer A Yonkus, Roberto Alva-Ruiz, Jill J Colglazier, Michael L Kendrick, Manju Kalra, Todd E Rasmussen, Randall D Demartino, Thomas C Bower, Mark J Truty, Bernardo C Mendes","doi":"10.1097/SLA.0000000000006350","DOIUrl":"10.1097/SLA.0000000000006350","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to determine perioperative outcomes and the patency of interposition conduits for visceral arterial reconstruction in this setting.</p><p><strong>Background: </strong>Visceral arterial encasement in locally advanced pancreatic cancer was historically a contraindication for surgery. With modern, effective neoadjuvant strategies, our recent experience has made advanced vascular resection and reconstruction feasible in selected patients.</p><p><strong>Methods: </strong>A retrospective review was performed of patients undergoing pancreatic tumor resection with en bloc arterial resection and interposition revascularization between June 2002 and October 2022. Endpoints included graft patency, vascular-related complications, reinterventions, morbidity, and mortality.</p><p><strong>Results: </strong>Visceral arterial reconstruction with interposition grafting was performed in 111 patients undergoing en bloc arterial resections for pancreatic cancer. Graft types included autologous arterial conduits (n=66, 58 superficial femoral arteries (SFA) and 8 splenic arteries), cryopreserved arterial allografts (n=24), autologous saphenous veins (n=12), synthetic conduits (n=8), and composite autologous artery and synthetic (n=1). Perioperative 90-day mortality decreased significantly over time to 5% in the last 6 years. Vascular complications related to arterial reconstruction occurred in 11% (n=12) and included pseudoaneurysm (n=6), graft thrombus (n=2), stenosis requiring reintervention (n=2), hepatic failure (n=1), and hepatic and intestinal ischemia (n=1). Nine (8%) patients underwent vascular-related reinterventions. After a median follow-up of 17 months, primary patency was 81% for the entire cohort and was highest in the SFA group (95%). The donor limb/harvest site complication rate was 8% with 100% primary patency.</p><p><strong>Conclusion: </strong>Visceral arterial resection with interposition reconstruction for locally advanced pancreatic cancer can be performed with acceptable vascular morbidity and durable patency. Autologous SFA was the most suitable conduit for reconstructions in our experience, with the highest primary patency.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1006-1014"},"PeriodicalIF":7.5,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141074834","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}