Annals of surgery最新文献

{"title":"Transcriptome Dynamics From Primary Gastric Cancer to Peritoneal Metastases: Translational Insights for Surgical Oncology.","authors":"Maria Bencivenga, Michele Simbolo, Stefano Gobbo, Alessandra Franceschi, Angela Sandri, Alberto Verlato, Federica Filippini, Erica Secchettin, Fabrizio Tedone, Cristina Migliore, Claudio Luchini, Jan Ewald, Rita Teresa Lawlor, Alessia Nottegar, Giovanni de Manzoni","doi":"10.1097/SLA.0000000000007183","DOIUrl":"10.1097/SLA.0000000000007183","url":null,"abstract":"<p><strong>Background and aims: </strong>Peritoneal metastases (PMs) represent the most frequent, clinically challenging dissemination pattern in advanced gastric cancer, especially poorly cohesive (PCGC) subtype, and are associated with poor prognosis. We aimed to characterize the transcriptomic landscape of primary gastric tumors (PGTs) and matched PMs to identify differential molecular programs, tumor-microenvironment (TME) features, and potential biomarkers.</p><p><strong>Methods: </strong>We analyzed 55 FFPE samples from 23 treatment-naïve patients with synchronous peritoneal-only stage IV PCGC and 10 non-neoplastic gastric controls (NNC). RNA sequencing was analyzed using DESeq2 and GSEA, with cell proportions estimated through immune deconvolution (TIMER/xCell).</p><p><strong>Results: </strong>A total of 4279 differentially expressed genes were identified across all groups. CLDN18 expression progressively decreased from NNCs to PGTs and PMs. Direct PGT-PM comparison revealed that PGTs were characterized by cytoskeletal and extracellular-matrix remodeling genes upregulation, mitotic/cell-cycle, NOTCH and apical-junction pathways enrichment, and memory T-cell predominance. Compared with PGTs, PMs showed increased IGF1, IGFN1, NTRK2 and adipogenesis-related transcripts, adipogenesis and MAPK7/11-NTRK2 signaling enrichment, and macrophage-dominant and dendritic-cell-dominant microenvironments. epithelial-mesenchymal transition (EMT), inflammatory pathways, and cancer-associated fibroblasts were shared by both tumor lesions. PMs did not match established TCGA or PCGC subtypes, suggesting a distinct molecular identity.</p><p><strong>Conclusions: </strong>PMs are characterized by TME remodeling and transcriptional reprogramming. Shared EMT and inflammatory pathways act as bridge linking PGT to PM, consistent with adaptive exploitation of physiological peritoneal programs. Collectively, our findings suggest a transcriptomic framework in which PM can be characterized as a distinct niche-conditioned biological entity and support microenvironment-informed diagnostic and therapeutic strategies.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"971-977"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872699","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":"Robotic Whole-graft Liver Transplant: Lesson Learned And Outcomes After 45 Cases.","authors":"Fabrizio Di Benedetto, Paolo Magistri, Joao Santos Coelho, Roberta Odorizzi, Raquel Mega, Barbara Catellani, Silvia Gomes da Silva, Cristiano Guidetti, Mafalda Sobral, Gian Piero Guerrini, Emanuel Vigia, Stefano Di Sandro, Hugo Pinto-Marques","doi":"10.1097/SLA.0000000000007181","DOIUrl":"10.1097/SLA.0000000000007181","url":null,"abstract":"<p><strong>Background and aims: </strong>Robotic liver transplantation (RLT) represents the latest evolution in solid organ transplantation. While early reports demonstrated technical feasibility of whole-graft RLT, evidence on clinical outcomes benchmarked against established standards remains limited. This study aimed to evaluate perioperative post-transplant outcomes of whole-graft RLT and to assess whether benchmark performance can be achieved in clinical practice.</p><p><strong>Study design: </strong>This retrospective multicenter cohort study included consecutive patients undergoing whole-graft RLT at 2 European centers between February 2024 and October 2025. Preoperative, perioperative, and follow-up data were retrieved from prospectively maintained databases. The primary endpoint was comparison of outcomes with LT benchmark criteria.</p><p><strong>Results: </strong>Forty-five patients met inclusion criteria; one was excluded due to conversion before robotic docking, yielding a final cohort of 44 patients. Hepatocellular carcinoma was the leading indication for transplantation (47.7%). Median MELD score was 11 (range 6-28), and 61.4% of recipients had clinically significant portal hypertension. Median operative time was 551 minutes, with a median warm ischemia time of 60 minutes. Conversion to open surgery occurred in 4 cases (9.1%), all of which recovered uneventfully. Median ICU and hospital stay were 2 and 10 days, respectively. Overall mortality was 2.3%. All benchmark thresholds were met except operative time, which significantly improved over time.</p><p><strong>Conclusion: </strong>Robotic whole-graft liver transplantation achieved benchmark-level outcomes for major perioperative and early post-transplant parameters. Despite prolonged operative duration related to procedural complexity and learning curve, RLT appears safe and reproducible when implemented in highly specialized centers with advanced transplant and robotic hepatobiliary expertise.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1009-1016"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676829","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":"Incidence and Risk Factors for Persistent Perineal Sinus After Proctectomy in Crohn Disease: A Single-center Retrospective Cohort Study.","authors":"Wout De Coster, André J L D'Hoore, Kim Vandeuren, Leen Van Langenhoven, Steffen Fieuws, Albert Wolthuis, Gabriele Bislenghi","doi":"10.1097/SLA.0000000000007168","DOIUrl":"10.1097/SLA.0000000000007168","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective cohort study aimed to determine the incidence of persistent perineal sinus (PPS) after proctectomy for Crohn disease (CD) and to identify associated risk factors.</p><p><strong>Summary background data: </strong>Proctectomy remains necessary in a subset of patients with CD, yet impaired perineal wound healing and PPS continue to represent major sources of postoperative morbidity.</p><p><strong>Methods: </strong>All patients undergoing proctectomy for CD between 1993 and 2023 at a tertiary referral center were included. The primary outcome was development of PPS, defined as a perineal wound remaining unhealed for ≥6 months after proctectomy. Associated risk factors were analyzed using regression analyses.</p><p><strong>Results: </strong>Among 139 patients, 66.20% were women, and PPS occurred in 26. Healing was 81.30% (95% CI, 74.40%-87.30%) at 6 months and 93.50% (95% CI, 88.60%-96.80%) at 12 months; median healing time was 1.80 months (IQR, 0.90-4.60).Patients operated after 2011 (n=113, 81.30%) were significantly older, more ASA III, and active smokers, with longer disease duration, lower CRP, and higher number of advanced therapies.PPS was associated with younger age (OR 0.79; P =0.014) and omentoplasty (OR 2.60; P =0.036). After correction for year of surgery, only older age independently predicted faster healing (OR 0.90; 95% CI, 0.83-0.97; P =0.005), while ≥3 therapy lines showed a nonsignificant protective effect (OR 0.36; 95% CI, 0.12-1.07; P =0.067).</p><p><strong>Conclusion: </strong>Although PPS remains frequent after proctectomy for Crohn disease, most patients ultimately achieve perineal healing. Older age at surgery is the only independent predictor of faster healing. Improved control of systemic inflammation may reduce the risk of PPS.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1057-1062"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148756893","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":"Towards Benchmark-level Outcomes in Donation After Circulatory Death Liver Transplantation: A Comparative Analysis of Machine Preservation Strategies.","authors":"Chase J Wehrle, Aleah Brubaker, Riccardo De Carlis, Femke De Goeij, Christoph Eckharter, Sangeeta Satish, Elizabeth Dewey, Nihal Aykun, Marina Sycheva, Sophie Hansen, Janske Reiling, Leonie Van Leeuwen, Raphael Fischer, William Archie, Cristina Jimenez-Soto, Ahmed Hussein, Anji Wall, Kristopher Croome, Shennen Mao, Michelle Nguyen, Amit K Mathur, Giulano Testa, David Aufhauser, Jennifer Philip, Ahmed Nassar, Adhnan Mohamed, Martin Montenovo, Wail Johnson, Shaheed Merani, Alan Langnas, Trevor Nydam, Ivan Rodriguez, Yanik Bababekov, Valberto Sanha, F Selin Yildirim, Eduardo Fernandes, Koji Hashimoto, Koji Tomiyama, James Guarrera, Keri E Lunsford, Roberto Hernandez-Alejandro, Peter Abt, Mohammed Zeeshan Akhtar, Dionisios Vrochides, Rebeca Sanabria-Mateos, Jean Botha, Andrew Barbas, Luciano De Carlis, Wojciech G Polak, Pascale Tinguely, Jeroen De Jonge, Marty Sellers, Antonio D Pinna, Andrea Schlegel","doi":"10.1097/SLA.0000000000007193","DOIUrl":"10.1097/SLA.0000000000007193","url":null,"abstract":"<p><strong>Introduction: </strong>Donation after circulatory death (DCD) graft use has become a standard practice globally to increase access to liver transplantation (LT). Machine preservation strategies have been widely adopted to improve graft quality, mitigate ischemia-reperfusion injury, expand organ utilization and enable organ viability assessment. However, the various approaches to MP have never been directly compared, particularly in the DCD cohort which might experience the greatest benefit.</p><p><strong>Methods: </strong>All cases of adult DCD-LT 2014-2024 preserved MP were collected from centers in Italy, The Netherlands, Switzerland, UK, and USA. DCD grafts preserved with cold storage (SCS) alone from previously established DCD-benchmarking cohorts served as comparators. Core Outcome Sets methodology was employed for standardized outcome analysis, comparing the impact of MP technologies in DCD grafts within established \"benchmark\" criteria to those with extended risk factors outside benchmarks.</p><p><strong>Results: </strong>Data were collected for 1538 perfused DCD-LT from >30 transplant centers; 995 (65%) were outside-benchmark criteria. Nearly half received NRP alone or combined with ex-situ perfusion (49%). Inside benchmark, nonanastomotic biliary strictures (NAS) were equally common in upfront NMP (14%) and back-to-base (B-t-B) NMP (14%). NRP (1%) and NRP+HOPE (2%) were protective ( P <0.001). Outside benchmark, NAS was least frequent in the NRP+HOPE (2%), and NRP-alone (4%) group, and most common in the B-t-B NMP (18%, P <0.001) cohort. Upfront NMP demonstrated a lower observed NAS incidence than B-to-B NMP (9% vs. 18%). NRP, NRP+HOPE, and HOPE demonstrated a pattern of convergence in outcomes between inside- and outside-benchmark grafts in multivariable analyses. Binary logistic mixed-effects modelling demonstrated NAS-reduction with NRP+HOPE (OR=0.201, 95% CI= 0.075-0.569) and NRP alone (OR=0.281, 0.105-0.569). Other preservation modalities did not differ, including upfront NMP, which was similar to B-t-B NMP and SCS. Increasing donor age was detrimental to NAS rates (OR=1.02, 95% CI= 1.004-1.036). Donor and preservation factors demonstrated a 19% impact on NAS versus recipient factors (labMELD, age, BMI), which contributed with only 3% (Conditional Pseudo-R 2 =0.201, Marginal=0.187). Similar trends were observed regarding actuarial 1-year GS.</p><p><strong>Conclusions and relevance: </strong>Machine preservation strategies were associated with differences in outcomes in DCD LT and with lower observed NAS incidence and favorable adjusted survival estimates in DCD LT. NMP-based preservation was not associated with statistically significant reductions in NAS compared with benchmark SCS cohorts.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1026-1034"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862971","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":"Cost-effectiveness Analysis of Robotic Versus Open Pancreatoduodenectomy (DIPLOMA-2): A Multicenter International Randomized Trial.","authors":"Julia E Menso, Caro L Bruna, Nine de Graaf, Anouk M L H Emmen, Mahsoem Ali, Bergthor Björnsson, Ugo Boggi, Olivier R Busch, Annalisa Comandatore, Freek Daams, Giovanni Ferrari, Sebastiaan Festen, Jony van Hilst, Ignace H J T de Hingh, Mathieu D'Hondt, Benedetto Ielpo, Tobias Keck, Bas Groot Koerkamp, Daan J Lips, Misha D P Luyer, J Sven Mieog, Luca Morelli, I Quintus Molenaar, Marco Ramera, Francesco Sucameli, Roeland F de Wilde, Patrick Maisonneuve, Gudrun M W Björnelv, Mohammad Abu Hilal, Marc G Besselink, Åsmund A Fretland","doi":"10.1097/SLA.0000000000007188","DOIUrl":"10.1097/SLA.0000000000007188","url":null,"abstract":"<p><strong>Background: </strong>Although robot-assisted pancreatoduodenectomy (RPD) enhances patient recovery, it could be associated with higher costs than open pancreatoduodenectomy (OPD), potentially limiting its widespread adoption. High-level evidence comparing costs of RPD and OPD is lacking. This analysis in a randomized trial compared costs and cost-effectiveness between RPD and OPD.</p><p><strong>Methods: </strong>Predefined cost-effectiveness analysis in the international randomized DIPLOMA-2 trial (ISRCTN27483786) comparing RPD and OPD in patients with primary resectable neoplasm in 14 centers in 6 European countries (2022-2023). Primary outcomes were mean total hospital costs (euro) at 6 months postoperatively and cost-effectiveness based on costs per quality-adjusted life year (QALY; incremental cost-utility ratio). Three analyses were performed: (1) costs, (2) QALYs including Health-Related Quality of Life (HR-QoL), and (3) cost-effectiveness with probabilities at various willingness-to-pay (WTP) thresholds.</p><p><strong>Results: </strong>Overall, 268 patients were included (170 RPD, 98 OPD). No significant difference in total hospital costs was found between RPD and OPD (€30,956 vs. €28,271, P =0.538). The intraoperative costs were €5,491 higher with RPD (€11,906 vs. €6,451, P <0.001), whereas postoperative costs were €2806 lower (€19,051 vs. €21,856, P =0.518). The HR-QoL index scores were comparable at 1 and 3 months, but worse at 6 months with RPD (Δ-0.08 [-0.15 to -0.001]). Consequently, over 6 months a QALY loss was observed with RPD (Δ-0.02 [-0.07 to 0.01]) with a <30% probability of RPD being cost-effective across various WTP thresholds.</p><p><strong>Conclusion: </strong>This analysis in a randomized trial found no significant differences in costs between RPD and OPD up to 6 months. Nonsignificantly lower QALYs at 6 months with RPD resulted in a <30% probability that RPD is cost-effective compared with OPD within 6 months after surgery in selected patients in high-volume centers.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"920-927"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757395","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":"Real-World Analysis of Hypothermic Oxygenated Perfusion and Normothermic Machine Perfusion in Liver Transplantation: An International Cohort Study.","authors":"Matthias Pfister, Janina Eden, Hannah Rasel, Fariba Abbassi, Simon Störzer, Florin Botea, Bettina M Buchholz, Francisco Calderon Novoa, Stefania Camagni, William C Chapman, Umberto Cillo, Arielle Cimeno, Philippe Compagnon, Miriam Cortes-Cerisuelo, Alexander R Cortez, Kris P Croome, Riccardo De Carlis, Dulce Diogo, Fabrizio Di Benedetto, Daniele Dondossola, John Fung, Jiri Fronek, Carlos Garcia, Georg Györi, Matthew Hamilton, Julie K Heimbach, Philipp Houben, Dionysios Koliogiannis, Chandrashekhar A Kubal, Hwai-Ding Lam, Tyler Lunow-Luke, Georg Lurje, Ajay Mahenthiran, Diethard Monbaliu, Hussein Nassar, Andreas Pascher, Madhukar S Patel, Damiano Patrono, Robert J Porte, Lukas Prommegger, Rithin Punjala, Matteo Ravaioli, Michel Rayar, John P Roberts, Garrett R Roll, Sangeeta Satish, Andrea Schlegel, Moritz Schmelzle, Stefan Schneeberger, Markus Selzner, James Shapiro, Gustaf Sörensen, Neeta Vachharajani, Parsia Vagefi, W Kenneth Washburn, Antonio Pinna, Philipp Dutkowski, Vincent E de Meijer, Pierre-Alain Clavien","doi":"10.1097/SLA.0000000000007195","DOIUrl":"10.1097/SLA.0000000000007195","url":null,"abstract":"<p><strong>Objective: </strong>To report real-world data on hypothermic oxygenated perfusion (HOPE) and normothermic machine perfusion (NMP) in liver transplantation (LT).</p><p><strong>Summary background data: </strong>Real-world comparisons between HOPE and NMP are limited and methodologically challenging due to heterogeneity in donor and recipient risk profiles and regional differences in practice patterns.</p><p><strong>Methods: </strong>This international cohort study analyzed consecutive NMP-preserved LTs performed at 15 predominantly North American centers between 2021 and 2025. Outcomes were compared with the European HOPE-REAL cohort, comprising HOPE-treated LTs from 22 centers between 2012 and 2021. Risk-adjusted analyses were performed, stratified by graft type and risk category. Imbalances in baseline characteristics were addressed using entropy balancing.</p><p><strong>Results: </strong>A total of 954 NMP-treated and 1202 HOPE-treated grafts were analyzed, revealing substantial differences in donor risk. Extended-criteria DBD grafts accounted for 30% versus 64%, and futile DCD grafts for 10% versus 30%, in the NMP and HOPE cohorts, respectively. In the NMP cohort, death-censored graft survival at 1, 2, and 3 years exceeded 96% for DBD grafts and 94% for DCD grafts. Comparable outcomes were observed in the HOPE cohort, with 93% survival in DBD and 87% in DCD grafts at up to 3 years, despite significantly higher donor risk in the HOPE-DCD cohort. After risk adjustment, death-censored graft survival remained similar between both modalities across graft types and risk categories.</p><p><strong>Conclusions: </strong>Real-world data on HOPE-treated and NMP-treated LT demonstrate excellent outcomes. Nevertheless, compared with HOPE, further high-quality evidence and longer preservation time is needed to substantiate the clinical benefits of NMP in high-risk grafts.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1017-1025"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878945","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":"Patients and P Values - The Challenges of Academic Surgery.","authors":"J Peter A Lodge","doi":"10.1097/SLA.0000000000007187","DOIUrl":"10.1097/SLA.0000000000007187","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"865-870"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676879","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":"Parathyroidectomy Reduced the Risk of Incident Major Adverse Cardiovascular Events Among Patients With Primary Hyperparathyroidism - Results From a Population-Wide Target Trial Emulation Study.","authors":"Man H M Fung, Xiaodong Liu, Lanlan Li, Carlos K H Wong, Yan Luk, David T W Lui, Simon Y K Law, Brian H H Lang","doi":"10.1097/SLA.0000000000007169","DOIUrl":"10.1097/SLA.0000000000007169","url":null,"abstract":"<p><strong>Objective: </strong>Using target trial emulation to compare the risk of major adverse cardiovascular events (MACE) in patients with primary hyperparathyroidism (PHPT) treated with versus without surgery.</p><p><strong>Background: </strong>PHPT was associated with increased cardiovascular morbidity and mortality. However, the impact of parathyroidectomy on cardiovascular outcomes in PHPT remained uncertain.</p><p><strong>Methods: </strong>The electronic health database encompassing the entire public health system in Hong Kong from 2006 to 2023 was used to emulate a randomized controlled trial. PHPT was defined by concomitantly raised serum calcium and parathyroid hormone. MACE was defined by myocardial infarction, stroke, heart failure, or cardiovascular mortality. Patients with MACE before PHPT diagnosis were excluded. Marginal structural model with inverse probability of treatment weighting, modelling surgery as a time-varying exposure was applied. MACE risk between surgery versus nonsurgery management was compared with the Cox proportional hazards model. Sensitivity analyses censored patients developing MACE <1 year, and excluded patients with follow-up <1 year.</p><p><strong>Results: </strong>Among 6898 PHPT patients identified, 1959 (28.4%) underwent parathyroidectomy. Five hundred ninety-seven MACE occurred in the nonsurgery group (median follow-up 3.22 y, incidence rate: 26.87/1000 person-years), versus 168 in the surgery group (median follow-up 8.27 y, incidence rate: 9.83/1000 person-years). Surgery reduced the risk of MACE significantly (HR: 0.72; 95% CI: 0.57-0.90, P =0.005). Patients with higher calcium levels (>2.8 mmol/L) had more profound MACE risk reduction (HR: 0.64 [95% CI: 0.44-0.93] vs. 0.72 [95% CI: 0.53-0.98]; interaction P =0.047). Sensitivity analyses showed consistent findings.</p><p><strong>Conclusion: </strong>Parathyroidectomy reduced the risk of MACE in patients with PHPT. Keywords: Primary hyperparathyroidism; parathyroidectomy; major adverse cardiovascular events; myocardial infarction; stroke.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"928-934"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676894","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":"Neoadjuvant Immunotherapy Using PD-1 Inhibitors for Resectable Stage III Cutaneous Melanoma - Different Outcomes Between Patients With Lymph Node and In-transit Metastases.","authors":"Ellen Krabbe, Anne Huibers, Ana Carneiro, Karolin Isaksson, Karl Björkström, Braslav Jovanovic, Antonios Valachis, Gustav J Ullenhag, Hildur Helgadottir, Lars Ny, Axel Nelson, Roger Olofsson Bagge","doi":"10.1097/SLA.0000000000007177","DOIUrl":"10.1097/SLA.0000000000007177","url":null,"abstract":"<p><strong>Background and aims: </strong>Neoadjuvant immunotherapy has emerged as the preferred treatment strategy for patients with resectable stage III melanoma. However, real-world data remain limited, especially regarding patients with in-transit metastasis (ITM). The aim of this study was to evaluate neoadjuvant immunotherapy in a population-based cohort of patients with stage III melanoma with a specific focus on patients with ITM.</p><p><strong>Study design: </strong>This population-based multicenter observational study included all patients with macroscopic stage III cutaneous melanoma treated with neoadjuvant PD-1 inhibitors at 5 academic cancer centers in Sweden from 2022 to 2025. Patients were stratified into 3 groups, LN metastasis only, ITM only, and concurrent LN and ITM involvement. The primary endpoint was major pathological response (MPR). Secondary endpoints included event-free survival (EFS), distant metastasis-free survival (DMFS), locoregional recurrence-free interval (LRFI), and safety outcomes.</p><p><strong>Results: </strong>A total of 212 patients with a median follow-up of 14.7 months were included, of whom 41 had ITM only and 12 had both LN and ITM. The MPR rate was significantly higher in patients with LN metastases (52%) compared with ITM (22%) or concurrent LN and ITM (25%) ( P <0.001). EFS and LRFI were significantly inferior in patients with ITM compared with LN metastases. In multivariable Cox regression analyses, ITM was associated with a higher risk of events for EFS (HR 2.00; 95% CI: 1.08-3.71; P =0.028) and LRFI (HR 4.41; 95% CI: 1.76-11.02; P =0.002). Although DMFS differed between groups in unadjusted analyses, no association was observed after multivariable adjustment (HR 1.04; 95% CI: 0.46-2.33; P =0.925).</p><p><strong>Discussion: </strong>This study represents the largest real-world cohort specifically evaluating patients with ITM treated with neoadjuvant immunotherapy. The lower pathological response rate and inferior EFS observed in patients with ITM compared with LN metastases, together with an increased risk of locoregional recurrence, but no difference in DMFS, suggest that ITM may represent a biologically distinct disease phenotype with a higher propensity for locoregional treatment failure.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"950-956"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597989","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":"Safety and Performance of the Colovac Anastomosis Protection Device. A Pooled Analysis of Prospective Studies Compared With Diverting Loop Ileostomy (SAFE-2025).","authors":"Patricia Sylla, Katherine Lam, Niels Komen, Jean-Jacques Tuech, Antonio Spinelli, Joseph Martz, Rebecca Rhee, Jorge Marcet, Guy Bernard Cadière, Philippe Rouanet, Aleksei Karachun, Quentin Denost, Narkhodzha Sametdinov, Andre D'Hoore, Sang Lee, Jérémie H Lefèvre","doi":"10.1097/SLA.0000000000007171","DOIUrl":"10.1097/SLA.0000000000007171","url":null,"abstract":"<p><strong>Objective: </strong>To compare the safety and effectiveness of the Colovac Anastomosis Protection Device with standard diverting ostomy (DO) following low anterior resection (LAR) for rectal cancer.</p><p><strong>Summary background data: </strong>DO is standard of care (SOC) following LAR for rectal cancer but is associated with substantial morbidity. Colovac Device is designed to divert the fecal stream away from the anastomosis intraluminally.</p><p><strong>Methods: </strong>Three prospective multicenter Colovac trials were pooled and compared with a prospective cohort of patients undergoing LAR with DO for rectal cancer using a propensity score-weighted approach to balance baseline characteristics. The primary safety endpoint for both Colovac and SOC trials was the rate of device-related or stoma-related early major complications by POD10. Secondary endpoints included early anastomotic leak (AL) rates, fecal stream diversion effectiveness, and device migration.</p><p><strong>Results: </strong>Patients were included (Colovac=49, DO=54). By POD10, device- or stoma-related major complications rates were 4.1% (2/49) vs 5.6% (3/54) ( P =0.167). All Colovac devices were successfully placed and retrieved with stoma avoidance achieved in 83.7% at POD10. Major complication rates were similar between groups. Rates of AL detected on POD9/10 were comparable between Colovac and control patients (28.6% vs. 20.4%, P =0.102), with total AL rate of 32.6% in Colovac versus 27.8% ( P =0.342) in control at POD30. Effective fecal diversion was achieved in 91.7% of Colovac patients, with device migration in 14.3%.</p><p><strong>Conclusions: </strong>Colovac enabled ostomy avoidance in most patients without increasing major complications or AL, suggesting its role as a potential alternative to DO following LAR for rectal cancer.</p><p><strong>Trial registration: </strong>SAFE-2019: NCT05180565; SAFE-2: NCT05010850; SAFE-2023: NCT06540807; SH-SOC23: NCT06152276.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1063-1071"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872680","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}