Annals of surgery最新文献

{"title":"Integrative Muscle-Adipose Score (IMAS): A Novel Unified, Sex-Sensitive Body Composition-Based Survival Predictor Enhancing Risk Stratification After Liver Transplantation.","authors":"Frederik Schliephake, Isabella Lurje, Jan Bednarsch, Katharina Dreher, Jude Bitar, Carolin V Schneider, Deniz Uluk, Zoltan Czigany, Pavel Strnad, Cornelius Engelmann, Ulf P Neumann, Florian W Vondran, Johann Pratschke, Robert Öllinger, Frank Tacke, Georg Lurje","doi":"10.1097/SLA.0000000000007192","DOIUrl":"10.1097/SLA.0000000000007192","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the potential of integrating muscle and fat compartments into a novel and unified score for outcome prediction in a bicentric European cohort of LT recipients.</p><p><strong>Background: </strong>Body composition (BC) reflects nutritional status and metabolic reserves and influences outcomes after orthotopic liver transplantation (LT). Validated tools for predicting long-term survival after LT remain scarce. Increasing evidence highlights sex-specific disparities in post-transplant outcomes.</p><p><strong>Study design: </strong>A total of 695 adult patients undergoing LT at Charité-Berlin (n=412, 2010 to 2020; discovery cohort) and University Hospital Aachen (n=283, 2010 to 2018; validation cohort) were included. CT-based BC was assessed at lumbar level 3/4. Muscle mass, quality, and adipose tissue were integrated into the integrative muscle-adipose score (IMAS) and correlated with survival and postoperative morbidity.</p><p><strong>Results: </strong>Median follow-up was 54 (discovery) and 47 months (validation). A total of 31% of recipients were female. IMAS quartiles significantly stratified overall survival in both cohorts ( P <0.01). Low IMAS was independently prognostic of overall survival in both cohorts. Sex-specific IMAS cutoffs were independently prognostic in both sexes (♂︎: HR=1.89, 95% CI: 1.37-2.70, P =0.001; ♀︎: HR=2.04, 95% CI: 1.17-3.55, P =0.012), whereas the BAR score failed to predict long-term survival in female recipients. Across sexes, low IMAS was associated with significantly lower restricted mean survival time at 5 years (♂︎ 43.2 vs. 50.16 mo, P <0.001; ♀︎ 44.2 vs. 51.71 mo, P =0.013) and a higher Comprehensive Complication Index 90 days after LT.</p><p><strong>Conclusion: </strong>The IMAS provides a novel, reproducible sex-sensitive framework for long-term outcome prediction after LT.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"1042-1049"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872730","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":"Intraoperative Adverse Events in Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Incidence, Management, and Impact on Surgical Outcomes.","authors":"Franco Badaloni, Adam Zeyara, Gino M Kuiper, Stijn Vanstraelen, Ludovico Campi, Jan Willem van den Berg, Richard van Hillegersberg, Jelle P Ruurda","doi":"10.1097/SLA.0000000000007167","DOIUrl":"10.1097/SLA.0000000000007167","url":null,"abstract":"<p><strong>Objective: </strong>Assess the incidence and management of intraoperative adverse events (IAEs) during robot-assisted minimally invasive esophagectomy (RAMIE) and evaluate their impact on postoperative outcomes.</p><p><strong>Background: </strong>IAEs are an inherent component of surgical practice and owing to its complexity, esophagectomy is no exception. Data on their incidence and management remain limited. Robotic assistance may facilitate management of these events.</p><p><strong>Methods: </strong>This retrospective observational cohort study analyzed prospectively collected data from consecutive RAMIE performed at UMC Utrecht using the da Vinci Xi system. iAEs were categorized using the ClassIntra classification. Perioperative outcomes were compared according to major IAEs occurrence (ClassIntra ≥III).</p><p><strong>Results: </strong>Between 2018 and 2025, 478 RAMIE were performed. IAEs occurred in 41 patients (8.6%; 46 events), of which 92.7% were managed robotically without conversion. Bleeding was the most common event (69.6%), followed by chyle leaks (8.7%), lung injuries (8.7%), and airway injuries (4.3%). Major IAEs occurred in 20 patients (4.2%) and were associated with increased mean blood loss (1211 vs. 296 mL, P <0.001), higher conversion rates (15.0% vs. 1.3%, P =0.005) and longer mean operative time (478.6 vs. 413.3 min, P =0.022). Major postoperative complications (35.0% vs. 37.3%, P =1.000), median hospital length of stay (11 vs. 11 d, P =0.311) and in-hospital mortality (5.0% vs. 2.7%, P =0.446) were comparable between groups.</p><p><strong>Conclusion: </strong>In this retrospective cohort, over 90% of IAEs during RAMIE were managed robotically without conversion, with no significant increase in postoperative morbidity. These results should be interpreted in the context of an expert center and a limited number of events.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"957-963"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787253","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":"Differential Effects of VEGFA and EGF Polymorphisms on Susceptibility and Postoperative Outcome in Cholangiocarcinoma.","authors":"Justus Pein, Saskia Nicklisch, Paul Horn, Carolin V Schneider, Niharika Jakhar, Marlene Kohlhepp, Deniz Uluk, Linda Hammerich, Florian Roßner, David Horst, Cornelius Engelmann, Frank Tacke, Isabella Lurje, Georg Lurje","doi":"10.1097/SLA.0000000000007176","DOIUrl":"10.1097/SLA.0000000000007176","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the impact of VEGFA and EGF genetic polymorphisms on postoperative survival, susceptibility, transcriptomics, and systemic proteomic regulation in cholangiocarcinoma (CCA).</p><p><strong>Background: </strong>Angiogenesis and growth factor signaling via vascular endothelial growth factor A (VEGFA) and epidermal growth factor (EGF) are key drivers of CCA biology, yet the clinical relevance of their genetic variants remains poorly defined.</p><p><strong>Methods: </strong>A cohort of 221 patients undergoing curative-intent CCA resection at Charité-Berlin was analyzed. Patients were genotyped for 6 angiogenesis-related SNPs, including VEGFA rs3025039 and EGF rs4444903, and survival associations were assessed using Cox regression. The prognostic relevance of intratumoral VEGFA and EGF mRNA expression and pathway co-expression was evaluated in an independent transcriptomic cohort. Population-level associations with CCA susceptibility and serum proteomics were analyzed in the UK Biobank (n>500,000).</p><p><strong>Results: </strong>The VEGFA rs3025039 T allele was associated with improved cancer-specific survival, particularly in intrahepatic CCA, while the EGF rs4444903 G allele was linked to improved survival in perihilar CCA. High intratumoral VEGFA or EGF expression correlated with poorer survival in external validation, but this association was lost for EGF after multivariable adjustment. VEGFA -high tumors showed increased proliferative and suppressed immune transcriptional signatures, whereas EGF -high tumors displayed limited changes. UK Biobank analysis revealed increased intrahepatic CCA susceptibility among VEGFA T allele carriers, while the EGF G allele was associated with elevated circulating EGF levels.</p><p><strong>Conclusions: </strong>VEGFA and EGF polymorphisms exert distinct effects on CCA, influencing disease susceptibility, postoperative outcomes, and systemic signaling, supporting their potential as biomarkers for clinical stratification.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"935-942"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597960","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":"Hospital-Level Determinants of Mortality After Pancreas Surgery: A Global Infrastructure Analysis.","authors":"Camila Hidalgo Salinas, Pascale Tinguely, Dimitri A Raptis, Sterre van Herwijnen, Ammar A Javed, Rafael Perera, Cristina R Ferrone, Christopher L Wolfgang, Giuseppe K Fusai","doi":"10.1097/SLA.0000000000007196","DOIUrl":"10.1097/SLA.0000000000007196","url":null,"abstract":"<p><strong>Objective: </strong>To identify modifiable hospital-level determinants of mortality after pancreas surgery and assess their cumulative protective effects through the development of a Hospital Resource Index (HRI) on a global scale.</p><p><strong>Background: </strong>Ninety-day mortality rates after pancreas surgery vary globally (2%-10%); however, institutional factors affecting mortality remain poorly understood. Although caseload volume has driven centralization policies in many health care systems, it is not fully explanatory, and the impact of specific modifiable structural and process-related hospital factors remains unclear.</p><p><strong>Methods: </strong>We linked patient outcome data from the 2021 PancreasGroup.org global prospective cohort to hospital infrastructure data from the PancreasGroup.org global survey. Binary availability of 20 hospital-level factors was assessed. Factors significantly associated with mortality on univariable multilevel regression were combined into an additive HRI. Multivariable logistic regression evaluated associations between HRI and 90-day mortality.</p><p><strong>Results: </strong>Analyses included 2928 patients from 214 centers across 60 countries. Six hospital factors were significantly associated with lower mortality, including interventional radiology/endoscopy availability, structured nutrition support, evidence-based practice adoption, staff training, equipment maintenance, and favorable nurse-patient ratios. Each additional HRI point was associated with 12% lower mortality odds (OR: 0.88, 95% CI: 0.81-0.95, P =0.001), independent of caseload volume (OR: 0.73, P =0.014, optimal cutoff 55 cases per year), country's development index, and patient and procedural characteristics. Patients treated at hospitals with all 6 HRI resources had 54% lower adjusted odds of 90-day mortality than those at hospitals with none (OR 0.46, 95% CI 0.30-0.70).</p><p><strong>Conclusions: </strong>The developed HRI showed cumulative protective effects on mortality after pancreas surgery, with volume remaining independently protective in the adjusted model, providing actionable targets for resource allocation to enhance pancreas surgery outcomes beyond centralization globally.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"985-992"},"PeriodicalIF":7.4,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910819","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":"Technical Complications and Salvage of Hepatic Artery Infusion Pumps: An Institutional Experience of 2935 Consecutive Cases.","authors":"Omar A Zaki, Lauren E Schleimer, Hannah L Kalvin, Ankur Choubey, Ahmad B Barekzai, Joslyn Jung, Misha Armstrong, Remo Alessandris, Merve Rousian, Ruben Geevarghese, Danielle Silliman, Mithat Gönen, Brett S Marinelli, Michael E Lidsky, Vinod P Balachandran, Jeffrey A Drebin, Lily V Saadat, Alice C Wei, Kevin C Soares, T Peter Kingham, William R Jarnagin, Michael I D'Angelica","doi":"10.1097/SLA.0000000000007238","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007238","url":null,"abstract":"<p><strong>Objective: </strong>Describe the technical complications of hepatic artery infusion pump (HAIP) placement and characterize salvage rates.</p><p><strong>Summary background data: </strong>HAIP chemotherapy is an effective tool used in the treatment of hepatic malignancies and has become increasingly adopted at select centers. Much of the safety data is reported from small, newer programs or older, large series.</p><p><strong>Methods: </strong>Retrospective analysis of all patients who underwent HAIP placement at our institution between 2000 and 2022 was conducted. Pump salvage was defined as the ability to receive HAIP chemotherapy after a pump-associated complication. Pump failure was defined as an HAIP-related complication permanently stopping ongoing HAIP chemotherapy.</p><p><strong>Results: </strong>Over the study period, 2935 patients had an HAIP placed for colorectal liver metastases (n=2582, 88%), intrahepatic cholangiocarcinoma (n=294, 10%) or another malignancy (n=59, 2%). Of all patients, 759 (26%) had an HAIP-related complication, with 404/759 (53%) having their pump salvaged. The most common complications were abnormal perfusion (n=360 [12%], 285/360 [79%] salvaged), arterial pseudoaneurysm and/or hemorrhage (n=117 [4%], 7/117 [6%] salvaged), and pump-pocket infection (n=115 [4%], 60/115 [52%] salvaged). The complications with the highest salvage rates were pump-pocket seroma (n=15/16, 94%), pump-flipping (n=41/44, 93%), and pump-pocket hematoma (n=45/49, 92%). Unsalvaged complications were catheter dislodgement from vessel (n=0/47, 0%), catheter erosion into bowel (n=0/25, 0%), and arterial thrombosis (n=0/19, 0%). The cumulative incidence of pump failure at 1 year in patients receiving adjuvant therapy was 6.6%, and 4.5% among those receiving palliative therapy.</p><p><strong>Conclusions: </strong>HAIP-related complications occur in about one quarter of patients, predominantly perfusion and pump-pocket complications. These are salvageable in the majority of cases with multidisciplinary interventions.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149219729","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":"Patient-reported Outcomes According to Mesh Position After Elective Incisional Hernia Repair: A Nationwide Survey- and Register-based Study.","authors":"Camilla Witthøft, Usamah Ahmed, Hugin Reistrup, Anders Gram-Hanssen, Jacob Rosenberg, Nadia A Henriksen, Jason J Baker","doi":"10.1097/SLA.0000000000007241","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007241","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to investigate the association between mesh position and patient-reported outcomes, including prevalence of severe chronic pain, foreign body sensation, self-reported recurrence, and physical impact score in patients undergoing elective incisional hernia repair.</p><p><strong>Background: </strong>Patient-reported outcomes are increasingly recognized as important measures of treatment success following incisional hernia repair, yet the impact of mesh position remains uncertain.</p><p><strong>Methods: </strong>This nationwide Danish survey- and register-based cohort study was conducted within the AFTERHERNIA Project and based on the Abdominal Hernia questionnaire. All patients undergoing elective incisional hernia repair in Denmark between January 1, 2014, and March 31, 2024, were eligible for inclusion. Survey responses were linked with operative data from the Danish Ventral Hernia Database. Adjusted prevalences and means were estimated using g-computation.</p><p><strong>Results: </strong>Of 2827 eligible patients, 2348 patients responded, corresponding to a response rate of 83%. Among these, 28% of patients received onlay, 28% retromuscular, 13% preperitoneal, and 31% intraperitoneal mesh position with defect closure. Onlay was associated with a higher prevalence of foreign body sensation compared with retromuscular position (adjusted prevalence, 37.1% vs. 30.3%; difference, 6.8%; 95% CI, 0.9-12.8). No differences were observed across mesh positions regarding the prevalence of severe chronic pain, self-reported recurrence, and physical impact score.</p><p><strong>Conclusions: </strong>Onlay position was associated with a higher prevalence of foreign body sensation compared with retromuscular position, while no differences were observed regarding the prevalence of severe chronic pain, self-reported recurrence, or physical impact score.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178957","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":"Caregiving in Surgery: Insights on Measurement, Inclusivity, and Policy.","authors":"Julia R Berian, Beth Fields","doi":"10.1097/SLA.0000000000007240","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007240","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178981","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":"Preoperative Injection of Botulinum Toxin Into the Sphincter of Oddi Does Not Prevent Pancreatic Fistula After Distal Pancreatectomy: The Randomized Controlled PREBOTPilot Trial.","authors":"Claudia E Mack, Rosa Klotz, Ulla Klaiber, Peter Sauer, Anja Sander, Lukas Baumann, Friederike Schäfer, Alexandra Kunz, Markus W Büchler, Thilo Hackert","doi":"10.1097/SLA.0000000000007239","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007239","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether preoperative injection of botulinum toxin (BTX) into the sphincter of Oddi (SO) is a safe and feasible strategy to prevent postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP).</p><p><strong>Summary background data: </strong>POPF remains a common and potentially serious complication following DP, affecting up to 30% of patients. Pharmacologically induced sphincter relaxation by endoscopic injection of BTX into the SO has been described as a new approach to prevent POPF after DP by improved drainage of pancreatic fluid towards the duodenum.</p><p><strong>Methods: </strong>Patients scheduled for elective primary distal pancreatectomy (DP), irrespective of the underlying disease, were included in this monocenter, randomized controlled, open-label, phase-II trial with 2 parallel arms. Patients randomly assigned to the intervention group received an endoscopic injection of BTX (100 units) into the SO 3-10 days before surgery. Patients in the control group did not undergo any preoperative intervention. The combined primary endpoint was defined as the occurrence of clinically relevant postoperative pancreatic fistula (POPF grades B/C) and/or death due to any cause within 30 days following DP.</p><p><strong>Results: </strong>From March 2020 to August 2023, 50 patients were included in the trial. Subsequent to the analysis of the primary endpoint, which revealed no tendency of a beneficial effect on the rate of POPF after DP following BTX injection, even with the most favorable outcome upon further inclusion of the remaining 10 patients planned for recruitment, the recruitment was prematurely terminated. All 26 patients in the intervention group underwent successful SO BTX injection within a median of 6 (IQR of 5-8) days before surgery. DP was performed in 41 patients (82%). Postinterventional pancreatitis was not detected. Within 30 days, POPF grade B/C occurred in 6 patients in the intervention and 3 patients in the control group (28.6% vs. 15%, P=0.294). One patient in the intervention group died during the trial due to POPF-induced postpancreatectomy hemorrhage (PPH).</p><p><strong>Conclusion: </strong>Preoperative injection of BTX into the SO did not reduce clinically relevant POPF or 30-day mortality following DP, and the trial was prematurely terminated for futility. Although the intervention was safe and feasible, these findings do not support its use for the prevention of POPF after DP.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178960","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":"Anti-DEI Policies and Academic Surgery: Preserving the Mission in an Era of Legal Constraint.","authors":"Allison N Martin, Alexandra C Istl, Tania K Arora, Courtney Collins, Justin Dimick, Lisa M McElroy, Olamide Alabi, Tracy S Wang, Oluwadamilola M Fayanju","doi":"10.1097/SLA.0000000000007237","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007237","url":null,"abstract":"<p><strong>Importance: </strong>The January 2025 federal executive orders (EOs) restricting diversity, equity, and inclusion (DEI) programming in government-funded and private institutions represent a structural inflection point for academic surgery. The effects extend beyond institutional compliance and directly threaten workforce sustainability, research enterprises, and editorial freedom.</p><p><strong>Objective: </strong>To evaluate the immediate and projected effects of January 2025 federal EOs on research, editorial freedom, and workforce recruitment and retention in academic surgery, and to propose adaptive strategies for mission preservation.</p><p><strong>Design: </strong>A narrative synthesis of the literature and multi-institutional experience presented during a 2026 Academic Surgical Congress Committee panel session evaluated across multiple domains: workforce, scientific research/education, patient care, and editorial ecosystems.</p><p><strong>Results: </strong>Anti-DEI EOs produced measurable disruptions across the domains examined. Regarding the workforce, survey data indicate that 50% of faculty in affected states are seeking positions elsewhere, and underrepresented-in-medicine trainees are redistributing away from institutions with policy climates perceived as hostile. In research, federal grant withdrawals and self-censorship constrain equity-focused scientific inquiry and threaten surgeon-scientist career trajectories. In publishing, editorial leaders report early signals of declining submissions addressing disparities, reflecting investigators' concerns for possible retaliation rather than actual changes in editorial policy. Across domains, a false binary of \"doubling down\" versus \"pivot\" obscures a potentially more viable path: adaptive reframing that modifies language and programmatic infrastructure, while sustaining core missions.</p><p><strong>Conclusions: </strong>Academic surgery should preserve its mission to train a diverse surgical workforce, advance rigorous science, and deliver equitable patient care. Adaptive reframing, by embedding equity-oriented work within quality improvement, workforce sustainability, and patient safety frameworks, offers a principled strategy for navigating evolving legal constraints, without abandoning institutional missions or scientific integrity.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178986","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":"Rethinking Education in Acute Care Surgery.","authors":"Alicia Rosenzveig, Dexter Choi, Sandy Widder, Morad Hameed, Nada Gawad","doi":"10.1097/SLA.0000000000007242","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007242","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149178971","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}