Annals of surgery最新文献

{"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}

{"title":"Chronic Pain and Sexual Dysfunction After Groin Hernia Repair in Adolescents: A Nationwide Survey.","authors":"Hugin Reistrup, Siv Fonnes, Jacob Rosenberg","doi":"10.1097/SLA.0000000000006716","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006716","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prevalence of chronic pain and sexual dysfunction after groin hernia repair in adolescents.</p><p><strong>Summary background data: </strong>Adolescents present unique challenges in groin hernia management due to their evolving anatomy, yet data on patient-reported outcomes remain limited.</p><p><strong>Methods: </strong>A nationwide survey was conducted in Denmark, linking patient-reported outcomes to the Danish National Patient Register and Civil Registration System. Patients who underwent primary unilateral groin hernia repair during adolescence (10-19 years) between 1992 and 2022 were identified. The primary outcome was chronic pain assessed with the short-form Inguinal Pain Questionnaire. Secondary outcomes included chronic pain assessed with the Activities Assessment Scale and sexual dysfunction assessed with the Sexual Inguinal Hernia Questionnaire.</p><p><strong>Results: </strong>Among 2,486 participants (response rate: 60.8%) completing the survey (80% male; median age at repair 16 [IQR, 12-19] years), 7.3% (95% CI, 6.3-8.4) reported chronic pain across all follow-up periods. In participants with less than 15 years of follow-up, 9% to 15% reported chronic pain depending on age at the time of repair and repair method. Chronic pain during sexual activity was reported by 8.6% (95% CI, 7.5-10) of participants. No significant differences in chronic pain or sexual dysfunction were observed between repair methods. Femoral hernia repairs were rare.</p><p><strong>Conclusions: </strong>Chronic pain and sexual dysfunction were common long-term complications of groin hernia repair in adolescents, regardless of repair methods. Optimizing outcomes could include a tailored, patient-centered approach by hernia experts, ensuring optimal care for this unique, young, low-volume population within hernia surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794601","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":"Change is Hardest Right Before the Glass Ceiling Breaks: An Update on Women Pursuing Careers in Academic Surgery at a National Level.","authors":"Haley Harris, Isabelle Tan, Yuqing Qiu, Julianna Brouwer, Jonathan Abelson, Julie Ann Sosa, Heather Yeo","doi":"10.1097/SLA.0000000000006718","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006718","url":null,"abstract":"<p><strong>Objectives: </strong>This study aims to provide a comprehensive update on the representation of women in academic surgery by specialty, measuring progress and opportunity with regard to women \"breaking\" the glass ceiling at the trainee, faculty, and department chair levels.</p><p><strong>Background: </strong>Over the past two decades, initiatives have contributed to educational awareness, culture shifts, and a focus on inclusive excellence in surgery, leading to an increase in the number of women surgeons. Despite progress, a persistent gender gap in surgical faculty positions remains, and projections suggest that it will take more than a century to reach parity at the highest levels of academic surgery.</p><p><strong>Methods: </strong>Data from the Association of American Medical Colleges FACTS and Faculty Rosters and the American Medical Colleges and Graduate Medical Education reports from 2006 to 2023 were analyzed to assess gender representation in surgery. Linear regression analyses were used to describe trends in the proportions of women who are promoted along the professional development pathway (resident to faculty to department chair) from 2006 to 2023.</p><p><strong>Results: </strong>Over our 17-year study period, all included surgical subspecialties increased in the proportion of women trainees, with the largest average annual increase in the proportion of women trainees observed in pediatric, plastic, and vascular surgery training programs. Although all surgical faculty levels experienced growth in the proportion of women, the average annual change in the proportion of women decreased as seniority increased. At the observed trend, it is projected that surgical department chairs will not achieve equal proportions of men and women until the year 2102.</p><p><strong>Conclusion: </strong>Across the board, the proportion of women in surgery has increased. However, there remains opportunity for improvement, particularly at the senior faculty and department chair levels. There continues to be significant opportunity around retention and promotion of women.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794647","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":"Treatment of Low Anterior Resection Syndrome in Specialized Multidisciplinary Late Sequelae Clinics: A Prospective Cohort Study.","authors":"Mira Mekhael, Helle Ø Kristensen, Mette Borre, Asbjørn M Drewes, Katrine J Emmertsen, Janne Fassov, Klaus Krogh, Michael B Lauritzen, Søren Laurberg, Jakob Lykke Poulsen, Ole Thorlacius-Ussing, Peter Christensen, Therese Juul","doi":"10.1097/SLA.0000000000006714","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006714","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcomes of a multidisciplinary effort involving surgical and gastroenterological departments in managing bowel dysfunction, specifically low anterior resection syndrome (LARS), following rectal cancer treatment.</p><p><strong>Summary background data: </strong>An increasing number of rectal cancer survivors experience LARS, heightening the need for specialized treatment.</p><p><strong>Methods: </strong>Patients referred to our late sequelae clinics with LARS following sphincter-preserving treatment were eligible for inclusion. Patients were treated in the surgical or gastroenterological units or both based on symptoms. Patients completed patient-reported outcome measures at the first visit, upon discharge, and 12 months after discharge. Treatment outcomes were evaluated by the LARS score and its five single items, six single items covering additional LARS symptoms, the EuroQoL 5-dimension 5-level (EQ-5D-5L) VAS and utility scores, self-rated bowel function, and bowel function impact on quality of life (QoL).</p><p><strong>Results: </strong>We included 201 patients. Three-quarters were treated in the surgical units, whereas the rest required gastroenterological treatment. After treatment, the mean LARS score decreased by 4.7 points (P<0.001), whereas the mean EQ-VAS and utility score increased by 7.1 (P<0.001) and 0.06 points (P<0.001), respectively. All individual symptoms significantly improved. Improvement in self-rated bowel function and bowel function impact on QoL were 55.8% (P<0.001) and 45.7% (P<0.001), respectively. Similar results were recorded at the 12-month follow-up.</p><p><strong>Conclusion: </strong>These results encourage establishing late sequelae clinics with a joint gastroenterological and surgical approach to treat LARS following rectal cancer treatment.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762584","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":"Beyond the Scalpel: Tackling Challenges Faced by LGBTQ+ Surgical Trainees and Faculty.","authors":"Steven Xie, Andrew Schlussel, Jenny Shao","doi":"10.1097/SLA.0000000000006715","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006715","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762449","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":"Enhancing Surgeons' Mindfulness, Well-being, and Performance: Insights From a Scoping Review.","authors":"Beth Frates","doi":"10.1097/SLA.0000000000006613","DOIUrl":"10.1097/SLA.0000000000006613","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"549-550"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876006","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":"Laparoscopic Pylorus-preserving Gastrectomy Versus Distal Gastrectomy for Early Gastric Cancer: A Multicenter Randomized Controlled Trial (KLASS-04).","authors":"Hyuk-Joon Lee, Young-Woo Kim, Do Joong Park, Sang Uk Han, Keun Won Ryu, Hyung-Ho Kim, Woo Jin Hyung, Ji-Ho Park, Yun-Suhk Suh, Oh-Kyung Kwon, Wook Kim, Young-Kyu Park, Hong Man Yoon, Sang-Hoon Ahn, Seong-Ho Kong, Han-Kwang Yang","doi":"10.1097/SLA.0000000000006503","DOIUrl":"10.1097/SLA.0000000000006503","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the long-term outcomes of laparoscopic pylorus-preserving gastrectomy (LPPG) with laparoscopic distal gastrectomy (LDG) for early gastric cancer.</p><p><strong>Background: </strong>Pylorus-preserving gastrectomy is considered a function-preserving surgery for early gastric cancer. However, there has been no multicenter randomized controlled trial comparing pylorus-preserving gastrectomy with distal gastrectomy until now.</p><p><strong>Methods: </strong>A multicenter randomized controlled trial (KLASS-04) with 256 patients with cT1N0M0 gastric cancer located in the mid portion of the stomach was conducted. The primary endpoint was the incidence of dumping syndrome at postoperative 1 year. Secondary endpoints included survival and recurrence, gallstone formation, nutritional parameters, gastroscopic findings, and quality of life for 3 years.</p><p><strong>Results: </strong>In the intention-to-treat analyses, there was no difference in the incidence of dumping syndrome at 1 year postoperatively (13.2% in LPPG vs 15.8% in LDG, P = 0.622). Gallstone formation after surgery was significantly lower in LPPG than in LDG (2.33% vs 8.66%, P = 0.026). Hemoglobin (+0.01 vs -0.76 gm/dL, P < 0.001) and serum protein (-0.15 vs -0.35 gm/dL, P = 0.002) were significantly preserved after LPPG. However, reflux esophagitis (17.8% vs 6.3%, P = 0.005) and grade IV delayed gastric emptying (16.3% vs 3.9%, P = 0.001) were more common in LPPG. Changes in body weight and postoperative quality of life were not significantly different between groups. Three-year overall survival and disease-free survival were not different (1 case of recurrence in each group, P = 0.98).</p><p><strong>Conclusions: </strong>LPPG can be used as an alternative surgical option for cT1N0M0 gastric cancer in the mid portion of the stomach.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"573-581"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103735","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}