Annals of surgery最新文献

{"title":"Perioperative Collagen IV-Targeted Ac2-26 Nanoparticles Enhance Anastomotic Healing in Acute Crohn's Disease-Like Colitis: A Preclinical Study on Systemic, Oral, and Rectal Delivery Routes.","authors":"Kamacay Cira,Vincent Vieregge,Sebastian Pollak,Jong Hyun Lee,Stefan Reischl,Robert Leon Walter,Zoe Clees,Atsuko Kasajima,Thomas Metzler,Helmut Friess,Nazila Kamaly,Philipp-Alexander Neumann","doi":"10.1097/sla.0000000000006929","DOIUrl":"https://doi.org/10.1097/sla.0000000000006929","url":null,"abstract":"OBJECTIVEThis preclinical study investigates a novel targeted collagen type IV nanoparticle formulation, Ac2-26 coated with chitosan and pectin ((pc)-Col-IV-Ac2-26-NPs), to promote anastomotic healing in a model of acute Crohn's disease (CD) with distal colo-colonic anastomosis, using intraperitoneal, oral and rectal delivery to optimize therapeutic effects while minimizing systemic immunosuppression.SUMMARY BACKGROUND DATASurgery remains critical for CD-patients due to irreversible tissue damage, with anti-inflammatory therapies increasing the risk of postoperative complications like anastomotic leaks.METHODFemale BALB/c mice (n=152) with CD-like colitis (2,4,6-Trinitrobenzenesulfonic acid) were randomized to receive (pc)-Col-IV-Ac2-26-NPs or scrambled NPs intraperitoneally, orally, or rectally every 3.5 days pre- and postoperatively, followed by distal end-to-end colo-colonic anastomosis. Perioperative outcomes (weight loss, disease activity index (DAI)), anastomotic healing scores (endoscopic, histologic), and immunohistochemical (IHC) markers were assessed on postoperative days (POD) 3 and 7.RESULTSNPs accumulated selectively at the anastomosis in a route-dependent manner and associated with higher collagen expression (P<0.0001), reduced pro-inflammatory (nuclear RelA; iNOS+-M1 macrophages, all P<0.0001) and increased pro-resolving markers (ANXA1; Arg-1+-M2 Macrophages, all P<0.0001) at the anastomotic site. These effects were most pronounced with rectal delivery, corresponding with improved preoperative DAI (P=0.03) and both endoscopic (POD3:P<0.0103; POD7:P<0.0077) and histologic (POD3:P<0.0112; POD7:P<0.0170) healing scores. While intraperitoneal delivery produced similar outcomes, oral delivery showed the weakest effect.CONCLUSION(pc)-Col-IV-Ac2-26-NPs promote anastomotic healing during CD-colitis through targeted, route-dependent immunomodulation and tissue repair, with rectal delivery showing the highest local efficacy. These findings support their potential as locally acting, non-immunosuppressive therapy for high-risk CD-patients undergoing intestinal surgery.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"64 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995882","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":"In vivo Hypothermic Perfusion Intestinal Auto-transplantation for Patients With Tumors Invading the Mesenteric Root Vascular System: An Unusual Consecutive 19-case Series (with video).","authors":"Peng Li, Chong Yang, Xinyu You, Jipeng Jiang, Donghui Cheng, Bangyou Zuo, Yu Zhang","doi":"10.1097/SLA.0000000000006924","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006924","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to investigate the safety and outcomes of radical resection combined with in vivo hypothermic perfusion and intestinal auto-transplantation (IATx) for tumors invading the mesenteric root vascular system.</p><p><strong>Background: </strong>Radical resection combined with IATx is safe and effective for mesenteric root tumors invading the vascular system. However, classic IATx procedures require removing the mesenteric root tumor as well as the small intestine and ascending colon for ex vivo hypothermic perfusion. These conditions result in more gastrointestinal anastomoses and resection of the ileocolonic junction, thereby extending the operation time and increasing the risk of severe complications postoperatively. In this study, the safety, feasibility, efficacy, and outcomes of alternative in vivo hypothermic perfusion and IATx were explored.</p><p><strong>Methods: </strong>This retrospective study analyzed data from 19 patients who underwent in vivo hypothermic perfusion and IATx for mesenteric root tumors invading the vascular system, especially the superior mesenteric artery (SMA) and superior mesenteric vein (SMV), between June 2022 and January 2024. The operative parameters, pathological findings, and surgical outcomes were systematically analyzed.</p><p><strong>Results: </strong>All patients successfully underwent in vivo hypothermic perfusion combined with IATx. The average operation time was 10.5 hours, with all patients achieving negative surgical margins. Indocyanine green fluorescence imaging revealed a stable blood supply to the intestines from the SMA. None of the patients experienced postoperative gastrointestinal bleeding or anastomotic leakage. Additionally, no patient died perioperatively or needed intravenous fluid infusion after discharge. Among the 19 patients included in this study, 3 had locally recurrent tumors resulting in 1 death; 3 had liver metastasis, while 13 exhibited no signs of recurrence or metastasis.</p><p><strong>Conclusion: </strong>In vivo hypothermic perfusion combined with IATx represents a safe and feasible option for treating mesenteric root tumors invading the vascular system, representing a curative approach in a selected patient group. However, further investigations of long-term oncological outcomes and multidisciplinary studies are needed to validate these findings.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939853","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":"Transitional Subtype of Circulating Tumor Cells in Early Post-Operative Period of 5-Year Survivors Following Resection of Pancreatic Ductal Adenocarcinoma.","authors":"Ammar A Javed, Ingmar F Rompen, Joseph R Habib, Jin He, Christopher L Wolfgang","doi":"10.1097/SLA.0000000000006925","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006925","url":null,"abstract":"<p><strong>Objectives: </strong>The objective was to assess the ability of circulating tumor cells (CTCs) to predict long-term survival (LTS, >5 y after resection) in pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Summary of background data: </strong>Predictors of LTS remain poorly understood in PDAC.</p><p><strong>Methods: </strong>Patients enrolled in the prospective CLUSTER Trial for serial assessment of CTCs, undergoing PDAC resection were included (2016-2018). Number of epithelial (eCTCs) and transitional (trCTCs) CTCs were serially assessed. Clinicopathological factors and CTC characteristics associated with LTS were identified and their ability to predict LTS was assessed.</p><p><strong>Results: </strong>In 133 patients, 41% and 82% received neoadjuvant and/or adjuvant therapy, respectively. LTS was achieved by 17% patients. Nodal disease and perineural invasion (PNI) were present in 62%, and 80% of patients, respectively. Preoperatively eCTCs and trCTCs were observed in 97% and 68% of patients as compared to 77% and 27% postoperatively. PNI (OR:0.19,95%CI:0.06-0.60), nodal disease (OR:0.28,95%CI:0.09-0.82), and postoperative trCTCs (OR:0.04,95%CI:0.01-0.38) were independently associated with LTS. A clinical score based on PNI and nodal disease demonstrated an AUC of 0.79 (95%CI:0.69-0.89) in predicting LTS. Addition of postoperative trCTC into a translational score demonstrated an AUC of 0.84 (95%CI:0.75-0.92). Upon internal validation the clinical and translational scores had AUCs of 0.78 (95%CI:0.67-0.89) and 0.84 (95%CI:0.73-0.92), respectively (P<0.001).</p><p><strong>Conclusions: </strong>Patients with residual postoperative trCTCs are unlikely to achieve LTS and trCTCs emerge as one of the strongest predictors of LTS in resected PDAC. Inclusion of postoperative trCTC status to clinicopathological factors improves our ability to predict LTS.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939881","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":"Moving the Needle on Health System Care Delivery: From Observation to Intervention.","authors":"Calista Harbaugh, Kristy Broman","doi":"10.1097/SLA.0000000000006927","DOIUrl":"10.1097/SLA.0000000000006927","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939833","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":"Association of Neighborhood Socioeconomic Status and Ethnic Diversity with Failure to Rescue in Curative-intent Colorectal Cancer Surgery: A Population-based Cohort Study.","authors":"Adom Bondzi-Simpson, Tiago Ribeiro, Andrea Covelli, Aisha Lofters, Rinku Sutradhar, Rebecca A Snyder, Callisia N Clarke, Natalie G Coburn, Julie Hallet","doi":"10.1097/SLA.0000000000006928","DOIUrl":"10.1097/SLA.0000000000006928","url":null,"abstract":"<p><strong>Objective: </strong>To examine the association between neighborhood-level socioeconomic status (SES) and ethnic diversity and failure to rescue (FTR) after curative-intent colorectal cancer (CRC) resection.</p><p><strong>Background of data: </strong>FTR is an outcome reflecting a system's ability to detect and treat clinical deterioration after complications. However, little is known about how social characteristics influence FTR in oncologic populations.</p><p><strong>Methods: </strong>We conducted a population-based retrospective cohort study of adults undergoing resection for stage I-III CRC (2007-2020). Exposures were SES and ethnic diversity defined by ecologic measures from census data. The primary outcome was FTR, defined as in-hospital death following a major postoperative complication. Logistic regression examined the association between exposures and FTR while adjusting for confounders. Subgroup analysis explored associations by cancer site and procedure setting.</p><p><strong>Results: </strong>Among 60,470 patients included, FTR occurred in 1,158 (1.9%). Of those, 25.0% resided in the lowest SES neighborhood (5th quintile) versus 16.9% in the highest (1st quintile) (P<0.001), and 18.5% resided in the most ethnically diverse neighborhoods (5th quintile) versus 21.2% in the least (1st quintile, P=0.12). After adjustment, residing in the lowest SES (Odds Ratio, OR 1.26; 95% confidence interval, CI 1.05-1.52) or most ethnically diverse neighborhoods (OR 1.53, 95%CI 1.26-1.85) was associated with higher odds of FTR compared to patients residing in the highest SES or least ethnically diverse neighborhoods. These observations persisted in the colon but not rectal cancer subgroup and in the emergency but not elective setting.</p><p><strong>Conclusion: </strong>These findings outline inequalities in post-operative outcomes by social characteristics pointing towards potential gaps in structures of care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939875","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":"Prevention of Liver-related Surgical Site Infections in Combined Liver and Colorectal Surgery.","authors":"Donatien Fouché, Stylianos Tzedakis, David Fuks, Antoine Dewitte, Benjamin Fernandez, Bertrand Célérier, Lara Boissieras, Christophe Laurent, Jean-Philippe Adam, Louise Peugeot, Ugo Marchese, Arthur Marichez, Laurence Chiche","doi":"10.1097/SLA.0000000000006926","DOIUrl":"10.1097/SLA.0000000000006926","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate the role of short-course (72h) postoperative antibiotic prophylaxis (PPA) in reducing liver-specific surgical site infections (liver-SSI) incidence.</p><p><strong>Summary background data: </strong>Simultaneous liver and colorectal resections (SLCR) represent a valid oncologic strategy for colorectal liver metastases, however, this approach has been reported to increase the risk of postoperative liver-SSIs.</p><p><strong>Methods: </strong>Patients undergoing SLCR (2012-2024) in two tertiary centers were included and divided into two groups: patients receiving intraoperative antibiotic prophylaxis alone (IPA) and those receiving additional PPA. Outcomes included liver-SSI incidence, severe morbidity (Clavien-Dindo grade III-IV), and length of hospital stay. Matching (PSM) and Inverse Probability Treatment Weigthing (IPTW) on a propensity score and mixed-effects models were employed to adjust for confounders and center-level clustering. We tested for interactions with the liver resection approach (laparoscopy-laparotomy) and extend (major-minor).</p><p><strong>Results: </strong>Of 250 patients (median [95%CI] age: 67.0 years [65.0-68.0], 58.0% men), 40% (n=100) received PPA. Liver-SSI was significantly less frequent in the PPA group (11% vs. 29.3%; P<0.001), with consistent results across centers and across resection approach (pinteraction=0.451) and extend (pinteraction=0.490). The PPA group experienced shorter hospital stay (8.0 days [7.0-10.0] vs. 11.0 days [9.0-12.0], P=0.045) and fewer severe complications (15% vs. 29.3%, P=0.01). PPA was independently associated with a reduced risk of liver-SSI before (OR: 0.24, 95%CI:0.09-0.57, P=0.002) and after matching (ORPSM: 0.27, 95%CI: 0.09-0.73, P=0.014) and IPTW (ORIPTW: 0.27, 95%CI: 0.15-0.47, P<0.001).</p><p><strong>Conclusions: </strong>PPA is associated with a significant liver-SSI reduction following SLCR and our findings support its use, warranting further validation in prospective randomized studies.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939821","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":"Leadership in Surgery: Insights from the Helm of Academic Medicine.","authors":"Syed Shahyan Bakhtiyar","doi":"10.1097/SLA.0000000000006930","DOIUrl":"10.1097/SLA.0000000000006930","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939862","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":"Timing Is Everything: Early Initiation of VTE Prophylaxis Following Major Trauma Is Effective and Safe.","authors":"Andrew J Kerwin, Saskya Byerly, Dina M Filiberto, Emily K Lenart, Martin A Croce, Ernest E Moore, Mary Margaret Knudson","doi":"10.1097/SLA.0000000000006784","DOIUrl":"10.1097/SLA.0000000000006784","url":null,"abstract":"<p><strong>Objective: </strong>To examine the efficacy and safety of the initiation of pharmacologic venous thromboembolism (VTE) prophylaxis within 24 hours of admission for major trauma patients at risk for VTE.</p><p><strong>Background: </strong>Pharmacologic VTE prophylaxis following major trauma is essential, but there is a fear of bleeding complications. The safety of initiating treatment within 24 hours of admission has not been established.</p><p><strong>Methods: </strong>We examined the efficacy and safety of early initiation of pharmacologic VTE prophylaxis. Patients were stratified by time to initiation [≤24 h (EARLY) or >24 h (LATE)] and compared. VTE, VTE prophylaxis agents, and bleeding complications secondary to VTE prophylaxis were analyzed. A generalized linear mixed model (GLMM) was performed to identify predictors of VTE.</p><p><strong>Results: </strong>There were 3369 EARLY group patients and 3200 LATE group patients. More patients in the LATE group developed VTE (7.8% vs. 2.8%; P <0.001). Among 345 patients with VTE, deep venous thrombosis (DVT) alone [181 (72%) vs. 61 (65%)], pulmonary embolism (PE) alone [46 (18%) vs. 22 (23%)] and both DVT and PE [24 (10%) vs. 11 (12%)] were present in the LATE compared with the EARLY group. The LATE group had a higher incidence of increased or new intracranial hemorrhage following prophylaxis initiation (0.5% vs. 0.2%; P =0.009) and higher mortality (1.8% vs. 0.6%; P <0.001). GLMM demonstrated that EARLY VTE prophylaxis was associated with a lower risk of VTE [odds ratio (OR): 0.58; 95% CI: 0.44-0.78; P <0.001], after controlling for covariates.</p><p><strong>Conclusions: </strong>Initiating VTE prophylaxis within the first 24 hours after admission resulted in a 42% reduction of the risk of VTE without increased risk of bleeding and should be regarded as the standard of care, even in traumatic brain injury patients.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"382-388"},"PeriodicalIF":6.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257149","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":"First National Effort to Optimize the Performance of Cancer Surgery by the American College of Surgeons Commission on Cancer and Cancer Surgery Standards Program: Early Results After Implementation of the Operative Standards.","authors":"Matthew H G Katz, Amanda B Francescatti, Timothy W Mullett, James Harris, Aaron D Bleznak, Heidi Nelson, Ronald J Weigel, Erin K Reuter, Bell M Pastore, Elizabeth C Funk, Kelley Chan, Peter J Carpenter, William R Burns, Mediget Teshome, Timothy J Vreeland, Kelly K Hunt, Tina J Hieken","doi":"10.1097/SLA.0000000000006785","DOIUrl":"10.1097/SLA.0000000000006785","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the first 3 years of compliance with the American College of Surgeons Commission on Cancer (CoC) Operative Standards.</p><p><strong>Background: </strong>CoC implemented evidence-based standards to improve the quality of sentinel lymph node biopsy and axillary lymph node dissection for breast cancer (operative standards 5.3 and 5.4), wide local excision for melanoma (5.5), colectomy for colon cancer (5.6), proctectomy for rectal cancer (5.7), and pulmonary resection for lung cancer (5.8) at ∼1400 programs treating >74% of US cancer patients. Each operative standard defines a technical element of the operation and structured documentation.</p><p><strong>Methods: </strong>Compliance data are from site visits conducted between January 1, 2022, and December 31, 2024 (implementation/site visits began in 2021/2022 for 5.7 and 5.8 and 2023/2024 for 5.3-5.6). Compliance with each operative standard was determined by evaluation of 7 operative (5.3-5.6) or pathology (5.7, 5.8) reports. Deficiency in technical performance, documentation, or both was considered noncompliance.</p><p><strong>Results: </strong>Reviewers conducted 974 site visits of Comprehensive Community (44%), Community (23%), Academic Comprehensive (16%), network (12%), NCI-Designated Comprehensive (4%), and other (1%) cancer programs. Program compliance rates ranged from 53% to 88%. Documentation noncompliance was more common for standards 5.3 to 5.6 (based on operative reports), and technical noncompliance was more common for 5.7 and 5.8 (based on pathology reports). Compliance significantly ( P =0.006) varied by program type for 5.8 (highest: 66% at NCI-designated Comprehensive programs; lowest: 37% at Community Cancer programs).</p><p><strong>Conclusions: </strong>Early compliance with CoC operative standards varied, indicating local and large-scale national quality improvement efforts are needed.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"371-381"},"PeriodicalIF":6.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265113","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":"Impact of a Patient-centered Program for Low Anterior Resection Syndrome: A Multicenter, Single-blinded, Randomized Controlled Trial.","authors":"Richard Garfinkle, Marie Demian, Sarah Sabboobeh, Sahir Bhatnagar, Julie Savard, Sebastien Drolet, Sender A Liberman, Carl J Brown, Jason Park, Jeongyoon Moon, Carmen G Loiselle, Steven D Wexner, Liliana Bordeianou, Gabriela Ghitulescu, Julio Faria, Nancy Morin, Carol-Ann Vasilevsky, Marylise Boutros","doi":"10.1097/SLA.0000000000006777","DOIUrl":"10.1097/SLA.0000000000006777","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the impact of a low anterior resection syndrome (LARS) patient-centered program (LARS-PCP)-an informational and guided self-management intervention-on global quality of life (QoL) after surgery in comparison to standard care.</p><p><strong>Background: </strong>Self-management using conservative measures is the cornerstone of LARS treatment; however, due to the individual and symptom-based nature of LARS, self-management largely consists of unguided troubleshooting with minimal success.</p><p><strong>Methods: </strong>Adult patients who had undergone a restorative proctectomy with a diverting ostomy and who were scheduled for ostomy closure were randomized in a 1:1 ratio into 1 of 2 arms: LARS-PCP or standard care. The LARS-PCP consisted of an informational tool and nursing support centralized from one institution. Outcomes were measured with the use of patient-reported outcomes measures at various timepoints over the 12-month follow-up period. The primary outcome was global QoL at 6 months after ostomy closure.</p><p><strong>Results: </strong>In total, 160 patients were randomized: 78 to the LARS-PCP and 82 to standard care. At 6 months after ostomy closure, LARS-PCP was associated with a higher mean global QoL (79.7 ±8.7 vs. 67.8 ±9.5, P= 0.001). This association was maintained at 12-month follow-up (82.0 ±9.1 vs. 74.9 ±10.1, P= 0.036). The incidence of major LARS was lower at 1-month (60.0% vs. 81.7%, P =0.008) postoperatively among LARS-PCP participants but was similar at 3, 6, and 12 months.</p><p><strong>Conclusions: </strong>This was the first multicenter randomized controlled trial to demonstrate that nurse-guided LARS self-management improved QoL after restorative proctectomy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"361-370"},"PeriodicalIF":6.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273976","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}