Annals of surgery最新文献

{"title":"SETI-The Semi-Elective Transplant Initiative: A Systems-Based Approach to Expanding Kidney Transplant Access Through Operational Redesign.","authors":"Christof Kaltenmeier, Steven I Hanish, Santosh Nagaraju, Tara Barry, Eric D Bolin, Patrick J Cawley, Pravin Meenashi Sundaram, Tom Crawford, Kannan Samy, Diego Di Sabato, Dirk J van der Windt, John W McGillicuddy, Amanda Celia, Prabhakar K Baliga, Joseph Scalea","doi":"10.1097/SLA.0000000000007235","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007235","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether formal integration of preservation strategy with predictable operating room access was associated with measurable changes in transplant timing, preservation practice, the logistical profile of transplanted grafts, and early clinical outcomes.</p><p><strong>Summary background data: </strong>Deceased donor kidney transplantation remains a reactive process requiring urgent mobilization of hospital resources. As volumes increase and hospitals operate near capacity, this creates operational barriers that limit organ utilization. We report a retrospective evaluation of a prospectively implemented operational redesign; the design does not support causal inference.</p><p><strong>Methods: </strong>Adult deceased-donor kidney transplants (January 2022-June 2025) were grouped into pre-SETI, SETI-1 (expanded machine perfusion), and SETI-2 (morning operating room access). A contemporaneous SRTR cohort (N=12,302) served as the comparator.</p><p><strong>Results: </strong>Among 936 transplants, mean cold ischemia time (CIT) increased after SETI (20.2→21.9 h, P=0.0039). Donation after circulatory death (DCD) kidneys with CIT >30 hours increased from 0.5% pre-SETI to 7.7% after full implementation (P<0.0001). Overnight perfusion increased more than 3-fold, and operative starts shifted toward 8-10 AM. Kidney Donor Profile Index rose across eras (median: 29→33→43, P<0.001). No significant differences were observed in DGF (41.4→38.2%, P=0.071) or graft failure (5.4→3.2%, P=0.34); these comparisons were underpowered and do not establish equivalence. Donor hypertension predicted graft failure, whereas CIT, DCD status, and SETI era did not.</p><p><strong>Conclusions: </strong>Systems-based operational redesign transformed reactive deceased-donor kidney transplantation into a proactive model, enabling transplantation of a greater proportion of logistics-sensitive grafts, including DCD kidneys and organs with prolonged CIT, within existing healthcare resources. Whether this increases net organ utilization was not established by these data.</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":"149178926","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":"De-escalation of Axillary Surgery in Early Breast Cancer: Translating SOUND and INSEMA into Clinical Practice.","authors":"Lisa R Allen, George Plitas, Ross Sawka, Andrea V Barrio, Kimberly N Feigin, Diana A Roth O'Brien, Deborah Capko, Daniel X Choi, Stephanie Downs-Canner, Mahmoud El-Tamer, Andreas Giannakou, Neha Goel, Alexandra S Heerdt, Laurie J Kirstein, Minna K Lee, Anita Mamtami, Giacomo Montagna, Tracy-Ann Moo, Kate R Pawloski, Virgilio Sacchini, Audree B Tadros, Varadan Sevilimedu, Monica Morrow","doi":"10.1097/SLA.0000000000007232","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007232","url":null,"abstract":"<p><strong>Objective: </strong>To prospectively evaluate how often axillary staging can successfully be omitted in postmenopausal HR+/HER2- patients.</p><p><strong>Background: </strong>Three randomized trials showed no difference in recurrence or survival outcomes with omission of sentinel lymph node biopsy (SLNB) in cT1-T2N0 patients with a negative axillary ultrasound (AUS) undergoing breast-conserving surgery (BCS). We prospectively evaluated applicability of this approach.</p><p><strong>Methods: </strong>From 3/1/24 to 9/1/25, SLNB was omitted in postmenopausal women age 50-70 years with unicentric or multifocal, clinical stage 1, grade 1/2, HR+/HER2- cancers and a normal AUS undergoing BCS. After the results of INSEMA were reported, tumors up to 2.5 cm were included. Patients with pathology showing grade 3, T≥3 cm, or HR- or HER2+ underwent multidisciplinary discussion regarding the need for SLNB.</p><p><strong>Results: </strong>In 437 patients with 442 cancers, the median patient age was 63 years, median mammographic tumor size was 0.9 cm, and 74% were grade 2. A total of 34 patients (8%) had high-risk features on final pathology (grade 3, n=20; T≥3 cm, n=11; HER2+, n=3) and 14 (3.2%) had SLNB. Of these, 2 had SLN metastases. A total of 96% of patients received radiotherapy (40% whole breast, 56% partial breast), 415 (95%) received adjuvant endocrine therapy, and 31 (7%) received chemotherapy. At 7.7-month median follow-up, there have been no axillary recurrences.</p><p><strong>Conclusion: </strong>Adoption of the SOUND, INSEMA, and BOOG 13-08 data allowed omission of SLNB in 97% of postmenopausal patients age ≤70 years with cT1-2N0, grade 1/2, HR+/HER2- cancers and a normal AUS, reducing the burden of treatment.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164318","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":"What Factors Drive Female Surgeons to Change Jobs or Leave Medicine Altogether?","authors":"Stephanie F Brierley, Kathleen Heller, Kathleen van Leeuwen, Gwen M Grimsby","doi":"10.1097/SLA.0000000000007236","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007236","url":null,"abstract":"<p><strong>Objective: </strong>To explore reasons female surgeons change jobs or leave medicine entirely.</p><p><strong>Summary of background data: </strong>Only a quarter of physicians in surgical specialties are female. Identifying reasons for career dissatisfaction is crucial to improve retention.</p><p><strong>Methods: </strong>An anonymous survey was distributed via private female physician social media groups (physician credentials required) and email communication from 2/2024 to 5/2024. Respondents' demographics, personal and professional characteristics, and job transitions were collected. Respondents who have not changed jobs or left medicine were excluded. Respondents were categorized into female surgeons or female nonsurgeons, and responses were compared between the 2 groups.</p><p><strong>Results: </strong>A total of 593 surveys were included: 170 (28.7%) female surgeons and 423 (71.3%) female nonsurgeons. Among surgeons, 10 (5.9%) left medicine and 167 (99.4%) changed jobs at least once. Compared with nonsurgeons, surgeons were more frequently non-Hispanic/Latino ethnicity (97.6% vs. 92.3%, P=0.016), more frequently completed fellowship training (58.8% vs. 40.4%, P<0.001), and a higher proportion currently worked in an academic clinical job (44.1% vs. 30%, P=0.002). All other demographics, personal and professional characteristics were comparable between the 2 groups. Surgeons more frequently identified pay inequity (5.3% vs. 1.2%, P=0.005) and harassment/bullying/discrimination (15.3% vs. 6.4%, P<0.001) as the primary reasons for their job change, while nonsurgeons more frequently cited long hours (39.5% vs. 28.7%, P=0.015).</p><p><strong>Conclusions: </strong>Pay inequity and harassment/bullying/discrimination emerged as primary factors driving job changes among female surgeons compared with nonsurgeons. Nearly half of all surgeons indicated an improved work environment and culture could have prevented them from leaving. Efforts are needed to address these concerns and improve retention.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149163940","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":"Postoperative Day 2 C-reactive Protein Identifies Patients at Low Risk of Anastomotic Leakage After Colon Cancer Resection.","authors":"Saija Sinimäki, Claus L Andersen, Jesper Nors, Claudia Jaensch, Annette Boesen Bräuner, Per V Andersen, Mads Klein, Lene H Iversen, Kåre A Gotschalck","doi":"10.1097/SLA.0000000000007234","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007234","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether C-reactive protein (CRP) <100 mg/L on postoperative day (POD) 2 excludes anastomotic leakage (AL) after colon cancer resection.</p><p><strong>Summary background data: </strong>CRP <100 mg/L on POD3 is widely used to exclude AL, but enhanced recovery after surgery (ERAS) increasingly discharges patients before POD3, highlighting the need for an earlier biochemical criterion.</p><p><strong>Methods: </strong>This two-cohort multicenter diagnostic accuracy study included patients undergoing elective colon cancer resection with primary anastomosis. AL was defined as Clavien-Dindo grade ≥3. POD2 CRP <100 mg/L was evaluated for excluding AL. In patients with POD2 CRP ≥100 mg/L, POD3 dynamics were evaluated using a POD3/POD2 ratio <1.</p><p><strong>Results: </strong>AL occurred in 4.0% and 4.7% of patients in test (n=401) and validation (n=213) cohorts. POD2 CRP <100 mg/L was present in 240 (60%) and 97 (46%) patients, with AL in only 1.3% and 1.0%, yielding negative predictive values (NPVs) of 98.8% and 99.0%. In contrast, AL occurred in 8.1% and 7.8% of patients with POD2 CRP ≥100 mg/L. In the combined cohort, a POD3/POD2 ratio <1 further stratified risk among these higher-risk patients, with NPVs of 98.9% and 97.9% for minimally invasive and open surgery, respectively, and using this two-step strategy, nearly 90% of patients could be discharged by POD2 or 3 with AL risk near 1%.</p><p><strong>Conclusions: </strong>POD2 CRP <100 mg/L, supplemented by selective POD3 reassessment, provides a simple algorithm to support safe early discharge after colon cancer resection within ERAS pathways.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134926","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 Cost of Uncertainty: Can We Afford to Miss Residual Disease?","authors":"Folarin Adeyemi, Daniela Molena","doi":"10.1097/SLA.0000000000007233","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007233","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126371","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":"Surgical Artificial Intelligence Innovation Trends and Regulatory Insights: A Systematic Analysis of Food and Drug Administration-Approved Devices.","authors":"Rishikesh Gandhewar, Ahmad Guni, Devansh Tandon, Sonam Patel, William Waldock, Nafi Dilaver, Haoyu Zhang, Krsto Pandza, Ara Darzi, Hutan Ashrafian","doi":"10.1097/SLA.0000000000007229","DOIUrl":"10.1097/SLA.0000000000007229","url":null,"abstract":"<p><strong>Objective: </strong>To characterise the landscape of surgical artificial intelligence (AI) devices approved by the US Food and Drug Administration (FDA).</p><p><strong>Background: </strong>AI has the potential to improve surgical pathways, offering capability across screening, diagnosis, decision support, and intraoperative care. Despite this, real-world adoption remains limited. Regulatory approval serves as a key step in clinical translation but is influenced by challenges in evidence generation, safety, bias, transparency, and implementation. Consequently, the characteristics, evidence base, and functional roles of FDA-cleared surgical AI devices remain incompletely defined.</p><p><strong>Methods: </strong>FDA-cleared AI/machine learning medical devices were systematically screened for surgical relevance up to July 2025. Eligible devices were extracted for clinical application, underlying AI technology, evidence quality, and regulatory pathway. Devices were categorised using an adapted descriptive, diagnostic, predictive, prescriptive framework, and predicate networks were evaluated for risk of predicate creep. Analyses were performed in R.</p><p><strong>Results: </strong>A total of 314 devices (25.1%) had surgical applications. Most were imaging-based devices and mapped to general surgery (24.8%), orthopaedic surgery (18.2%), neurosurgery (17.2%), and cardiac surgery (10.8%). The majority of devices were descriptive (50.6%) or diagnostic (40.4%), with relatively few predictive (1.3%) or prescriptive (7.6%) applications. Clinical validation was predominantly based on retrospective or bench studies, with only 5.1% supported by higher-quality prospective evidence. The premarket notification 510(k) pathway accounted for 95.2% of approvals. Among these, 37.5% demonstrated a high risk of predicate creep, reflecting substantial differences in intended use or technological characteristics compared with predicate devices.</p><p><strong>Conclusion: </strong>FDA-approved surgical AI devices are currently dominated by imaging-based diagnostic tools.The widespread reliance on the 510(k) pathway and the observed prevalence of predicate creep highlight important considerations for regulatory evaluation. As AI applications expand toward predictive and interventional roles, improved evidence transparency and robust assessment of device equivalence will be essential to support safe clinical adoption.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149134908","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 Extent of Surgical Resection on Survival in Patients With High-risk Neuroblastoma","authors":"Christa N. Grant,Arlene Naranjo,Fan F. Zhang,Lisa R. Diller,Erin G. Brown,James D. Geiger,John J. Doski,Daphne A. Haas-Kogan,Jed G. Nuchtern,Andrew M. Davidoff,Julie Park,Steven G. DuBois,Rochelle Bagatell,Dave R. Lal,Erika A. Newman","doi":"10.1097/sla.0000000000007228","DOIUrl":"https://doi.org/10.1097/sla.0000000000007228","url":null,"abstract":"Objective: The impact of extent of resection of the primary tumor on outcomes in patients with high-risk neuroblastoma (HRNB) remains uncertain. We evaluated this issue in patients with HRNB treated on a prospective trial of multimodality therapy. Summary of Background Data: Patients with HRNB enrolled on COG ANBL0532 who underwent surgical resection of their primary tumor during induction were included. Extent of resection was defined by the surgeon as complete excision (CE) if ≥90% of the tumor was resected, and incomplete excision (IE) if &lt;90% was resected. Methods: Overall and event-free survival (OS, EFS) were estimated from time of surgery and compared between groups with a log-rank test. Cumulative incidence of local progression (CILP) was estimated using competing risks analysis and compared between groups with Gray test. Results: A total of 326 patients met inclusion criteria (CE=269, IE=57). Demographics were comparable between groups. CE was more likely in patients with adrenal tumors, MYCN -amplified tumors, and those without image-defined risk factors ( P &lt;0.05). Patients with CE had improved 5-year EFS (50.3%±3.3% vs. 31.0%±6.4%; P =0.0016) and OS (61.8%±3.1% vs. 41.1%±6.9%; P =0.0094) and decreased 5-year CILP (12.8%±2.1% vs. 24.8%±5.8%; P =0.0306). When stratified by extent of resection and autologous stem-cell transplant type, patients with CE randomized to tandem transplant had the highest 5-year EFS, while patients with IE and single transplant had inferior outcomes (57.9±5.5% vs. 18.5±11.8%; P =0.0411). Among patients who received immunotherapy CE was associated with improved 5-year EFS. There was no difference in surgical complications between IE and CE. Conclusions: CE of the primary tumor was associated with significantly higher EFS, OS, and decreased CILP, with no increase in surgical complications. As part of a comprehensive, multimodal treatment strategy, complete primary tumor resection when feasible is a critical component of therapy.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"8 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088079","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":"Pan-European Training Program for Robotic Pancreatoduodenectomy (LEARNBOT)","authors":"Leia R. Jones,Maurice J.W. Zwart,Felix Nickel,Thilo Hackert,Freek Daams,Bas Groot Koerkamp,Quintus Molenaar,Ugo Boggi,Olivier Saint Marc,Philip Leenart,Rawin Amiri,Mahsoem Ali,Sebastiaan Festen,Olivier Busch,Paul S. Krohn,Ernesto Sparrelid,Bergthor Björnsson,Christian Toso,Edoardo Rosso,Benjamin Strücker,Peter Strandberg-Holka,Maxime Dewulf,Maximilian Schmeding,Emre Bozkurt,Giovanni Ferrari,Steve White,Emanuel Vigia,Zahir Soonawalla,Martijn Stommel,Tim Worthington,Martin Lovecek,Declan Dunne,Giovanni Marchegiani,Filip Gryspeerdt,Melissa E. Hogg,Mohammad Abu Hilal,Marc G. Besselink,for the European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)","doi":"10.1097/sla.0000000000007170","DOIUrl":"https://doi.org/10.1097/sla.0000000000007170","url":null,"abstract":"Objective: To assess the feasibility of and clinical outcomes after a pan-European training program for robotic pancreatoduodenectomy (RPD). Summary Background Data: The implementation of RPD into clinical practice comes with considerable challenges, leading to concerns about patient safety, oncological outcomes, and costs. To address this, a structured training program was implemented in which 2 surgeons at each of the 20 sites were trained and maintained as a consistent operative team. Study Design: A structured training program for RPD was implemented, and outcomes prospectively collected in 20 European high-volume centers, all without previous RPD experience, from 12 countries. The program included a video library, biotissue simulation (pancreaticojejunostomy and hepaticojejunostomy), off-site RPD case observations, and on-site proctoring. Surgeons’ simulation anastomoses were assessed using Objective Structured Assessment of Technical Skills (OSATS) and technical errors. The primary endpoint was intra- and postoperative patient outcome. A key secondary analysis assessed safety using OSATS scores and error counts, and major correlated with conversion and postoperative outcomes. Results: Overall, 486 RPD procedures were performed. Median intraoperative blood loss was 200 mL (IQR: 100–400), operative time was 475 minutes (IQR: 414–553.3), and the conversion rate was 18.3% (n=89). The rate of Clavien-Dindo grade ≥III complications was 31.4% (n=153), POPF was 21.2% (n=103), delayed gastric emptying was 15% (n=73), postpancreatectomy hemorrhage was 8.6% (n=42), and in-hospital/30-day mortality was 2.7% (n=13). Median length of stay was 12 days (IQR: 8–20). During simulation training, OSATS scores significantly improved (0.350 points/attempt ( ρ ), P &lt;0.001) while the duration of reconstruction decreased ( P &lt;0.001). Multivariable analysis found no association between error count and major complications. Conclusions: We report on the first successfully completed international training program for RPD. Simulation established a standardized technical competency, although a learning-curve effect (major complications) remained detectable per center. These data highlight that safe adoption of complex procedures requires structured, team-based, proctored training beyond simulation alone.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"41 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088077","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 Side-to-Side Versus End-to-Side Gastrojejunostomy on the Rate of Delayed Gastric Emptying After Pancreatoduodenectomy (IPAD study)","authors":"Fabien Robin,Edouard Wasielewski,Mohamed A. Chaouch,Chloé Rousseau,Anaïs Palen,Raffaele V. De Rosa,Jacques Ewald,Alessia Fassari,Aude Merdrignac,Marie Livin,Yolene Pages,Bruno Laviolle,Olivier Turrini,Jonathan Garnier,Laurent Sulpice","doi":"10.1097/sla.0000000000007182","DOIUrl":"https://doi.org/10.1097/sla.0000000000007182","url":null,"abstract":"Objective: To evaluate whether side-to-side gastrojejunostomy (SSGJ) reduces delayed gastric emptying (DGE) compared with end-to-side gastrojejunostomy (ESGJ) after pancreatoduodenectomy (PD). Summary Background Data: DGE is one of the most frequent complications after PD, leading to prolonged recovery and increased morbidity. Retrospective studies have suggested that the configuration of the gastrojejunostomy may influence DGE, but no randomized trial has confirmed this. Methods: The IPAD study was a prospective, randomized, open-label trial conducted at 2 high-volume pancreatic centers in France. Adult patients undergoing PD for benign or malignant disease were randomized intraoperatively (1:1) to SSGJ or ESGJ and followed for 90 days. The primary endpoint was the incidence of DGE. Secondary endpoints included postoperative complications, nutritional outcomes, and quality of life (QoL) assessed at 90 days using the GastroIntestinal Quality of Life Index (GIQLI). Results: From May 1, 2021 to July 1, 2023, among 171 screened patients, 158 were randomized (79 per group). Baseline characteristics were comparable except for sex distribution and rates of hypertension and chronic obstructive pulmonary disease. DGE occurred in 38.0% of patients after SSGJ and 30.4% after ESGJ (risk ratio 1.25; 95% CI: 0.81–1.94; P =0.314). Rates of pancreatic fistula, biliary fistula, reintervention, and mortality were similar. At 90 days, nutritional parameters and GIQLI scores (87.9 vs. 86.6; P =0.68) did not differ between groups. Conclusions: The present RCT found no significant difference in the rate of DGE between SSGJ and ESGJ. Postoperative outcomes, nutritional status, and quality of life were comparable, indicating that both techniques yielded comparable outcomes.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"15 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088081","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":"Well-being, Learning Environment, and Mistreatment Among Unionized Versus Nonunionized Surgery Residents During the COVID-19 Pandemic","authors":"Alexa J. Hughes,Maya L. Hunt,Brian M. Ruedinger,Amy L. Holmstrom,Josh S. Eng,Jeanette W. Chung,Yue-Yung Hu,Thomas J. Nasca,Karl Y. Bilimoria","doi":"10.1097/sla.0000000000007226","DOIUrl":"https://doi.org/10.1097/sla.0000000000007226","url":null,"abstract":"Objective: To evaluate whether residency program unionization was associated with differences in resident well-being, learning environment, and mistreatment during the COVID-19 pandemic. Background: Resident unionization increased following the COVID-19 pandemic, driven by concerns regarding well-being and working conditions. However, evidence regarding the impact of unionization on resident outcomes remains limited. Methods: This difference-in-differences (DiD) study used data from a national survey administered to general surgery residents following the American Board of Surgery In-Training Examination from 2020 to 2023. We compared responses obtained before the pandemic (January 2020) and during the pandemic (January 2021), with 2022–2023 data included in sensitivity analyses. Residents from 310 programs (94.5% of eligible programs) were included, of which 30 (9.7%) were unionized. Outcomes included resident well-being (burnout, thoughts of attrition, and suicidal ideation), learning environment (duty-hour violations, protected educational time, and program responsiveness to resident concerns), and mistreatment. Results: A total of 13,539 responses were analyzed (response rates: 85.5% in 2020 and 81.2% in 2021). Unionization was not significantly associated with changes in burnout (DiD P =0.06), thoughts of attrition (DiD P =0.83), or suicidal ideation (DiD P =0.25). No significant differences were observed in duty-hour violations (DiD P =0.56) or protected educational time (DiD P =0.51). By 2023, nonunionized programs showed greater improvement in duty-hour violations (DiD P =0.003) and protected educational time (DiD P &lt;0.001). Unionized programs demonstrated a transient improvement in program responsiveness to resident concerns during the initial pandemic period (DiD P =0.04), which did not persist by 2023 (DiD P =0.53). No differences were observed for mistreatment measures. Conclusions: Unionization was not associated with improvements in resident well-being, the learning environment, or mistreatment during the pandemic, with the exception of a transient improvement in program responsiveness to resident concerns. These findings suggest that unionization alone may not be sufficient to protect resident wellness during periods of systemic stress.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"15 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088082","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}