Annals of surgery最新文献

{"title":"Age Matters: What Affects the Cumulative Lifespan of a Transplanted Liver?","authors":"Chase J Wehrle, Marianna Maspero, Antonio D Pinna, Philipp Dutkowski, Charles Miller, Koji Hashimoto, Pierre-Alain Clavien, Andrea Schlegel","doi":"10.1097/SLA.0000000000006259","DOIUrl":"10.1097/SLA.0000000000006259","url":null,"abstract":"<p><strong>Objective: </strong>To assess factors affecting the cumulative lifespan of a transplanted liver.</p><p><strong>Background: </strong>Liver aging is different from other solid organs. It is unknown how old a liver can actually get after liver transplantation.</p><p><strong>Methods: </strong>Deceased donor liver transplants from 1988 to 2021 were queried from the United States UNOS registry. Cumulative liver age was calculated as donor age + recipient graft survival.</p><p><strong>Results: </strong>In total, 184,515 livers were included. Most were donation after brain death donors (n = 175,343). The percentage of livers achieving >70, 80, 90, and 100 years cumulative age was 7.8% (n = 14,392), 1.9% (n = 3576), 0.3% (n = 528), and 0.01% (n = 21), respectively. The youngest donor age contributing to a cumulative liver age >90 years was 59 years, with posttransplant survival of 34 years. In pediatric recipients, 736 (4.4%) and 282 livers (1.7%) survived >50 and 60 years overall, respectively. Transplanted livers achieved cumulative age >90 years in 2.86 per 1000 and >100 years in 0.1 per 1000. The U.S. population at large has a cumulative \"liver age\" >90 years in 5.35 per 1000 persons, and >100 years in 0.2 per 1000. Livers aged >60 years at transplant experienced both improved cumulative survival ( P < 0.0001) and interestingly improved survival after transplantation ( P < 0.0001). Recipient warm ischemia time of >30 minutes was most predictive of reduced cumulative liver survival overall (n = 184,515, hazard ratio = 1.126, P < 0.001) and excluding patients with mortality in the first 6 months (n = 151,884, hazard ratio = 0.973, P < 0.001).</p><p><strong>Conclusions: </strong>In summary, transplanted livers frequently get as old as those in the average population despite ischemic-reperfusion-injury and immunosuppression. The presented results justify using older donor livers regardless of donation type, even in sicker recipients with limited options.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"485-495"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140136355","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 Video Data: \"In,\" \"Out,\" or \"Shake it All About\" the Medical Record.","authors":"Ronan A Cahill, Mindy N Duffourc, Sara Gerke","doi":"10.1097/SLA.0000000000006336","DOIUrl":"10.1097/SLA.0000000000006336","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"382-384"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875662","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":"Addressing Inequities in Assessment: The American Board of Surgery.","authors":"Andrew T Jones, Carol L Barry, Caroline O Prendergast, Valentine N Nfonsam, Jo Buyske","doi":"10.1097/SLA.0000000000006498","DOIUrl":"10.1097/SLA.0000000000006498","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"385-387"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981542","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":"Prevalence and Risk Factors for Malignant Nodal Involvement in Early Esophago-Gastric Adenocarcinoma: Results From the Multicenter Retrospective Congress Study (endosCopic resectiON, esophaGectomy or Gastrectomy for Early Esophagogastric Cancers).","authors":"Philip H Pucher, Saqib A Rahman, Pradeep Bhandari, Natalie Blencowe, Swathikan Chidambaram, Tom Crosby, Richard P T Evans, Ewen A Griffiths, Sivesh K Kamarajah, Sheraz R Markar, Nigel Trudgill, Timothy J Underwood, James A Gossage","doi":"10.1097/SLA.0000000000006496","DOIUrl":"10.1097/SLA.0000000000006496","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study was to quantify lymph node metastasis (LNM) risk and outcomes following treatment of early esophago-gastric (EG) adenocarcinoma.</p><p><strong>Background: </strong>The standard of care for early T1N0 EG cancer is endoscopic resection (ER). Radical surgical resection is recommended for patients perceived to be at risk of LNM. Current models to select organ-preserving versus surgical treatment are inconsistent.</p><p><strong>Methods: </strong>CONGRESS is a UK-based multicenter retrospective cohort study. Patients diagnosed with clinical or pathological T1N0 EG adenocarcinoma from 2015 to 2022 were included. Outcomes and rates of LNM were assessed. Cox regression was performed to assess the impact of prognostic and treatment factors on overall survival.</p><p><strong>Results: </strong>A total of 1601 patients from 26 centers were included, with median follow-up 32 months (IQR 14-53). 1285/1612 (80.3%) underwent ER, 497/1601 (31.0%) underwent surgery. Overall rate of LNM was 13.5%. On ER staging, tumour depth (T1bsm2-3 17.6% vs T1a 7.1%), lymphovascular invasion (17.2% vs 12.6%), or signet cells (28.6% vs 13.0%) were associated with LNM. In multivariable regression analysis, these were not significantly associated with LNM rates or survival. Adjusting for demographic and tumour variables, surgery after ER was associated with significant survival benefit, HR 0.33 (0.15-0.77), P =0.010.</p><p><strong>Conclusions: </strong>This large multicenter data set suggests that early EG adenocarcinoma is associated with significant risk of LNM. These data are representative of current real clinical practice with ER-based staging, and suggests previously held beliefs regarding reliability of predictive factors for LNM may need to be reconsidered. Further research to identify patients who may benefit from organ-preserving versus surgical treatment is urgently required.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"363-370"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142103738","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":"Results of a Decade of Work by Surgeons and Researchers Nationwide to Reduce the Impact of Surgery on the Opioid Epidemic.","authors":"Cornelius Thiels","doi":"10.1097/SLA.0000000000006596","DOIUrl":"10.1097/SLA.0000000000006596","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"353"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142765725","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":"Mapping the Void: Understanding Diversity, Equity, and Inclusion Training in Medicine.","authors":"Chelsea A Harris, Andrew Vastardis, Chad Jobin, Lesly Dossett","doi":"10.1097/SLA.0000000000006604","DOIUrl":"10.1097/SLA.0000000000006604","url":null,"abstract":"<p><strong>Objective: </strong>To delineate how identity-based bias exposure evolves with rank and/or context among health care workers, and assess their attitudes toward existing diversity, equity, and inclusion (DEI) education.</p><p><strong>Background: </strong>Although DEI training is widely mandated for health care workers, few studies examine how clinicians' needs evolve across a career, how context impacts recipients' ability to respond, or how well existing programs adapt to individual contexts.</p><p><strong>Methods: </strong>A 54-question electronic survey was distributed during Morbidity and Mortality conferences beginning in December 2020. Descriptive statistics were performed regarding respondents' bias exposure across rank, perceptions regarding existing training's fidelity to recipients' lived experience, and ability to confer useful response strategies.</p><p><strong>Results: </strong>This study included 648 individuals (65.6% White; 50.2% women) practicing in mostly academic medical centers (70.6%). Respondents affirmed that discrimination was common, with half (320, 49.4%) reporting that they experienced bias at least monthly. Among people of color, the proportion reporting monthly exposure decreased with rank. Women of color experienced the biggest drop (74% as residents/fellows down to 11% in late career). Broadly, participants reported the greatest discomfort in addressing subtle bias from patients or high-ranked individuals, and this did not uniformly improve with seniority. Finally, although 478 (73.8%) individuals reported receiving DEI training, 51.3% of respondents reported online DEI modules had little utility. Shortcomings included that training focused on individual rather than structural solutions and that it did not confer response strategies users could reliably employ.</p><p><strong>Conclusions: </strong>Identity and context strongly influence both clinicians' exposure and ability to respond to bias in the hospital environment, independent of seniority. Existing DEI training fails to account for this nuance, ultimately diminishing its utility to clinicians.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"430-437"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794328","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":"Too Big to Fail: Volumetric Analyses and Incidence of Posthepatectomy Liver Failure in 125 Major Hepatectomies in Children.","authors":"Juri Fuchs, Lucas Rabaux-Eygasier, Thomas Husson, Virginie Fouquet, Florent Guerin, Geraldine Hery, Sophie Branchereau","doi":"10.1097/SLA.0000000000006595","DOIUrl":"10.1097/SLA.0000000000006595","url":null,"abstract":"<p><strong>Objective: </strong>To assess the incidence of posthepatectomy liver failure (PHLF) and the role of the future liver remnant (FLR) in children undergoing major hepatectomy.</p><p><strong>Background: </strong>Incidence and risk factors of PHLF in children are unclear, with no validated definition for this age group. Consequently, the role of the FLR in pediatric hepatectomy and evidence-based preoperative guidelines remains undefined.</p><p><strong>Methods: </strong>All pediatric patients undergoing major hepatectomy at a tertiary care center over a 10-year study period were analyzed. Preoperative imaging was used for volumetry. The incidence of PHLF was assessed by applying predefined definitions, and the prognostic impact of the FLR on PHLF and complications was evaluated.</p><p><strong>Results: </strong>A total of 125 children underwent major hepatectomy, including 35 trisectionectomies. There was a strong correlation between imaging-based measured total liver volume (TLV) and calculated standard liver volume ( r = 0.728, P < 0.001). The median TLV-to-body weight (BW) ratio was 3.4%, and the median FLR/BW ratio was 1.5%. The median FLR-to-TLV ratio was 44% (range: 18%-97%). No clinically relevant PHLF occurred. FLR/TLV and FLR/BW ratios had low predictive value for postoperative liver dysfunction and morbidity.</p><p><strong>Conclusions: </strong>This is the largest reported single-center series of pediatric major hepatectomies. PHLF is exceedingly rare in children. The liver volume-to-BW ratio is higher in children compared with adults, and the FLR is sufficient even in extreme resections with <20% of the liver remnant. These findings strongly question the use of asociating liver partition and portal vein ligation for staged hepatectomy, portal vein embolization, or transplantation based on suspected insufficient liver remnants in children.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"476-484"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142708665","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 End of Race-Conscious Admissions: Why Sealing the Leaky Pathway in Academic Surgery Is More Urgent Than Ever.","authors":"Kaitlyn F Nimmer, Reagan A Collins, Callisia N Clarke","doi":"10.1097/SLA.0000000000006494","DOIUrl":"10.1097/SLA.0000000000006494","url":null,"abstract":"<p><strong>Abstract: </strong>The end of race-conscious admissions poses a significant challenge to the recruitment of underrepresented in medicine surgical trainees and surgeons in the United States. These developing limitations underscore the importance of retention within the academic surgical pathway as we seek to diversify the physician workforce in order to best serve our patients.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"378-381"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141892689","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":"Disparities in Access, Quality, and Clinical Outcome for Latino Californians With Colon Cancer.","authors":"Aaron J Dawes, Ganesh Rajasekar, Katherine D Arnow, Amber W Trickey, Alex H S Harris, Arden M Morris, Todd H Wagner","doi":"10.1097/SLA.0000000000006251","DOIUrl":"10.1097/SLA.0000000000006251","url":null,"abstract":"<p><strong>Objective: </strong>To compare access, quality, and clinical outcomes between Latino and non-Latino White Californians with colon cancer.</p><p><strong>Background: </strong>Racial and ethnic disparities in cancer care remain understudied, particularly among patients who identify as Latino. Exploring potential mechanisms, including differential utilization of high-volume hospitals, is an essential first step to designing evidence-based policy solutions.</p><p><strong>Methods: </strong>We identified all adults diagnosed with colon cancer between January 1, 2010 and December 31, 2020 from a statewide cancer registry linked to hospital administrative records. We compared survival, access (stage at diagnosis, receipt of surgical care, treatment at a high-volume hospital), and quality of care (receipt of adjuvant chemotherapy and adequacy of lymph node resection) between patients who identified as Latino and non-Latino White.</p><p><strong>Results: </strong>A total of 75,543 patients met inclusion criteria, including 16,071 patients who identified as Latino (21.3%). Latino patients were significantly less likely to undergo definitive surgical resection [marginal difference (MD): -0.72 percentage points, 95% CI: -1.19, -0.26], have an operation in a timely manner (MD: -3.24 percentage points, 95% CI: -4.16, -2.32), or have an adequate lymphadenectomy (MD: -2.85 percentage points, 95% CI: -3.59, -2.12) even after adjustment for clinical and sociodemographic factors. Latino patients treated at high-volume hospitals were significantly less likely to die and more likely to meet access and quality metrics.</p><p><strong>Conclusions: </strong>Latino patients with colon cancer experienced delays, segregation, and lower receipt of recommended care. Hospital-level colectomy volume appears to be strongly associated with access, quality, and survival-especially for patients who identify as Latino-suggesting that directing at-risk patients with cancer to high-volume hospitals may improve health equity.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"469-475"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11345884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139970787","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":"Pancreatic Serous Cystadenoma: A Continuing Diagnostic Challenge.","authors":"Charnwit Assawasirisin, Motaz Qadan, Satita Aimprasittichai, Avinash Kambadakone, Maximiliano Servin-Rojas, Andrew L Warshaw, Keith D Lillemoe, Carlos Fernández-Del Castillo","doi":"10.1097/SLA.0000000000006203","DOIUrl":"10.1097/SLA.0000000000006203","url":null,"abstract":"<p><strong>Objective: </strong>To understand the natural history of serous cystadenoma (SCA), and the diagnostic accuracy of SCA and identify possible factors that lead to the correct diagnosis.</p><p><strong>Background: </strong>SCA is a benign cystic pancreatic neoplasm of the pancreas, accounting for ~15% of resected pancreatic cysts. Current recommendations are to proceed with surgical resection in symptomatic patients or when there is uncertainty regarding diagnosis. The latter continues to be a challenge since intentional resection of an SCA accounts for only a minority of resected cases.</p><p><strong>Methods: </strong>Retrospective single-institution review of patients who on final pathology had a diagnosis of pancreatic SCA and of patients who had this diagnosis and were managed nonoperatively. Demographic data, cyst characteristics, and growth rate were collected for analysis.</p><p><strong>Results: </strong>A total of 250 patients were analyzed. Median age was 62 (range: 22-89), 65% were females, and 34% had symptoms. Tumor size ranged from 0.6 to 20, with a median of 3.4 cm. The morphologic appearance was microcystic in 58%, macrocystic in 16%, mixed-type in 23%, and solid in 3%. Pancreatic duct dilation and pancreatic atrophy were found in 22% and 14%, respectively. The average growth rate was 1.8 mm/year regardless of tumor size. Of the 172 patients who underwent surgery, SCA was the preoperative diagnosis in only 33%. A correct diagnosis was independently associated with large tumors and cyst fluid carcinoembryonic antigen analysis. Pancreatic duct dilation was independently associated with an in-growing cyst and the presence of calcification.</p><p><strong>Conclusions: </strong>SCA is a slow-growing pancreatic cystic neoplasm that is mostly asymptomatic but can lead to pancreatic duct dilation and atrophy in some patients. A surprisingly small number of correct preoperative diagnoses confirms that this entity continues to be a diagnostic challenge. A more thorough preoperative workup that includes endoscopic ultrasonography should improve the rate of misdiagnosis.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"501-507"},"PeriodicalIF":7.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139478089","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}