Annals of surgery最新文献

{"title":"New Biomarkers to Define a Biological Borderline Situation for Pancreatic Adenocarcinoma: Results of an Ancillary Study of the PANACHE01-PRODIGE48 Trial.","authors":"Jean Pinson, Julie Henriques, Ludivine Beaussire, Nasrin Sarafan-Vasseur, Antonio Sa Cunha, Jean-Baptiste Bachet, Dewi Vernerey, Frederic Di Fiore, Lilian Schwarz","doi":"10.1097/SLA.0000000000006468","DOIUrl":"10.1097/SLA.0000000000006468","url":null,"abstract":"<p><strong>Objective: </strong>To investigate in patients treated for a resectable pancreatic ductal adenocarcinoma [pancreatic adenocarcinoma (PA)], the prognostic value of baseline carbohydrate antigen 19.9 (CA19-9) and circulating tumor DNA (ctDNA) for overall survival (OS), to improve death risk stratification, based on a planned ancillary study from PANACHE01-PRODIGE 48 trial.</p><p><strong>Background: </strong>Biological borderline situation that was first used by the MD Anderson, became a standard practice following the international consensus conference in 2016 to manage PA. Regarding the risk of systemic disease, especially in the setting of \"markedly elevated\" CA19-9, neoadjuvant therapy is advised to avoid unnecessary surgery, with a risk of early recurrence. To best define biological borderline situations, new biomarkers are needed.</p><p><strong>Methods: </strong>Characteristics at diagnosis and OS were compared between patients with or without ctDNA status available. OS was estimated with the Kaplan-Meier method and compared with a log-rank test. The restricted cubic spline approach was used to identify the optimal threshold for biological parameters for death risk stratification. Univariate and multivariate Cox proportional hazard models were estimated to assess the association of ctDNA status and other parameters with OS.</p><p><strong>Results: </strong>Among the 132 patients from the primary population for analysis in the PANACHE01 -PRODIGE 48 trial, 92(71%) were available for ctDNA status at diagnosis. No selection bias was identified between patients with or without ctDNA status. Fourteen patients (15%) were ctDNA+ and exhibited a higher risk for death [ P = 0.0188; hazard ratio (95% CI): 2.28 (1.12-4.63)]. In the 92 patients with ctDNA status available among the other parameters analyzed, only CA19-9 was statically associated with OS in univariate analysis. Patients with a log of CA19-9 equal or superior to 4.4 that corresponds to a CA19-9 of 80 UI/mL were identified at higher risk for death [ P = 0.0143; hazard ratio (95% CI): 2.2 (1.15-4.19)]. In multivariate analysis, CA19-19 remained independently associated with OS ( P = 0.0323). When combining the 2 biomarkers, the median OS was 19.4 [IC 95%: 3.8-not reached (NR)] months, 30.2 (IC 95%: 17.1-NR) months and NR (IC 95%: 39.3-NR) for \"CA19-9 high and ctDNA+ group,\" \"CA19-9 high or ctDNA+ group,\" and \"CA19-9 low and ctDNA- group,\" respectively (log-rank P = 0.0069).</p><p><strong>Conclusions: </strong>Progress in the management of potentially operable PA remains limited, relying solely on strategies to optimize the sequence of complete treatment, based on modern multidrug chemotherapy (FOLFIRINOX, GemNabPaclitaxel) and surgical resection. The identification of risk criteria, such as the existence of systemic disease, is an important issue, currently referred to as \"biological borderline disease.\" Few data, particularly from prospective studies, allow us to identify biomarkers","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"734-744"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888299","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":"Interobserver Variability in the International Study Group for Pancreatic Surgery (ISGPS)-Defined Complications After Pancreatoduodenectomy: An International Cross-Sectional Multicenter Study.","authors":"Tessa E Hendriks, Alberto Balduzzi, Susan van Dieren, J Annelie Suurmeijer, Roberto Salvia, Thomas F Stoop, Marco Del Chiaro, Sven D Mieog, Mark Nielen, Sabino Zani, Daniel Nussbaum, Thilo Hackert, Jakob R Izbicki, Ammar A Javed, D Brock Hewitt, Bas Groot Koerkamp, Roeland F de Wilde, Yi Miao, Kuirong Jiang, Kohei Nakata, Masafumi Nakamura, Jin-Young Jang, Mirang Lee, Cristina R Ferrone, Shailesh V Shrikhande, Vikram A Chaudhari, Olivier R Busch, Ajith K Siriwardena, Oliver Strobel, Jens Werner, Bert A Bonsing, Giovanni Marchegiani, Marc G Besselink","doi":"10.1097/SLA.0000000000006473","DOIUrl":"10.1097/SLA.0000000000006473","url":null,"abstract":"<p><strong>Objective: </strong>To determine the interobserver variability for complications of pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery (ISGPS) and others.</p><p><strong>Background: </strong>Good interobserver variability for the definitions of surgical complications is of major importance in comparing surgical outcomes between and within centers. However, data on interobserver variability for pancreatoduodenectomy-specific complications are lacking.</p><p><strong>Methods: </strong>International cross-sectional multicenter study including 52 raters from 13 high-volume pancreatic centers in 8 countries on 3 continents. Per center, 4 experienced raters scored 30 randomly selected patients after pancreatoduodenectomy. In addition, all raters scored 6 standardized case vignettes. This variability and the \"within centers\" variability were calculated for 2-fold scoring (no complication/grade A vs grade B/C) and 3-fold scoring (no complication/grade A vs grade B vs grade C) of postoperative pancreatic fistula, postpancreatoduodenectomy hemorrhage, chyle leak, bile leak, and delayed gastric emptying. Interobserver variability is presented with Gwet AC-1 measure for agreement.</p><p><strong>Results: </strong>Overall, 390 patients after pancreatoduodenectomy were included. The overall agreement rate for the standardized cases vignettes for 2-fold scoring was 68% (95% CI: 55%-81%, AC1 score: moderate agreement), and for 3-fold scoring 55% (49%-62%, AC1 score: fair agreement). The mean \"within centers\" agreement for 2-fold scoring was 84% (80%-87%, AC1 score; substantial agreement).</p><p><strong>Conclusions: </strong>The interobserver variability for the ISGPS-defined complications of pancreatoduodenectomy was too high even though the \"within centers\" agreement was acceptable. Since these findings will decrease the quality and validity of clinical studies, ISGPS has started efforts aimed at reducing the interobserver variability.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"728-733"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141858882","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":"Optimal Treatment Strategies for cT2 Staged Adenocarcinoma of the Esophagus and the Gastroesophageal Junction: A Multinational, High-volume Center Retrospective Cohort Analysis.","authors":"Naita M Wirsik, Cezanne D Kooij, Niall Dempster, Nerma Crnovrsanin, Noel E Donlon, Eren Uzun, Kunal Bhanot, Henrik Nienhüser, Daniela Polette, Kammy Kewani, Peter Grimminger, Daniel Reim, Florian Seyfried, Hans F Fuchs, Suzanne S Gisbertz, Christoph-Thomas Germer, Jelle P Ruurda, Fredrik Klevebro, Wolfgang Schröder, Magnus Nilsson, John V Reynolds, Mark I Van Berge Henegouwen, Sheraz Markar, Richard Van Hillegersberg, Thomas Schmidt, Christiane J Bruns","doi":"10.1097/SLA.0000000000006478","DOIUrl":"10.1097/SLA.0000000000006478","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate outcomes after primary surgery (PS) or neoadjuvant treatment followed by surgery (NAT/S) in cT2 staged adenocarcinomas of the esophagus (EAC) and gastroesophageal junction (GEJ), a multinational high-volume center study was undertaken.</p><p><strong>Background: </strong>The optimal treatment approach with either NAT/S or PS for clinically staged cT2cN any or cT2N0 EAC and GEJ remains unknown due to the lack of randomized controlled trials.</p><p><strong>Methods: </strong>A retrospective analysis of prospectively maintained databases from 10 centers was performed. Between January 2012 and August 2023, 645 patients who fulfilled inclusion criteria of GEJ Siewert type I, II, or EAC with cT2 status at diagnosis underwent PS or NAT/S with curative intent. The primary endpoint was overall survival (OS).</p><p><strong>Results: </strong>In the cT2cN any cohort, 192 patients (29.8%) underwent PS and 453 (70.2%) underwent NAT/S. In all cT2cN0 patients (n = 333), NAT/s remained the more frequent treatment (56.2%). Patients undergoing PS were in both cT2 cohorts older ( P < 0.001) and had a higher American Society of Anesthesiologists classification ( P < 0.05). R0 resection showed no differences between NAT/S and PS in both cT2 cohorts ( P > 0.4).Median OS was 51.0 months in the PS group (95% CI: 31.6-70.4) versus 114.0 months (95% CI: 53.9-174.1) in the NAT/S group ( P = 0.003) of cT2cN any patients. For cT2cN0 patients, NAT/S was associated with longer OS ( P = 0.002) and disease-free survival ( P = 0.001). After propensity score matching of the cT2N0 patients, survival benefit for NAT/S remained ( P = 0.004). Histopathology showed that 38.1% of cT2cN any and 34.2% of cT2cN0 patients were understaged.</p><p><strong>Conclusions: </strong>Due to the unreliable identification of cT2N0 disease, all patients should be offered a multimodal therapeutic approach.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"799-807"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896602","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 Impact of Postoperative Complications on Recovery of Health-Related Quality of Life and Functional Capacity After Pancreatectomy: Findings From a Prospective Observational Study.","authors":"Nicolò Pecorelli, Giovanni Guarneri, Francesca Di Salvo, Alessia Vallorani, Chiara Limongi, Gianluca Corsi, Giulia Gasparini, Martina Abati, Stefano Partelli, Stefano Crippa, Massimo Falconi","doi":"10.1097/SLA.0000000000006472","DOIUrl":"10.1097/SLA.0000000000006472","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the extent to which postoperative complications impact patient health-related quality of life (HRQoL) and survival after pancreatic surgery.</p><p><strong>Background: </strong>Pancreatectomy is frequently associated with severe postoperative morbidity, which can affect patient recovery. Few and conflicting data are available regarding the effect of post-pancreatectomy complications on patient-reported HRQoL.</p><p><strong>Methods: </strong>This is an observational cohort study including consecutive patients enrolled in a prospective clinical trial (NCT04431076) who underwent elective pancreatectomy (2020-2022). Before surgery and on postoperative days 15, 30, 90, and 180, patients completed the PROMIS-29 profile and Duke Activity Status Index questionnaires to assess their HRQoL and functional capacity. Mean differences in HRQoL scores were obtained using multivariable linear regression adjusting for preoperative scores and confounders.</p><p><strong>Results: </strong>Of 528 patients, 370 (70%) experienced morbidity within 90 days, and 154 (29%) had severe complications (Clavien-Dindo grade >2). Delayed gastric emptying had the greatest impact on HRQoL, showing decreased mental health up to POD90 and physical health up to POD180 compared with uncomplicated patients. An inverse relationship between complication severity grade and HRQoL was evident for most domains, with Clavien-Dindo grade 3b to 4 patients showing worse HRQoL and functional capacity scores up to 6 months after surgery. In 235 pancreatic cancer patients, grade 3b and 4 complications were associated with reduced disease-specific survival (median 25 vs 41 mo, P <0.001).</p><p><strong>Conclusions: </strong>In patients undergoing pancreatic resection, postoperative complications significantly impact all domains of patient quality of life with a dose-effect relationship between complication severity and impairment of HRQoL and functional capacity.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"719-727"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888301","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-depth Clinical, Hemodynamic, and Volumetric Assessment of the Resection and Partial Liver Transplantation With Delayed Total Hepatectomy-Type Auxiliary Liver Transplantation in Noncirrhotic Setting: Are We Simply Dealing With a Transplant Model of Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy?","authors":"Laurent Coubeau, Alix Fontaine, Olga Ciccarelli, Eliano Bonaccorsi, Max Derudder, Géraldine Dahqvist, Lancelot Marique, Raymond Reding, Isabelle A Leclercq, Alexandra Dili","doi":"10.1097/SLA.0000000000006475","DOIUrl":"10.1097/SLA.0000000000006475","url":null,"abstract":"<p><strong>Background: </strong>The Resection And Partial Liver Transplantation with Delayed total hepatectomy (RAPID) procedure involves left hepatectomy with orthotopic implantation of a left lobe and right portal vein ligation. This technique induces volumetric graft increase, allowing for a right completion hepatectomy within 15 days. Notably, there is a lack of data on the hemodynamics of small-for-size grafts exposed to portal overflow without triggering small-for-size syndrome.</p><p><strong>Methods: </strong>A prospective single-center protocol included 8 living donors and 8 RAPID noncirrhotic recipients. Comprehensive clinical and biological data were collected, accompanied by intraoperative arterial and portal flow and pressure measurements. Early kinetic growth rate (eKGR%) and graft function were assessed using computed tomography and 99Tc-mebrofenin scintigraphy on postoperative days 7 and 14. Findings were compared with retrospective data from 13 left living donor liver transplantation (LDLT) recipients.</p><p><strong>Results: </strong>The median Graft-body weight ratio was 0.41% (interquartile range: 0.34-0.49), markedly lower than in LDLT. However, there was no significant difference in eKGR between RAPID and LDLT grafts. Sequential analysis revealed variable eKGR per day: 10.6% (7.8-13.2) in the first week and 7.6% (6-9.1) in the second week posttransplantation. Indexed portal flow (indexed portal vein flow) was significantly higher in RAPID compared with left LDLT ( P = 0.01). No hemodynamic parameters were found to correlate with regeneration speed. We modulated portal flow in 2 out of 8 cases.</p><p><strong>Conclusions: </strong>This study presents the first report of hemodynamic and volumetric data for the RAPID technique. Despite initial graft volumes falling below conventional LDLT recommendations, the study highlights acceptable clinical outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"753-762"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896589","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":"Evidence for the Positive Impact of Centralization in Esophageal Cancer Surgery.","authors":"Noel E Donlon, Brendan Moran, Maria Davern, Matthew G Davey, Czara Kennedy, Roisin Leahy, Jenny Moore, Sinead King, Maeve Lowery, Moya Cunningham, Claire L Donohoe, Dermot O'Toole, Narayanasamy Ravi, John V Reynolds","doi":"10.1097/SLA.0000000000006487","DOIUrl":"10.1097/SLA.0000000000006487","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the impact of centralization on key metrics, outcomes, and patterns of care at the Irish National Center.</p><p><strong>Background: </strong>Overall survival rates for esophageal cancer in the West have doubled in the last 25 years. An international trend towards centralization may be relevant; however, this model remains controversial, with Ireland centralizing esophageal cancer surgery in 2011.</p><p><strong>Methods: </strong>All patients (n=1245) with adenocarcinoma of the esophagus or junction treated with curative intent involving surgery, including endoscopic surgery, were included (n=461 from 2000 to 2011, and 784 from 2012 to 2022). All data entry was prospectively recorded. Overall survival was measured (1) for the entire cohort, (2) for patients with locally advanced disease (cT 2-3 N 0-3 ), and (3) for patients undergoing neoadjuvant therapy. All complications were recorded as per Esophageal Complication Consensus Group definitions, and the Clavien-Dindo severity classification. Data were analyzed using GraphPad Prism (v.6.0) for Windows and SPSS (v.23.0) software (SPSS) R Studio (R version 4.2.2). Survival times were calculated using a log-rank test and Cox regression analysis, and Kaplan-Meier curves were generated.</p><p><strong>Results: </strong>Endotherapy for cT1a/intramucosal cancer adenocarcinoma increased from 40 (9% total) to 245 (31% total) procedures between the pre-centralization and post-centralization (post-C) periods. A significantly ( P < 0.001) higher proportion of patients with cT 2-3 N 0-3 disease in the post-C period underwent neoadjuvant therapy (66% vs 53%). Operative mortality was lower ( P =0.02) post-C, at 2% versus 4.5%, and ≥IIIa Clavien-Dindo major complications decreased from 33% to 25% ( P < 0.01). Recurrence rates were lower post-C (38% vs 53%, P < 0.01). Median overall survival was 73.83 versus 47.23 months in the 2012 to 2022 and 2000 to 2011 cohorts, respectively ( P < 0.001). For those who received neoadjuvant therapy, the median survival was 28.5 months pre-centralization and 42.5 months post-C ( P < 0.001).</p><p><strong>Conclusions: </strong>These data highlight improvements in both operative outcomes and survival from the time of centralization, and a major expansion of endoscopic surgery. Although not providing proof, the study suggests a positive impact of formal centralization with governance on key quality metrics and an evolution in patterns of care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"772-779"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141974938","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":"Ex-vivo Liver Resection and Autotransplantation for Liver Malignancy : A Large Volume Retrospective Clinical Study.","authors":"Abudusalamu Aini, Qian Lu, Zhiyu Chen, Zhanyu Yang, Zhipeng Liu, Leida Zhang, Jiahong Dong","doi":"10.1097/SLA.0000000000006505","DOIUrl":"10.1097/SLA.0000000000006505","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effectiveness of optimized ex-vivo liver resection and autotransplantation (ELRA) for treating liver malignancies.</p><p><strong>Background: </strong>ELRA is a promising surgery for radical resection of conventionally unresectable tumors, despite the disappointing long-term prognosis during its developmental stages. A recent multicenter study reported 5-year overall and disease-free survival rates of 28% and 20.8%, respectively.</p><p><strong>Methods: </strong>We retrospectively analyzed data of patients who underwent ELRA for advanced liver cancers between 2009 and 2022. We applied ELRA via our novel surgical indication classification system where the surgical risk with curative intent for advanced liver malignancy was controllable using the ex-vivo approach. The ELRA was optimized for determinacy, predictability, and controllability via the precision liver surgery paradigm.</p><p><strong>Results: </strong>Thirty-seven cases with liver malignancies were enrolled. The operative time and anhepatic phase duration were 649.6±200.0 and 261.2±74.5 minutes, respectively, while the intraoperative blood loss was 1902±1192 mL. Negative resection margins were achieved in all patients, and the 90-day morbidity at Clavien-Dindo IIIa/IIIb and mortality rates were 27.0% and 24.3%. Post-ELRA 1-, 3-, and 5-year actual overall survival rates were 62.2%, 37.8%, and 35.1%, respectively, and 1-, 3-, and 5-year actual disease-free survival rates were 43.2%, 24.3%, and 18.9%, respectively.</p><p><strong>Conclusions: </strong>Long-term outcomes of ELRA under precision liver surgery for advanced liver malignancy were favorable. Appropriate criteria for disease selection and surgical indications and optimized procedures together can improve surgical treatment and patient prognosis.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"879-886"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981544","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":"Survival and Prognostic Factors After Adrenalectomy for Secondary Malignancy: A Combined Analysis of a French University Center Registry (Eurocrine) of 307 Patients and a French Nationwide Study of 2515 Patients.","authors":"Agathe Rémond, Camille Marciniak, Xavier Lenne, Vincent Chouraki, Mathilde Gobert, Gregory Baud, Laure Maillard, Damien Bouriez, Ellen Liekens, Gianluca Donatini, Claire Nominé-Criqui, Ambroise Ravenet, Nicolas Santucci, Paulina Kuczma, Nicolas Bouviez, Christophe Tresallet, Eric Mirallié, Sophie Deguelte, Laurent Brunaud, Carole Guerin, Caroline Gronnier, Jean-Christophe Lifante, Amélie Bruandet, Didier Theis, Alexis Cortot, Arnaud Scherpereel, Aghiles Hamroun, François Pattou, Robert Caiazzo","doi":"10.1097/SLA.0000000000006479","DOIUrl":"10.1097/SLA.0000000000006479","url":null,"abstract":"<p><strong>Objective: </strong>To provide a nationwide description of postoperative outcomes and analysis of prognostic factors following adrenalectomy for metastases.</p><p><strong>Background: </strong>Adrenal glands are a common site of metastases in many malignancies. Diagnosis of adrenal metastases is on the rise, leading to an increasing number of patient candidates for surgery without consensual management.</p><p><strong>Methods: </strong>We conducted a population-based study between January 2012 and December 2022 using the French National Health Data System (SNDS) and the Eurocrine registry (NCT03410394). The first database exhaustively covers all procedures carried out in France, while the second provides more clinical information on procedures and tumor characteristics, based on the experience of 11 specialized centers.</p><p><strong>Results: </strong>From the SNDS, we extracted 2515 patients who underwent adrenalectomy for secondary malignancy and 307 from the Eurocrine database. The most common primary malignancies were lung cancer (n=1203, 47.8%) and renal cancer (n=555, 22.1%). One-year survival was 84.3% (n=2120). Thirty-day mortality and morbidity rates were, respectively, 1.3% (n=32) and 29.9% (n=753, including planned intensive care unit - stays). Radiotherapy within the year before adrenalectomy was significantly associated with higher 30-day major complication rates ( P =0.039). In the Eurocrine database, the proportion of laparoscopic procedures reached 85.3% without impairing resection completeness (R0: 92.9%). Factors associated with poor overall survival were the presence of extra-adrenal metastases (hazard ratio =0.64; P =0.031) and incomplete resection (≥R1; hazard ratio=0.41; P =0.015).</p><p><strong>Conclusions: </strong>The number of patients who can receive local treatment for adrenal metastases is rising, and adrenalectomy is more often minimally invasive and has a low morbidity rate. Subsequent research should evaluate which patients would benefit from adrenal surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"825-834"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896605","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":"Artificial Intelligence to Predict the Risk of Lymph Node Metastasis in T2 Colorectal Cancer.","authors":"Katsuro Ichimasa, Caterina Foppa, Shin-Ei Kudo, Masashi Misawa, Yuki Takashina, Hideyuki Miyachi, Fumio Ishida, Tetsuo Nemoto, Jonathan Wei Jie Lee, Khay Guan Yeoh, Elisa Paoluzzi Tomada, Roberta Maselli, Alessandro Repici, Luigi Maria Terracciano, Paola Spaggiari, Yuichi Mori, Cesare Hassan, Antonino Spinelli","doi":"10.1097/SLA.0000000000006469","DOIUrl":"10.1097/SLA.0000000000006469","url":null,"abstract":"<p><strong>Objective: </strong>To develop and externally validate an updated artificial intelligence (AI) prediction system for stratifying the risk of lymph node metastasis (LNM) in T2 colorectal cancer (CRC).</p><p><strong>Background: </strong>Recent technical advances allow complete local excision of T2 CRC, traditionally treated with surgical resection. Yet, the widespread adoption of this approach is hampered by the inability to stratify the risk of LNM.</p><p><strong>Methods: </strong>Data from patients with pT2 CRC undergoing surgical resection between April 2000 and May 2022 at one Japanese and one Italian center were analyzed. Primary goal was AI system development for accurate LNM prediction. Predictors encompassed 7 variables: age, sex, tumor size, tumor location, lymphovascular invasion, histologic differentiation, and carcinoembryonic antigen level. The tool's discriminating power was assessed through area under the curve, sensitivity, and specificity.</p><p><strong>Results: </strong>Out of 735 initial patients, 692 were eligible. Training and validation cohorts comprised of 492 and 200 patients, respectively. The AI model displayed an area under the curve of 0.75 in the combined validation data set. Sensitivity for LNM prediction was 97.8%, and specificity was 15.6%. The positive and the negative predictive value were 25.7% and 96%, respectively. The false negative rate was 2.2%, and the false positive was 84.4%.</p><p><strong>Conclusions: </strong>Our AI model, based on easily accessible clinical and pathologic variables, moderately predicts LNM in T2 CRC. However, the risk of false negative needs to be considered. The training of the model including more patients across western and eastern centers - differentiating between colon and rectal cancers - may improve its performance and accuracy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"850-857"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791750","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":"Reconstruction Techniques and Associated Morbidity in Minimally Invasive Gastrectomy for Cancer: Insights From the GastroBenchmark and GASTRODATA databases.","authors":"Marcel André Schneider, Jeesun Kim, Felix Berlth, Yutaka Sugita, Peter P Grimminger, Bas P L Wijnhoven, Hidde Overtoom, Ines Gockel, René Thieme, Ewen A Griffiths, William Butterworth, Henrik Nienhüser, Beat Müller, Nerma Crnovrsanin, Daniel Gero, Felix Nickel, Suzanne Gisbertz, Mark I van Berge Henegouwen, Philip H Pucher, Kashuf Khan, Asif Chaudry, Pranav H Patel, Manuel Pera, Mariagiulia Dal Cero, Carlos Garcia, Guillermo Martinez Salinas, Paulo Kassab, Osvaldo Antônio Prado Castro, Enrique Norero, Paul Wisniowski, Luke Randall Putnam, Pietro Maria Lombardi, Giovanni Ferrari, Rita Gudaityte, Almantas Maleckas, Leanne Prodehl, Antonio Castaldi, Michel Prudhomme, Hyuk-Joon Lee, Takeshi Sano, Gian Luca Baiocchi, Giovanni De Manzoni, Simone Giacopuzzi, Maria Bencivenga, Riccardo Rosati, Francesco Puccetti, Domenico D'Ugo, Souya Nunobe, Han-Kwang Yang, Christian Alexander Gutschow","doi":"10.1097/SLA.0000000000006470","DOIUrl":"10.1097/SLA.0000000000006470","url":null,"abstract":"<p><strong>Objective/background: </strong>Various anastomotic and reconstruction techniques are used for minimally invasive total (miTG) and distal gastrectomy (miDG). Their effects on postoperative morbidity have not been extensively studied.</p><p><strong>Methods: </strong>MiTG and miDG patients were selected from 9356 oncological gastrectomies performed in 2017-2021 in 43 centers. Endpoints included anastomotic leakage (AL) rate and postoperative morbidity tested by multivariable analysis.</p><p><strong>Results: </strong>Three major anastomotic techniques [circular stapled (CS); linear stapled (LS); and hand sewn (HS)], and 3 major bowel reconstruction types [Roux (RX); Billroth I (BI); Billroth II (BII)] were identified in miTG (n=878) and miDG (n=3334). Postoperative complications, including AL (5.2% vs 1.1%), overall (28.7% vs 16.3%), and major morbidity (15.7% vs 8.2%), as well as 90-day mortality (1.6% vs 0.5%) were higher after miTG compared with miDG. After miTG, the AL rate was higher after CS (4.3%) and HS (7.9%) compared with LS (3.4%). Similarly, major complications (LS: 9.7%, CS: 16.2%, and HS: 12.7%) were lowest after LS. Multivariate analysis confirmed anastomotic technique as a predictive factor for AL, overall, and major complications. In miDG, AL rate (BI: 1.4%, BII 0.8%, and RX 1.2%), overall (BI: 14.5%, BII: 15.0%, and RX: 18.7%), and major morbidity (BI: 7.9%, BII: 9.1%, and RX: 7.2%), and mortality (BI: 0%, BII: 0.1%, and RY: 1.1%%) were not affected by bowel reconstruction.</p><p><strong>Conclusions: </strong>In oncologically suitable situations, miDG should be preferred to miTG, as postoperative morbidity is significantly lower. LS should be a preferred anastomotic technique for miTG in Western Centers. Conversely, bowel reconstruction in DG may be chosen according to the surgeon's preference.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"788-798"},"PeriodicalIF":7.5,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11446507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888300","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}