Annals of surgery最新文献

{"title":"A Randomized Controlled Trial of the Implementation of BREASTChoice, a Multilevel Breast Reconstruction Decision Support Tool With Personalized Risk Prediction: Erratum.","authors":"","doi":"10.1097/SLA.0000000000006636","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006636","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"281 4","pages":"e3"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613174","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":"Perioperative Broad-spectrum Antibiotics are Associated With Decreased Surgical Site Infections Compared to 1st-3rd Generation Cephalosporins After Open Pancreaticoduodenectomy in Patients With Jaundice or a Biliary Stent: Erratum.","authors":"Lyonell B Kone, Carolina Torres Perez-Iglesias, Mihaela Banulescu, Vijay K Maker, Ajay V Maker","doi":"10.1097/SLA.0000000000006658","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006658","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"281 4","pages":"e5"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Resection Rectopexy Versus Delorme's Procedure In Full-Thickness Rectal Prolapse - A Randomized Multicenter Trial (DELORES-RCT).","authors":"Florian Herrle, Flavius Sandra-Petrescu, Simone Rothenhoefer, Julia Hardt, Steffen Seyfried, Andreas Joos, Alexander Herold, Dieter Bussen, Stefan Post, Marion Brunner, Alois Fürst, Gianluca De Santo, Robert Siegel, Martin Strik, Michael Sprossmann, Eugen Berg, Andreas Ommer, Martin K Walz, Claudia Benecke, Ralf Bouchard, Tobias Keck, Dirk Weimann, Thomas Schiedeck, Nicolas Demartines, Dieter Hanloser, Anja Sander, Lukas D Sauer, Christina Klose, Meinhard Kieser, Markus Diener, Rosa Klotz, Christoph Reissfelder, Peter Kienle","doi":"10.1097/SLA.0000000000006708","DOIUrl":"10.1097/SLA.0000000000006708","url":null,"abstract":"<p><strong>Objective: </strong>The DELORES trial investigated whether laparoscopic resection rectopexy (LRR) is superior to Delorme's procedure (DP) in full-thickness rectal prolapse.</p><p><strong>Summary of background data: </strong>Multiple perineal and transabdominal procedures are current practice for rectal prolapse surgery. Evidence from adequately designed randomized studies addressing the question of which of these procedures are superior in terms of recurrence and bowel function is lacking.</p><p><strong>Methods: </strong>DELORES was a randomized, observer-blinded, expertise-based multicenter trial. Patients with full-thickness rectal prolapse were eligible. Primary outcome was time to recurrence of full-thickness rectal prolapse within 24 months after primary surgery. Main secondary endpoints were morbidity, hospital stay, quality of life, constipation and fecal incontinence. (DRKS00000482).</p><p><strong>Results: </strong>A total of 358 patients were screened between September 2010 and January 2016. Based on screening, 70 patients were randomized and 65 were included in the analysis (33 LRR and 32 DP procedures). Median follow-up was 23.9 months. Analysis of the primary outcome showed that LRR was superior to DP ( P =0.0012). During the 24-month follow-up, 8.2% of patients in the LRR group had a full-thickness prolapse recurrence versus 42.8% in the DP group. Median time to recurrence was 11.9 months for LRR and 8.2 months for DP. Median duration of surgery was 212 min (LRR) versus 77 min (DP). Overall postoperative morbidity was low. The reoperation rate was higher for DP (0% LRR vs. 33.3% DP). Quality of life (FIQL) and incontinence scores (Wexner) were more favorable for LRR at 24-month follow-up.</p><p><strong>Conclusion: </strong>Laparoscopic resection rectopexy is superior to Delorme's procedure in terms of recurrence and has favorable functional results.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727589","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":"An Open Letter from the American Board of Surgery Assessment Committee Regarding the Reporting of General Surgery In-Training Exam Scores.","authors":"Peter S Yoo, Brenessa Lindeman, Andrew Jones","doi":"10.1097/SLA.0000000000006713","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006713","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727579","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":"Ductal Cancerization at the Pancreatic Neck Margin: Prevalence and Oncologic Relevance.","authors":"Michael J Pflüger, Doreen M Zucha, Benedict Kinny-Köster, Brian A Pedro, Jiayun Lu, Shuang Zhang, Hao Wang, John L Cameron, Elizabeth D Thompson, Jin He, Laura D Wood","doi":"10.1097/SLA.0000000000006706","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006706","url":null,"abstract":"<p><strong>Objective: </strong>To determine the prevalence of ductal cancerization at the pancreatic neck margin and to investigate its prognostic significance.</p><p><strong>Summary background data: </strong>Ductal cancerization (cancerization of ducts; COD) describes the growth of invasive cancer in pre-existing ducts, and is frequently seen in pancreatic cancer resection specimens. Although COD is a well-defined histological diagnosis, it is not routinely reported on final pathology. Therefore, the prevalence and oncologic significance of COD at the pancreatic neck margin is unknown.</p><p><strong>Methods: </strong>We queried our institutional database for pancreatic cancer resections performed between 2014-2018. Diagnostic slides were reviewed by expert pathologists for the presence of COD at the final neck margin, and statistical analysis was performed to correlate these findings with outcomes.</p><p><strong>Results: </strong>Of 767 pancreatic resections meeting our eligibility criteria, final pancreatic neck margin was histologically evaluated in 309 cases (40.3%). COD was present at the final neck margin of 16 cases (5.2%). Overall-survival (OS) and recurrence-free survival (RFS) were both significantly shorter when COD was present at the final neck margin (HR 1.86; 95%CI 1.09-3.17; P=0.024 and HR 2.01; 95%CI 1.16-3.49; P=0.013, respectively) when adjusted for cancer stage, margin status, and adjuvant therapy in multivariate analysis. In contrast, presence of high-grade pancreatic intraepithelial neoplasia (HG-PanIN) at the final neck margin did not impact oncologic outcome.</p><p><strong>Conclusions: </strong>Although COD is uncommon at the final pancreatic neck margin, it is associated with poor survival and increased recurrence. Therefore, and to clearly distinguish it from its mimicker HG-PanIN, routine reporting in histopathological assessment may be advised.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717640","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":"Greater Familiarity Between Surgeon and Operating Room Allied Health Staff is Associated with Shorter Case Duration - A Multi-Institutional Study.","authors":"David A Etzioni, Melana Elliot, Lani MacMillan, Mark Tyson, Steven P Petrou, Matthew P Abdel, Christina M Cadaret, Ross F Goldberg, Elizabeth B Habermann, Robert R Cima, Yu-Hui Chang, Christopher Hasse","doi":"10.1097/SLA.0000000000006711","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006711","url":null,"abstract":"<p><strong>Objective: </strong>To characterize the relationship between surgeon-staff familiarity and the time required to perform an operation.</p><p><strong>Summary background data: </strong>The clinical and operational efficiency of operating rooms (ORs) is a driver of hospital finances and patient outcomes. Surgeon-staff familiarity is an important focus for quality improvement and process optimization.</p><p><strong>Methods: </strong>A retrospective cohort study was performed analyzing operations performed at four academic hospitals between July 1,2019, and December 31,2023. Exclusion criteria (urgent operations, two-specialty cases, low surgeon/specialty volume in dataset, scheduled length > 8 hours) were applied to limit heterogeneity. The exposure of interest was familiarity between surgeon and allied health staff (scrub technicians and circulating nurses) present during an operation (represented as the median staff experience with the index surgeon in the previous 180 days). The primary outcome was whether the actual case length was (versus was not) 10% shorter than the scheduled case length (\"shorter case length\"). A secondary outcome was quantification of the difference between the observed and expected case length and whether the surgical time (cut-close) was shorter.</p><p><strong>Results: </strong>A total of 257,645 operations performed by 25 different specialties comprised the analyzed cohort. Higher levels of surgeon-staff familiarity were associated with a higher likelihood of a shorter case length (observed:expected ratio = 1.16 [1.14-1.18] for high/high levels of familiarity, compared with 0.90 [0.88-0.91] for low/low levels of familiarity). Greater familiarity was also associated with case lengths that were shorter relative to scheduled case length (high/high levels of familiarity 8.7% shorter than low/low levels, P < 0.001). Within the four most common types of cases, those operations performed by teams with higher levels of familiarity had shorter surgical times (cut-to-close).</p><p><strong>Conclusion: </strong>This study found that operations were more efficiently performed when the scrub technician and circulating nurse staff had a greater recent experience with the primary surgeon. Surgical team familiarity should be considered a focus of operational and clinical excellence.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717648","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 Resection Margin Status on Recurrence and Possible Candidates for Adjuvant Radiotherapy in Resected Distal Cholangiocarcinoma.","authors":"Won-Gun Yun, Yoon Soo Chae, Youngmin Han, Inhyuck Lee, Go-Won Choi, Younsoo Seo, Young Jae Cho, Hye-Sol Jung, Joon Seong Park, Jin-Young Jang, Wooil Kwon","doi":"10.1097/SLA.0000000000006712","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006712","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the prognostic impact of resection margin in distal cholangiocarcinoma (dCC).</p><p><strong>Background: </strong>Due to the relatively low prevalence of dCC in Western countries and the use of various definitions of resection margin status, the prognostic impact of bile duct resection margin status remains unclear.</p><p><strong>Methods: </strong>This study included consecutive patients who underwent curative surgery and were diagnosed with dCC between 2000 and 2022. Bile duct resection margin status was classified as clear margin, low-grade dysplasia (LGD), high-grade dysplasia (HGD), and tumor present.</p><p><strong>Results: </strong>Of the 587 patients, 506 (86.2%), 17 (2.9%), 42 (7.2%), and 22 (3.7%) patients had clear margin, LGD, HGD, and tumor present at the margin, respectively. In the node-negative group, patients with clear margin (42.5%) had significantly lower 5-year cumulative overall recurrence rates compared with those with LGD (64.3%), HGD (74.4%), and tumor present status (100.0%). However, in the node-positive group, no significant differences were found in the 5-year cumulative recurrence rates among patients with clear margin (68.8%), HGD (91.1%), and tumor present status (75.0%). In addition, among the node-negative group with a non-clear margin, patients who received adjuvant radiotherapy showed significantly lower 5-year cumulative recurrence rates compared with those who did not receive adjuvant radiotherapy (69.5% versus 87.5%, P=0.037).</p><p><strong>Conclusions: </strong>Local treatment, including surgery and radiotherapy, may be crucial in node-negative patients but may have limited impact in node-positive patients. In node-positive patients, surgery without clinical deterioration, along with the timely initiation of adjuvant chemotherapy, may be crucial.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717563","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 Effect of Rurality on Time to Surgery and Overall Survival among Women with Breast Cancer.","authors":"Kriyana P Reddy, Cara L Berkowitz, Kathleen Jarrell, Rachel Berger, Sarah Hulse, Leisha C Elmore, Rebecca Fishman, Alina M Mateo, Dahlia M Sataloff, Julia C Tchou, Jennifer Q Zhang, Anne Marie McCarthy, Oluwadamilola M Fayanju","doi":"10.1097/SLA.0000000000006710","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006710","url":null,"abstract":"<p><strong>Objective: </strong>How does distance to care affect time to surgery (TTS) and overall survival (OS) among rural patients with breast cancer?</p><p><strong>Summary background data: </strong>TTS>60 days is associated with known sociodemographic characteristics and worse OS after breast cancer diagnosis, but the relationship between rurality, proximity to care, TTS, and OS remains unknown.</p><p><strong>Methods: </strong>We identified females≥18 years with stage 0-III breast cancer diagnosed 2004-2019 who received upfront surgery in the National Cancer Database. Mediation and Cox proportional hazards analyses were conducted to assess the relationship between rurality, distance to treatment facility, prolonged TTS (i.e., >60 days), and OS.</p><p><strong>Results: </strong>Of 1,979,194 patients meeting inclusion criteria, 1.4% resided in rural areas. In the multivariate mediation analysis, the total effect of rurality on prolonged TTS corresponded to an aOR of 0.89 (95% CI 0.86-0.93), the direct effect corresponded to an aOR of 0.84 (95% CI 0.79-0.89), and the indirect effect corresponded to an aOR of 1.10 (95% CI 1.09-1.10). Over 50% of the total effect of rurality on prolonged TTS was mediated by proximity to treatment facility. After adjusting for clinical and sociodemographic factors, TTS of 61-90 days was associated with worse OS in both rural (HR 1.37, 95% CI 1.14-1.63) and urban (HR 1.75, 95% CI 1.72-1.78) patients with comparable results observed for TTS >90 days.</p><p><strong>Conclusions: </strong>Although geographic proximity to care mediates the relationship between rurality and prolonged TTS, rurality has an intrinsic protective effect on TTS that is independent of the adverse effect of increased distance to care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717578","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":"Fully Robotic Left Lobe Donor Hepatectomy is Safer Compared to Open.","authors":"Dieter C Broering, Yasser Elsheikh, Yasir Alnemary, Daniel Borja-Cacho, Mark L Sturdevant, Saleh Alabbad, Massimo Malago, Dimitri A Raptis","doi":"10.1097/SLA.0000000000006705","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006705","url":null,"abstract":"<p><strong>Objective: </strong>To compare the outcomes of fully robotic versus open left lobe donor hepatectomies, focusing on donor safety.</p><p><strong>Summary background data: </strong>Right lobe hepatectomies are traditionally preferred for adult liver transplants due to their larger graft size but may involve increased risks for donors. Left lobe hepatectomies are considered safer for donors but are less commonly used due to concerns about small-for-size syndrome in adult settings.</p><p><strong>Patients and methods: </strong>We conducted an analysis of 339 living liver donors from a prospectively maintained registry at a single institution from November 2011 to June 2023, comparing 72 open and 267 robotic left lobe hepatectomies. Primary outcomes included donor complication rates until hospital discharge while secondary outcomes focused on hospital stay and recipient complications.</p><p><strong>Results: </strong>Robotic hepatectomy was associated with significantly less blood loss (mean 77 (SD 68) vs. 316 (SD 168) mL, P<0.001), lower donor morbidity 6% vs. 18%, P=0.003), and shorter hospital stay (3 vs. 5 days, P<0.001). Adult recipients receiving robotically retrieved donor grafts were associated with a lower overall morbidity rate (40% vs. 59%, P=0.033) compared to open.</p><p><strong>Conclusion: </strong>Robotic left donor hepatectomy significantly improves donor safety compared to the open approach, supporting its use as a less invasive and donor-centered option in living donor liver transplantation. This study, the largest known series of left lobe donor hepatectomies, demonstrates the robotic approach superiority, potentially setting a new standard in the field of living donor liver transplantation.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707859","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":"Lowest Measured Temperature and Adverse Outcomes after Cardiac Surgery: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery DatabaseTM.","authors":"Karsten Bartels, Hilary P Grocott, Bruce A Bollen, Xiaoke Feng, Svetlana K Eden, Matthew S Shotwell, Joseph D Schmoker, Ashish S Shah, G Burkhard Mackensen, Gudrun Kunst, Louise Y Sun, Thomas A Schwann, Frederick W Lombard, Miklos D Kertai","doi":"10.1097/SLA.0000000000006704","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006704","url":null,"abstract":"<p><strong>Objective: </strong>To determine the relationship between intraoperative lowest measured temperature (LMT) during cardiac surgery using cardiopulmonary bypass (CPB) and the risk for postoperative stroke. Secondarily, to determine the association between LMT and risk for 30-day mortality and other adverse outcomes.</p><p><strong>Background: </strong>The effectiveness of deliberate hypothermia during CPB for the prevention of cardiac surgery-associated stroke and adverse outcomes remains uncertain.</p><p><strong>Methods: </strong>This cohort study from the Society of Thoracic Surgeons Adult Cardiac Surgery DatabaseTM included 1,847,808 patients who underwent coronary artery bypass graft surgery (CABG), valve surgery, and combined CABG-valve procedures between July 1, 2011, to March 1, 2022. Using propensity score-weighted regression analysis, we analyzed the effect of LMT on the incidence of postoperative stroke and other adverse outcomes. Since the relationship between LMT and the examined outcomes was non-linear, LMT was treated as a continuous variable.</p><p><strong>Results: </strong>In risk adjusted analyses, no association was observed between the LMT and the primary outcome of postoperative stroke (P=0.316). For the secondary outcomes, encephalopathy or coma (P=0.649), or 30-day mortality (P=0.691) were also not associated with lower LMT. Acute kidney injury (P<0.001) was less common with lower and more common with higher LMTs. Pneumonia (P=0.002) was less common, yet reoperation for bleeding (P<0.001) was more common with higher LMTs.</p><p><strong>Conclusions: </strong>Hypothermia during CPB did not alter the risk of postoperative stroke. Secondary outcomes varied in their directionality of association with temperature, indicating that certain cardiac surgery patients may benefit, but others could be harmed by routine therapeutic hypothermia during CPB.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707884","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}