Annals of surgery最新文献

{"title":"Portomesenteric Venous Thrombosis After Pancreatic Cancer Surgery With Venous Resection and Reconstruction: Timing, Incidence, and Risk Factors.","authors":"Hiroyuki Ishida, Shuichi Watanabe, Salvador Rodriguez Franco, Oskar Franklin, Thomas F Stoop, Michael J Kirsch, Richard D Schulick, Marco Del Chiaro","doi":"10.1097/SLA.0000000000006605","DOIUrl":"10.1097/SLA.0000000000006605","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the incidence and risk factors of portomesenteric venous thrombosis (PVT) after pancreatic cancer surgery with portomesenteric venous resection (PVR).</p><p><strong>Background: </strong>Pancreatic cancer surgery with PVR can be complicated by PVT, but the long-term associations, risk factors, and consequences of PVT have not been clearly elucidated.</p><p><strong>Methods: </strong>This study included pancreatic cancer patients undergoing any type of pancreatic resection with PVR at the University of Colorado Hospital between January 2012 and June 2023. The study period was divided based on the implementation of local standardization of PVR techniques in August 2018. PVT was classified as early or late (≤ or >30 d postoperatively). Risk factors for late PVT were assessed with Cox regression models.</p><p><strong>Results: </strong>Among 152 patients, 3.3% (n=5) developed early PVT. Its incidence decreased from 12% (n=3/25) to 1.6% (n=2/127) after technical standardization ( P =0.03). Of 130 patients with available postoperative imaging, 21.5% (n=28) developed late PVT at a median of 7.4 months from surgery. Late PVT was frequently diagnosed with local recurrence (75%) and was associated with shorter recurrence-free survival (median 9.0 vs 16.3 mo, P =0.014). Multivariable analysis showed that neoadjuvant radiotherapy (hazard ratio, 2.19; 95% CI: 1.02-4.67) and local recurrence (HR, 5.21; 95% CI: 2.18-12.4) were associated with an increased risk of late PVT.</p><p><strong>Conclusions: </strong>Early PVT after pancreatectomy with PVR is rare. Late PVT is associated with neoadjuvant radiotherapy and local recurrence. These findings may inform risk assessment in pancreatic cancer patients undergoing PVR.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"804-812"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827227","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":"Video Assessment of Surgical Performance in Robotic Gastroenterostomy During Pancreatoduodenectomy: Evaluating the Learning Curve and Risk of Delayed Gastric Emptying.","authors":"Maurice J W Zwart, Bram L J van den Broek, Diederik S J Paijens, Sabrina L M Zwetsloot, Annalisa Comandatore, Olivier R Busch, Khé T C Tran, Misha D Luyer, Jennifer Schreinemakers, Jan H Wijsman, George P van der Schelling, Ignace H J T de Hingh, Jan S D Mieog, Bert A Bonsing, Kosei Takagi, Roeland F de Wilde, Luca Morelli, Herbert J Zeh, Amer H Zureikat, Melissa E Hogg, Bas Groot Koerkamp, Marc G Besselink","doi":"10.1097/SLA.0000000000006692","DOIUrl":"10.1097/SLA.0000000000006692","url":null,"abstract":"<p><strong>Objective: </strong>To identify learning curves for robotic gastroenterostomy (RGE) during robotic pancreatoduodenectomy (RPD) and the predictive value of the objective structured assessment of technical skills (OSATS) score for delayed gastric emptying (DGE) according to the Birkmeyer and colleagues and University of Pittsburgh Medical Center method.</p><p><strong>Background: </strong>In some series, RPD has been associated with an increased risk of DGE. It is unclear whether this is attributable to learning curve. Improved surgical performance and experience have not yet been linked to a decrease in DGE in RPD.</p><p><strong>Methods: </strong>Post hoc study of the prospective multicenter (LAELAPS-3) training program, including videos of RGE during RPD. Surgical performance was scored with OSATS by 2 blinded graders. The main outcomes are the combined OSATS scores of 2 blinded graders over time (learning curve). Secondary outcome is the correlation between OSATS scores and clinically relevant DGE (grade B/C).</p><p><strong>Results: </strong>Videos from 192 RGE anastomoses were included. DGE occurred in 42/192 (21.9%) patients. The mean OSATS score was 22.4 (SD ± 5.1) and predicted DGE Area under the curve (AUC): 0.668, P < 0.001). The predictive OSATS elements for DGE were gentleness (AUC: 0.719, P < 0.001), instrument handling (AUC: 0.595 P = 0.043), tissue exposure (AUC: 0.625, P = 0.009), and summary score (AUC: 0.665, P < 0.001). An OSATS score >25 was associated with a 59.9% reduced relative risk of grade B/C DGE [11.3% (8/71) vs 28.1% (34/121); odds ratio (OR): 0.325, P = 0.006]. Cumulative sum analysis of RGE-OSATS identified a turning point at 34 procedures [25.7% (36/140) before vs 11.5% (6/52) after; OR: 0.156, P = 0.035]. On multivariable analysis for grade B/C DGE, OSATS ≤25 remained an independent risk factor (OR: 2.907, P = 0.028).</p><p><strong>Conclusions: </strong>Better surgical performance during gastroenteric anastomosis in RPD, as assessed by OSATS, is associated with a reduced rate of grade B/C DGE. OSATS could serve as a tool for competency-based training programs and quality-controlled implementation of RPD.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"787-795"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603478","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":"Tangential Versus Segmental Portomesenteric Venous Resection During Pancreatoduodenectomy for Pancreatic Cancer: An International Multicenter Cohort Study on Surgical and Oncological Outcome.","authors":"Thomas F Stoop, Adrienne Molnár, Leonard W F Seelen, Toshitaka Sugawara, Jacobien C M Scheepens, Mahsoem Ali, Ammar A Javed, Asif Halimi, Atsushi Oba, Bas Groot Koerkamp, Bodil Andersson, Caroline Williamsson, Christopher L Wolfgang, Daisuke Ban, Ernesto Sparrelid, Freek Daams, Geert Kazemier, Hjalmar C van Santvoort, Ingmar F Rompen, I Quintus Molenaar, Joseph R Habib, Lysanne P M Beuk, Niek J Geerdink, Roeland F de Wilde, Olivier R Busch, Oskar Swartling, Paulina Bereza-Carlson, Poya Ghorbani, Reeve L Kruize, Richard D Schulick, Salvador Rodriguez Franco, Tatsunori Miyata, Oskar Franklin, Yosuke Inoue, Marc G Besselink, Marco Del Chiaro","doi":"10.1097/SLA.0000000000006638","DOIUrl":"10.1097/SLA.0000000000006638","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether tangential versus segmental portomesenteric venous resection (PVR) impacts surgical and oncological outcomes in patients undergoing pancreatoduodenectomy for pancreatic cancer with portomesenteric vein (PMV) involvement.</p><p><strong>Background: </strong>Current comparative studies on tangential versus segmental PVR as part of pancreatoduodenectomy for pancreatic cancer include all degrees of PMV involvement, including cases where tangential PVR may not be a feasible approach, limiting the clinical applicability.</p><p><strong>Methods: </strong>An international retrospective study in 10 centers from 5 countries, including all consecutive patients after pancreatoduodenectomy with PVR for pancreatic cancer with ≤180 degrees PMV involvement on cross-sectional imaging at diagnosis (2014-2020). Cox and logistic regression analyses were performed to investigate the association of tangential versus segmental PVR with overall survival (OS) from surgery, recurrence-free survival (RFS), locoregional recurrence, and in-hospital/30-day major morbidity, adjusting for potential confounders.</p><p><strong>Results: </strong>Overall, 357 patients who underwent pancreatoduodenectomy with PVR were included (42% tangential PVR, 58% segmental PVR). The adjusted risk for in-hospital/30-day major morbidity was 23% (95% CI, 17-32) after tangential and 23% (95% CI, 17-30) after segmental PVR ( P =0.98). After adjusting for confounders, PVR type was not associated with OS [HR=0.94 (95% CI, 0.69-1.30)], RFS [HR=0.94 (95% CI, 0.69-1.28)], and locoregional recurrence [OR=0.76 (95% CI, 0.40-1.46)].</p><p><strong>Conclusions: </strong>In patients undergoing pancreatoduodenectomy for pancreatic cancer with ≤180 degrees PMV involvement, the type of PVR (ie, tangential vs segmental) was not associated with differences in surgical and oncological outcome. This suggests that if both procedures are technically feasible, surgeons can choose the type of PVR based on their preference.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"821-830"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021888","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":"Burn Injury Rewires Immune and Neuronal Extracellular Vesicle Communication.","authors":"Kristin N Grimsrud, Tajia Green, Yirui Tang, Shannon M Clayton, Briana M Ward, David Wang, Blythe Durbin-Johnson, Aijun Wang, Tina L Palmieri","doi":"10.1097/SLA.0000000000007161","DOIUrl":"10.1097/SLA.0000000000007161","url":null,"abstract":"<p><strong>Objective: </strong>We examined extracellular vesicle (EV) protein alterations after burn injury to elucidate molecular pathways linking immune-neural communication and the pathophysiology of burns.</p><p><strong>Background: </strong>Severe burn injury triggers widespread inflammation and metabolic stress with downstream consequences. EVs are essential mediators of cell-to-cell communication and protein transport for regulating inflammation, metabolism, and neuronal signaling that may reflect burn-related alterations.</p><p><strong>Methods: </strong>Plasma EVs from 37 adult burn patients (≥15% total body surface area burn [TBSA]) and 21 nonburn controls were analyzed. An age-restricted subcohort (<40 years) was additionally evaluated to minimize potential confounders of age. A subset (4 per group) underwent cell type-specific EV enrichment. Proteomic profiling and functional enrichment analyses, including gene ontology (GO) over-representation analysis (ORA), Reactome gene set enrichment analysis (GSEA), and Ingenuity Pathway Analysis (IPA), were performed to identify differential protein abundance and associated biological pathways.</p><p><strong>Results: </strong>Burn injury produced distinct alterations in EV proteomic profiles. Among 919 detected proteins, 326 were decreased and 593 were increased. The 5 most significant proteins (adjusted P -value<0.05) distinguishing burns from controls were CRP, ITGA11, MYH9, CALR, and ANTXR2. GO ORA, Reactome GSEA, and IPA consistently identified enrichment of immune activation and inflammatory regulation pathways, including immune cell chemotaxis, acute-phase signaling, cytokine signaling, complement activation, coagulation, and cellular stress pathways. Similar inflammatory pathway enrichment persisted in the age-restricted subcohort. Exploratory analyses of cell type-enriched EVs demonstrated distinct proteomic trends across immune and neuronal EV populations, although no subtype-specific proteins exhibited statistical significance.</p><p><strong>Conclusions: </strong>Burn injury profoundly alters EV cargo across general, immune, and neuronal types, reflecting proinflammatory and neuroimmune-associated signaling. This coordinated EV remodeling may reflect the hyperinflammatory responses, altered healing, and downstream biological pathway alterations. EV-based biomarkers may enable improved diagnostic and therapeutic strategies to mitigate dysregulated immune and healing responses in burn patients.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"689-698"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618211","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":"Comprehensive Analysis of US Health Care Spending on Injuries.","authors":"John W Scott, Grace E Kennedy, Haley Lescinsky, Sawyer W Crosby, Meera Beauchamp, Azalea Thomson, Kayla V Taylor, Barclay T Stewart, Nakul P Raykar, Tom C Tsai, Joseph V Sakran, Kristan L Staudenmayer, Eileen M Bulger, Joseph L Dieleman","doi":"10.1097/SLA.0000000000007199","DOIUrl":"10.1097/SLA.0000000000007199","url":null,"abstract":"<p><strong>Background: </strong>Traumatic injury affects every age group, payer, and care setting in the United States, yet how injury-related spending distributes across these dimensions has not been comprehensively quantified.</p><p><strong>Objective: </strong>To estimate US health care spending on injuries in 2022 by mechanism, payer, and type of care.</p><p><strong>Methods: </strong>Cross-sectional analysis using the Institute for Health Metrics and Evaluation's Disease Expenditure Project, which harmonizes over 40 billion claims across Medicare, Medicaid, and commercial payers. Spending was attributed to injury diagnoses, adjusted for comorbidities, and stratified across 38 age and sex groups, 9 mechanism categories, 4 payers, and 5 types of care to evaluate for distinct spending phenotypes.</p><p><strong>Results: </strong>US injury spending totaled $106.7 billion in 2022, with 52% occurring outside acute care settings and ambulatory care ($42.2B, 40%) nearly equaling inpatient care ($42.3B, 40%). Falls predominated ($56.2B, 53%), followed by transport injuries ($23.3B, 22%). Distinct spending phenotypes varied by mechanism: falls concentrated among women aged 65 and older with heavy post-acute utilization, while firearms and assault concentrated among men aged 15 to 39 with predominantly acute care. Payer burden stratified by mechanism (falls: 40% Medicare; transport injuries: 58% private; assault: 52% Medicaid). For patients under age 65, private insurance spent 3 times more per inpatient encounter than Medicaid across all mechanisms, while Medicare and private insurance had similar spending per inpatient encounter for those over 65.</p><p><strong>Conclusions: </strong>This first comprehensive, claims-based accounting of the nearly $107 billion spent annually on injuries in the United States reveals distinct spending phenotypes defined by mechanism, demographics, and payer, with direct implications for how trauma systems are planned, financed, and sustained.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"717-726"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700551","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":"Implications of Neoadjuvant Therapy on Prognostic Factors in Pancreatic Ductal Adenocarcinoma: A Path Towards Personalized Prognostication.","authors":"Ammar A Javed, Joseph R Habib, Paul C M Andel, Brady A Campbell, Ingmar F Rompen, Omar Mahmud, Asad Fatimi, Iris W J M van Goor, Thijs J Schouten, Thomas F Stoop, Camila Hidalgo Salinas, Hjalmar C van Santvoort, Bas Groot Koerkamp, I Quintus Molenaar, Christopher L Wolfgang, Marc G Besselink, Jin He, Lois A Daamen","doi":"10.1097/SLA.0000000000006660","DOIUrl":"10.1097/SLA.0000000000006660","url":null,"abstract":"<p><strong>Objective: </strong>To investigate prognostic factors in the context of neoadjuvant therapy (NAT) and develop tools that can allow for accurate and personalized patient prognostication.</p><p><strong>Background: </strong>NAT might impact the prognostic ability of well-established clinicopathologic factors in resected pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Methods: </strong>Patients after resection for PDAC were identified from the Dutch Pancreatic Cancer Group Recurrence Database and institutional databases at NYU Langone Health and the Johns Hopkins Hospital (2014-2019). Patients were stratified into NAT and chemo-naïve groups. Overall survival (OS), calculated from the time of resection, was estimated using Kaplan-Meier and compared using log-rank tests. Prognostic factors associated with OS were assessed in both groups using univariable and multivariable Cox regression analyses and presented using hazard ratios with corresponding 95% CIs. Predictive models were developed and an interactive tool was created to predict survival independently in both groups.</p><p><strong>Results: </strong>Of 2760 patients with resected PDAC, 778 patients (28%) received NAT. Independent predictors for worse OS in chemo-naïve patients included age ≥65 years, markedly elevated carbohydrate antigen 19-9 (≥500 U/mL) at diagnosis, higher AJCC-T stage (T3/4 vs T1/2), worsening AJCC N-stage (N2 vs N1 vs N0), poor tumor differentiation, perineural invasion, and microscopically positive resection margin (R1 vs R0). Contrastingly, predictors for worse OS in patients undergoing NAT included non-normalization of carbohydrate antigen 19-9 after NAT (<37 U/mL), presence of nodal disease (N1/2 vs N0 given no statistical difference between N1 and N2 disease), and grade of treatment response (moderate/poor vs complete/near complete).</p><p><strong>Conclusions: </strong>Prognostic factors for OS in patients with resected PDAC differ between patients undergoing chemo-naïve and NAT. Personalized prediction tools for OS in resected PDAC based on these specific factors are available online (www.pancpals.com/tools).</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"e79-e86"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143389624","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":"New Tumor Classification Using Invasion Depth in Biliary Tract Cancer Around the Cystic Duct Junction.","authors":"Yuta Ushida, Nobuyuki Watanabe, Shoji Kawakatsu, Ryusei Yamamoto, Takashi Mizuno, Shunsuke Onoe, Yukihiro Yokoyama, Toshio Kokuryo, Tsuyoshi Igami, Junpei Yamaguchi, Masaki Sunagawa, Taisuke Baba, Yoshie Shimoyama, Tomoki Ebata","doi":"10.1097/SLA.0000000000006672","DOIUrl":"10.1097/SLA.0000000000006672","url":null,"abstract":"<p><strong>Objective: </strong>To propose a shared T classification system for biliary tract cancers located around the cystic duct junction.</p><p><strong>Summary background data: </strong>These cancers include perihilar cholangiocarcinoma (PCC), distal cholangiocarcinoma (DCC), and cystic duct carcinoma (CDC), which are staged according to discrete tumor classification.</p><p><strong>Methods: </strong>From 2011 to 2019, patients with biliary tract cancers that clinically invaded the junction (junctional cholangiocarcinoma [JCC] ) were classified as having PCC, DCC, CDC, or unclassifiable tumor (UT) based on topologic predominance. The prognostic stratifying ability of the specific American Joint Committee on Cancer T system and depth-based classification were compared between patients with JCC and UT.</p><p><strong>Results: </strong>Among 191 patients with JCC, 63, 20, and 20 had PCC, DCC, and CDC, respectively; the remaining 88 (46%) had UT. The DCC group showed a better survival rate of 70% at 5 years than the other groups (48% for UT, 36% for PCC, and 29% for CDC). Specific tumor classifications of PCC, DCC, and CDC significantly stratified survival in 88 patients with UT, with c-indices of 0.611, 0.613, and 0.563, respectively. Stratified by depth-based classification (T1, ≤1 mm; T2, >1-5; T3, 6-10; and T4, >10 mm), the 5-year survival rates were 83%, 67%, 44%, and 0% in the UT cohort ( P <0.001, C-index, 0.654) and 88%, 60%, 41%, and 24% in the entire JCC cohort ( P <0.001, C-index, 0.632), respectively.</p><p><strong>Conclusions: </strong>The depth-based T classification significantly stratified survival in the clinical category of JCC and histologically defined UT. Cholangiocarcinoma and CDC in this region can be grouped under the banner of the JCC.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"796-803"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143432380","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":"Tele-Robotic Surgery for Combat Casualty Care: Proof of Feasibility.","authors":"Tasha Merchant, Francesco Bianco, Maj Christopher Dyke, Gerald Gantt, Ernest Lockrow, Marko Rojnica, Valentina Valle, Dennis Fowler, Kate Petty, Yulun Wang, Shane Farritor, Piet Hinoul, Dmitry Oleynikov, Eric Elster, Enrico Benedetti, Capt Matthew Bradley, Stephen T Bartlett","doi":"10.1097/SLA.0000000000007178","DOIUrl":"10.1097/SLA.0000000000007178","url":null,"abstract":"<p><strong>Objective: </strong>These experiments test the feasibility of tele-robotic surgery for the shipboard care of combat casualties.</p><p><strong>Summary background data: </strong>Limited research on the effects of telecommunications latency on tele-robotics has been a consistent concern in the growth of tele-robotic surgery. These experiments are designed to provide well-controlled real-world data on robotic surgical performance with electronically added latency that simulates combat-relevant, satellite-based tele-robotic communication.</p><p><strong>Methods: </strong>Surgeons at 2 university hospitals separated by 1096 km bi-directionally performed remote cholecystectomy (Ch) and right colectomy (Co) dissections on cadaver subjects. Varying latency between 0 and 300 ms was electronically added. Network performance, OR time, Global Performance (GP), and Surgery Task Load Index (TLX) were determined. Statistical analysis: simple linear regression.</p><p><strong>Results: </strong>Network latency was 28 ms, jitter 0.03 ms, with zero packet loss. Including robotic intrinsic latency of 50 ms, total latency (TOT) varied from 78 to 378 ms. 12 Ch and 14 Co were performed by 4 surgeons. Co OR time unexpectedly decreased with TOT ( P =0.005), but Ch did not ( P =0.47). OR time was strongly associated with general surgeon experience ( P =0.024). TLX was strongly associated with surgeon experience ( P <0.001) but not TOT ( P =0.47). GP was consistently between 4/5 and 5/5 across all domains and did not correlate with TOT ( P =0.41). Each surgeon showed rapid cognitive and motor adaptation to increasing latency.</p><p><strong>Conclusions: </strong>Experienced robotic surgeons rapidly develop cognitive and motor adaptation to tele-robotic latency. Satellite-based tele-robotic surgery in combat environments may add greater latency than fiber-optic-connected civilian applications. Our data indicate a significantly greater tolerance for latency than previously reported. Development of telerobotic surgery for combat casualties is highly feasible.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"709-716"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787260","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":"Revisiting the Women's Health and Cancer Rights Act: Updating Federal Protections for Modern Breast Reconstruction.","authors":"Shivani A Shah, Andrea L Pusic, Nicholas L Berlin","doi":"10.1097/SLA.0000000000007022","DOIUrl":"10.1097/SLA.0000000000007022","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"727-729"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146103633","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":"KRAS Mutations in Duodenal Lavage Fluid After Secretin Stimulation for Detection of Pancreatic Cancer.","authors":"Shinichi Yachida, Shigetaka Yoshinaga, Satoshi Shiba, Makiko Urabe, Hidenori Tanaka, Yohei Takeda, Akinori Shimizu, Yuri Sakamoto, Susumu Hijioka, Shin Haba, Reiko Ashida, Yoshinori Kushiyama, Kento Asano, Makiko Kobayashi, Yoshiyuki Murawaki, Kouji Onishi, Taro Yamashita, Hirokazu Kimura, Yasushi Totoki, Hideki Kamada, Hajime Isomoto, Satoshi Hattori, Chigusa Morizane, Kazuyoshi Ohkawa, Masayuki Kitano, Kazuo Hara, Kenji Ikezawa, Keiji Hanada, Kazuya Matsumoto","doi":"10.1097/SLA.0000000000006645","DOIUrl":"10.1097/SLA.0000000000006645","url":null,"abstract":"<p><strong>Objective: </strong>Although pancreatic ductal adenocarcinoma (PDAC) is still a devastating disease, the survival rate for surgically removed PDACs has significantly improved in recent years. Early detection is essential in managing PDAC.</p><p><strong>Background: </strong>The presence of KRAS mutations in PDAC leads to the initial genetic abnormality and offers a significant timeframe for identifying resectable PDACs. A minimally invasive and highly specific PDAC screening test is necessary to prevent the need for invasive follow-up tests.</p><p><strong>Methods: </strong>Between July 2021 and March 2023, 169 cases were enrolled in 7 institutions. By administering secretin before esophagogastroduodenoscopy (EGD), the excretion of pancreatic juice into the papillary fluid can be stimulated, creating a resource for testing. Washing fluid was collected using a specialized catheter from control individuals (n=75) and patients with resectable PDAC (n=89) at the initial diagnosis. A highly sensitive technique was employed to study KRAS gene mutations.</p><p><strong>Results: </strong>This study obtained an AUC of 0.934 (95% CI: 0.904, 0.964) when using KRAS mutations in duodenal lavage fluid to differentiate between patients with resectable PDAC and healthy controls. The estimated sensitivities were calculated with specificity set at 100%, resulting in a sensitivity of 83.1% (95% CI: 71.7%, 91.2%). The McNemer test showed a significantly higher sensitivity for KRAS mutations than serum CEA and CA19-9 ( P <0.0001).</p><p><strong>Conclusions: </strong>We created a method to identify resectable PDACs by analyzing KRAS mutation levels in duodenal fluid collected during EGD with secretin stimulation of pancreatic juice secretion.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"e62-e72"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143122023","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}