Annals of surgery最新文献

{"title":"Postoperative Antibiotics after Appendectomy for Acute Appendicitis: No Evidence of Benefit, Even With Intra-abdominal Fluid.","authors":"Sophie Laroche, Thibault Voron, Penelope Raimbert, Maxime K Collard, Clotilde Debove, François Paye, Jérémie H Lefèvre, Yann Parc","doi":"10.1097/SLA.0000000000006693","DOIUrl":"10.1097/SLA.0000000000006693","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the necessity of postoperative antibiotics following appendectomy for acute appendicitis (AA), particularly in patients with intra-abdominal fluid, and to identify factors associated with postoperative infections.</p><p><strong>Background: </strong>Postoperative antibiotic use after appendectomy remains controversial, especially in the presence of intra-abdominal fluid. While some surgeons prescribe antibiotics empirically, there is no consensus on whether they reduce the risk of postoperative infections in patients with intra-abdominal fluid accumulation.</p><p><strong>Methods: </strong>A retrospective study was conducted at Saint Antoine Hospital (2013-2020) analyzing 1539 patients with AA (abscess and peritonitis were excluded). The presence of intra-abdominal fluid, antibiotic use, and postoperative outcomes were recorded. Risk factors for infections were identified through univariate and multivariate analysis.</p><p><strong>Results: </strong>Intra-abdominal fluid was present in 880 patients (57.2%), with 474 exhibiting serosanguinous intra-abdominal fluid and 406 presenting purulent intra-abdominal fluid. Postoperative antibiotics were administered to 18.1% of patients, yet no significant difference in infection rates was found between patients with and without peritoneal intra-abdominal fluid. The study identified 3 independent risk factors for postoperative infection: American Society of Anesthesiologists score [hazard ratio (HR) = 5.129, P = 0.004], symptom duration >2 days (HR = 2.290, P = 0.029), and the presence of appendicolith (HR = 2.204, P = 0.042). Postoperative antibiotic use did not significantly prevent infections, but inadequate antibiotic therapy was associated with higher rates of readmission and infectious outcomes.</p><p><strong>Conclusions: </strong>Routine use of postoperative antibiotics for AA, even with intra-abdominal fluid, may not be necessary. Further research is needed to determine whether a targeted antibiotic approach based on risk factors for postoperative infections can improve outcomes without exacerbating antibiotic resistance.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"831-838"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603462","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":"Making the House a Home: Cultivating Community in Surgery.","authors":"Chukwuma N Eruchalu, Alexander R Cortez, Leah K Winer, Nancy L Cho","doi":"10.1097/SLA.0000000000007028","DOIUrl":"10.1097/SLA.0000000000007028","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"730-732"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211702","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":"Chronic Pain and Sexual Dysfunction After Groin Hernia Repair in Adolescents: A Nationwide Survey.","authors":"Hugin Reistrup, Siv Fonnes, Jacob Rosenberg","doi":"10.1097/SLA.0000000000006716","DOIUrl":"10.1097/SLA.0000000000006716","url":null,"abstract":"<p><strong>Objective: </strong>To assess the prevalence of chronic pain and sexual dysfunction after groin hernia repair in adolescents.</p><p><strong>Background: </strong>Adolescents present unique challenges in groin hernia management due to their evolving anatomy, yet data on patient-reported outcomes remain limited.</p><p><strong>Methods: </strong>A nationwide survey was conducted in Denmark, linking patient-reported outcomes to the Danish National Patient Register and Civil Registration System. Patients who underwent primary unilateral groin hernia repair during adolescence (10-19 years) between 1992 and 2022 were identified. The primary outcome was chronic pain assessed with the short-form Inguinal Pain Questionnaire. Secondary outcomes included chronic pain assessed with the Activities Assessment Scale and sexual dysfunction assessed with the Sexual Inguinal Hernia Questionnaire.</p><p><strong>Results: </strong>Among 2486 participants (response rate: 60.8%) completing the survey [80% males; median age at repair 16 (interquartile range: 12-19) years], 7.3% (95% CI: 6.3-8.4) reported chronic pain across all follow-up periods. In participants with <15 years of follow-up, 9% to 15% reported chronic pain depending on age at the time of repair and repair method. Chronic pain during sexual activity was reported by 8.6% (95% CI: 7.5-10) of participants. No significant differences in chronic pain or sexual dysfunction were observed between repair methods. Femoral hernia repairs were rare.</p><p><strong>Conclusions: </strong>Chronic pain and sexual dysfunction were common long-term complications of groin hernia repair in adolescents, regardless of repair methods. Optimizing outcomes could include a tailored, patient-centered approach by hernia experts, ensuring optimal care for this unique, young, low-volume population within hernia surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"751-758"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143794601","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":"Medicaid Expansion Is Associated With Decreased Mortality in Patients Diagnosed With Colorectal Cancer and Synchronous Liver Metastasis.","authors":"Julien T Hohenleitner, Rohin Gawdi, David Hyman, Lyudmyla Demyan, Angelina Lionetta, Oliver J Standring, Murtuza Hassan, Steven M Cohen, Gerardo Vitiello, Danielle K DePeralta, Mark A Talamini, Sepideh Gholami, Matthew J Weiss","doi":"10.1097/SLA.0000000000007162","DOIUrl":"10.1097/SLA.0000000000007162","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of Medicaid expansion (ME) and its timing on treatment patterns and survival in patients younger than 65 years with colorectal cancer and synchronous liver metastasis (CRLM).</p><p><strong>Background data: </strong>Management of CRLM requires multidisciplinary oncologic and surgical care. In 2010, the Affordable Care Act expanded Medicaid eligibility to adults earning ≤138% of the Federal Poverty Level. The effect of ME on outcomes in metastatic colorectal cancer requiring complex care remains incompletely defined.</p><p><strong>Methods: </strong>The SEER 2022 database was queried for patients <65 years old diagnosed with CRLM from 2010 to 2019. Patients with extrahepatic metastases or no follow-up were excluded. Event-study difference-in-differences analyses compared outcomes between expansion and nonexpansion states. Cox proportional hazards models clustered by state adjusted for demographic and socioeconomic factors evaluated 3-year all-cause and disease-specific mortality.</p><p><strong>Results: </strong>Among 33,216 patients with CRLM, 13.4% underwent metastasectomy. In ME states, the 3-year disease-specific mortality rate decreased from 75% pre-expansion to 68% after 6+ years. Risk of 3-year disease-specific mortality in ME states compared with nonexpansion states was reduced beginning 2-3 years after expansion and persisted over time (HR range 0.90-0.95). Reduction in risk of disease-specific mortality was most pronounced among patients undergoing liver metastasectomy (HR range: 0.71-0.85). ME was not associated with increased likelihood of metastasectomy.</p><p><strong>Conclusions: </strong>ME was independently associated with improved survival among patients with CRLM, particularly those receiving surgical and systemic therapy. These data suggest ME may improve continuity of complex multidisciplinary oncologic care and access to systemic therapy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"699-708"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629314","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":"Balancing Oversight and Innovation: The Case of Skin Substitutes.","authors":"Alex J Dong, Nicholas L Berlin, Thomas C Tsai","doi":"10.1097/SLA.0000000000007032","DOIUrl":"10.1097/SLA.0000000000007032","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"733-735"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146211457","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":"Liver Transplantation for Hepatocellular Carcinoma","authors":"Benjamin Tran,Rebecca Marino,Justine Aziz,Joseph DiNorcia,Julia Torabi,Nadin Badran,Myron Schwartz,Sander Florman,Kirema Garcia-Reyes,Rahul Patel,Edward Kim,Parissa Tabrizian","doi":"10.1097/sla.0000000000007221","DOIUrl":"https://doi.org/10.1097/sla.0000000000007221","url":null,"abstract":"Objective: To establish the significance of complete pathologic response (cPR) on survival and locoregional treatment outcomes in a large US cohort. Background: cPR in hepatocellular carcinoma (HCC) is associated with improved post–liver transplant (LT) outcomes. cPR rates, modality-specific differences, and predictors remain undefined. Materials and Methods: Patients were identified from the United Network for Organ Sharing (UNOS) database (2012–2024). cPR was defined as the absence of a viable tumor on explant pathology. Logistic regression identified predictors of cPR, Fine-Gray models estimated the incidence of cPRand Kaplan-Meier analysis assessed survival. Results: Among 7398 LT recipients, 2167 (29.3%) achieved cPR. Imaging–pathology concordance was poor (30.5%), with imaging overestimating response in 42.6% of cases (κ=0.17, P &lt;0.001). Longer waitlist time [&gt;18 vs. &lt;6 mo; odds ratio (OR): 1.94, 95% CI: 1.57–2.40], Y-90 (41.2%), and ablation (36.4%) were associated with higher cPR rates than transarterial chemoembolization (24.0%; P &lt;0.001). On multivariable analysis, yttrium-90 (Y-90) [adjusted OR (aOR): 1.89, 95% CI: 1.46–2.05] and ablation (aOR: 1.23, 95% CI: 1.08–1.39) independently increased cPR, whereas greater tumor burden and elevated alpha-fetoprotein reduced cPR. Y-90 benefit was greatest when administered ≤6 months of waitlisting (OR: 2.40, 95% CI: 1.59–3.61) and in all-comer candidates (OR: 1.58, 95% CI: 1.17–3.26). Fine-Gray analysis confirmed the highest cumulative incidence of cPR with Y-90 across transplant eligibility criteria. cPR was associated with improved 5-year overall survival (86.6% vs. 77.4%) and recurrence-free survival (76.9% vs. 63.1%; P &lt;0.001). Conclusions: Nearly one-third of LT recipients with HCC achieved cPR, which was associated with improved survival. Y-90 was independently associated with higher cPR rates, particularly when administered early and among patients with higher tumor burden.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"13 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149088183","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":"Treatment of Low Anterior Resection Syndrome in Specialized Multidisciplinary Late Sequelae Clinics: A Prospective Cohort Study.","authors":"Mira Mekhael, Helle Ø Kristensen, Mette Borre, Asbjørn M Drewes, Katrine J Emmertsen, Janne Fassov, Klaus Krogh, Michael B Lauritzen, Søren Laurberg, Jakob Lykke Poulsen, Ole Thorlacius-Ussing, Peter Christensen, Therese Juul","doi":"10.1097/SLA.0000000000006714","DOIUrl":"10.1097/SLA.0000000000006714","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the outcomes of a multidisciplinary effort involving surgical and gastroenterological departments in managing bowel dysfunction, specifically low anterior resection syndrome (LARS), following rectal cancer treatment.</p><p><strong>Background: </strong>An increasing number of rectal cancer survivors experience LARS, heightening the need for specialized treatment.</p><p><strong>Methods: </strong>Patients referred to our late sequelae clinics with LARS following sphincter-preserving treatment were eligible for inclusion. Patients were treated in the surgical or gastroenterological units or both based on symptoms. Patients completed patient-reported outcome measures at the first visit, upon discharge, and 12 months after discharge. Treatment outcomes were evaluated by the LARS score and its five single items, six single items covering additional LARS symptoms, the EuroQoL 5-dimension 5-level (EQ-5D-5L) VAS and utility scores, self-rated bowel function, and bowel function impact on quality of life.</p><p><strong>Results: </strong>We included 201 patients. Three-quarters were treated in the surgical units, whereas the rest required gastroenterological treatment. After treatment, the mean LARS score decreased by 4.7 points ( p <0.001), whereas the mean EQ-VAS and utility score increased by 7.1 ( p <0.001) and 0.06 points ( p <0.001), respectively. All individual symptoms significantly improved. Improvement in self-rated bowel function and bowel function impact on quality of life were 55.8% ( p <0.001) and 45.7% ( p <0.001), respectively. Similar results were recorded at the 12-month follow-up.</p><p><strong>Conclusion: </strong>These results encourage establishing late sequelae clinics with a joint gastroenterological and surgical approach to treat LARS following rectal cancer treatment.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"839-848"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762584","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":"Biliary Atresia-Extracellular Matrix Score: Automated Quantification of Liver Fibrosis Architecture in Biliary Atresia With Potential for Prognostic Value-A Pilot Study.","authors":"Norah E Liang, Jason L Guo, Michelle F Griffin, Khristian Erich Bauer-Rowe, Amrita Narang, Michael Januszyk, Gillian L Fell, James C Y Dunn, Stephanie D Chao, Serena Y Tan, Michael T Longaker, Jeong S Hyun","doi":"10.1097/SLA.0000000000006698","DOIUrl":"10.1097/SLA.0000000000006698","url":null,"abstract":"<p><strong>Objective: </strong>To quantify liver fibrosis in infants with biliary atresia (BA) through automated analysis of collagen extracellular matrix (ECM) ultrastructure in index liver biopsies and use a composite fibrosis architecture score to predict native liver survival.</p><p><strong>Background: </strong>Despite early management with Kasai portoenterostomy, BA remains the leading indication for pediatric liver transplantation. There is no established method for quantitatively assessing liver fibrosis in patients with BA, and no factors to accurately predict which patients will ultimately require transplantation early versus late.</p><p><strong>Methods: </strong>Index liver biopsies from 12 patients with BA who underwent Kasai portoenterostomy at our institution were retrieved from our pathology archives. Liver biopsies from control patients without BA and with minimal liver fibrosis on biopsy were used as \"Low Fibrosis Controls\". Biopsies from BA patients who underwent upfront liver transplantation were used as \"High Fibrosis Controls\". Masson's trichrome-stained biopsies were scanned, tiled, binarized, and quantified for 147 ECM features. These features were reduced by Uniform Manifold Approximation and Projection. Pseudotime analysis was applied to summarize global variations in architecture and assign BA-ECM scores to all biopsy images in an unsupervised manner. A retrospective chart review was then performed to correlate clinical characteristics with BA-ECM score. BA-ECM scores were compared between BA patients who had been actively listed for liver transplantation during the study period and those who had not.</p><p><strong>Results: </strong>BA-ECM score, a multidimensional fibrosis architecture score, was significantly higher for biopsies from listed patients compared with non-listed patients (35.9 vs 22.9, * P < 0.0001). High BA-ECM score was characterized by thick, patchy, irregular ECM, whereas low BA-ECM score was associated with large-volume thin, porous collagen fibers. Survival analysis stratified by the third quartile BA-ECM score of all data points demonstrated a significant difference in native liver survival (* P = 0.02).</p><p><strong>Conclusions: </strong>We present the application of an automated ECM ultrastructure analysis tool designed to capture and quantify 147 aspects of fibrotic tissue heterogeneity. These manifold features are summarized using a multidimensional BA-ECM score that could be used to prognosticate disease course for patients with BA.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"776-786"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662131","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":"Durability of Practice Change in Hernia Surgery Following De-implementation of Intensive Implementation Strategies.","authors":"Rachna Sridhar, Alex K Hallway, Amy M Kilbourne, Dana A Telem, Anne P Ehlers","doi":"10.1097/SLA.0000000000007086","DOIUrl":"10.1097/SLA.0000000000007086","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"862-863"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147866302","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":"Exercise Modulates Adiposity-induced Immune Dysfunction in NSCLC and Non-tumor-Bearing Lungs: Implications for Lung Cancer Therapy and Interception.","authors":"Randall Smith, Kayleigh Erickson, Deschana Washington, Robert Zollo, Sukumar Kalvapudi, Yeshwanth Vedire, Cara Petrucci, Robert Vethanayagam, Hua-Hsin Hsiao, Spencer Rosario, Joseph Barbi, Sai Yendamuri, Andrew Ray","doi":"10.1097/SLA.0000000000007151","DOIUrl":"10.1097/SLA.0000000000007151","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether physical activity modulates adiposity-driven immune suppression in the lung and tumor microenvironment to restore antitumor immunity.</p><p><strong>Background: </strong>Obesity is associated with immune dysfunction that supports lung cancer progression, namely reduced cytotoxic T-cell activity and expansion of suppressor populations. These alterations extend to the lung, the site of new and metastatic tumors. Although exercise improves metabolic and inflammatory profiles, its impact on adiposity-associated immune dysregulation in these compartments remains unclear.</p><p><strong>Methods: </strong>Obese and lean mice were implanted with Lewis lung carcinomas under sedentary conditions or with exercise wheel access. Exercise effects on the tumor and infiltrating leukocytes were assessed by RNA sequencing and flow cytometry. The lungs of obese and lean tumor-naïve mice with and without exercise were also characterized by flow, as were bronchoalveolar lavage samples from patients (n = 73) stratified by total fat area and physical activity with multivariable adjustments.</p><p><strong>Results: </strong>Obese mice allowed voluntary exercise displayed less profound enhancement of Tregs and potentially suppressive myeloid cells and fewer CD8⁺ T-cell deficits in the tumor and lung. These mice displayed significant delays in tumor growth, while muted effects were seen in lean mice. Transcriptomic modulation consistent with altered vascular and metabolic programs was also evident in active obese mice. In human bronchoalveolar lavage, physical activity was also linked to reductions in Programmed Death receptor 1⁺ Tregs and suppressive myeloid cells enhanced by adiposity.</p><p><strong>Conclusions: </strong>Exercise may reverse adiposity-associated immune suppression in the lung and tumor microenvironments to complement lung cancer interception and treatment strategies.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"665-679"},"PeriodicalIF":7.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676838","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}