Annals of surgery最新文献

{"title":"Should Older Patients Accept a High KDPI Kidney or Wait? A National Data Analysis of Matched Cohorts.","authors":"Tambi Jarmi, Rose Mary Attieh, Emily Brennan, Shawna Green, Aaron C Spaulding","doi":"10.1097/SLA.0000000000006695","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006695","url":null,"abstract":"<p><strong>Objective: </strong>This study addressed whether kidney transplant (KTx) candidates, ages 60+, should accept a high KDPI kidney and differences when considering a high (>85% vs low (<85%) KDPI KTx.</p><p><strong>Summary/background data: </strong>To date, there is limited survival data to guide decision-making for patients aged 60 years and older who are faced with the choice of accepting a high KDPI kidney or remaining on the waitlist.</p><p><strong>Methods: </strong>Propensity-matched cohort study using data from United Network on Organ Sharing (2014-2021). Cox proportional hazard models and competing risk models allowed comparison of (1) patient survival on the waitlist or after KTx and (2) patient and graft survival after KTx for the second comparison between matched groups, stratified by age groups: 60-65, 66-70, and 71+.</p><p><strong>Results: </strong>Receiving a >85% KDPI kidney versus remaining on the waitlist was associated with reduced mortality (HR 0.68, 95% CI 0.59-0.80, P<0.001) overall and across the two oldest age groups: 66-70 (HR 0.57, 95% CI 0.44-0.73, P<0.001) and 71+ (HR 0.59, 95% CI 0.44-0.83, P<0.001). Those aged 60-65 did not experience a survival benefit (HR 0.86, 95% CI 0.67-1.11, P=0.259). Patients ages 60+ receiving a >85% or ≤85% KDPI kidney experience comparable survival rates.</p><p><strong>Conclusion: </strong>Our study revealed a survival advantage linked to receiving a lower-quality KTx than remaining on the waitlist in the overall sample and for those 66+. Graft failure and survival were independent of the organ quality.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613172","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 Gastro-enterostomy 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, T C Khé Tran, Misha D Luyer, Jennifer Schreinemakers, Jan H Wijsman, George P van der Schelling, Ignace H J T de Hingh, J Sven 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":"https://doi.org/10.1097/SLA.0000000000006692","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to identify learning curves for robotic gastro-enterostomy (RGE) during RPD and the predictive value of the objective structured assessment of technical skills (OSATS) score for DGE according to the Birkmeyer et al and UPMC method.</p><p><strong>Summary of background data: </strong>In some series, robotic pancreatoduodenectomy (RPD) has been associated with increased risk of delayed gastric emptying (DGE). It is unclear whether this is attributable to learning curve. Improved surgical performance and experience has not yet been linked to a decrease in delayed gastric emptying 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 two blinded graders. The main outcomes are the combined OSATS scores of two 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. Mean OSATS score was 22.4 (SD±5.1) and predicted DGE (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); OR 0.325, P=0.006). CUSUM analysis of RGE-OSATS identified a turning point at 34 procedures (27.5% (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 gastro-enteric 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":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"https://doi.org/10.1097/SLA.0000000000006693","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the necessity of postoperative antibiotics following appendectomy for acute appendicitis, 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 1,539 patients with acute appendicitis (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 sero-sanguinous 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 three independent risk factors for postoperative infection: ASA score (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>Conclusion: </strong>Routine use of postoperative antibiotics for acute appendicitis, 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":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-12","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":"Corporatization in Medicine? No End in Sight.","authors":"Larry R Kaiser","doi":"10.1097/SLA.0000000000006694","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006694","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603423","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":"Decision-making Factors in Surgical Techniques and Attitudes Towards Environmental Sustainability.","authors":"Kim E van Nieuwenhuizen, Herman J Friedericy, Anne C van der Eijk, Frank Willem Jansen, M Elske van den Akker-van Marle","doi":"10.1097/SLA.0000000000006691","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006691","url":null,"abstract":"<p><strong>Objective: </strong>Our study examines factors influencing surgical specialists' choice of surgical technique and assesses the significance of the carbon footprint in this decision-making process. It also investigates their attitudes, behaviours and barriers to environmental sustainability.</p><p><strong>Background: </strong>Climate change significantly threatens health, with surgery being a major contributor to healthcare's carbon footprint.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using a discrete choice experiment (DCE) and a questionnaire. Respondents were Dutch-speaking surgeons, gynaecologists and urologists with experience in minimally invasive surgery. They judged 14 choice sets, each presenting two hypothetical surgical scenarios that varied in postoperative length of stay, patient's preference, specialists' experience, costs, national guideline recommendations, and carbon footprint. The questionnaire explored attitudes, behaviours, and barriers to environmental sustainability.</p><p><strong>Results: </strong>Among the 116 respondents, patient's preference emerged as the most important factor in the choice of a surgical technique (Relative Importance (RI) 27.35 [95% Confidence Interval (95% CI) 19.57-35.12]), followed by postoperative length of stay (RI 21.41 [95% CI 14.07-28.75]), specialists' experience (RI 16.07 [95% CI 11.45-20.69]), costs (RI 13.98 [95% CI 8.42-19.55]), national guideline recommendations (RI 13.29 [95% CI 8.41-18.16] and carbon footprint (RI 7.90 [95% CI 3.63-12.18]). Respondents expressed concern about climate change (105/116; 90%), with 85% (98/116) altering personal behaviours, and 49% (57/116) changing work practices. They feel surgical specialists have responsibility to be aware of surgery's environmental impact (97/116; 84%), and a part have knowledge to decrease this impact (39/116; 34%). Main barriers are time (73/116; 63%), costs (74/116; 64%) and inadequate training and information (67/116; 58%).</p><p><strong>Conclusions: </strong>Patient's preference and postoperative length of stay are prioritised in surgical decision-making, while carbon footprint is the least significant factor. To enhance sustainability in surgical practice, barriers must be addressed, and sustainable techniques and devices should be developed and standardised, ensuring sustainability is inherent in the available options, rather than just relying on individual choice.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603453","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":"Acquired Nonmalignant Tracheoesophageal Fistula: Changing Causes and Surgical Methods Over 40 Years.","authors":"Guillaume Fadel, Olaf Mercier, Nicolas Leymarie, Justin Issard, Jean-François Honart, Delphine Mitilian, Dominique Fabre, Frédéric Kolb, Elie Fadel","doi":"10.1097/SLA.0000000000006689","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006689","url":null,"abstract":"<p><strong>Objective: </strong>Our aim was to assess changes in causes, surgical treatments, and outcomes of Acquired non-malignant tracheoesophageal fistula (ANM-TEF) over 40 years of experience.</p><p><strong>Background: </strong>ANM-TEF are rare but life-threatening disease. Their management are not well established.</p><p><strong>Methods: </strong>We included the 90 consecutive patients who underwent surgical ANM-TEF repair at our institution between 1981 and 2022. We compared the 48 patients managed in 1981-2007 to the 42 patients managed in 2008-2022.</p><p><strong>Results: </strong>Intubation was the cause in 44/48 (91.7%) and 9/42 (21.4%) patients in the early and recent periods (P=10-12). Emerging causes in the recent period were laryngeal cancer treatment (33.3%) and esophageal procedures (40.5%). In 1981-2007, the main surgical technique was direct esophageal suturing and tracheal repair (N=19), followed by tracheal resection-reconstruction (N=16); Pearson's technique was used for laryngotracheal fistulas (N=5). Fasciocutaneous perforator flaps were more often required after laryngeal or esophageal procedures, due to blood-supply compromise (1/48 [2.1%] and 23/42 [66.7%] in the early and recent periods, respectively; P=10-9). In the recent period, 6 patients required cervical esophagostomy and delayed jejunal free-flap reconstruction. Overall, day-90 mortality was 13.3%, with no significant between-group difference; fistula closure was initially successful in 78 (86.6%) patients; and the main postoperative complications were recurrent nerve palsy (22%), recurrent fistula (18%), tracheal stenosis (10%), and dysphagia (7%).</p><p><strong>Conclusions: </strong>Laryngeal and esophageal surgery has superseded intubation as the main cause of ANM-TEF. Despite the worse local tissue damage, outcomes remain unchanged, thanks to new surgical techniques including fasciocutaneous flap reconstruction.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565844","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":"Surgery for Borderline Resectable and Locally Advanced Pancreatic Cancer with Arterial Encasement after Neoadjuvant Therapy: A Single-center Experience.","authors":"Hiroyuki Ishida, Oskar Franklin, Salvador Rodriguez Franco, Toshimasa J Clark, Thomas F Stoop, Michael J Kirsch, Richard D Schulick, Marco Del Chiaro","doi":"10.1097/SLA.0000000000006690","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006690","url":null,"abstract":"<p><strong>Objective: </strong>To investigate complications and survival following surgical resection for pancreatic cancer with arterial encasement.</p><p><strong>Summary background data: </strong>Surgery for pancreatic cancer with extensive involvement (encasement) of the major visceral arteries remains a topic of debate due to concerns regarding morbidity, mortality, and uncertain oncological benefit.</p><p><strong>Methods: </strong>Pancreatic cancer patients with arterial encasement of the superior mesenteric artery (SMA), the hepatic artery (HA), and/or the celiac artery (CA) at baseline imaging who underwent resection after neoadjuvant therapy at the University of Colorado Hospital between January 2017 and September 2023 were included. Surgical and oncological outcomes were evaluated.</p><p><strong>Results: </strong>Of the 61 patients who underwent resection, arterial encasement was diagnosed at SMA in 20 (33%), HA in 14 (23%), CA in four (6.6%), replaced HA in one (1.6%), and two or more arteries in 22 (36%). Arterial resection was performed in 14 patients (23%) and arterial divestment was performed in 47 patients (77%). Major morbidity rate (Clavien-Dindo grade ≥3) was 21.3% and 90-day mortality rate was 4.9%. R0 resection rate was 70.5%. Median overall survival (OS) after surgery was 21.2 months with 5-year survival rate of 22.1%. Patients with pathological node-negative disease exhibited a longer median OS (29.1 vs. 16.6 mo, P=0.004), and a higher 5-year survival rate of 37.8% vs. 7.4%.</p><p><strong>Conclusions: </strong>Even in pancreatic cancer patients with arterial encasement, surgery following NAT can be performed safely and offer long-term survival. The development of preoperatively assessable biomarkers for chemotherapy response and regional nodal metastasis is necessary to improve patient selection.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565845","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":"Machine Learning Accurately Predicts Patient-Reported Outcomes 1 Year After Breast Reconstruction.","authors":"Jonlin Chen, Ariel Gabay, Lillian A Boe, Ronnie L Shammas, Carrie Stern, Andrea Pusic, Babak J Mehrara, Chris Gibbons, Jonas A Nelson","doi":"10.1097/SLA.0000000000006688","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006688","url":null,"abstract":"<p><strong>Objective: </strong>To develop and evaluate machine learning algorithms for predicting patient-reported outcomes following breast reconstruction.</p><p><strong>Summary of background data: </strong>Machine learning may inform PROs in breast reconstruction, possibly enhancing shared decision-making and tailoring patient care.</p><p><strong>Methods: </strong>Data on patient characteristics, reconstructive technique, and BREAST-Q scores from women undergoing breast reconstruction at Memorial Sloan Kettering Cancer Center (MSKCC) between January 2010 and March 2024 was retrospectively collected. Five machine learning algorithms were developed and validated on this data to predict improved versus not improved BREAST-Q scores after reconstruction. Models were externally validated models using multicenter data from the Mastectomy Reconstruction Outcomes Consortium (MROC). Models were evaluated using the area under the receiver operator curve, sensitivity, specificity, and Brier score.</p><p><strong>Results: </strong>A total of 4,776 patients (2,687 from MSKCC, 2,089 from MROC) were included in model development and validation. Machine learning algorithms demonstrated AUCs of 0.97 for physical wellbeing of the abdomen, 0.86 for satisfaction with breast, 0.79 for sexual wellbeing, 0.78 for physical wellbeing of the chest, and 0.74 for psychosocial wellbeing. Variables that contributed the most to model predictions across all domains were preoperative BREAST-Q scores, timing of radiation, BMI, age, and reconstructive technique.</p><p><strong>Conclusions: </strong>Machine learning algorithms can accurately predict PROs before breast reconstruction. Ultimately, this data-driven approach may streamline shared decision-making and enhance patient-centered care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555676","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":"A Multicenter Assessment of the Accuracy of Claims Data in Appendicitis Research.","authors":"Brendin R Beaulieu-Jones, Aksel D Laudon, Swetha Duraiswamy, Frank Yang, Elizabeth Chen, David R Flum, Kasey Lerner, Heather Evans, Alex Charboneau, Vlad V Simianu, Lauren Thompson, Faris Azar, Victoria Valdes, Chaitan Narsule, Sabrina E Sanchez, Frederick Thurston Drake","doi":"10.1097/SLA.0000000000006686","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006686","url":null,"abstract":"<p><strong>Objective: </strong>To investigate accuracy of ICD-9/10 billing codes in a multicenter cohort.</p><p><strong>Summary of background data: </strong>Health services research on appendicitis often relies on administrative databases. However, billing codes may misclassify disease severity, as we demonstrated previously in a single institution study.</p><p><strong>Methods: </strong>We performed a multicenter study of adult patients with appendicitis who presented to one of six US medical centers during 2012-2015 (ICD-9 era) and 2018-2021 (ICD-10 era). Patients were identified based on ICD codes. Diagnosis was confirmed via chart review. Each patient was characterized as complicated or uncomplicated based on AAST criteria; this was considered the gold standard. Billing codes were compared to gold standard to calculate test parameters (i.e., sensitivity).</p><p><strong>Results: </strong>1832 patients met inclusion criteria. 54.1% were male, 25% non-white, and 44% publicly insured or uninsured. In total, 21.1% of patients had complicated appendicitis based on gold standard: 18.8% (312/1661) of surgical patients and 43.9% (75/171) of non-operative patients (P<0.001). Among all patients, 17.3% had a billing code for complicated appendicitis (12.5% true positives and 4.8% false positives). 40.8% (158 of 387) of patients with complicated appendicitis were misclassified as having uncomplicated appendicitis via ICD codes. Sensitivity and PPV for complicated appendicitis were 0.59 (95% CI: 0.54-0.64) and 0.72 (95% CI: 0.67-0.77), respectively.</p><p><strong>Conclusions: </strong>Billing codes have poor sensitivity and PPV for distinguishing complicated from uncomplicated appendicitis. These results have significant implications for how we should interpret data from administrative database studies and construct future analyses. Inaccuracies in billing codes negatively impact hospital reimbursement, with tendency toward underpayment.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555656","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":"Neoadjuvant Chemotherapy for Intraductal Papillary Mucinous Neoplasm-derived Pancreatic Cancer.","authors":"Joseph R Habib, Ingmar F Rompen, Ammar A Javed, Brady A Campbell, Benedict Kinny-Köster, Po Hong Tan, Richard M Miller, Riccardo Pellegrini, Alessio Marchetti, Paul C M Andel, Giampaolo Perri, Kelly J Lafaro, D Brock Hewitt, Jörg Kaiser, Lois A Daamen, Thomas Hank, Greg D Sacks, Adrian T Billeter, Katherine Morgan, Oliver R Busch, Beat P Müller-Stich, Giovanni Marchegiani, Zhi Ven Fong, I Quintus Molenaar, Marc G Besselink, Markus W Büchler, Christopher L Wolfgang, Jin He, Martin Loos","doi":"10.1097/SLA.0000000000006687","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006687","url":null,"abstract":"<p><strong>Summary of background data: </strong>Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer is typically managed like pancreatic intraepithelial neoplasia (PanIN)-derived pancreatic cancer. However, in IPMN-derived pancreatic cancer, the role of chemotherapy remains controversial, particularly in the neoadjuvant setting (NAT).</p><p><strong>Objective: </strong>To evaluate the role of neoadjuvant chemotherapy in IPMN-derived pancreatic cancer.</p><p><strong>Methods: </strong>Patients with IPMN-derived pancreatic cancer treated with either upfront surgery (US) or NAT were identified from eight international centers (2000-2023). Clinicopathologic data were compared. Date of first treatment was used for Kaplan-Meier and log-rank tests to compare overall (OS) and recurrence free survival (RFS). Multivariable Cox-regression was performed in patients that underwent NAT.</p><p><strong>Results: </strong>In 1,019 patients, 76 (7%) underwent NAT. Patients who received NAT had higher baseline CA19-9 levels (P<0.001). Of these 76 patients, 27 (36%), 20 (26%), and 29 (38%) had resectable, borderline resectable, or locally advanced pancreatic cancer at diagnosis, respectively. Advanced resectability stage was significantly more common in the NAT patients as compared to those who underwent US (P<0.001). OS for US patients was 38.0 months (95%CI: 33.7.1-44.3), which was not statistically different than those that received NAT [27.5 mo (95%CI: 23.1-46.7), P=0.121]. This was also valid for patients with resectable disease [US: 38.1 mo vs. NAT: 35.6 mo, P=0.920)]. Complete or marked pathological treatment response (P=0.046) and serological CA19-9 normalization after NAT (P=0.017) were associated with improved survival. On Cox-regression for OS, N2 disease [HR: 4.15 (95%CI: 1.71-10.10)], elevated CA19-9 [HR: 2.02 (95%CI:1.06-3.85)] and R1 margin [HR: 2.36 (95%CI:1.20-4.61)] was independently associated with OS after NAT, while resectability status was not.</p><p><strong>Conclusion: </strong>After NAT and resection, advanced resectability stage was not associated with worse OS indicating the value of this approach for borderline resectable and locally advanced IPMN-derived pancreatic cancer. The benefit of NAT in resectable disease is unclear and may require an individualized approach. Biological treatment effect can be assessed with CA19-9 and confirmed by pathologic response.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555677","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}