Annals of surgery最新文献

{"title":"BA-ECM 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":"https://doi.org/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>Summary background data: </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 BA patients were retrieved from our pathology archives 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. Retrospective chart review was performed to correlate clinical characteristics with BA-ECM score.</p><p><strong>Results: </strong>BA-ECM score, a multi-dimensional fibrosis architecture score, was significantly higher for biopsies from listed patients compared to non-listed patients (35.9 vs. 22.9, *P<0.0001). High BA-ECM score was characterized by thick, patchy, irregular ECM, while 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 multi-dimensional BA-ECM score that could be used to prognosticate disease course for BA patients.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-20","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":"Targeted Muscle Reinnervation at the Time of Major Limb Amputation Reduces Long-Term Use and Dependence for Opioid Analgesic Therapy: A Multicenter Propensity-Matched Study.","authors":"Jackson M Cathey, Kevin M Klifto, Justin L Anderson, Sean Y Li, Eliana B Saltzman, Neill Y Li","doi":"10.1097/SLA.0000000000006697","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006697","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of primary targeted muscle reinnervation (TMR) performed at the time of major limb amputation on long-term opioid use, opioid dependence, and neuropathic pain medication use compared to standard amputation.</p><p><strong>Summary background data: </strong>Postoperative pain following major limb amputation is common, often leading to prolonged opioid use, dependence, and neuropathic pain. TMR, a surgical technique that redirects amputated nerves into motor targets, has been proposed as a method to reduce pain-related complications, but prior studies are limited by small sample sizes, single-center experiences, and insufficient follow-up data. This study utilizes a multicenter database to assess long-term outcomes of TMR compared to standard amputation.</p><p><strong>Methods: </strong>A multicenter query was conducted using the TriNetX Research Network to identify patients undergoing major limb amputation with or without TMR over 20 years. Propensity score matching was used to create comparable cohorts for analysis. Primary outcomes included opioid use, opioid dependence, neuropathic pain medication use, and stump-related complications, evaluated from 90 days to 3 years postoperatively.</p><p><strong>Results: </strong>Among 43,890 patients, those undergoing primary TMR (n=644) had significantly lower risks of opioid use (RR=0.72; 95%CI [0.60, 0.86], P<0.001) and opioid dependence (RR=0.50; 95%CI [0.27, 0.92], P=0.023) compared to matched controls undergoing standard amputation (n=644). In the ischemia subgroup, TMR patients had a 41% lower risk of opioid use (RR=0.59; 95%CI [0.42, 0.83], P=0.002). No differences in neuropathic pain medication use or stump-related complications were observed between cohorts. Time-course analysis demonstrated persistent reductions in opioid use among TMR patients at all intervals from 3 months to 3 years.</p><p><strong>Conclusions: </strong>Primary TMR at the time of major limb amputation significantly reduces long-term opioid use and dependence, particularly in patients with limb-threatening ischemia, without increasing the risk of stump-related complications. These findings support the broader adoption of TMR to improve postoperative outcomes in amputees.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655905","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 Rural Exposure during General Surgery Residency on Practice in a Rural Community.","authors":"Nina M Clark, Paul McClure, Aaron Erickson, C Holly A Andrilla, Gordon Riha, Ashley Dennis, Barclay T Stewart, Dana C Lynge, Davis G Patterson","doi":"10.1097/SLA.0000000000006696","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006696","url":null,"abstract":"<p><strong>Objective: </strong>We sought to evaluate associations between rural training exposure during surgical residency and eventual practice in a rural community, and whether specific types of exposure were more likely to yield rural surgeons.</p><p><strong>Background: </strong>Growing deficits in the rural surgery workforce have prompted increased attention toward rural training. However, the association between exposure to rural surgery during residency and practice in rural communities remains limited.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of US general surgery residency graduates from 2011-2020. Program information was abstracted from residency websites, the American College of Surgeons (ACS), and the American Medical Association. A survey distributed to programs and direct review of residency websites were used to characterize the type of rural surgery exposure offered to trainees. We evaluated associations between exposure to rural surgery in training and ultimate practice in a rural location.</p><p><strong>Results: </strong>Of 11,407 surgeons, 6.2% reported working in rural communities. Graduates of programs with rural training according to residency websites or the ACS were more likely to work in rural areas (OR 1.81 [95%CI 1.32-2.49] and 2.09 [1.28-3.40]). Rurally located programs, rural rotations, and programs with a rural mission were associated with greater odds of graduates working in rural areas (P<0.05 for all). Rural tracks were not associated with more rural graduates.</p><p><strong>Conclusions: </strong>Among graduates of general surgery residency programs, rural exposures during training were associated with eventual practice in rural communities. Programs with rural missions, in rural locations, or offering rural rotations produced graduates who were more likely to work in rural areas, while rural track programs did not, highlighting the need for further study of individual rural exposure to establish effective training paradigms. Specific policies facilitating rural exposure and surgical programs in rural communities may be effective methods for addressing workforce deficits.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655804","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":"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}