Annals of surgery最新文献

{"title":"Why Open Surgery Must Live: Accompanying Laparoscopy to Its Death, A Reply to Kim et al.","authors":"Tommaso Violante, Richard Sassun, Marco Novelli, Matteo Rottoli, David Larson","doi":"10.1097/SLA.0000000000007224","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007224","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918229","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":"How We \"Watch\" in Watch and Wait for Rectal Cancer.","authors":"Beiqun Zhao, Madhulika Varma","doi":"10.1097/SLA.0000000000007222","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007222","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918223","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":"Actual Five-year Survival After Neoadjuvant Therapy and Resection for Localized Pancreatic Ductal Adenocarcinoma.","authors":"Federico De Stefano, Giulio Belfiori, Nathaniel F Wu, Jill N Allen, Laura Cerri Crn, Jeffrey W Clark, Paolo Giorgio Arcidiacono, Cristina Ferrone, Theodore S Hong, Domenico Tamburrino, Stefano Partelli, Motaz Qadan, Michele Reni, David P Ryan, Marco Schiavo Lena, Gabriele Capurso, Colin D Weekes, Jennifer Y Wo, Keith D Lillemoe, Stefano Crippa, Massimo Falconi, Carlos Fernández-Del Castillo","doi":"10.1097/SLA.0000000000007214","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007214","url":null,"abstract":"<p><strong>Objective: </strong>To determine actual 5-year survival after neoadjuvant therapy and resection for pancreatic ductal adenocarcinoma (PDAC).</p><p><strong>Background: </strong>Long-term outcomes after neoadjuvant therapy and resection for PDAC remain poorly defined, as current knowledge largely relies on actuarial estimates.</p><p><strong>Methods: </strong>Retrospective cohort study of consecutive patients who underwent neoadjuvant therapy followed by curative-intent pancreatectomy for localized PDAC at 2 high-volume centers between January 2015 and February 2021. Only patients with complete follow-up (death or ≥5 y) were included. The primary endpoint was actual 5-year survival from surgery.</p><p><strong>Results: </strong>Among 660 patients, actual 5-year survival was 34.5%. Recurrence occurred in 74.1% and was predominantly early, with nearly two-thirds of recurrences among patients who did not achieve 5-year survival occurring within 1 year after surgery. Long-term survivors had lower recurrence rates (92/228, 40.4%) and more commonly developed delayed (>2 y), locoregional, or pulmonary recurrence. The probability of achieving 5-year survival increased to 62.0% (95% CI: 56-67) and 81.9% (95% CI: 76-86) among patients who remained recurrence-free at 1 and 2 years, respectively. Actual 5-year survival was 42.5%, 29.0%, and 17.5% in patients with resectable, borderline-resectable, and locally advanced disease at diagnosis, respectively. Independent predictors of long-term survival included low comorbidity burden, baseline CA19-9 <200 U/mL, resectable disease at diagnosis, ypT0-1 stage, and R0 resection.</p><p><strong>Conclusions: </strong>Over one-third of patients undergoing neoadjuvant therapy and resection for localized PDAC were alive at 5 years, and most remained disease-free. Long-term outcomes were primarily determined by early systemic failure, whereas delayed oligometastatic recurrence identified a subgroup with prolonged survival.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918242","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":"Procedural Maturation and Midterm Durability of the Posterior Rectus Sheath Flap for Hiatal Augmentation in Complex Paraesophageal Hernias.","authors":"Yalini Vigneswaran, Michelle Campbell, Alex W Lois, Lawrence J Gottlieb, Mustafa Hussain","doi":"10.1097/SLA.0000000000007213","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007213","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate procedural maturation, donor-site morbidity, and midterm durability of posterior rectus sheath flap for hiatal augmentation (PoRSHA) within an IDEAL Phase 2b framework.</p><p><strong>Background: </strong>Large paraesophageal hernia repair remains limited by high recurrence rates associated with structural weakness of the diaphragmatic crura. Existing reinforcement strategies remain limited by inconsistent long-term durability. PoRSHA, a vascularized autologous tissue technique developed for complex hiatal repair, previously demonstrated early feasibility and promising early outcomes in IDEAL Phase 2a evaluation.</p><p><strong>Methods: </strong>This prospective single-center IDEAL Phase 2b study included 104 consecutive patients undergoing PoRSHA between 2021 and 2026. The analytic cohort consisted of patients with primary type III/IV (n=71) and recurrent paraesophageal hernias (n=23). Radiologic recurrence (>2 cm) was assessed using Kaplan-Meier analysis to account for variable imaging follow-up. Secondary outcomes included symptomatic recurrence requiring reoperation, postoperative dysphagia, and donor-site morbidity.</p><p><strong>Results: </strong>Estimated radiologic recurrence in the overall analytic cohort was 1.4% at 12 months and 13.8% at 24 months (95% CI, 5.7%-31.3%), remaining stable at 18.1% through 48 months. After exclusion of the procedural maturation phase (n=16), estimated radiologic recurrence improved to 9.2% at both 24 months and 36 months (95% CI, 2.9%-27.4%), with no additional recurrences during follow-up. Recurrences were small and did not result in reoperation. Donor-site morbidity was infrequent.</p><p><strong>Conclusions: </strong>Following procedural maturation, PoRSHA demonstrated favorable midterm durability with limited donor-site morbidity. These findings support continued multicenter evaluation of vascularized autologous tissue augmentation for complex paraesophageal hernia repair.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886189","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":"Morphology-Based Surgery for Chronic Pancreatitis Across Europe: Toward the Next Generation of Unified Guidelines.","authors":"Charlotte L Van Veldhuisen, Charlotte A Leseman, Fleur E M De Rijk, Joana C Marques-Antunes, Fabio Ausania, Orlin Belyaev, Frederik Berrevoet, Marja Boermeester, Ugo Boggi, Stefan A Bouwense, Marco J Bruno, Olivier R Busch, Kevin C Conlon, Safi Dokmak, Massimo Falconi, Poya Ghorbani, Filip Gryspeerdt, Roel Haen, Arturan Ibrahimli, Jakob R Izbicki, Christina Krikke, Arto Kokkola, Lancelot Marique, J S D Mieog, Gennaro Nappo, Janis Pavulans, Haralds Plaudis, Geert Roeyen, Pasquale Scognamiglio, Domenico Tamburrino, Tore Tholfsen, Marie Toschka, Faik G Uzunoglu, Susan Van Dieren, Casper H J Van Eijck, Jeanin E van Hooft, Hjalmar C Van Santvoort, Robert C Verdonk, Rogier P Voermans, Anne Waage, Marc G Besselink","doi":"10.1097/SLA.0000000000007202","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007202","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the use and impact of current surgical guidelines for chronic pancreatitis (CP) across Europe.</p><p><strong>Summary background data: </strong>Current guidelines recommend morphology-based surgery for CP, but international studies evaluating their use and impact are lacking.</p><p><strong>Methods: </strong>Post hoc analysis of the prospective multicenter ESCOPA study, including patients undergoing surgery for symptomatic CP at 22 centers in 13 countries (June 2021-November 2022), with 6-month follow-up. Patients were stratified by morphologic subtype: \"isolated dilated main pancreatic duct (MPD),\" \"isolated enlarged pancreatic head (PH),\" \"combined dilated MPD and enlarged PH,\" and \"small duct disease.\" Treatment was based on the European HaPanEU and International IAP-APA-JPS-EPC guidelines. Primary outcomes were 90-day major morbidity, mortality, and pain relief at 6 months. Practice variation was assessed, including a case-based survey.</p><p><strong>Results: </strong>Overall, 207 patients were included following surgery for CP, with 1.4% 90-day mortality and 72.6% pain relief. The surgical approach varied widely by morphologic subtype: duodenum-preserving pancreatic head resections (DPPHR) were most common for \"combined dilated MPD and enlarged PH\" (46.8%, P=0.016); whereas formal pancreatectomy predominated for \"isolated dilated MPD\" (63.3%, P=0.040) and \"small duct disease\" (66.0%, P=0.004). Guideline-concordant surgery (66%) was not associated with improved rates of major morbidity (12.9% vs. 18.8%, P=0.387), mortality (1.6% vs. 1.6%, P>0.999), or pain relief (75.3% vs. 66.7%, P=0.468). Outcomes were also comparable between drainage/parenchyma-preserving surgery and formal pancreatectomy. Survey findings confirmed practice variation, including the use of formal and V-shaped pancreatectomy for small duct disease.</p><p><strong>Conclusion: </strong>The substantial variation in surgical practice for CP across Europe highlights the need for unified guidelines with clear recommendations, particularly regarding formal and V-shaped pancreatectomy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886267","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":"Single-dose Preoperative Glucocorticoids in Major Gastrointestinal Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Rathin Gosavi, Baxter Smith, Kavindu Hathurusinghe, Anjana Ravi, Sarah A Martin, Walston Reginald Martis, Vignesh Narasimhan, Geraldine Oo","doi":"10.1097/SLA.0000000000007215","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007215","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical efficacy and safety of single-dose preoperative systemic glucocorticoids in adults undergoing major gastrointestinal surgery.</p><p><strong>Summary of background data: </strong>Major gastrointestinal surgery induces a systemic inflammatory response that contributes to postoperative morbidity and delayed recovery. Single-dose glucocorticoids attenuate inflammation, but uncertainty remains regarding clinical benefit, safety, and optimal dosing.</p><p><strong>Methods: </strong>A PRISMA-compliant systematic review and meta-analysis of randomized controlled trials was performed and registered with PROSPERO. Trials comparing a single preoperative systemic glucocorticoid with placebo or no steroid in adult major gastrointestinal surgery were included. Primary outcomes were total postoperative complications and infectious complications. Secondary outcomes included length of stay, anastomotic leak, postoperative day 1 inflammatory markers, and mortality. Random-effects models were used. Dose-stratified analyses were prespecified and exploratory.</p><p><strong>Results: </strong>Eighteen randomized trials, including 3667 patients were analyzed. Preoperative glucocorticoids reduced total postoperative complications (OR 0.69, 95% CI: 0.54-0.89; I²=12%) and infectious complications (OR 0.62, 95% CI: 0.45-0.88; I²=55%). Length of stay was reduced by 1.09 days (95% CI: -1.68 to -0.50). Postoperative day 1 IL-6 was lower with glucocorticoids, while CRP showed no consistent difference. Anastomotic leak and mortality were not increased. Exploratory analyses suggested greater benefit with higher-dose regimens.</p><p><strong>Conclusions: </strong>Single-dose preoperative systemic glucocorticoids reduce postoperative morbidity, infections, and length of stay after major gastrointestinal surgery, without evidence of increased surgical harm in included trial populations.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886253","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 Prospective, Observational Study of Observation Versus Colectomy in Recurrent Diverticulitis.","authors":"Alexander T Hawkins, Russell L Rothman, Lauren R Samuels, Timothy Geiger, Matthew Mutch, Scott Regenbogen, Marissa C Kuo, Michael Feng, Isabella Schafer, David Penson","doi":"10.1097/SLA.0000000000007217","DOIUrl":"10.1097/SLA.0000000000007217","url":null,"abstract":"<p><strong>Background: </strong>Understanding changes in quality of life that occur with colectomy is critical to decision-making in management of recurrent diverticulitis. We hypothesized that patients choosing colectomy at surgical consultation would report better disease-specific quality of life at 1 year than those choosing observation.</p><p><strong>Objective: </strong>To investigate the association between colectomy versus observation for recurrent sigmoid diverticulitis and disease-specific quality of life at 1 year.</p><p><strong>Methods: </strong>We performed a multicenter prospective observational study including patients with recurrent uncomplicated diverticulitis choosing colectomy versus observation at initial consultation. The primary outcome was disease-specific quality of life at 1 year, measured by the Diverticulitis Quality of Life questionnaire total score.</p><p><strong>Results: </strong>A total of 113 patients were enrolled (median age 57; 64% female, 92% white); 42 (37%) chose colectomy at surgical consultation. At enrollment, median lifetime episodes of diverticulitis were similar between groups (colectomy: 5, observation: 4); the colectomy group had a higher rate of hospitalization in the past 5 years (colectomy: 71%, observation: 49%). In an adjusted linear mixed effects model, choosing colectomy was associated with better quality of life by 1.73 points (95% CI: 1.02-2.46) compared with choosing observation. 7 people (17%) who chose colectomy experienced recurrence within 1 year compared with 32 who chose observation (45%). In an adjusted model, choosing colectomy was associated with lower odds of recurrence (aOR 0.16; 95% CI: 0.05-0.48).</p><p><strong>Conclusion: </strong>For patients with recurrent sigmoid diverticulitis presenting for surgical consultation, colectomy may offer meaningful improvement in disease-specific quality of life and may be associated with reduced 1-year recurrence rates.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886199","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":"Beyond the Helm: Reflections on Leadership in Academic Surgery From the Experience of Early-Career Surgeons.","authors":"Jad M Abdelsattar, Heather J Logghe","doi":"10.1097/SLA.0000000000007216","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007216","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886241","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":"Cancer Surgery Outcomes After Implementation of a Global Budget Model in Rural Hospitals.","authors":"Jacob Whitman, Eric T Roberts, Jonathan G Yabes, Donald Bourne, Zhaojun Sun, Manisha Bhattacharya, Jeremy M Kahn, Bruce L Jacobs, Lindsay M Sabik","doi":"10.1097/SLA.0000000000007207","DOIUrl":"10.1097/SLA.0000000000007207","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the association between the implementation of the Pennsylvania Rural Health Model (PARHM), a global budget program for rural hospitals, and short-term outcomes for rural residents undergoing cancer surgery.</p><p><strong>Background: </strong>Rural hospitals play a critical role in delivering surgical care but face ongoing financial instability. Global budget models aim to stabilize hospitals and preserve access to care. While designed to stabilize finances and improve population health, its impact on quality of care for complex surgical services remains unknown.</p><p><strong>Methods: </strong>We conducted a repeated cross-sectional study using a stacked difference-in-differences design to compare outcomes before and after the implementation of PARHM. Linked Pennsylvania inpatient discharge and cancer registry data (2016-2023) were used to identify patients undergoing inpatient surgery for 11 cancer types. Patients residing in hospital service areas (HSAs) with PARHM-participating hospitals were compared with those in PARHM-eligible nonparticipating HSAs. Models adjusted for patient and area characteristics and included HSA and year fixed effects.</p><p><strong>Results: </strong>Among 17,048 cancer surgery admissions, 3537 occurred in PARHM HSAs and 13,511 in comparison HSAs. Baseline patient and area characteristics were broadly similar across groups. PARHM implementation was not associated with changes in 30- or 90-day mortality, readmission, or composite outcomes. Findings were generally consistent across adoption cohorts and cancer types, with no evidence of systematic improvement or deterioration in outcomes following implementation.</p><p><strong>Conclusions: </strong>Implementation of PARHM was not associated with changes in short-term cancer surgery outcomes among rural residents in Pennsylvania. Alternative strategies may be needed to improve short-term surgical oncology outcomes in rural hospitals.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13596121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878885","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":"Benchmarking Robotic Pancreatoduodenectomy: Is It Time to Benchmark Surgeons, Not Just Patients?","authors":"Sangrag Ganguli, Melissa E Hogg","doi":"10.1097/SLA.0000000000007212","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007212","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":7.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148878917","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}