Annals of surgery最新文献

{"title":"Prospective Sensory Outcomes for Targeted Nipple-areola Complex Reinnervation in Gender-affirming Double Incision Mastectomy With Free Nipple Grafting.","authors":"Katya Remy, Kathryn Packowski, Chase Alston, Liana N Kozanno, Katherine H Carruthers, Eleanor G Tomczyk, Jonathan M Winograd, William G Austen, Ian L Valerio, Lisa Gfrerer","doi":"10.1097/SLA.0000000000006192","DOIUrl":"10.1097/SLA.0000000000006192","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the anatomy and sensory outcomes of targeted nipple-areola complex reinnervation (TNR) in gender-affirming double incision mastectomy with free nipple grafting.</p><p><strong>Background: </strong>TNR is a novel technique to preserve and reconstruct intercostal nerves (ICNs) to improve postoperative sensation. There is little evidence of relevant anatomy and outcomes.</p><p><strong>Methods: </strong>Twenty-five patients were prospectively enrolled. Data included demographics, surgical technique, and axon/fascicle counts. Quantitative sensory evaluation using monofilaments and qualitative patient-reported questionnaires was completed preoperatively, and at 1, 3, 6, 9, and 12 months postoperatively.</p><p><strong>Results: </strong>Fifty mastectomies were performed. Per mastectomy, the median number of ICN found and used was 2 (1-5). Axon and fascicle counts were not significantly different between ICN branches ( P > 0.05). Body Mass Index ≥30 kg/m 2 and mastectomy weight ≥800 g were associated with significantly worse preoperative sensation ( P < 0.05). Compared with preoperative values, nipple-areola complex (NAC) sensation was worse at 1 month ( P < 0.01), comparable at 3 months ( P > 0.05), and significantly better at 12 months ( P < 0.05) postoperatively. Chest sensation was comparable to the preoperative measurements at 1 and 3 months ( P > 0.05), and significantly better at 12 months ( P < 0.05) postoperatively. NAC sensation was significantly better when direct coaptation was performed compared with the use of allograft only ( P < 0.05), and with direct coaptation of ≥2 branches compared with direct coaptation of a single branch ( P < 0.05). All patients reported a return of nipple and chest sensation at 1 year postoperatively and 88% reported a return of some degree of erogenous sensation.</p><p><strong>Conclusions: </strong>TNR allows for restoration of NAC and chest sensation within 3 months postoperatively. The use of multiple ICN branches and direct coaptation led to the best sensory outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"163-171"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139429519","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":"Utility of Enteral Contrast Protocols in Pediatric Adhesive Small Bowel Obstruction: A Prospective Multicenter Observational Study.","authors":"Shannon N Acker, Romeo Ignacio, Katie W Russell, Lorraine Kelley-Quon, Katrine Lofberg, Justin Lee, Aaron R Jensen, Kaci Pickett-Nairne, Connor Prendergast, Stephanie E Iantorno, Hari Thangarajah, Utsav Patwardhan, Caroline Melhado, Allen Zhong, Ben Padilla, David H Rothstein, Lauren Nicassio, Samir Pandya, Maria Valencia, Kasper Wang, Tom H Inge","doi":"10.1097/SLA.0000000000006207","DOIUrl":"10.1097/SLA.0000000000006207","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to determine the utility of enteral contrast-based protocols in the diagnosis and management of adhesive small bowel obstruction (ASBO) for children.</p><p><strong>Background: </strong>Enteral contrast-based protocols for adults with ASBO are associated with a decreased need for surgery and shorter hospitalization. Pediatric-specific data are limited.</p><p><strong>Methods: </strong>We conducted a prospective observational study between October 2020 and December 2022 at 9 children's hospitals that are members of the Western Pediatric Surgery Research Consortium. Inclusion criteria were children aged 1 to 20 years diagnosed with ASBO who underwent a trial of nonoperative management at hospital admission. Comparisons were made between those children who received an enteral contrast challenge and those who did not. The primary outcome was the need for surgery.</p><p><strong>Results: </strong>We enrolled 136 children (71% male; median age: 12 years); 84 (62%) received an enteral contrast challenge. There was no difference in the rate of operative intervention between the no-contrast (34.6%) and contrast groups (36.9%; P =0.93). Eighty-seven (64%) were successfully managed nonoperatively with no difference in median length of stay ( P =0.10) or rate of unplanned readmission ( P =0.14). Among the 49 children who required an operation, there was no significant difference in the time from admission to surgery or rate of small bowel resection based on prior contrast administration.</p><p><strong>Conclusions: </strong>The addition of enteral contrast-based protocols for the management of pediatric ASBO does not decrease the likelihood of surgery or shorten hospitalization. Larger randomized studies may be needed to further define the role of radiologic contrast in the management of ASBO in children.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"116-123"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11263503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519389","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":"Intraoperative Completion Studies and Their Associations With Carotid Endarterectomy Outcomes.","authors":"Christoph Knappich, Bianca Bohmann, Felix Kirchhoff, Vanessa Lohe, Shamsun Naher, Michael Kallmayer, Hans-Henning Eckstein, Andreas Kuehnl","doi":"10.1097/SLA.0000000000006284","DOIUrl":"10.1097/SLA.0000000000006284","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed at assessing outcomes after carotid endarterectomy (CEA) in dependence of center policy with respect to imaging intraoperative completion study (ICS i ) usage.</p><p><strong>Background: </strong>Although randomized controlled studies are missing, a beneficial effect was shown for ICS i techniques (ie, angiography and intraoperative duplex ultrasound) after CEA.</p><p><strong>Methods: </strong>This secondary data analysis is based on the German statutory quality assurance database. The research was funded by Germany's Federal Joint Committee Innovation Fund (G-BA Innovationsfonds, 01VSF19016 ISAR-IQ). According to their ICS i policy, hospitals were categorized as routine ICS i (>90%), selective ICS i (10%-90%), or sporadic ICS i (<10%) centers. Primary study outcome was in-hospital stroke or death. Multivariable regression analyses were performed.</p><p><strong>Results: </strong>Between 2012 and 2016, a total of 119,800 patients underwent CEA. In-hospital stroke or death rates were lower in routine ICS i centers (1.7%) compared with selective (2.1%) and sporadic ICS i centers (2.0%). The multivariable regression analysis showed, that in routine ICS i centers, ICS i use was associated with lower rates of stroke or death (adjusted odds ratio: 0.64; 95% CI: 0.44-0.93). In selective ICS i centers, ICS i was not associated with the occurrence of either of the assessed outcomes. In sporadic ICS i centers, ICS i was associated with higher rates of stroke or death (adjusted odds ratio: 1.91; 95% CI: 1.26-2.91).</p><p><strong>Conclusions: </strong>Lowest in-hospital stroke or death rates are achieved in routine ICS i centers. Although ICS i is associated with a lower perioperative risk in routine ICS i centers, it might act as a surrogate marker for worse outcomes due to intraoperative irregularities in sporadic ICS i centers. Routine use of ICS i is advisable.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"154-162"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12140550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140304459","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":"High-stakes Technical Performance Assessments Across the Continuum of Surgical Training.","authors":"Conor Toale, Dara O Kavanagh, Michael Devine, Marie Morris","doi":"10.1097/SLA.0000000000006553","DOIUrl":"10.1097/SLA.0000000000006553","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this article is to outline proposals for the use of high-stakes technical performance assessments, defined as assessments of technical skill that take place outside of the operating theatre, across the continuum of surgical training.</p><p><strong>Background: </strong>Technological advancements have allowed for the assessment of operative technical skills outside of the workplace environment, developed and evaluated in line with modern concepts of assessment validity. With the introduction of competency-based education principles across surgical training curricula, increasing scrutiny is being placed on the validity and reliability of assessments used to inform high-stakes training decisions regarding selection, progression through training, autonomy granting, and end-of-training certification. The role of performance assessments, conducted outside of the workplace environment, is yet to be fully established.</p><p><strong>Methods: </strong>This article discusses the use of high-stakes performance assessments across the continuum of surgical training, with reference to relevant theories of surgical skill acquisition and assessment, along with contemporary evidence from the performance science literature.</p><p><strong>Results: </strong>Assessments of increasing professional authenticity are required across the continuum of surgical training. In an attempt to capture inherent ability rather than skill at the time of trainee selection, assessments should be of deliberately low levels of professional authenticity. Assessment in early surgical training should focus on ensuring competence in core surgical skills and then assessing for canonical competence across a series of commonly encountered procedures. Baseline competence in these procedures should ideally be assessed before the transition to the (supervised) lead operator, with a view to ensuring patient safety and improving the efficiency of in-theatre training. Assessment later in training relies more heavily on the workplace, with simulation offering a complimentary role in ensuring a minimum competency standard in procedures less likely to be encountered in the workplace.</p><p><strong>Conclusions: </strong>High-stakes performance assessments can play an important role as part of a programmatic approach to surgical training and certification. They can and should be designed with an appropriate level of professional authenticity to ensure adequate and appropriate representation of the assessment construct.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"56-62"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142339729","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":"Increased Musculoskeletal Deformities and Decreased Lung Volume in Patients After EA/Tef Repair: A Real-time MRI Study.","authors":"Ophelia Aubert, Martin Lacher, Steffi Mayer, Jens Frahm, Dirk Voit, Maciej Rosolowski, Anke Widenmann, Franz W Hirsch, Daniel Gräfe","doi":"10.1097/SLA.0000000000006193","DOIUrl":"10.1097/SLA.0000000000006193","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess morphologic and functional postoperative changes after open or minimally invasive (MIS) repair of esophageal atresia (EA) compared with healthy controls by thoracic real-time magnetic resonance imaging (MRI).</p><p><strong>Background: </strong>Musculoskeletal deformities and pulmonary morbidity are common in children after EA repair. The real-time MRI is a novel technique that provides ultrafast, high-quality images during spontaneous breathing, without sedation, even in young children.</p><p><strong>Methods: </strong>Children aged 3 to 18 years were prospectively examined with a 3 Tesla MRI. Musculoskeletal deformities, static thoracic cross-sectional areas (CSAs) at 3 different levels and lung volumes, as well as dynamic right-to-left ratio of CSA of hemithoraces and lung volumes during forced breathing were evaluated.</p><p><strong>Results: </strong>Seventy-two children (42 open, 8 MIS, 22 controls) were recruited. In the EA group, rib fusions and adhesions (78%, P <0.01) and scoliosis (15%, P =0.32) were found after thoracotomy but not after MIS. The mean right-to-left ratio of CSA and lung volumes were lower after EA repair compared with controls ( P <0.05), indicating impaired thoracic and lung development. The number of thoracotomies was a significant risk factor for smaller thoracic volumes ( P <0.05).</p><p><strong>Conclusions: </strong>For the first time, morphologic changes and thoracic motility after EA repair were visualized by dynamic real-time MRI. After EA repair, children show decreased right-sided thoracic and lung development compared with controls. Open repair leads to significantly more musculoskeletal deformities. This study emphasizes that musculoskeletal morbidity following a thoracotomy in infancy is high.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"70-76"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139701670","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 Primary Report 166 Cases of Abdominal or Pelvic Neuroblastoma Surgery Utilizing the International Neuroblastoma Surgical Report Form (INSRF).","authors":"Saishuo Chang, Shen Yang, Tong Yu, Qi Zhang, Yu Lin, Qinghua Ren, Haiyan Cheng, Xiaofeng Chang, Zhiyun Zhu, Siyu Cai, Jun Feng, Jianyu Han, Wei Yang, Hong Qin, Huanmin Wang","doi":"10.1097/SLA.0000000000006292","DOIUrl":"10.1097/SLA.0000000000006292","url":null,"abstract":"<p><strong>Background: </strong>Surgery is pivotal in the management of neuroblastoma (NB), particularly in patients with image-defined risk factors. The International Neuroblastoma Surgical Report Form (INSRF) was introduced to enhance surgical reporting quality and analyze the defining role of extensive surgery in NB. This study reports our experience with INSRF and explores new criteria for evaluating the extent of surgical resection.</p><p><strong>Methods: </strong>INSRF was deployed to critically analyze 166 patients with abdominal or pelvic NB who underwent surgery at our department between October 2021 and June 2023. Patient demographics, clinical characteristics, surgical data sets, and postoperative complications were described in detail. Receiver operating characteristic curves were used to explore a new method to evaluate the extent of resection. A questionnaire was formulated to obtain attitudes/feedback and commentary from surgical oncologists with INSRF.</p><p><strong>Results: </strong>One hundred sixty-six NB patients with a median disease age of 36.50 months. This study collated 320 INSRF reports. Among the 166 index cases, 137 were documented by 2 surgeons, with a concordance rate of 16.78%. Items with high inconsistency were (1) the extent of tumor resection (29.20%), (2) renal vein involvement (25.55%), (3) abdominal aorta encasement (16.79%), and (4) mesenteric infiltration (17.52%). According to INSRF, the extent of resection was complete excision in 86 (51.81%) patients, minimal residual tumor < 5 cm 3 in 67 (40.36%) patients, and incomplete excision > 5 cm 3 in 13 (7.83%) patients. In receiver operating characteristic curve analysis, the number of vessels encased by tumors >3 had a high predictive value in determining that a tumor could not be completely resected (area under the curve 0.916, sensitivity 0.838, specificity 0.826) using INSRF as the gold standard reference. The questionnaires showed that surgeons agreed that the extent of resection and tumor involvement of organ/vascular structures were important, while the definition and intervention(s) of intraoperative complications were less operational and understandable.</p><p><strong>Conclusions: </strong>INSRF has significant clinical applications in NB surgery. The extent of resection can be predicted based on the number of tumor-encased blood vessels. Supplementary information should be considered with the INSRF to aid practitioner reporting. Multicenter studies are needed to explore the defining role of INSRF in NB surgical management.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"132-137"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334473","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":"Fully Robotic Left Lobe Donor Hepatectomy Is Safer Compared to Open.","authors":"Dieter C Broering, Yasser Elsheikh, Yasir Alnemary, Daniel Borja-Cacho, Mark L Sturdevant, Saleh Alabbad, Massimo Malago, Dimitri A Raptis","doi":"10.1097/SLA.0000000000006705","DOIUrl":"10.1097/SLA.0000000000006705","url":null,"abstract":"<p><strong>Objective: </strong>To compare the outcomes of fully robotic versus open left lobe donor hepatectomies, focusing on donor safety.</p><p><strong>Background: </strong>Right lobe hepatectomies are traditionally preferred for adult liver transplants due to their larger graft size but may involve increased risks for donors. Left lobe hepatectomies are considered safer for donors but are less commonly used due to concerns about the small-for-size syndrome in adult settings.</p><p><strong>Methods: </strong>We conducted an analysis of 339 living liver donors from a prospectively maintained registry at a single institution from November 2011 to June 2023, comparing 72 open and 267 robotic left lobe hepatectomies. Primary outcomes included donor complication rates until hospital discharge, whereas secondary outcomes focused on hospital stay and recipient complications.</p><p><strong>Results: </strong>Robotic hepatectomy was associated with significantly less blood loss (mean 77 (SD: 68) vs 316 (SD: 168) mL, P <0.001), lower donor morbidity 6% vs 18%, P =0.003), and shorter hospital stay (3 vs 5 d, P <0.001). Adult recipients receiving robotically retrieved donor grafts were associated with a lower overall morbidity rate (40% vs 59%, P =0.033) compared to open.</p><p><strong>Conclusions: </strong>Robotic left donor hepatectomy significantly improves donor safety compared with the open approach, supporting its use as a less invasive and donor-centered option in living donor liver transplantation. This study, the largest known series of left lobe donor hepatectomies, demonstrates the robotic approach's superiority, potentially setting a new standard in the field of living donor liver transplantation.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"108-115"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143707859","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 Novel Serum Exosomal MicroRNA Signature in the Early Prediction of Persistent Organ Failure in Patients With Acute Pancreatitis.","authors":"Lei Li, Qichen Zhang, Yongpu Feng, Fanyang Kong, Fengyuan Sun, Pei Xie, Jiangman Zhao, Hang Yu, Jiahuan Zhou, Shouxin Wu, Shengbing Zhao, Zhaoshen Li, Feng Liu, Yiqi Du, Xiangyu Kong","doi":"10.1097/SLA.0000000000006229","DOIUrl":"10.1097/SLA.0000000000006229","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether serum exosomal microRNAs (miRNAs) could be potential biomarkers in predicting acute pancreatitis (AP) with persistent organ failure (POF) at an early phase.</p><p><strong>Background: </strong>Novel biomarkers are sorely needed for early prediction of POF in patients with AP.</p><p><strong>Methods: </strong>In the discovery stage, exosomal miRNAs were profiled in sera from APs with or without POF (5 vs 5) using microarrays. POF-associated miRNA signatures then were assessed in the training cohort (n = 227) and further validated in 3 independent cohorts (n = 516), including one nested case-control cohort.</p><p><strong>Results: </strong>A total of 743 APs were recruited in this large-scale biomarker identification study with a nested case-control study. Data from the discovery cohort demonstrated that 90 exosomal miRNAs were significantly dysregulated in APs with POF compared with controls. One miRNA classifier (Cmi) comprising 3 miRNAs (miR-4265, 1208, 3127-5p) was identified in the training cohort and was further evaluated in 2 validation cohorts for their predictive value for POF. Area under the curves for Cmi ranged from 0.88 to 0.90, which was statistically superior to area under the curves of Acute Physiology and Chronic Health Examination-II and bedside index for severity in AP, and outperformed blood urea nitrogen and creatinine in POF prediction across all cohorts ( P < 0.05). Higher levels of Cmi indicated an increased need for intensive care unit admission, prolonged hospitalization, and elevated mortality rate, thus poor prognosis. In the nested case-control study, Cmi could help identify prediagnostic POF in postendoscopic retrograde cholangiopancreatography pancreatitis cases within \"golden hours\" after endoscopic retrograde cholangiopancreatography with high efficacy.</p><p><strong>Conclusions: </strong>Serum exosomal Cmi may be an early predictor for POF in AP, even within \"golden hours\" after AP onset.</p><p><strong>Trail registration: </strong>ClinicalTrials.gov (NCT02602808).</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"93-99"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139696837","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":"Short-term and Long-term Outcomes of Robotic Enucleation of Tumors Located in the Pancreatic Head and Uncinate Process.","authors":"Huiyi Ou, Mengmin Chen, Kai Qin, Shiwei Zhao, Dan Li, Yusheng Shi, Yuanchi Weng, Georgios Gemenetzis, Xiaxing Deng, Chenghong Peng, Baiyong Shen, Jiabin Jin","doi":"10.1097/SLA.0000000000006198","DOIUrl":"10.1097/SLA.0000000000006198","url":null,"abstract":"<p><strong>Objective: </strong>To assess short-term and long-term outcomes following robotic enucleation (REn) of tumors in the proximal pancreas.</p><p><strong>Background: </strong>Despite the advantages of preserving function via pancreatic enucleation, controversies persist, since this can be associated with severe complications, such as clinically relevant postoperative pancreatic fistula, especially when performed near the main pancreatic duct. The safety and efficacy of REn in this context remain largely unknown.</p><p><strong>Methods: </strong>A retrospective analysis was performed of all patients who underwent REn for benign and low-grade malignant neoplasms in the pancreatic head and uncinate process between January 2005 and December 2021. Clinicopathologic, perioperative, and long-term outcomes were compared with a similar open enucleation (OEn) group.</p><p><strong>Results: </strong>Of 146 patients, 92 underwent REn with a zero conversion-to-open rate. REn was superior to OEn in terms of shorter operative time (90.0 minutes vs 120.0 minutes, P< 0.001), decreased blood loss (20.0 mL vs 100.0 min, P =0.001), and lower clinically relevant postoperative pancreatic fistula rate (43.5% vs 61.1%, P =0.040). Bile leakage rate, major morbidity, 90-day mortality, and length of hospital stay were comparable between groups. No post-REn grade C POPF or grade IV/V complication was identified. Subgroup analyses for uncinate process tumors and proximity to the main pancreatic duct did not demonstrate inferior postoperative outcomes. In a median follow-up period of 50 months, REn outcomes were comparable to OEn regarding recurrence rate and pancreatic endocrine or exocrine function.</p><p><strong>Conclusions: </strong>REn for pancreatic head and uncinate process tumors improved clinically relevant outcomes without increased major complications compared to OEn, while demonstrating comparable long-term oncological and functional outcomes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"86-92"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519460","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":"Hospital Volume for Rectal Cancer Resection Plays a Pivotal Role in Improving Outcomes: A Population-based Analysis.","authors":"Lien van Walle, Geert Silversmit, Annelies Debucquoy, Liesbet Van Eycken, André d'Hoore, Karin Haustermans, Albert Wolthuis","doi":"10.1097/SLA.0000000000006328","DOIUrl":"10.1097/SLA.0000000000006328","url":null,"abstract":"<p><strong>Objective: </strong>Assessing the association between hospital surgical volume (SV) and outcomes after rectal cancer surgery (RCS), using national population-based data.</p><p><strong>Background: </strong>For RCS, the association of higher SV with improved short-term and/or long-term outcomes remains controversial.</p><p><strong>Methods: </strong>National Cancer Registry data and administrative data were used to select patients diagnosed with stage I to III rectal cancer in 2009 to 2018 and who underwent RCS. The average annual SV of RCS was categorized as low (<15; LV), medium (15-29; MV), or high (≥30; HV). The association between SV and 90-day and 1-year excess postoperative mortality (90DPM and 1YEPM) and 5-year observed survival (5YOS) was evaluated.</p><p><strong>Results: </strong>From the 11,519 patients, RCS was performed in LV (4088; 36%), MV (2795; 24%), or HV (4636; 40%) hospitals. Observed 90DPM was significantly better in HV (2.3%; 95% CI: 1.9, 2.8) than in LV (3.7%; 95% CI: 3.2, 4.4) and MV (3.5% 95% CI: 2.9, 4.3) with adjusted OR of 1.4 ( P <0.0001). Continuous regression analysis showed significantly higher 90DPM in annual SV<35 compared with ≥35 (OR=1.6; 95% CI: 1.21, 2.11; P =0.0009). Observed 1YEPM was significantly better in HV (2.9%; 95% CI: 2.2, 3.6) compared to LV (4.7%; 95% CI: 3.9, 5.6) with adjusted excess HR of 1.31 (95% CI: 1.00, 1.73) and P =0.05, and to MV (5.0%; 95% CI: 4.0, 6.1) with adjusted excess HR of 1.45 (95% CI: 1.09, 1.94) and P =0.01. The 5YOS was significantly better in HV (75.9%; 95% CI: 74.6, 77.2) than in LV (70.3%; 95% CI: 68.8, 71.8) and MV (71.5%; 95% CI: 69.7, 73.2) with adjusted HR of 1.4 in both LV and MV versus HV ( P ≤0.003).</p><p><strong>Conclusion: </strong>This population-based study identified robustly superior outcomes at 90 days, 1 year, and 5 years after RCS in hospitals with higher volumes.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"124-131"},"PeriodicalIF":7.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140848723","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}