Annals of Surgical Oncology最新文献

{"title":"Data-Driven Surgical Referrals for Primary Hyperparathyroidism and Associated Surgical Outcomes: A Simulation Study.","authors":"David Rekhtman, Danielle E Brown, Jasmine Hwang, James Sharpe, J Walker Rosenthal, Caitlin Finn, Douglas Fraker, Rachel Kelz","doi":"10.1245/s10434-025-17699-7","DOIUrl":"10.1245/s10434-025-17699-7","url":null,"abstract":"<p><strong>Background: </strong>To minimize complications after parathyroidectomy, it is critical to connect patients with facilities equipped to perform this specialized procedure. This study assessed the effect of \"referring\" patients to higher-performing facilities for parathyroidectomy.</p><p><strong>Methods: </strong>A simulation study of adults who underwent parathyroidectomy for primary hyperparathyroidism was conducted using the Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery and Services databases. Wilson score estimates were used to generate serious adverse event (SAE) rates for a training cohort to divide surgical facilities into quality quartiles. Using each facility's fixed effect from the regression model, this study simulated the difference in SAE and cost for each patient between treatment at their original facility and treatment at an alternative higher-quality facility based on a lower SAE rate. The set of potential alternative facilities was determined based on proximity or original facility health system affiliation.</p><p><strong>Results: </strong>Of the 14,738 patients included in the proximity analysis 11,733 were randomized to the training group and 3005 to the testing cohort. The baseline characteristics and outcomes did not differ between the cohorts. Among the patients in the testing cohort, 314 were simulated to receive care at a higher-quality facility. The simulation predicted decreased SAE rates (2% vs. 3%; p < 0.001), with slightly increased total cost ($6391 vs. $6,351; p = 0.032). The results in the two simulations were similar.</p><p><strong>Conclusions: </strong>Simulation indicated that data-driven parathyroidectomy referrals can reduce SAE and advance surgical health equity. Data-driven facility selection is one way to achieve better surgical outcomes.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7489-7497"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASO Author Reflections: Predictive Clinical Nomograms for Postoperative Outcomes Following Porto-Mesenteric Vein Resection with Pancreatectomy: Identifying the Best Patient for a High-Acuity Surgery.","authors":"Shailesh V Shrikhande, Deeksha Kapoor, Vikram A Chaudhari, Manish S Bhandare","doi":"10.1245/s10434-025-17833-5","DOIUrl":"10.1245/s10434-025-17833-5","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7454-7456"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appendiceal Neuroendocrine Tumors: Prognostic Role of Mesoappendiceal Invasion and Implications for Recommending Right Hemicolectomy versus Simple Appendectomy.","authors":"Diamantis I Tsilimigras, Pamela Lu, Susan Tsai, Timothy M Pawlik, Bhavana Konda, Dipen Patel, Vineeth Sukrithan, Jordan M Cloyd","doi":"10.1245/s10434-025-17982-7","DOIUrl":"10.1245/s10434-025-17982-7","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines are conflicting as to whether mesoappendiceal invasion (MAI) among patients with appendiceal neuroendocrine tumors (aNETs) warrants right hemicolectomy (RHC), especially in the absence of other concomitant high-risk features.</p><p><strong>Methods: </strong>Patients who underwent resection of aNETs were identified in the National Cancer Database. Patients with pT3 aNETs (i.e. size > 4 cm or MAI/subserosal invasion [SI]+) were further stratified as pT3a (size ≤ 4 cm, + MAI/SI) or pT3b (size > 4 cm, ± MAI/SI). The association of MAI/SI with nodal metastasis (pN+) relative to the presence/absence of other risk factors was examined. The prognostic impact of the extent of resection (i.e. RHC vs. appendectomy) among patients with MAI/SI was assessed.</p><p><strong>Results: </strong>Among 4819 patients who underwent resection for aNETs, 1662 had pT3 tumors, of which 1309 (78.7%) were pT3a and 353 (21.3%) were pT3b. The overall incidence of pN+ disease was 7.5%, and varied by American Joint Committee on Cancer (AJCC) pT stage (pT1: 0.9%; pT2: 9.2%; pT3: 8.5%; pT4: 29.8%; p < 0.001). pT3a stage was less frequently associated with pN+ disease compared with pT3b disease (6.8% vs. 14.7%; p = 0.02). In the absence of other established risk factors, the presence of MAI/SI alone was associated with a low probability of pN+ (3.4%). The 3-year overall survival among patients with pT3a aNETs was comparable following RHC versus simple appendectomy (92.7% vs. 95.2%; p = 0.43).</p><p><strong>Conclusions: </strong>Among patients with resected aNETs, MAI/SI alone in the absence of other established risk factors was associated with a low likelihood of nodal metastasis and equivalent long-term outcomes regardless of the extent of surgical resection. The presence of MAI/SI alone should not be an indication for RHC.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7627-7633"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454516/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attrition after Neoadjuvant Chemotherapy in Foregut Cancer: Experience at a Tertiary Center in the Deep South.","authors":"Michelle Holland, Jaspinder Sanghera, Ioannis Liapis, Rida Ahmad, Krisha Amin, Ahmed Abdalla, Martin J Heslin, Smita Bhatia, Annabelle L Fonseca","doi":"10.1245/s10434-025-17795-8","DOIUrl":"10.1245/s10434-025-17795-8","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemotherapy (NAC) is increasingly used in the management of foregut cancers to downstage tumors, treat micrometastases, and improve oncological outcomes. However, many patients fail to undergo surgical resection after NAC. This study aims to identify the underlying causes of non-tumor biology-related attrition and thus evaluate the potentially modifiable factors contributing to pre-surgical attrition.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients with non-metastatic gastric or pancreatic adenocarcinoma treated between 2018-2022 at a tertiary and safety net hospital in the Southeastern U.S. Multivariable logistic regression and a root cause analysis (RCA) were performed to examine the association of sociodemographic factors with attrition and delineate underlying root causes.</p><p><strong>Results: </strong>Of 169 patients who received NAC, 47% (n = 80) experienced potentially modifiable attrition that was unrelated to disease progression. A diagnosis of pancreatic cancer (p = 0.001), age ≥ 75 (p = 0.04), and ≥ 3 ED visits after diagnosis (p=0.03) were independently associated with attrition on multivariable analysis. Four causes of non-tumor biology-related attrition were identified on RCA: physical deconditioning due to chemotherapy toxicity, malignancy or procedural complications, loss to follow-up resulting from missed appointments, healthcare delivery factors including delayed or absent referral to specialists, and patient refusal of treatment. Attrition was associated with significantly worse survival in both pancreatic and gastric cancer.</p><p><strong>Discussion: </strong>Nearly 50% of patients receiving NAC for pancreatic and gastric cancer failed to undergo surgery due to potentially modifiable causes. Addressing the underlying barriers through the implementation of structured prehabilitation programs, symptom management clinics, and cancer care navigators may reduce non-tumor biology-related attrition and improve outcomes.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7740-7750"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon Attitudes to Guideline-Concordant Extended Pharmacologic Venous Thromboembolism Prophylaxis after Cancer Surgery Within a Regional Health System: A Qualitative Study.","authors":"Megan K Scharner, Shannon Phillips, Nivetha Baskar, Natalie Koren, Maggie Westfal, Thomas Curran","doi":"10.1245/s10434-025-17870-0","DOIUrl":"10.1245/s10434-025-17870-0","url":null,"abstract":"<p><strong>Background: </strong>While infrequent, venous thromboembolism (VTE) is a significant cause of morbidity and mortality after cancer surgery. Extended pharmacologic VTE prophylaxis (ePPX) decreases VTE risk and is recommended by professional societies. Observational studies have shown limited ePPX utilization, although reasons for non-adherence have not been forthcoming from existing data.</p><p><strong>Objective: </strong>The aim of this study was to obtain insight toward surgeon practices and attitudes regarding ePPX within a regional health system.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 13 surgeons and 2 advanced practice providers who perform gastrointestinal, urologic, or gynecologic cancer resections. Interviews characterized perceptions of VTE risk, VTE prevention strategies, and an electronic medical record-based decision support tool to improve ePPX utilization. Transcripts were thematically analyzed with conceptual coding.</p><p><strong>Results: </strong>Thirteen surgeons and two advance-practice providers were interviewed; 5 were female. Six surgeons practice in the community and seven practice in the academic setting. Sixty percent (n = 9; 8 academic) of providers utilized ePPX 'routinely', with professional society guidelines and medical literature the most cited reasons. Thirty-three percent (n = 5; 4 community) of providers utilized ePPX 'selectively', with injection medication and surgeon routine the most cited reasons. One community surgeon 'never' utilized ePPX. Academic providers were more likely to utilize ePPX than community providers. All providers were open to the electronic medical record decision support tool.</p><p><strong>Conclusions: </strong>Diverse practice patterns of ePPX were identified across providers, with community surgeons more likely to prescribe ePPX selectively or never. Surgeon education, utilization of an oral medication, and cost mitigation may improve ePPX adherence.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7596-7603"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing a Replaced Right Hepatic Artery During Robot-Assisted Pancreatoduodenectomy in Practical Steps.","authors":"Jonathan Garnier, Olivier R C Busch, Freek Daams, Jakob Kist, Sebastiaan Festen, Marc G Besselink","doi":"10.1245/s10434-025-17662-6","DOIUrl":"10.1245/s10434-025-17662-6","url":null,"abstract":"<p><strong>Background: </strong>A replaced right hepatic artery (rRHA) arising from the superior mesenteric artery (SMA) is the most common hepatic arterial variant, occurring in ~12% of the population. Its close anatomical relationship with the pancreatic head poses significant challenges in hepatobiliary and pancreatic surgery, making it particularly vulnerable to injury during dissection. This can lead to ischemic complications or necessitate complex vascular reconstruction. In robot-assisted pancreatoduodenectomy (RPD) for resectable tumors, rather than focusing on resectability, the goal is to preserve the rRHA while ensuring an oncologically sound dissection. Thus, detection and precise understanding of the rRHA course and variations is essential.</p><p><strong>Methods: </strong>We illustrate the management of rRHA in two patients with distinct anatomical features undergoing RPD. The first, a woman with distal cholangiocarcinoma and a low BMI (23 kg/m²), had close rRHA-pancreatic head connections. The second, a man with ampullary carcinoma and a higher BMI (26 kg/m²), presented with significant fat infiltration and a small-caliber rRHA.</p><p><strong>Perioperative management: </strong>Preoperative high-resolution CT angiography mapped the vascular anatomy and guided surgical planning. Intraoperative strategies included meticulous dissection, early rRHA identification and vessel loop placement, SMA dissection, to end with rRHA origin dissection and control beneath the portal vein. These steps ensured preservation of the rRHA while maintaining oncologic integrity.</p><p><strong>Conclusion: </strong>Preserving the rRHA during RPD requires a combination of detailed preoperative vascular mapping and intraoperative precision. Further studies are essential to refine and validate standardized strategies, with RPD rapidly becoming the standard of care in expert pancreatic centers.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7443-7445"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined Laparoscopic and Open Surgical Approach for Well Differentiated Trans-compartmental Liposarcoma Between Pelvic and Femoral Regions.","authors":"Matteo Aulicino, Giorgio D'Annibale, Cecilia Orsini, Lorenzo Barberis, Tommaso Partipilo, Francesco Santullo, Andrea Di Giorgio, Carlo Abatini, Miriam Attalla El Halabieh, Federica Ferracci, Fabio Pacelli, Claudio Lodoli","doi":"10.1245/s10434-025-17553-w","DOIUrl":"10.1245/s10434-025-17553-w","url":null,"abstract":"<p><strong>Background: </strong>Soft tissue sarcomas are rare neoplasms, accounting for only 1% of all solid tumors in adults. Liposarcomas represent the most common histological subtype,¹ with aggressive local invasiveness and poor prognosis.² When feasible, resection achieving negative surgical margins remains the only potentially curative treatment.³ Advances in laparoscopic surgical techniques have broadened the indications for minimally invasive oncologic procedures, particularly in cases involving retroperitoneal structures.⁴ These developments support the consideration of laparoscopy in selected retroperitoneal tumors as well. However, the minimally invasive approach to retroperitoneal sarcomas remains unconventional and is mostly described in case reports and small series.^5-9 Moreover, a significant technical and oncological challenge is posed by well differentiated \"trans-compartmental\" liposarcoma which originate in one anatomical region and extend into adjacent districts through anatomical foramina.^10,11 Frequently these tumors originate from the pelvic region and extend outside the retroperitoneal space trough the abdominal wall into the inguinal or crural spaces, simulating hernias.^12-15 METHODS: In this video, we present the case of a 62 years old patient with a well differentiated liposarcoma originating from the right pelvic region and extending along the iliofemoral axis into the right femoral area.</p><p><strong>Results: </strong>The video demonstrates a step-by-step approach to oncological surgery through a combined laparoscopic and inguinal approach, identifying critical anatomical landmarks and outlining the rationale guiding the reconstructive phase.</p><p><strong>Conclusions: </strong>Minimally invasive surgical management of soft tissue sarcomas is technically feasible in tertiary referral centers with advanced expertise in laparoscopic surgery. Optimal oncological outcomes are achievable by integrating different surgical approaches, emphasizing the relevance of a tailored strategy.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7834-7835"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of Recurrence Sites in Esophageal Squamous Cell Carcinoma after Neoadjuvant Chemoradiation with Elective Nodal Irradiation: Insights for Radiation Field Optimization.","authors":"Ye Jin Yoo, Jeong Yun Jang, Sung-Bae Kim, Sook Ryun Park, Yong-Hee Kim, Hyeong Ryul Kim, Jong Hoon Kim","doi":"10.1245/s10434-025-17708-9","DOIUrl":"10.1245/s10434-025-17708-9","url":null,"abstract":"<p><strong>Background: </strong>The optimal radiation field for neoadjuvant chemoradiotherapy (NCRT) in patients with esophageal squamous cell carcinoma (ESCC) remains debated. This study investigated recurrence patterns following NCRT with elective nodal irradiation (ENI), specifically comparing the recurrence sites relative with radiation treatment fields.</p><p><strong>Patients and methods: </strong>We retrospectively analyzed 255 patients with ESCC treated with NCRT with ENI. Radiation fields included supraclavicular or celiac lymph nodes on the basis of tumor location. An imaginary involved field irradiation (IFI) was defined to cover the gross tumor with margins. Recurrence sites were classified as within IFI field, between IFI and ENI margins, or outside ENI field.</p><p><strong>Results: </strong>With a median follow-up of 42.2 months, 65 patients (25.5%) experienced recurrence, and 66.2% of these recurrences occurred with distant metastasis. Among 22 patients with isolated local recurrence (LR), 12 (54.5%) occurred within IFI field and 6 (27.3%) between IFI and ENI margins. The rate of isolated LR between IFI and ENI margins was 0% in upper, 6.2% in middle, and 3.9% in lower thoracic tumors. Among 120 patients with pathologic complete response (pCR), isolated LR occurred in 4 (3.3%), with only 1 case between IFI and ENI margins. In 135 patients with non-pCR, isolated LR was observed in 18 (13.3%), with only 5 between IFI and ENI margins.</p><p><strong>Conclusions: </strong>Two-thirds of the recurrences occurred with distant metastasis and over half of isolated locoregional recurrences occurred within the IFI field. This highlights the need to reassess extended radiation field and to consider individualized radiation strategies on the basis of tumor location and pathologic response.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7852-7859"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Curability and Life Expectancy in Surgical Patients with Advanced Cancer: A Mixed Methods Analysis of Factors that Affect Views on Cancer Prognosis.","authors":"Beatrice J Sun, Emily M Pang, Tiffany M Yue, Byrne Lee","doi":"10.1245/s10434-025-17768-x","DOIUrl":"10.1245/s10434-025-17768-x","url":null,"abstract":"<p><strong>Background: </strong>Expectations about disease prognosis are challenging and understudied in patients with advanced cancers. We evaluateed patient factors associated with prognostic understanding in this population.</p><p><strong>Methods: </strong>In this explanatory sequential mixed methods study, surveys were administered to patients with advanced-stage cancer who were seen in the surgical oncology clinic (2022-2024); a subset of patients underwent semistructured interviews. Perceived disease curability and life expectancy were compared between the patient and surgeon: the patient's prognostic rating equal to or less optimistic than their surgeon's was categorized as \"concordant,\" whereas a higher rating was \"discordant\" and reflected an optimistic outlook.</p><p><strong>Results: </strong>In total, 165 surveys were completed. Median age was 58 years. The most common primary malignancies were appendiceal, colorectal, and gynecologic. Median time since cancer diagnosis was 18 months. Overall, 32% of patients demonstrated concordant views on curability, whereas 60% were concordant on life expectancy. Patients who had children younger than 18 years were more optimistic about disease curability and more discordant with their surgeon (84% vs. 62% discordant, p = 0.007). Additionally, patients who had lived beyond 1 year since cancer diagnosis were more optimistic about life expectancy (47% vs. 27% discordant, p = 0.012). Qualitative analysis revealed that the responsibility to nurture their children; hope of living long-term with cancer; and perspective to live in the moment were reasons to maintain an optimistic outlook.</p><p><strong>Conclusions: </strong>Our study illustrates the discordance between patient-surgeon views on curability and life expectancy in advanced cancer, while highlighting the importance of understanding patient factors that may influence their outlook on cancer.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7577-7586"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Preoperative Diabetes on Insulin Management and Nutritional Status After Total or Completion Pancreatectomy.","authors":"Tomotaka Kato, Yoshihiro Ono, Toru Kitazawa, Kosuke Kobayashi, Atsushi Oba, Takafumi Sato, Hiromichi Ito, Yosuke Inoue, Akio Saiura, Yu Takahashi","doi":"10.1245/s10434-025-17749-0","DOIUrl":"10.1245/s10434-025-17749-0","url":null,"abstract":"<p><strong>Background: </strong>Insulin requirements after total or completion pancreatectomy (TP/CP) remain uncertain, complicating postoperative diabetes and nutritional care. This study uncovers key factors influencing these requirements.</p><p><strong>Methods: </strong>This retrospective study included 53 patients who underwent TP/CP between July 2005 and October 2023. Data on the perioperative clinical, diabetic, and nutritional factors were also collected. Multivariable analyses were performed for the insulin-to-glucose ratio (IGR) on postoperative days (POD) 1 and 2 and the insulin dose during long-term follow-up.</p><p><strong>Results: </strong>The median insulin dose and IGR on POD 1 and 2 were 47 units/day and 0.26 units/g, respectively. The median insulin dose at discharge was 18 U/day, which increased to 23 U/day during follow-up. High preoperative HbA1c levels (odds ratio [OR], 8.68) and long operation time (OR 7.26) were determinants of high IGR. Although long-standing diabetes mellitus before surgery did not correlate with IGR, it was the sole predictor of high insulin requirement (OR 8.09) during follow-up (30 vs. 20 units/day). This resulted in improved nutritional status, as reflected by changes in body weight (P < 0.001) and nutritional scores (CONUT score, P = 0.041; geriatric nutritional risk index, P = 0.002). In contrast, patients without preoperative diabetes tended to require low insulin doses during follow-up, leading to poor diabetic control and worsening of nutritional status, as reflected in the CONUT score (P = 0.013).</p><p><strong>Conclusions: </strong>Adjusting insulin doses and controlling diabetes can be more challenging when performing TP/CP in patients without diabetes than in patients with long-standing diabetes mellitus. Careful management is required for these patients to achieve better nutritional status.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7422-7432"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}