Surgery最新文献

{"title":"Axillary staging outcomes in women undergoing mastectomy for ductal carcinoma in situ in the era of gene expression assays","authors":"Anna Levine DO ,&nbsp;Hayden Wood BS ,&nbsp;Ibukunoluwa Omole BA ,&nbsp;Amie M. Hop MD ,&nbsp;G. Paul Wright MD ,&nbsp;Jessica L. Thompson MD","doi":"10.1016/j.surg.2025.109909","DOIUrl":"10.1016/j.surg.2025.109909","url":null,"abstract":"<div><h3>Background</h3><div>Approximately 20% of women diagnosed with ductal carcinoma in situ on core biopsy will be upstaged to invasive disease on final pathology. Sentinel lymph node biopsy at the time of mastectomy for ductal carcinoma in situ is the current standard of care. However, the underlying invasive cancer is frequently of low grade with favorable biology, bringing into question the necessity of sentinel lymph node biopsy to help guide clinical treatment recommendations. The primary study objective was to determine how often sentinel lymph node biopsy at the time of mastectomy for ductal carcinoma in situ alters adjuvant therapy recommendations.</div></div><div><h3>Methods</h3><div>A single-institution cancer registry retrospectively identified women treated with mastectomy for a preoperative diagnosis of ductal carcinoma in situ between November 2017 and November 2023, excluding those with a previous history of ipsilateral breast cancer. The impact of pathologic nodal status on adjuvant treatment was evaluated.</div></div><div><h3>Results</h3><div>The study population included 175 patients with a total of 38 invasive cancers identified. Of those with pT1 malignancies, 3 had a positive sentinel node. One patient was recommended for additional adjuvant treatment, in the form of radiation therapy, as a result of axillary staging. No patients were recommended for chemotherapy based solely on sentinel lymph node biopsy results.</div></div><div><h3>Conclusion</h3><div>Despite current recommendations to perform sentinel lymph node biopsy in ductal carcinoma in situ treated with mastectomy in the event invasive cancer is identified on final pathology, our outcomes suggest nodal status has limited impact on adjuvant therapy offerings. These findings indicate that sentinel lymph node biopsy may not be requisite for every patient undergoing mastectomy for ductal carcinoma in situ.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109909"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145696314","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":"Association between anesthesiologist volume and postoperative outcomes in hepatectomy and pancreatectomy","authors":"Jackson A. Baril MD ,&nbsp;Emma Holler PhD ,&nbsp;Cary Jo R. Schlick MD, MS ,&nbsp;Ryan J. Ellis MD, MS ,&nbsp;Thomas K. Maatman MD ,&nbsp;Alexandra M. Roch MD, MS ,&nbsp;E. Molly Kilbane RN ,&nbsp;Eugene P. Ceppa MD ,&nbsp;Michael G. House MD ,&nbsp;Nicholas J. Zyromski MD ,&nbsp;Jerry Young MD ,&nbsp;C. Max Schmidt MD, MBA, PhD","doi":"10.1016/j.surg.2025.109908","DOIUrl":"10.1016/j.surg.2025.109908","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative fluid and hemodynamic management impact postoperative outcomes. Few studies have examined anesthesiologist volume-outcomes in hepato-pancreato-biliary surgery. The objectives of this study are to describe anesthesiologist experience levels in hepatectomy and pancreatectomy and examine their association with intraoperative intravenous fluids and postoperative outcomes.</div></div><div><h3>Methods</h3><div>Adult patients who underwent hepatectomy or pancreatectomy from 2017 to 2023 were identified at a single center. For each case, anesthesiologist volume was defined as the number of pancreatectomies, hepatectomies, or both supported primarily by that anesthesiologist in the preceding 12 months. Primary outcomes of interest were intraoperative intravenous fluid volume and 30-day serious morbidity.</div></div><div><h3>Results</h3><div>Of 3,016 patients included, 1,868 (61.9%) underwent pancreatectomy and 1,148 (38.1%) underwent hepatectomy. The median anesthesiologist experience was 14 (interquartile range, 9–18) in pancreatectomies, 8 (interquartile range, 5–12) in hepatectomies, and 21 (interquartile range, 14–29) combined. High-volume anesthesiologist cases were defined as the 75th percentile. High-volume anesthesiologists were not associated with volume of intravenous fluid (coefficient = −19.0 mL, 95% confidence interval, −116.5 to 78.4, <em>P</em> = .70). After adjusting for patient factors, surgeon, and operation type, high-volume anesthesiologists were not significantly associated with serious morbidity overall (adjusted odds ratio, 0.80; 95% confidence interval, 0.64–1.02, <em>P</em> = .07). However, operation-specific high-volume anesthesiologists were associated with decreased serious morbidity in pancreatectomy (adjusted odds ratio, 0.72; 95% confidence interval, 0.55–0.95, <em>P</em> = .02) but not in hepatectomy (adjusted odds ratio, 0.92; 95% confidence interval, 0.62–1.35, <em>P</em> = .66).</div></div><div><h3>Conclusions</h3><div>A volume-outcome relationship was found between anesthesiologist experience with pancreatectomy and morbidity but not in intravenous fluid use, hepatectomy, or pancreatectomy and hepatectomy combined. The impact of anesthesiologist care in pancreatic surgery may relate to anesthesiologist experience.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109908"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744656","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":"Utilizing local anesthesia and monitored anesthesia care sedation in open inguinal hernia repair in complex, comorbid patients","authors":"Alynna J. Wiley MD ,&nbsp;Stephanie M. Jensen MD ,&nbsp;Alexandra S. Adams MS ,&nbsp;Alexis M. Holland MD ,&nbsp;Gregory T. Scarola MS, MBA ,&nbsp;Keith S. Gersin MD ,&nbsp;Brittany S. Mead MD ,&nbsp;Vedra A. Augenstein MD ,&nbsp;Kent W. Kercher MD ,&nbsp;Sullivan A. Ayuso MD ,&nbsp;B. Todd Heniford MD","doi":"10.1016/j.surg.2025.109910","DOIUrl":"10.1016/j.surg.2025.109910","url":null,"abstract":"<div><h3>Introduction</h3><div>With the advancement of modern surgical technology, the interest in minimally invasive techniques for inguinal hernia repair has grown exponentially with open inguinal hernia repair becoming somewhat passé. However, patients, especially those with comorbidities, can avoid general anesthesia with open inguinal hernia repair. This study evaluated outcomes in patients undergoing open inguinal hernia repair under local anesthesia with sedation.</div></div><div><h3>Methods</h3><div>A prospectively maintained institutional database was queried for open inguinal hernia repair under local anesthesia with sedation. Patient demographics, operative details, and outcomes were analyzed descriptively. Intraoperatively, with the patient supine and prepared, a field block with a combination of 0.25% bupivacaine (Marcaine) with epinephrine and 1% lidocaine was performed before a modified Lichtenstein repair.</div></div><div><h3>Results</h3><div>Open inguinal hernia repair was performed in 164 patients with a mean age of 71.1 ± 14.0 years. Mean body mass index was 24.7 ± 3.7 kg/m², mean number of comorbidities was 3.3 ± 2.5, 15.2% of patients had diabetes, 37.8% had a history of smoking, 45.7% were American Society of Anesthesiologists III, 17.1% were American Society of Anesthesiologists IV/V, and 22.0% had recurrent hernias. All patients received synthetic mesh. Unilateral repair was performed in the majority of patients (98.8%). No patient required a general anesthetic. Total mean operative time was 75.4 ± 29.9 minutes. Mean operating room charge was $6149.1 ± $3413.5. Postoperatively, 1.8% of patients had wound cellulitis, 0.6% of patients developed a seroma requiring aspiration, and 3.7% experienced urinary retention. There were no recurrences with a mean follow-up of 17.8 ± 26.7 months.</div></div><div><h3>Conclusion</h3><div>Open inguinal hernia repair under local anesthesia with sedation is an effective, safe approach to manage inguinal hernias with limited cost, complications, and recurrences with 1.5 years of follow-up. This technique may benefit patients with comorbidities or patients who choose to avoid general anesthesia.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109910"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145640045","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":"Acknowledgments of Peer Reviewers","authors":"","doi":"10.1016/S0039-6060(26)00030-9","DOIUrl":"10.1016/S0039-6060(26)00030-9","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110108"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146188659","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":"Estrogen modulates microvesicle effects in stored murine whole blood","authors":"Lindsey J. Wattley MD,&nbsp;Greg Wetmore MD,&nbsp;Ellen Becker MD,&nbsp;Ryan C. Chae MD,&nbsp;Charlotte Cox,&nbsp;Rebecca Schuster MS,&nbsp;Bernadin Joseph BS,&nbsp;Michael D. Goodman MD,&nbsp;Timothy A. Pritts MD PhD","doi":"10.1016/j.surg.2025.109919","DOIUrl":"10.1016/j.surg.2025.109919","url":null,"abstract":"<div><h3>Background</h3><div>Recent studies suggest that donor sex affects coagulation parameters in whole blood. Additional experiments have examined the effect of storage on the coagulation of whole blood; however, the effects of donor sex on storage-related changes have not been examined. We determined the sex-specific effects of estrogen on microvesicle formation during whole blood storage as well as microvesicle modulation of storage coagulopathy.</div></div><div><h3>Methods</h3><div>Whole blood obtained from male and female mice was stored under standard storage conditions or treated with ethinyl estradiol or vehicle (dimethyl sulfoxide) for 10 days. The storage lesion was assessed. Coagulation potential was examined using rotational thromboelastometry. In additional experiments, microvesicles isolated from day 10 whole blood were added to stored whole blood and coagulation was examined.</div></div><div><h3>Results</h3><div>After 10 days of storage, several aspects of the storage lesion differ in blood from male, as compared with female, donors. Ethinyl estradiol reduced microvesicle concentration in male blood to levels similar to day 10 female whole blood. On rotational thromboelastometry analysis, the addition of male microvesicles mitigated the storage coagulopathy of female whole blood on nonactivated thromboelastometry and extrinsically activated test.</div></div><div><h3>Conclusions</h3><div>Male- and female-stored whole blood differ in aspects of the storage lesion. In stored whole blood, male erythrocytes demonstrate reduced membrane integrity with increased microvesicle shedding. This was ameliorated by blood storage with estrogen. Storage coagulopathy in female blood was lessened by the addition of microvesicles. Our data demonstrate that estrogen and biological sex play a key role in microvesicle production and coagulation potential during whole blood storage.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109919"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688175","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":"Can large language models extract operative standards from narrative operative reports in rectal cancer?","authors":"Karen Trang MD ,&nbsp;Beiqun Zhao MD, MAS ,&nbsp;Colleen P. Flanagan MD ,&nbsp;Logan Pierce MD ,&nbsp;Lindsay Welton MD ,&nbsp;Melissa Gunderson MD ,&nbsp;Genevieve B. Melton MD, PhD ,&nbsp;Elizabeth Wick MD","doi":"10.1016/j.surg.2025.110037","DOIUrl":"10.1016/j.surg.2025.110037","url":null,"abstract":"","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110037"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918531","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":"Predicting high-risk pathology across the spectrum of resected and surveilled intraductal papillary mucinous neoplasms: A cohort study","authors":"Chase J. Wehrle MD,&nbsp;Pranav Kumar BA,&nbsp;Abby Gross MD,&nbsp;Breanna Perlmutter MD,&nbsp;Jenny Chang MD,&nbsp;Antonio Giusepucci BA,&nbsp;Robert Naples MD,&nbsp;Kathryn Stackhouse MD,&nbsp;John McMichael PhD,&nbsp;Samer Naffouje MD,&nbsp;Daniel Joyce MD,&nbsp;Robert Simon MD,&nbsp;Toms Augustin MD, MPH,&nbsp;R. Matthew Walsh MD","doi":"10.1016/j.surg.2025.110023","DOIUrl":"10.1016/j.surg.2025.110023","url":null,"abstract":"<div><h3>Introduction</h3><div>Clinical practice guidelines for intraductal papillary mucinous neoplasms are based on expert opinion because of paucity of clinical evidence. We aim to establish the data-driven correlation between worrisome/high-risk/clinically relevant progression features and high-risk pathology on fine needle aspiration or resection.</div></div><div><h3>Design</h3><div>A prospectively maintained database (1997–2023) of presumed pancreatic cystic neoplasms was queried for intraductal papillary mucinous neoplasm with potentially concerning feature(s) per Fukuoka guidelines. Association and predictive power of specific features was examined via logistic mixed effects modeling and least absolute shrinkage and selection operator regression.</div></div><div><h3>Results</h3><div>Of the 2,686 patients diagnosed with intraductal papillary mucinous neoplasms, 460 (17.1%) had a feature of clinically relevant progression. Median follow-up was 7.1 years (interquartile range 2.99–11.9). Most (<em>n</em> = 365; 79%) were offered pancreatic resection with 230 (63%) undergoing resection. Sixty-nine (15.6%) developed invasive carcinoma. Endoscopic ultrasonography–guided cytology at diagnosis demonstrated a sensitivity of 28.4% (95% confidence interval 18.0%–40.7%) and specificity 98.9% (97.2%–99.7%) for high-risk pathology. Endoscopic ultrasonography–guided cytology after clinically relevant progression demonstrated a specificity of 100% (95% confidence interval 92.1%–100%) and sensitivity 16.1% (5.5%–33.7%).On mixed effects modeling, enhancing nodule (odds ratio 24.6, 95% confidence interval 6.58–91.74), main pancreatic duct involvement (odds ratio 4.77, 95% confidence interval 1.18–14.05), and symptoms (hazard ratio 12.139, 95% confidence interval 1.786–82.48) predicted high-risk pathology; other features, including size or size growth, did not (conditional pseudo-<em>R</em>² = 0.218, marginal = 0.243). On least absolute shrinkage and selection operator analysis, enhancing nodule was the strongest predictor of both high-risk pathology and invasive carcinoma followed by main pancreatic duct dilatation and thick cyst wall. Age, body mass index, cyst size, and rate of size growth all had coefficients converging to zero.</div></div><div><h3>Conclusion</h3><div>Enhancing nodule and any degree of main duct dilatation in an intraductal papillary mucinous neoplasm portend a high risk of malignant pathology, whereas cyst size and growth rate notably did not. These data should aid clinical management and might inform future practice guidelines.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110023"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820782","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":"Ideal impedance planimetry (EndoFLIP) distensibility ranges for male and female patients undergoing laparoscopic fundoplication","authors":"Sullivan A. Ayuso MD,&nbsp;Jean-Christophe N. Rwigema MD,&nbsp;Derrius J. Anderson MD,&nbsp;Kristine Kuchta MS,&nbsp;Natalie Liu MD,&nbsp;H. Mason Hedberg MD,&nbsp;Michael B. Ujiki MD","doi":"10.1016/j.surg.2025.109903","DOIUrl":"10.1016/j.surg.2025.109903","url":null,"abstract":"<div><h3>Background</h3><div>The distensibility index is the most commonly used impedance planimetry (EndoFLIP) parameter and has been shown to correlate closely with postoperative outcomes. This study aims to compare postoperative outcomes between male and female patients undergoing laparoscopic fundoplication and use them to formulate ideal distensibility index ranges.</div></div><div><h3>Methods</h3><div>A prospectively maintained single-institution database was queried for patients undergoing elective laparoscopic fundoplication from 2018 to 2024. Baseline demographics, postoperative outcomes, and quality-of-life outcomes were evaluated. EndoFLIP measurements were correlated to quality-of-life outcomes, and ideal ranges for distensibility index were calculated using a receiver operating characteristic curve analysis. Standard statistical methods were used.</div></div><div><h3>Results</h3><div>A total of 323 patients were identified: 95 male and 228 female. Baseline age was similar (62.0 ± 15.0 vs 65.0 ± 13.0 years, <em>P</em> = .26), but female patients had a higher body mass index (28.2 ± 4.5 vs 29.9 ± 5.7 kg/m², <em>P</em> = .02). Mean postfundoplication distensibility indices were 3.0 ± 1.3 and 2.7 ± 1.2, respectively (<em>P</em> = .31). There was no difference in 30-day readmissions (5.3% vs 6.6%, <em>P</em> = .65) or overall complications (6.3% vs 7.0%, <em>P</em> = .82). At each postoperative time point, dysphagia score, reflux symptom index, and gastroesophageal reflux disease health-related quality-of-life scores were statistically similar for male and female patients (all <em>P</em> &gt; .05). The ideal distensibility indices were 2.4–3.6 mm²/mm Hg for male patients and 2.0–3.6 mm²/mm Hg for female patients.</div></div><div><h3>Conclusion</h3><div>For male and female patients undergoing laparoscopic fundoplication, quality-of-life metrics were similar up to 2 years postoperatively. Although not amenable to direct statistical evaluation, the ideal distensibility index ranges appeared comparable between sexes, which favors a uniform postfundoplication distensibility index.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 109903"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688171","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":"Can virtual noncontrast computed tomography improve the diagnostic uncertainty of adrenal incidentalomas?","authors":"Likolani Arthurs MD ,&nbsp;Max Schumm MD ,&nbsp;Paige Curcio BS ,&nbsp;Zoran Gajic MD ,&nbsp;Robert Petrocelli MD ,&nbsp;Myles Taffel MD ,&nbsp;Rajam Raghunathan MD, PhD ,&nbsp;Olivia McAllister-Nevins BA ,&nbsp;Cadence Chan BS ,&nbsp;Kepal Patel MD ,&nbsp;Rachel Liou MD ,&nbsp;Jason Prescott MD, PhD ,&nbsp;John Allendorf MD ,&nbsp;Insoo Suh MD","doi":"10.1016/j.surg.2025.110038","DOIUrl":"10.1016/j.surg.2025.110038","url":null,"abstract":"<div><h3>Background</h3><div>Although most adrenal incidentalomas are benign, many are identified by single-phase contrast-enhanced computed tomography, which is unreliable for excluding malignancy. Virtual noncontrast computed tomography is a newer modality with the potential to better characterize adrenal nodules.</div></div><div><h3>Methods</h3><div>Virtual noncontrast computed tomography of adrenal nodules with available reference standard of true noncontrast computed tomography were identified (2016–2024). Images were evaluated for nodule characteristics including Hounsfield unit attenuation and variability. Nodules were classified as benign (≤10 Hounsfield units) or indeterminate/suspicious (&gt;10 Hounsfield units) by true noncontrast computed tomography. Hounsfield units were compared between virtual noncontrast computed tomography and true noncontrast computed tomography. Variability in attenuation measurements was compared by evaluating Hounsfield unit differences 1 slice up and down from the chosen mid-depth image. Receiver operating characteristic analysis was used to define optimal virtual noncontrast computed tomography accuracy thresholds.</div></div><div><h3>Results</h3><div>After excluding 5 adrenal nodules due to suboptimal imaging, 67 nodules were identified. Based on true noncontrast computed tomography Hounsfield units, 23 nodules (34.3%) were benign, and 44 (65.7%) were indeterminate/suspicious. Hounsfield unit measurements for each nodule exhibited wide variability by both virtual noncontrast computed tomography and true noncontrast computed tomography. Virtual noncontrast computed tomography and true noncontrast computed tomography were significantly correlated with moderate effect size (Pearson coefficient 0.69, <em>P</em> &lt; .001). Conflicting impressions occurred for 6 nodules (9.0%). Overall, virtual noncontrast computed tomography exhibited outstanding discrimination between benign and indeterminate/suspicious nodules (area under the curve 0.94). Maintaining a threshold of ≤10 Hounsfield units achieved 93% sensitivity, 76% specificity, and 84% negative predictive value, whereas ≤7 Hounsfield units achieved 100% negative predictive value. The functional utility of virtual noncontrast computed tomography as a rule-out test applied to 16% of nodules.</div></div><div><h3>Conclusion</h3><div>Despite wide variability in Hounsfield unit measurements, adrenal nodules are well defined by both virtual noncontrast computed tomography and true noncontrast computed tomography. Well-reconstructed virtual noncontrast computed tomography images can accurately rule out malignancy in selected patients, potentially obviating the need for additional imaging.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110038"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918500","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":"Necessity of lymph node dissection in solid pseudopapillary tumor of the pancreas: A retrospective analysis","authors":"Huizhong Shi MD ,&nbsp;Xiaoyu Yang MM ,&nbsp;Xie Song MD ,&nbsp;Zhengjian Wang MD ,&nbsp;Chaoqun Ma MD ,&nbsp;Qingqiang Ni MD ,&nbsp;Shunzhen Zheng MD ,&nbsp;Fangfeng Liu MD ,&nbsp;Hong Chang MD","doi":"10.1016/j.surg.2025.110046","DOIUrl":"10.1016/j.surg.2025.110046","url":null,"abstract":"<div><h3>Background</h3><div>Solid pseudopapillary tumor of the pancreas is a rare low-grade malignant neoplasm. The clinical relevance of lymph node dissection during surgical resection remains controversial due to limited evidence.</div></div><div><h3>Method</h3><div>We retrospectively reviewed the clinical records of patients with solid pseudopapillary tumor of the pancreas who underwent surgery at Shandong Provincial Hospital between 2005 and 2024. Lymph node status and clinicopathologic characteristics were analyzed. The patients were divided into 2 groups according to whether the lymph nodes were cleared or not, and the association between lymph node dissection and postoperative outcomes was evaluated.</div></div><div><h3>Result</h3><div>A total of 351 patients were included, with a male to female ratio of 63:288. Among 109 patients who underwent lymph node dissection, no lymph node metastasis was identified. Tumor location, age at diagnosis, and clinical presentation did not differ between sexes; however, female patients had significantly larger tumors than male patients (5.74 ± 3.46 cm vs 4.57 ± 2.82 cm, <em>P</em> = .013). A total of 182 patients were followed up after surgery, with a 41-month median follow-up time, including 60 patients with lymph node dissection and 122 patients without lymph node dissection. No tumor recurrence or metastasis occurred in either group, and the complication rates were comparable.</div></div><div><h3>Conclusion</h3><div>In the absence of radiologic or intraoperative suspicion of nodal involvement, routine lymph node dissection may be unnecessary in solid pseudopapillary tumor of the pancreas surgery.</div></div>","PeriodicalId":22152,"journal":{"name":"Surgery","volume":"191 ","pages":"Article 110046"},"PeriodicalIF":2.7,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913045","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}