American journal of surgery最新文献

Background: We aim to compare the relative performance of flexible sigmoidoscopy (FS), rectal magnetic resonance imaging (MRI), and their combinations during interim (i) and final (f) analysis to evaluate concordance with complete response (CR) following total neoadjuvant treatment (TNT) in rectal cancer.

Method: Patients who opted TNT and underwent restaging with FS and MRI between 2015 and 2022 were evaluated. Concordance between the assessment methods and CR was analyzed using the weighted-κ test.

Results: A cohort comprising 208 patients revealed CR rate of 42.3 ​%. When evaluating individual methods, fFS alone demonstrated the most heightened sensitivity (68.2 ​%) for CR detection, with a moderate level of concordance (κ ​= ​0.46). Only the combinations of iFS-fFS and fFS-fMRI reached a comparable level of concordance to that achievable by fFS alone.

Conclusion: Among the available diagnostic tools, the combination of final MRI and FS still appears to offer the highest concordance with CR, with relatively higher sensitivity. Additionally, interim MRI may not add significant clinical value and could be omitted.

Background: In 2021, European radiology and gastrointestinal societies updated their guidelines regarding the management of gallbladder polyps (GBP). In 2022, the Society of Radiologists in Ultrasound (SRU) also released their guidelines. We compared the two sets to determine the differences in management and outcomes for GBPs.

Methods: We performed a retrospective analysis from 2018 to 2023 of 118 patients referred for GBPs. Radiologists retrospectively reviewed patient ultrasounds (US) and assigned an SRU category. We applied both sets of guidelines to identify next recommended step and performed a cost analysis.

Results: When applying European versus SRU guidelines, 52.5 ​% (n ​= ​62) versus 16.9 ​% (n ​= ​20) would have undergone immediate surgery (p ​< ​0.0001). US would have been considered a reasonable next step in 28.8 ​% (n ​= ​34) vs 42.4 ​% (n ​= ​50) (p ​= ​0.03). Adherence to SRU guidelines would have resulted in $1837 less spent per person (p ​< ​0.001).

Conclusion: Our findings found that adherence to SRU guidelines leads to less surgeries and follow up compared to European guidelines without causing harm. Further studies should be done to validate these findings and support standardized reporting of GBP.

Introduction: The diagnosis of choledochal cysts in the adult population is complicated by the expected physiologic dilation of the common bile duct after cholecystectomy. We aimed to compare patients who underwent choledochal cyst resection based on cholecystectomy status.

Methods: A retrospective analysis was conducted of patients who underwent choledochal cyst resection between 1/1/1998-12/31/2021. Patients were categorized based on whether they had undergone cholecystectomy prior to choledochal cyst diagnosis. Preoperative imaging characteristics, pathology findings, and outcomes were evaluated.

Results: Amongst 119 patients who underwent excision, 58 (46 ​%) had and 69 (54 ​%) had not undergone prior cholecystectomy. Preoperative imaging demonstrated no difference in biliary tract diameter although a greater proportion of patients with a gallbladder in place had an anomalous pancreaticobiliary junction (55 ​% v 33 ​%, p ​< ​0.05). Biliary malignancy was observed in a greater proportion of patients with prior cholecystectomy although this was not statistically significant (5 ​% v 3 ​%; p ​= ​0.9). Rates of post-operative complications were statistically similar between patient cohorts.

Discussion: Radiographic and clinical features were similar among patients who had and had not undergone cholecystectomy. Choledochal cyst patients should be managed uniformly regardless of cholecystectomy status.

Objective: The optimal level of resident autonomy in emergency colorectal surgery is unclear. This study assessed perioperative outcomes in patients undergoing emergency colectomy with end stoma based on the presence of an attending surgeon.

Participants: A retrospective analysis was conducted at a tertiary teaching hospital, including 360 patients who underwent emergency colectomy with end stoma between 2013 and 2023. The primary outcome was perioperative complications, including mortality.

Results: Of the 360 patients, 36 (10 ​%) had surgery without an attending surgeon present. Baseline characteristics such as age (p ​= ​0.34), Charlson Comorbidity Index (p ​= ​0.313), and sex (p ​= ​0.598) were similar across groups. Perioperative outcomes showed no significant differences in major complications (Clavien-Dindo ≥3, p ​= ​0.176), 90-day complication rate (p ​= ​0.698), or 90-day mortality (p ​= ​0.389). Malignancy-related cases also did not differ in lymph node yield (p ​= ​0.685) or overall survival (log-rank p ​= ​0.574).

Conclusion: In this study, Hartmann resections performed by resident teams were not associated with worse perioperative or oncologic outcomes, suggesting that resident autonomy can be safely increased without compromising patient safety.