Annals of surgery最新文献

Objective: To evaluate the outcomes of a multidisciplinary effort involving surgical and gastroenterological departments in managing bowel dysfunction, specifically low anterior resection syndrome (LARS), following rectal cancer treatment.

Summary background data: An increasing number of rectal cancer survivors experience LARS, heightening the need for specialized treatment.

Methods: Patients referred to our late sequelae clinics with LARS following sphincter-preserving treatment were eligible for inclusion. Patients were treated in the surgical or gastroenterological units or both based on symptoms. Patients completed patient-reported outcome measures at the first visit, upon discharge, and 12 months after discharge. Treatment outcomes were evaluated by the LARS score and its five single items, six single items covering additional LARS symptoms, the EuroQoL 5-dimension 5-level (EQ-5D-5L) VAS and utility scores, self-rated bowel function, and bowel function impact on quality of life (QoL).

Results: We included 201 patients. Three-quarters were treated in the surgical units, whereas the rest required gastroenterological treatment. After treatment, the mean LARS score decreased by 4.7 points (P<0.001), whereas the mean EQ-VAS and utility score increased by 7.1 (P<0.001) and 0.06 points (P<0.001), respectively. All individual symptoms significantly improved. Improvement in self-rated bowel function and bowel function impact on QoL were 55.8% (P<0.001) and 45.7% (P<0.001), respectively. Similar results were recorded at the 12-month follow-up.

Conclusion: These results encourage establishing late sequelae clinics with a joint gastroenterological and surgical approach to treat LARS following rectal cancer treatment.

Objective: To evaluate the long-term outcomes of laparoscopic pylorus-preserving gastrectomy (LPPG) with laparoscopic distal gastrectomy (LDG) for early gastric cancer.

Background: Pylorus-preserving gastrectomy is considered a function-preserving surgery for early gastric cancer. However, there has been no multicenter randomized controlled trial comparing pylorus-preserving gastrectomy with distal gastrectomy until now.

Methods: A multicenter randomized controlled trial (KLASS-04) with 256 patients with cT1N0M0 gastric cancer located in the mid portion of the stomach was conducted. The primary endpoint was the incidence of dumping syndrome at postoperative 1 year. Secondary endpoints included survival and recurrence, gallstone formation, nutritional parameters, gastroscopic findings, and quality of life for 3 years.

Results: In the intention-to-treat analyses, there was no difference in the incidence of dumping syndrome at 1 year postoperatively (13.2% in LPPG vs 15.8% in LDG, P = 0.622). Gallstone formation after surgery was significantly lower in LPPG than in LDG (2.33% vs 8.66%, P = 0.026). Hemoglobin (+0.01 vs -0.76 gm/dL, P < 0.001) and serum protein (-0.15 vs -0.35 gm/dL, P = 0.002) were significantly preserved after LPPG. However, reflux esophagitis (17.8% vs 6.3%, P = 0.005) and grade IV delayed gastric emptying (16.3% vs 3.9%, P = 0.001) were more common in LPPG. Changes in body weight and postoperative quality of life were not significantly different between groups. Three-year overall survival and disease-free survival were not different (1 case of recurrence in each group, P = 0.98).

Conclusions: LPPG can be used as an alternative surgical option for cT1N0M0 gastric cancer in the mid portion of the stomach.

Objective: The primary objective was to compare the rates of early allograft dysfunction (EAD) in patients undergoing elective adult live donor liver transplantation (ALDLT) with and without graft portal inflow modulation (GIM) for portal hyperperfusion. The secondary objectives were to compare time to normalization of bilirubin and International Normalized Ratio, day 14 ascitic output more than 1 L, small-for-size syndrome, intensive care unit/high dependency unit and total hospital stay, and 90-day morbidity and mortality.

Background: GIM can prevent EAD in ALDLT patients with portal hyperperfusion.

Methods: A single-center randomized trial with and without GIM for portal hyperperfusion by splenic artery ligation (SAL) in ALDLT was performed. After reperfusion, patients with portal venous pressure (PVP)>15 mm Hg with a gradient (PVP-central venous pressure) of ≥7 mm Hg and/or portal venous flow (PVF) >250 mL/min/100 g of liver were randomized into 2 groups: GIM and No GIM.

Results: 75 of 209 patients satisfied the inclusion criteria, and 38 underwent GIM. Baseline PVF and PVP were comparable between the GIM and no GIM groups. SAL significantly reduced the PVF and PVP ( P <0.001). There were no significant differences in the primary and secondary outcomes between the 2 groups. In the subgroup analysis, with a Graft to Recipient Weight Ratio ≤0.8, there were no significant differences in the primary and secondary outcomes.

Conclusions: SAL significantly decreased PVP and PVF but did not decrease rates of EAD in adult LDLT.

Objective: To investigate the impact of carotid interventions on the mental well-being of patients with carotid stenosis.

Background: Ongoing research highlights the effect of carotid interventions on neurocognitive function in patients with advanced carotid atherosclerosis. However, data regarding the impact of carotid revascularization on mood are scarce.

Methods: A total of 157 patients undergoing carotid revascularization were prospectively recruited. The primary outcome was depressive mood, evaluated preoperatively and at 1-, 6-, and 12-month postintervention using the long form of the geriatric depression scale (GDS-30) questionnaire. Other tests were also used to assess cognition at the respective timepoints. Statistical analyses were performed to assess the postoperative outcomes compared with baseline.

Results: Baseline depression (GDS>9) was observed in 49 (31%) subjects, whereas 108 (69%) patients were not depressed (GDS≤9). The average preoperative GDS score was 15.42 ± 4.40 (14.2-16.7) and 4.28 ±2.9 (3.7-4.8) in the depressed and nondepressed groups, respectively. We observed a significant improvement in GDS scores within the depressed group at 1 month ( P =0.002), 6 months ( P =0.027), and 1 year ( P <0.001) postintervention compared with pre-op, whereas the nondepressed group had similar post-op GDS scores at all timepoints compared with baseline. Significant improvement in measures of executive function was seen in nondepressed patients at all 3 timepoints, whereas depressed patients showed an improvement at 1-year follow-up.

Conclusions: Our study highlights improvement in mood among patients with advanced carotid disease who screened positive for depression at baseline. Further studies with larger sample sizes are warranted to investigate the association between depression, carotid disease, and carotid intervention.

Objective: To review the evidence on mindfulness-based interventions (MBIs) for surgeons.

Background: Health care professionals have alarmingly high rates of burnout, yet little is known about psychological factors that support resilience. MBIs, which involve codified training in specific skills such as self-awareness, emotional regulation, and perspective-taking, have shown benefit to professionals in high-stress environments but have had limited implementation in the health care workplace and in surgery. To our knowledge, there has not been a scoping review of MBIs in surgery to date.

Methods: We conducted a scoping review of the evidence for the feasibility and effectiveness of MBIs for surgeons, including evidence on interventions that explicitly train mindfulness, which spans multiple cohorts and settings, utilizing different methodologies and outcome measures.

Results: This scoping review yielded 24 studies, including 2 mixed method/qualitative studies, 9 randomized control trials, 3 nonrandomized interventional studies, and 8 single-arm interventional studies.

Conclusions: We find that MBIs in surgery (1) are feasible in surgical contexts, with implementation science providing insights on sustainability; (2) increase mindfulness, (3) improve well-being in terms of burnout and both psychological and neurophysiological measures of stress, and (4) enhance performance as measured in executive function, surgical skills, and communication skills. These conclusions are supported by psychometric measures, observations of technical skills, and neurophysiological evidence. Future directions include studying MBIs in larger and more diverse populations and iteratively tailoring mindfulness-based interventions to other health care contexts.

Objective: Improvement of surgical care is dependent upon evidence-based practices (EBPs), policies, procedures, and innovations. The objective of this study was to understand and synthesize the use of implementation science (IS) in surgical care.

Background: This article summarizes the existing literature to identify the frequency and types of EBPs selected for surgical care, IS frameworks that guided the published research, and prominent facilitators and barriers.

Methods: A modified version of the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews Checklist were used to provide the guidance and standards to conduct this scoping review. We queried Ovid MEDLINE, American Psychological Association PsycINFO, Embase, Cumulated Index to Nursing and Allied Health Literature, Web of Science, and Google Scholar for manuscripts published January 2001-June 2023.

Results: The initial search found 3674 citations, of which 129 met the inclusion criteria. The heterogeneity and volume of innovations within the surgical IS field were vast. The most frequent innovations were in perioperative care, safety in surgery, and Enhanced Recovery After Surgery. Six constructs were identified as both major facilitators and barriers: support from leadership, surgeon and staff knowledge regarding EBPs, relationship/team building, environmental context, data, and resources.

Conclusion: Identifying these implementation factors used in the surgical field enables us to determine variables that support and inhibit the adoption and implementation of new practices, support practice change, enhance quality and equity of surgical care, and identify research gaps for future IS in surgical care.