Pub Date : 2026-01-01Epub Date: 2024-08-15DOI: 10.1097/SLA.0000000000006504
Andrew P Loehrer, Saania Mirpuri, Oluwadamilola M Fayanju
{"title":"The Pathology of Poverty: Social Conditions Driving Breast Cancer Inequity at the Level of Tumor Biology.","authors":"Andrew P Loehrer, Saania Mirpuri, Oluwadamilola M Fayanju","doi":"10.1097/SLA.0000000000006504","DOIUrl":"10.1097/SLA.0000000000006504","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"e1-e2"},"PeriodicalIF":6.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12264799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141981545","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}
Pub Date : 2026-01-01Epub Date: 2025-06-13DOI: 10.1097/SLA.0000000000006788
Miquell Miller, Rachel Ekaireb, Alexis Woods, Elizabeth Wick, Ankit Sarin
{"title":"Telehealth Policy and Rural-Urban Disparities in Cancer Care Access.","authors":"Miquell Miller, Rachel Ekaireb, Alexis Woods, Elizabeth Wick, Ankit Sarin","doi":"10.1097/SLA.0000000000006788","DOIUrl":"10.1097/SLA.0000000000006788","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"40-42"},"PeriodicalIF":6.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282138","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}
Pub Date : 2025-12-31DOI: 10.1097/SLA.0000000000007003
Kui Chen, Zhihao Li, Bianca O Kirsh, Ping Luo, Stephanie Pedersen, Roxana C Bucur, Nadia A Rukavina, Jeffrey P Bruce, Arnavaz Danesh, Mazdak Riverin, Sandra E Fischer, Mamatha Bhat, Nazia Selzner, Sonya A MacParland, Carol-Anne Moulton, Steven Gallinger, Ian D McGilvray, Mark S Cattral, Markus Selzner, Trevor W Reichman, Chaya Shwaartz, Blayne A Sayed, Sean P Cleary, Gonzalo Sapisochin, Anand Ghanekar, Trevor J Pugh
Objective: To evaluate the utility of cfMeDIP-seq for detecting hepatocellular carcinoma (HCC) and monitoring recurrence following curative-intent liver surgery.
Summary background data: HCC remains a leading cause of cancer mortality, with high recurrence rates after surgery. Current surveillance depends on imaging and tumor-informed genomics, both limited by sensitivity and tissue access. A tumor-agnostic, noninvasive cfDNA-based method could significantly improve clinical management.
Methods: 236 cfDNA samples were collected at surgery (b-HCC, n=89) and follow-up (f-HCC, n=112) from 89 HCC patients undergoing liver transplantation (n=57) or resection (n=32), plus 35 healthy controls (CTL). cfMeDIP-seq was performed followed by machine learning to: (i) develop an HCC-specific classifier in a discovery cohort (52 b-HCC vs. 35 CTL); (ii) test the classifier in a validation cohort of 37 patients; and (iii) assign an HCC methylation score (HMS) reflecting the probability of a sample containing HCC-derived cfDNA. Relationships between HMS and clinical variables were assessed.
Results: The classifier identified HCC with 97% sensitivity and 99% specificity in the discovery cohort and 97% accuracy in the validation cohort. Baseline HMS >0.9 was associated with higher recurrence risk (HR 3.43, 95% CI 1.30-9.06, P=0.013). HMS decreased by 3-44% (median 17%) within 13 weeks post-surgery. HMS trajectories diverged for recurrent and non-recurrent patients, with HMS rise indicating clinical recurrence. HMS was independent of other clinicopathologic variables.
Conclusion: Tumor-agnostic cfDNA methylomes accurately detect HCC and predict recurrence after liver resection or transplantation. This approach may have important implications for HCC diagnosis, treatment, and monitoring.
目的：评价cfMeDIP-seq在肝手术后肝细胞癌（HCC）检测和复发监测中的应用价值。摘要背景资料：HCC仍然是癌症死亡的主要原因，术后复发率高。目前的监测依赖于成像和肿瘤信息基因组学，两者都受到敏感性和组织获取的限制。一种肿瘤不可知、无创的基于cfdna的方法可以显著改善临床管理。方法：从89例接受肝移植（n=57）或肝切除（n=32）的肝癌患者和35例健康对照（CTL）中收集236份cfDNA样本（b-HCC, n=89）和随访（f-HCC, n=112）。cfMeDIP-seq之后进行机器学习，以：(i)在发现队列中开发hcc特异性分类器（52 b-HCC vs 35 CTL）；（ii）在37例患者的验证队列中测试分类器；（iii）分配HCC甲基化评分（HMS），反映样本中含有HCC衍生cfDNA的可能性。评估HMS与临床变量之间的关系。结果：该分类器在发现队列中识别HCC的灵敏度为97%，特异性为99%，在验证队列中准确率为97%。基线HMS >.9与较高的复发风险相关（HR 3.43, 95% CI 1.30-9.06， P=0.013）。术后13周内HMS下降3-44%（中位17%）。复发和非复发患者的HMS轨迹不同，HMS上升表明临床复发。HMS独立于其他临床病理变量。结论：与肿瘤无关的cfDNA甲基组能准确检测HCC并预测肝切除或移植后的复发。这种方法可能对HCC的诊断、治疗和监测具有重要意义。
{"title":"Plasma Cell-free DNA Methylomes for Hepatocellular Carcinoma Detection and Monitoring After Liver Resection or Transplantation.","authors":"Kui Chen, Zhihao Li, Bianca O Kirsh, Ping Luo, Stephanie Pedersen, Roxana C Bucur, Nadia A Rukavina, Jeffrey P Bruce, Arnavaz Danesh, Mazdak Riverin, Sandra E Fischer, Mamatha Bhat, Nazia Selzner, Sonya A MacParland, Carol-Anne Moulton, Steven Gallinger, Ian D McGilvray, Mark S Cattral, Markus Selzner, Trevor W Reichman, Chaya Shwaartz, Blayne A Sayed, Sean P Cleary, Gonzalo Sapisochin, Anand Ghanekar, Trevor J Pugh","doi":"10.1097/SLA.0000000000007003","DOIUrl":"https://doi.org/10.1097/SLA.0000000000007003","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the utility of cfMeDIP-seq for detecting hepatocellular carcinoma (HCC) and monitoring recurrence following curative-intent liver surgery.</p><p><strong>Summary background data: </strong>HCC remains a leading cause of cancer mortality, with high recurrence rates after surgery. Current surveillance depends on imaging and tumor-informed genomics, both limited by sensitivity and tissue access. A tumor-agnostic, noninvasive cfDNA-based method could significantly improve clinical management.</p><p><strong>Methods: </strong>236 cfDNA samples were collected at surgery (b-HCC, n=89) and follow-up (f-HCC, n=112) from 89 HCC patients undergoing liver transplantation (n=57) or resection (n=32), plus 35 healthy controls (CTL). cfMeDIP-seq was performed followed by machine learning to: (i) develop an HCC-specific classifier in a discovery cohort (52 b-HCC vs. 35 CTL); (ii) test the classifier in a validation cohort of 37 patients; and (iii) assign an HCC methylation score (HMS) reflecting the probability of a sample containing HCC-derived cfDNA. Relationships between HMS and clinical variables were assessed.</p><p><strong>Results: </strong>The classifier identified HCC with 97% sensitivity and 99% specificity in the discovery cohort and 97% accuracy in the validation cohort. Baseline HMS >0.9 was associated with higher recurrence risk (HR 3.43, 95% CI 1.30-9.06, P=0.013). HMS decreased by 3-44% (median 17%) within 13 weeks post-surgery. HMS trajectories diverged for recurrent and non-recurrent patients, with HMS rise indicating clinical recurrence. HMS was independent of other clinicopathologic variables.</p><p><strong>Conclusion: </strong>Tumor-agnostic cfDNA methylomes accurately detect HCC and predict recurrence after liver resection or transplantation. This approach may have important implications for HCC diagnosis, treatment, and monitoring.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":""},"PeriodicalIF":6.4,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861793","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}
Pub Date : 2025-12-24DOI: 10.1097/sla.0000000000007007
Rachael Acker,Lisa McElroy,Ginny L Bumgardner,Mary T Hawn,Jeffrey B Matthews,Rachel R Kelz
{"title":"An Entrustable Professional Activity for Research in Surgical Residency Training.","authors":"Rachael Acker,Lisa McElroy,Ginny L Bumgardner,Mary T Hawn,Jeffrey B Matthews,Rachel R Kelz","doi":"10.1097/sla.0000000000007007","DOIUrl":"https://doi.org/10.1097/sla.0000000000007007","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"29 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145813468","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}
Pub Date : 2025-12-24DOI: 10.1097/sla.0000000000006998
Ingmar F Rompen,Joseph R Habib,Alessio Marchetti,Elisabetta Sereni,Jin He,D Brock Hewitt,Greg D Sacks,Katherine Morgan,Ammar A Javed,Christopher L Wolfgang
AIMTo evaluate whether transitional circulating tumor cells (trCTCs) predict systemic recurrence of pancreatic ductal adenocarcinoma (PDAC) and assess their potential role in risk stratification for systemic treatment.BACKGROUNDThe high metastatic potential of PDAC is believed to be associated with early dissemination after cancer cell reprogramming via an epithelial-to-mesenchymal transition. These cells are detectable in circulation as trCTCs and could serve as valuable biomarker capturing systemic disease involvement.METHODSThe prospective CLUSTER trial enrolled patients scheduled for PDAC resection (2016-2018). Pre- and postoperative CTCs were isolated with the Isolation-by-SizE-of-Tumor-Cells device and characterized by immunofluorescence. Cox regression with spline terms assessed associations between preoperative biomarkers and systemic recurrence, while multivariable subgroup analyses with interaction tests evaluated overall survival (OS) stratified by adjuvant chemotherapy.RESULTSIn preoperative samples, trCTCs were detected in 82 (67%) of 123 patients with a median number of two cells per ml (IQR 1-3). A linear association between preoperative trCTC counts and systemic recurrence (χ²=13.2, P=0.004) was observed, but no relevant correlation with CA19-9 levels was found (Pearson correlation=0.05, 95% CI:-0.13-0.23). Furthermore, trCTC-positivity after resection predicts recurrence and is associated with prolonged OS associated with adjuvant therapy (HR 0.21, 95%CI: 0.09-0.49) after adjustment for tumor stage and neoadjuvant chemotherapy.CONCLUSIONSPreoperatively, higher trCTC counts are associated with increased risk of systemic recurrence, while postoperative presence reflects minimal residual disease. Integrating trCTC assessment alongside currently used biomarkers into the clinical pathway for patients with PDAC could enhance risk stratification and support more personalized treatment decisions.
目的评估移行性循环肿瘤细胞（trCTCs）是否能预测胰腺导管腺癌（PDAC）的全身复发，并评估其在全身治疗的风险分层中的潜在作用。背景：PDAC的高转移潜力被认为与癌细胞重编程后通过上皮到间质转化的早期传播有关。这些细胞作为trctc可在循环中检测到，并可作为捕获全身性疾病的有价值的生物标志物。方法前瞻性CLUSTER试验纳入了计划进行PDAC切除术的患者（2016-2018）。用肿瘤细胞大小分离装置分离术前和术后的ctc，并用免疫荧光法对其进行表征。采用样条项的Cox回归评估了术前生物标志物与全身复发之间的关联，而采用相互作用试验的多变量亚组分析评估了辅助化疗分层的总生存期（OS）。结果术前样本中，123例患者中有82例（67%）检测到trCTCs，中位数为2个/ ml （IQR 1-3）。术前trCTC计数与全身复发呈线性相关（χ²=13.2，P=0.004），但与CA19-9水平无相关性（Pearson相关=0.05,95% CI:-0.13-0.23）。此外，在调整肿瘤分期和新辅助化疗后，术后trctc阳性预测复发，并与辅助治疗相关的OS延长相关（HR 0.21, 95%CI: 0.09-0.49）。结论：手术前，较高的trCTC计数与全身复发的风险增加有关，而术后的存在反映了最小的残留疾病。将trCTC评估与目前使用的生物标志物整合到PDAC患者的临床途径中可以增强风险分层并支持更个性化的治疗决策。
{"title":"Transitional Type Circulating Tumor Cells Predict Systemic Recurrence and Support Risk Stratification for Chemotherapy After Resection of Pancreatic Ductal Adenocarcinoma: Long-term Outcomes of the CLUSTER Trial.","authors":"Ingmar F Rompen,Joseph R Habib,Alessio Marchetti,Elisabetta Sereni,Jin He,D Brock Hewitt,Greg D Sacks,Katherine Morgan,Ammar A Javed,Christopher L Wolfgang","doi":"10.1097/sla.0000000000006998","DOIUrl":"https://doi.org/10.1097/sla.0000000000006998","url":null,"abstract":"AIMTo evaluate whether transitional circulating tumor cells (trCTCs) predict systemic recurrence of pancreatic ductal adenocarcinoma (PDAC) and assess their potential role in risk stratification for systemic treatment.BACKGROUNDThe high metastatic potential of PDAC is believed to be associated with early dissemination after cancer cell reprogramming via an epithelial-to-mesenchymal transition. These cells are detectable in circulation as trCTCs and could serve as valuable biomarker capturing systemic disease involvement.METHODSThe prospective CLUSTER trial enrolled patients scheduled for PDAC resection (2016-2018). Pre- and postoperative CTCs were isolated with the Isolation-by-SizE-of-Tumor-Cells device and characterized by immunofluorescence. Cox regression with spline terms assessed associations between preoperative biomarkers and systemic recurrence, while multivariable subgroup analyses with interaction tests evaluated overall survival (OS) stratified by adjuvant chemotherapy.RESULTSIn preoperative samples, trCTCs were detected in 82 (67%) of 123 patients with a median number of two cells per ml (IQR 1-3). A linear association between preoperative trCTC counts and systemic recurrence (χ²=13.2, P=0.004) was observed, but no relevant correlation with CA19-9 levels was found (Pearson correlation=0.05, 95% CI:-0.13-0.23). Furthermore, trCTC-positivity after resection predicts recurrence and is associated with prolonged OS associated with adjuvant therapy (HR 0.21, 95%CI: 0.09-0.49) after adjustment for tumor stage and neoadjuvant chemotherapy.CONCLUSIONSPreoperatively, higher trCTC counts are associated with increased risk of systemic recurrence, while postoperative presence reflects minimal residual disease. Integrating trCTC assessment alongside currently used biomarkers into the clinical pathway for patients with PDAC could enhance risk stratification and support more personalized treatment decisions.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"46 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145813469","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}
Pub Date : 2025-12-22DOI: 10.1097/sla.0000000000007006
Jocelyn L Streid,Annette A Wang,Angela M Bader,Mariah K Tanious
OBJECTIVETo investigate prevalence of unconfirmed code statuses among surgical patients presenting with MOLST forms.BACKGROUNDConfirming code status is critical to preoperative planning for high-risk patients. Patients may present with documented preferences, such as Medical Orders for Life Sustaining Treatment (MOLST) forms. However, some electronic health records (EHR) allow for unconfirmed code status orders, such as "Full Code Presumed" and "No Code Status."METHODSThis study includes patients with preexisting MOLST forms who underwent operating room procedures at a tertiary care center over a one-year period. Chart review was used to measure frequency and duration of unconfirmed code status orders, as well as to extract the circumstances of order placement.RESULTSOf 402 patients meeting inclusion criteria, 92.5% held at least one unconfirmed code status during their encounter. The median total time a patient spent with an unconfirmed order was 48.7 hours (IQR 9.0-122.6). 52.6% of admitted patients were discharged with an unconfirmed code status. Two patients died with the order "full code presumed" in place. 54.3% of patients with unconfirmed code statuses had presented with MOLST forms indicating no CPR and/or no intubation. Patients were most at risk of an unconfirmed code status during admission and on the day of surgery.CONCLUSIONSUse of unconfirmed code status orders was nearly universal in this surgical population, indicating that even patients with preexisting documented preferences are at risk of code status ambiguity in the EHR. To ensure goal-concordant care, interventions must target early code status confirmation for this vulnerable population.
{"title":"Incidence of Unconfirmed Code Status Documentation in Surgical Patients with Preoperative Medical Orders for Life Sustaining Treatment (MOLST).","authors":"Jocelyn L Streid,Annette A Wang,Angela M Bader,Mariah K Tanious","doi":"10.1097/sla.0000000000007006","DOIUrl":"https://doi.org/10.1097/sla.0000000000007006","url":null,"abstract":"OBJECTIVETo investigate prevalence of unconfirmed code statuses among surgical patients presenting with MOLST forms.BACKGROUNDConfirming code status is critical to preoperative planning for high-risk patients. Patients may present with documented preferences, such as Medical Orders for Life Sustaining Treatment (MOLST) forms. However, some electronic health records (EHR) allow for unconfirmed code status orders, such as \"Full Code Presumed\" and \"No Code Status.\"METHODSThis study includes patients with preexisting MOLST forms who underwent operating room procedures at a tertiary care center over a one-year period. Chart review was used to measure frequency and duration of unconfirmed code status orders, as well as to extract the circumstances of order placement.RESULTSOf 402 patients meeting inclusion criteria, 92.5% held at least one unconfirmed code status during their encounter. The median total time a patient spent with an unconfirmed order was 48.7 hours (IQR 9.0-122.6). 52.6% of admitted patients were discharged with an unconfirmed code status. Two patients died with the order \"full code presumed\" in place. 54.3% of patients with unconfirmed code statuses had presented with MOLST forms indicating no CPR and/or no intubation. Patients were most at risk of an unconfirmed code status during admission and on the day of surgery.CONCLUSIONSUse of unconfirmed code status orders was nearly universal in this surgical population, indicating that even patients with preexisting documented preferences are at risk of code status ambiguity in the EHR. To ensure goal-concordant care, interventions must target early code status confirmation for this vulnerable population.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"21 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801331","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}
Pub Date : 2025-12-22DOI: 10.1097/sla.0000000000007004
Cody Lendon Mullens,Samantha L Savitch,Lena M Napolitano,Justin B Dimick,Kyle H Sheetz
{"title":"Uptake of Robotic Appendectomy: A Single State Analysis.","authors":"Cody Lendon Mullens,Samantha L Savitch,Lena M Napolitano,Justin B Dimick,Kyle H Sheetz","doi":"10.1097/sla.0000000000007004","DOIUrl":"https://doi.org/10.1097/sla.0000000000007004","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"66 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801330","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}
Pub Date : 2025-12-22DOI: 10.1097/sla.0000000000007001
Alessandra Borghi,Marco Fiore,Gabriele Tiné,Dirk C Strauss,Sylvie Bonvalot,Chandrajit P Raut,Piotr Rutkowski,Samuel Ford,Carol J Swallow,David E Gyorki,Markus Albertsmeier,Ferdinando Cananzi,Kenneth Cardona,Carolyn Nessim,Valerie Grignol,Elisabetta Pennacchioli,Marko Novak,Shintaro Iwata,Daniela Salvatore,Elena Di Blasi,Michelle Wilkinson,Dimitri Tzanis,Jiping Wang,Jacek Skoczylas,Max Almond,Rebecca A Gladdy,Catherine Mitchell,Andrew Hayes,Sergio Valeri,Rosalba Miceli,Alessandro Gronchi,
OBJECTIVEThis study aimed to prospectively assess the accuracy of preoperative biopsy in primary retroperitoneal sarcoma (RPS) across sarcoma referral centers.SUMMARY BACKGROUND DATAHistological subtype and malignancy grade are key for guiding RPS treatment strategies. However, the accuracy of preoperative biopsy remains uncertain.METHODSData on adult patients with primary localized RPS who underwent preoperative biopsy followed by curative-intent surgery (2017-2020) were collected from the Retroperitoneal Sarcoma Registry. The study aimed to assess concordance between biopsy and surgical specimen histology and grade, using Cohen's kappa statistic. Concordance was also analyzed by center volume (high ≥13 vs. low <13 cases/year).RESULTSOf 894 enrolled patients, histologic concordance was observed in 87.7% of cases (unweighted κ=0.814; 95% CI, 0.773-0.854). Among 172 tumors initially diagnosed as well-differentiated liposarcomas, 44 (25.6%) were reclassified as dedifferentiated liposarcomas. Grade concordance was observed in 232 of 346 cases (76.1%; weighted κ=0.652; 95% CI, 0.589-0.715), with no difference between computed tomography- and ultrasound-guided biopsies. Concordance by tumor grade was 98.9% (grade 1), 62.1% (grade 2), and 40.2% (grade 3). In dedifferentiated liposarcomas, grade concordance was 59.7% (weighted κ=0.385; 95% CI, 0.292-0.479). High-volume centers showed higher concordance for both histology (κ=0.780) and grade (κ=0.680) compared with low-volume centers (κ=0.622 and 0.564, respectively).CONCLUSIONSWhile preoperative biopsy for RPS provides satisfactory histologic accuracy, tumor grade is frequently underestimated. This diagnostic inaccuracy may impact treatment decisions, particularly regarding preoperative therapies. Incorporating additional diagnostic factors may improve the accuracy of preoperative assessment.
{"title":"Accuracy of Histology and Malignancy Grade between Preoperative Biopsy and Surgical Specimens in Primary Retroperitoneal Sarcoma. A Study from the Prospective Retroperitoneal Sarcoma Registry (Resar).","authors":"Alessandra Borghi,Marco Fiore,Gabriele Tiné,Dirk C Strauss,Sylvie Bonvalot,Chandrajit P Raut,Piotr Rutkowski,Samuel Ford,Carol J Swallow,David E Gyorki,Markus Albertsmeier,Ferdinando Cananzi,Kenneth Cardona,Carolyn Nessim,Valerie Grignol,Elisabetta Pennacchioli,Marko Novak,Shintaro Iwata,Daniela Salvatore,Elena Di Blasi,Michelle Wilkinson,Dimitri Tzanis,Jiping Wang,Jacek Skoczylas,Max Almond,Rebecca A Gladdy,Catherine Mitchell,Andrew Hayes,Sergio Valeri,Rosalba Miceli,Alessandro Gronchi, ","doi":"10.1097/sla.0000000000007001","DOIUrl":"https://doi.org/10.1097/sla.0000000000007001","url":null,"abstract":"OBJECTIVEThis study aimed to prospectively assess the accuracy of preoperative biopsy in primary retroperitoneal sarcoma (RPS) across sarcoma referral centers.SUMMARY BACKGROUND DATAHistological subtype and malignancy grade are key for guiding RPS treatment strategies. However, the accuracy of preoperative biopsy remains uncertain.METHODSData on adult patients with primary localized RPS who underwent preoperative biopsy followed by curative-intent surgery (2017-2020) were collected from the Retroperitoneal Sarcoma Registry. The study aimed to assess concordance between biopsy and surgical specimen histology and grade, using Cohen's kappa statistic. Concordance was also analyzed by center volume (high ≥13 vs. low <13 cases/year).RESULTSOf 894 enrolled patients, histologic concordance was observed in 87.7% of cases (unweighted κ=0.814; 95% CI, 0.773-0.854). Among 172 tumors initially diagnosed as well-differentiated liposarcomas, 44 (25.6%) were reclassified as dedifferentiated liposarcomas. Grade concordance was observed in 232 of 346 cases (76.1%; weighted κ=0.652; 95% CI, 0.589-0.715), with no difference between computed tomography- and ultrasound-guided biopsies. Concordance by tumor grade was 98.9% (grade 1), 62.1% (grade 2), and 40.2% (grade 3). In dedifferentiated liposarcomas, grade concordance was 59.7% (weighted κ=0.385; 95% CI, 0.292-0.479). High-volume centers showed higher concordance for both histology (κ=0.780) and grade (κ=0.680) compared with low-volume centers (κ=0.622 and 0.564, respectively).CONCLUSIONSWhile preoperative biopsy for RPS provides satisfactory histologic accuracy, tumor grade is frequently underestimated. This diagnostic inaccuracy may impact treatment decisions, particularly regarding preoperative therapies. Incorporating additional diagnostic factors may improve the accuracy of preoperative assessment.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"36 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801328","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}
Pub Date : 2025-12-22DOI: 10.1097/sla.0000000000007005
Sarah Sheskey,Wei San Loh,Kyle H Sheetz
{"title":"Expanding Landscape of Payments from Robotic Surgical Companies to U.S. Providers and Hospitals.","authors":"Sarah Sheskey,Wei San Loh,Kyle H Sheetz","doi":"10.1097/sla.0000000000007005","DOIUrl":"https://doi.org/10.1097/sla.0000000000007005","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"3 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801329","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}
Pub Date : 2025-12-19DOI: 10.1097/sla.0000000000006999
Dong G Hur,Syed M Hameed,Jeff Choi
OBJECTIVECompare trauma activation fees (TAFs) between for-profit and nonprofit trauma centers within granular geographic clusters, accounting for regional market competition and socioeconomic factors.BACKGROUNDTAFs remain unregulated, and evidence suggests higher fees among for-profit centers. Evaluating whether these differences are justified requires examining trauma centers within geographic clusters alongside market and socioeconomic characteristics.METHODSThis cross-sectional study analyzed TAFs at American College of Surgeons Committee-on-Trauma-verified level 1-3 trauma centers. Clusters were identified using hierarchical density-based spatial clustering. We obtained market competition and socioeconomic data of residents within one-hour driving distance. Mixed-effects regression assessed associations between TAFs and ownership status.RESULTSAmong 55 clusters of trauma centers (N=546), 26 included both for-profit and nonprofit centers. Within these, median (IQR) tier 1 TAFs were higher in for-profit centers ($29,000[20,000-38,000] vs. $11,000[7,800-15,000]; P<0.001). Residents near for-profit centers had greater socioeconomic disadvantage (Area-Deprivation-Index: 42.3[27.3] vs. 33.9[28.0], SMD=-0.30) and higher exposure to concentrated markets (Herfindahl-Hirschman Index >2500: 29.4% vs. 14.9%, SMD= 0.56). We found no significant association between TAFs and for-profit status alone (β=870[-2,830-4,580]; P=0.64), but a significant interaction between for-profit status and level 1/2 centers (β=15,300[15,100-15,600]; P<0.001).CONCLUSIONAmong level 1/2 trauma centers, for-profit status was associated with higher TAFs after accounting for clustering, socioeconomic, and market factors. Negotiated payor fees or cash prices remain unclear, yet higher TAFs among for-profit centers warrant further investigation. Until the drivers of TAF differences are clarified, higher fees at for-profit centers and the need for regulation warrant further investigation.
{"title":"Trauma Activation Fees Among For-profit and Nonprofit Trauma Centers: Hierarchical Spatial Clustering Analysis of Regional Market Competition, and Socioeconomic Characteristics of Neighboring Residents.","authors":"Dong G Hur,Syed M Hameed,Jeff Choi","doi":"10.1097/sla.0000000000006999","DOIUrl":"https://doi.org/10.1097/sla.0000000000006999","url":null,"abstract":"OBJECTIVECompare trauma activation fees (TAFs) between for-profit and nonprofit trauma centers within granular geographic clusters, accounting for regional market competition and socioeconomic factors.BACKGROUNDTAFs remain unregulated, and evidence suggests higher fees among for-profit centers. Evaluating whether these differences are justified requires examining trauma centers within geographic clusters alongside market and socioeconomic characteristics.METHODSThis cross-sectional study analyzed TAFs at American College of Surgeons Committee-on-Trauma-verified level 1-3 trauma centers. Clusters were identified using hierarchical density-based spatial clustering. We obtained market competition and socioeconomic data of residents within one-hour driving distance. Mixed-effects regression assessed associations between TAFs and ownership status.RESULTSAmong 55 clusters of trauma centers (N=546), 26 included both for-profit and nonprofit centers. Within these, median (IQR) tier 1 TAFs were higher in for-profit centers ($29,000[20,000-38,000] vs. $11,000[7,800-15,000]; P<0.001). Residents near for-profit centers had greater socioeconomic disadvantage (Area-Deprivation-Index: 42.3[27.3] vs. 33.9[28.0], SMD=-0.30) and higher exposure to concentrated markets (Herfindahl-Hirschman Index >2500: 29.4% vs. 14.9%, SMD= 0.56). We found no significant association between TAFs and for-profit status alone (β=870[-2,830-4,580]; P=0.64), but a significant interaction between for-profit status and level 1/2 centers (β=15,300[15,100-15,600]; P<0.001).CONCLUSIONAmong level 1/2 trauma centers, for-profit status was associated with higher TAFs after accounting for clustering, socioeconomic, and market factors. Negotiated payor fees or cash prices remain unclear, yet higher TAFs among for-profit centers warrant further investigation. Until the drivers of TAF differences are clarified, higher fees at for-profit centers and the need for regulation warrant further investigation.","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"20 1","pages":""},"PeriodicalIF":9.0,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145777495","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}
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