Annals of surgery最新文献_第5页

A Phase III Randomized Controlled Trial of Pyloroplasty versus No Pyloroplasty in Patients Undergoing Minimally Invasive Esophagectomy or Robot-Assisted Minimally Invasive Esophagectomy. 微创食管切除术或机器人辅助微创食管切除术患者幽门成形术与非幽门成形术的III期随机对照试验

IF 9 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-19 DOI: 10.1097/sla.0000000000006997

James Luketich,Inderpal Sarkaria,Ryan Levy,Evan Alicuben,William E Gooding,Peter Davis,Omar Awais,Neil Christie,Renee Levesque,Julie Ward,John Ryan,Matthew Schuchert,Arjun Pennathur,

OBJECTIVETo assess the value of adding of a pyloroplasty procedure during the performance of minimally invasive esophagectomy (MIE) or robotically assisted MIE (RAMIE), we conducted a prospective, phase III randomized controlled trial (RCT)(NCT03740542).BACKGROUNDMany surgeons include pyloroplasty when performing esophagectomy, but few studies have provided level 1 evidence to support or refute this step especially in the era of MIE and RAMIE.METHODSAn adaptive randomization trial design was utilized to maximize patients treated on more effective therapy and conversely minimize accrual to a less effective procedure. The trial was designed to proceed until one arm was established as superior or until a total of 140 patients had been treated and deemed evaluable for response. The primary endpoints of the study were pneumonia and/or anastomotic leak requiring surgery within 30 days of surgery.RESULTSOver a 4-year period, 143 patients were randomized, and 134 patients were evaluable. The greater likelihood of success for pyloroplasty throughout the trial resulted in more patients randomized towards pyloroplasty (n= 90) vs. no pyloroplasty (n=44). Pneumonia or an anastomotic leak occurred in 16 of 90 (18%) patients in the pyloroplasty arm vs. 12 of 44 (27%) in the no-pyloroplasty arm. The stopping criteria were met when the posterior probability of pyloroplasty being superior reached 90%.CONCLUSIONSThe design of this trial led to early stopping because the short-term results indicated that outcomes in the pyloroplasty arm were superior to the no-pyloroplasty arm. This RCT provides evidence for short-term benefits of adding pyloroplasty to MIE or RAMIE. The long-term outcomes and quality of life measures continue to be monitored.

为了评估在微创食管切除术（MIE）或机器人辅助食管切除术（RAMIE）中添加幽门成形术的价值，我们进行了一项前瞻性III期随机对照试验（RCT）（NCT03740542）。背景：许多外科医生在进行食管切除术时包括幽门成形术，但很少有研究提供1级证据来支持或反驳这一步骤，特别是在MIE和RAMIE时代。方法采用自适应随机化试验设计，最大限度地使患者接受更有效的治疗，相反，最大限度地减少无效治疗的累积。试验的目的是继续进行，直到一个组被确定为优越，或者直到总共140名患者接受治疗并被认为可评估反应。该研究的主要终点是肺炎和/或手术后30天内需要手术的吻合口漏。结果在4年的时间里，143例患者被随机分组，134例患者可评估。在整个试验过程中，幽门成形术成功的可能性更大，导致更多的患者随机选择幽门成形术（n= 90）而不是没有幽门成形术（n=44）。幽门成形术组90例患者中有16例（18%）发生肺炎或吻合口漏，而非幽门成形术组44例患者中有12例（27%）发生肺炎或吻合口漏。当幽门成形术的后验概率达到90%时，符合停止标准。结论：该试验的设计导致早期停止，因为短期结果表明幽门成形术组的结果优于未幽门成形术组。这项随机对照试验提供了在MIE或RAMIE中增加幽门成形术的短期益处的证据。继续监测长期结果和生活质量指标。

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引用次数: 0

Long-Term (>10 Years) Outcomes of Laparoscopic Nissen Fundoplication: A Systematic Review and Meta-Analysis. 腹腔镜尼森基金会应用的长期（bbb10年）结果：系统回顾和荟萃分析。

IF 9 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-18 DOI: 10.1097/sla.0000000000007000

Josefina Principe,Cristian A Angeramo,José Barros Sosa,Juan J Baz Gallego,Fernando A M Herbella,Marco G Patti,Francisco Schlottmann

OBJECTIVEThe aim of this meta-analysis was to evaluate long-term outcomes and patient-reported satisfaction after LNF.SUMMARY BACKGROUND DATALaparoscopic Nissen fundoplication (LNF) has demonstrated short- and mid-term symptom relief in patients with gastroesophageal reflux disease (GERD). However, long-term outcomes have not been clearly defined.METHODSA systematic PubMed search identified studies of LNF for GERD with ≥10-year follow-up. The main outcome was effectiveness of the operation, which was determined by symptomatic improvement, esophagitis improvement, and proton-pump inhibitors (PPIs) use. Secondary endpoints included adverse events, patient satisfaction and willingness to undergo LNF again. A meta-analysis of proportions was performed to calculate weighted pooled estimates with 95% confidence intervals, and paired t-tests compared pre- and postoperative symptoms.RESULTSA total of 12 studies comprising 1,334 patients were analyzed. The mean follow-up across studies was 13.1 (10-22) years. The presence of heartburn decreased from 94.2% to 33.7% (P<0.001), regurgitation from 68.7% to 13.4% (P=0.02), and esophagitis from 61.7% to 7.4% (P=0.001). The weighted pooled proportion of symptom recurrence was 17% (95% CI, 5%-47%). Postoperative PPIs use was reported in 24% (95% CI, 14%-38%) of patients. Gas-bloating and dysphagia occurred in 53% (95% CI, 20%-83%) and 26% (95% CI, 18%-37%) of patients. Overall patient satisfaction was 87% (95% CI, 81%-92%), and 87% of patients (95% CI, 82%-90%) reported willingness to undergo LNF again. The proportion of patients requiring reoperation was 6% (95% CI, 3%-9%).CONCLUSIONSLNF provides durable long-term improvement of GERD symptoms. Although postoperative gas-bloating and dysphagia are frequent, long-term patients' satisfaction is high.

目的本荟萃分析的目的是评估LNF后的长期结果和患者报告的满意度。腹腔镜尼森底扩术（LNF）已证明可缓解胃食管反流病（GERD）患者的短期和中期症状。然而，长期结果尚未明确界定。方法在PubMed上进行系统检索，确定了LNF治疗GERD的研究，随访≥10年。主要结果是手术的有效性，这是由症状改善、食管炎改善和质子泵抑制剂（PPIs）的使用决定的。次要终点包括不良事件、患者满意度和再次接受LNF的意愿。对比例进行荟萃分析，以95%置信区间计算加权汇总估计值，配对t检验比较术前和术后症状。结果共纳入12项研究，1334例患者。这些研究的平均随访时间为13.1年（10-22年）。胃灼热从94.2%降至33.7% (P<0.001)，反流从68.7%降至13.4% (P=0.02)，食管炎从61.7%降至7.4% （P=0.001）。加权合并症状复发率为17% （95% CI, 5%-47%）。24% （95% CI, 14%-38%）的患者术后使用PPIs。53% （95% CI, 20%-83%）和26% （95% CI, 18%-37%）的患者发生气胀和吞咽困难。总体患者满意度为87% (95% CI, 81%-92%)， 87%的患者（95% CI, 82%-90%）报告愿意再次接受LNF。需要再手术的患者比例为6% （95% CI, 3%-9%）。结论slnf对胃反流症状有持久、长期的改善作用。术后虽常有气胀、吞咽困难，但患者长期满意度高。

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引用次数: 0

Construct Validity and Reliability of the Comprehensive Complication Index as a Morbidity Outcome Measure in Pancreatic Surgery. 构建综合并发症指数作为胰腺手术发病率结局指标的效度和信度。

IF 9 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-17 DOI: 10.1097/sla.0000000000007002

Nicolò Pecorelli,Francesca Fermi,Fariba Abbassi,Elisa Bannone,Giovanni Capretti,Elena Desiato,Gabriele Di Lucca,Greta Donisi,Alessandro Fogliati,Isabella Frigerio,Giovanni Guarneri,Federico Gronchi,Katharina L Lucas,Salvatore Paiella,Michaela Ramser,Marta Sandini,Alessia Vallorani,Giovanni Butturini,Luca Gianotti,Roberto Salvia,Alessandro Zerbi,Julio F Fiore,Pierre-Alain Clavien,Massimo Falconi

OBJECTIVETo assess the reliability and construct validity of the CCI®️ following pancreatic surgery.SUMMARY BACKGROUND DATAThe Comprehensive Complication Index (CCI®️) is the only validated metric that quantifies cumulative morbidity, with a continuous score ranging from 0 (no complications) to 100 (death).METHODSTo address construct validity, we assessed patients undergoing elective pancreatic surgery for any disease at five Italian centers enrolled in a randomized controlled trial (NCT04438447) and a prospective cohort study (NCT04431076). The severity of 90-day complications was assessed using the CCI®️. We tested 10 a priori construct validity hypotheses through linear regression. Regression coefficients represented the between-group mean difference in CCI®️, with an effect size ≥0.2 considered potentially meaningful. Validity was deemed adequate if >75% of the hypotheses were supported. To address reliability, three independent raters among six centers assessed the CCI®️ from 100 anonymous case vignettes to evaluate inter-rater and inter-center reliability through intraclass correlation coefficient (ICC) and standard error of measurement (SEM).RESULTS797 patients were included (66±11 y, 50% female, 60% malignancy). The construct validity was supported by data, with 9/10 a priori hypotheses confirmed (90%). The CCI®️ showed excellent inter-rater (ICC=0.96, 95%CI: 0.95-0.97), high inter-center reliability (ICC >0.75 in each center), with a SEM ranging from 2.73 to 6.38.CONCLUSIONSThis study supports CCI®️as a valid and reliable measure of morbidity after pancreatic surgery, supporting its use in both clinical practice and comparative effectiveness research.

目的评价胰腺手术后CCI®️的信度和结构效度。综合并发症指数（CCI®️）是唯一经过验证的量化累积发病率的指标，其连续评分范围从0（无并发症）到100（死亡）。方法：为了解决结构效度问题，我们评估了意大利5个中心的随机对照试验（NCT04438447）和前瞻性队列研究（NCT04431076）中接受选择性胰腺手术的任何疾病患者。使用CCI®️评估90天并发症的严重程度。我们通过线性回归检验了10个先验构造效度假设。回归系数表示CCI®️组间平均差异，效应值≥0.2被认为具有潜在意义。如果有75%的假设得到支持，则认为有效性是足够的。为了解决可靠性问题，六个中心中的三个独立评分者评估了CCI®️，从100个匿名案例中评估了评级者和中心间的可靠性，通过类内相关系数（ICC）和测量标准误差（SEM）来评估评级者和中心间的可靠性。结果共纳入797例患者（66±11岁，女性50%，恶性肿瘤60%）。结构效度得到数据支持，9/10的先验假设得到证实（90%）。CCI®️具有良好的中心间信度（ICC=0.96, 95%CI: 0.95-0.97），较高的中心间信度（每个中心的ICC >0.75）， SEM范围为2.73 ~ 6.38。结论：本研究支持CCI®️作为胰腺手术后发病率的有效和可靠的衡量指标，支持其在临床实践和比较有效性研究中的应用。

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引用次数: 0

Elucidating the Optimal Use of Mitigation Strategies for Improving Pancreatic Fistula Rates after Pancreatoduodenectomy. 阐明改善胰十二指肠切除术后胰瘘发生率的最佳缓解策略。

IF 9 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-12 DOI: 10.1097/sla.0000000000006995

Max M Judish,Charles M Vollmer,

OBJECTIVETo identify optimal approaches to fistula mitigation for pancreatoduodenectomy.BACKGROUNDPostoperative Pancreatic Fistula (POPF) is the most consequential complication following pancreatoduodenectomy (PD). To date, the various POPF prevention methods have been investigated predominantly in isolation; however, the complexity of PD demands studying the interplay between approaches.METHODS7128 PDs with complete POPF, Fistula Risk Score (FRS), and mitigation data were performed from 2000-2024 between 18 international institutions. Techniques analyzed were: drains, stents, octreotide, pancreatogastrostomy, and sealants. POPF was tabulated for strategy combinations, accounting for FRS. The additive effect of early drain removal (EDR; POD≤4) was assessed.RESULTSThe fistula rate was 15.1%. Mitigation application rates were drains=94.0%; stents=37.4%; octreotide=21.2%; pancreatogastrostomy=3.5%; and sealants=3.3%. Analyzed individually, drains were not associated with POPF, while stents, octreotide, pancreatogastrostomy, and sealants were associated with increased POPF. Risk adjustment revealed nuance among the 27 observed mitigation combinations. For Negligible and Low FRS patients, no approach improved upon omission. Drain-alone was best for Moderate FRS patients (POPF: 13.1% vs. 19.8%, P<0.001). Best outcomes for High FRS patients were achieved by employing Drain+Stent (23.7% vs. 38.5%, P<0.001). These results inform a "playbook" of optimal management. Increased adherence to these tenets was associated with improved surgeon practice-level fistula rates (P=0.034). Universal adoption of optimal fistula mitigation projects to eliminate from one-third of fistulas, up to one-half when incorporating EDR.CONCLUSIONThis robust experience indicates that many frequently employed fistula mitigation tactics are actually ineffective. Conversely, the optimal approaches identified herein are underutilized-in just 32% of patients. Simplified, tailored application can drive down stubborn fistula rates, enhance care, and move toward personalized medicine for fistula prevention.

目的探讨胰十二指肠切除术中减少瘘管的最佳方法。背景术后胰瘘（POPF）是胰十二指肠切除术（PD）后最严重的并发症。迄今为止，主要在隔离情况下研究了各种预防POPF的方法；然而，PD的复杂性要求研究各种方法之间的相互作用。方法从2000年至2024年，在18个国际机构中进行了7128例具有完整的POPF、瘘风险评分（FRS）和缓解数据的pd。分析的技术包括：引流管、支架、奥曲肽、胰胃造口术和密封剂。将策略组合的POPF制成表格，计入FRS，评估早期引流去除的加性效应（EDR, POD≤4）。结果瘘管发生率为15.1%。缓释施用率为排水沟=94.0%；支架= 37.4%;octreotide = 21.2%;pancreatogastrostomy = 3.5%;和密封剂= 3.3%。单独分析，引流管与POPF无关，而支架、奥曲肽、胰胃造口术和密封剂与POPF增加相关。风险调整揭示了27种观察到的缓解组合之间的细微差别。对于可忽略和低FRS患者，没有任何方法在遗漏后得到改善。单独引流对中度FRS患者最好（POPF: 13.1% vs. 19.8%， P<0.001）。采用引流+支架治疗高FRS患者效果最佳（23.7% vs 38.5%， P<0.001）。这些结果为最佳管理提供了“剧本”。加强对这些原则的遵守与外科医生实践水平瘘发生率的提高相关（P=0.034）。普遍采用最佳的瘘管缓解项目，将瘘管从三分之一减少到二分之一，如果纳入电子药物治疗。结论：这一强有力的经验表明，许多常用的瘘缓解策略实际上是无效的。相反，本文确定的最佳方法未得到充分利用，只有32%的患者未得到充分利用。简化，量身定制的应用可以降低顽固瘘管率，加强护理，并朝着个性化医疗瘘管预防。

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引用次数: 0

Rare and Tricky: The Relationship Between Hospital Trauma Volume and Delay in Surgical Intervention in Blunt Intestinal Injury. 罕见而棘手：钝性肠损伤的医院创伤量与手术干预延迟的关系。

IF 9 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-11 DOI: 10.1097/sla.0000000000006993

Yasmin Arda,Vahe S Panossian,Ikemsinachi C Nzenwa,John O Hwabejire,Michael P DeWane,Charudutt N Paranjape,Joshua S Ng-Kamstra,Jonathan Parks,Katherine Albutt,George C Velmahos,Haytham M A Kaafarani

OBJECTIVEThis study aimed to evaluate the impact of hospital blunt intestinal injury (BInI) trauma volume on time to surgery in patients with BInI.SUMMARY OF BACKGROUND DATAThe diagnosis of BInI is challenging, even for trauma experts, leading to frequent delays in necessary surgical intervention.METHODSThe 2017-2020 ACS-TQIP database was used to identify patients ≥18 years with full-thickness ileal, jejunal, or colonic perforation secondary to blunt trauma. Hospitals were stratified by the annual volume of BInI. Multivariable logistic regression adjusting for demographics, comorbidities, and injury characteristics/severity was used to study the impact of hospital trauma volume on delayed surgery (>24 hours) and outcomes (e.g. mortality, sepsis). Sensitivity analyses were performed classifying hospitals by their volume of (1) blunt trauma and (2) all trauma admissions.RESULTSOut of a total of 4,005,762 trauma patients, 3,954 were included: 1,397 (35.3%) in low BInI volume, 1,373 (34.7%) in medium BInI volume, and 1,184 (30%) in high BInI volume hospitals. The mean time to surgery was 18±46 hours in low-volume compared to 15±45 hours in high-volume hospitals (P<0.001). On multivariable analysis, high BInI volume was independently associated with early surgery (aOR for delayed surgery 0.68, 95% CI 0.53-0.88) and a 42% lower risk of post-injury sepsis (aOR 0.58, 95% CI 0.37-0.91) compared to low BInI volume. High blunt trauma and all trauma hospital volumes were similarly associated with early surgery (aOR 0.65, 95% CI 0.51-0.84; aOR 0.66, 95% CI 0.51-0.85, respectively).CONCLUSIONSHigh trauma hospital volume is independently associated with prompt surgical intervention and improved outcomes in patients with BInI. These findings highlight the importance of clinical trauma experience and available resources for trauma care in early diagnosis and management of the rare and tricky intestinal injuries.

目的探讨医院钝性肠损伤（BInI）外伤量对BInI患者手术时间的影响。背景数据总结：即使对创伤专家来说，BInI的诊断也是具有挑战性的，导致必要的手术干预经常延迟。方法2017-2020 ACS-TQIP数据库用于识别≥18岁的钝性创伤致全厚度回肠、空肠或结肠穿孔患者。按年度BInI量对医院进行分层。采用调整人口统计学、合并症和损伤特征/严重程度的多变量logistic回归来研究医院创伤量对延迟手术（bbb24小时）和结局（如死亡率、败血症）的影响。根据(1)钝性创伤和(2)所有创伤入院量对医院进行敏感性分析。结果共纳入4005762例创伤患者，其中低BInI医院1397例（35.3%），中等BInI医院1373例（34.7%），高BInI医院1184例（30%）。小容量医院的平均手术时间为18±46小时，而大容量医院为15±45小时（P<0.001）。在多变量分析中，与低BInI容量相比，高BInI容量与早期手术（延迟手术的aOR为0.68,95% CI 0.53-0.88）和损伤后脓毒症风险降低42% （aOR为0.58,95% CI 0.37-0.91）独立相关。高钝性创伤和所有创伤医院容量同样与早期手术相关（分别为aOR 0.65, 95% CI 0.51-0.84; aOR 0.66, 95% CI 0.51-0.85）。结论高创伤住院容量与颅脑损伤患者及时手术干预和改善预后独立相关。这些发现强调了临床创伤经验和现有资源对早期诊断和治疗罕见和棘手的肠道损伤的重要性。

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引用次数: 0

Long-term Outcomes of Spleen-preserving Distal Pancreatectomy With or Without Preservation of Splenic Vessels: A Bi-institutional Experience. 保留脾血管或不保留脾血管的远端胰腺切除术的长期结果：双机构的经验。

IF 9 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-11 DOI: 10.1097/sla.0000000000006992

Shahrzad Arya,Marco Ventin,Liti Zhang,Carlos Fernandez-Del Castillo,Alexandra Gangi,Nicholas Nissen,Kambiz Kosari,Giulia Cattaneo,Motaz Qadan,Keith D Lillemoe,Andrew L Warshaw,Cristina R Ferrone

OBJECTIVETo compare the short- and long-term outcomes of the Warshaw (splenic vessel resection) and Kimura (splenic vessel preservation) techniques in spleen-preserving distal pancreatectomy (SPDP).SUMMARY BACKGROUND DATASPDP is an alternative to splenectomy that preserves immune function. Both Warshaw and Kimura are used, but comparative data on their long-term safety and indications are limited.METHODSRetrospective bi-institutional analysis of 297 patients undergoing SPDP at Massachusetts General Hospital and Cedars-Sinai Medical Center (2002-2020). Clinicopathologic, operative, and radiologic outcomes were compared.RESULTSOf 297 patients, 245 (82.5%) underwent Warshaw and 52 (17.5%) Kimura. Warshaw was more commonly performed for larger tumors (2.5 cm vs. 1.5 cm, P<0.001), proximal lesions (specimen 8.2 cm vs. 5.7 cm, P<0.001), and malignant or complex disease, Kimura was more commonly performed minimally invasively (MIS) (73.1% vs. 44.1%, P<0.001) and was associated with shorter operative time. Higher ASA class, larger tumor size, pancreatic ductal adenocarcinoma, and the Warshaw technique independently predicted longer operative time in MIS cases, suggesting a preferential adoption of the Warshaw technique for technically more challenging tumor dissections. Short-term morbidity, readmission, and mortality rates were comparable. With a median follow-up of 85.8 monthssplenic hypoperfusion (30.4% vs. 12.2%, P=0.010), and perigastric varices (19.6% vs. 7.3%, P=0.056) were more frequent after Warshaw, although most were clinically silent, and the need for secondary splenectomy was rare (1.2%).CONCLUSIONSBoth techniques are safe and effective for SPDP. Warshaw is preferred for proximal, malignant, or complex lesions, while Kimura may minimize long-term splenic sequelae in small, distal, benign tumors. An anatomy- and disease-driven approach remains essential to optimize outcomes.

目的比较Warshaw（脾血管切除）技术和Kimura（脾血管保留）技术在保脾远端胰腺切除术（SPDP）中的近期和远期疗效。背景：aspdp是脾切除术的替代选择，可保留免疫功能。Warshaw和Kimura都被使用，但关于其长期安全性和适应症的比较数据有限。方法回顾性分析2002-2020年在马萨诸塞州总医院和雪松-西奈医学中心接受SPDP治疗的297例患者。比较临床病理、手术和放射学结果。结果297例患者中，Warshaw手术245例（82.5%），Kimura手术52例（17.5%）。Warshaw更常用于较大的肿瘤（2.5 cm对1.5 cm， P<0.001）、近端病变（标本8.2 cm对5.7 cm， P<0.001）和恶性或复杂疾病，Kimura更常用于微创（MIS）（73.1%对44.1%，P<0.001），并与较短的手术时间相关。较高的ASA等级、较大的肿瘤大小、胰腺导管腺癌和Warshaw技术独立预测MIS病例更长的手术时间，提示在技术上更具挑战性的肿瘤解剖中优先采用Warshaw技术。短期发病率、再入院率和死亡率具有可比性。中位随访时间为85.8个月，Warshaw术后脾灌注不足（30.4% vs. 12.2%， P=0.010）和胃周静脉曲张（19.6% vs. 7.3%， P=0.056）更为常见，尽管大多数患者临床无症状，且需要二次脾切除术的病例很少（1.2%）。结论两种方法治疗SPDP安全有效。Warshaw手术适用于近端、恶性或复杂病变，而Kimura手术可减少远端、良性肿瘤的长期脾后遗症。解剖学和疾病驱动的方法仍然是优化结果的关键。

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引用次数: 0

Robotic Versus Open and Laparoscopic Pancreaticoduodenectomy: A Nationwide Matched Study in Japan. 机器人与开放和腹腔镜胰十二指肠切除术：日本一项全国性的匹配研究。

IF 9 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-10 DOI: 10.1097/sla.0000000000006996

Naoki Ikenaga,Hiraku Kumamaru,Masafumi Inomata,Naoko Kinukawa,Toshimitsu Iwasaki,Koki Otsuka,Hideki Ueno,Yuko Kitagawa,Ken Shirabe,Masafumi Nakamura

OBJECTIVETo evaluate real-world clinical outcomes of robotic pancreaticoduodenectomy (PD) versus open and laparoscopic PD in a nationwide cohort.SUMMARY BACKGROUND DATAWhile robotic PD has gained popularity as a minimally invasive approach to pancreatic surgery, its clinical effectiveness remains uncertain owing to the limited generalizability of existing evidence.METHODSData from the Japanese National Clinical Database, which captures over 95% of surgical procedures conducted nationwide, were analyzed. Patients who underwent PD between January 2019 and December 2023 were included. Propensity score matching was used to compare robotic PD with open and laparoscopic PD.RESULTSAmong 46,166 eligible PD cases, 1,371 were robotic. To ensure consistent surgical proficiency, the analysis included cases performed at institutions conducting ≥20 PDs annually (n=23,613). Following 1:1 matching, 1,248 robotic-open and 1,066 robotic-laparoscopic pairs were identified. Robotic PD was associated with a lower severe complication incidence than that with open (22.2% vs. 25.9%; odds ratio, 0.82; 95% confidence interval, 0.68-0.98; P=0.031) and laparoscopic PD (23.0% vs. 27.6%; odds ratio, 0.78; 95% confidence interval, 0.64-0.95; P=0.015). Robotic PD was also associated with a lower incidence of pancreatic fistula and shorter hospital stay, despite extended operative time. An increased incidence of deep venous thrombosis was observed in the robotic PD group.CONCLUSIONSIn this nationwide, Japanese credentialed setting, robotic PD was associated with improved short‑term outcomes compared with those of open and laparoscopic PD. As PD outcomes are influenced by surgeon/institutional experience and case complexity (tumor factors), these aspects should be carefully considered when selecting robotic PD.

目的在全国队列中评估机器人胰十二指肠切除术（PD）与开放和腹腔镜PD的实际临床结果。虽然机器人PD作为一种微创胰腺手术方法越来越受欢迎，但由于现有证据的可推广性有限，其临床有效性仍不确定。方法分析来自日本国家临床数据库的数据，该数据库捕获了全国95%以上的外科手术。纳入了2019年1月至2023年12月期间接受PD治疗的患者。倾向评分匹配用于比较机器人PD与开放和腹腔镜PD。结果在46,166例符合条件的PD病例中，1,371例是机器人。为了确保一致的手术熟练程度，分析纳入了每年进行≥20例pd的机构的病例（n=23,613）。按照1:1的匹配，确定了1248对机器人开放和1066对机器人腹腔镜。机器人PD的严重并发症发生率低于开放式PD （22.2% vs. 25.9%；优势比0.82；95%可信区间，0.68-0.98；P=0.031）和腹腔镜PD （23.0% vs. 27.6%；优势比0.78；95%可信区间，0.64-0.95；P=0.015）。机器人PD也与较低的胰瘘发生率和较短的住院时间相关，尽管手术时间延长。在机器人PD组中观察到深静脉血栓的发生率增加。结论：在日本全国范围内，与开放和腹腔镜PD相比，机器人PD具有改善的短期预后。由于PD的结果受外科医生/机构经验和病例复杂性（肿瘤因素）的影响，因此在选择机器人PD时应仔细考虑这些方面。

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引用次数: 0

There Were Signs: Essay for Surgical Perspectives in Annals of Surgery. 有迹象：外科年鉴上的外科观点论文。

IF 9 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-10 DOI: 10.1097/sla.0000000000006994

Mary Dorothy Fogerty

引用次数: 0

Laparoscopic Resection Rectopexy Versus Delorme's Procedure In Full-thickness Rectal Prolapse: A Randomized Multicenter Trial (DELORES-RCT). 腹腔镜直肠切除术与Delorme手术治疗全层直肠脱垂——一项随机多中心试验（delore - rct）。

IF 6.4 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-01 Epub Date: 2025-03-28 DOI: 10.1097/SLA.0000000000006708

Florian Herrle, Flavius Sandra-Petrescu, Simone Rothenhoefer, Julia Hardt, Steffen Seyfried, Andreas Joos, Alexander Herold, Dieter Bussen, Stefan Post, Marion Brunner, Alois Fürst, Gianluca De Santo, Robert Siegel, Martin Strik, Michael Sprossmann, Eugen Berg, Andreas Ommer, Martin K Walz, Claudia Benecke, Ralf Bouchard, Tobias Keck, Dirk Weimann, Thomas Schiedeck, Nicolas Demartines, Dieter Hahnloser, Anja Sander, Lukas D Sauer, Christina Klose, Meinhard Kieser, Markus Diener, Rosa Klotz, Christoph Reissfelder, Peter Kienle

Objective: The DELORES trial investigated whether laparoscopic resection rectopexy (LRR) is superior to Delorme's procedure (DP) in full-thickness rectal prolapse.

Background: Multiple perineal and transabdominal procedures are current practice for rectal prolapse surgery. Evidence from adequately designed randomized studies addressing the question of which of these procedures are superior in terms of recurrence and bowel function is lacking.

Methods: DELORES was a randomized, observer-blinded, expertise-based multicenter trial. Patients with full-thickness rectal prolapse were eligible. The primary outcome was time to recurrence of full-thickness rectal prolapse within 24 months after primary surgery. The main secondary endpoints were morbidity, hospital stay, quality of life, constipation, and fecal incontinence (DRKS00000482).

Results: A total of 358 patients were screened between September 2010 and January 2016. Based on screening, 70 patients were randomized and 65 were included in the analysis (33 LRR and 32 DP procedures). The median follow-up was 23.9 months. Analysis of the primary outcome showed that LRR was superior to DP ( P =0.0012). During the 24-month follow-up, 8.2% of patients in the LRR group had a full-thickness prolapse recurrence versus 42.8% in the DP group. The median time to recurrence was 17.8 months for LRR and 8.2 months for DP. The median duration of surgery was 212 min (LRR) versus 77 min (DP). Overall postoperative morbidity was low. The reoperation rate was higher for DP (0% LRR vs. 33.3% DP). Quality of life (FIQL) and incontinence scores (Wexner) were more favorable for LRR at 24-month follow-up.

Conclusions: LRR is superior to DP in terms of recurrence and has favorable functional results.

目的：DELORES试验探讨腹腔镜直肠切除术（LRR）是否优于Delorme手术（DP）治疗全层直肠脱垂。背景资料总结：目前直肠脱垂手术采用多会阴和经腹手术。缺乏充分设计的随机研究的证据来解决哪一种手术在复发和肠功能方面更优越的问题。方法：DELORES是一项随机、观察者盲法、基于专家的多中心试验。全层直肠脱垂患者入选。主要观察指标为术后24个月内全层直肠脱垂复发的时间。主要次要终点为发病率、住院时间、生活质量、便秘和大便失禁。(DRKS00000482)。结果：2010年9月至2016年1月共筛查358例患者。在筛选的基础上，70例患者被随机分组，65例纳入分析（33例LRR和32例DP）。中位随访时间为23.9个月。主要转归分析显示LRR优于DP （P=0.0012）。在24个月的随访中，LRR组8.2%的患者出现全层脱垂复发，而DP组为42.8%。LRR的中位复发时间为11.9个月，DP为8.2个月。中位手术时间为212分钟（LRR）， 77分钟（DP）。术后总体发病率低。DP的再手术率更高（LRR为0%，DP为33.3%）。在24个月的随访中，生活质量（FIQL）和尿失禁评分（Wexner）对LRR更有利。结论：腹腔镜直肠固定术在复发率上优于Delorme手术，功能效果良好。

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引用次数: 0

Elucidating the Mechanism of Radiation Therapy on Mesenchymal Cell Fate in Preventing Heterotopic Ossification. 阐明放射治疗在预防异位骨化过程中对间质细胞命运的影响机制

IF 6.4 1区医学 Q1 SURGERY

Annals of surgery

Pub Date : 2025-12-01 Epub Date: 2024-06-03 DOI: 10.1097/SLA.0000000000006366

Meng-Lun Hsieh, Ji Hae Choi, Sneha Korlakunta, Yuanyuan Zhang, Benjamin Levi

Objective: To recapitulate the use of radiation in preventing heterotopic ossification (HO) in an animal model to thereby mechanistically investigate radiation-induced changes at the single-cell level.

Background: HO is the formation of extra-skeletal bone in abnormal areas including muscle and soft tissue. Radiation therapy is a clinically proven, localized preventive measure for HO. Despite its efficacy, there is a lack of standardization of radiation prescription; however, the mechanism of the impact of radiation on HO prevention remains unknown.

Methods: C57BL6J male mice underwent burn/tenotomy with and without perioperative radiation treatment. Single-cell RNA sequencing was performed to analyze downstream signaling after HO-forming injury. Immunofluorescence microscopy was used to visualize protein expression changes in HO progenitor cells. In vivo range of motion analyses, histological staining, and micro-computerized tomography were performed to investigate mature HO's effect on joint function and to characterize total HO structure and volume.

Results: In one fraction, 7 Gy delivered to the injury site within 72 hours postoperatively significantly decreases HO formation and improves hindlimb range of motion. In-depth single-cell transcriptomic analyses with immunofluorescent staining demonstrate decreased cellular numbers, as well as aberrant endochondral differentiation and downregulation of associated upstream BMP and ALK4 signaling pathways in irradiated mesenchymal progenitor cells.

Conclusions: Our study is the first to explore the mechanism of radiotherapy prophylaxis in the prevention of traumatic HO. Not only does radiation decreases total HO progenitor cell numbers but also reduces aberrant osteochondral differentiation at the injury site, thereby decreasing overall HO and improving joint function.

放射治疗是一种经临床验证的异位骨化（HO）局部预防措施。尽管其疗效显著，但放射处方的剂量和分次缺乏标准化，而且放射治疗在预防异位骨化中的作用机制仍不清楚。在这里，我们利用烧伤和腱鞘切除术诱发的创伤性HO小鼠模型，证明了在术后72小时内对损伤部位进行7Gy的分次照射可显著减少HO的形成，并改善后肢的活动范围。深入的单细胞转录组分析与免疫荧光染色相结合，证明了细胞数量的减少、软骨内分化的异常以及辐照间充质祖细胞相关上游信号通路的下调。我们的研究为未来探索辐射在预防 HO 形成方面的机理和临床相关研究提供了框架。

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引用次数: 0