OBJECTIVE To validate the ISGPS complexity grading system for minimally invasive pancreaticoduodenectomy (MIPD). BACKGROUND Although concerns about patient safety persist, MIPD is gaining popularity. The ISGPS recently introduced a difficulty grading system to improve patient selection by aligning procedural complexity with surgeon and center expertise. METHODS Data from MIPD cases reported in the

OBJECTIVE To examine the relationship between moral injury and surgical practice, further explore the concept of protective equity, and understand its role in mitigating the impact of morally injurious events throughout a surgical career. BACKGROUND Moral injury in healthcare settings has evolved from Jonathan Shay's original definition, modified by Brett Litz and others, to encompass the psychological

OBJECTIVE We aimed to study the impact of anorectal malformation (ARM) type and sacral ratio on continence outcomes in children. We secondarily aimed to compare continence outcomes by age group and determine quality of life (QoL) with different bowel regimens. SUMMARY BACKGROUND DATA Children with ARM experience dysfunctional stooling into adulthood. Little is known about how ARM type, sacral ratio

OBJECTIVE This clinical trial investigated the safety and efficacy of single-cycle pembrolizumab in patients with localized deficient mismatch repair (dMMR) colon cancer. BACKGROUND Neoadjuvant immunotherapy has induced remarkable rates of pathological complete response in patients with dMMR colon cancer. However, the optimal length and type of treatment are yet to be determined. METHODS This was an

OBJECTIVE To investigate the incidence and risk factors of portomesenteric venous thrombosis (PVT) after pancreatic cancer surgery with portomesenteric venous resection (PVR). SUMMARY BACKGROUND DATA Pancreatic cancer surgery with PVR can be complicated by PVT, but the long-term associations, risk factors, and consequences of PVT have not been clearly elucidated. METHODS This study included pancreatic

OBJECTIVE To develop and validate a signature to precisely predict prognosis in pancreatic ductal adenocarcinoma (PDAC) undergoing resection and adjuvant chemotherapy. SUMMARY BACKGROUND DATA PDAC is largely heterogeneous, and responds discrepantly to treatment. METHODS 551 consecutive patients with PDAC from 3 tertiary centers were initially enrolled. Genetic events of the four most commonly mutated

OBJECTIVE To describe the evolution of management strategies for neuroendocrine liver metastases (NE LM) and trends in patient outcomes over the preceding 3 decades. SUMMARY BACKGROUND DATA Liver metastases are common in neuroendocrine neoplasms and impair prognosis. A broad therapeutic armamentarium has evolved over recent decades but there remains uncertainty regarding optimal treatment selection

OBJECTIVE To examine the optimal method of assessing response to neoadjuvant therapy (NAT) in operable pancreatic ductal adenocarcinoma (PDAC) patients. SUMMARY OF BACKGROUND DATA PDAC response to NAT is measured with biochemical, radiographic and pathologic parameters, which can often be discordant with each other. METHODS PDAC patients undergoing resection after NAT at a single institution were retrospectively

OBJECTIVES The efficacy of enhanced recovery after surgery (ERAS) to improve the prognosis of patients who undergo laparoscopic distal gastrectomy (LDG) for gastric cancer is uncertain. This randomized study compared oncological outcomes in LDG after ERAS or conventional care. BACKGROUND At present, randomized controlled trials have confirmed that ERAS can improve the short-term clinical outcomes of

OBJECTIVE The present study aimed to assess the efficacy of this approach and establish the criteria that identify LAPC patients who may achieve survival benefits from RRCIA. SUMMARY BACKGROUND DATA Surgical resection for locally advanced pancreatic cancer (LAPC) remains challenging and associated with high morbidity and mortality, especially for surgery with major arterial reconstruction. We previously

OBJECTIVE To characterize the association between type of fellowship training and patient outcomes following hepatopancreatic (HP) surgery across different surgeon career stages using a national representative cohort of Medicare beneficiaries. BACKGROUND The current state of training in HPB surgery in North America is defined through three main pathways: the Complex General Surgical Oncology (CGSO)

OBJECTIVE To identify the risk factors, manifestations, and clinical implications of chyle leak (CL) after pancreatic surgery, and to reappraise the International Study Group for Pancreatic Surgery (ISGPS) definition and classification of CL. SUMMARY BACKGROUND DATA The risk factors, clinical scenarios, and management of CL after pancreatic surgery remain controversial. METHODS Data from patients who

OBJECTIVE To compare early patency and outcomes of single outflow (SOT) and double outflow (DOT) reconstruction in right lobe living donor liver transplantation (RtLDLT) in a multicenter open-labelled randomized controlled trial. SUMMARY BACKGROUND DATA Optimum graft venous outflow is a key factor in determining outcomes of RtLDLT. There is no data directly comparing SOT and DOT technique of graft

OBJECTIVE To delineate how identity-based bias exposure evolves with rank and/or context among healthcare workers, and assess their attitudes toward existing DEI education. BACKGROUND Although Diversity, Equity and Inclusion (DEI) training is widely mandated for healthcare workers, few studies examine how clinicians' needs evolve across a career, how context impact recipients' ability to respond, or

OBJECTIVE To assess the incidence of posthepatectomy liver failure (PHLF) and the role of the future liver remnant (FLR) in children undergoing major hepatectomy. SUMMARY BACKGROUND DATA Incidence and risk factors of PHLF in children are unclear, with no validated definition for this age group. Consequently, the role of the FLR in pediatric hepatectomy and evidence-based preoperative guidelines remain

OBJECTIVE To compare target artery (TA) outcomes after fenestrated or branched endovascular aortic repair (FB-EVAR) versus open surgical repair (OSR) of thoracoabdominal aortic aneurysms (TAAAs). BACKGROUND Few studies have compared TA outcomes after endovascular incorporation and open reconstruction. METHODS Among consecutive patients who underwent elective OSR or FB-EVAR of TAAAs (2008-2020), we

OBJECTIVE The aim of this study was to evaluate the different phases of the learning curve for robotic distal pancreatectomy (RDP) in international expert centers. SUMMARY BACKGROUND DATA RDP is an emerging minimally invasive approach; however, only limited, mostly single center data are available on its safe implementation, including the learning curve. METHODS Consecutive patients undergoing elective

Metabolic surgery - operating on a normal organ for a beneficial metabolic gain - is not only an emerging discipline of surgery but the progenitor of therapy for the major global afflictions of atherosclerotic cardiovascular disease, cancer, type 2 diabetes, and obesity, as well as at least 18 other disease entities.

BACKGROUND Postoperative morbidity can reduce quality of life, physical performance, and tolerability of postoperative chemotherapy in patients with colorectal liver metastases (CRLM). Exercise can improve these outcomes in some cancer populations. However, it remains unknown whether exercise can be delivered in the early postoperative period following surgery for CRLM without increasing the risk of

IMPORTANCE The current research aimed to conduct a detailed analysis of intraoperative surgical performance, short-term outcomes, identify and categorize technical errors, and hazard-zones enacted during total gastrectomy performed robotically and laparoscopically by surgeons. Prospective research is needed to determine whether the technical advantages of robotic surgery translate to patient outcomes

OBJECTIVE To determine the association between residence in racialized neighborhoods with direct healthcare expenditure and days at home (DAH) after moderate to severe traumatic brain injury (TBI). SUMMARY BACKGROUND DATA Differences in ethno-racial background have been associated with health outcome disparities. Much of this prior research was conducted in settings without universal healthcare coverage

OBJECTIVE To investigate patency and clinical outcomes of alloplastic and other venous interposition graft materials in pancreatic surgery. BACKGROUND Vascular pancreatic surgery is increasingly performed for locally advanced pancreatic neoplasms. Different than other centers, we prefer to use alloplastic vascular graft materials for superior mesenteric vein and portal vein interposition in pancreatic

OBJECTIVE To examine perceived OR ergonomics facilitators and barriers, with a focus on the interdisciplinary team. SUMMARY BACKGROUND DATA Poor ergonomics causes musculoskeletal injuries affecting all operating room (OR) staff with repercussions on patient care, outcomes, and sustainability. Lack of ergonomic awareness and education are risk factors. METHODS We conducted a self-administered web-based

OBJECTIVE To quantify recent trends in access to timely, high-quality, affordable surgical care in the US. BACKGROUND Insufficient access to surgical care remains an ongoing concern in the US. Previous attempts to understand and quantify barriers in access to surgical care in the US lack a comprehensive, policy-relevant lens. METHODS This observational cross-sectional study evaluates multiple domains

OBJECTIVE To evaluate machine learning models' performance in predicting acute pancreatitis severity using early-stage variables while excluding laboratory and imaging tests. SUMMARY BACKGROUND DATA Severe acute pancreatitis (SAP) affects approximately 20% of acute pancreatitis (AP) patients and is associated with high mortality rates. Accurate early prediction of SAP and in-hospital mortality is crucial

OBJECTIVE To review the surveillance of IPMN, the risk of pancreatic cancer and the cost of surveillance. BACKGROUND The increasing IPMN prevalence and low pancreatic cancer associated with IPMN question the necessity and cost-effectiveness of surveillance. Guidelines favour a 'watch and wait' approach, lacking clarity on stopping surveillance. This study aims to identify patients with pancreatic cancer

OBJECTIVE This study aimed to compare the ability of a deep-learning platform (the MACSSwin-T model) with healthcare professionals in detecting cerebral aneurysms from operative videos. Secondly, we aimed to compare the neurosurgical team's ability to detect cerebral aneurysms with and without AI-assistance. BACKGROUND Modern microscopic surgery enables the capture of operative video data on an unforeseen

OBJECTIVE This study examined the predictive value of Flavin Mononucleotide (FMN) levels in the flush solution used during cold storage of donor livers on outcomes post-transplantation. BACKGROUND Static cold storage for liver grafts induces hypoxia with subsequent impaired mitochondrial function and Flavin Mononucleotide (FMN) release upon reperfusion. METHODS This study enrolled 62 recipients who

OBJECTIVE To undertake a systematic review of the medical literature on telesurgery, with a key focus on identifying the key technical and non-technical themes searched in medical articles and to analyze gaps in the current knowledge base on telesurgery. BACKGROUND It has now been over two decades since the first successful case of telesurgery and since this time there have been significant technological

OBJECTIVE To assess 30-day outcomes of da Vinci robotic-assisted (dV-RAS) versus laparoscopic/thoracoscopic (lap/VATS) or open oncologic surgery. SUMMARY BACKGROUND DATA Complex procedures in deep/narrow spaces especially benefit from dV-RAS. Prior procedure-specific comparisons are not generalizable. METHODS PubMed, Scopus and EMBASE were systematically searched (latest: 11/17/2023) following PRISMA

OBJECTIVE To investigate the incidence of male sexual dysfunction (SD) including erectile dysfunction (ErD) and ejaculatory dysfunction (EjD) after minimally invasive rectal cancer surgery. BACKGROUND Male SD significantly affects post-rectal cancer surgery quality of life (QOL). Current assessments using the International Index of Erectile Function-5 are unsuitable for patients with reduced postoperative

OBJECTIVE To validate the ISGPS definition and grading system of PPAP after pancreatoduodenectomy (PD). SUMMARY BACKGROUND DATA In 2022, the International Study Group for Pancreatic Surgery (ISGPS) defined post-pancreatectomy acute pancreatitis (PPAP) and recommended a prospective validation of its diagnostic criteria and grading system. METHODS This was a prospective, international, multicenter study

OBJECTIVE This study aimed to investigate the prevalence and distribution of carcinoma in the liver margin (LM) of resected perihilar cholangiocarcinoma (pCCA) and establish a method for LM examination. BACKGROUND LM is the largest margin in resected pCCA with undefined status and assessment method. METHODS 227 pCCA cases underwent major hepatectomy were divided into a discovery cohort (n=101) assessed

OBJECTIVE BACKGROUND Combined pancreatic and vascular resections are increasingly performed for pancreatic ductal adenocarcinoma (PDAC). We evaluated the outcomes after pancreatectomy with non-vascular resection (NVR), venous resection (VR), and arterial resection (AR). METHODS Retrospective review (2011-2023) of 715 PDAC patients treated with curative-intent surgery. Associations among clinicopathological

OBJECTIVE To describe long-term re-presentations and interventions following non-operative management (NOM) of acute appendicitis (AA). SUMMARY BACKGROUND DATA Trial data suggest NOM of AA carries a substantial risk of subsequent appendectomy, although NOM is increasingly offered to patients. Population-based data is required to understand the real-world long-term course of patients undergoing NOM

OBJECTIVE To understand mortality and secondary outcomes in patients with both end-stage kidney disease (ESKD) and chronic limb-threatening ischemia (CLTI) after no procedural treatment, primary amputation, endovascular treatment, and open surgery. SUMMARY BACKGROUND DATA ESKD and CLTI commonly cooccur and limited prior work has demonstrated poor outcomes including one-year survival despite treatment

OBJECTIVE To evaluate the morphologic landscape of pancreatic ductal adenocarcinoma (PDAC), intratumor spatial heterogeneity, and the resulting clinical impact following post-neoadjuvant pancreatectomy. SUMMARY BACKGROUND DATA The clinical value of PDAC morphologic subtypes and intratumor spatial heterogeneity post-treatment remains an open issue. MATERIALS AND METHODS The study cohort included patients

OBJECTIVE To evaluate treatment outcomes, overall survival (OS), and prognostic factors for OS in patients diagnosed with T1 ampullary cancer. BACKGROUND Ampullary cancer is a rare gastrointestinal malignancy with limited data from large cohorts, especially regarding T1 disease. METHODS Patients diagnosed with clinical (c) T1 ampullary cancer and patients with pathological (p) T1 in the case of cTx

OBJECTIVE The primary objective was to determine the prognostic significance of circulating tumor DNA (ctDNA) in patients receiving neoadjuvant chemotherapy (NAC) for localized pancreatic ductal adenocarcinoma (PDAC) using digital droplet polymerase chain reaction (ddPCR). SUMMARY AND BACKGROUND DATA Increasingly, ctDNA is being used for clinical decision-making in a variety of solid malignancies.

OBJECTIVE This systematic review and meta-analysis aimed to compare outcomes between abdominal drain placement and no drain placement post-pancreatectomy. BACKGROUND Left pancreatectomy (LP) is a surgical procedure commonly employed for various pancreatic conditions, often associated with postoperative complications like post-operative pancreatic fistula (POPF). While routine abdominal drainage following

OBJECTIVE This study identified failures in emergency inter-hospital transfer, or re-triage, at high-level trauma centers receiving severely injured patients. SUMMARY BACKGROUND DATA The re-triage process averages four hours despite the fact timely re-triage within two hours mitigates injury-associated mortality. Non-trauma and low-level trauma centers reported most critical failures were in finding

OBJECTIVES To describe financial toxicity (FT) in patients who have undergone gastrointestinal (GI) surgery and its correlation with patients' emotional (EWB) and social well-being (SWB). BACKGROUND FT describes the financial burden associated with treatment and its impact on patient outcomes. Few prior studies have examined FT in gastrointestinal surgery and its impact on patient quality of life.

OBJECTIVE To determine if cancer patients experience variability in incidence or management of emergency general surgery (EGS) conditions compared to non-cancer patients. BACKGROUND The true frequency, and natural history of EGS conditions among cancer patients has not been characterized. METHODS We utilized SEER-Medicare data from January 2006-December 2015 to compare patients with breast, prostate

OBJECTIVE To determine the influence of operating room familiarity on surgeon stress. BACKGROUND Regulating surgeon stress may improve patient safety. This study evaluated how assisting surgeon and operating room familiarity influence intraoperative heart rate variability among surgeons. METHODS Attending surgeons from seven specialties within four university hospitals in France were enrolled from

OBJECTIVE To generate a prediction model for selection of treatment modality for early-stage non-small cell lung cancer (NSCLC). SUMMARY BACKGROUND DATA Stereotactic body radiotherapy (SBRT) and minimally invasive surgery (MIS) are used in the local treatment of early-stage NSCLC. However, selection of patients for either SBRT or MIS remains challenging, due to the multitude of factors influencing

OBJECTIVE We evaluated whether superficial lymphatic anatomy and functional lymph node drainage are symmetric between the right and left upper extremities of healthy female volunteers, and if handedness is associated with symmetry of superficial lymphatic anatomy. BACKGROUND Symmetry of lymphatic anatomy has been assumed historically. This assumption of individual anatomic symmetry is being utilized

OBJECTIVES This study assesses the feasibility of acute type A dissections treatment with a dedicated aortic root endograft concept and introduces a new aortic classification. SUMMARY BACKGROUND DATA Acute type A aortic dissection (ATAAD) remains a catastrophic aortic condition with perioperative mortality ranging from 12% and 20%. Total Aortic root endovascular repair, "Endobentall concept", has been

OBJECTIVE To assess the efficacy and safety of fully closed-loop (FCL) compared with usual care (UC) glucose control in patients experiencing major abdominal surgery-related stress hyperglycaemia. SUMMARY BACKGROUND DATA Major abdominal surgery-related stress and periprocedural interventions predispose to perioperative hyperglycaemia, both in diabetes and non-diabetes patients. Insulin corrects hyperglycaemia

OBJECTIVE The aim of this article to outline proposals for the use of high stakes technical performance assessments, defined as assessments of technical skill that take place outside of the operating theatre, across the continuum of surgical training. SUMMARY BACKGROUND DATA Technological advancements have allowed for the assessment of operative technical skill outside of the workplace environment