Annals of Surgery

OBJECTIVE: We sought to compare overall survival (OS) and disease control for patients with localized pancreatic adenocarcinoma (PDAC) treated with ablative dose radiotherapy (A-RT) vs. resection. SUMMARY BACKGROUND DATA: Locoregional treatment for PDAC includes resection when possible or palliative RT. A-RT may offer durable tumor control and encouraging survival. METHODS: This was a single-institution retrospective analysis of patients with PDAC treated with induction chemotherapy followed by A-RT (≥ 98Gy biologically effective dose (BED) using 15-25 fractions in 3-4...

No abstract text is available yet for this article.

OBJECTIVE: To determine out of pocket costs (OOPC) in patients undergoing thyroidectomy for benign and malignant conditions in a commercially insured US population. SUMMARY BACKGROUND DATA: Little is known about OOPC for thyroid surgery in the United States. METHODS: Retrospective cohort study using claims of patients undergoing thyroidectomy from the IBM Watson Marketscan database from 2008 to 2017. Out of pocket costs accrued from 90 days prior to surgery to 360 days after thyroid surgery were quantified...

OBJECTIVE: Develop unifying definitions and paradigms for data-driven methods to augment postoperative resource intensity decisions. SUMMARY BACKGROUND DATA: Postoperative level-of-care assignments and frequency of vital sign and laboratory measurements (i.e., resource intensity) should align with patient acuity. Effective, data-driven decision-support platforms could improve value of care for millions of patients annually, but their development is hindered by the lack of salient definitions and paradigms...

OBJECTIVE: To assess postoperative 90-day outcomes after minimally invasive (laparoscopic/robot-assisted) total pancreatectomy (MITP) in selected patients versus open total pancreatectomy (OTP) among European centers. BACKGROUND: Minimally invasive pancreatic surgery is becoming increasingly popular but data on MITP are scarce and multicenter studies comparing outcomes versus OTP are lacking. It therefore remains unclear if MITP is a valid alternative. METHODS: Multicenter retrospective propensity-score matched study including consecutive adult patients undergoing MITP or OTP for all indications at 16 European centers in 7 countries (2008-2017)...

OBJECTIVE: The objective of this study was to estimate the incidence and cumulative risk of major surgery in older persons over a 5-year period and evaluate how these estimates differ according to key demographic and geriatric characteristics. BACKGROUND: As the population of the United States ages, there is considerable interest in ensuring safe, high-quality surgical care for older persons. Yet, valid, generalizable data on the occurrence of major surgery in the geriatric population are sparse...

OBJECTIVE: The aim of this study was to investigate whether our previously reported improvements in short-term cancer esophagectomy outcomes after large-scale regionalization in the U.S. translated to longer-term survival benefit. BACKGROUND: Regionalization is associated with better early postoperative outcomes following cancer esophagectomy; however, data regarding its effect on long-term survival is mixed. METHODS: We retrospectively reviewed 461 patients undergoing cancer esophagectomy before (2009-2013, N = 272) and after (2014-2016, N = 189) regionalization...

OBJECTIVE: To estimate risks of myocardial infarction, ischemic stroke, and cardiovascular-related and all-cause mortality after Roux-en-Y gastric bypass (RYGB) for obesity compared with non-operated obese patients and matched non-obese population controls. BACKGROUND: Few studies have assessed the influence of RYGB on fatal and non-fatal myocardial infarction and ischemic stroke, and the results vary between studies. METHOD: All patients aged 20-65 years with obesity diagnosis in the nationwide Swedish Patient Registry in 2001-2013 were included...

OBJECTIVE: To develop an evidence-based framework for evaluation of therapeutic devices, based on ethical principles and clinical evidence considerations. SUMMARY BACKGROUND DATA: Nearly all medical products which do not work solely through chemical action are regulated as medical devices. Their huge range of purposes, mechanisms of action and risks pose challenges for regulation. High-profile implantable device failures have fuelled concerns about the level of clinical evidence needed for market approval...

OBJECTIVE: To describe a new international dataset for pathology reporting of colorectal cancer surgical specimens, produced under the auspices of the International Collaboration on Cancer Reporting (ICCR). BACKGROUND: Quality of pathology reporting and mutual understanding between colorectal surgeon, pathologist and oncologist are vital to patient management. Some pathology parameters are prone to variable interpretation, resulting in differing positions adopted by existing national datasets...

OBJECTIVE: Describe etiologies and trends in non-battle deaths (NBD) among deployed U.S. service members to identify areas for prevention. BACKGROUND: Injuries in combat are categorized as battle (result of hostile action) or non-battle related. Previous work found that one-third of injured US military personnel in Iraq and Afghanistan had non-battle injuries (NBI) and emphasized prevention. NBD have not yet been characterized. METHODS: U...

OBJECTIVE: Pig-to-primate renal xenotransplantation is plagued by early antibody mediated graft loss which precludes clinical application of renal xenotransplantation. We evaluated whether temporary complement inhibition with anti-C5 antibody Tesidolumab could minimize the impact of early antibody mediated rejection in rhesus monkeys receiving pig kidneys receiving costimulatory blockade-based immunosuppression. METHODS: Double (Gal and Sda) and triple xenoantigen (Gal, Sda, and SLA I) pigs were created using CRISPR/Cas...

OBJECTIVE: To estimate the association between estimated glomerular filtration rate (eGFR) and acute myocardial infarction (AMI) or death after ambulatory non-cardiac surgery. SUMMARY BACKGROUND DATA: People with chronic kidney disease (CKD) commonly undergo surgical procedures. While most are performed in an ambulatory setting, the risk of major perioperative outcomes after ambulatory surgery for people with CKD is unknown. METHODS: In this retrospective population-based cohort study using administrative health data from Alberta, Canada, we included adults with measured preoperative kidney function undergoing ambulatory non-cardiac surgery between April 1 2005 and February 28 2017...

OBJECTIVES: Select patients with anatomically favorable walled off pancreatic necrosis may be treated by endoscopic (Endo-TGD) or operative (OR-TGD) transgastric debridement. We compared our experience with these two approaches. SUMMARY BACKGROUND DATA: Select necrotizing pancreatitis (NP) patients are suitable for transgastric debridement which may be accomplished endoscopically or surgically. Limited experience exists contrasting these techniques exists. METHODS: Patients undergoing Endo-TGD and OR-TGD at a single, high-volume pancreatic center between 2008-2019 were identified from a prospective database...

OBJECTIVE: Compare oncological long-term and short-term outcomes between patients with distal cT2N0 rectal cancer treated with chemoradiotherapy and local excision (CRT+LE) and patients treated with total mesorectal excision (TME). SUMMARY BACKGROUND DATA: Previous studies showed that CRT+LE is equivalent to TME in local tumor control and survival for T2N0 rectal cancer. METHODS: Seventy-nine patients with cT2N0 rectal adenocarcinoma treated with CRT+LE in the ACOSOG Z6041 trial were compared to cohort of 79 patients with pT2N0 tumors treated with upfront TME in the Dutch TME trial...

OBJECTIVE: The objective of this study was to determine baseline health-related quality of life (QoL) in patients with pancreatic adenocarcinoma (PA), peri-ampullary cancers, and benign pancreaticobiliary (PB) conditions at the time of the first visit to a PB surgery clinic, and to explore the relationship between QoL, demographics, clinical parameters, complications and survival. SUMMARY BACKGROUND DATA: Few studies have examined baseline QoL measures, the impact of co-morbidities, age, gender and smoking on subsequent post-operative complications and survival in patients with PA, related PB cancers, and with benign PB conditions...

No abstract text is available yet for this article.

OBJECTIVE: A large-scale multicenter retrospective cohort study was conducted to compare the short- and long-term outcomes of robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) for gastric cancer. SUMMARY OF BACKGROUND DATA: RG is being increasingly used worldwide, but data from large-scale multicenter studies on the short- and long-term oncologic outcomes of RG versus LG are limited. The potential benefits of RG compared with LG for gastric cancer remain controversial...

No abstract text is available yet for this article.

OBJECTIVE: To investigate the association between hospital volume and failure to rescue (FtR), after open (OAR) and endovascular (EVAR) repair of intact abdominal aortic aneurysms (AAA) among centers participating in the VASCUNET and International Consortium of Vascular Registries (ICVR). SUMMARY BACKGROUND DATA: FtR (i.e., in-hospital death following major complications) is a composite end-point representing the inability to treat complications effectively and prevent death...