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"What's a Win": A Qualitative Study Exploring Surgeon Perspectives on Operative Intent in Non-curative Cancer Surgery. Ann. Surg. (IF 7.5) Pub Date : 2025-05-22 Orly N Farber,Amanda J Reich,Kenneth Williams,Zara Cooper,Jennifer W Mack,George Q Zhang,Tatiana Ramos,Elizabeth J Lilley
OBJECTIVE To explore surgeons' perspectives on and priorities for communicating about non-curative operations for patients with advanced cancers, which aim to improve longevity or quality of life without possibility of cure. SUMMARY BACKGROUND DATA Describing the potential benefits of non-curative surgery is important so that treatment decisions are based on an accurate understanding of what surgery
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Towards an Honest Reflection of Work by HPB Surgeons. Ann. Surg. (IF 7.5) Pub Date : 2025-05-22 Samer A Naffouje,Toms Augustin,Robert Simon,Daniel Joyce,Robert Naples,Anthony Visioni,Kathryn Stackhouse,R Matthew Walsh,Fadi S Dahdaleh
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Impact of Hypovolemic Phlebotomy with Low Central Venous Pressure on Intraoperative Blood Loss in Open Liver Resection: A Double-Blind Randomized Controlled Trial. Ann. Surg. (IF 7.5) Pub Date : 2025-05-21 Warangkana Lapisatepun,Anon Chotirosniramit,Sunhawit Junrungsee,Nutthanun Tungsrirut,Kullakanya Maykanggoon,Phuriphong Chantima,Atipa Nitayamekin,Worakitti Lapisatepun
OBJECTIVE To assess the efficacy and safety of hypovolemic phlebotomy (HP) versus conventional management (control group) in achieving low central venous pressure (CVP) to reduce blood loss during open liver resections. BACKGROUND Excessive blood loss increases perioperative complications and worsen patient outcomes. HP is used to reduce blood loss and the need for allogenic transfusions. This study
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Evidence-Based Integration of Environmental Sustainability into Clinical Guidelines for Operating Rooms: A Systematic Review. Ann. Surg. (IF 7.5) Pub Date : 2025-05-21 Kim E van Nieuwenhuizen,Charlotte T J Michels,Ingena G I A Both,Jeroen B Guinée,Frank Willem Jansen,
OBJECTIVE To assess the feasibility of integrating environmental sustainability into clinical guidelines for operating rooms (ORs) and provide evidence-based recommendations. SUMMARY BACKGROUND DATA Surgical practices contribute significantly to healthcare's environmental impact. Incorporating sustainability into evidence-based clinical guidelines can support environmentally responsible decision-making
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MicroRNA Classifier Based on EUS-FNA for the Early Detection of Occult Liver Metastasis in Pancreatic Ductal Adenocarcinoma. Ann. Surg. (IF 7.5) Pub Date : 2025-05-21 Xiulin Hu,Yuting Xie,Shimin Wang,Xiaoju Su,Mengshi Li,Yongpu Feng,Fengyuan Sun,Yang Yang,Jianduo Zhang,Congjia Ma,Mengfan Wang,Kaixuan Wang,Jing Sun,Zhaoshen Li,Xiangyu Kong
OBJECTIVE This study aimed to investigate whether microRNAs (miRNAs) quantified from primary pancreatic ductal adenocarcinoma (PDAC) samples could serve as potential biomarkers for identifying PDAC with occult liver metastasis. SUMMARY BACKGROUND DATA Undetectable occult liver metastasis impair the survival of PDAC. Novel biomarkers are immediately required to detect occult liver metastasis in PDAC
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Multistate Model of Chronic Wounds, Amputations, and Mortality: Cohort Study of a State-wide Registry. Ann. Surg. (IF 7.5) Pub Date : 2025-05-21 Joshua S Choi,Manoj Kumar,Andrew R Wilson,Shomita S Mathew-Steiner,Kanhaiya Singh,David J Margolis,Titus K L Schleyer,Chandan K Sen
OBJECTIVE Use a new patient registry to characterize and predict progression of lower-extremity chronic wounds to amputation and/or death, while considering infection history. BACKGROUND Chronic wounds are a common health issue causing amputation and death. The Regenstrief Chronic Wound Registry, created from one of the U.S.'s largest health information exchanges, can give insights into their epidemiology
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Specific Congenital Heart Disease Diagnoses Impact Congenital Diaphragmatic Hernia Outcomes: The Heart of the Matter. Ann. Surg. (IF 7.5) Pub Date : 2025-05-20 Kylie I Holden,Ashley H Ebanks,Rebecca A Stark,Yigit S Guner,Terry L Buchmiller,Tim Jancelewicz,Amir M Khan,Anthony Johnson,Kevin P Lally,Damien J LaPar,Matthew T Harting,
OBJECTIVE Our objective was to assess outcomes for newborns with congenital diaphragmatic hernia (CDH) and congenital heart disease (CHD). SUMMARY BACKGROUND DATA CDH is a complex malformation often associated with CHD, yet limited data exist on outcomes for infants with both conditions. This study highlights factors associated with survival and how specific cardiac diagnoses shape patient outcomes
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Novel Benchmark for Robotic Liver Resection - Bridging Tradition with Innovation. Ann. Surg. (IF 7.5) Pub Date : 2025-05-20 Zhihao Li,Matthias Pfister,Dimitri A Raptis,Yong Ma,Guangchao Yang,Linqiang Li,Xuan Song,Guillaume Millet,Stéphanie Truant,Raphael Venezia,Heithem Jeddou,Bastien Le Floch,Alain Valverde,Nicolas Peru,Patrick Pessaux,Fabio Giannone Codiglione,Jean-Yves Mabrut,Kayvan Mohkam,Antonio Sa Cunha,Chady Salloum,Pierre Y Blanc,Bertrand Le Roy,Claire Goumard,Olivier Scatton,Stylianos Tzedakis,David Fuks,Ismael
OBJECTIVE To establish benchmark cutoffs for robotic liver resection (R-LR), encompassing both major and minor resections, and to determine the impact of patient selection on outcomes. BACKGROUND R-LR is a key advancement in minimally invasive liver surgery but lacks standardized benchmarks, especially for minor resections. While guidelines endorse R-LR, its role in optimizing outcomes remains unclear
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Supply, Distribution, and Aging of the General Surgeon Workforce by Rurality and Over Time: A National Observational Study. Ann. Surg. (IF 7.5) Pub Date : 2025-05-16 E Grace Petty,Robert D Luke,Alexa P Soult,Casey P Balio
OBJECTIVE The purpose of this study is to estimate differences in the supply of general surgeons by age group and rurality and model potential impending shortages, with an emphasis on surgeons reaching and above the traditional retirement age. SUMMARY BACKGROUND DATA The healthcare workforce at large is experiencing shortages and impending retirements, which are especially prominent in rural communities
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Trends in Surgical Quality at Critical Access Hospitals. Ann. Surg. (IF 7.5) Pub Date : 2025-05-16 Cody Lendon Mullens,Janice C Probst,Patrick L Johnson,Nicholas Kunnath,Justin B Dimick,Andrew M Ibrahim
OBJECTIVE To longitudinally compare trends in quality of care for common surgical conditions at CAHs compared to non-CAHs. SUMMARY BACKGROUND DATA Critical access hospitals (CAH) simultaneously face challenges of preserving access and ensuring quality. Data have identified concerns of quality over time for medical conditions, but less is understood about surgical care. DESIGN, SETTING, PARTICIPANTS
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ACS NSQIP Risk Calculator Performance Across Multiple Domains of Operative Risk and Risk-associated Features. Ann. Surg. (IF 7.5) Pub Date : 2025-05-13 Mark E Cohen,Yaoming Liu,Bruce L Hall,Clifford Y Ko
OBJECTIVE To assess the accuracy of the ACS NSQIP Risk Calculator (RC) when applied to subsets of high-risk patients. BACKGROUND The RC plays an especially important role in surgical decision making in situations where probabilities for adverse events are high. However, the performance of the RC in these situations has not been studied in detail. Furthermore, past criticisms of the RC have evaluated
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Trust but Verify: Should Trauma Surgeons Directly Interpret the Trauma CT Scan Images? Ann. Surg. (IF 7.5) Pub Date : 2025-05-13 Yasmin Arda,George Velmahos,Haytham Ma Kaafarani
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Introducing a New Annals of Surgery Section: Professional Development for the Contemporary Surgeon. Ann. Surg. (IF 7.5) Pub Date : 2025-05-08 Lesly A Dossett,Justin B Dimick
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Combined Clinical and Histopathological Risk Stratification for Prediction of (severe) Endoscopic Postoperative Recurrence in Patients with Crohn's Disease after Ileocolic Resection: Results from A Prospective Multicenter Cohort Study. Ann. Surg. (IF 7.5) Pub Date : 2025-05-08 Michiel T J Bak,Lindsey Oudijk,Ariadne H A G Ooms,Evelien M J Beelen,Jarmila D W van der Bilt,Mariëlle Romberg-Camps,Gerard Dijkstra,Marjolijn Duijvestein,Sander van der Marel,Laurents P S Stassen,P W Jeroen Maljaars,Christianne J Buskens,Johan F M Lange,Gursah Kats-Ugurlu,Sita V Jansen,Bindia J H Jharap,Carmen S Horjus,Fiona D M van Schaik,Rachel L West,Nanne K H de Boer,C Janneke van der Woude,Kaushal
OBJECTIVE This study assessed the association of histopathological features in the resection specimen of CD patients with (severe) endoscopic postoperative recurrence (ePOR) in a large prospective, multicenter cohort study. SUMMARY BACKGROUND DATA The predictive value of histopathologic features of the intestinal resection specimen for the risk of Crohn's disease (CD) recurrence after ileocolic (re-)resection
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GLP-1RA in the Real World: 1-year Compliance and Outcomes of Semaglutide use in Patients With or Without Previous History of Bariatric Surgery. Ann. Surg. (IF 7.5) Pub Date : 2025-05-06 Pourya Medhati,Thomas H Shin,Katherine Wasden,Vasundhara Mathur,Caroline Apovian,Abdelrahman Nimeri,Eric G Sheu,Ali Tavakkoli
OBJECTIVE To investigate weight loss outcomes of semaglutide in a real-world setting, specifically in patients who have undergone metabolic/bariatric surgery (MBS). SUMMARY BACKGROUND DATA Despite excellent weight loss for semaglutide in clinical trials, actual results may be limited due to factors such as costs, drug availability, insurance coverage, and adverse events. METHODS A retrospective series
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Clinical Trial Deserts for Gastrointestinal Cancer in the United States: Association with Area Deprivation and Digital Divide. Ann. Surg. (IF 7.5) Pub Date : 2025-05-06 Odysseas P Chatzipanagiotou,Mujtaba Khalil,Selamawit Woldesenbet,Razeen Thammachack,Timothy M Pawlik
OBJECTIVE We sought to define potential census-tract level differences between areas designated as clinical trial (CT) deserts versus non-CT deserts, and assess the association of area deprivation and digital divide with CT access. SUMMARY BACKGROUND DATA CTs serve as the foundation of evidence-based medicine, influencing multiple aspects of patient care; therefore, ensuring equitable access is important
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Thank You, Dr. Keith Lillemoe, for Your Service to Annals of Surgery and Annals of Surgery Open. Ann. Surg. (IF 7.5) Pub Date : 2025-05-06
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Management of Bile Leak Post Minimally Invasive Subtotal Cholecystectomy: A Review. Ann. Surg. (IF 7.5) Pub Date : 2025-04-29 Shirley X Deng,Brittany Greene,Christopher Habbel,Lev Bubis,Melanie E Tsang,Shiva Jayaraman
OBJECTIVE Minimally invasive subtotal cholecystectomy is safe alternative to minimally invasive cholecystectomy that prevents bile duct injury. Nonetheless, it is associated with higher rates of other complications, namely post-operative bile leak and symptomatic remnant cholelithiasis. SUMMARY BACKGROUND DATA Bile leak presents as biloma requiring drainage and subsequently high bilious drain output
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Ten-year Results After Primary Gastric Bypass: Real-world Data from A Swedish Nationwide Registry. Ann. Surg. (IF 7.5) Pub Date : 2025-04-29 Magnus Sundbom,Erik Näslund,Johan Ottosson,Torsten Olbers,Suzanne Hedberg,Jeff Wennerlund,Anna Laurenius,Erik Stenberg
OBJECTIVE To determine the 10-year outcomes regarding weight loss and remission of obesity-related diseases after primary Roux-en-Y gastric bypass (RYGB), when performed in routine clinical care. SUMMARY OF BACKGROUND DATA Long-term results of metabolic bariatric surgery (MBS) are important, as the number of patients needing help with this chronic condition is increasing globally. However, results
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Frailty and Survival for Diagnoses Feasibly Managed Operatively or Nonoperatively. Ann. Surg. (IF 7.5) Pub Date : 2025-04-28 Emily Mosher,Hasan Nassereldine,Jeffrey C McKibben,Jason Johanning,Shipra Arya,Nader N Massarweh,Rupen Shah,Myrick Shinall,Paula Shireman,Patrick R Varley,Elizabeth L George,Ada Youk,Leah Backhus,Alaina J Brown,Neil Christie,Rajeev Dhupar,Nicole Donnellan,Nicholas John Giori,Matthew R Goede,Richard Guido,Joon Lee,Jennifer L Griffin Miller,Justin C Siebler,Daniel A Tonetti,Scott A Vincent,Katherine
OBJECTIVE Compare outcomes, stratified by frailty, of patients with eight common conditions with plausible operative and nonoperative management strategies. SUMMARY BACKGROUND DATA A surgical pause, evaluating potential adverse outcomes among frail patients, improves postoperative outcomes; however, the outcomes among patients opting for nonoperative management are unknown. METHODS In an observational
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The BARIREF Study: BARIatric Surgery Complications in Patients with Prior REFlux Surgery in a Large National Cohort. Ann. Surg. (IF 7.5) Pub Date : 2025-04-28 Francesco Abboretti,Styliani Mantziari,Damien Bouriez,Caroline Gronnier,Andrea Lazzati
OBJECTIVE To assess the outcomes of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in patients with prior fundoplication. SUMMARY BACKGROUND DATA Obesity and gastroesophageal reflux disease (GERD) often coexist, posing clinical challenges. Fundoplication is the standard treatment for GERD refractory to medical therapy. Managing obesity after fundoplication is complex and while RYGB is
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Comprehensive Review of the Management of Patients with Acute Cholecystitis Who Are Ineligible for Surgery. Ann. Surg. (IF 7.5) Pub Date : 2025-04-21 Todd H Baron,Irving Jorge,Ali Husnain,Petros Constantino Benias,Bradley N Reames,Ashok Bhanushali,Salvatore Docimo,Matthew Bloom,Riad Salem,Patrick Murphy,Harjit Singh,Shyam Varadarajulu,Ahsun Riaz
OBJECTIVE Review the current literature for available treatments for acute cholecystitis (AC) in non-surgical candidates and provide guidelines for the management of these patients. BACKGROUND Cholecystectomy is the gold standard treatment modality for AC. A considerable number of patients who are not eligible for surgery are managed by percutaneous and endoscopic techniques. There is recent data regarding
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Out of Sequence Allocation in Liver Transplantation: A Poorly Used Tool to Improve Organ Utilization. Ann. Surg. (IF 7.5) Pub Date : 2025-04-21 Chase J Wehrle,Abby Gross,Sangeeta Satish,Kumaran Shanmugarajah,Toshihiro Nakayama,Christina M Fleischer,Kyle Sheetz,Federico Aucejo,Kazunari Sasaki,David Ch Kwon,Masato Fujiki,Antonio D Pinna,Charles Miller,Koji Hashimoto,Andrea Schlegel,Glenn K Wakam
SIGNIFICANCE We evaluated the impact of OOS on organ utilization and also what factors impact the decision to employ OOS. BACKGROUND Deceased donor liver allocation typically follows a ranked match-run of potential recipients. Organ procurement organizations (OPOs) may deviate from liver transplant standardized allocation using "out-of-sequence" (OOS) matches. METHODS All eligible donors from the Scientific
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Estimation of Risk-Adjusted Outcomes for Non-Infectious Postoperative Complications using Interpretable Machine Learning and Electronic Health Record Data. Ann. Surg. (IF 7.5) Pub Date : 2025-04-21 Christina M Stuart,Yizhou Fei,Kathryn L Colborn,Yaxu Zhuang,William G Henderson,Adam R Dyas,Michael R Bronsert,Robert A Meguid
OBJECTIVE To compare statistical models applied to electronic health record (EHR) data to predict and identify non-infectious postoperative complications. The models have been published and are part of the Automated Surveillance of Postoperative Infections (ASPIN) project, which has expanded to include non-infectious complications. SUMMARY OF BACKGROUND DATA Postoperative complications occur in 15%
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Intermittent Inflow Occlusion in Robotic Right Donor Hepatectomy: A Randomised Controlled Trial. Ann. Surg. (IF 7.5) Pub Date : 2025-04-21 Rahul D Kunju,Christi Titus Varghese,Krishnanunni Nair,Shweta Mallick,Binoj Sivasankara Pillai Thankamony Amma,Ramachandran N Menon,Dinesh Balakrishnan,Unnikrishnan Gopalakrishnan,Sudheer Ov,S Sudhindran
OBJECTIVE To assess the safety and efficacy of intermittent inflow occlusion (IIO) during robotic right donor hepatectomy (RDH) for adult living donor liver transplantation. SUMMARY BACKGROUND DATA Although evidence supports minimally invasive donor hepatectomy, its adoption by surgeons remains limited. Key challenges include bleeding during parenchymal transection and prolonged warm ischemia during
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Neoadjuvant Chemotherapy with Gemcitabine and S-1 versus Upfront Surgery for Resectable Pancreatic Cancer: Results of the Randomized Phase II/III Prep-02/JSAP05 Trial. Ann. Surg. (IF 7.5) Pub Date : 2025-04-16 Michiaki Unno,Fuyuhiko Motoi,Yutaka Matsuyama,Sohei Satoi,Hirochika Toyama,Ippei Matsumoto,Suefumi Aosasa,Hirofumi Shirakawa,Keita Wada,Tsutomu Fujii,Hideyuki Yoshitomi,Shinichiro Takahashi,Masayuki Sho,Hideki Ueno,Tomoo Kosuge
OBJECTIVE This randomized phase II/III study evaluated the superiority of neoadjuvant therapy with gemcitabine plus S-1 over upfront surgery for patients with resectable pancreatic ductal adenocarcinoma (PDAC). SUMMARY BACKGROUND DATA Pancreatic ductal adenocarcinoma is a leading cause of cancer mortality that urgently requires better treatment. METHODS Patients with resectable PDAC (without arterial
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Hospital Configurations Leading to Successful Implementation of Enhanced Recovery Programs. Ann. Surg. (IF 7.5) Pub Date : 2025-04-16 Reiping Huang,Sarah L Remer,Leandra K Knapp,Mark E Cohen,Michael A Rosen,Bruce L Hall,Elizabeth C Wick,Clifford Y Ko
OBJECTIVE This study explains successful implementation of hospital enhanced recovery programs (ERPs) through unique configurations of contextual and implementation conditions. SUMMARY BACKGROUND DATA Despite proven benefits in improving surgical outcomes, ERPs are often ineffectively implemented in hospitals, possibly due to the complex ways in which the interventions, local environment contexts,
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Carbohydrate Antigen 19-9 Delta Function for Survival Prediction in Borderline Pancreatic Cancer. A PANC-PALS Consortium International Multicenter Derivation and Validation Study. Ann. Surg. (IF 7.5) Pub Date : 2025-04-16 Jonathan Garnier,Alessio Marchetti,Brady Campbell,Paul C M Andel,Marie-Sophie Alfano,Camila Hidalgo Salinas,Eddy Traversari,Joseph R Habib,Gabriella Lionetto,Anaïs Palen,Jacques Ewald,Kelly Lafaro,Daniel Brock Hewitt,Richard A Burkhart,Salvatore Paiella,Greg D Sacks,Giuseppe Malleo,Christopher L Wolfgang,Roberto Salvia,Jin He,Olivier Turrini,Ammar A Javed
OBJECTIVE To establish a novel method for evaluating carbohydrate antigen 19-9 (CA19-9) during neoadjuvant therapy (NAT) and assess its role in predicting overall (OS) and disease-free (DFS) survival in borderline resectable pancreatic adenocarcinoma (BR-PC). SUMMARY BACKGROUND DATA Static CA19-9 values or percentage changes often fail to capture therapeutic responses in patients with BR-PC undergoing
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Perspectives of Older Adults Undergoing Elective Major Surgery: A Qualitative Study of Patients Undergoing Colectomy. Ann. Surg. (IF 7.5) Pub Date : 2025-04-16 Christy Cauley,Atziri Rubio-Chavez,Zara Cooper,Sevdenur Cizginer,Ana Maria Vranceanu,Christine S Ritchie
OBJECTIVE Understand challenges faced by older adults who undergo elective major surgery. BACKGROUND Preparation for and recovery from elective major surgery is often described from clinician perspectives, limiting insights into older patients' experiences. METHODS We conducted a qualitative study with adults age 65+ years, 30-90 days post colectomy, using interviews and surveys at a Northeastern U
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Preoperative Patient Education on Opioid Use and Pain after Surgery: A Randomized Trial. Ann. Surg. (IF 7.5) Pub Date : 2025-04-14 Alparslan Turan,Tyler Karras,Sara Medellin,Amita Kharabe,Elyad Ekrami,Jiayi Wang,Esra Kutlu Yalcin,Karan Shah,Kenneth Cummings,Kurt Ruetzler,Daniel I Sessler,
OBJECTIVE To evaluate the impact of preoperative analgesic education on postoperative opioid consumption, pain scores, and patient satisfaction with analgesia. BACKGROUND Effective postoperative pain management is crucial for patient recovery and satisfaction, yet opioid use poses risks of tolerance and addiction. Preoperative patient education offers a potential avenue to mitigate opioid reliance
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110,000 Preventable Deaths: The Most Impactful Gaps in Firearm Suicide Prevention Laws 2010-2019. Ann. Surg. (IF 7.5) Pub Date : 2025-04-11 Aksel D Laudon,Jeffrey A Franks,Elizabeth S Davis,Xuewei Zhao,Kelly Kenzik,Crisanto M Torres,Sophia Smith,Lisa Allee,Dane R Scantling
OBJECTIVE We sought to identify which absent firearm laws would have prevented the most firearm suicides (FS) in each state of the US. SUMMARY BACKGROUND DATA Prior studies suggested efficacy for FS prevention varies greatly between different firearm laws. However, this body of work did not probe how this efficacy may differ by state. METHODS This state-level, retrospective cohort study of firearm
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Toward Competency Based Medical Education: A Plea to Synergize Frameworks and Tools. Ann. Surg. (IF 7.5) Pub Date : 2025-04-11 Brigitte K Smith,Holly Caretta-Weyer,Adnan Alseidi
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Automatic Generation of Liver Virtual Models with Artificial Intelligence: Application to Liver Resection Complexity Prediction. Ann. Surg. (IF 7.5) Pub Date : 2025-04-11 Omar Ali,Alexandre Bône,Caterina Accardo,Belkacem Acidi,Amaury Facque,Paul Valleur,Chady Salloum,Marc-Michel Rohe,Irene Vignon-Clementel,Eric Vibert,
OBJECTIVE The clinical aim of this work is to predict intraoperative LRC from preoperative CT scans only. SUMMARY OF BACKGROUND DATA Liver resection (LR) is the most prevalent curative treatment for primary liver cancer, yet overall mortality/morbidity rates remain elevated. The conventional definition and classification of LR complexity (LRC) lack inclusion of the disease-induced 3D anatomical surgery
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Attitudes toward Sustainability among Surgeons at Ten Academic Hospitals in the United States: Are we Ready, Willing, and Incentivized to Change? Ann. Surg. (IF 7.5) Pub Date : 2025-04-11 Tejas S Sathe,Jaeyun Jane Wang,Kaiyi Wang,Thomas A Sorrentino,Ava Yap,Amir Ashraf Ganjouei,Patricia O'Sullivan,Garrett R Roll,Seema Gandhi,Hanmin Lee,Adnan Alseidi,
OBJECTIVE Given the outsized contribution of surgical care to the carbon footprint of the health sector, we aim to understand attitudes towards sustainability among academic surgeons in the United States (U.S.). SUMMARY BACKGROUND DATA The healthcare sector accounts for 8.5% of United States (U.S.) greenhouse gas emissions-of which one third come from surgical care. Though prior studies suggested that
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Randomized Controlled Trial - Perioperative Telemonitoring of Patient Generated Health Data in Gastrointestinal Oncologic (GI) Surgery: Assessing Outcomes. Ann. Surg. (IF 7.5) Pub Date : 2025-04-11 Kelly M Mahuron,Patricia Esslin,Virginia Sun,Oluwatimilehin Okunowo,Darrell Fan,Andreas M Kaiser,I Benjamin Paz,Mustafa Raoof,Aaron Lewis,Kurt A Melstrom,Lily I Lai,Yanghee Woo,Gagandeep Singh,Yuman Fong,Laleh G Melstrom
OBJECTIVE To determine whether perioperative monitoring with nursing triage intervention is feasible and improves surgical outcomes and recovery. BACKGROUND There are increased demands for outpatient recovery after complex gastrointestinal oncologic surgery with simultaneous expectations of improving quality of life and expedited functional recovery. Telemonitoring is a proposed mechanism to achieve
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Associations of Patient Age, Tumor Nephrectomy Weight, and Tumor Diameter with Event-Free and Overall Survival in Stage I or II Favorable Histology Wilms Tumor: A Pooled Analysis of Children's Oncology Group Studies AREN0532 and AREN03B2. Ann. Surg. (IF 7.5) Pub Date : 2025-04-11 Lindsay A Renfro,Kelly L Vallance,Ian C Tfirn,Nicholas Evageliou,Daniel J Benedetti,Robert C Shamberger,Peter F Ehrlich,Nicholas G Cost,Jennifer H Aldrink,Ann Schechter,Amy Treece,Lauren N Parsons,Amy L Walz,Kathryn S Sutton,Amy E Armstrong,Conrad V Fernandez,Jeffrey S Dome,James I Geller,Elizabeth A Mullen,
OBJECTIVE To evaluate age, TNW, or tumor diameter (TD) as continuous prognostic variables for outcomes in early stage FHWT after accounting for biology and treatment. SUMMARY OF BACKGROUND DATA Patient age (< 2 vs. ≥ 2 years) and tumor nephrectomy weight (TNW; < 550g vs. ≥ 550 grams) have been used to risk stratify children with stage I favorable histology Wilms tumor (FHWT) on Children's Oncology
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Use of an Intraoperative Head, Neck, and Back Support Exoskeleton on Surgeons' Pain and Posture. Ann. Surg. (IF 7.5) Pub Date : 2025-04-09 Joseph Y Kim,Hamid Norasi,Stephen D Cassivi,Dalliah M Black,M Susan Hallbeck
OBJECTIVE Evaluate the effectiveness of an intraoperative exoskeleton that supports surgeons' heads, necks, and backs to reduce neck discomfort. SUMMARY BACKGROUND DATA Surgeons are at a considerable risk of developing neck pain and related injuries. Passive exoskeletons are a potential intervention to support surgeons' body parts and alleviate strain and discomfort. METHODS The NekSpine TM (a passive
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The #HOPE4LIVER single-arm Pivotal Trial for Histotripsy of Primary and Metastatic Liver Tumors: 1-year Update of Clinical Outcomes. Ann. Surg. (IF 7.5) Pub Date : 2025-04-09 Timothy J Ziemlewicz,Jeffrey J Critchfield,Mishal Mendiratta-Lala,Philipp Wiggermann,Maciej Pech,Xavier Serres-Créixams,Meghan Lubner,Tze Min Wah,Peter Littler,Clifford R Davis,Govindarajan Narayanan,Sarah B White,Osman Ahmed,Zach S Collins,Neehar D Parikh,Mathis Planert,Maximilian Thormann,Guido Torzilli,Luigi A Solbiati,Clifford S Cho
OBJECTIVE To evaluate the 1-year clinical outcomes of patients enrolled in the #HOPE4LIVER trial of hepatic histotripsy. SUMMARY BACKGROUND DATA Histotripsy is a novel non-invasive, non-thermal focused ultrasound therapy that liquefies tissue at the focal point of the transducer. Following diagnostic ultrasound targeting, an automated treatment is performed via a robotic arm to treat a user-defined
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An Alternative to "Checkmark Credentialling" for Effective Physician Benchmarking and Professional Improvement. Ann. Surg. (IF 7.5) Pub Date : 2025-04-09 Thoralf M Sundt,John B Herman,Michael Jellinek
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Efficacy of Neoadjuvant Therapy and the Prognostic Significance of Serum Carcinoembryonic Antigen Level in Patients with Localized Pancreatic Adenocarcinoma with Non-elevated Carbohydrate Antigen 19-9 Levels. Ann. Surg. (IF 7.5) Pub Date : 2025-04-08 Guoliang Qiao,Xiang Li,Marwa Mohamed,Louisa Bolm,Qian Zhu,Carlos Fernandez Del-Castillo,Qi Zhang,Yiwen Chen,Zhiyong Yang,Keith D Lillemoe,Xueli Bai,Motaz Qadan,Tingbo Liang
OBJECTIVE This study evaluated the effect of neoadjuvant therapy (NAT) and the prognostic significance of carcinoembryonic antigen (CEA) levels in patients with non-elevated serum carbohydrate antigen (CA) 19-9 levels. SUMMARY BACKGROUND DATA The impact of NAT followed by surgical resection on oncologic outcomes in patients with localized pancreatic ductal adenocarcinoma (PDAC) remains unclear. METHODS
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Reduction of Central Venous Pressure in Elective Robotic and Laparoscopic Liver Resection: The PRESSURE Trial - A Randomized Clinical Study. Ann. Surg. (IF 7.5) Pub Date : 2025-04-08 Patrick Téoule,Niccolo Dunker,Johanna Debatin,Dorothée Sturm,Svetlana Hetjens,Valentin Walter,Erik Rasbach,Christoph Reissfelder,Emrullah Birgin,Nuh N Rahbari
OBJECTIVE To compare perioperative outcomes in patients undergoing minimally invasive liver surgery (MILR) with or without central venous pressure (CVP) reduction (≤5 mmHg). BACKGROUND Reduction CVP during parenchymal transection is widely accepted in open hepatectomy to reduce intraoperative blood loss, as a major predictor of postoperative outcomes. However, the effect of CVP reduction on blood loss
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Chronic Pain and Sexual Dysfunction After Groin Hernia Repair in Adolescents: A Nationwide Survey. Ann. Surg. (IF 7.5) Pub Date : 2025-04-07 Hugin Reistrup,Siv Fonnes,Jacob Rosenberg
OBJECTIVE To assess the prevalence of chronic pain and sexual dysfunction after groin hernia repair in adolescents. SUMMARY BACKGROUND DATA Adolescents present unique challenges in groin hernia management due to their evolving anatomy, yet data on patient-reported outcomes remain limited. METHODS A nationwide survey was conducted in Denmark, linking patient-reported outcomes to the Danish National
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Change is Hardest Right Before the Glass Ceiling Breaks: An Update on Women Pursuing Careers in Academic Surgery at a National Level. Ann. Surg. (IF 7.5) Pub Date : 2025-04-07 Haley Harris,Isabelle Tan,Yuqing Qiu,Julianna Brouwer,Jonathan Abelson,Julie Ann Sosa,Heather Yeo
OBJECTIVES This study aims to provide a comprehensive update on the representation of women in academic surgery by specialty, measuring progress and opportunity with regard to women "breaking" the glass ceiling at the trainee, faculty, and department chair levels. BACKGROUND Over the past two decades, initiatives have contributed to educational awareness, culture shifts, and a focus on inclusive excellence
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Treatment of Low Anterior Resection Syndrome in Specialized Multidisciplinary Late Sequelae Clinics: A Prospective Cohort Study. Ann. Surg. (IF 7.5) Pub Date : 2025-04-02 Mira Mekhael,Helle Ø Kristensen,Mette Borre,Asbjørn M Drewes,Katrine J Emmertsen,Janne Fassov,Klaus Krogh,Michael B Lauritzen,Søren Laurberg,Jakob Lykke Poulsen,Ole Thorlacius-Ussing,Peter Christensen,Therese Juul
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
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Beyond the Scalpel: Tackling Challenges Faced by LGBTQ+ Surgical Trainees and Faculty. Ann. Surg. (IF 7.5) Pub Date : 2025-04-02 Steven Xie,Andrew Schlussel,Jenny Shao
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An Open Letter from the American Board of Surgery Assessment Committee Regarding the Reporting of General Surgery In-Training Exam Scores. Ann. Surg. (IF 7.5) Pub Date : 2025-03-28 Peter S Yoo,Brenessa Lindeman,Andrew Jones
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Laparoscopic Resection Rectopexy Versus Delorme's Procedure In Full-Thickness Rectal Prolapse - A Randomized Multicenter Trial (DELORES-RCT). Ann. Surg. (IF 7.5) Pub Date : 2025-03-28 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 Hanloser,Anja Sander,Lukas D
OBJECTIVE The DELORES trial investigated whether laparoscopic resection rectopexy (LRR) is superior to Delorme's procedure (DP) in full-thickness rectal prolapse. SUMMARY OF BACKGROUND DATA 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
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Impact of Resection Margin Status on Recurrence and Possible Candidates for Adjuvant Radiotherapy in Resected Distal Cholangiocarcinoma. Ann. Surg. (IF 7.5) Pub Date : 2025-03-27 Won-Gun Yun,Yoon Soo Chae,Youngmin Han,Inhyuck Lee,Go-Won Choi,Younsoo Seo,Young Jae Cho,Hye-Sol Jung,Joon Seong Park,Jin-Young Jang,Wooil Kwon
OBJECTIVE To evaluate the prognostic impact of resection margin in distal cholangiocarcinoma (dCC). BACKGROUND Due to the relatively low prevalence of dCC in Western countries and the use of various definitions of resection margin status, the prognostic impact of bile duct resection margin status remains unclear. METHODS This study included consecutive patients who underwent curative surgery and were
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The Effect of Rurality on Time to Surgery and Overall Survival among Women with Breast Cancer. Ann. Surg. (IF 7.5) Pub Date : 2025-03-27 Kriyana P Reddy,Cara L Berkowitz,Kathleen Jarrell,Rachel Berger,Sarah Hulse,Leisha C Elmore,Rebecca Fishman,Alina M Mateo,Dahlia M Sataloff,Julia C Tchou,Jennifer Q Zhang,Anne Marie McCarthy,Oluwadamilola M Fayanju
OBJECTIVE How does distance to care affect time to surgery (TTS) and overall survival (OS) among rural patients with breast cancer? SUMMARY BACKGROUND DATA TTS>60 days is associated with known sociodemographic characteristics and worse OS after breast cancer diagnosis, but the relationship between rurality, proximity to care, TTS, and OS remains unknown. METHODS We identified females≥18 years with
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Greater Familiarity Between Surgeon and Operating Room Allied Health Staff is Associated with Shorter Case Duration - A Multi-Institutional Study. Ann. Surg. (IF 7.5) Pub Date : 2025-03-27 David A Etzioni,Melana Elliot,Lani MacMillan,Mark Tyson,Steven P Petrou,Matthew P Abdel,Christina M Cadaret,Ross F Goldberg,Elizabeth B Habermann,Robert R Cima,Yu-Hui Chang,Christopher Hasse
OBJECTIVE To characterize the relationship between surgeon-staff familiarity and the time required to perform an operation. SUMMARY BACKGROUND DATA The clinical and operational efficiency of operating rooms (ORs) is a driver of hospital finances and patient outcomes. Surgeon-staff familiarity is an important focus for quality improvement and process optimization. METHODS A retrospective cohort study
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Ductal Cancerization at the Pancreatic Neck Margin: Prevalence and Oncologic Relevance. Ann. Surg. (IF 7.5) Pub Date : 2025-03-27 Michael J Pflüger,Doreen M Zucha,Benedict Kinny-Köster,Brian A Pedro,Jiayun Lu,Shuang Zhang,Hao Wang,John L Cameron,Elizabeth D Thompson,Jin He,Laura D Wood
OBJECTIVE To determine the prevalence of ductal cancerization at the pancreatic neck margin and to investigate its prognostic significance. SUMMARY BACKGROUND DATA Ductal cancerization (cancerization of ducts; COD) describes the growth of invasive cancer in pre-existing ducts, and is frequently seen in pancreatic cancer resection specimens. Although COD is a well-defined histological diagnosis, it
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Fully Robotic Left Lobe Donor Hepatectomy is Safer Compared to Open. Ann. Surg. (IF 7.5) Pub Date : 2025-03-26 Dieter C Broering,Yasser Elsheikh,Yasir Alnemary,Daniel Borja-Cacho,Mark L Sturdevant,Saleh Alabbad,Massimo Malago,Dimitri A Raptis,
OBJECTIVE To compare the outcomes of fully robotic versus open left lobe donor hepatectomies, focusing on donor safety. SUMMARY BACKGROUND DATA Right lobe hepatectomies are traditionally preferred for adult liver transplants due to their larger graft size but may involve increased risks for donors. Left lobe hepatectomies are considered safer for donors but are less commonly used due to concerns about
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Lowest Measured Temperature and Adverse Outcomes after Cardiac Surgery: Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery DatabaseTM. Ann. Surg. (IF 7.5) Pub Date : 2025-03-26 Karsten Bartels,Hilary P Grocott,Bruce A Bollen,Xiaoke Feng,Svetlana K Eden,Matthew S Shotwell,Joseph D Schmoker,Ashish S Shah,G Burkhard Mackensen,Gudrun Kunst,Louise Y Sun,Thomas A Schwann,Frederick W Lombard,Miklos D Kertai
OBJECTIVE To determine the relationship between intraoperative lowest measured temperature (LMT) during cardiac surgery using cardiopulmonary bypass (CPB) and the risk for postoperative stroke. Secondarily, to determine the association between LMT and risk for 30-day mortality and other adverse outcomes. BACKGROUND The effectiveness of deliberate hypothermia during CPB for the prevention of cardiac
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Development and Validation of Models for Preoperative Prediction of Risk and Postoperative Detection of Non-Infectious Complications Using Interpretable Machine Learning and Electronic Health Record Data. Ann. Surg. (IF 7.5) Pub Date : 2025-03-26 Adam Dyas,Christina M Stuart,Yizhou Fei,Robert A Meguid,Yaxu Zhuang,William G Henderson,Michael R Bronsert,Kathryn L Colborn
OBJECTIVE To apply interpretable machine learning methodology to electronic health record (EHR) data to develop models for preoperative risk estimation and postoperative detection of non-infectious postoperative complications. SUMMARY BACKGROUND DATA We previously developed preoperative risk and postoperative detection models for surveillance of postoperative infections. The purpose of the present
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Language Serving Hospitals and their Impact on Readmission for Surgical Patients with a Non-English Primary Language: A Retrospective Cohort Study. Ann. Surg. (IF 7.5) Pub Date : 2025-03-25 Brittany M Dacier,Alyssa N Jones,Benjamin G Allar,Jesus Mejia,Bryan S Torres,Rachel E Murphy,Nayeli Magana,Regan W Bergmark,Andrea L Pusic,Alicia Fernandez,David W Bates,Gregory L Peck,Gezzer Ortega
OBJECTIVE To assess postoperative readmission for patients with non-English primary language (NEPL) at Language Serving Hospitals (LSH) versus non-LSH. SUMMARY BACKGROUND DATA Patients with NEPL have worse surgical outcomes compared to patients with an English primary language. Hospital-level language access resources vary, potentially leading to disparate health outcomes. METHODS We performed a retrospective
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Contemporary Outcomes of Pancreatic Head Resection for Chronic Pancreatitis. Ann. Surg. (IF 7.5) Pub Date : 2025-03-21 Kyle A Lewellen,Thomas K Maatman,Andrew J Thyen,Meghan E Lark,James R Butler,Eugene P Ceppa,Michael G House,Attila Nakeeb,Alexandra M Roch,C Max Schmidt,Nicholas J Zyromski
OBJECTIVE To evaluate perioperative morbidity and mortality outcomes in a large, contemporary series of patients undergoing pancreas head resection for chronic pancreatitis. SUMMARY BACKGROUND DATA Select chronic pancreatitis (CP) patients benefit from pancreatic head resection, but contemporary data are sparse. Anatomy dictates selection of duodenum-preserving pancreatic head resection (DPPHR) or
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A New Gold Standard? Impact of Broad-spectrum Penicillin-based Antibiotic Prophylaxis on Outcome After Pancreatoduodenectomy - Results of a Systematic Review and Meta-analysis (PROSPERO CRD42024559197). Ann. Surg. (IF 7.5) Pub Date : 2025-03-21 Julian C Harnoss,Darius Halm,Sophie Weber,Benedict Kinny-Köster,Max Heckler,Rosa Klotz,Eva Kalkum,Jonathan M Harnoss,Julian Musa,Pascal Probst,Christoph W Michalski,Martin Loos,Thomas Hank
OBJECTIVE This review evaluated whether broad-spectrum penicillin-based antibiotic prophylaxis (BS-AB) such as piperacillin-tazobactam might lead to better outcomes in pancreatoduodenectomy compared to standard care antibiotics, mainly cephalosporins (CE-AB). BACKGROUND Pancreatoduodenectomy is commonly associated with high postoperative infectious complications contributing to increased morbidity
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Circulating Tumor DNA Assessment to Predict Risk of Recurrence after Surgery in Patients with Locally Advanced Esophageal Squamous Cell Carcinoma: A Prospective Observational Study. Ann. Surg. (IF 7.5) Pub Date : 2025-03-21 Shogo Takei,Daisuke Kotani,George Laliotis,Kazuma Sato,Naoto Fujiwara,Akihito Kawazoe,Tadayoshi Hashimoto,Saori Mishima,Izuma Nakayama,Yoshiaki Nakamura,Hideaki Bando,Yasutoshi Kuboki,Shingo Sakashita,Erik Spickard,Giby V George,Punashi Dutta,Shruti Sharma,Meenakshi Malhotra,Himanshu Sethi,Adham Jurdi,Minetta C Liu,Takayuki Yoshino,Kohei Shitara,Takashi Kojima,Takeo Fujita
OBJECTIVE To investigate the association between perioperative ctDNA status and prognosis in patients with esophageal squamous cell carcinoma (ESCC). BACKGROUND Circulating tumor DNA (ctDNA) has emerged as a promising biomarker for assessing molecular residual disease (MRD) in various malignancies. However, there are limited studies evaluating the utility of ctDNA for predicting recurrence risk in
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Rural Surgery Needs a Strategy, Not Just Another Training Track or Rotation. Ann. Surg. (IF 7.5) Pub Date : 2025-03-21 Cody Lendon Mullens,Tyler G Hughes
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Personalized Surveillance Intervals for Intraductal Papillary Mucinous Neoplasm (IPMN): Multicenter Study Using Parametric Models. Ann. Surg. (IF 7.5) Pub Date : 2025-03-21 Claudio Ricci,Stefano Crippa,Johnathan Hee,Hyesol Jung,Gabriele Capurso,Marco Ferronato,José Lariño Noia,Myrte Gorris,Paula Ghaneh,Ihsan Ekin Demir,Nuzhat Ahmad,Max Heckler,Giulio Belfiori,Francesca Aleotti,Youngmin Han,Wooil Kwon,Gaetano Lauri,Matteo Tacelli,Olivier Busch,Kulbir Mann,Marina Migliori,Paolo Giorgio Arcidiacono,Helmut Friess,Charles M Vollmer,Thilo Hackert,Marc Besselink,Riccardo Casadei
OBJECTIVE The aim was to build a calculator for personalized surveillance of BD-IPMNs. SUMMARY BACKGROUND DATA The interval time for surveillance of low-risk branch duct intraductal papillary mucinous neoplasms (BD-IPMNs) has not been established yet. METHODS The study included an international cohort of BD-IPMNs without worrisome features (WFs) or high-risk stigmata (HRS). IPMN evolution was defined