Annals of Surgery

Objective: We investigated neurotensin receptor 1 (NTSR1) as a potential mediator of the mechanical immune barrier that contributes to T-cell exclusion. Summary Background Data: The efficacy of immunotherapy in advanced colorectal cancer (CRC) is limited by primary resistance, frequently characterized by an “immune-excluded” phenotype where physical and biological barriers prevent effector T-cell…

Background: Standardized prescribing models can reduce discharge opioid prescription and excess pill volumes, mitigating potential opioid dependence and diversion after abdominal operations. This study’s objective was to determine which of 2 validated discharge prescribing models resulted in fewer opioids prescribed and consumed after major abdominal surgery. Methods: This was a pragmatic single-…

Objective: To evaluate the clinical validity of the critical view of quality (CVQ) as a measure of lymphadenectomy quality in minimally invasive distal gastrectomy and to develop a computer vision model for automated CVQ assessment. Background: Objective intraoperative assessment of lymphadenectomy quality in gastric cancer surgery remains limited, relying largely on postoperative surrogate marke…

Objective: To examine national trends in bivalirudin use among neonates with congenital diaphragmatic hernia (CDH) supported with extracorporeal membrane oxygenation (ECMO) and to evaluate its association with mortality and morbidity. Summary Background Data: Preliminary data suggest that first-line anticoagulation of the ECMO circuit with bivalirudin, a direct thrombin inhibitor, may improve out…

Objective: To characterize the incidence, clinical phase, team responsibility, and behavioral drivers of non-technical errors (NTEs) associated with death in emergency general surgery to inform future NTS improvement strategies. Background Data: Deficiencies in surgical non-technical skills (NTS) contribute substantially to patient harm. Emergency general surgery is common, complex, and high-risk…

Background: Obesity contributes to chronic inflammation and estrogen dysregulation, mechanisms linked to increased breast cancer (BC) risk and recurrence, particularly in postmenopausal women. Bariatric surgery and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are effective weight-loss interventions, but their comparative impact on BC outcomes remains unclear. This study compared long-term…

Objective: To develop a predictive model for pathological complete response (pCR) after total neoadjuvant therapy (TNT) to inform selection for watch-and-wait (W/W). Summary Background Data: Patient selection for W/W after TNT for locally advanced rectal cancer remains challenging. Methods: An ensemble of tabular foundation models was fine-tuned in adults with clinical stage II or III microsatell…

Objective: To explore surgical clinicians’ understanding of and activities related to palliative care (PC) in major elective surgery among seriously ill older adults. Summary Background Data: Despite professional standards and guidelines, PC remains infrequently utilized among seriously ill older adults undergoing major elective surgery. Methods: We conducted observations of clinic encounters and…

Objective: To compare outcomes of single(SLT) versus bilateral(BLT) lung transplantation among dually listed recipients hypothetically eligible for either treatment. Summary Background Data: Considerable debate remains regarding the added benefit of BLT versus SLT. Prior analyses were confounded by significant selection bias or limited in generalizability to the contemporary era; a randomized tri…

Objective: ABRUPT2 was a prospective, randomized, multicenter trial to determine whether lactated Ringer’s + 5% albumin (Alb) reduces resuscitation requirements compared to lactated Ringer’s (LR) alone in major burns. Summary Background Data: The prospective, observational, multicenter ABRUPT study(1) found that initiation of albumin rapidly lowered fluid input and improved urine output in patien…

Objective: This study prospectively compared lymphedema rates with perometer, tape measure, and bioimpedance spectroscopy (L-Dex) in patients with breast cancer undergoing axillary lymph node dissection (ALND). Background: Perometer, tape measure, and L-Dex are all used for diagnosing lymphedema, although lymphedema rates may vary between these techniques. Methods: From November 2016 to March 202…

Objective: To evaluate the safety and efficiency of a novel computed tomography (CT)-guided hookwire localization technique, aiming to enable parenchyma-sparing wedge resection using video-assisted thoracoscopic surgery (VATS) for small, hilar-proximal, ground-glass opacity (GGO)-dominant nodules. Summary Background Data: Localizing hilar-proximal GGOs remains challenging. For small, hilar-proxim…

Objective: To compare 1-year changes in estimated 10-year and lifetime atherosclerotic cardiovascular disease (ASCVD) risk following metabolic and bariatric surgery (MBS) versus glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy among adults with obesity. Summary Background Data: Obesity is a major driver of ASCVD through adverse metabolic and inflammatory pathways. Metabolic and bariatri…

Objective: To evaluate the impact of trauma center care on one-year mortality among injured older adults. Background: Older adults represent the fastest growing population of injured patients, however the long-term benefit of trauma center care among these patients is unknown. Methods: We performed a population-based cohort study of individuals age ≥ 65 with moderate or severe injuries (presence …

Objective: To assess the association between preoperative radiotherapy (RT) and major postoperative complications in patients with primary retroperitoneal sarcoma (RPS). Background: The effect of preoperative RT on postoperative morbidity in patients undergoing surgery for primary RPS remains uncertain. Methods: In the post hoc analysis, analyses were performed for the entire STRASS cohort and fo…