Ralph C Quillin

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A 59-year-old woman presenting with what appeared to be a perforated gallbladder was found at surgery to have a spontaneous perforation of the common bile duct, a rare condition more commonly seen in children. The bile duct was managed with an endoscopic stent, and the gallbladder was removed in a delayed procedure. The case highlights that bile duct perforation should be considered when patients with cholecystitis deteriorate unusually quickly.

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Using national transplant data from 2016 to 2024, researchers compared outcomes for liver transplant recipients whose organs were preserved with hypothermic versus normothermic machine perfusion. Both approaches expanded use of higher-risk donors dramatically, and one-year graft survival rates were statistically equivalent between the two methods. This is the first national comparison of the two techniques and confirms that neither method is clearly superior at the population level.

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At a single US center, livers from donation-after-circulatory-death donors preserved with hypothermic oxygenated machine perfusion had dramatically fewer complications than those preserved with traditional cold storage — with near-zero rates of the most serious bile duct injury. This benefit held even though the machine-perfused donors were older and had longer warm ischemia times, meaning higher-risk organs performed better when treated with the new technology. The study is the first US clinical series to confirm the European trial findings in this donor type.

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Researchers analyzed case logs from 1,343 general surgery graduates across 20 programs to characterize the training experience of those who pursued a surgical oncology fellowship. Future oncology fellows performed more cancer-relevant operations — particularly liver, pancreas, and endocrine cases — and were more likely to train at university-based programs with dedicated oncology faculty and NCI cancer centers. Dedicated research time and institutional NIH funding were the strongest independent predictors of pursuing this fellowship path.

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A single center reviewed 194 liver transplants using organs from donors with hepatitis C, following recipients for a median of 53 months. Transmission of hepatitis C occurred in only 6% of recipients who received antibody-positive but virus-negative organs, and every case was successfully treated. Long-term patient and graft survival were identical regardless of whether the donor organ carried the hepatitis C virus, confirming these organs can be used safely over the long term.

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Using data from the National Lung Screening Trial, researchers compared surgical outcomes for current versus former smokers undergoing lung cancer resection. Current smokers had higher rates of moderate-to-major complications but no difference in mortality compared to former smokers, and current smokers were more likely to be racial minorities. Requiring smoking cessation before surgery may worsen racial disparities without providing a clear mortality benefit.

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Transplant surgeons at a high-volume center wore biophysical monitors for five months, allowing researchers to measure their sleep deprivation and stress levels during 36 liver transplants. Surgeons were sleep-deprived in half of cases and under high stress in nearly all of them, yet most patient outcomes were comparable. The notable exception was bile leaks, which were more common when the surgeon was sleep-deprived — a finding warranting further investigation.

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A multi-institutional analysis of surgical training logs found that residents who went on to pursue breast surgical oncology fellowships performed 50% more breast operations during residency than their peers, despite having similar access to breast surgery rotations. However, these same residents logged fewer total cases across most other surgical domains. The pattern suggests future breast surgeons self-select toward breast cases early in training, with implications for how residency programs should be structured.

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Researchers measured blood markers of vascular injury in 51 kidney transplant patients before surgery and at multiple points afterward. Most markers of endothelial stress were highest before transplant and fell after surgery, suggesting the transplant itself partially relieves the chronic vascular damage caused by kidney failure. Two specific markers — PECAM-1 and VEGF-A — behaved differently and may help predict complications like delayed graft function.

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A study of nearly 5,000 kidney transplant referrals found that patients living in the most economically deprived neighborhoods were significantly less likely to be waitlisted or transplanted than those in wealthier areas. Researchers used this finding to build a scoring tool — the Kidney Transplant Access Prediction score — that identifies at the time of referral which patients are most at risk of never receiving a transplant. The tool can help transplant centers target outreach and support to patients who need it most.

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Using a decade of national transplant registry data, this study tracked how outcomes for obese liver transplant candidates and recipients have changed over time. Patients with severe obesity are now being listed and transplanted at higher illness severity scores than before, yet their waitlist and post-transplant mortality have both improved substantially over the study period. These favorable trends suggest that severely obese patients should be referred for evaluation earlier rather than deferred.

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A prospective single-center study followed 364 liver and kidney transplant recipients who received organs from donors with detectable hepatitis B virus in the blood. While about 15% of liver recipients developed post-transplant hepatitis B, every case cleared with antiviral treatment, and long-term patient and graft survival were equivalent to those who received hepatitis B-negative organs. This is the largest and longest follow-up study confirming that hepatitis B viremic organs can safely expand the donor pool.

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Thirty surgical faculty and residents tried to identify which of six personal statements were written by AI and which by real medical students, and they succeeded only 59% of the time — barely better than chance. AI-generated statements were actually rated as the best ones 60% of the time, yet most reviewers said AI use should be prohibited and would negatively affect their opinion of an applicant. The study exposes a fundamental enforcement gap: programs cannot reliably detect what they say they will penalize.

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A national survey of 481 surgeons found clear generational, regional, and gender differences in white coat preferences. Surgeons in the Midwest and those with more than 20 years of experience wore white coats most frequently, while women surgeons were more likely to wear one in clinic and more likely to say it helps distinguish them from nurses. The findings show that attire choices are deeply shaped by culture and professional identity rather than purely personal preference.

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After the 2020 organ allocation policy change known as acuity circles, the proportion of liver transplants performed using a local surgeon to recover the organ instead of the transplant center's own team rose from 22% to 38%. Despite local recovery being associated with longer cold ischemia times and greater travel distances for the organ, patient and graft survival were identical to primary team recovery. Local recovery appears safe and may help increase the total number of liver transplants performed.

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After COVID-19 forced a switch to virtual residency interviews in 2021, applicants became more competitive across general surgery, surgical subspecialties, and integrated specialties, while application volumes and program workload increased substantially. Match rates remained stable in most specialties, but the surgical subspecialties saw a small decline. The findings confirm that virtual interviewing has fundamentally changed the application landscape, with downstream effects that are still unfolding.

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A multi-institutional study of 1,342 general surgery graduates found that residents who pursued transplant fellowships had more transplant operative experience during residency, but the strongest predictors of choosing transplant were being a racial or ethnic minority, training at a program co-located with a transplant fellowship, and higher total transplant case volume. Each additional transplant operation a resident performed increased their odds of pursuing the field by 12%. The results suggest that exposure and mentorship — not demographics — are the most actionable levers for growing the transplant workforce.

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Researchers reviewed 565 liver transplants at a single center and found that 25% used organs that had been rejected by one or more other programs — so-called late-turndown livers. Recipients of these organs had similar 30-day, 6-month, and one-year survival compared to primary recipients, and median waitlist time fell sharply over the study period as late-turndown use increased. With careful selection, late-turndown livers can substantially increase transplant rates without compromising outcomes.

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A national cross-sectional study of 536 academic transplant surgeons found that women, who make up 17% of the field, have lower H-indices and fewer publications than men even after adjusting for academic rank. Men had been in practice longer on average, but women still had lower academic metrics in multivariable analysis, pointing to structural barriers beyond experience. The study calls for targeted interventions to address gender inequity in transplant surgery academia.

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A multicenter US randomized trial tested a portable hypothermic oxygenated machine perfusion device against standard cold storage for liver preservation before transplant. Early allograft dysfunction rates were 11% versus 16%, establishing that the machine perfusion approach was non-inferior to cold storage. Recipients of machine-perfused livers also had lower predicted graft failure scores and fewer biliary complications, supporting the safety and potential benefit of this preservation method.

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Using a national surgical database, researchers identified a seven-and-a-half-hour operative time threshold beyond which robotic pancreaticoduodenectomy became more dangerous than open surgery. Patients whose robotic procedures exceeded this threshold had higher rates of major complications and 30-day mortality than comparable open surgery patients. Obstructive jaundice and small pancreatic duct diameter were the main preoperative risk factors for prolonged robotic cases.

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For the roughly half of colorectal cancer patients who develop liver metastases, surgical removal cures only a fraction because most disease is not resectable. Liver transplantation has been tested in initial prospective trials as an option for carefully selected patients with unresectable disease, showing a meaningful survival benefit. This review argues that transplantation will likely become part of the standard multidisciplinary approach to metastatic colorectal cancer as patient selection criteria improve.

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A post-hoc analysis of training logs from 1,343 general surgery residents identified characteristics associated with landing in the bottom quartile for total operative volume. Low-volume residents were more likely to be female, underrepresented in medicine, and training at low-volume or highly NIH-funded programs. The findings highlight that disparities in operative experience are shaped by both individual and institutional factors that can be targeted for intervention.

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A multi-institutional study of case logs from 1,343 general surgery graduates found that Black residents performed 76 fewer total cases than White residents after adjustment for other factors, a gap that persisted throughout the entire 11-year study period. The disparity was concentrated in surgeon junior cases — the hands-on, learning-level role — suggesting Black residents are getting fewer opportunities at the exact stage of training most critical for skill development. No evidence of narrowing over time was found.

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A five-year follow-up study compared liver transplant recipients who needed temporary abdominal closure at the time of surgery to those whose abdomens were closed immediately. Patients requiring temporary closure were sicker going in and had longer hospital stays and higher readmission rates, but five-year survival was equivalent between the two groups in adjusted analysis. Temporary abdominal closure is a safe management option for the most complex transplant patients.

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This review discusses liver transplantation as an emerging treatment option for patients with colorectal cancer that has spread to the liver and cannot be removed surgically. Several small clinical trials have been completed showing a survival benefit in selected patients, and multiple ongoing trials are evaluating safety and outcomes more rigorously. Transplant oncology is positioned to become a standard option for this patient population that currently has limited alternatives to palliative chemotherapy.

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Across 1,343 general surgery graduates from 20 programs over 11 years, women performed significantly fewer total cases than men, largely due to fewer surgeon junior cases — the core learning role. On multivariable analysis, female sex independently reduced the odds of being a high-volume resident by 26%. The gap appears to be narrowing slowly over time, with women increasing their annual case volume faster than men, but the disparity has not been eliminated.

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A survey of 60 residency applicants who interviewed virtually during the 2020-2022 cycles found that 88% came away with a more favorable view of the program after a virtual interview, and factors like resident interactions and program culture were most influential. Half of applicants favored virtual-only interviews, but the majority wanted a hybrid option going forward. Applicants broadly supported capping interview numbers to reduce the burden on applicants and programs alike.

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Case logs for 50 surgical subspecialty residents were analyzed alongside a survey about their general surgery rotation experience. Subspecialty residents performed significantly fewer cases per month on surgery rotations compared to categorical general surgery residents, but 75% were satisfied with the experience and considered it valuable. The findings suggest these rotations are well regarded but structurally limited in the operative exposure they provide.

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Researchers used national transplant database records to categorize 209 early-career transplant surgeons by the type of transplant they performed most in their first five years of practice. About 41% were kidney-predominant, 18% liver-predominant, and 41% performed multiple organ types. Multiorgan surgeons performed the most transplants overall, and this data provides the first published picture of what a transplant career actually looks like after fellowship.

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A national transplant database study found that 24% of transplant surgeons who entered the field between 2008 and 2018 had left the field within a median of 2.75 years. Surgeons who left had lower case volumes, performed fewer pediatric transplants, and made up a smaller share of their center's volume — and their patients had worse outcomes. This is the first study to quantify how common early career departure is in transplant surgery and its association with poorer patient results.

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Using the National Cancer Database, researchers compared survival outcomes for colorectal liver metastasis patients whose tumors had DNA mismatch repair defects (microsatellite instability) versus those with stable microsatellites. Contrary to what is seen in early-stage colorectal cancer, microsatellite instability was associated with worse overall survival after liver metastasis resection. The finding establishes this biomarker as clinically meaningful for prognosis in the metastatic setting.

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An analysis of pediatric surgery fellowship match data and operative case logs from 2009 to 2019 found that the field remains the most competitive surgical subspecialty fellowship, with the highest proportion of unmatched applicants. Despite this selectivity, the total number of index operations completed by pediatric surgery fellows fell by 59 cases over the decade. The trend raises concerns about whether current training produces surgeons with adequate operative experience.

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A comparison of operative case logs from 5,482 general surgery graduates and 4,152 practicing surgeons found that resident training closely mirrors real-world practice in core domains like abdominal and alimentary tract surgery. Residents get more experience in subspecialty areas like trauma and vascular surgery due to their training environment, while practicing surgeons do more breast work. The data provide reassurance that surgical training is appropriately aligned with the operations graduates will encounter in practice.

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Across 1,192 general surgery graduates at 18 programs, residents who went on to any given fellowship consistently performed more cases in their future specialty area than peers who chose different careers — a pattern that held across all 12 fellowship types. This pre-specialization trend was observed at both the junior and senior levels of training. The findings suggest that early career interest shapes operative experience and should be factored into how residency programs are designed.

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A review of 334 cholecystectomy consent forms found that residents consistently documented more potential complications than attending surgeons — including bile duct injury, bile leak, and need for reoperation — despite equivalent patient populations. The difference likely reflects residents' more thorough medicolegal training rather than a difference in surgical risk awareness. The study highlights an opportunity to standardize consent documentation through better education about informed consent principles.

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In a multi-institutional study of 1,264 general surgery graduates, the 20% who entered practice directly after residency had higher operative volumes and were more likely to be graduates of high-volume programs. Research experience and fellowship training were the strongest factors pulling residents toward fellowship rather than direct practice. The findings help characterize who goes directly into practice and suggest that programs can better support both career paths through targeted mentorship.

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Researchers developed the Kidney Transplant Equity Index, a metric that measures how well individual transplant centers serve racial and ethnic minority patients relative to the rate of kidney failure in those communities. High-scoring centers transplanted far more Black, Hispanic, and Native American patients than low-scoring centers, and they also served more socioeconomically disadvantaged populations — while achieving better patient survival. The metric creates an accountability tool for identifying and spreading best practices in equitable access to transplantation.

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Using national cancer registry data, researchers compared survival outcomes for patients with intrahepatic bile duct cancer staged as T2, distinguishing between those with a single tumor and vascular invasion versus those with multiple tumors. Patients with multiple tumors had significantly worse overall survival than those with a single tumor even after surgical removal, and the gap was comparable to having lymph node-positive disease. The findings argue that current staging should separate these two groups because they carry meaningfully different prognoses.

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National transplant data from 2011 to 2019 showed that patients who received a donation-after-circulatory-death liver transplant at a low-volume center had significantly higher rates of graft failure and death at one year compared to those treated at high-volume centers. The busiest 5% of centers — those performing more than five such transplants per year — drove all of the mortality benefit, while no volume effect was detectable among the remaining 95% of centers. The findings support concentration of this technically demanding procedure at experienced centers.

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After a 2017 policy change gave liver transplant recipients with persistent kidney failure faster access to kidney transplants, the number of patients listed for and receiving a kidney after liver transplant increased substantially. Post-policy kidney after liver transplant recipients received more locally sourced organs and waited less time, while outcomes — including graft and patient survival — were equivalent to those seen in matched kidney transplant alone and simultaneous liver-kidney recipients. The safety-net policy achieved its intended goal.

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Case log data showed that the COVID-19 pandemic reduced general surgery resident case volumes nationally, with 2020 graduates completing about 1.5% fewer total cases and 8% fewer chief-level cases than 2019 graduates. At one institution, residents across all training levels performed 42% fewer operations during peak pandemic months. The magnitude of the impact on training quality and future competency warrants continued monitoring.

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In the first study to transplant hepatitis B virus-active organs into recipients with no hepatitis B history, 89 kidney and liver transplant recipients were followed for a median of one year. Post-transplant hepatitis B viremia occurred in 16% of kidney and 27% of liver recipients but cleared in nearly all cases with antiviral therapy. No HBV-related complications occurred, and graft and patient survival were no different from recipients who received HBV-negative organs.

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A PubMed search of 26 general and surgical subspecialty journals from 2015 to 2019 found that surgical education research makes up only about 1% of all surgical publications. General surgery journals published a significantly higher proportion of education research than subspecialty journals. The low overall volume and uneven distribution suggest that the field lacks a systematic, rigorous scientific approach to studying how surgeons should be trained.