JAMA surgery最新文献

{"title":"The Future of Oncology Is Now.","authors":"Syed A Ahmad,Greg C Wilson,Sameer H Patel","doi":"10.1001/jamasurg.2025.1978","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1978","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"187 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shifting From Thoracic Epidurals to Nerve Blocks-Redefining Gold Standards.","authors":"Joseph D Phillips","doi":"10.1001/jamasurg.2025.1920","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1920","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"13 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anastomotic Leak Prevention.","authors":"Xiaoyao Shen, Xiang Xia, Zizhen Zhang","doi":"10.1001/jamasurg.2025.1914","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1914","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intercostal or Paravertebral Block vs Thoracic Epidural in Lung Surgery: A Randomized Noninferiority Trial.","authors":"Louisa N Spaans,Marcel G W Dijkgraaf,Denis Susa,Erik R de Loos,Jo M J Mourisse,R Arthur Bouwman,Ad F T M Verhagen,Frank J C van den Broek,,Patrick Meijer,Marieke Kuut,Nike Hanneman,Jelle Bousema,Aimée Franssen,Hes Brokx,Eino van Duyn,Jan-Willem Potters,Renee van den Broek,Thomas van Brakel,Herman Rijna,Annemieke Boom,Valentin Noyez,Jeroen M H Hendriks,Suresh K Yogeswaran,Chris Dickhoff,Martijn van Dorp","doi":"10.1001/jamasurg.2025.1899","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1899","url":null,"abstract":"ImportanceEffective pain control after thoracic surgery is crucial for enhanced recovery. While thoracic epidural analgesia (TEA) traditionally ensures optimal analgesia, its adverse effects conflict with the principles of enhanced recovery after thoracic surgery. High-quality randomized data regarding less invasive alternative locoregional techniques are lacking.ObjectiveTo evaluate the efficacy of continuous paravertebral block (PVB) and a single-shot intercostal nerve block (ICNB) as alternatives to TEA.Design, Setting, and ParticipantsThis randomized clinical trial compared PVB and ICNB vs TEA (1:1:1) in patients undergoing thoracoscopic anatomical lung resection at 11 hospitals in the Netherlands and Belgium, enrolled from March 5, 2021, to September 5, 2023. The study used a noninferiority design for pain and a superiority design for quality of recovery (QoR).InterventionsContinuous PVB and single-shot ICNB.Main Outcomes and MeasuresPrimary outcomes were pain, defined as mean proportion of pain scores 4 or greater during postoperative days (POD) 0 through 2 (noninferiority margin for the upper limit [UL] 1-sided 98.65% CI, 17.5%), and QoR, assessed with the QoR-15 questionnaire at POD 1 and 2. Secondary measures included opioid consumption, mobilization, complications, and hospitalization.ResultsA total of 450 patients were randomized, with 389 included in the intention-to-treat (ITT) analysis (mean [SD] age, 66 [9] years; 208 female patients [54%] and 181 male [46%]). Of these 389 patients, 131 received TEA, 134 received PVB, and 124 received ICNB. The mean proportions of pain scores 4 or greater were 20.7% (95% CI, 16.5%-24.9%) for TEA, 35.5% (95% CI, 30.1%-40.8%) for PVB, and 29.5% (95% CI, 24.6%-34.4%) for ICNB. While PVB was inferior to TEA regarding pain (ITT: UL, 22.4%; analysis per-protocol [PP]: UL, 23.1%), ICNB was noninferior to TEA (ITT: UL, 16.1%; PP: UL, 17.0%). The mean (SD) QoR-15 scores were similar across groups: 104.96 (20.47) for TEA, 106.06 (17.94; P = .641) for PVB (P = .64 for that comparison), and 106.85 (21.11) for ICNB (P = .47 for that comparison). Both ICNB and PVB significantly reduced opioid consumption and enhanced mobility compared with TEA, with no significant differences in complications. Hospitalization was shorter in the ICNB group.Conclusions and RelevanceAfter thoracoscopic anatomical lung resection, only ICNB provides noninferior pain relief compared with TEA. ICNB emerges as an alternative to TEA, although risks and benefits should be weighed for optimal personalized pain control.Trial RegistrationClinicalTrials.gov Identifier: NCT05491239.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"66 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence-Powered Spatial Analysis of Immune Phenotypes in Resected Pancreatic Cancer.","authors":"Hyemin Kim,Jin Ho Choi,Yoojoo Lim,So Jeong Yoon,Kee-Taek Jang,Chan-Young Ock,Young Hoon Choi,Cheolyong Joe,Sanghoon Song,Jimin Moon,Heon Song,Sergio Pereira,Seungeun Lee,Sujin Park,Kyunga Kim,Se-Hoon Lee,Hongbeom Kim,Sang Hyun Shin,Jin Seok Heo,Kwang Hyuck Lee,Kyu Taek Lee,Jong Kyun Lee,In Woong Han,Joo Kyung Park","doi":"10.1001/jamasurg.2025.1999","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1999","url":null,"abstract":"ImportanceAlthough tumor-infiltrating lymphocytes (TILs) have been implicated as prognostic biomarkers across various malignancies, the clinical application remains challenging. This study evaluated the applicability of artificial intelligence (AI)-powered spatial mapping of TIL density for prognostic assessment in resected pancreatic ductal adenocarcinoma (PDAC).ObjectiveTo evaluate the prognostic significance of AI-powered spatial TIL analysis in resected PDAC and its clinical applicability.Design, Setting, and ParticipantsThis cohort study included patients with PDAC who underwent up-front R0 resection at a tertiary referral center between January 2017 and December 2020. Whole-slide images of retrospectively enrolled patients with PDAC and up-front R0 resection were analyzed. An AI-powered whole-slide image analyzer was used for spatial TIL quantification, segmentation of tumor and stroma, and immune phenotype classification as immune-inflamed phenotype, immune-excluded phenotype, or immune-desert phenotype. Study data were analyzed from January 2017 to August 2023.ExposureUse of AI-powered spatial analysis of the tumor microenvironment in resected PDACs.Main Outcomes and MeasuresTumor microenvironment-related risk factors and their associations with overall survival (OS) and recurrence-free survival (RFS) outcomes were identified.ResultsAmong 304 patients, the mean (SD) age was 66.8 (9.4) years with 171 male patients (56.3%), and preoperative clinical stages I and II were represented by 54.3% patients (165 of 304) and 45.7% patients (139 of 304), respectively. The TILs in the tumor microenvironment were predominantly concentrated in the stroma, and the median intratumoral TIL and stromal TIL densities were 100.64/mm2 (IQR, 53.25-121.39/mm2) and 734.88/mm2 (IQR, 443.10-911.16/mm2), respectively. Overall, 9.9% of tumors (30 of 304) were immune inflamed, 85.2% (259 of 304) were immune excluded, and 4.9% (15 of 304) were immune desert. The immune-inflamed phenotype was associated with the most prolonged OS (median not reached; P < .001) and RFS (median not reached; P = .001), followed by immune-excluded phenotype and immune-desert phenotype. High intratumoral TIL density was associated with longer OS (median, 52.47 months; 95% CI, 41.98-62.96; P = .004) and RFS (median, 21.67 months; 95% CI, 14.43-28.91; P = .02). A combined analysis of the pathologic stage with immune phenotype predicted better survival of stage II PDAC stratified as immune-inflamed phenotype than stage I PDAC stratified as non-immune-inflamed phenotype.Conclusions and RelevanceResults of this cohort study suggest that the use of AI has markedly condensed the labor-intensive process of TIL assessment, potentially rendering the process more feasible and practical in clinical application. Importantly, the IP may be one of the most important prognostic biomarkers in resected PDACs.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"39 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Error in Author Contributions.","authors":"","doi":"10.1001/jamasurg.2025.2209","DOIUrl":"10.1001/jamasurg.2025.2209","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anastomotic Leak Prevention-Reply.","authors":"Juha K A Rinne, Heikki Huhta, Olli Helminen","doi":"10.1001/jamasurg.2025.1917","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1917","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Predictive Tool for Ability to Remain at Home After Cancer Surgery in Older Adults.","authors":"Julie Hallet,Alyson L Mahar,Wing C Chan,Daniel I McIsaac,Natalie Coburn,Anna Gombay,Matthew Guttman,Barbara Haas,Amy Hsu,","doi":"10.1001/jamasurg.2025.1888","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1888","url":null,"abstract":"ImportanceShared decision-making with older adults regarding cancer surgery is critical. Prognostication tools that report individualized risk estimates of patient-centered outcomes can facilitate discussions.ObjectiveTo develop and internally validate a risk prediction model, STAYHOME, to estimate the risk of losing the ability to live at home for older adults after cancer surgery.Design, Setting, and ParticipantsThis was a retrospective population-based prognostic study conducted in Ontario, Canada. Included were adults 70 years and older undergoing cancer surgery over the period 2007 to 2019. Data were analyzed from June 2023 to January 2024.ExposuresPredictor variables selected among information available preoperatively. The predictive model included age, sex, rural residence, previous cancer diagnosis, type of surgery, frailty, preoperative home care use, neoadjuvant therapy, cancer site, and cancer stage.Main Outcomes and MeasuresInability to stay at home, defined as admission to nursing home. Fine-Gray models accounting for the competing risk of death were used. Discrimination and calibration were assessed. Bootstrap validation using 1000 samples with replacement was performed.ResultsAmong 97 353 patients (median [IQR] age, 76 [73-81] years; 61 370 female [63.0%]), there were 2658 events (2.7%) at 6 months and 3746 events (3.8%) events at 12 months. The mean predicted risk of not staying home was 2.4% at 6 months and 3.4% at 12 months. Areas under the curve were 0.76 and 0.75 for 6-and 12-month predictions, respectively. Deviation from the observed risk of not staying home was 0.33% (95% CI, 0.31%-0.34%) for 6-month predictions and 0.46% (95% CI, 0.44%-0.48%) for 12-month predictions. Calibration was maintained across risk deciles.Conclusions and RelevanceResults of this prognostic study reveal that STAYHOME used information available preoperatively to predict the risk of not remaining home after cancer surgery for older adults. It presented good discrimination and was well calibrated. Individualized risk estimates from STAYHOME may support counseling, shared decision-making, and setting of expectations before surgery.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"21 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food Insecurity in US Surgical Patients","authors":"Annabelle Jones, Anam N. Ehsan, Coral Katave, Juan P Herrera Escobar, Geoffrey A. Anderson, Niteesh Choudhry, Seth A. Berkowitz, Kavitha Ranganathan","doi":"10.1001/jamasurg.2025.1809","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1809","url":null,"abstract":"ImportanceFood insecurity, defined as uncertain access to enough food for a healthy life, is a growing issue in the US. While its link to chronic conditions is well documented, little is known regarding its impact on surgical patients.ObjectiveTo assess food insecurity, identify associated characteristics, and measure the rate of Supplemental Nutrition Assistance Program (SNAP) enrollment among surgical patients using a nationally representative sample.Design, Setting, and ParticipantsThis was a cross-sectional study using National Health Interview Survey (NHIS) data from 2011 through 2018. These data were analyzed from February 2024 through April 2025. Multivariable logistic regression models were used to analyze the association between surgery, food insecurity, and enrollment in SNAP. Data for this study came from the NHIS, a nationally representative survey used for health information, health access, and health behaviors of the civilian, noninstitutionalized US population, enabling broad applicability to surgical patients. The study included 254 283 individuals with data on surgery within the past year and 30-day food insecurity. Surgical and nonsurgical cohorts were created based on answers to, “During the past 12 months, have you had surgery or other surgical procedures as an inpatient or outpatient?”ExposuresThe main exposure included undergoing surgery in the past year. Other exposures were age, race, sex, employment status, household income, marital status, number of family members in the household, geographic region, health status, and insurance status.Main Outcomes and MeasuresThe proportion of food insecurity among the surgical cohort was the main outcome. Secondary outcomes included factors linked to food insecurity and SNAP enrollment, especially for those with incomes below 200% of the federal poverty level.ResultsSurgical patients (13 180 male [40.2%] and 19 643 female [59.8%]) reported higher food insecurity prevalence (11.6%) than nonsurgical patients (100 924 male [45.6%] and 120 536 female [54.4%]) (10.5%). Adjusted analyses indicated significantly higher odds of food insecurity among surgical patients (odds ratio, 1.12; 95% CI, 1.07-1.18; <jats:italic>P</jats:italic> &amp;amp;lt; .001). Food insecurity was strongly linked to lower income and poor health. SNAP enrollment was 16% overall and 40% among surgical patients with incomes less than 200% federal poverty level, associated with younger, low-income, unemployed, less educated, or publicly insured patients.Conclusions and RelevanceFood insecurity is a significant burden among surgical patients. Interventions, including food insecurity screening, may improve food access and health outcomes in this cohort.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"70 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluorescence-Guided Surgery for Assessing Margins in Head and Neck Cancer","authors":"Shravan Gowrishankar, Stan Van Keulen, Aviva Mattingly, Hidenori Tanaka, Mike Topf, Kyle Mannion, Alexander Langerman, Sarah Rohde, Robert Sinard, Jennifer Choe, Baran Sumer, Mark Varvares, Eben L. Rosenthal","doi":"10.1001/jamasurg.2025.1815","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.1815","url":null,"abstract":"ImportanceHead and neck squamous cell cancer (HNSCC) is associated with a higher positive margin rate compared with most other cancers in surgical oncology. This rate has remained stagnant over the past 3 decades. Fluorescence-guided surgery (FGS) is a promising tool to address high positive margin rates in multiple solid tumor types, including HNSCC. This review summarizes data from a decade of FGS research in this tumor type to outline how fluorescence can help improve margin clearance, especially at the deep margin. The principles presented can be broadly applied using HNSCC as a model disease.ObservationsIn contrast to the superficial mucosal margin, the deep margin is especially challenging for surgeons to visualize and contributes to the vast majority of positive margins and subsequent sequelae in HNSCC. Using fluorescence in vivo can highlight residual disease in the resection bed, while using fluorescence ex vivo can highlight how close the tumor margin is from the resection surface of the specimen, guiding sampling and further resection.Conclusions and RelevanceCurrently, there are several clinical trials investigating FGS to improve margin clearance in HNSCC, with many fluorescent agents already approved for use in other cancer types. As additional agents are brought into clinical use, it will be critical to understand how this technique will or will not improve oncological management in our patients. To address this important point, we present 2 key areas where surgeons will consider use of these FGS: to assess the peripheral mucosal margin and the deep surface of the tumor. We outline how in vivo and ex vivo fluorescence can be used for this purpose. We summarize data from multiple sources to explain how FGS is most likely to help with deep margin clearance.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"44 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}