JAMA surgery最新文献

{"title":"Pectus Arcuatum Definitions, Diagnostics, and Surgical Guidelines: A Systematic Review.","authors":"Rawan M Zeineddine,Ahmed E Khedr,Juan M Farina,Nour B Odeh,Abdulrahman Senjab,J Asher Jenkins,Dawn E Jaroszewski","doi":"10.1001/jamasurg.2025.2365","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2365","url":null,"abstract":"ImportancePectus arcuatum is a rare anterior chest wall deformity that is often confused with excavatum, carinatum, or a mixed deformity. A complete understanding of its clinical and physiological basis will improve diagnostic accuracy and allow for standardized management.ObjectivesTo gain a comprehensive understanding of pectus arcuatum, focusing on its nomenclatures, epidemiology, classification, pathophysiology, preoperative presentation and assessments, management options, and surgical outcomes.Evidence ReviewPubMed, Google Scholar, and subsequent reference searches were used to extract original studies addressing pectus arcuatum fully or partially. The searches were performed on February 2, 2025. Two independent reviewers screened articles based on preestablished inclusion and exclusion criteria. Quality assessment was performed, but given the rarity of arcuatum and the limited, heterogeneous nature of available literature, none of the studies were excluded based on the level of evidence or quality assessments. Using a standardized data extraction form, results were synthesized and presented as a review with recommendations to guide clinical decision-making.FindingsA total of 65 studies were included in the final review. Of those, 37 (56.9%) were cohort studies, 18 (27.7%) were case reports, 8 (12.3%) were case series, and 2 (3.1%) were technical reports. A total of 455 cases of pectus arcuatum were represented. Heterogeneity was found in nomenclature, epidemiology, associated conditions, assessments, management, and outcomes. An open surgical approach and, more recently, hybrid open and minimally invasive technique are reported for surgical repair. Postoperative outcomes were good in most surgical series, with no significant difference when compared with the repair of other pectus deformities.Conclusions and RelevanceResults of this systematic review reveal that pectus arcuatum is a rare variant of pectus deformities that is distinct from carinatum and excavatum. Unified terminology and standardized diagnostic criteria are important to facilitate proper management. Minimally invasive hybrid approaches continue to refine outcomes, balancing invasiveness with efficacy.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"13 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684363","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":"Long-Term Locoregional Outcomes in a Contemporary Cohort of Young Women With Breast Cancer.","authors":"Laura S Dominici,Yue Zheng,Tari A King,Julia Wong,Kathryn J Ruddy,Rulla M Tamimi,Jeffrey Peppercorn,Lidia Schapira,Virginia Borges,Steven Come,Laura C Collins,Ellen Warner,Ann H Partridge,Shoshana M Rosenberg","doi":"10.1001/jamasurg.2025.2324","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2324","url":null,"abstract":"ImportanceWomen diagnosed with breast cancer at a young age are felt to have a higher risk for locoregional recurrence (LRR) regardless of type of local therapy.ObjectiveTo assess the long-term incidence of isolated LRR by molecular subtype in a modern multicenter cohort of young women.Design, Setting, and ParticipantsThis cohort study, a multicenter prospective study named the Young Women's Breast Cancer Study, enrolled 1302 women diagnosed with breast cancer at 40 years or younger from 2006 to 2016. Treatment information and incident LRR (ipsilateral breast/chest or lymph node recurrence) were self-reported on study surveys and confirmed with medical record review; molecular subtype was determined by record review. Analysis was reported from February 2023 to May 2025.Main Outcomes and MeasuresCumulative incidence of isolated LRR was calculated using the Kaplan-Meier method; hazard ratios were estimated by Cox proportional hazards regression.ResultsThe cohort included 1135 women with stage I through III breast cancer who had a median follow-up of 10.1 years (range, 0.4-16.3 years). The age at diagnosis was younger than 30 years for 145 patients (12.8%), 31 to 35 years for 318 patients (28.0%), and 36 to 40 years for 672 patients (59.2%). There were 59 isolated local recurrences (5.2%) and 4 isolated regional recurrences (0.4%). Among patients with local therapy and subtype data available (n = 1128), 366 (32%) had luminal A-like tumors; 240 (21%), luminal B-like tumors; 231 (20%) luminal ERBB2 positive (+)-like (formerly HER2 positive); 90 (8%) ERBB2+-like; and 201 (18%) triple negative. A total of 346 women (30%) had breast-conserving therapy (BCT) (98% of whom had radiation), 296 (26%) unilateral mastectomy, and 487 (43%) bilateral mastectomy. Of women who had mastectomy, 425 (54%) had radiation. The cumulative incidence of LRR at 10.1 years by subtype was as follows: luminal A, 4.4% (range, 1.0%-6.9%); luminal B, 4.7% (range 1.8%-7.7%); luminal ERBB2+, 6.1% (range, 3.1%-8.3%); ERBB2+, 2.2% (range, 0%-6.3%); and triple negative, 6.5% (range, 4.2%-10.1%). The cumulative incidence of LRR by locoregional treatment type at 10.1 years was 6.7% after BCT (range, 4.3%-10.1%), 6.5% after mastectomy without radiation (range, 0%-7.7%), and 2.4% after mastectomy with radiation (range, 1%-4.2%). Although mastectomy with radiation was associated with the lowest risk of LRR on multivariable analysis, when examined within molecular subtype, there were no differences seen.Conclusions and RelevanceIn this contemporary cohort of women diagnosed with breast cancer at age 40 years or younger, risk of isolated LRR was relatively low (5.6%) at a median follow-up of 10.1 years, and significant differences were not seen by tumor subtype. Concerns for long-term risk of LRR should not influence surgical decision-making with young women, irrespective of molecular subtype.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"11 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684361","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":"Revisiting Timing of Coronary Artery Bypass Graft in Acute Coronary Syndrome.","authors":"Wenyi Liu,Yongxing Li,Yongfeng Lai","doi":"10.1001/jamasurg.2025.2374","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2374","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"14 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684365","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":"Recurrence Risk in Young Women With Breast Cancer.","authors":"Julie A Margenthaler","doi":"10.1001/jamasurg.2025.2332","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2332","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"687 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684364","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":"Metastatic Melanoma Outcomes and the Evolving Role of Surgery in the Immunotherapy Era.","authors":"Hilary R Keller,Douglas A Hanes,Jillian K McCabe,Danny Lascano,Paul Shin,Melanie Goldfarb,Richard Essner","doi":"10.1001/jamasurg.2025.2335","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2335","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"10 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144684362","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":"Revisiting Timing of Coronary Artery Bypass Graft in Acute Coronary Syndrome-Reply.","authors":"Derek Y F So, Jean-Francois Tanguay, George A Wells","doi":"10.1001/jamasurg.2025.2377","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2377","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144690308","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":"Clinical Practice Guideline Recommendations on Mental Health in Trauma: A Systematic Review.","authors":"Mélanie Bérubé,Alexandra Lapierre,William Panenka,Meaghan O'Donnell,Nori Bradley,Lynne Moore,Laurence Bourque,Mickael Thébaud,Patrick Archambault,Léonie Archambault,Alexis F Turgeon,Tassia Macedo,Juanita Haagsma,Jagadish Rao,Naisan Garraway,Matthew Menear,Michel Perreault,Marc-Aurèle Gagnon,Helen-Maria Vasiliadis,Christine Genest,Hélène Provencher,Henry Thomas Stelfox","doi":"10.1001/jamasurg.2025.2226","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2226","url":null,"abstract":"ImportanceMany survivors of traumatic injuries are affected by mental disorders, which has recently led to the publication of clinical practice guidelines (CPGs). However, there is no comprehensive synthesis of guideline recommendations to inform clinicians on those that should be prioritized for implementation and thus promote adherence to them.ObjectiveTo identify guideline recommendations for the prevention and management of mental disorders in patients with traumatic injuries, appraise their quality, and synthesize the quality of evidence and the strength of included recommendations.Evidence ReviewMEDLINE, Embase, CINAHL, PsycINFO, Cochrane Central, Web of Science, and 61 websites of professional associations and guideline repositories were searched between January 2008 and September 2024. We included CPGs pertinent to the acute and early recovery phases (<3 months) of adult patients (≥18 years) with traumatic injuries with at least 1 recommendation on mental health. Pairs of reviewers independently extracted data and assessed guideline quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. The quality of evidence on recommendations was synthesized using a matrix based on the categories of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Mental health recommendations had to target prevention, screening, evaluation, intervention, referral for follow-up or specialized services, and a patient- and family-centered care approach.FindingsForty-three CPGs were included, 25 of which (58%) were high quality. Rigor of development, applicability, lack of involvement from all interested parties, and editorial independence were the most common methodological weaknesses. High-quality CPGs included 200 recommendations; of these, 50 (25%) were supported by moderate- to high-quality evidence and 30 (60%) targeted patients with traumatic brain injury. They covered mainly nonpharmacological and pharmacological interventions to treat acute stress disorder, substance use disorders, posttraumatic stress disorder, depression, or aggression. Fewer recommendations related to prevention, screening, evaluation, and referral were identified as having high empirical support.Conclusions and RelevanceFifty recommendations were identified that may be considered for implementation in clinical settings in patients with traumatic brain injury and other trauma populations. Our review underlines important areas for future research, including training for clinicians, a patient- and family-centered care approach, and health care equity.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"12 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639646","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":"Near-Infrared Autofluorescence for Parathyroid Detection During Endocrine Neck Surgery: A Randomized Clinical Trial.","authors":"Alexandria G Cousart,Colleen M Kiernan,Parker A Willmon,Giju Thomas,Tracy S Wang,Paul G Gauger,Quan-Yang Duh,Hunter J Underwood,Anee Jackson,Anuradha Patel,Anita Mahadevan-Jansen,Carmen C Solórzano","doi":"10.1001/jamasurg.2025.2233","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2233","url":null,"abstract":"ImportanceInadvertent removal and damage to parathyroid glands (PGs) can lead to hypoparathyroidism, making it crucial to accurately identify and preserve these glands during parathyroidectomy and thyroidectomy.ObjectiveTo assess if fiber-based near-infrared autofluorescence (NIRAF) increases the number of intraoperatively identified PGs and reduces the occurrence of hypoparathyroidism.Design, Setting, and ParticipantsThis multicenter randomized clinical trial with a 6-month follow-up was conducted between March 2020 and July 2024. It included 4 medical centers across the US, 4 senior (more than 10 years of experience) and 3 junior (less than 5 years of experience) surgeons. A total of 754 patients were enrolled and 752 were randomized, including 398 patients (2 withdrew) who underwent parathyroidectomy and 354 patients who had total/completion thyroidectomy. Data were analyzed from March 2020 to January 2025.InterventionsUse of fiber-based NIRAF during thyroidectomy and parathyroidectomy.Main Outcomes and MeasuresThe primary outcome was the mean number of PGs identified intraoperatively. The secondary outcome was the rate of hypoparathyroidism (transient and at last follow-up).ResultsOf 752 patients randomized, 712 were analyzed for the primary outcome (94.4%) (overall median [IQR] age, 59 [25] years; 516 females [68.4%]). A total of 161 underwent parathyroidectomy with NIRAF, while 159 had conventional surgery. Additionally, 176 underwent thyroidectomy using NIRAF and 178 had traditional surgery. The mean number of PGs identified during parathyroidectomy was not significantly higher when using NIRAF for focused procedures (mean, NIRAF, 1.6; 95% CI, 1.4-1.8 vs control, 1.5; 95% CI, 1.4-1.7). During bilateral explorations, the surgeons improved in the mean number of PGs identified when using NIRAF (mean NIRAF, 3.5; 95% CI, 3.4-3.7 vs control, 3.2; 95% CI, 3.0-3.4; P < .001). During thyroidectomy, the mean number of PGs identified increased when using NIRAF (mean NIRAF, 3.3; 95% CI, 3.2-3.4 vs control, 2.8; 95% CI, 2.7-3.0; P < .001). There was no significant difference in hypoparathyroidism after thyroidectomy, either transient (NIRAF: 48 of 173 patients [27.8%]; control: 44 of 169 patients [26%]) or at the last follow-up (NIRAF: 3 of 176 patients [1.7%]; control: 6 of 176 patients [3.4%]).Conclusions and RelevanceFiber-based NIRAF can increase the number of PGs identified during thyroidectomy and bilateral exploration parathyroidectomy without increasing the duration of the surgery.Trial RegistrationClinicalTrials.gov Identifiers: NCT05579782, NCT05022667, NCT05022641, NCT04281875, NCT04299425, NCT05152927.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"4 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144639645","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":"Open Anterior Mesh Repair vs Modified Open Anterior Mesh Repair for Groin Hernia in Women: A Randomized Clinical Trial.","authors":"Alphonsus Matovu,Pär Nordin,Andreas Wladis,Gabriel Sandblom,Moses Elaju,Fredrik Lindmark,Olof Bladin,Jenny Löfgren","doi":"10.1001/jamasurg.2025.2244","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2244","url":null,"abstract":"ImportanceMost women in low- and middle-income countries lack access to laparoscopic methods for groin hernia repair; therefore, an open technique through which both inguinal and femoral hernias can be treated is needed. This could be an option in the absence or inability to use laparoscopic methods.ObjectiveTo determine the safety and effectiveness of open anterior mesh (OAM) repair compared with modified open anterior mesh (MOAM) repair, which includes opening the transversalis fascia and covering the femoral canal with a mesh flap.Design, Setting, and ParticipantsThis was a parallel, 2-arm, double-blind, randomized clinical trial conducted in Northern Uganda, in East Africa, at 2 public hospitals between October 2019 and February 2023. Included in the study were adult women 18 years and older with a primary groin hernia, American Society of Anesthesiologists (ASA) class I or II, and the ability to give informed consent.InterventionsOAM in the control arm and MOAM in the intervention arm.Main Outcomes and MeasuresThe primary outcome was groin hernia recurrence 1 year postoperatively.ResultsA total of 200 participants (mean [SD] age, 52.7 [14.0] years) were included in the study; 99 (49.5%) were allocated to OAM repair, and 101 (50.5%) were allocated to MOAM repair. Nearly 45% of the participants (89 of 200) had a femoral hernia; therefore, 35 of 99 participants (35.4%) in the control arm received the intervention procedure. One year postoperatively, the overall recurrence was 5.6% (11 of 195 participants), and the intention-to-treat analysis showed that 4 of 97 participants (4.1%) in the control arm and 7 of 98 participants (7.1%) in the intervention arm had recurrence (absolute difference = -3.0 percentage points; 95% CI, -9.5 to 3.4; P = .36).Conclusions and RelevanceResults of this randomized clinical trial demonstrate that the MOAM repair was a good option for groin hernia repair in women in low-resource settings. Femoral hernias were very common in the study population, and exposure of the femoral canal was essential to detect these hernias.Trial RegistrationISRCTN Identifier: ISRCTN10330683.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"12 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640096","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":"Locating Parathyroid Glands in Thyroid Surgery-Eye of the Beholder.","authors":"Martin Almquist","doi":"10.1001/jamasurg.2025.2222","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.2222","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"104 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640097","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}