JAMA surgery最新文献

{"title":"Precision Exercise Effect on Fatigue and Function in Lung Cancer Surgery","authors":"Cornelia M. Ulrich, Caroline Himbert, Christopher A. Barnes, Kenneth M. Boucher, Bailee Daniels, Victoria M. Bandera, Jennifer A. Ligibel, David W. Wetter, Rachel Hess, Jaewhan Kim, Kelly Lundberg, Brian Mitzman, Robin Marcus, Samuel R. G. Finlayson, Paul C. LaStayo, Thomas K. Varghese","doi":"10.1001/jamasurg.2025.0130","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0130","url":null,"abstract":"ImportanceExercise intervention studies have shown benefits for patients with lung cancer undergoing surgery, yet most interventions to date have been resource intensive and have followed a one-size-fits-all approach.ObjectiveTo determine whether a personalized, clinic-aligned perioperative exercise program with remote monitoring and instructions can improve physical function and fatigue among patients undergoing surgery for lung cancer.Design, Setting, and ParticipantsThe Precision-Exercise-Prescription (PEP) randomized clinical trial is a single-center phase 3 trial. Adult patients with primary lung cancer (stages I-IIIa) or oligometastatic disease to the lung (where all disease could be removed) were assessed for eligibility and randomized to either an exercise intervention or standard care. Patients were enrolled between November 2017 and 2021, and the trial continued during the COVID-19 pandemic. Data were analyzed from November 2022 to December 2023.InterventionsThe structured exercise program, personalized based on mobility scores, was a home-based exercise intervention prescribed and monitored remotely by a licensed physical therapist. The program started approximately 2 weeks before surgery and continued after surgery. Standard care included use of incentive spirometer and encouragement to exercise without a formal program.Main Outcomes and MeasuresPhysical function (6-minute walk test [6MWT]), the Short Physical Performance Battery, and cancer-related fatigue (Functional Assessment of Chronic Illness Therapy–Fatigue) were assessed at baseline and 2 months after surgery.ResultsA total of 182 patients (92 receiving exercise intervention, 90 receiving standard care) were assessed in the intention-to-treat population. Patients had a mean (SD) age of 62.7 (13.8) years, 108 (59%) were female, and 89 (49%) had low mobility scores (Activity Measure for Post-Acute Care scores, 1-3). Physical function in the exercise group increased at 2 months after surgery (mean [SE] 6MWT at baseline, 467.9 [13.0] m; at 2 months, 482.2 [14.1] m), compared with a decrease in the standard-care group (mean [SE] 6MWT at baseline, 481.4 [11.1] m; at 2 months, 471.5 [14.0] m). Mean (SE) between-group changes in 6MWT distance for intent to treat from baseline to 2 months were 22.7 (12.7) m (<jats:italic>P</jats:italic> = .08), with greater effect sizes among women (mean [SE], 37.8 [17.3] m; <jats:italic>P</jats:italic> = .03). Similarly, women showed greater improvements in the Short Physical Performance Battery (mean [SE], 0.9 [0.4]; <jats:italic>P</jats:italic> = .04). Patients in the exercise group maintained stable fatigue scores at 2 months, whereas participants in the standard-care group deteriorated (mean [SD], 3.7 [1.4]; <jats:italic>P</jats:italic> = .009), with greater effect sizes among individuals who were younger, from rural areas, had overweight or obesity, and had primary lung cancer.Conclusions and RelevanceThe PEP intervention, a personalized, clinic-","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"13 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599348","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":"Wearable Intraoperative Augmented Reality for Surgery","authors":"Tony Jiang, Philip Edgcumbe, Kathryn V. Isaac","doi":"10.1001/jamasurg.2024.5494","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.5494","url":null,"abstract":"This Surgical Innovation explores the potential that wearable augmented reality devices have for improving intraoperative imaging, patient outcomes, and surgical workflows.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"128 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599346","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":"Prognostic Impact of Fluorescent Lymphography on Gastric Cancer After Neoadjuvant Chemotherapy","authors":"Yi-Hui Tang, Ze-Ning Huang, Yu-Qin Sun, Ya-Qi Zhao, Wen-Wu Qiu, Ji-Xun He, Ping Li, Jian-Wei Xie, Jia-Bin Wang, Qi-Yue Chen, Long-Long Cao, Chao-Hui Zheng, Jian-Xian Lin, Su Yan, Chang-Ming Huang","doi":"10.1001/jamasurg.2025.0108","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0108","url":null,"abstract":"ImportanceIndocyanine green (ICG)–guided lymphadenectomy has been increasingly used to treat gastric cancer. However, its oncologic impact remains unclear.ObjectiveTo investigate the effect of ICG tracing on long-term outcomes in patients diagnosed with locally advanced gastric cancer undergoing neoadjuvant chemotherapy (NAC) followed by laparoscopic radical gastrectomy.Design, Settings, and ParticipantsThis retrospective cohort study included patients diagnosed with cT2-4N0/+M0 gastric adenocarcinoma who underwent NAC and laparoscopic radical gastrectomy at 3 teaching hospitals in China between January 2015 and June 2021, with follow-up data examined until June 2024. Overlap weighting (OW) was used to compare outcomes between the ICG and non–ICG groups. Results were tested for robustness using propensity score matching (PSM) and instrumental variable analysis.ExposureICG–guided lymphadenectomy during laparoscopic gastrectomy.Main Outcomes and MeasuresThe primary end points were 3-year survival outcomes, including overall survival (OS) and recurrence-free survival (RFS).ResultsData from 459 patients (338 men [73.6%] and 121 women [26.4%]; mean [SD] age, 60.8 [9.9] years), of whom 119 underwent ICG–guided lymphadenectomy, were included. After OW adjustment, the ICG group exhibited a higher number of lymph nodes harvested (47.4 vs 38.3; <jats:italic>P</jats:italic> &amp;amp;lt; .001) and better 3-year OS (78.6% vs 66.6%; <jats:italic>P</jats:italic> = .04) and RFS (74.0% vs 57.0%; <jats:italic>P</jats:italic> = .03) compared with the non–ICG group. Multivariable Cox regression analysis revealed that ICG tracing was an independent prognostic factor for both OS (hazard ratio, 0.59; 95% CI, 0.39-0.90; <jats:italic>P</jats:italic> = .02) and RFS (hazard ratio, 0.59; 95% CI, 0.40-0.87; <jats:italic>P</jats:italic> = .01), with the results remaining significant in both doubly robust and instrumental variable-adjusted models. Furthermore, in the OW–adjusted population, the OS benefit of ICG tracing was more pronounced in subgroups with ypN2/3 gastric adenocarcinoma (70.3% vs 36.2%; <jats:italic>P</jats:italic> = .01) and those achieving major pathological response (97.7% vs 77.6%; <jats:italic>P</jats:italic> = .04) (both <jats:italic>P</jats:italic> for interaction = .04). Similar results were obtained after adjusting for PSM.Conclusion and RelevanceIn this study, ICG tracing was associated with enhanced lymphadenectomy and improved survival outcomes in patients with locally advanced gastric cancer after NAC. A prospective randomized clinical trial is needed to verify these findings.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"7 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143599367","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":"Mixed Results With Oral Antibiotics for Fracture-Related Infections.","authors":"Kamal M F Itani, William G Henderson","doi":"10.1001/jamasurg.2024.6440","DOIUrl":"10.1001/jamasurg.2024.6440","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"284-285"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005731","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":"Impact of IVF Restriction on Patients With Cancer and Surgeons.","authors":"Alexa C Glencer, Laura J Esserman","doi":"10.1001/jamasurg.2024.4741","DOIUrl":"10.1001/jamasurg.2024.4741","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"239-240"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768966","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":"Delayed Mortality in Patients Receiving Postoperative High-Acuity Care.","authors":"Guy Ludbrook, Esrom E Leaman, Michael P W Grocott, Colin Royse, Jamie Sleigh, Sandy Clarke-Errey, L Bogdan Solomon","doi":"10.1001/jamasurg.2024.5289","DOIUrl":"10.1001/jamasurg.2024.5289","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"356-357"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807014","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":"Injury to Internal Thoracic Artery to Left Anterior Descending Artery Grafts in Cardiac Reoperations.","authors":"Joshua E Insler, Richard A E Ramsingh, Jules J Bakhos, Penny L Houghtaling, Marijan Koprivanac, Lars G Svensson, Eugene H Blackstone, Faisal G Bakaeen","doi":"10.1001/jamasurg.2024.4952","DOIUrl":"10.1001/jamasurg.2024.4952","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"354-356"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807017","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":"Silent Cost of Private Equity Hospitals.","authors":"Aaron R Dezube, Virginia R Litle","doi":"10.1001/jamasurg.2024.5983","DOIUrl":"10.1001/jamasurg.2024.5983","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"303"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914601","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":"Anterior Gastropexy for Paraesophageal Hernia Repair: A Randomized Clinical Trial.","authors":"Clayton C Petro, Ryan C Ellis, Sara M Maskal, Sam J Zolin, Chao Tu, Adele Costanzo, Lucas R A Beffa, David M Krpata, Diya Alaedeen, Ajita S Prabhu, Benjamin T Miller, Kevin F Baier, Alisan Fathalizadeh, John Rodriguez, Michael J Rosen","doi":"10.1001/jamasurg.2024.5788","DOIUrl":"10.1001/jamasurg.2024.5788","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Paraesophageal hernias can cause severe limitations in quality of life and life-threatening complications. Even though minimally invasive paraesophageal hernia repair (MIS-PEHR) is safe and effective, anatomic recurrence rates remain notoriously high. Retrospective data suggest that suturing the stomach to the anterior abdominal wall after repair-an anterior gastropexy-may reduce recurrence, but this adjunct is currently not the standard of care.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine whether anterior gastropexy reduces 1-year recurrence after MIS-PEHR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This registry-based randomized clinical trial was conducted by 10 surgeons at 3 academic hospitals within the Cleveland Clinic Enterprise. Between June 26, 2019, and July 24, 2023, 348 patients were assessed for eligibility, and 240 patients were enrolled and randomized. Statistical analysis was performed from January to March 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Enrolled patients were randomized to and received either an anterior gastropexy (n = 119) or no anterior gastropexy (n = 121).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome: &lt;/strong&gt;The primary outcome was recurrence as determined by reherniation of the stomach greater than 2 cm above the diaphragm on routine imaging at 1 year or reoperation. Secondary outcomes included quality of life as measured by the Gastroesophageal Reflux Health-Related Quality of Life survey, additional foregut symptom questionnaire, and patient satisfaction at 30 days and 1 year.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 240 patients were randomized to either anterior gastropexy (n = 119; 104 [97%] women; median [IQR] age, 70 [64-75] years) or no anterior gastropexy (n = 121; 97 [80%] women; median [IQR] age, 68 [62-73] years) at the end of their MIS-PEHR. At 1 year, 188 patients (78%) had completed follow-up. By intention-to-treat analysis, 1-year recurrence was significantly lower in patients who received an anterior gastropexy (15% vs 36%; risk difference, 0.21 [95% CI, 0.09-0.33]), which remained significant after risk-adjusted regression analysis (hazard ratio, 0.38 [95% CI, 0.23-0.60]). Of 13 reoperations (5.4%) for recurrence in the first year, 3 (2.5%) were in the anterior gastropexy group and 10 (8.2%) were in the no-gastropexy group (P = .052). Two patients (1.7%) had their anterior gastropexy sutures removed for pain. There were no significant differences in quality-of-life outcomes at 30 days and 1 year between treatment groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;This randomized clinical trial found that the addition of an anterior gastropexy to MIS-PEHR is superior to no gastropexy in regard to reducing 1-year paraesophageal hernia recurrence. These results suggest that an anterior gastropexy should be routinely used in the context of minimally invasive paraesophageal hernia repair.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Trial registration: &lt;/strong&gt;ClinicalTrials.gov Identif","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"247-255"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904718/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142877043","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":"Best Practices for Big Data Sources and Methods in Surgery.","authors":"Shipra Arya, Lesly A Dossett, Melina R Kibbe","doi":"10.1001/jamasurg.2024.6000","DOIUrl":"10.1001/jamasurg.2024.6000","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"245-246"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949202","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}