JAMA surgery最新文献

{"title":"Ampullary Adenocarcinoma-Advancing Prognostication and Personalized Treatment.","authors":"Serena Zheng,Timothy R Donahue","doi":"10.1001/jamasurg.2024.3574","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3574","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170818","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":"Genome-Derived Ampullary Adenocarcinoma Classifier and Postresection Prognostication","authors":"Brett L. Ecker, Kenneth Seier, Austin M. Eckhoff, Gabriella N. Tortorello, Peter J. Allen, Vinod P. Balachandran, Nicola Blackburn, Michael I. D’Angelica, Ronald P. DeMatteo, Daniel G. Blazer, Jeffrey A. Drebin, William E. Fisher, Danielle Fortuna, Anthony J. Gill, Marie-Claude Gingras, T. Peter Kingham, Major K. Lee, Michael E. Lidsky, Daniel P. Nussbaum, Michael J. Overman, Jaswinder S. Samra, Ronglai Shen, Carlie S. Sigel, Kevin C. Soares, Charles M. Vollmer, Alice C. Wei, Sabino Zani, Robert E. Roses, Mithat Gonen, William R. Jarnagin","doi":"10.1001/jamasurg.2024.3588","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3588","url":null,"abstract":"ImportanceAmpullary adenocarcinoma (AA) is characterized by clinical and genomic heterogeneity. A previously developed genomic classifier defined biologically distinct phenotypes with greater accuracy than standard histologic classification. External validation is needed before routine clinical use.ObjectiveTo test external validity of the prognostic value of the hidden genome classifier of AA.Design, Setting, and ParticipantsThis retrospective cohort study took place at 6 international academic institutions. Consecutive patients (n = 192) who underwent curative-intent resection of histologically confirmed AA were included. The data were analyzed from January 2005 through July 2020.ExposuresThe multilevel meta-feature regression model previously trained on a prospectively sequenced cohort of 3411 patients (1001 pancreatic adenocarcinoma, 165 distal bile duct adenocarcinoma, and 2245 colorectal adenocarcinoma) was applied to AA sequencing data to quantify the relative proportions of parental cell of origin.Main Outcome and MeasuresGenomic classification was correlated with immunohistologic subtype (intestinal [INT] or pancreatobiliary [PB]) and with overall survival (OS), using the log-rank test and Cox proportional hazard models.ResultsAmong 192 patients with AA (median age, 69.0 [IQR, 60.0-74.0] years and 134 were male [64%]), concordance between immunohistologic and genomic subtypes was 55%. Most INT subtype tumors were categorized into the colorectal genomic subtype (43 of 57 [72.9%]). Of the 114 PB subtype tumors, 29 had a pancreatic genomic profile (25.4%) and 24 had a distal bile duct genomic profile (21.1%). Whereas the standard immunohistologic subtypes were not associated with survival (log rank <jats:italic>P</jats:italic> = .26), predicted genomic probabilities were correlated with survival probability. Genomic scores with higher colorectal probability were associated with higher survival probability; higher pancreatic and distal bile duct probabilities were associated with lower survival probability.Conclusions and RelevanceThe AA genomic classifier is reproducible with available molecular testing in a diverse international cohort of patients and improves stratification of the divergent clinical outcomes beyond standard immunohistologic classification. These data provide a molecular classification that may be incorporated into clinical trials for prospective validation.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170846","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":"Pain Management Details for Serratus Anterior Plane Blocks in Early Rib Fracture-Reply.","authors":"Christopher Partyka,Anthony Delaney,Kate Curtis","doi":"10.1001/jamasurg.2024.3572","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3572","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":16.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142170847","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":"Parathyroidectomy and the Development of New Depression Among Adults With Primary Hyperparathyroidism.","authors":"Lia D Delaney, Adam Furst, Heather Day, Katherine Arnow, Robin M Cisco, Electron Kebebew, Maria E Montez-Rath, Manjula Kurella Tamura, Carolyn D Seib","doi":"10.1001/jamasurg.2024.3509","DOIUrl":"10.1001/jamasurg.2024.3509","url":null,"abstract":"<p><strong>Importance: </strong>Primary hyperparathyroidism (PHPT) is a common endocrine disorder associated with neuropsychiatric symptoms. Although parathyroidectomy has been associated with improvement of preexisting depression among adults with PHPT, the effect of parathyroidectomy on the development of new depression is unknown.</p><p><strong>Objective: </strong>To determine the effect of early parathyroidectomy on the incidence of new depression among adults with PHPT compared with nonoperative management.</p><p><strong>Design, setting, and participants: </strong>Analyzed data included observational national Veterans Affairs data from adults with a new diagnosis of PHPT from 2000 through 2019 using target trial emulation with cloning, a biostatistical method that uses observational data to emulate a randomized clinical trial. New depression rates were compared between those treated with early parathyroidectomy vs nonoperative management using an extended Cox model with time-varying inverse probability censoring weighting, adjusted for patient demographics, comorbidities, and depression risk factors. Eligible adults with a new biochemical diagnosis of PHPT, excluding those with past depression diagnoses, residing in an assisted living/nursing facility, or with Charlson Comorbidity Index score higher than 4 were included. These data were analyzed January 4, 2023, through June 15, 2023.</p><p><strong>Exposure: </strong>Early parathyroidectomy (within 1 year of PHPT diagnosis) vs nonoperative management.</p><p><strong>Main outcome: </strong>New depression, including among subgroups according to patient age (65 years or older; younger than 65 years) and baseline serum calcium (11.3 mg/dL or higher; less than 11.3 mg/dL).</p><p><strong>Results: </strong>The study team identified 40 231 adults with PHPT and no history of depression of whom 35896 were male (89%) and the mean (SD) age was 67 (11.3) years. A total of 3294 patients underwent early parathyroidectomy (8.2%). The weighted cumulative incidence of depression was 11% at 5 years and 18% at 10 years among patients who underwent parathyroidectomy, compared with 9% and 18%, respectively, among nonoperative patients. Those treated with early parathyroidectomy experienced no difference in the adjusted rate of new depression compared with nonoperative management (hazard ratio, 1.05; 95% CI, 0.94-1.17). There was also no estimated effect of early parathyroidectomy on new depression in subgroup analyses based on patient age or serum calcium.</p><p><strong>Conclusions: </strong>In this study, there was no difference in the incidence of new depression among adults with PHPT treated with early parathyroidectomy vs nonoperative management, which is relevant to preoperative discussions about the benefits and risks of operative treatment.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125735","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":"Sex and Size Disparities in Access to Liver Transplant for Patients With Hepatocellular Carcinoma.","authors":"David C Cron, Rafal D Mazur, Irun Bhan, Joel T Adler, Heidi Yeh","doi":"10.1001/jamasurg.2024.3498","DOIUrl":"10.1001/jamasurg.2024.3498","url":null,"abstract":"<p><strong>Importance: </strong>Women on the liver transplant waiting list are less likely to undergo a transplant than men. Recent approaches to resolving this disparity have involved adjustments to Model for End-Stage Liver Disease (MELD) scoring, but this will not affect candidates who rely on exception scores rather than calculated MELD score, the majority of whom have hepatocellular carcinoma (HCC).</p><p><strong>Objective: </strong>To evaluate the association between female sex, candidate size, and access to liver transplant among wait-listed patients with HCC.</p><p><strong>Design, setting, and participants: </strong>This retrospective cohort study used US transplant registry data of all adult (aged ≥18 years) wait-listed liver transplant candidates receiving an HCC exception score between January 1, 2010, and March 2, 2023.</p><p><strong>Exposure: </strong>Wait-listed liver transplant candidate sex.</p><p><strong>Main outcomes and measures: </strong>The association of female sex with (1) deceased-donor liver transplant (DDLT) and (2) death or waiting list removal for health deterioration were estimated using multivariable competing-risks regression. Results with and without adjustment for candidate height and weight (mediators of the sex disparity) were compared.</p><p><strong>Results: </strong>The cohort included 31 725 candidates with HCC (mean [SD] age at receipt of exception, 61.2 [7.1] years; 76.3% men). Compared with men, women had a lower 1-year cumulative incidence of DDLT (50.8% vs 54.0%; P < .001) and a higher 1-year cumulative incidence of death or delisting for health deterioration (16.2% vs 15.0%; P = .002). After adjustment, without accounting for size, women had a lower incidence of DDLT (subdistribution hazard ratio [SHR], 0.92; 95% CI, 0.89-0.95) and higher incidence of death or delisting (SHR, 1.06; 95% CI, 1.00-1.13) compared with men. When adjusting for candidate height and weight, there was no association of female sex with incidence of DDLT or death or delisting. However, at a height cutoff of 166 cm, short women compared with short men were still less likely to undergo a transplant (SHR, 0.93; 95% CI, 0.88-0.99).</p><p><strong>Conclusions and relevance: </strong>In this study, women with HCC were less likely to receive a DDLT and more likely to die while wait-listed than men with HCC; these differences were largely (but not entirely) explained by sex-based differences in candidate size. For candidates listed with exception scores, additional changes to allocation policy are needed to resolve the sex disparity, including solutions to improve access to size-matched donor livers for smaller candidates.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125737","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":"Primary Hyperparathyroidism-\"Overtones\" May Be Overblown.","authors":"Michael W Yeh","doi":"10.1001/jamasurg.2024.3519","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3519","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125736","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":"Mentorship of Junior Surgical Faculty Across Academic Programs in Surgery.","authors":"Jingjing Yu, Perisa Ruhi-Williams, Christian de Virgilio, Shahrzad Bazargan-Hejazi, Helen E Ovsepyan, Steven D Wexner, Katharine A Kirby, Fatemeh Tajik, Angelina Lo, Aya Fattah, Farin F Amersi, Kristine E Calhoun, Lisa A Cunningham, Paula I Denoya, Henry R Govekar, Sara M Grossi, Jukes P Namm, V Prasad Poola, Robyn E Richmond, Christine H Rohde, Mayank Roy, Tara A Russell, Nicola Sequeira, Anaar E Siletz, Tiffany N Tanner, Brian T Valerian, Maheswari Senthil","doi":"10.1001/jamasurg.2024.3390","DOIUrl":"10.1001/jamasurg.2024.3390","url":null,"abstract":"<p><strong>Importance: </strong>Because mentorship is critical for professional development and career advancement, it is essential to examine the status of mentorship and identify challenges that junior surgical faculty (assistant and associate professors) face obtaining effective mentorship.</p><p><strong>Objective: </strong>To evaluate the mentorship experience for junior surgical faculty and highlight areas for improvement.</p><p><strong>Design, setting, and participants: </strong>This qualitative study was an explanatory sequential mixed-methods study including an anonymous survey on mentorship followed by semistructured interviews to expand on survey findings. Junior surgical faculty from 18 US academic surgery programs were included in the anonymous survey and interviews. Survey responses between \"formal\" (assigned by the department) vs \"informal\" (sought out by the faculty) mentors and male vs female junior faculty were compared using χ2 tests. Interview responses were analyzed for themes until thematic saturation was achieved. Survey responses were collected from November 2022 to August 2023, and interviews conducted from July to December 2023.</p><p><strong>Exposure: </strong>Mentorship from formal and/or informal mentors.</p><p><strong>Main outcomes and measures: </strong>Survey gauged the availability and satisfaction with formal and informal mentorship; interviews assessed broad themes regarding mentorship.</p><p><strong>Results: </strong>Of 825 survey recipients, 333 (40.4%) responded; 155 (51.7%) were male and 134 (44.6%) female. Nearly all respondents (319 [95.8%]) agreed or strongly agreed that mentorship is important to their surgical career, especially for professional networking (309 respondents [92.8%]), career advancement (301 [90.4%]), and research (294 [88.3%]). However, only 58 respondents (18.3%) had a formal mentor. More female than male faculty had informal mentors (123 [91.8%] vs 123 [79.4%]; P = .003). Overall satisfaction was higher with informal mentorship than formal mentorship (221 [85.0%] vs 40 [69.0%]; P = .01). Most male and female faculty reported no preferences in gender or race and ethnicity for their mentors. When asked if they had good mentor options if they wanted to change mentors, 141 (47.8%) responded no. From the interviews (n = 20), 6 themes were identified, including absence of mentorship infrastructure, preferred mentor characteristics, and optimizing mentorship.</p><p><strong>Conclusions and relevance: </strong>Academic junior surgical faculty agree mentorship is vital to their careers. However, this study found that few had formal mentors and almost half need more satisfactory options if they want to change mentors. Academic surgical programs should adopt a framework for facilitating mentorship and optimize mentor-mentee relationships through alignment of mentor-mentee goals and needs.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125734","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":"Admission and Patients Undergoing Surgery at Risk of Patient-Directed Discharges.","authors":"Hannah C Decker, Amy Shui, Hemal K Kanzaria, Logan Pierce, Elizabeth Wick","doi":"10.1001/jamasurg.2024.2565","DOIUrl":"10.1001/jamasurg.2024.2565","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11375520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125730","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":"Mechanical Bowel Preparation and Oral Antibiotics Prior to Rectal Resection.","authors":"Jing Yi Kwan, Giordano Perin, Sabapathy Balasubramanian","doi":"10.1001/jamasurg.2024.2989","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.2989","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125732","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":"There Are Enough Qualified Women-Intentionality Overcomes Implicit Bias.","authors":"Melina R Kibbe","doi":"10.1001/jamasurg.2024.3347","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3347","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":null,"pages":null},"PeriodicalIF":15.7,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142125739","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}