JAMA surgery最新文献

{"title":"Stomach-Preserving Surgery for Early Gastric Cancer-Reply.","authors":"Bang Wool Eom, Mira Han, Hong Man Yoon","doi":"10.1001/jamasurg.2024.4759","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4759","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583033","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 Assessment in Older Adults After Traumatic Injury.","authors":"Natasha Gonzalez, Hope Schwartz, Rebecca Menza, Amy M Shui, Robert Mackersie, Tasce Bongiovanni","doi":"10.1001/jamasurg.2024.3368","DOIUrl":"10.1001/jamasurg.2024.3368","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583028","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":"Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma.","authors":"Paul C M Andel, Iris W J M van Goor, Simone Augustinus, Frederik Berrevoet, Marc G Besselink, Rajesh Bhojwani, Ugo Boggi, Stefan A W Bouwense, Geert A Cirkel, Jacob L van Dam, Angela Djanani, Dimitri Dorcaratto, Stephan Dreyer, Marcel den Dulk, Isabella Frigerio, Poya Ghorbani, Mara R Goetz, Bas Groot Koerkamp, Filip Gryspeerdt, Camila Hidalgo Salinas, Martijn Intven, Jakob R Izbicki, Rosa Jorba Martin, Emanuele F Kauffmann, Reinhold Klug, Mike S L Liem, Misha D P Luyer, Manuel Maglione, Elena Martin-Perez, Mark Meerdink, Vincent E de Meijer, Vincent B Nieuwenhuijs, Andrej Nikov, Vitor Nunes, Elizabeth Pando Rau, Dejan Radenkovic, Geert Roeyen, Francisco Sanchez-Bueno, Alejandro Serrablo, Ernesto Sparrelid, Konstantinos Tepetes, Rohan G Thakkar, George N Tzimas, Robert C Verdonk, Meike Ten Winkel, Alessandro Zerbi, Vincent P Groot, I Quintus Molenaar, Lois A Daamen, Hjalmar C van Santvoort","doi":"10.1001/jamasurg.2024.5024","DOIUrl":"10.1001/jamasurg.2024.5024","url":null,"abstract":"<p><strong>Importance: </strong>International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide.</p><p><strong>Objective: </strong>To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA).</p><p><strong>Design, setting, and participants: </strong>This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging.</p><p><strong>Exposures: </strong>Symptomatic follow-up or routine imaging in patients who underwent PDAC resection.</p><p><strong>Main outcomes and measures: </strong>Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS.</p><p><strong>Results: </strong>Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04).</p><p><strong>Conclusion and relevance: </strong>In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583031","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":"Error in Figure.","authors":"","doi":"10.1001/jamasurg.2024.5361","DOIUrl":"10.1001/jamasurg.2024.5361","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11581710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583024","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":"Stomach-Preserving Surgery for Early Gastric Cancer.","authors":"Tao Jiang, Deng-Chao Wang, Yue-Hua Lei","doi":"10.1001/jamasurg.2024.4756","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4756","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583032","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":"Parastomal Hernia Prevention Using Funnel-Shaped Intra-Abdominal Mesh Compared to No Mesh: The Chimney Randomized Clinical Trial.","authors":"Elisa Mäkäräinen, Heikki Wiik, Maziar Nikberg, Jyrki Kössi, Monika Carpelan-Holmström, Tarja Pinta, Kirsi Lehto, Marko Nikki, Jyri Järvinen, Pasi Ohtonen, Tero Rautio","doi":"10.1001/jamasurg.2024.3260","DOIUrl":"10.1001/jamasurg.2024.3260","url":null,"abstract":"<p><strong>Importance: </strong>Prophylactic placement of a mesh has been suggested to prevent parastomal hernia. Evidence to support this practice is contradictory.</p><p><strong>Objective: </strong>To determine whether funnel-shaped permanent synthetic parastomal mesh is effective and safe in parastomal hernia prevention.</p><p><strong>Design, setting, and participants: </strong>The Chimney Trial was a randomized single-blinded multicenter trial conducted in 4 hospitals in Finland and 1 in Sweden from February 2019 and September 2021. Of 439 patients with rectal adenocarcinoma undergoing either laparoscopic or robotic-assisted abdominoperineal resection or the Hartmann procedure, 143 were enrolled in the trial, 135 received their allocated intervention, and 121 were analyzed at 12-month follow-up. Data were analyzed from December 2023 to May 2024.</p><p><strong>Intervention: </strong>In the intervention group, a permanent colostomy was created with a funnel-shaped intraperitoneal mesh and compared to a control group with a stoma without the mesh.</p><p><strong>Main outcome and measure: </strong>The primary end point was the incidence of computed tomography (CT)-confirmed parastomal hernia 12 months after surgery.</p><p><strong>Results: </strong>There were 68 patients (mean [SD] age, 68.7 [11.6] years; 36 [53% male and 32 [47%] female) who received the intended allocation in the mesh group and 67 (mean [SD] age, 66.4 [11.7] years; 48 [72%] male and 19 [28%] female) who received the intended allocation in the control group. CT scans were available for 58 patients in the mesh group and 59 patients in the control group at the 12-month follow-up. CT scans confirmed parastomal hernia in 6 of 58 patients (10%) in the mesh group compared to 22 of 59 patients (37%) in the control group (difference, 27%; 95% CI, 12-41; P < .001). Clinical parastomal hernia as a secondary outcome was recorded in 1 of 60 patients (2%) in the mesh group compared to 27 of 61 (43%) in the control group (difference, 41%; 95% CI, 29-55; P < .001). The number of patients with Clavien-Dindo class II ileus was 23 (35%) in the mesh group compared to 11 (17%) in the control group (difference, 18%; 95% CI, 3-32; P = .006). Only slight differences between the groups were detected in other stoma-related complications, readmissions, operative time, surgical site infections, reoperations, and quality of life.</p><p><strong>Conclusions and relevance: </strong>In this study, funnel-shaped parastomal mesh prevented a significant number of parastomal hernias without predisposing patients to mesh- or stoma-related complications during 12-month follow-up. The results of this study suggest the funnel-shaped mesh is a feasible option to prevent parastomal hernia.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03799939.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1244-1250"},"PeriodicalIF":15.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11359091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080289","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":" ","pages":"1291-1298"},"PeriodicalIF":15.7,"publicationDate":"2024-11-01","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":"Robotic or Laparoscopic Cholecystectomy-Safety First-Reply.","authors":"Kyle H Sheetz, Justin B Dimick","doi":"10.1001/jamasurg.2024.3768","DOIUrl":"10.1001/jamasurg.2024.3768","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1330"},"PeriodicalIF":15.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142287515","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":"Quality of Life and Clinical Outcomes in Symptomatic Peripheral Artery Disease.","authors":"Manasi Tannu, Jennifer A Rymer","doi":"10.1001/jamasurg.2024.3094","DOIUrl":"10.1001/jamasurg.2024.3094","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1271"},"PeriodicalIF":15.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142017460","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":"Successful Prevention of Parastomal Hernia Formation With Intra-Abdominal Funnel-Shaped Mesh.","authors":"Imran J Anwar, Jacob A Greenberg","doi":"10.1001/jamasurg.2024.3252","DOIUrl":"10.1001/jamasurg.2024.3252","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"1250-1251"},"PeriodicalIF":15.7,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142080290","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}