JAMA surgery最新文献

{"title":"Options for Management of Fractures of the Humeral Diaphysis.","authors":"Kevin C Chung","doi":"10.1001/jamasurg.2025.0395","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0395","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709819","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":"Operative vs Nonoperative Management of Fractures of the Humeral Diaphysis: The Humeral Shaft Fracture Fixation Randomized Clinical Trial.","authors":"William M Oliver, Katrina R Bell, Thomas H Carter, Catriona Graham, Timothy O White, Nicholas D Clement, Andrew D Duckworth, Samuel G Molyneux","doi":"10.1001/jamasurg.2025.0301","DOIUrl":"10.1001/jamasurg.2025.0301","url":null,"abstract":"<p><strong>Importance: </strong>Humeral shaft fractures are routinely managed nonoperatively, but this approach is potentially associated with higher nonunion rates and inferior functional outcomes when compared with operative fixation.</p><p><strong>Objective: </strong>To assess whether there is any difference in outcome between surgery and functional bracing for adults with an isolated, closed humeral shaft fracture.</p><p><strong>Design, setting, and participants: </strong>This prospective, superiority, parallel-group randomized clinical trial was conducted between September 2018 and October 2023 and took place at an academic major trauma center in the United Kingdom. Patients were reviewed at 2 and 6 weeks and 3, 6, and 12 months postintervention. Patients included 70 adults with an isolated, closed humeral shaft fracture. Exclusion criteria included absolute indications for surgery, pathological/periprosthetic fractures, multiple traumas, significant frailty, and inability to comply with follow-up. Data were analyzed from November 2023 through January 2024.</p><p><strong>Interventions: </strong>Open reduction and plate fixation (n = 36) or functional bracing (n = 34). Seven patients did not receive their assigned treatment (operative, 5; nonoperative, 2).</p><p><strong>Main outcomes and measures: </strong>The primary outcome measure was the Disabilities of the Arm, Shoulder, and Hand score (DASH) at 3 months postintervention. Secondary outcomes included health-related quality of life (EuroQol 5-Dimension [EQ-5D]/health visual analog scale [EQ-VAS] and Short Form [SF]-12 Physical Component Summary [PCS]/Mental Component Summary [MCS] scores), pain, shoulder/elbow range of motion, and complications. Intention-to-treat analyses were used.</p><p><strong>Results: </strong>The study included 70 patients (mean [SD] age, 49 [17.1] years; 38 female [54%] and 32 male [46%]). At 3 months, 66 patients (94%) had completed follow-up. The operative group had a significantly better DASH score (difference, 15.0; P = .01). Surgery was also associated with a superior DASH score at 6 weeks (difference, 14.7; P = .01), but not at 6 months (P = .10) or at 12 months (P = .78). Surgery was further associated with a higher EQ-5D score (6 weeks: difference, 0.126, P = .03), EQ-VAS score (6 months: difference, 7; P = .04), and SF-12 MCS score (6 weeks: difference, 9.3; P = .001; 3 months: difference, 6.9; P = .01; and 6 months: difference, 7.1; P = .01). Brace-related dermatitis was significantly more common in the nonoperative group (18% vs operative 3%; P = .05). There were 8 nonunions (11%; operative 6% vs nonoperative 18%, P = .14).</p><p><strong>Conclusions and relevance: </strong>For patients with a humeral shaft fracture in this study, surgery conferred early functional advantages over bracing. However, these benefits should be considered in the context of potential operative risks and the absence of any difference in outcomes at 1 year.</p><p><strong>Trial reg","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709818","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":"Perioperative Penicillin and Cephalosporin Antibiotic Allergy Assessment and Testing: The PREPARE Pilot Randomized Clinical Trial.","authors":"Joseph Francis De Luca, Sara Vogrin, Natasha Elizabeth Holmes, Gemma Kate Reynolds, Jamie Lee Waldron, Fionnuala Cox, Justin Nazareth, Ranjan Guha, Ned Douglas, Andrew Hardidge, Trisha Nicole Peel, Jo Anne Douglass, Douglas Forsyth Johnson, Jason Anthony Trubiano","doi":"10.1001/jamasurg.2025.0279","DOIUrl":"10.1001/jamasurg.2025.0279","url":null,"abstract":"<p><strong>Importance: </strong>Antibiotic allergy labels (AALs) impact patient health and perioperative outcomes. Antibiotic allergy delabeling could improve antibiotic prescribing and infection-related outcomes perioperatively.</p><p><strong>Objective: </strong>To assess the feasibility and safety of antibiotic allergy assessment and delabeling in anesthesiologist-led preoperative assessment clinics and expand delabeling efforts outside of specialist allergy clinics.</p><p><strong>Design, setting, and participants: </strong>This randomized clinical trial was a multicenter, phase 2 feasibility and safety trial conducted between December 14, 2020, and October 31, 2023, at outpatient preoperative anesthesiologist-led clinics at 3 tertiary hospitals in Melbourne, Australia. Participants were adults (age ≥18 years) with a reported β-lactam AAL likely to require intravenous antibiotic therapy for perioperative prophylaxis. Randomization was carried out on a 1:1 basis.</p><p><strong>Interventions: </strong>Enhanced allergy assessment by anesthesiologists using a smartphone application with a decision support algorithm adapted from a validated antibiotic allergy assessment tool. Risk scores guided antibiotic allergy testing: direct oral challenge (low risk) or skin testing followed by oral challenge (medium to high risk).</p><p><strong>Main outcomes and measures: </strong>The 2 primary feasibility outcomes were the proportion of patients randomized to intervention who received intervention per protocol and proportion of patients consenting to participate out of all eligible. The primary safety outcome was the proportion of the intervention group experiencing an antibiotic-associated adverse event (AE) within 90 days postsurgery.</p><p><strong>Results: </strong>Of 150 patients enrolled, 74 were randomly assigned to receive the intervention and 76 to control. The median age was 67 years (range, 28-89 years); 78 (52%) were female and 72 (48%) were male. For feasibility of recruitment, 150 of 511 patients (29.4%; 95% CI, 25.4%-33.5%) with eligible AALs were enrolled. For feasibility of intervention delivery, 47 of 74 patients (63.5%; 95% CI, 51.5%-74.4%) randomized to intervention had allergy testing; 28 of 30 patients (93%) assessed as low risk and 19 of 44 patients (43%) assessed as moderate/high risk proceeded to allergy testing. Antibiotic-related AE were reported in 4 of 74 intervention patients (5.4%, 95% CI, 1.5%-13.3%), 1 event was immune mediated (benign rash) without a delay to surgery. There was less restricted antibiotic use in the intervention group (6 patients; 10.7%) compared with the control group (10 patients; 17.9%).</p><p><strong>Conclusions and relevance: </strong>Low-risk β-lactam AAL were successfully evaluated and delabeled by anesthesiologists in the preoperative clinic using the intervention. The absence of severe AE after the intervention provides reassurance that antibiotic allergy delabeling can be achieved as part of a preopera","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709821","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":"JAMA Surgery Peer Reviewers in 2024.","authors":"","doi":"10.1001/jamasurg.2025.0339","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0339","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"e250339"},"PeriodicalIF":15.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657206","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":"Is There a Need for Drain Placement After Gastrectomy?","authors":"Kyle D Klingbeil, Ami Hayashi, Edward H Livingston","doi":"10.1001/jamasurg.2025.0169","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0169","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657191","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":"Neoadjuvant Chemoradiotherapy vs Chemoimmunotherapy for Esophageal Squamous Cell Carcinoma","authors":"Xufeng Guo, Chunji Chen, Jinbo Zhao, Changchun Wang, Xinyu Mei, Jianfei Shen, Huilai Lv, Yongtao Han, Qifeng Wang, Jiahua Lv, Hainan Chen, Xiaolong Yan, Zhichao Liu, Zhengyang Zhang, Qihong Zhong, Youhua Jiang, Liwei Xu, Xiaoyang Li, Dong Qian, Dehua Ma, Minhua Ye, Chunguo Wang, Zimin Wang, Jiangbo Lin, Ziqiang Tian, Xuefeng Leng, Zhigang Li","doi":"10.1001/jamasurg.2025.0220","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0220","url":null,"abstract":"ImportanceThe association of neoadjuvant chemoimmunotherapy (NCIT) vs chemoradiotherapy (NCRT) with tumor downstaging and survival in locally advanced esophageal squamous cell carcinoma (ESCC) remains unclear because of limited evidence.ObjectiveTo compare the associations of NCIT and NCRT with tumor regression and long-term survival in patients with locally advanced ESCC.Design, Setting, and ParticipantsIn this comparative effectiveness research study, from January 2016 to March 2023, patients with locally advanced ESCC who underwent esophagectomy following NCRT or NCIT were identified from a prospective database of 8 high-volume esophageal surgery centers in China. Follow-up began on the date of surgery and continued until the last recorded contact or March 2024, whichever occurred first. Data were analyzed between April and September 2024.Main Outcomes and MeasuresThe primary end points were 2-year overall survival (OS) and disease-free survival (DFS). Secondary end points included major pathologic response (MPR) and pathologic complete response (pCR). Cox proportional hazard regression analysis was used to investigate the risk factors for OS and DFS.ResultsThe study included 1428 patients (median [IQR] age, 63 [57-68] years; 1184 men [82.9%]), with 704 patients in the NCRT group and 724 patients in the NCIT group. After propensity score matching, there were 532 patients in each group. The 2-year OS (81.3% vs 71.3%; hazard ratio, 1.57; 95% CI, 1.26-1.96; <jats:italic>P</jats:italic> &amp;amp;lt; .001) and DFS (73.9% vs 63.4%; hazard ratio, 1.37; 95% CI, 1.11-1.69; <jats:italic>P</jats:italic> &amp;amp;lt; .001) rates were significantly higher in NCIT group than in the NCRT group. The NCRT group had a higher MPR rate than that of the NCIT group (71.8% vs 61.5%), whereas the pCR rates were similar (25.9% vs 22.9%). Multivariable Cox analysis demonstrated that NCIT and MPR were independently associated with both OS and DFS. The NCIT group exhibited a lower overall recurrence rate (126 patients [23.7%] vs 190 patients [35.7%]) and distant metastasis rate (72 patients [13.5%] vs 133 patients [25.0%]), although locoregional metastasis rates were similar (98 patients [18.4%] vs 111 patients [20.9%]). Better OS and DFS were obtained for the NCIT group than for the NCRT group, regardless of whether adjuvant immunotherapy was given.Conclusions and RelevanceCompared with NCRT, patients with locally advanced ESCC receiving NCIT had better 2-year OS and DFS. The decrease in distant metastasis may be the main reason, but further prospective randomized clinical trials are needed to verify this finding.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"70 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653590","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":"Total Endoscopic Robotic Mitral Valve Repair Surgery.","authors":"Ahmed H Aly, T Sloane Guy","doi":"10.1001/jamasurg.2025.0154","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0154","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657213","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":"Two Guidelines on Coronary Disease and the Atlantic Divide.","authors":"Faisal Bakaeen, Torsten Doenst","doi":"10.1001/jamasurg.2025.0158","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0158","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657214","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":"Molecular Testing and Targeted Therapies in Hepatobiliary Cancers","authors":"Diamantis I. Tsilimigras, Razelle Kurzrock, Timothy M. Pawlik","doi":"10.1001/jamasurg.2025.0242","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0242","url":null,"abstract":"ImportanceHepatobiliary cancers are heterogeneous and molecularly complex. Recent advances in next-generation sequencing (NGS) have enhanced the understanding of their molecular landscape and enabled deployment of biomarker-based gene- and immune-targeted therapies. This review examines the role of molecular testing and targeted therapies in these malignant neoplasms.ObservationsPatients with hepatobiliary cancers have poor outcomes. Precision oncology studies have shown that while many common molecular alterations are not currently targetable in hepatocellular carcinoma (HCC), a large number of actionable alterations characterize biliary tract cancers (BTCs), with several therapies now approved by the US Food and Drug Administration. Immunotherapy is increasingly adopted in clinical practice, either as monotherapy or combined with cytotoxic chemotherapy, for both HCC and BTCs. Moreover, multiple solid cancer tumor-agnostic therapies are approved (larotrectinib, entrectinib, and repotrectinib for <jats:italic>NTRK</jats:italic> fusions; selpercatinib for <jats:italic>RET</jats:italic> fusions; dabrafenib and trametinib combination for <jats:italic>BRAF</jats:italic> V600E mutations; dostarlimab or pembrolizumab for tumors with high microsatellite instability and pembrolizumab for tumor mutation burden ≥10 mutations/megabase), highlighting the need for NGS as well as ERBB2 (formerly HER2) immunohistochemistry (IHC) (with the recent approval of solid tissue–agnostic deruxtecan trastuzumab for ERBB2-positive [IHC 3+] cancer) across cancers. N-of-1 clinical trials using customized drug combinations matched to the tumor’s molecular profile have yielded encouraging results and provide a promising framework for future clinical trial design.Conclusions and RelevanceMolecular testing and gene- and immune-targeted therapies are transforming hepatobiliary cancer treatment. Tumor-agnostic and N-of-1 clinical trials have challenged traditional clinical trial paradigms and provide the foundation for truly personalized oncology for patients with these aggressive cancers. Further work is needed to determine how to leverage these novel approaches into the management of operable disease.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"183 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653589","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":"Is There a Need for Drain Placement After Gastrectomy?-Reply.","authors":"Jacopo Weindelmayer, Giovanni de Manzoni, Giuseppe Verlato","doi":"10.1001/jamasurg.2025.0172","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.0172","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657194","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}