JAMA surgery最新文献

{"title":"De-Escalation of Nodal Surgery in Clinically Node-Positive Breast Cancer.","authors":"Neslihan Cabioglu, Havva Belma Koçer, Hasan Karanlik, Mehmet Ali Gülçelik, Abdullah Igci, Mahmut Müslümanoglu, Cihan Uras, Baris Mantoglu, Didem Can Trabulus, Giray Akgül, Mustafa Tükenmez, Kazim Senol, Enver Özkurt, Ebru Sen, Güldeniz Karadeniz Çakmak, Süleyman Bademler, Selman Emiroglu, Nilüfer Yildirim, Halil Kara, Ahmet Dag, Ece Dilege, Ayse Altinok, Gül Basaran, Ecenur Varol, Ümit Ugurlu, Yasemin Bölükbasi, Yeliz Emine Ersoy, Baha Zengel, Niyazi Karaman, Serdar Özbas, Leyla Zer, Halime Gül Kiliç, Orhan Agcaoglu, Gürhan Sakman, Zafer Utkan, Aykut Soyder, Alper Akcan, Sefa Ergün, Ravza Yilmaz, Adnan Aydiner, Atilla Soran, Kamuran Ibis, Vahit Özmen","doi":"10.1001/jamasurg.2024.5913","DOIUrl":"10.1001/jamasurg.2024.5913","url":null,"abstract":"<p><strong>Importance: </strong>Increasing evidence supports the oncologic safety of de-escalating axillary surgery for patients with breast cancer after neoadjuvant chemotherapy (NAC).</p><p><strong>Objective: </strong>To evaluate the oncologic outcomes of de-escalating axillary surgery among patients with clinically node (cN)-positive breast cancer and patients whose disease became cN negative after NAC (ycN negative).</p><p><strong>Design, setting, and participants: </strong>In the NEOSENTITURK MF-1803 prospective cohort registry trial, patients from 37 centers with cT1-4N1-3M0 disease treated with sentinel lymph node biopsy (SLNB) or targeted axillary dissection (TAD) alone or with ypN-negative or ypN-positive disease after NAC were recruited between February 15, 2019, and January 1, 2023, and evaluated.</p><p><strong>Exposure: </strong>Treatment with SLNB or TAD after NAC.</p><p><strong>Main outcomes and measures: </strong>The primary aim of the study was axillary, locoregional, or distant recurrence rates; disease-free survival; and disease-specific survival. Number of axillary lymph nodes removed was also evaluated.</p><p><strong>Results: </strong>A total of 976 patients (median age, 46 years [range, 21-80 years]) with cT1-4N1-3M0 disease underwent SLNB (n = 620) or TAD alone (n = 356). Most of the cohort had a mapping procedure with blue dye alone (645 [66.1%]) with (n = 177) or without (n = 468) TAD. Overall, no difference was found between patients treated with TAD and patients treated with SLNB in the median number of total lymph nodes removed (TAD, 4 [3-6] vs SLNB, 4 [3-6]; P = .09). Among patients with ypN-positive disease, those who underwent TAD were more likely to have a lower median lymph node ratio (TAD, 0.28 [IQR, 0.20-0.40] vs SLNB, 0.33 [IQR, 0.20-0.50]; P = .03). At a median follow-up of 39 months (IQR, 29-48 months), no significant difference was found in the rates of ipsilateral axillary recurrence (0.3% [1 of 356] vs 0.3% [2 of 620]; P ≥ .99) or locoregional recurrence (0.6% [2 of 356] vs 1.1% [7 of 620]; P = .50) between the TAD and SLNB groups, with an overall locoregional recurrence rate of 0.9% (9 of 976). The initial clinical tumor stage, pathologic complete response, and use of blue dye alone as a mapping procedure were not associated with the outcome. Even though patients with TAD demonstrated an increased disease-free survival rate compared with the SLNB group, this difference did not reach statistical significance (94.9% vs 92.6%; P = .07). Factors associated with decreased 5-year disease-specific survival were cN2-3 axillary stage (cN1, 98.7% vs cN2-3, 96.8%; P = .03) and nonluminal type tumor pathologic characteristics (luminal, 98.9% vs nonluminal, 96.9%; P = .007).</p><p><strong>Conclusions and relevance: </strong>The short-term results suggest very low rates of axillary and locoregional recurrence in a select group of patients with cN-negative disease after NAC treated with TAD alone or SLNB alone followed b","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"257-266"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914671","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":"Surgical Decision-Making and Umbilical Hernia Repair Outcomes.","authors":"Aymen H Sadaka, William J O'Brien, Kamal M F Itani","doi":"10.1001/jamasurg.2024.4748","DOIUrl":"10.1001/jamasurg.2024.4748","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"351-352"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768999","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":"Association Between Surgeon Stress and Major Surgical Complications.","authors":"Jake Awtry, Sarah Skinner, Stephanie Polazzi, Jean-Christophe Lifante, Tanujit Dey, Antoine Duclos","doi":"10.1001/jamasurg.2024.6072","DOIUrl":"10.1001/jamasurg.2024.6072","url":null,"abstract":"<p><strong>Importance: </strong>Surgeon stress can influence technical and nontechnical skills, but the consequences for patient outcomes remain unknown.</p><p><strong>Objective: </strong>To investigate whether surgeon physiological stress, as assessed by sympathovagal balance, is associated with postoperative complications.</p><p><strong>Design, setting, and participants: </strong>This multicenter prospective cohort study included 14 surgical departments involving 7 specialties within 4 university hospitals in Lyon, France. Exclusion criteria consisted of patient age younger than 18 years, palliative surgery, incomplete operative time-stamping data, procedures with a duration of less than 20 minutes, and invalid surgeon heart rate variability (HRV) data. Data were accrued between November 1, 2020, and December 31, 2021, with 30-day follow-up completed on May 8, 2022. Analyses were performed from January 1 to May 31, 2024.</p><p><strong>Exposure: </strong>Sympathovagal balance of the attending surgeon in the first 5 minutes of surgery.</p><p><strong>Main outcomes and measures: </strong>Major surgical complications, extended intensive care unit stay, and mortality within 30 days, after adjustment via mixed-effects multivariable logistic regression for surgeon age, professional status, the time of incision, the random effect of the surgeon, and a composite risk score incorporating patient comorbidities and surgery characteristics. Sympathovagal balance was quantified by the low frequency to high frequency (LF:HF) ratio derived from HRV data measured by chest monitors worn intraoperatively. The LF:HF ratio was normalized at the surgeon level to the median value observed for each surgeon during the study period to control for baseline differences.</p><p><strong>Results: </strong>A total of 793 surgical procedures performed by 38 attending surgeons were included in the analysis. Median patient age was 62 (IQR, 47-72) years, and 412 (52.0%) were female, with a median of 2 (IQR, 1-4) comorbidities. Median surgeon age was 46 (IQR, 39-52) years, 39 (78.9%) were male, and 22 (57.9%) were professors. Median surgeon heart rate was 88 (IQR, 77-99) beats per minute. Median surgeon LF:HF ratio was 7.16 (IQR, 4.52-10.72) before and 1.00 (IQR, 0.71-1.32) after normalization. Increased surgeon sympathovagal balance during the first 5 minutes of surgery was associated with significantly reduced major surgical complications (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.98; P = .04), though not with reduced intensive care unit stay (AOR, 0.34; 95% CI, 0.11-1.01; P = .05) or mortality (AOR, 0.18; 95% CI, 0.03-1.03; P = .05).</p><p><strong>Conclusions and relevance: </strong>Increased surgeon stress at the beginning of a procedure was associated with improved clinical patient outcomes. The results are illustrative of the complex relationship between physiological stress and performance, identify a novel association between measurable surgeon human factors and patien","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"332-340"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983616","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":"Increasing Enrollment of Women in Surgical Clinical Trials.","authors":"Judith C Lin, Linda M Harris, Melina R Kibbe","doi":"10.1001/jamasurg.2024.5213","DOIUrl":"10.1001/jamasurg.2024.5213","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"243-244"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914596","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":"Disparities in Access to Time-Sensitive Emergency Trauma Care.","authors":"Cherisse Berry","doi":"10.1001/jamasurg.2024.6411","DOIUrl":"10.1001/jamasurg.2024.6411","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"321"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143005722","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":"Turning Stress Into Success-Surgery as Professional Sport.","authors":"Steven Yule, Jennifer Yule, Calum Arthur","doi":"10.1001/jamasurg.2024.6041","DOIUrl":"10.1001/jamasurg.2024.6041","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"341"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982752","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":"Effective Deimplementation of Low-Value Preoperative Testing: Choosing Wisely, From Policy to Practice.","authors":"Margaret E Smith, Alex B Haynes","doi":"10.1001/jamasurg.2024.6040","DOIUrl":"10.1001/jamasurg.2024.6040","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"312"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983621","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":"Tranexamic Acid in General Surgery-Who Benefits the Most?","authors":"Marjorie Liggett, Hasan Alam","doi":"10.1001/jamasurg.2024.6060","DOIUrl":"10.1001/jamasurg.2024.6060","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"275"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983646","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":"Safety and Efficacy of Tranexamic Acid in General Surgery.","authors":"Lily J Park, Maura Marcucci, Sandra N Ofori, Flavia K Borges, Rahima Nenshi, Charlotte Tiffanie Bendtz Kanstrup, Michael Rosen, Giovanni Landoni, Vladimir Lomivorotov, Thomas W Painter, Denis Xavier, Maria Jose Martinez-Zapata, Wojciech Szczeklik, Christian S Meyhoff, Matthew T V Chan, Marko Simunovic, Jessica Bogach, Pablo E Serrano, Kumar Balasubramanian, Margherita Cadeddu, Ilun Yang, Won Ho Kim, P J Devereaux","doi":"10.1001/jamasurg.2024.6048","DOIUrl":"10.1001/jamasurg.2024.6048","url":null,"abstract":"<p><strong>Importance: </strong>Perioperative bleeding is common in general surgery. The POISE-3 (Perioperative Ischemic Evaluation-3) trial demonstrated efficacy of prophylactic tranexamic acid (TXA) compared with placebo in preventing major bleeding without increasing vascular outcomes in noncardiac surgery.</p><p><strong>Objective: </strong>To determine the safety and efficacy of prophylactic TXA, specifically in general surgery.</p><p><strong>Design, setting, and participants: </strong>Subgroup analyses were conducted that compared randomized treatment with TXA vs placebo according to whether patients underwent general surgery or nongeneral surgery in the POISE-3 blinded, international, multicenter randomized clinical trial. Participants were 45 years or older, were undergoing noncardiac surgery, had increased cardiovascular risk, and were expected to require at least an overnight hospital admission after surgery. Among 26 581 eligible patients identified, 17 046 were excluded, resulting in 9535 patients randomized to the POISE-3 trial. Participants were enrolled from June 2018 through July 2021. The data were analyzed during December 2023.</p><p><strong>Intervention: </strong>Prophylactic, 1-g bolus of intravenous TXA or placebo at the start and end of surgery.</p><p><strong>Main outcomes and measures: </strong>The primary efficacy outcome was a composite of life-threatening bleeding, major bleeding, or bleeding into a critical organ. The primary safety outcome was a composite of myocardial injury after noncardiac surgery, nonhemorrhagic stroke, peripheral arterial thrombosis, or symptomatic proximal venous thromboembolism at 30 days. Cox proportional hazards models were conducted, incorporating tests of interaction.</p><p><strong>Results: </strong>Among 9535 POISE-3 participants, 3260 underwent a general surgery procedure. Mean age was 68.6 (SD, 9.6) years, 1740 were male (53.4%), and 1520 were female (46.6%). Among general surgery patients, 8.0% and 10.5% in the TXA and placebo groups, respectively, had the primary efficacy outcome (hazard ratio [HR], 0.74; 95% CI, 0.59-0.93; P = .01) and 11.9% and 12.5% in the TXA and placebo groups, respectively, had the primary safety outcome (HR, 0.95; 95% CI, 0.78-1.16; P = .63). There was no significant interaction by type of surgery (general surgery vs nongeneral surgery) on the primary efficacy (P for interaction = .81) and safety (P for interaction = .37) outcomes. Across subtypes of general surgery, TXA decreased the composite bleeding outcome in hepatopancreaticobiliary surgery (HR, 0.55; 95% CI, 0.34-0.91 [n = 332]) and colorectal surgery (HR, 0.67; 95% CI, 0.45-0.98 [n = 940]). There was no significant interaction across subtypes of general surgery (P for interaction = .68).</p><p><strong>Conclusions and relevance: </strong>In this study, TXA significantly reduced the risk of perioperative bleeding without increasing cardiovascular risk in patients undergoing general surgery procedures.</p><p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"267-274"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11904705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142983575","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":"Surgical Turnover Time Using Lean Six Sigma.","authors":"Anagha Cupples, Ingrid Duva, Hope Birdsong, Nader N Massarweh","doi":"10.1001/jamasurg.2024.4956","DOIUrl":"10.1001/jamasurg.2024.4956","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"352-354"},"PeriodicalIF":15.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11618629/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769002","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}