Journal of Surgical Research最新文献

{"title":"Geriatric Trauma Activation","authors":"Samara Sober BS ,&nbsp;Lauren Langman BS ,&nbsp;Ambika Mukhi MS ,&nbsp;Jonathan Martin MD ,&nbsp;James Vosswinkel MD ,&nbsp;Adam J. Singer MD ,&nbsp;Suzanne Fields MD ,&nbsp;Randeep S. Jawa MD","doi":"10.1016/j.jss.2025.09.010","DOIUrl":"10.1016/j.jss.2025.09.010","url":null,"abstract":"<div><h3>Introduction</h3><div>The American College of Surgeons indicated geriatric-specific trauma team activation criteria to minimize undertriage. We evaluated activation volumes and outcomes for older adults before and after implementation of revised criteria.</div></div><div><h3>Methods</h3><div>Data were collected from institutional trauma registry and nonregistry data repository for patients ≥65 y presenting directly to a level I trauma center with blunt trauma, preguideline, and post guideline revision. The repository encompasses activation patients with no injuries or minor injuries who are discharged home from the ED or admitted for noninjury related reasons. Trauma team activation rates, resource utilization, and outcomes were examined.</div></div><div><h3>Results</h3><div>After revision, trauma registry (prerevision: 295 <em>versus</em> post revision: 915 patients) and nonregistry (prerevision: 132 <em>versus</em> post revision: 1703 patients) activations markedly increased. The most common activation criterion post revision was elderly fall on antithrombotic (prerevision: 34.9% <em>versus</em> post revision: 69.6%). Activated registry patients had significantly lower median Injury Severity Scores (prerevision: 10 <em>versus</em> post revision: 5) and mortality rates (prerevision: 8.1% <em>versus</em> post revision: 4.3%), with higher emergency department to home discharge rates (prerevision: 10.2% <em>versus</em> post revision: 28.9%) post guideline revision. Activations were associated with prerevision: 4.5-fold and post revision: 4.0-fold faster time to index computed tomography scan completion than nonactivations.</div></div><div><h3>Conclusions</h3><div>Activations markedly increased post guideline revision with many patients having no injuries or minor injuries that did not meet registry inclusion criteria. The increased activations were largely associated with elderly falls on antithrombotics. Among those meeting criteria, the Injury Severity Score was low, and they were more frequently discharged home from the ED. An opportunity for optimizing resource utilization may exist.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 231-240"},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caveat Emptor: Characterizing Water Bead Consumer and Safety Reporting","authors":"Jennifer M. Schuh MD ,&nbsp;Mallory N. Perez MD ,&nbsp;Emmanuel L. Abebrese MD ,&nbsp;Araceli A. Morelos MD ,&nbsp;Carlos A. Dounce MD ,&nbsp;Mehul V. Raval MD, MS ,&nbsp;Jose H. Salazar MD, PhD","doi":"10.1016/j.jss.2025.09.011","DOIUrl":"10.1016/j.jss.2025.09.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Water beads, often marketed as toys, rapidly expand in water and have caused injuries from ingestion, aspiration, and as projectiles. This study analyzed consumer reports to assess the scope and severity of such reported injuries compared to the published literature.</div></div><div><h3>Methods</h3><div>The United States Consumer Product Safety Commission Reports database was searched for “water beads” yielding 5931 entries spanning 2012-2023. Twenty-six relevant reports were analyzed for state, age, mechanism, anatomic injury location, setting of medical encounters, imaging obtained, interventions, and outcomes.</div></div><div><h3>Results</h3><div>The 26 consumer reports described 45 individuals across 15 states. Ingestion cases (mean age 1.3 y; range 0-4) and noningestion injuries (mean age 13.1 y; range 1-37) were reported. The most common injuries were projectile ocular trauma (38%) and ingestions (31%). Medical encounters included three emergency room visits, 15 hospital admissions, and six unspecified visits. Diagnostic imaging was reported in 31% of cases. Surgery was reported in 62% of reports (16/26), including 10 intestinal operations. Outcomes included permanent neurologic injury, ocular impairment, and otologic damage.</div></div><div><h3>Conclusions</h3><div>Water beads have been found to cause aspiration, ingestion, and projectile injuries resulting in long-term neurologic, otologic, and ocular damage. Special care is needed for children of ≤4 y old for whom there is a risk of obstruction after ingestion. Medical professionals should maintain a high index of suspicion when children report water bead exposure. The consumer reports underrepresent the true scope and degree of injury; increased consumer reporting is important for regulatory agencies, the public, and provider awareness.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 218-223"},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Analysis of Solid Pseudopapillary Neoplasms in Children Versus Adults","authors":"Ioannis A. Ziogas MD, MPH ,&nbsp;Kristine S. Corkum MD ,&nbsp;Andrii Khomiak MD, PhD ,&nbsp;Nicholas R. Schmoke MD ,&nbsp;Nicholas G. Cost MD ,&nbsp;Denis Bensard MD ,&nbsp;Richard D. Schulick MD, MBA ,&nbsp;Marco Del Chiaro MD, PhD ,&nbsp;Benedetto Mungo MD ,&nbsp;Jonathan P. Roach MD","doi":"10.1016/j.jss.2025.09.025","DOIUrl":"10.1016/j.jss.2025.09.025","url":null,"abstract":"<div><h3>Introduction</h3><div>Solid pseudopapillary neoplasm (SPN) comprises 2% of pancreatic tumors. We aimed to examine the clinical characteristics, management, and outcomes of SPN in children and adults using US-based national cancer registry data.</div></div><div><h3>Methods</h3><div>In this retrospective National Cancer Database analysis, children (&lt;18 y) and adults (≥18 y) with SPN were included (2004-2020).</div></div><div><h3>Results</h3><div>A total of 1325 patients (231 children, 1094 adults) with SPN were identified. There were no differences between groups regarding tumor size, metastasis, or stage. Most patients in both groups underwent surgical treatment (96.5% <em>versus</em> 92.1%, <em>P</em> = 0.056), whereas a smaller proportion of children received chemotherapy compared to adults (0.9% <em>versus</em> 4.2%, <em>P</em> = 0.01). The 10-year overall survival rate was 99.1% in children <em>versus</em> 88.0% in adults. In multivariable Cox regression, when adjusted for tumor location and receipt of chemotherapy and radiation, adulthood (hazard ratio [HR]: 5.32, 95% confidence interval [95% CI]: 1.26-22.49, <em>P</em> = 0.02), Charlson-Deyo score ≥2 (HR: 3.04, 95% CI: 1.21-7.63, <em>P</em> = 0.02) compared to 0, stage II (HR: 2.48, 95% CI: 1.27-4.82, <em>P</em> = 0.008), stage III (HR: 6.82, 95% CI: 1.50-31.02, <em>P</em> = 0.01), and stage IV (HR: 5.94, 95% CI: 2.49-14.16, <em>P</em> &lt; 0.001) compared to stage I were associated with an increased risk of mortality, whereas Hispanic compared to White patients (HR: 0.44, 95% CI: 0.21-0.95, <em>P</em> = 0.04) and surgically treated patients had a decreased risk of mortality (HR: 0.10, 95% CI: 0.05-0.21, <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Despite similar stage presentation, children with SPN exhibit prolonged survival compared to adults. Most patients underwent surgical treatment, whereas children were less likely to undergo chemotherapy than adults.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 224-230"},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical Considerations in the Deployment of Artificial Intelligence in Surgery","authors":"Paola A. Barrios MD, MS ,&nbsp;Nicole Meredyth MD ,&nbsp;Rachel Morris MD ,&nbsp;Krista Haines MD ,&nbsp;Grace J. Kim MD ,&nbsp;Carrie Y. Peterson MD, MS","doi":"10.1016/j.jss.2025.08.019","DOIUrl":"10.1016/j.jss.2025.08.019","url":null,"abstract":"<div><div>Artificial intelligence (AI) is an attractive option to optimize surgical decision-making. However, multiple ethical concerns exist when applying AI to clinical care. We must consider the benefits of increased efficiency and potential accuracy of using AI against the principles of medical ethics, notably patient autonomy, beneficence, nonmaleficence, and justice. Discrepancies can result in concerns with bias, inequality, transparency, and patient safety as the medical field learns and begins to integrate this new technology. This manuscript is an extension of our 2024 meeting symposium on the topic and provides a review of the current literature around the ethical challenges of AI in academic surgery. We consider accountability, consent, notification, and bias in the setting of patient care and surgical education. Our goal is to equip physicians with a clear understanding of the ethical challenges and considerations surrounding AI to help them make informed decisions about integrating the technology into their practice and careers.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 268-274"},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter Regarding: The Performance of ChatGPT-4.0 and ChatGPT-4omni on Answering Thyroid Question: A Multicenter Study.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkit","doi":"10.1016/j.jss.2025.08.021","DOIUrl":"https://doi.org/10.1016/j.jss.2025.08.021","url":null,"abstract":"","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Early Palliative Care Involvement on More At-Risk Patients Undergoing Surgery for Cancer","authors":"Peter A. Bryant MD ,&nbsp;Onur M. Orun MS ,&nbsp;Rameela Raman PhD ,&nbsp;Myrick C. Shinall Jr. MD, PhD","doi":"10.1016/j.jss.2025.09.009","DOIUrl":"10.1016/j.jss.2025.09.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Two recent clinical trials of patients undergoing nonpalliative surgery for abdominal malignancies found no benefit from early specialist palliative intervention. However, more at-risk patients may benefit from this intervention.</div></div><div><h3>Methods</h3><div>This secondary, post-hoc exploratory analysis of data from one of these trials examines heterogeneity of treatment effect to identify at-risk subgroups of patients who benefit from early specialist palliative intervention. Regression models with interaction terms between treatment and age, frailty, and baseline values of patient reported outcomes (PROs) were used to examine heterogeneity of treatment effect for five PROs at 90 d postoperatively.</div></div><div><h3>Results</h3><div>At alpha = 0.2, there was evidence of possible heterogeneity of treatment effect in six models: by age for the outcomes of physical and functional quality of life (<em>P</em> = 0.12), anxiety (<em>P</em> = 0.03), and depression (<em>P</em> = 0.01); by baseline PRO value for the outcomes of physical and functional quality of life (<em>P</em> = 0.04), anxiety (<em>P</em> = 0.19), and life space (<em>P</em> = 0.03). Graphical examination did not reveal a consistent pattern of more positive intervention effects for more at-risk patients.</div></div><div><h3>Conclusions</h3><div>We found no consistent pattern in heterogeneity of effect to suggest a particular subgroup benefitting from early specialist palliative intervention. This further supports the conclusion that the palliative care needs of these patients are met by their usual care teams.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 202-209"},"PeriodicalIF":1.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145232834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine Learning Algorithm-Based Tumor-Stroma Ratio Can Stratify the Prognosis of Intrahepatic Cholangiocarcinoma","authors":"Xin Zhang MD ,&nbsp;Chen-Song Huang MD ,&nbsp;Xi-Tai Huang MD,&nbsp;Ai-Qing Fu MS,&nbsp;Wei Chen MD, PhD,&nbsp;Jian-Peng Cai MD, PhD,&nbsp;Jia-Ming Lai MD,&nbsp;Xiao-Yu Yin MD, PhD","doi":"10.1016/j.jss.2025.09.007","DOIUrl":"10.1016/j.jss.2025.09.007","url":null,"abstract":"<div><h3>Introduction</h3><div>The study aimed to quantify tumor components through the machine learning algorithm and explore effective biomarkers to stratify the prognosis of intrahepatic cholangiocarcinoma (iCCA) after radical surgery.</div></div><div><h3>Methods</h3><div>A cohort of 237 iCCA patients who underwent radical resection was recruited. The semiautomated pipeline was constructed to measure the tumor microenvironment components, including tumor, lymphocyte, and stromal cells, tumor-stroma ratio, and tumor-infiltrated lymphocytes ratio % were calculated. The overall survival (OS) and disease-free survival (DFS) were compared to evaluate their prognostic values. The predictive values for adjuvant chemotherapy were then explored.</div></div><div><h3>Results</h3><div>The Kaplan–Meier analysis showed that high-stroma and low-tumor-infiltrated lymphocytes ratio % were associated with shorter DFS and OS, and the multivariable Cox analysis also verified the prognosis values of iCCA including DFS (hazard ratio: 1.59, 95% confidence interval: 1.10-2.30, <em>P</em> = 0.015) and OS (hazard ratio: 1.92, 95% confidence interval: 1.27-4.17, <em>P</em> &lt; 0.001). The nomograms presented better performance than previous staging systems, including the 8th American Joint Committee on Cancer system and the Liver Cancer Study Group of Japan system. The low-stroma cohort was more likely to benefit from chemotherapy, including DFS and OS (<em>P</em> = 0.019 and <em>P</em> = 0.002).</div></div><div><h3>Conclusions</h3><div>Machine learning–based tumor-stroma ratio could serve as an effective prognostic biomarker for iCCA after radical surgery and potentially predict the therapeutic response of adjuvant chemotherapy.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 184-193"},"PeriodicalIF":1.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Early Postoperative Hypoxia and Postoperative Pulmonary Complications in Lung Resection Surgery: A Retrospective Cohort Study","authors":"Jun Li BS,&nbsp;Chao Liao BS,&nbsp;Xuping Hu MD,&nbsp;Mengya Luo BS,&nbsp;Changchun Chen MD,&nbsp;Yiwu Sun MD,&nbsp;Liang Wang MD","doi":"10.1016/j.jss.2025.09.031","DOIUrl":"10.1016/j.jss.2025.09.031","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite extensive research has explored the predictive role of preoperative and intraoperative pulse oxygen saturation (SpO₂) levels in postoperative pulmonary complications (PPCs), relatively little attention has been given to the association between early postoperative SpO₂ and PPCs. Patients undergoing lung resection surgery often experience early postoperative hypoxia. This study aimed to assess whether early postoperative hypoxia predicts PPCs after lung resection surgery.</div></div><div><h3>Materials and methods</h3><div>This retrospective cohort study analyzed data from the electronic medical records of patients who underwent elective lung resection surgery with one-lung ventilation from January 2020 to December 2023. Early postoperative hypoxia was defined as an SpO₂ &lt; 92% in conscious, extubated patients breathing room air for at least 5 min in the postanesthesia care unit. Multivariate logistic regression and modified Poisson regression analyses were performed to examine the association between early postoperative hypoxia and PPCs occurring within the first seven postoperative days.</div></div><div><h3>Results</h3><div>A total of 1147 patients were analyzed. Of these, 156 patients (13.6%) developed PPCs, and 212 patients (18.5%) experienced early postoperative hypoxia. Multivariate logistic regression analysis revealed that early postoperative hypoxia was independently associated with an increased incidence of PPCs (odds ratio 5.39; 95% confidence interval [CI], 3.69-7.92; <em>P</em> &lt; 0.001). The sensitivity and specificity of early postoperative hypoxia for predicting PPCs were 0.86 (95% CI, 0.84–0.89) and 0.51 (95% CI, 0.42-0.57), respectively. Modified Poisson regression analysis further confirmed that early postoperative hypoxia significantly increased PPCs risk (relative risk 4.30; 95% CI, 3.26-5.67; <em>P</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Early postoperative hypoxia is common among patients undergoing lung resection surgery and significantly increases the risk of developing PPCs.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 194-201"},"PeriodicalIF":1.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ground Level Fall, Who Do You Call? Appropriate Trauma for Ground-Level Falls on Anticoagulants","authors":"Avi Bhavaraju MD ,&nbsp;Krista Stephenson MD ,&nbsp;Lawrence VanDyke BS ,&nbsp;Kyle Kalkwarf MD","doi":"10.1016/j.jss.2025.09.005","DOIUrl":"10.1016/j.jss.2025.09.005","url":null,"abstract":"<div><h3>Introduction</h3><div>While most trauma activations are based on mechanism or physiologic parameters, many centers incorporate specific risk factors (e.g., anticoagulant use) to upgrade lower-energy mechanisms. To address concerns about delays in diagnosing and treating traumatic intracranial hemorrhage in high-risk patients, our hospital revised its trauma activation criteria in December 2018. The update designated all anticoagulated patients with evidence of an injury above the clavicles as partial trauma team activation, ensuring an automatic response from the attending trauma surgeon and trauma surgery resident team. We hypothesized that early involvement of the trauma surgery team would be associated with a decrease in the time to critical intervention.</div></div><div><h3>Methods</h3><div>This is a single-center retrospective cohort study evaluating all ground-level falls on therapeutic anticoagulation or nonacetylsalicylic acid antiplatelet agents with evidence of an injury cephalad to the clavicles that were included in our institutional trauma registry from the beginning of 2014 to the end of 2019. The analysis examined injury incidence and the timeliness of interventions.</div></div><div><h3>Results</h3><div>Seventy-seven percent of the cohort had minor or no injuries and 38.4% were discharged from the emergency department. The most frequent nonminor injuries were intracranial hemorrhages (9.2%, <em>n</em> = 88), extremity fractures (10.9%, <em>n</em> = 104), and spine fractures (5.6%, <em>n</em> = 53). An emergent intervention was performed in 1.8% of patients (<em>n</em> = 17). After revising the activation criteria, time to computed tomography imaging decreased (average 76.4 ± 63.4 <em>versus</em> 36.8 ± 57.0 min, <em>P</em> &lt; 0.0001); however, time from arrival to intervention for intracranial hemorrhage did not significantly decrease (average 281.5 ± 205.8 <em>versus</em> 230.7 ± 96.5 min, <em>P</em> = 0.36).</div></div><div><h3>Conclusions</h3><div>Given the low likelihood of urgent or emergent interventions that only a trauma surgeon can perform, trauma surgery team involvement in caring for this anticoagulated low-energy mechanism cohort may not represent an appropriate allocation of center resources. Rather than activating the trauma surgery team, a more selective approach is warranted to mitigate costs, decrease unnecessary charges, and optimize hospital resources. Emergency department protocols for expedited imaging and the rapid involvement of appropriate specialists may be more appropriate than a higher activation level.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 176-183"},"PeriodicalIF":1.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectal Cancer Surgery and Survival in Asian American, Native Hawaiian, and Pacific Islander Patients","authors":"Kera L. Kwan MD MS ,&nbsp;Carlos I. Oronce MD MPH PhD ,&nbsp;Nicholas J. Jackson PhD MPH ,&nbsp;Tara A. Russell MD MPH PhD ,&nbsp;Marcia M. Russell MD","doi":"10.1016/j.jss.2025.09.024","DOIUrl":"10.1016/j.jss.2025.09.024","url":null,"abstract":"<div><h3>Introduction</h3><div>Racial disparities in rectal cancer outcomes are well documented, yet Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients are often treated as a single group in research, obscuring subgroup differences. We examine variation in sphincter-preserving surgery (SPS)—which avoids a permanent ostomy when oncologically feasible—and survival among AANHPI subgroups.</div></div><div><h3>Methods</h3><div>We conducted a retrospective study using Surveillance, Epidemiology, and End Results data, identifying AANHPI patients with nonmetastatic rectal adenocarcinoma who underwent surgery (2007-2021). Racial subgroups were defined as East Asian, Native Hawaiian and other Pacific Islander (NHPI), Other Asian, South Asian, and Southeast Asian. Logistic regression was used to estimate odds of SPS, and Cox proportional hazards models assessed overall survival.</div></div><div><h3>Results</h3><div>Among 7989 patients, 87.1% underwent SPS and the 5-year observed overall survival was 81.4%. In fully adjusted models, NHPI patients had 42% lower odds of SPS (odds ratio: 0.58, 95% confidence interval: 0.46-0.74) and a 24% higher risk of mortality from any cause (hazard ratio 1.24, 95% confidence interval 1.04-1.48) compared to East Asian patients. Disparities in both outcomes were most pronounced in NHPI patients in higher-income counties. However, disparities in SPS were worse in NHPI patients with regional disease, compared to disparities in survival, which were worse in NHPI patients with localized disease.</div></div><div><h3>Conclusions</h3><div>Significant variation exists in rectal cancer treatment and survival across AANHPI subgroups, with NHPI patients facing the most pronounced disparities. These disparities were worse in higher-income counties, highlighting the need for further investigation into structural drivers of disparities affecting NHPI patients.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"315 ","pages":"Pages 165-175"},"PeriodicalIF":1.7,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}