Journal of the American College of Surgeons最新文献

{"title":"Invited Commentary: A Warning Sign or Rescue Flare? New Insights on Sarcopenia in Early-Stage Non-Small Cell Lung Cancer.","authors":"Nikia T Toomey, David D Shersher","doi":"10.1097/XCS.0000000000001342","DOIUrl":"10.1097/XCS.0000000000001342","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"280-281"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143483197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incisional Hernia Risk Reduction for Living Kidney Donors: Kidney Extraction Site Matters.","authors":"Rachana Punukollu, Sandra Arias, Stephanie Ohara, Alexandru Nica, Logan G Briggs, Christopher Cosentino, Peter Frasco, Paul Andrews, Michelle Nguyen, Shennen Mao, Julie Heimbach, Caroline Jadlowiec","doi":"10.1097/XCS.0000000000001356","DOIUrl":"10.1097/XCS.0000000000001356","url":null,"abstract":"<p><strong>Background: </strong>Although most transplant centers preferentially offer minimally invasive approaches to donor nephrectomies, there remains less standardization specific to the kidney extraction site. This study aimed to evaluate incisional hernia occurrence in living kidney donors based on kidney extraction site location.</p><p><strong>Study design: </strong>This was a retrospective study of all donors who underwent minimally invasive living donor nephrectomies at the Mayo Clinic Arizona between 2011 and 2023 with a 2-year external validation cohort from Mayo Clinic Florida and Mayo Clinic Minnesota. The cohort was divided into 2 groups based on the kidney extraction site type: midline infraumbilical and Pfannenstiel.</p><p><strong>Results: </strong>In the primary cohort, incisional hernia occurrence was observed in 1.2% of donors with an infraumbilical midline kidney extraction site compared with 0.1% with a Pfannenstiel extraction site (p = 0.04). Donors with an infraumbilical midline kidney extraction site were more likely to be men (50.8% vs 23.3%, p < 0.0001), have a higher BMI (mean 27.2 vs 26 kg/m 2 , p < 0.0001), and have current or former tobacco use (p = 0.002). There were no differences in incisional hernia occurrence when comparing minimally invasive surgical techniques (p = 0.52). In the external validation cohort, hernia occurrence was observed in 4.5% of donors with a midline incision compared with 0.0% with a Pfannenstiel incision (p = 0.09). Using combined data from the 3 sites, the use of a Pfannenstiel incision as the extraction site was associated with significantly lower odds of developing a hernia compared with the infraumbilical midline incision (odds ratio 0.06, 95% CI 0.008 to 0.456).</p><p><strong>Conclusions: </strong>Although the risk of hernia in living kidney donors is generally low, the use of a Pfannenstiel incision for kidney extraction appears to offer an additional incremental reduction in risk.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"195-202"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143408633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative Sarcopenia and Association with Recurrence in Resected Early-Stage Non-Small Cell Cancer.","authors":"Arsalan A Khan, Savan K Shah, Wara Naeem, Sanjib Basu, Gillian C Alex, Nicole M Geissen, Michael J Liptay, Christopher W Seder","doi":"10.1097/XCS.0000000000001360","DOIUrl":"10.1097/XCS.0000000000001360","url":null,"abstract":"<p><strong>Background: </strong>We hypothesize that reduction in skeletal muscle volume between the time of surgery and the first postoperative surveillance CT scan is associated with recurrence in resected patients with early-stage non-small cell lung cancer (NSCLC).</p><p><strong>Study design: </strong>Patients who underwent lung resection for pT1-2aN0 NSCLC between 2010 and 2021 were identified. Exclusion criteria included neoadjuvant or adjuvant therapy, missing CT scan data, and steroid use. Volumetric body composition analysis was performed with Data Analysis Facilitation Suite software using preoperative and initial postoperative surveillance CT scans. A Cox proportional hazards model was used to examine the association between body composition changes and recurrence.</p><p><strong>Results: </strong>Overall, 233 patients were examined, including 63% (147 of 233) women with a median BMI of 27 (interquartile range [IQR] 23 to 30) kg/m 2 , and a median tumor size of 1.6 (IQR 1.3 to 2.2) cm. Disease recurrence was observed in 14% (33 of 233), and the median time to recurrence was 15 (IQR 9 to 25) months. In patients that recurred, median skeletal muscle percent change was -3.6% (IQR -9.26 to 1.23) and 1.99% (IQR -4.6 to 11.4) in nonrecurrent patients. On univariable analysis, loss in skeletal muscle volume >1% was associated with worse disease-free survival (hazard ratio 2.93, 95% CI 1.42 to 6.04, p = 0.004). On multivariable analysis, after controlling for sex, age, race, BMI, pack years, forced expiratory volume in 1 second, histology, tumor size, number of nodes, procedure type, and comorbidities, this association persisted (hazard ratio 3.16, 95% CI 1.44 to 6.94, p = 0.004).</p><p><strong>Conclusions: </strong>Loss in skeletal muscle volume on first surveillance CT scan is associated with recurrence after resection of early-stage NSCLC.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"269-279"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Invited Commentary: Idiopathic Subglottic Stenosis, the Epithelial-Mesenchymal Transition, and Adaptive Immunity.","authors":"David E Rosow","doi":"10.1097/XCS.0000000000001433","DOIUrl":"10.1097/XCS.0000000000001433","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"192-194"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protein Kinase C-β Inhibition and Survival Signaling after Simulated Cardioplegic-Ischemia/Reperfusion in Nondiabetic and Diabetic Human Coronary Arterial Endothelial Cells.","authors":"Ju-Woo Nho, Debolina Banerjee, Dwight D Harris, Christopher Stone, Hang Xing, Meghamsh Kanuparthy, Janelle Li, Frank W Sellke, Jun Feng","doi":"10.1097/XCS.0000000000001248","DOIUrl":"10.1097/XCS.0000000000001248","url":null,"abstract":"<p><strong>Background: </strong>Cardioplegic-ischemia/reperfusion (I/R) injury poses substantial challenges during postoperative recovery, with diabetic patients particularly susceptible to adverse events. Using a model entailing the subjection of human coronary artery endothelial cells (HCAECs) to simulated cardioplegic I/R, we investigated the potential of protein kinase C β (PKC-β) inhibition to augment cellular survival in this context.</p><p><strong>Study design: </strong>HCAECs were isolated from harvested coronary arteries of diabetic (D) and nondiabetic (C) patients (N = 4 per group). HCAECs were either cultured under normoxic conditions without drug (D and C), subjected to hypoxia and reoxygenation alone (DH and CH), or subjected to hypoxia and reoxygenation and the PKC-β inhibitor LY333531 (DHT and CHT). Molecular signaling was assessed using immunoblotting.</p><p><strong>Results: </strong>Simulated I/R decreased anti-apoptotic phosphorylated protein kinase b (p-Akt, p = 0.04) and p-Akt:Akt ratio (p = 0.004) in CH vs C, with PKC-β inhibition restoring expression in CHT (p ≤ 0.04). Treatment also increased the p-Akt:Akt ratio in DHT vs D (p = 0.03). Anti-apoptotic inducible nitric oxide synthase increased in CHT vs CH (p = 0.003), and the pro-apoptotic phosphorylated class O forkhead box transcription factor (p-FOXO): FOXO ratio decreased in CHT vs CH (p = 0.001). I/R elevated Bcl-2-associated agonist of cell death (BAD) in CH vs C (p = 0.01), but PKC-β inhibition increased anti-apoptotic p-BAD (p = 0.001) and p-BAD:BAD ratio (p = 0.03) in CHT. I/R also increased cleaved PARP (p < 0.001) and cleaved caspase 3 (p < 0.001) in DH vs D, both of which were reversed by treatment (p < 0.001 for DHT vs DH).</p><p><strong>Conclusions: </strong>PKC-β inhibitor treatment increased pro-survival signaling and decreased pro-apoptotic signaling in nondiabetic and diabetic HCAECs subjected to simulated I/R, with mechanistic differences observed between these cohorts.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"118-135"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12147101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142801230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness of Laparoscopic vs Open Liver Resection: A Propensity Score-Matched Single-Center Analysis of 920 Cases.","authors":"Ye Xin Koh, Yun Zhao, Ivan En-Howe Tan, Hwee Leong Tan, Darren Weiquan Chua, Ek Khoon Tan, Jin Yao Teo, Kwok Ann Ang, Marianne Kit Har Au, Brian Kim Poh Goh","doi":"10.1097/XCS.0000000000001250","DOIUrl":"10.1097/XCS.0000000000001250","url":null,"abstract":"<p><strong>Background: </strong>This study compared the clinical and economic outcomes of laparoscopic (LLR) and open liver resection (OLR) for all hepatectomies, including minor and major hepatectomy.</p><p><strong>Study design: </strong>This retrospective study included 920 consecutive elective patients undergoing liver resection from 2017 to 2023. Patient demographics, postoperative surgical outcomes, postoperative length of stay (LOS), and cost were compared between LLR and OLR before and after propensity score matching (PSM). A decision model was developed to assess the cost-effectiveness of LLR vs OLR.</p><p><strong>Results: </strong>After PSM, LLR was associated with significantly fewer postoperative transfusions for all hepatectomies (p < 0.001) and major hepatectomy (p = 0.001). LLR was associated with a shorter postoperative median LOS (p < 0.001), lower 30-day readmission (p = 0.022) and reoperation (p = 0.044) rate, and significantly reduced postoperative pneumonia (p = 0.038), unplanned intubation (p = 0.020), sepsis (p = 0.041), and major complication (p < 0.001) for all hepatectomies. This clinical superiority was complemented by a significant reduction in total cost for all (p < 0.001), minor (p = 0.001), and major (p < 0.001) hepatectomy. Cost-effectiveness analysis revealed that LLR was dominant over OLR, with a negative incremental cost-effectiveness ratio (-$2,120.72) and an increased net monetary benefit ($75,015.92) at the willingness-to-pay threshold of $25,000. The probability of LLR being cost-effective was 99.8% across various willingness-to-pay thresholds.</p><p><strong>Conclusions: </strong>LLR is a safe and cost-effective alternative to OLR. Although LLR has higher initial procedural costs, these are offset by significant reduction in postoperative major complication, LOS, and total cost.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"203-219"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strengthening the Analysis of Cost-Effectiveness in Laparoscopic vs Open Liver Resection.","authors":"Rohan Kapoor, M D Ray","doi":"10.1097/XCS.0000000000001271","DOIUrl":"10.1097/XCS.0000000000001271","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"315-316"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One Step Closer to Minimally Invasive Reoperation for Gallbladder Cancer: In Reply to Takamatsu and colleagues.","authors":"Yeshong Park, Sae Byeol Choi, Boram Lee, Ho-Seong Han, Chi-Young Jeong, Chang Moo Kang, Dae Wook Hwang, Wan-Joon Kim, Yoo-Seok Yoon","doi":"10.1097/XCS.0000000000001394","DOIUrl":"10.1097/XCS.0000000000001394","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"320-321"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Laparotomy in America.","authors":"Per-Olof Hasselgren","doi":"10.1097/XCS.0000000000001305","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001305","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":"241 2","pages":"301-306"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Similar Associated Risk of Complication and Death for Adolescent Gunshot Wounds Treated at Pediatric-Only Hospitals When Compared with Combined Pediatric and Adult Centers.","authors":"Lily Nguyen, Areg Grigorian, Carlin Lee, Laura F Goodman, Yigit Guner, Catherine Kuza, Lourdes Swentek, Jeffry Nahmias","doi":"10.1097/XCS.0000000000001249","DOIUrl":"10.1097/XCS.0000000000001249","url":null,"abstract":"<p><strong>Background: </strong>Adult trauma centers, including combined pediatric and adult centers (CPACs), see high volumes of penetrating trauma. Few studies have compared outcomes of adolescents presenting with gunshot wounds at CPACs vs pediatric-only hospitals (POHs). This study aimed to compare injury patterns, complication, and mortality for adolescents sustaining gunshot wounds presenting to CPACs vs POHs, hypothesizing decreased associated risk of complication and mortality at CPACs.</p><p><strong>Study design: </strong>The TQIP database from 2017 to 2021 was queried for adolescents (aged 12 to 17 years) with isolated gunshot wounds. Patients transferred or with brain injury were excluded. CPACs included centers with adult and pediatric American College of Surgeons verification, whereas POHs only had pediatric American College of Surgeons verification. Multivariable logistic regression analysis was performed to identify risk factors associated with in-hospital complications and mortality, controlling for age, injury severity score, vitals, operation, and blood transfusion.</p><p><strong>Results: </strong>Of 3,064 adolescents presenting with gunshot wounds, 1,512 (49.3%) presented to CPACs. When compared with POH, CPAC patients were slightly older (median 16 vs 15 years old, p < 0.001) had increased injury severity score (median 9 vs 4, p < 0.001), and injury to the spine (9.3% vs 5.7%, p < 0.001), heart (2.3% vs 0.7%, p < 0.001), lung (19.1% vs 10.6%, p < 0.001), liver (8.5% vs 4.8%, p < 0.001), and spleen (3.2% vs 1.5%, p = 0.002). CPAC adolescents also had increased rate of emergent operation (31.9% vs 23.5%, p < 0.001). However, on multivariable analysis, CPAC adolescents had a similar associated risk of in-hospital complication (odds ratio 0.91, 95% CI 0.59 to 1.41, p = 0.68) and mortality (odds ratio 0.76, 95% CI 0.40 to 1.48, p = 0.42).</p><p><strong>Conclusions: </strong>Adolescent patients with gunshot wounds had similar associated risk of mortality and complication when comparing POHs with CPACs. This suggests that adolescents with gunshot wounds receive similar care at both CPACs and POHs. Additional research is warranted to corroborate these findings.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"232-238"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}