Journal of the American College of Surgeons最新文献

{"title":"Invited Commentary: Pediatric Trauma Systems Collectively Afford a Chance of Survival for the Most Vulnerable.","authors":"Kenneth Wilson, Selwyn O Rogers","doi":"10.1097/XCS.0000000000001446","DOIUrl":"10.1097/XCS.0000000000001446","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"239-240"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078217","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":"Sabbaticals for Academic Surgeons: A Forgotten Enterprise in Faculty Development?","authors":"Eric R Carlson, L D Britt","doi":"10.1097/XCS.0000000000001290","DOIUrl":"10.1097/XCS.0000000000001290","url":null,"abstract":"<p><p>Academic sabbaticals are exceptional opportunities for surgeons; however, their impact on effective faculty development in academic medical centers is underestimated, their completion by surgeons is infrequent, and reports of their outcomes and benefits to their institution are lacking in the international literature. Financial pressures in academic medical centers result in surgical faculty concentrating their efforts on reimbursable clinical care, often at the expense of their continuous professional development. It is the purpose of this article to review the structure, purpose, outcomes, financial challenges, and unintended consequences associated with academic sabbaticals while suggesting that these endeavors are largely forgotten enterprises in the faculty development arena. We therefore recommend that increased awareness of these opportunities be brought to the attention of surgical faculty.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"287-292"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007397","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: Beyond IL-35 and IL-27: Epstein-Barr Virus-Induced Gene 3 as a Novel Mediator of T-Cell Exhaustion in Gastric Cancer.","authors":"Birendra Kumar Sah","doi":"10.1097/XCS.0000000000001266","DOIUrl":"10.1097/XCS.0000000000001266","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"145"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142882416","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":"Machine Learning Prediction of Financial Toxicity in Patients with Resected Lung Cancer.","authors":"Nathaniel Deboever, Qasem Al-Tashi, Michael Eisenberg, Maliazurina B Saad, Mara B Antonoff, Wayne L Hofstetter, Reza J Mehran, David C Rice, Jack Roth, Stephen G Swisher, Ara A Vaporciyan, Garrett L Walsh, Jia Wu, Ravi Rajaram","doi":"10.1097/XCS.0000000000001373","DOIUrl":"10.1097/XCS.0000000000001373","url":null,"abstract":"<p><strong>Background: </strong>Financial toxicity (FT) refers to the financial stress and detrimental impact on quality of life experienced by patients due to treatment cost. In patients with resected lung cancer (LC), we sought to identify those at risk of developing moderate or severe (\"major\") FT using machine learning (ML) techniques based on preoperative characteristics.</p><p><strong>Study design: </strong>Patients who underwent LC resection at a single center between January 2016 and December 2021 were surveyed to ascertain demographic information, financial data, and presence of major FT. Clinicopathologic variables were extracted from a prospective database. Patients were randomly divided into training and test sets. First, we identified the most informative features. Then, 4 ML algorithms (decision tree, random forest, gradient boosting, and extreme gradient boosting) were trained. We ensembled the 4 models' predictions to optimize the model.</p><p><strong>Results: </strong>There were 1,477 patients identified, of whom 462 (31.3%) completed the survey. Forty-six patients (10.0%) experienced major FT. The variables most influential in our models included age, race and ethnicity, smoking status, household income, credit score, marital and employment status, size of residence, BMI, histology, extent of resection, and preoperative forced expiratory volume in 1 second. The ensemble model yielded an accuracy of 0.86, precision of 0.93, and sensitivity of 0.86, leading to an F1 score of 0.88, indicative of a reliable algorithm.</p><p><strong>Conclusions: </strong>ML algorithms can accurately identify patients at risk of experiencing major FT after LC surgery. Preoperatively identifying patients with cancer vulnerable to financial stress may allow an opportunity for intervention to address downstream cost considerations.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"107-116"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542404","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: Nipple-Sparing Mastectomy, Informed Consent, and Shared Decision-Making.","authors":"Erin M Bayley","doi":"10.1097/XCS.0000000000001364","DOIUrl":"10.1097/XCS.0000000000001364","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"260-261"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015167","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: Paying the Price: The Financial Burden of Lung Cancer.","authors":"Allison N Moore, Robert M Van Haren","doi":"10.1097/XCS.0000000000001343","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001343","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":"241 2","pages":"116-117"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642805","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":"First-in-Human Side-to-Side Duodenoileal Bipartition for Weight Loss and Type 2 Diabetes with the Swallowable Biofragmentable Magnetic Anastomosis System.","authors":"Michel Gagner, David Abuladze, Jane Buchwald, Levan Koiava, Lamees Almutlaq","doi":"10.1097/XCS.0000000000001384","DOIUrl":"10.1097/XCS.0000000000001384","url":null,"abstract":"<p><strong>Background: </strong>Anastomosis creation using a novel magnetic compression technique may provide an alternative minimally invasive approach to gastrointestinal surgery. The biofragmentable magnetic anastomosis system (BMAS) is endolaparoscopically placed to effect magnetic duodenoileostomy (MagDI) bipartition for reduction of weight and type 2 diabetes (T2D). MagDI obviates major risks associated with enterotomy, stapling or suturing, and retained foreign materials.</p><p><strong>Study design: </strong>This was a first-in-human prospective investigation of feasibility, safety, and efficacy in adults with BMI 30.0 or more to 35.0 or less kg/m 2 . An initial BMAS magnet, swallowed by the patient or delivered under anesthesia by endoscopy, was guided laparoscopically to the distal ileum; a second magnet was endoscopically positioned in the postpyloric duodenum; magnets were aligned to fuse for 7 to 21 days forming the duodenoileostomy. Primary endpoints are feasibility and severe adverse event (AE) incidence by Clavien-Dindo grade. Secondary endpoints are weight and T2D reduction.</p><p><strong>Results: </strong>Between December 20, 2022, and May 21, 2024, 15 patients (mean BMI 33.0 ± 0.4 kg/m 2 ), all with T2D (glycosylated hemoglobin 8.2% ± 0.4%, glucose 187.9 ± 15.5 mg/dL, on T2D medications) underwent MagDI. The mean operative time was 51.3 ± 5.3 minutes. Feasibility at 90 days was confirmed in 100.0% with 0.0% leakage, bleeding, infection, stricture, and mortality; 89.4% of AEs were mild; and 3 Clavien-Dindo-III severe AEs were resolved. At 1 year, 100.0% of anastomoses were patent, BMI was (8) 30.1 ± 0.9 kg/m 2 , excess weight loss was 38.8%, glycosylated hemoglobin was 6.6% ± 0.1%, and glucose was 142.8 ± 9.5 mg/dL.</p><p><strong>Conclusions: </strong>The novel swallowable, BMAS was feasible, safe, and effective in achieving incisionless, suture- or staple-free magDI. The device and procedure provide a promising minimally invasive option for moderate, clinically meaningful weight loss and T2D mitigation.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"146-159"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12262126/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585911","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":"Nipple-Sparing Mastectomy and Infection Risk after Immediate Breast Reconstruction.","authors":"Margaret A Olsen, Katelin B Nickel, Julie A Margenthaler, Terence M Myckatyn, David K Warren","doi":"10.1097/XCS.0000000000001424","DOIUrl":"10.1097/XCS.0000000000001424","url":null,"abstract":"<p><strong>Background: </strong>Wound complications are known to occur after nipple-sparing mastectomy (NSM), especially in procedures involving a periareolar incision. We sought to determine the independent risk of infection and overall wound complications associated with NSM vs skin-sparing mastectomy (SSM) in a contemporary cohort of women undergoing immediate implant reconstruction.</p><p><strong>Study design: </strong>We identified 352 women 21 years of age or older undergoing mastectomy and immediate implant reconstruction from September 2021 to December 2022 using electronic health records from 2 hospitals. The relative risk (RR) of surgical site infection (SSI) and of serious wound complication (infection or noninfectious wound complication [NIWC; dehiscence or tissue necrosis] requiring surgical treatment in the operating room) within 180 days after surgery associated with NSM vs SSM was determined using a modified Poisson regression model, controlling for established risk factors for SSI.</p><p><strong>Results: </strong>NSM was performed in 128 women (36.4%), most commonly via an inframammary fold incision (73.4%). SSI occurred in 49 (13.9%) women within 180 days after surgery, whereas 70 (19.9%) women developed an SSI or NIWC. Although the incidence of SSI and the composite SSI/NIWC outcomes was similar after NSM vs SSM (14.8% vs 13.4% and 21.1% vs 19.2%, respectively); in multivariable analysis, NSM was associated with increased risk of both SSI (RR 2.13, 95% CI 1.26 to 3.59) and SSI/NIWC (RR 2.19, 95% CI 1.40 to 3.43).</p><p><strong>Conclusions: </strong>NSM was associated with increased risk of both SSI and NIWCs requiring surgical treatment after controlling for other established risk factors, despite uncommon use in this cohort of a periaerolar incision. This information should be communicated to women at the time of presurgical counseling to facilitate shared decision-making.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"254-260"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974548","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: Evaluating the Need for Type and Screen Tests Before Thoracic Operation: Transfusing a Culture of Value-Based Care, Not Patients.","authors":"David B Nelson, Inderpal S Sarkaria","doi":"10.1097/XCS.0000000000001383","DOIUrl":"10.1097/XCS.0000000000001383","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"252-253"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585992","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: Lessons Learned from Developing a Mentoring Program: One Size Does Not Fit All.","authors":"Edwin Christopher Ellison","doi":"10.1097/XCS.0000000000001297","DOIUrl":"10.1097/XCS.0000000000001297","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"298-300"},"PeriodicalIF":3.8,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143523835","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}