Journal of the American College of Surgeons最新文献

{"title":"Discussion.","authors":"","doi":"10.1097/XCS.0000000000001320","DOIUrl":"10.1097/XCS.0000000000001320","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"487-490"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080285","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":"Discussion.","authors":"","doi":"10.1097/XCS.0000000000001317","DOIUrl":"10.1097/XCS.0000000000001317","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"447-448"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080343","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":"Discussion.","authors":"","doi":"10.1097/XCS.0000000000001336","DOIUrl":"10.1097/XCS.0000000000001336","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"676-678"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066496","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":"Discussion.","authors":"","doi":"10.1097/XCS.0000000000001332","DOIUrl":"10.1097/XCS.0000000000001332","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"635-637"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080438","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":"Discussion.","authors":"","doi":"10.1097/XCS.0000000000001308","DOIUrl":"https://doi.org/10.1097/XCS.0000000000001308","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":"240 4","pages":"708-711"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674147","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":"Multi-Institutional Analysis of Pancreaticoduodenectomy for Nonfamilial Periampullary Adenoma: A Novel Risk Score to Guide Shared Decision-Making.","authors":"Parit T Mavani, Caitlin Sok, Nina Eng, Angelo Marra, Laleh Foroutani, Adnan Alseidi, Hussein Hariri, Gregory Wilson, Syed A Ahmad, Charles Scoggins, Caitlin Hester, Jashodeep Datta, Nipun Merchant, Michael LeCompte, Hong Jin Kim, Gregory Sigler, Nabeel Zafar, Sharon Weber, Orjola Prela, Darren Carpizo, Christina Kasting, Ryan Fields, Juan M Sarmiento, Maria C Russell, Mihir M Shah, Shishir K Maithel, David A Kooby","doi":"10.1097/XCS.0000000000001289","DOIUrl":"10.1097/XCS.0000000000001289","url":null,"abstract":"<p><strong>Background: </strong>Pancreaticoduodenectomy (PD) may occasionally be indicated for complete removal of periampullary (duodenal and ampullary) adenomas (PAs). As compared with malignant indications, PD for benign or premalignant disease is often associated with increased morbidity. Although the Spigelman classification assesses malignancy risk for familial adenomatous polyposis (FAP)-related duodenal adenomas, no malignancy risk score (MRS) exists for non-FAP-related PAs. We developed an MRS for non-FAP-related PAs undergoing PD to weigh the risk of malignancy and postoperative morbidity.</p><p><strong>Study design: </strong>We retrospectively analyzed patients with non-FAP-related PA who underwent PD at 8 institutions (2010 to 2022). Patient and lesion factors associated with final malignant pathology were identified using multivariable logistic regression to create MRS. Postoperative complications were assessed according to MRS.</p><p><strong>Results: </strong>Of 127 patients, 59 (46.5%) had evidence of malignancy on final pathology. The odds of malignancy were higher in patients aged 65 years or older (odds ratio [OR] 3.2, p = 0.01), having bile duct 9 mm or more (OR 3.3, p = 0.009), having preoperative symptoms (OR 7.7, p = 0.002), and having high-grade dysplasia (OR 7.5, p < 0.001). A MRS was derived ranging from 0 to 6: age 65 years or older = 1, bile duct 9 mm or more = 1, symptomatic = 2, and high-grade dysplasia = 2. Patients were stratified into low-risk (MRS 1 to 2, n = 26), intermediate-risk (MRS 3 to 4, n = 59), and high-risk groups (MRS 5 to 6, n = 26), with malignancy rates increasing with MRS (10.3%, 44.1%, and 88.2%, p < 0.001). Patients in the no- or low-risk group (MRS 0 to 2) had higher odds of major postoperative complications compared with patients in the intermediate- or high-risk group (MRS 3 or higher, OR 2.9, p = 0.047).</p><p><strong>Conclusions: </strong>This novel MRS stratifies the risk of malignancy in non-FAP-related PAs managed with PD. This score can be used to counsel patients who may require PD for complete tumor removal about their risk of harboring malignancy and their risk of major postoperative complications.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"392-402"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11928246/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007303","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":"Breast Conservation Surgery for Breast Cancer in Men.","authors":"Jennifer Den, Nicole Nelson, Kamil Khanipov, V Suzanne Klimberg","doi":"10.1097/XCS.0000000000001285","DOIUrl":"10.1097/XCS.0000000000001285","url":null,"abstract":"<p><strong>Background: </strong>Male breast cancer (MBC) is a rare disease, accounting for 1% of all breast cancer diagnosed in the US. The rarity of MBC has limited the development of treatment algorithms specific to men. Therefore, the standard of care has been mastectomy. The safety and feasibility of breast-conserving surgery (BCS) in MBC are unclear. This study assessed whether overall survival (OS) outcomes, local recurrence (LR), and postoperative complications differed between patients with MBC who underwent conservative surgery or mastectomy.</p><p><strong>Study design: </strong>A retrospective search for men aged 18 years or older diagnosed with breast cancer was conducted using the TriNetX network. Cohort 1 included patients who underwent BCS. Cohort 2 included patients who underwent mastectomy. Propensity score matching was conducted using age, BMI, tobacco use, cancer stage and tumor size (T1 to T4), radiation, chemotherapy, hormonal therapy, genetics, and comorbidities. Outcomes of interest were 5-year OS, LR, and postoperative complications.</p><p><strong>Results: </strong>A total of 423 patients underwent BCS, and 1,101 patients underwent mastectomy. After matching, 401 patients per cohort were identified. No difference was observed in 5-year OS with the Kaplan-Meier analysis (Cohort 1: 84% vs Cohort 2: 86%, log-rank test p = 0.412) or with LR (11% vs 13%, p = 0.384). The mastectomy cohort was more likely to have postoperative complications, with a risk of 24% compared with 17% in the BCS cohort (p = 0.011).</p><p><strong>Conclusions: </strong>No difference was observed in the 5-year OS and LR rate between patients with MBC who undergo BCS or mastectomy. The postoperative complication rate was higher with mastectomies. We conclude that BCS for unicentric MBC is feasible and preferred for T1 and T2 cancers.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"627-635"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978980","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":"Impact of Massive Transfusion Activation on Time to Delivery of the First Cooler and Patient Survival: A Study of 4,313 Consecutive Activations.","authors":"Jan-Michael Van Gent, Devi Bavishi, Thomas W Clements, James B Dickey, Rhonda Hobbs, Yu Bai, Lillian S Kao, Bryan A Cotton","doi":"10.1097/XCS.0000000000001282","DOIUrl":"10.1097/XCS.0000000000001282","url":null,"abstract":"<p><strong>Background: </strong>In 2012, TQIP guidelines for massive transfusion protocols (MTPs) recommended delivery of blood product coolers within 15 minutes. Subsequent work found that every minute delay in cooler arrival was associated with a 5% increased risk of mortality. We sought to assess the impact and sustainability of quality improvement (QI) interventions on time to MTP cooler delivery and their association with trauma patient survival.</p><p><strong>Study design: </strong>In 2009, a QI process was initiated to improve MTP activation and delivery of blood (QI 1). In 2012, TQIP Best Practice Guidelines were implemented at our facility (QI 2). In 2016, we implemented measures to activate our MTP based off prehospital Assessment of Blood Consumption score higher than 1 or any prehospital blood transfusion (QI 3). All patients receiving MTP from January 2009 and December 2022 were included. Patients were compared by year and their respective QI interventions. Primary outcome was time from MTP activation to delivery of the first cooler. A regression model was then constructed to evaluate time to the first cooler on outcomes.</p><p><strong>Results: </strong>During the study period, 52,328 trauma patients were admitted, with 4,313 MTP trauma activations. With each subsequent QI intervention, time to first MTP cooler and mortality both decreased, whereas injury severity increased. Multivariate regression noted that when the time to first cooler could be kept to 8 minutes or less, mortality was reduced by 35% (odds ratio 0.64, 95% CI 0.44 to 0.92; p = 0.019).</p><p><strong>Conclusions: </strong>With increased MTP activations, delivery of the first cooler was faster and mortality improved. Keeping cooler times under 8 minutes was associated with increased survival. The measurement and monitoring of \"door-to-cooler\" time should be considered as a metric to assess performance and delivery of institutional MTP.</p>","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"578-585"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978987","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":"Discussion.","authors":"","doi":"10.1097/XCS.0000000000001315","DOIUrl":"10.1097/XCS.0000000000001315","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"422-424"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080289","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":"Discussion.","authors":"","doi":"10.1097/XCS.0000000000001313","DOIUrl":"10.1097/XCS.0000000000001313","url":null,"abstract":"","PeriodicalId":17140,"journal":{"name":"Journal of the American College of Surgeons","volume":" ","pages":"402-404"},"PeriodicalIF":3.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143066438","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}