American journal of surgery最新文献

{"title":"Postoperative serum VEGF concentration and recurrence after curative colon cancer surgery: findings from a multicenter prospective cohort","authors":"Clara Téllez ,&nbsp;Meritxell Labró-Ciurans ,&nbsp;Sofía de la Serna ,&nbsp;Rubén Hernando ,&nbsp;Matteo Frasson ,&nbsp;Aleidis Caro ,&nbsp;David Parés ,&nbsp;Xavier Mayol ,&nbsp;Adrián Vizoso ,&nbsp;Xavier Durán ,&nbsp;Olga Morató ,&nbsp;Miguel Pera ,&nbsp;Marta Pascual","doi":"10.1016/j.amjsurg.2025.116603","DOIUrl":"10.1016/j.amjsurg.2025.116603","url":null,"abstract":"<div><h3>Background</h3><div>Angiogenesis is essential for tumor progression, with vascular endothelial growth factor (VEGF) as a key regulator. A prior single-center study identified VEGF &gt;370 ​pg/mL on postoperative day 4 (POD4) as a predictor of recurrence in colon cancer (CC).</div></div><div><h3>Methods</h3><div>We conducted a prospective study including 255 patients undergoing curative-intent CC surgery across seven Spanish institutions (NTC04851054). Serum VEGF was measured via ELISA on POD4.</div></div><div><h3>Results</h3><div>After a median follow-up of 34 months, recurrence occurred in 15.7 ​% of patients. The previously proposed VEGF cutoff was not validated. No significant differences in VEGF were observed between patients with and without recurrence. However, higher VEGF levels were associated with open surgery (p ​= ​0.013) and postoperative complications (p ​&lt; ​0.001), with a trend in anastomotic leakage (p ​= ​0.062).</div></div><div><h3>Conclusions</h3><div>VEGF was not predictive of recurrence in this setting but remains a relevant marker of perioperative angiogenic activity, warranting further investigation.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"249 ","pages":"Article 116603"},"PeriodicalIF":2.7,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060132","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":"“That's what sets you at ease:” A qualitative analysis of patient preferences during anorectal exams","authors":"Derek Chan ,&nbsp;Ava Ferguson Bryan ,&nbsp;Daniel Kim ,&nbsp;Julie Chor ,&nbsp;Lisa Cannon ,&nbsp;Kinga S. Olortegui","doi":"10.1016/j.amjsurg.2025.116600","DOIUrl":"10.1016/j.amjsurg.2025.116600","url":null,"abstract":"<div><h3>Introduction</h3><div>Increased attention is being paid to sensitive but necessary medical examinations, but the literature on guidelines for the anorectal exam remains limited. We performed a qualitative investigation of the patient experience to identify best practice recommendations from the patient's perspective for practitioners conducting the anorectal exam.</div></div><div><h3>Methods</h3><div>We conducted semi-structured interviews with patients aged 18 and older who had received at least one anorectal examination at the University of Chicago Medicine, Colon &amp; Rectal Surgery clinic. The interviews investigated contextual aspects of the anorectal examination, such as the urgency of the visit, the clinical environment, and patients' encounters with the anorectal examination. We sought recommendations on how to improve the examination experience. Interviews were digitally recorded and transcribed. Content analysis was performed by two independent researchers. Interviews were obtained until thematic saturation was reached.</div></div><div><h3>Results</h3><div>Twenty-three participants (48 ​% female, 48 ​% first-time examinees) completed interviews. Regarding examination preparation, most participants preferred obtaining exam information directly from their providers. Without prompting, many female patients expressed a preference for a female provider. Most exam logistics were non-contributory to the patient experience (exam room, gown, instrument use, etc.). Most patients did not mind chaperones if they were additionally serving another role (i.e. assisting in the examination). When chaperones were explicitly offered, every patient declined.</div></div><div><h3>Conclusion</h3><div>Recommendations included (1) establishing rapport and educating before the examination, (2) building practices to orient patients, (3) explaining procedural steps and eliciting continuous feedback, and (4) implementing routine use of chaperones instead of asking patients to opt-in, when possible. These findings emphasize the need for best practice guidelines and educational interventions to equip healthcare providers for conducting anorectal examinations.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116600"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003939","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":"The role of artificial intelligence in surgeon-performed ultrasonographic evaluation of cytologically indeterminate thyroid nodules","authors":"Man Him Matrix Fung ,&nbsp;Wai In Ng ,&nbsp;Henry Ethan Lee ,&nbsp;Tin Ho Chan ,&nbsp;Steven Tsz King Leung ,&nbsp;Yan Luk ,&nbsp;Brian Hung Hin Lang","doi":"10.1016/j.amjsurg.2025.116599","DOIUrl":"10.1016/j.amjsurg.2025.116599","url":null,"abstract":"<div><h3>Introduction</h3><div>Evaluating indeterminate thyroid nodules(ITN) is challenging, especially without molecular tests. This study examines whether artificial intelligence (AI) assistance can improve ITN diagnostic accuracy and bridge expertise gaps in surgeon-performed ultrasound.</div></div><div><h3>Methods</h3><div>134 ultrasound clips from 67 patients with ITN were reviewed by doctors of four levels: endocrine-surgery specialist, senior residents, junior residents, and medical student. After a 2-week wash-out, they re-evaluated the clips using AI-SONIC, an AI platform analyzing ultrasound real-time to predict cancer risk. Performance was validated against final histopathology.</div></div><div><h3>Results</h3><div>Without AI, medical students, junior residents and senior residents performed significantly worse than specialists(AUROC 0.530–0.560 vs 0.771, p ​&lt; ​0.05). AI-SONIC improved residents' and medical students' diagnostic accuracy to levels comparable with specialists(AUROC 0.733–0.751 vs 0.771). The specialists’ performance remained unchanged with AI assistance.</div></div><div><h3>Conclusion</h3><div>AI enhances ultrasound evaluation of ITN by junior surgeons and medical students, elevating their accuracy to expert levels, supporting clinical assessment and medical education.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"249 ","pages":"Article 116599"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010112","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":"Risk assessment tools for women with breast atypia: A systematic review","authors":"Tori C. Nierenberg ,&nbsp;Juliet C. Dalton ,&nbsp;Rylan Howell ,&nbsp;Samantha Kaplan ,&nbsp;Akiko Chiba ,&nbsp;Ton Wang ,&nbsp;Jennifer K. Plichta","doi":"10.1016/j.amjsurg.2025.116598","DOIUrl":"10.1016/j.amjsurg.2025.116598","url":null,"abstract":"<div><h3>Background</h3><div>Breast atypia is a benign breast disease found in a minority of percutaneous biopsies and is associated with an increased risk of breast cancer. Risk assessment calculators/tools have variable performance in this subgroup. We systematically reviewed tools developed or validated for women with breast atypia to guide clinicians and inform future model development.</div></div><div><h3>Methods</h3><div>We searched three databases for original studies published prior to November 13, 2023, that investigated the development or validation of risk assessment tools in atypia patients. PROBAST was used to assess the risk of bias and applicability.</div></div><div><h3>Results</h3><div>From 6252 records, 12 studies (1993–2022) were included (91.6 ​% U.S.-based; median sample size 540). The Gail model (C-index 0.5) and Tyrer-Cuzick model (0.49–0.54) performed poorly. Newer models demonstrated improved calibration (0.59–0.68), though 41.6 ​% had high risk of bias.</div></div><div><h3>Conclusions</h3><div>Current tools inadequately predict breast cancer risk in atypia patients. Novel, population-specific models are needed.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116598"},"PeriodicalIF":2.7,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010040","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":"Conversion therapy for patients with unresectable intermediate-advanced hepatocellular carcinoma: A comparative analysis in a real-world cohort","authors":"Yangyang Ou ,&nbsp;Yiyu Chen ,&nbsp;Kang Chen ,&nbsp;Ming Yao,&nbsp;Guanglin Ling,&nbsp;Chun Liao,&nbsp;Yanlong Liu,&nbsp;Haizhao Cao,&nbsp;Jianjun Li,&nbsp;Chunming Wang,&nbsp;Yuanneng Nong,&nbsp;Ji'an Chen,&nbsp;Fei Huang,&nbsp;Yubin Huang,&nbsp;Xiaoyong Cai,&nbsp;Yihe Yan","doi":"10.1016/j.amjsurg.2025.116602","DOIUrl":"10.1016/j.amjsurg.2025.116602","url":null,"abstract":"<div><h3>Background</h3><div>Conversion therapy offers new hope for patients with unresectable hepatocellular carcinoma (uHCC), thereby becoming a pivotal advancement in the field of liver cancer treatment.</div></div><div><h3>Methods</h3><div>This study consecutively collected clinical data of patients who received different conversion therapy regimens from June 2020 to March 2024, and retrospectively analyzed their efficacy and survival prognosis.</div></div><div><h3>Results</h3><div>In this study, the conversion success rate of patients with uHCC after conversion therapy was 20.4 ​%. Patients who successfully converted had a better long-term prognosis than those who failed. Compared with patients treated with combination therapy, the conversion rate and objective response rate of single local treatment were lower.</div></div><div><h3>Conclusions</h3><div>The choice of conversion therapy is crucial for the prognosis of patients with uHCC. The triple therapy of Hepatic Arterial Infusion Chemotherapy (HAIC) combined with Tyrosine Kinase Inhibitor (TKI) and Immune Checkpoint Inhibitor (ICI) demonstrates favorable outcomes and manageable safety profiles.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116602"},"PeriodicalIF":2.7,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145044339","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":"Reducing hypocalcemia in patients undergoing thyroidectomy for Graves’ disease with a parathyroid hormone based protocol","authors":"C. Corbin Frye ,&nbsp;Zhixing Song ,&nbsp;Ashba Allahwasaya ,&nbsp;Kerrick Akinola ,&nbsp;Sanjana Balachandra ,&nbsp;Raj Roy ,&nbsp;Andrea Gillis ,&nbsp;Jessica Fazendin ,&nbsp;Brenessa Lindeman ,&nbsp;Herbert Chen","doi":"10.1016/j.amjsurg.2025.116570","DOIUrl":"10.1016/j.amjsurg.2025.116570","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients with Graves' disease have a high risk of post-thyroidectomy hypocalcemia. Our aim was to evaluate the postoperative outcomes of hypoparathyroidism and hypocalcemia in Graves' disease.</div></div><div><h3>Methods</h3><div>A prospectively maintained, single institution database was retrospectively reviewed to identify patients with Graves' Disease who had undergone total or completion thyroidectomy. The primary outcomes of interest were postoperative hypoparathyroidism and hypocalcemia and secondary outcomes included surgical complication rates. Outcomes were further stratified based on post-anesthesia care unit (PACU) measurement of parathyroid hormone (PTH) levels and preoperative thyrotoxic status.</div></div><div><h3>Results</h3><div>Of the 245 Graves' thyroidectomy patients identified, nearly a third of patients (32.0 ​%) were thyrotoxic preoperatively. In the PACU, 26.5 ​% of patients had a PTH &lt;10 ​pg/mL, although 62.9 ​% of these patients had normal PTH levels two-weeks postoperatively. Postoperative hypoparathyroidism was associated with White race and hypocalcemia two-weeks post-operatively. Thyrotoxic patients were more likely to have persistent hypocalcemia.</div></div><div><h3>Conclusion</h3><div>In this large series of Graves' patients undergoing thyroidectomy, in which a substantial proportion of patients had uncontrolled disease, a quarter of patients had hypoparathyroidism immediately after surgery, although this self-resolved for more than half of patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"249 ","pages":"Article 116570"},"PeriodicalIF":2.7,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079550","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":"Frailty impacts outcomes for all older adult age groups in emergency laparotomy","authors":"Jefferson A. Proaño-Zamudio,&nbsp;Yasmin Arda,&nbsp;Teresia M. Perkins,&nbsp;Ikemsinachi C. Nzenwa,&nbsp;Dias Argandykov,&nbsp;Wardah Rafaqat,&nbsp;Charudutt N. Paranjape,&nbsp;George C. Velmahos,&nbsp;Haytham M.A. Kaafarani,&nbsp;John O. Hwabejire","doi":"10.1016/j.amjsurg.2025.116571","DOIUrl":"10.1016/j.amjsurg.2025.116571","url":null,"abstract":"<div><h3>Background</h3><div>The quantitative effect of frailty on post-operative complications in older adults undergoing surgical emergencies is not well understood.</div></div><div><h3>Methods</h3><div>The 2013-2019ACS-NSQIP database was used to identify emergency laparotomy patients≥65 years. Frailty was measured using the modified-frailty-index-5 factors (mFI-5). We examined 30-day mortality, discharge to home, post-operative complications and unplanned readmissions. Multivariable logistic regression examined the association between frailty and outcomes.</div></div><div><h3>Results</h3><div>52,356 patients were included. The median age was 76(70–82) years. Most patients (68 ​%) had an mFI-5 score between 0.2 and 0.5. Higher frailty index was associated with higher mortality and shorter length of survival (log-rank p ​&lt; ​0.001). On multivariable analysis, a higher frailty index was associated with increased mortality, pneumonia, urinary tract infection, respiratory failure, acute kidney injury, and readmission in a linear fashion.</div></div><div><h3>Conclusion</h3><div>Increasing levels of frailty not only increase the risk of adverse post-operative outcomes, but also increase the risk of further functional loss and deterioration after discharge.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"249 ","pages":"Article 116571"},"PeriodicalIF":2.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913721","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":"If you build it, they will come - Implementation of a prehospital whole blood program","authors":"R.B. Fransman ,&nbsp;C.H. Meyer ,&nbsp;J. Nguyen ,&nbsp;S.R. Todd ,&nbsp;E.R. Benjamin ,&nbsp;L de leon Castro ,&nbsp;S. Collins ,&nbsp;L. Pack ,&nbsp;A. Schwartz ,&nbsp;B. Spaeth ,&nbsp;M. Thorton ,&nbsp;M.S. McCain ,&nbsp;J. Sikora ,&nbsp;L. Kumar","doi":"10.1016/j.amjsurg.2025.116587","DOIUrl":"10.1016/j.amjsurg.2025.116587","url":null,"abstract":"<div><h3>Introduction</h3><div>We sought to develop, implement and evaluate an urban prehospital whole blood (PH-WB) program.</div></div><div><h3>Methods</h3><div>Using retrospective heat map data, Quick Response Vehicles (QRVs) carrying PH-WB were strategically placed throughout the city and dispatched using dynamic deployment. Patient inclusion criteria were age ≥15 years, traumatic mechanism, and SBP ≤90 ​mmHg. Prospective data were collected between 3/21-6/21/2025.</div></div><div><h3>Results</h3><div>375 patients were transfused 588 units of PH-WB, with 55 ​% receiving &gt;1 unit. With transfusion, the average SBP increased by 28 ​mmHg and pulse decreased by 19 bpm from field to ED arrival. The overall survival at 24-h and 30-days was 83 ​% and 80.8 ​%, respectively.</div></div><div><h3>Conclusion</h3><div>This study demonstrates the successful implementation of large-scale PH-WB program utilizing creative strategies to cover a large catchment zone with limited resources. Preliminary results document safe delivery of PH-WB, minimal variation in pre-hospital scene times, 0 ​% expiration rate of whole-blood in the field and high compliance with protocols.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"250 ","pages":"Article 116587"},"PeriodicalIF":2.7,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004056","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":"Delays in Crime Victim Compensation in Illinois affect the most vulnerable.","authors":"Joy Ayemoba, Clarice Robinson, Rachel Nordgren, Myles Francis, Carla Galvan, Leon Sawh, Fatima Bouftas, Ezra Moos, Diane N Haddad, Marion C Henry, Carmelle V Romain, Kylie Callier, Phillip M Dowzicky, Tanya L Zakrison, Franklin Cosey-Gay, Charlotte Kvasnovsky","doi":"10.1016/j.amjsurg.2025.116579","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116579","url":null,"abstract":"<p><strong>Introduction: </strong>Crime victim compensation (CVC) was developed to help individuals and families with expenses following violent injury. Administrative obstacles and potential biases may contribute to disparities in CVC. We explored rates of successful claims, award amounts and time to disbursement in Illinois.</p><p><strong>Methods: </strong>We completed a freedom of information act request for CVC data from the Office of the Illinois Attorney General from January 2012 to July 2024. Results were stratified by race, mechanism of victimization and denial characteristics.</p><p><strong>Results: </strong>We identified 42,477 claimants for CVC in Illinois during our study period. Of these claims 16,935 (39.9 ​%) were awarded. Black applicants composed the largest portion of denied claims (N ​= ​9,055, 37.7 ​%) and comprised almost half of all claims denied based on 'victim misconduct' (N ​= ​1,924, 42.5 ​%). Mean time to case closure ranged from 345 to 405 days following homicide.</p><p><strong>Conclusion: </strong>Focused advocacy is needed to support survivors in pursuit of this program.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116579"},"PeriodicalIF":2.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939438","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":"From the Editor – in – Chief","authors":"Herbert Chen (Editor-in-Chief)","doi":"10.1016/j.amjsurg.2025.116581","DOIUrl":"10.1016/j.amjsurg.2025.116581","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"248 ","pages":"Article 116581"},"PeriodicalIF":2.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144939418","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}