American Surgeon最新文献

{"title":"Laparoscopic Warshaw Procedure for Solid Pseudopapillary Neoplasms in Children.","authors":"Chirag Ram, Katharyn Cassella, Jan A Niec, Melissa A Hilmes, Hernán Correa, Maren E Shipe, Irving J Zamora, Harold N Lovvorn","doi":"10.1177/00031348241312125","DOIUrl":"https://doi.org/10.1177/00031348241312125","url":null,"abstract":"<p><strong>Background: </strong>Solid pseudopapillary neoplasms (SPNs) arising in the body or tail of the pancreas can be amenable to laparoscopic distal pancreatectomy with or without concomitant splenectomy. The purpose of this study was to evaluate laparoscopic distal pancreatectomy for SPN using the Warshaw technique as a means to preserve spleens in children.</p><p><strong>Methods: </strong>We reviewed our database of SPN patients 19 years and younger (January 2006-December 2023). Five had a laparoscopic Warshaw procedure. Using the volumetric analysis tool in Sectra, a pediatric radiologist calculated preoperative tumor, pancreas, and spleen volumes (including postoperative organ volumes) on computed tomography. Descriptive statistics were performed.</p><p><strong>Results: </strong>All five spleens were salvaged, although small infarcts occurred centrally in four patients. Splenic volumes on first imaging after Warshaw averaged 93.9% of preoperative size. Splenic volumes were preserved over time, as the most recent scans averaged 110.6% of the preoperative spleen volume. Collateral flow through the short gastric arteries, inferred from dilation on scans, increased in all patients. Median tumor volume was 85.2 mL, and all SPN were resected with negative margins. No relapse occurred (median follow up: 407 days). Median estimated blood loss was 100 mL, median length of procedure was 4.9 hours, and median inpatient length of stay was 3 days. A multimodal pain regimen, including preoperative TAP blocks, non-opiate, and opiate medications, resulted in a median 81 Morphine Milligram Equivalents (MMEs) administered during the hospital stay.</p><p><strong>Conclusion: </strong>Laparoscopic Warshaw for SPN in children appears highly effective at preserving splenic volume without compromising oncologic fidelity or consuming excess inpatient resources.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241312125"},"PeriodicalIF":1.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in Advanced Stage Colorectal Cancer Outcomes in Appalachia: A Comprehensive Review.","authors":"Chen Chia Wang, Trevor Farmer, Mary Garland-Kledzik, Deepa R Magge","doi":"10.1177/00031348241312124","DOIUrl":"https://doi.org/10.1177/00031348241312124","url":null,"abstract":"<p><p>The Appalachian region consists of over 26 million Americans, of whom almost 2.5 million live in rural areas. Various social determinants of health including but not limited to rural living conditions and geographic isolation, food insecurity, and low income contribute to disparate health outcomes compared to the rest of the country. Obesity, hypertension, diabetes, stroke, and chronic heart diseases are all more prevalent in Appalachia. These comorbidities, combined with the aforementioned social vulnerabilities, place the Appalachian population at increased risk of higher cancer incidence and poorer outcomes. Lung, cervical, breast, penile, prostate, colorectal, and head and neck cancers are all shown to have higher rates and poorer outcomes within Appalachia relative to the country. Advanced staged colorectal cancer patients are a unique population that may be even further impacted by the social inequities in Appalachia, given the resource-intensive and multi-disciplinary approach required for effective treatment. Unfortunately, there is a dire lack of investigation into the incidence and outcomes of advanced stage colorectal cancer in Appalachian residents. This review summarizes the existing literature on disparate cancer outcomes in the Appalachian population, with a focus on advanced stage colorectal cancer. We also propose various approaches that could decrease malignancy rates and improve outcomes, such as dietary adjustments, screening tools, and public educational endeavors. We also acknowledge the role high-volume centers can play in working towards accessible care and the potential for collaborations between large institutions within Appalachian regions to spur the change that is greatly needed.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241312124"},"PeriodicalIF":1.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Surgery in Safety-Net Hospitals: Addressing Health Disparities and Improving Access to Care.","authors":"Chevar South, Olajumoke Megafu, Carolyn Moore, Taylor Williams, Larry Hobson, Omar Danner, Shaneeta Johnson","doi":"10.1177/00031348241312121","DOIUrl":"https://doi.org/10.1177/00031348241312121","url":null,"abstract":"<p><p>Minimally invasive surgery (MIS) has demonstrated significant clinical and economic benefits that have been consistently validated and reproduced in practice and the literature for the past few decades. These benefits include improved patient outcomes, reduced complications, shorter hospital stays, decreased narcotic use, quicker recovery times, and lower rates of wound infections. However, safety-net hospitals, which historically serve a larger percentage of underserved and marginalized populations, often lack the resources to invest in high capital equipment. This limitation decreases access for these marginalized groups to the advantages of MIS, particularly robotic surgery and a wider range of surgical operations. This disparity in access to care highlights a critical shortfall in the delivery of health care for these patients and other vulnerable populations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31348241312121"},"PeriodicalIF":1.0,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding the NCCN Guidelines With AI: A Comparative Evaluation of ChatGPT-4.0 and Llama 2 in the Management of Thyroid Carcinoma.","authors":"Shivam Pandya, Tamir E Bresler, Tyler Wilson, Zin Htway, Manabu Fujita","doi":"10.1177/00031348241269430","DOIUrl":"10.1177/00031348241269430","url":null,"abstract":"<p><strong>Introduction: </strong>Artificial Intelligence (AI) has emerged as a promising tool in the delivery of health care. ChatGPT-4.0 (OpenAI, San Francisco, California) and Llama 2 (Meta, Menlo Park, CA) have each gained attention for their use in various medical applications.</p><p><strong>Objective: </strong>This study aims to evaluate and compare the effectiveness of ChatGPT-4.0 and Llama 2 in assisting with complex clinical decision making in the diagnosis and treatment of thyroid carcinoma.</p><p><strong>Participants: </strong>We reviewed the National Comprehensive Cancer Network® (NCCN) Clinical Practice Guidelines for the management of thyroid carcinoma and formulated up to 3 complex clinical questions for each decision-making page. ChatGPT-4.0 and Llama 2 were queried in a reproducible manner. The answers were scored on a Likert scale: 5) Correct; 4) correct, with missing information requiring clarification; 3) correct, but unable to complete answer; 2) partially incorrect; 1) absolutely incorrect. Score frequencies were compared, and subgroup analysis was conducted on <i>Correctness</i> (defined as scores 1-2 vs 3-5) and <i>Accuracy</i> (scores 1-3 vs 4-5).</p><p><strong>Results: </strong>In total, 58 pages of the NCCN Guidelines® were analyzed, generating 167 unique questions. There was no statistically significant difference between ChatGPT-4.0 and Llama 2 in terms of overall score (Mann-Whitney U-test; Mean Rank = 160.53 vs 174.47, <i>P</i> = 0.123), <i>Correctness</i> (<i>P</i> = 0.177), or <i>Accuracy</i> (<i>P</i> = 0.891).[Formula: see text].</p><p><strong>Conclusion: </strong>ChatGPT-4.0 and Llama 2 demonstrate a limited but substantial capacity to assist with complex clinical decision making relating to the management of thyroid carcinoma, with no significant difference in their effectiveness.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"94-98"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Taxonomy of Intraoperative Cholangiograms in Suspected Choledocholithiasis: A Tool for Advancing Laparoscopic Common Bile Duct Exploration Outcomes Research.","authors":"Elizabeth C Wood, Micaela K Gomez, Jessica L Rauh, Juhi Saxena, Jeffery Conner, Gregory R Stettler, Carl Westcott, Andrew M Nunn, Lucas P Neff, Maggie E Bosley","doi":"10.1177/00031348241268068","DOIUrl":"10.1177/00031348241268068","url":null,"abstract":"<p><strong>Background: </strong>Cholangiography for visualization of the biliary tree during laparoscopic cholecystectomy is an important diagnostic roadmap in the context of suspected choledocholithiasis (CDL). The renewed interest in transcystic laparoscopic common bile duct exploration (LCBDE) necessitates a general description of the range of CDL presentations. Our aim was to establish a novel classification system of intraoperative cholangiograms (IOCs) to advance research efforts in this field.</p><p><strong>Methods: </strong>A novel cholangiogram classification system, featuring 8 distinct presentations of choledocholithiasis, was applied to a data set of 80 preintervention IOCs for suspected choledocholithiasis. The classification system is as follows: A (no common bile duct stones, duodenal filling present, and concern for air bubbles), B (no common bile duct stones, no duodenal filling, and concern for sludge), C1 (stone(s) < 2x size of cystic duct with duodenal filling), C2 (stone(s) < 2x size of cystic duct without duodenal filling), D1 (stone(s) ≥ 2x size of cystic duct with duodenal filling), D2 (stone(s) ≥ 2x size of cystic duct without duodenal filling), E1 (congenital anatomical variant and/or common duct stricture), and E2 (surgically altered biliary anatomy).</p><p><strong>Results: </strong>Cholangiogram review yielded preintervention classifications for 6 of 8 variants (A-E): A (7.5%), B (3.75%), C1 (23.75%), C2 (42.5%), D1 (15%), and D2 (7.5%). Analysis of cystic duct diameter yielded no significant differences among classification groups, indicating no predominant pattern of cystic duct anatomy within a given classification.</p><p><strong>Discussion: </strong>An IOC classification system for suspected choledocholithiasis is foundational to answering key clinical questions for transcystic laparoscopic common bile duct exploration.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"7-11"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141791705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes and Treatment Strategy of Mirizzi's Syndrome Treated With Surgery.","authors":"Xiaojun Sui, Ming Li, Dapeng Zhang","doi":"10.1177/00031348241267955","DOIUrl":"10.1177/00031348241267955","url":null,"abstract":"<p><strong>Background: </strong>There is currently no standardized treatment for Mirizzi's syndrome (MS). We aim to explore the surgical treatment strategy for MS by analyzing its clinical characteristics and treatment outcomes.</p><p><strong>Methods: </strong>This retrospective study analyzed the clinical data of 130 patients with MS who underwent surgery at our hospital from April 2013 to April 2020.</p><p><strong>Results: </strong>The study population comprised 130 patients with MS, with an approximately balanced sex ratio and a median age of 58.5 years. The preoperative diagnostic rate was 82.3%. The diagnostic accuracy of ERCP was 92.5%, higher than that of MRCP and ultrasound. All patients underwent surgical treatment, with 74 cases of laparoscopic surgery, 43 cases of laparotomy, and 13 cases of laparoscopic surgery converted to laparotomy. A total of 23 patients experienced short-term and long-term complications after surgery, with a complication rate of 17.7%. There was no statistical difference between laparoscopic surgery and open surgery in terms of intraoperative hemorrhage, operative time, and postoperative complication rate. However, the length of hospital stay was shorter in the laparoscopic surgery compared to the open surgery, which was statistically different from each other.</p><p><strong>Conclusion: </strong>ERCP is the gold standard for the diagnosis of MS, especially for identifying the type of MS. ERCP plays an important role in both the preoperative and postoperative phases of MS. Our study demonstrated that laparoscopic surgery was a safe and feasible option for MS treatment, even requires less hospitalization than open surgery.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"31-37"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141873974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local Control of Pyoderma Gangrenosum Using Human Amniotic Membrane and Transcriptome Analysis.","authors":"Mark A Maier, Jenna R Dennis, Cameron J Fontenot, Nicholas A Taylor, Rawaa Almukhtar, Frank H P Lau, Alison A Smith","doi":"10.1177/00031348241269421","DOIUrl":"10.1177/00031348241269421","url":null,"abstract":"<p><p>Pyoderma gangrenosum (PG) is a rare, chronic, ulcerative disease characterized by non-healing wounds that worsen with debridement, a phenomenon called pathergy. No consensus regarding pathogenesis, diagnosis, or treatment exists for PG. A previous pilot study using dehydrated human amniotic/chorionic membrane (dHACM), following excisional debridement, augmented PG wound healing and allowed for subsequent wound closure through split-thickness skin grafting (STSG). In this clinical trial (NCT05120726), four patients with an established PG diagnosis were enrolled to undergo treatment with dHACM and characterize the pre- and post-treatment transcriptome profiles. RNA sequencing was used to isolate the total RNA from specimens. Genes of particular interest were quantified through real-time quantitative reverse transcription polymerase chain reaction. We observed varied changes to the local expression of inflammatory response, positive regulators of cellular proliferation, and extracellular matrix disassembly cytokines. All PG wounds produced granulation tissue following treatment and were closed using split-thickness skin grafts.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"144-147"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Preoperative Osteosarcopenia and Postoperative Administration of Pancrelipase on the Prognosis of Borderline Resectable and Unresectable Locally Advanced Pancreatic Cancer.","authors":"Michinori Matsumoto, Tadashi Uwagawa, Yoshihiro Shirai, Masashi Tsunematsu, Kenei Furukawa, Koichiro Haruki, Norimitsu Okui, Kohei Okazaki, Shunta Ishizaki, Toru Ikegami","doi":"10.1177/00031348241272420","DOIUrl":"10.1177/00031348241272420","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to identify postoperative recurrence and prognostic factors, including osteosarcopenia for borderline resectable (BR) and unresectable locally advanced (UR-LA) pancreatic cancer and to examine the impact of postoperative pancreatic enzyme replacement therapy (PERT).</p><p><strong>Methods: </strong>We retrospectively examined 32 resected patients with BR and UR-LA pancreatic cancer. We investigated independent factors in the disease-free survival and overall survival. The relation of osteosarcopenia with the clinicopathological factors was investigated. Additionally, the association of the administration of a standard dose of pancrelipase, the amount of lipase required for patients with pancreatic exocrine insufficiency, for ≥6 months postoperatively with improvement of sarcopenia, osteopenia, and osteosarcopenia and completion rate of adjuvant chemotherapy was investigated.</p><p><strong>Results: </strong>Multivariate analyses identified osteosarcopenia (<i>P</i> = 0.049) and lymph node metastasis (<i>P</i> = 0.01) as independent recurrence predictors, and osteosarcopenia (<i>P</i> = 0.002), maximum tumor diameter ≥40 mm (<i>P</i> = 0.006), and no adjuvant therapy (<i>P</i> = 0.01) as independent prognostic predictors. In the osteosarcopenia group, serum CA19-9 levels were higher (<i>P</i> = 0.03). The administration of a standard dose of pancrelipase for ≥6 months postoperatively was none in the osteosarcopenia group (0% vs 42.9%, <i>P</i> = 0.01), while significantly improved postoperative sarcopenia (33% vs 0%, <i>P</i> = 0.004), increased number of cycles of adjuvant chemotherapy (n = 6 vs n = 3, <i>P</i> = 0.03), and the completion rate of adjuvant chemotherapy in excluding cases interrupted because of recurrence (86% vs 25%, <i>P</i> = 0.007).</p><p><strong>Conclusions: </strong>Osteosarcopenia was an independent recurrent and prognostic factor in patients after pancreatectomy for locally advanced pancreatic cancer. Appropriate postoperative PERT may contribute to a better prognosis by improving sarcopenia and increasing the completion rate of adjuvant chemotherapy.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"65-75"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Surgical Parathyroidectomy on Craniofacial Morphology in Patients With Renal Failure.","authors":"Zhenpeng Liao, Zhongkang Ye, Xu Zhang, Jun Zhang, Peng He, Haiyu Hong, Jiaoping Mi","doi":"10.1177/00031348241272425","DOIUrl":"10.1177/00031348241272425","url":null,"abstract":"<p><strong>Purpose: </strong>Parathyroidectomy is beneficial in tertiary hyperparathyroidism (THPT) consequent to chronic renal failure. The craniofacial morphology of patients who undergo total parathyroidectomy and autologous transplantation (tPTX + AT) has not been widely studied. This study assessed the efficacy of tPTX + AT in THPT and evaluated possible improvements in craniofacial features.</p><p><strong>Methods: </strong>This retrospective analysis included patients who were diagnosed with medically refractory THPT and had undergone tPTX + AT between September 2013 and May 2021. The VAS was used to evaluate improvements in various symptoms including bone pain and pruritus. Changes in serum calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH) levels were also assessed. The impact of the procedure was assessed by comparing two-photon X-ray bone mineral density measurements obtained 1 year before and after surgery.</p><p><strong>Results: </strong>The VAS of pain and pruritus decreased significantly on the first postoperative day (<i>P</i> < 0.05). Calcium levels changed significantly (from 2.50 ± 0.22 mmol/L to 2.10 ± 0.26 mmol/L) on postoperative day 1 (<i>P</i> = 0.0000); iPTH levels also declined substantially on this day, reducing from 211.00 (122.10, 252.80) to 5.04 (2.96, 9.40) pmol/L. Bone mineral density increased significantly across various regions including the greater trochanter of the femur, intertrochanteric area, total hip, and third lumbar vertebra (<i>P</i> < 0.05). The angles between the upper incisor and mandibular plane and the lower lip and Ricketts E line (drawn from the tip of the nose to the soft tissue area) also improved (<i>P</i> = 0.043, <i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>Total parathyroidectomy and autologous transplantation can rapidly alleviate bone pain and skin itching in THPT. It may also improve bone density and facial soft tissue.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"86-93"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proximal Gastrectomy With Double-Tract Reconstruction for Gastroesophageal Junction Injury.","authors":"Mina F Nordness, Mayur B Patel, Michele Fiorentino, Chandrasekhar Padmanabhan","doi":"10.1177/00031348241269403","DOIUrl":"10.1177/00031348241269403","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"148-150"},"PeriodicalIF":1.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}