Annals of surgery最新文献

{"title":"The Hispanic Paradox and the Rising Incidence and Mortality From Hepatobiliary and Gastric Cancers Among Hispanic Individuals in the United States: A Call for Surgeon Advocates.","authors":"Benjamin Grobman, Gezzer Ortega, George Molina","doi":"10.1097/SLA.0000000000006510","DOIUrl":"10.1097/SLA.0000000000006510","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"556-558"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142035040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity in Pay: Rethinking the GME Funding Model: Erratum.","authors":"","doi":"10.1097/SLA.0000000000006657","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006657","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"281 4","pages":"e4"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Promoting Female Surgeons Through Structured Award Nominations.","authors":"Karen Trang, Caroline Q Stephens, Colleen Flanagan, Ava Yap, Audrey Brown, Yvonne Kelly, Heather L Yeo, Julie Ann Sosa, Lucy Z Kornblith, Madhulika G Varma","doi":"10.1097/SLA.0000000000006430","DOIUrl":"10.1097/SLA.0000000000006430","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"551-553"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141475764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in End-of-Life Care and Satisfaction Among Veterans Undergoing Surgery.","authors":"Shukri H A Dualeh, Maia S Anderson, Paul Abrahamse, Neil Kamdar, Emily Evans, Pasithorn A Suwanabol","doi":"10.1097/SLA.0000000000006253","DOIUrl":"10.1097/SLA.0000000000006253","url":null,"abstract":"<p><strong>Objective: </strong>To examine trends in end-of-life care services and satisfaction among veterans undergoing any inpatient surgery.</p><p><strong>Background: </strong>The Veterans Health Administration has undergone system-wide transformations to improve end-of-life care yet the impacts on end-of-life care services use and family satisfaction are unknown.</p><p><strong>Methods: </strong>We performed a retrospective, cross-sectional analysis of veterans who died within 90 days of undergoing inpatient surgery between January 2010 and December 2019. Using the Veterans Affairs (VA) Bereaved Family Survey (BFS), we calculated the rates of palliative care and hospice use and examined satisfaction with end-of-life care. After risk and reliability adjustment for each VA hospital, we then performed a multivariable linear regression model to identify factors associated with the greatest change.</p><p><strong>Results: </strong>Our cohort consisted of 155,250 patients with a mean age of 73.6 years (SD: 11.6). Over the study period, rates of palliative care consultation and hospice use increased more than two-fold (28.1%-61.1% and 18.9%-46.9%, respectively) while the rate of BFS excellent overall care score increased from 56.1% to 64.7%. There was wide variation between hospitals in the absolute change in rates of palliative care consultation, hospice use, and BFS excellent overall care scores. Rural location and Accreditation Council for Graduate Medical Education accreditation were hospital-level factors associated with the greatest changes.</p><p><strong>Conclusions: </strong>Among veterans undergoing inpatient surgery, improvements in satisfaction with end-of-life care paralleled increases in end-of-life care service use. Future work is needed to identify actionable hospital-level characteristics that may reduce heterogeneity between VA hospitals and facilitate targeted interventions to improve end-of-life care.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"682-688"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341773/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139929700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural Nontrauma Centers: The Unrecognized Cornerstone of Rural Trauma Care.","authors":"Marta L McCrum","doi":"10.1097/SLA.0000000000006597","DOIUrl":"10.1097/SLA.0000000000006597","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"540-541"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Perioperative Glucagon-like Peptide-1 Receptor Agonist Use and Postoperative Outcomes.","authors":"Seth Z Aschen, Ashley Zhang, Gillian M O'Connell, Sophia Salingaros, Caroline Andy, Christine H Rohde, Jason A Spector","doi":"10.1097/SLA.0000000000006614","DOIUrl":"10.1097/SLA.0000000000006614","url":null,"abstract":"<p><strong>Objective: </strong>To assess rates of surgical complications and postoperative readmission in diabetic patients with and without active perioperative prescriptions for glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications.</p><p><strong>Background: </strong>With the rapid growth of GLP-1 RA use in the United States, it is important to understand the potential effect of these drugs on surgical outcomes broadly.</p><p><strong>Methods: </strong>In this retrospective, observational cohort analysis, patients with a diagnosis of type 1 or type 2 diabetes undergoing a surgical procedure at a multicenter quaternary-care health care system between February 2020 and July 2023 were included. Propensity score matching was performed between procedures in patients with and without an active GLP-1 RA prescription. The primary outcome was 30-day readmission, and secondary outcomes were documented dehiscence, infection, hematoma, and bleeding within 180 days after surgery.</p><p><strong>Results: </strong>Among 74,425 surgical procedures in 21,772 patients included in the analysis, 27.2% were performed in the setting of an active GLP-1 RA prescription. In 13,129 patients [48.0% men, 52.0% women; median (interquartile range) age, 67 (57, 75)], 35,020 procedures were propensity score matched. After matching, the active GLP-1 RA prescription group had a significantly reduced risk of 30-day readmission [relative risk (RR): 0.883; 95% CI: 0.789-0.987; P = 0.028; number needed to treat (NNT): 219; 95% CI: 191-257], postoperative wound dehiscence (RR: 0.711; 95% CI: 0.577-0.877; P = 0.001; NNT: 266; 95% CI: 202-391), and postoperative hematoma (RR: 0.440; 95% CI: 0.216-0.894; P = 0.023; NNT: 1786; 95% CI: 652-2416). No significant differences were seen in rates of infection and bleeding.</p><p><strong>Conclusions: </strong>An active perioperative GLP-1 RA prescription in patients with diabetes was associated with significant reductions in risk-adjusted readmission, wound dehiscence, and hematoma, and no difference in infection and bleeding rates. Further study is warranted to elucidate any causal association.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"600-607"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive Artificial Intelligence System for Early Predicting Residual Cancer Burden During Neoadjuvant Chemotherapy in Breast Cancer.","authors":"Wei Li, Yu-Hong Huang, Teng Zhu, Yi-Min Zhang, Xing-Xing Zheng, Ting-Feng Zhang, Ying-Yi Lin, Zhi-Yong Wu, Zai-Yi Liu, Ying Lin, Guo-Lin Ye, Kun Wang","doi":"10.1097/SLA.0000000000006279","DOIUrl":"10.1097/SLA.0000000000006279","url":null,"abstract":"<p><strong>Objective: </strong>To develop an artificial intelligence (AI) system for the early prediction of residual cancer burden (RCB) scores during neoadjuvant chemotherapy (NAC) in breast cancer.</p><p><strong>Background: </strong>RCB III indicates drug resistance in breast cancer, and early detection methods are lacking.</p><p><strong>Methods: </strong>This study enrolled 1048 patients with breast cancer from 4 institutions, who were all receiving NAC. Magnetic resonance images were collected at the pre-NAC and mid-NAC stages, and radiomics and deep learning features were extracted. A multitask AI system was developed to classify patients into 3 groups (RCB 0 to I, II, and III ) in the primary cohort (PC, n=335). Feature selection was conducted using the Mann-Whitney U test, Spearman analysis, least absolute shrinkage and selection operator regression, and the Boruta algorithm. Single-modality models were developed, followed by model integration. The AI system was validated in 3 external validation cohorts (EVCs, n=713).</p><p><strong>Results: </strong>Among the patients, 442 (42.18%) were RCB 0 to I, 462 (44.08%) were RCB II, and 144 (13.74%) were RCB III. Model I achieved an area under the curve of 0.975 in the PC and 0.923 in the EVCs for differentiating RCB III from RCB 0 to II. Model II distinguished RCB 0 to I from RCB II-III, with an area under the curve of 0.976 in the PC and 0.910 in the EVCs. Subgroup analysis confirmed that the AI system was consistent across different clinical T stages and molecular subtypes.</p><p><strong>Conclusions: </strong>The multitask AI system offers a noninvasive tool for the early prediction of RCB scores in breast cancer, supporting clinical decision-making during NAC.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"645-654"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11888841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Transition of Resident Surgeons to Special Forces Resident Surgeons During Wartime: Preparedness Above All.","authors":"Nir Tsur, Mor Rittblat, Ory Wiesel","doi":"10.1097/SLA.0000000000006338","DOIUrl":"10.1097/SLA.0000000000006338","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"554-555"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140875663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Validation of the Predictive and Prognostic ChemoResist Signature in Resected Pancreatic Ductal Adenocarcinoma: Multicohort Study.","authors":"Lei Huang, Quanli Han, Liangchao Zhao, Zhikuan Wang, Guanghai Dai, Yan Shi","doi":"10.1097/SLA.0000000000006610","DOIUrl":"10.1097/SLA.0000000000006610","url":null,"abstract":"<p><strong>Objective: </strong>To develop and validate a signature to precisely predict prognosis in pancreatic ductal adenocarcinoma (PDAC) undergoing resection and adjuvant chemotherapy.</p><p><strong>Background: </strong>PDAC is largely heterogeneous and responds discrepantly to treatment.</p><p><strong>Methods: </strong>A total of 551 consecutive patients with PDAC from 3 different cohorts of tertiary centers were initially enrolled. Genetic events of the 4 most commonly mutated genes in PDAC and expressions of 12 PI3K/AKT/mammalian target of rapamycin (mTOR) pathway markers were examined. A 9-feature signature for the prediction of chemotherapy benefits was constructed in the training cohort using the least absolute shrinkage and selection operator Cox regression model and validated in 2 independent cohorts.</p><p><strong>Results: </strong>Utilizing the least absolute shrinkage and selection operator model, a predictive and prognostic signature, named ChemoResist, was established based on KRAS single nucleotide variant (SNV), phosphatase and tensin homologue (PTEN), and mTOR expressions, and 6 clinicopathologic features. Significant differences in survival were observed between high and low-ChemoResist patients receiving chemotherapy in both the training [median overall survival (OS), 17 vs 42 months, P < 0.001; median disease-free survival (DFS), 10 vs 23 months, P < 0.001] and validation cohorts (median OS, 18 vs 35 months, P = 0.034; median DFS, 11 vs 20 months, P = 0.028). The ChemoResist classifier also significantly differentiated patient survival in whole patients regardless of chemotherapy. Multivariable-adjusted analysis substantiated the ChemoResist signature as an independent predictive and prognostic factor. For predicting 2-year OS, the ChemoResist classifier had significantly higher areas under the curve than TNM stage (0.788 vs 0.636, P < 0.001), other clinicopathologic characteristics (0.505-0.668), and single molecular markers (0.507-0.591) in the training cohort. Furthermore, patients with low ChemoResist scores exhibited a more favorable response to adjuvant chemotherapy compared with those with high ChemoResist scores (hazard ratio for OS: training, 0.22 vs 0.57; validation, 0.26 vs 0.50; hazard ratio for DFS: training, 0.35 vs 0.54; validation, 0.18 vs 0.59). The ChemoResist signature was further validated in the total cohort undergoing R0 resection.</p><p><strong>Conclusions: </strong>The ChemoResist signature could precisely predict survival in PDAC undergoing resection and chemotherapy, and its predictive value surpassed the TNM stage and other clinicopathologic factors. Moreover, the ChemoResist classifier could assist with identifying patients who would more likely benefit from adjuvant chemotherapy.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"632-644"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of the Implementation of BREASTChoice, a Multilevel Breast Reconstruction Decision Support Tool With Personalized Risk Prediction: Erratum.","authors":"","doi":"10.1097/SLA.0000000000006636","DOIUrl":"https://doi.org/10.1097/SLA.0000000000006636","url":null,"abstract":"","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":"281 4","pages":"e3"},"PeriodicalIF":7.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143613174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}