Pub Date : 2026-01-14DOI: 10.1001/jamasurg.2025.6067
Julia H Song,Patricia L Turner,Thomas C Tsai
{"title":"Implications of Eliminating Medicare's Inpatient Only List.","authors":"Julia H Song,Patricia L Turner,Thomas C Tsai","doi":"10.1001/jamasurg.2025.6067","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6067","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"177 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961493","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}
Pub Date : 2026-01-07DOI: 10.1001/jamasurg.2025.5929
Cathal O'Reilly,Jennifer L McGarry,Alexandra M Zaborowski,Matthew G Davey,Denis Evoy,Jane Rothwell,Damian McCartan,Claire L Rutherford,Michael R Boland,Ruth S Prichard
ImportanceRisk-reducing bilateral mastectomy reduces the incidence of breast cancer in female carriers of the BRCA pathogenic variants, but its association with mortality remains uncertain.ObjectiveTo evaluate the association between risk-reducing bilateral mastectomy and overall and breast cancer-specific mortality in female carriers of BRCA pathogenic variants.Data SourcesPubMed, Scopus, CINAHL, Embase, and CENTRAL were searched in May 2025, with English-language restriction and no date limit. Reference lists of included studies and relevant reviews were also examined.Study SelectionEligible studies compared female carriers of BRCA1 and BRCA2 pathogenic variants who underwent risk-reducing bilateral mastectomy with those who did not and reported overall mortality or breast cancer-specific mortality. Studies including patients with a history of breast cancer were excluded.Data Extraction and SynthesisThis meta-analysis followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Two authors independently performed study selection, data extraction, and risk of bias assessment (using Risk of Bias in Nonrandomized Studies-of Interventions, version 2). Odds ratios (ORs) and hazard ratios (HRs) were pooled using fixed- and random-effects models according to methodological assessment.Main Outcomes and MeasuresOverall and breast cancer-specific mortality.ResultsSix observational studies met the inclusion criteria, comprising 6135 carriers of the BRCA1 or BRCA2 variant. Weighted median age at inclusion was 38.0 years, with reported age ranges spanning 15.3 to 85.3 years. Risk-reducing bilateral mastectomy was associated with lower overall mortality in both unadjusted (OR, 0.38; 95% CI, 0.27-0.55; P < .001) and adjusted (HR, 0.37; 95% CI, 0.23-0.60; P < .001) analyses. Breast cancer-specific mortality was also reduced (OR, 0.19; 95% CI, 0.08-0.47; P < .001; HR, 0.14; 95% CI, 0.04-0.49; P = .002).Conclusions and RelevanceRisk-reducing bilateral mastectomy was associated with lower overall and breast cancer-specific mortality in carriers of the BRCA variants. These findings support the role of risk-reducing bilateral mastectomy as a potentially life-extending intervention and may inform the shared decision-making discussions in these women.
降低风险的双侧乳房切除术降低了BRCA致病变异女性携带者的乳腺癌发病率，但其与死亡率的关系仍不确定。目的评估降低风险的双侧乳房切除术与BRCA致病变异女性携带者的总体死亡率和乳腺癌特异性死亡率之间的关系。数据源pubmed， Scopus， CINAHL， Embase和CENTRAL于2025年5月检索，有英文限制，无日期限制。还审查了纳入研究的参考清单和相关综述。研究选择：符合条件的研究比较了BRCA1和BRCA2致病变异的女性携带者，她们接受了降低风险的双侧乳房切除术，并报告了总死亡率或乳腺癌特异性死亡率。有乳腺癌病史的患者被排除在外。本荟萃分析遵循流行病学观察性研究荟萃分析（MOOSE）指南。两位作者独立进行了研究选择、数据提取和偏倚风险评估（使用《非随机研究干预的偏倚风险》，版本2）。根据方法学评估，采用固定效应和随机效应模型汇总优势比（ORs）和风险比（hr）。主要结局和测量：总体死亡率和乳腺癌特异性死亡率。结果6项观察性研究符合纳入标准，包括6135名BRCA1或BRCA2变异携带者。纳入时的加权中位年龄为38.0岁，报告的年龄范围为15.3至85.3岁。降低风险的双侧乳房切除术与两组患者较低的总死亡率相关(OR, 0.38; 95% CI, 0.27-0.55; P <。0.001)和调整后(HR, 0.37; 95% CI, 0.23-0.60; P <。001)分析。乳腺癌特异性死亡率也降低（OR, 0.19; 95% CI, 0.08-0.47; P < .001； HR, 0.14; 95% CI, 0.04-0.49; P = .002）。结论和相关性：降低风险的双侧乳房切除术与BRCA变异携带者较低的总体死亡率和乳腺癌特异性死亡率相关。这些发现支持降低风险的双侧乳房切除术作为一种潜在的延长生命的干预措施的作用，并可能为这些妇女的共同决策讨论提供信息。
{"title":"Risk-Reducing Bilateral Mastectomy and Mortality in Carriers of BRCA1 and BRCA2 Variants: A Systematic Review and Meta-Analysis.","authors":"Cathal O'Reilly,Jennifer L McGarry,Alexandra M Zaborowski,Matthew G Davey,Denis Evoy,Jane Rothwell,Damian McCartan,Claire L Rutherford,Michael R Boland,Ruth S Prichard","doi":"10.1001/jamasurg.2025.5929","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5929","url":null,"abstract":"ImportanceRisk-reducing bilateral mastectomy reduces the incidence of breast cancer in female carriers of the BRCA pathogenic variants, but its association with mortality remains uncertain.ObjectiveTo evaluate the association between risk-reducing bilateral mastectomy and overall and breast cancer-specific mortality in female carriers of BRCA pathogenic variants.Data SourcesPubMed, Scopus, CINAHL, Embase, and CENTRAL were searched in May 2025, with English-language restriction and no date limit. Reference lists of included studies and relevant reviews were also examined.Study SelectionEligible studies compared female carriers of BRCA1 and BRCA2 pathogenic variants who underwent risk-reducing bilateral mastectomy with those who did not and reported overall mortality or breast cancer-specific mortality. Studies including patients with a history of breast cancer were excluded.Data Extraction and SynthesisThis meta-analysis followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Two authors independently performed study selection, data extraction, and risk of bias assessment (using Risk of Bias in Nonrandomized Studies-of Interventions, version 2). Odds ratios (ORs) and hazard ratios (HRs) were pooled using fixed- and random-effects models according to methodological assessment.Main Outcomes and MeasuresOverall and breast cancer-specific mortality.ResultsSix observational studies met the inclusion criteria, comprising 6135 carriers of the BRCA1 or BRCA2 variant. Weighted median age at inclusion was 38.0 years, with reported age ranges spanning 15.3 to 85.3 years. Risk-reducing bilateral mastectomy was associated with lower overall mortality in both unadjusted (OR, 0.38; 95% CI, 0.27-0.55; P < .001) and adjusted (HR, 0.37; 95% CI, 0.23-0.60; P < .001) analyses. Breast cancer-specific mortality was also reduced (OR, 0.19; 95% CI, 0.08-0.47; P < .001; HR, 0.14; 95% CI, 0.04-0.49; P = .002).Conclusions and RelevanceRisk-reducing bilateral mastectomy was associated with lower overall and breast cancer-specific mortality in carriers of the BRCA variants. These findings support the role of risk-reducing bilateral mastectomy as a potentially life-extending intervention and may inform the shared decision-making discussions in these women.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"391 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907801","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}
Pub Date : 2026-01-07DOI: 10.1001/jamasurg.2025.5847
Anai N Kothari
{"title":"Suitability of Large Language Models and Predicting Case Duration-Reply.","authors":"Anai N Kothari","doi":"10.1001/jamasurg.2025.5847","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5847","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"82 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907803","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}
Pub Date : 2026-01-07DOI: 10.1001/jamasurg.2025.5844
Jordan Prosky,Judy Wawira Gichoya
{"title":"Suitability of Large Language Models and Predicting Case Duration.","authors":"Jordan Prosky,Judy Wawira Gichoya","doi":"10.1001/jamasurg.2025.5844","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5844","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"39 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907798","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}
Pub Date : 2026-01-01DOI: 10.1001/jamasurg.2025.4916
Kaelyn C Cummins, Allan Tsung
{"title":"Total Pancreatectomy-Still a Last-Resort Procedure.","authors":"Kaelyn C Cummins, Allan Tsung","doi":"10.1001/jamasurg.2025.4916","DOIUrl":"10.1001/jamasurg.2025.4916","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"58"},"PeriodicalIF":14.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495553","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}
Pub Date : 2026-01-01DOI: 10.1001/jamasurg.2025.5416
{"title":"Change to Open Access.","authors":"","doi":"10.1001/jamasurg.2025.5416","DOIUrl":"10.1001/jamasurg.2025.5416","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":"104"},"PeriodicalIF":14.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12631564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549136","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}
ImportanceDespite the recovery advantages of minimally invasive surgical techniques, moderate to severe pain after laparoscopic colorectal surgery is a common barrier to improving postoperative recovery quality.ObjectiveTo evaluate whether intrathecal morphine (ITM) combined with transversus abdominis plane block (TAPB) improves postoperative recovery quality after laparoscopic colorectal surgery.Design, Setting, and ParticipantsThis prospective, double-blind randomized clinical trial was conducted at Sun Yat-sen University Cancer Center between October 15, 2024, and February 15, 2025. Adults scheduled for elective laparoscopic colorectal surgery were randomized 1:1 to ITM or saline placebo. Data were analyzed from March 1, 2025, to March 31, 2025.InterventionsBoth groups received liposomal bupivacaine for TAPB as part of standard enhanced recovery after surgery (ERAS) protocol. The intervention group received ITM, 3 µg/kg, while the control group received intrathecal normal saline.Main Outcomes and MeasuresThe primary outcome was the Quality of Recovery 15 (QoR-15) score at 24 hours postoperatively. Secondary outcomes included postoperative pain scores, cumulative opioid consumption (in morphine milligram equivalents [MME]), time to first flatus, time to first ambulation, incidence of adverse effects, and length of hospital stay.ResultsA total of 252 patients were included in the intention-to-treat analysis (mean [SD] age, 58.4 [11.1] years; 112 female patients [44.4%]). At 24 hours postoperatively, the intervention group had significantly higher mean (SE) QoR-15 scores compared to the control group (114.95 [1.04] vs 102.22 [0.76]; mean difference, 12.21; 95% CI, 9.91-14.51; P < .001), indicating better recovery quality. Postoperative mean (SD) morphine consumption was lower in the intervention group compared to the control group (4.4 [6.4] MME vs 10.4 [11.1] MME; mean difference, -6.59; 95% CI, -8.88 to -4.31; P < .001). The intervention group also had a reduced incidence of nausea (23.8% vs 37.3%; adjusted risk difference, -15.06%; 95% CI, -26.60% to -3.52%; P = .01), but a high incidence of pruritus was observed in the intervention group (19.0% vs 3.2%; adjusted risk difference, 15.08%; 95% CI, 7.26%-22.90%; P < .001).Conclusions and RelevancePer the results of this randomized clinical trial, in laparoscopic colorectal surgery, ITM combined with TAPB can significantly enhance early postoperative recovery and analgesia, albeit with an increased risk of pruritus. This strategy may be a valuable component of multimodal analgesia regimens following laparoscopic colorectal surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT06636864.
尽管微创手术技术具有恢复优势，但腹腔镜结直肠手术后中度至重度疼痛是提高术后恢复质量的常见障碍。目的评价鞘内吗啡（ITM）联合经腹平面阻滞（TAPB）对腹腔镜结直肠癌术后恢复质量的影响。设计、环境和参与者这项前瞻性、双盲随机临床试验于2024年10月15日至2025年2月15日在中山大学癌症中心进行。计划进行择期腹腔镜结直肠手术的成人按1:1随机分为ITM组或生理盐水安慰剂组。数据分析时间为2025年3月1日至2025年3月31日。干预措施：两组均接受布比卡因脂质体治疗TAPB，作为标准手术后增强恢复（ERAS）方案的一部分。干预组给予ITM，剂量为3µg/kg，对照组给予鞘内生理盐水。主要观察指标术后24小时恢复质量15 （QoR-15）评分为主要观察指标。次要结局包括术后疼痛评分、阿片类药物累积消耗（吗啡毫克当量[MME]）、第一次放屁时间、第一次下床时间、不良反应发生率和住院时间。结果共有252例患者被纳入意向治疗分析（平均[SD]年龄58.4[11.1]岁，女性112例[44.4%]）。术后24小时，干预组QoR-15平均评分（SE）明显高于对照组(114.95 [1.04]vs 102.22[0.76]；平均差值12.21;95% CI, 9.91 ~ 14.51; P <。001)，表明恢复质量较好。干预组术后平均吗啡用量（SD）低于对照组（4.4 [6.4]MME vs 10.4 [11.1] MME；平均差异为-6.59;95% CI, -8.88 ~ -4.31; P < .001）。干预组恶心发生率也降低（23.8% vs 37.3%），校正风险差为-15.06%，95% CI为-26.60% ~ -3.52%,P =。干预组瘙痒的发生率较高（19.0% vs 3.2%，校正风险差为15.08%，95% CI为7.26% ~ 22.90%,P < 0.001）。结论及相关性本随机临床试验结果显示，在腹腔镜结直肠手术中，ITM联合TAPB可显著增强术后早期恢复和镇痛，但瘙痒风险增加。该策略可能是腹腔镜结直肠手术后多模式镇痛方案的一个有价值的组成部分。临床试验注册号：NCT06636864。
{"title":"Intrathecal Morphine for Enhanced Recovery After Laparoscopic Colorectal Surgery: A Randomized Clinical Trial.","authors":"Liquan Zheng,Yali Lu,Xiaofan Lu,Lizhen You,Chuanchuan Yu,Jielan Lai,Mei Xu,Manxiu Xie,Ying Xiao,Renchun Lai","doi":"10.1001/jamasurg.2025.5699","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5699","url":null,"abstract":"ImportanceDespite the recovery advantages of minimally invasive surgical techniques, moderate to severe pain after laparoscopic colorectal surgery is a common barrier to improving postoperative recovery quality.ObjectiveTo evaluate whether intrathecal morphine (ITM) combined with transversus abdominis plane block (TAPB) improves postoperative recovery quality after laparoscopic colorectal surgery.Design, Setting, and ParticipantsThis prospective, double-blind randomized clinical trial was conducted at Sun Yat-sen University Cancer Center between October 15, 2024, and February 15, 2025. Adults scheduled for elective laparoscopic colorectal surgery were randomized 1:1 to ITM or saline placebo. Data were analyzed from March 1, 2025, to March 31, 2025.InterventionsBoth groups received liposomal bupivacaine for TAPB as part of standard enhanced recovery after surgery (ERAS) protocol. The intervention group received ITM, 3 µg/kg, while the control group received intrathecal normal saline.Main Outcomes and MeasuresThe primary outcome was the Quality of Recovery 15 (QoR-15) score at 24 hours postoperatively. Secondary outcomes included postoperative pain scores, cumulative opioid consumption (in morphine milligram equivalents [MME]), time to first flatus, time to first ambulation, incidence of adverse effects, and length of hospital stay.ResultsA total of 252 patients were included in the intention-to-treat analysis (mean [SD] age, 58.4 [11.1] years; 112 female patients [44.4%]). At 24 hours postoperatively, the intervention group had significantly higher mean (SE) QoR-15 scores compared to the control group (114.95 [1.04] vs 102.22 [0.76]; mean difference, 12.21; 95% CI, 9.91-14.51; P < .001), indicating better recovery quality. Postoperative mean (SD) morphine consumption was lower in the intervention group compared to the control group (4.4 [6.4] MME vs 10.4 [11.1] MME; mean difference, -6.59; 95% CI, -8.88 to -4.31; P < .001). The intervention group also had a reduced incidence of nausea (23.8% vs 37.3%; adjusted risk difference, -15.06%; 95% CI, -26.60% to -3.52%; P = .01), but a high incidence of pruritus was observed in the intervention group (19.0% vs 3.2%; adjusted risk difference, 15.08%; 95% CI, 7.26%-22.90%; P < .001).Conclusions and RelevancePer the results of this randomized clinical trial, in laparoscopic colorectal surgery, ITM combined with TAPB can significantly enhance early postoperative recovery and analgesia, albeit with an increased risk of pruritus. This strategy may be a valuable component of multimodal analgesia regimens following laparoscopic colorectal surgery.Trial RegistrationClinicalTrials.gov Identifier: NCT06636864.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"22 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807649","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}
Pub Date : 2025-12-23DOI: 10.1001/jamasurg.2025.5711
Armaan K Malhotra,Husain Shakil,Vishwathsen Karthikeyan,Christopher S Lozano,Christopher D Witiw,Jefferson R Wilson,Avery B Nathens
{"title":"Forecasting the Impact of Fully Automated Vehicle Adoption on US Road Traffic Injuries.","authors":"Armaan K Malhotra,Husain Shakil,Vishwathsen Karthikeyan,Christopher S Lozano,Christopher D Witiw,Jefferson R Wilson,Avery B Nathens","doi":"10.1001/jamasurg.2025.5711","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5711","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"24 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807650","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}
Pub Date : 2025-12-23DOI: 10.1001/jamasurg.2025.5606
Giammauro Berardi,Alessandro Cucchetti,Giuseppe Maria Ettorre
{"title":"Sample Size Calculation and Protocol Deviations in the PREHEP Trial-Reply.","authors":"Giammauro Berardi,Alessandro Cucchetti,Giuseppe Maria Ettorre","doi":"10.1001/jamasurg.2025.5606","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5606","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"32 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145807651","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：