Pub Date : 2024-11-13DOI: 10.1001/jamasurg.2024.5091
Brian T. Fry, Leah J. Schoel, Ryan A. Howard, Jyothi R. Thumma, Abigail L. Kappelman, Alexander K. Hallway, Anne P. Ehlers, Sean M. O’Neill, Michael A. Rubyan, Jenny M. Shao, Dana A. Telem
ImportanceComponent separation is a reconstructive technique used to facilitate midline closure of large or complex ventral hernias. Despite a contemporary surge in popularity, the incidence and long-term outcomes after component separation remain unknown.ObjectiveTo evaluate the incidence and long-term outcomes of component separation for abdominal wall hernia repair.Design, Setting, and ParticipantsThis cohort study examined 100% Medicare administrative claims data from January 1, 2007, to December 31, 2021. Participants were adults (aged ≥18 years) who underwent elective inpatient ventral hernia repair. Data were analyzed from January through June 2024.ExposureUse of component separation technique during ventral hernia repair.Main Outcomes and MeasuresThe primary outcomes were the incidence of component separation over time and operative recurrence rates up to 10 years after surgery for hernia repairs with and without component separation. The secondary outcome was rate of operative recurrence after component separation stratified by surgeon volume.ResultsAmong 218 518 patients who underwent ventral hernia repair, the mean (SD) age of the cohort was 69.1 (10.9) years; 127 857 patients (58.5%) were female and 90 661 (41.5%) male. A total of 23 768 individuals had component separation for their abdominal wall hernia repair. The median (IQR) follow-up time after the index hernia surgery was 7.2 (2.7-10) years. Compared with patients who did not have a component separation, patients undergoing repair with component separation were slightly younger; more likely to be male; and more likely to have comorbidities, including obesity, and had surgeries that were more likely to be performed open and use mesh. Proportional use of component separation increased from 1.6% of all inpatient hernia repairs in 2007 (279 patients) to 21.4% in 2021 (1569 patients). The 10-year adjusted operative recurrence rate after component separation was lower (11.2%; 95% CI, 11.0%-11.3%) when compared with hernia repairs performed without component separation (12.9%; 95% CI, 12.8%-13.0%; P = .003). Operative recurrence was lower for the top 5% of surgeons by component separation volume (11.9%; 95% CI, 11.8%-12.1%) as opposed to the bottom 95% of surgeons by volume (13.6%; 95% CI, 13.4%-13.7%; P = .004).Conclusions and RelevanceThis study found that component separation was associated with a protective effect on long-term operative recurrence after ventral hernia repair among Medicare beneficiaries, which is somewhat unexpected given the intent of its use for higher complexity hernias. Surgeon volume, while significant, had only a minor influence on operative recurrence rates.
{"title":"Long-Term Outcomes of Component Separation for Abdominal Wall Hernia Repair","authors":"Brian T. Fry, Leah J. Schoel, Ryan A. Howard, Jyothi R. Thumma, Abigail L. Kappelman, Alexander K. Hallway, Anne P. Ehlers, Sean M. O’Neill, Michael A. Rubyan, Jenny M. Shao, Dana A. Telem","doi":"10.1001/jamasurg.2024.5091","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.5091","url":null,"abstract":"ImportanceComponent separation is a reconstructive technique used to facilitate midline closure of large or complex ventral hernias. Despite a contemporary surge in popularity, the incidence and long-term outcomes after component separation remain unknown.ObjectiveTo evaluate the incidence and long-term outcomes of component separation for abdominal wall hernia repair.Design, Setting, and ParticipantsThis cohort study examined 100% Medicare administrative claims data from January 1, 2007, to December 31, 2021. Participants were adults (aged ≥18 years) who underwent elective inpatient ventral hernia repair. Data were analyzed from January through June 2024.ExposureUse of component separation technique during ventral hernia repair.Main Outcomes and MeasuresThe primary outcomes were the incidence of component separation over time and operative recurrence rates up to 10 years after surgery for hernia repairs with and without component separation. The secondary outcome was rate of operative recurrence after component separation stratified by surgeon volume.ResultsAmong 218 518 patients who underwent ventral hernia repair, the mean (SD) age of the cohort was 69.1 (10.9) years; 127 857 patients (58.5%) were female and 90 661 (41.5%) male. A total of 23 768 individuals had component separation for their abdominal wall hernia repair. The median (IQR) follow-up time after the index hernia surgery was 7.2 (2.7-10) years. Compared with patients who did not have a component separation, patients undergoing repair with component separation were slightly younger; more likely to be male; and more likely to have comorbidities, including obesity, and had surgeries that were more likely to be performed open and use mesh. Proportional use of component separation increased from 1.6% of all inpatient hernia repairs in 2007 (279 patients) to 21.4% in 2021 (1569 patients). The 10-year adjusted operative recurrence rate after component separation was lower (11.2%; 95% CI, 11.0%-11.3%) when compared with hernia repairs performed without component separation (12.9%; 95% CI, 12.8%-13.0%; <jats:italic>P</jats:italic> = .003). Operative recurrence was lower for the top 5% of surgeons by component separation volume (11.9%; 95% CI, 11.8%-12.1%) as opposed to the bottom 95% of surgeons by volume (13.6%; 95% CI, 13.4%-13.7%; <jats:italic>P</jats:italic> = .004).Conclusions and RelevanceThis study found that component separation was associated with a protective effect on long-term operative recurrence after ventral hernia repair among Medicare beneficiaries, which is somewhat unexpected given the intent of its use for higher complexity hernias. Surgeon volume, while significant, had only a minor influence on operative recurrence rates.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"108 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142610345","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 : 2024-11-13DOI: 10.1001/jamasurg.2024.4522
Danielle Brabender, Kazuhide Matsushima, Morgan Schellenberg, Kenji Inaba, Charles Wade, John B. Holcomb, Matthew Martin
This comparative effectiveness research uses data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) randomized clinical trial to compare benefits with balanced resuscitation for thoracic vs abdominopelvic traumatic hemorrhage.
{"title":"Benefits of Different Balanced Resuscitation Ratios for Thoracic vs Abdominopelvic Traumatic Hemorrhage","authors":"Danielle Brabender, Kazuhide Matsushima, Morgan Schellenberg, Kenji Inaba, Charles Wade, John B. Holcomb, Matthew Martin","doi":"10.1001/jamasurg.2024.4522","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4522","url":null,"abstract":"This comparative effectiveness research uses data from the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) randomized clinical trial to compare benefits with balanced resuscitation for thoracic vs abdominopelvic traumatic hemorrhage.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"34 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602026","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 : 2024-11-13DOI: 10.1001/jamasurg.2024.4811
Thomas Li, Sunny Nalavenkata, Jonathan Fainberg
ImportanceActive surveillance (AS) has become an increasingly important option for managing low-risk and select intermediate-risk prostate cancer. Although imaging, particularly multiparametric magnetic resonance imaging (mpMRI), has emerged in the prebiopsy pathway for the diagnosis of prostate cancer, the role of mpMRI in patient selection for AS and the necessity of prostate biopsies during AS remain poorly defined. Despite well-founded biopsy schedules, there has been substantial investigation into whether imaging may supplant the need for prostate biopsies during AS. This review aimed to summarize the contemporary role of imaging in the diagnosis and surveillance of prostate cancer.ObservationsMultiparametric MRI is the most established form of imaging in prostate cancer, with routine prebiopsy use being shown to help urologists distinguish between clinically significant and clinically insignificant disease. The visibility of these lesions on mpMRI closely correlates with their behavior, with visible disease portending a worse prognosis. Combined with other clinical data, risk calculators may better delineate patients with higher-risk disease and exclude them from undergoing AS. While current evidence suggests that mpMRI cannot replace the need for prostate biopsy during AS due to the possibility of missing higher-risk disease, the addition of prostate biomarkers may help to reduce the frequency of these biopsies. The role of prostate-specific antigen positron emission tomography/computed tomography is still emerging but has shown promising early results as an adjunct to mpMRI in initial diagnosis.Conclusions and RelevanceImaging in prostate cancer helps to better select patients appropriate for AS, and future studies may strengthen the predictive capabilities of risk calculators. Multiparametric MRI has been shown to be imperative to rationalizing biopsies for patients enrolled in AS. However, heterogeneity in the evidence of mpMRI during AS has suggested that further prospective studies and randomized clinical trials, particularly in homogenizing reporting standards, may reveal a more defined role in monitoring disease progression.
{"title":"Imaging in Diagnosis and Active Surveillance for Prostate Cancer","authors":"Thomas Li, Sunny Nalavenkata, Jonathan Fainberg","doi":"10.1001/jamasurg.2024.4811","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4811","url":null,"abstract":"ImportanceActive surveillance (AS) has become an increasingly important option for managing low-risk and select intermediate-risk prostate cancer. Although imaging, particularly multiparametric magnetic resonance imaging (mpMRI), has emerged in the prebiopsy pathway for the diagnosis of prostate cancer, the role of mpMRI in patient selection for AS and the necessity of prostate biopsies during AS remain poorly defined. Despite well-founded biopsy schedules, there has been substantial investigation into whether imaging may supplant the need for prostate biopsies during AS. This review aimed to summarize the contemporary role of imaging in the diagnosis and surveillance of prostate cancer.ObservationsMultiparametric MRI is the most established form of imaging in prostate cancer, with routine prebiopsy use being shown to help urologists distinguish between clinically significant and clinically insignificant disease. The visibility of these lesions on mpMRI closely correlates with their behavior, with visible disease portending a worse prognosis. Combined with other clinical data, risk calculators may better delineate patients with higher-risk disease and exclude them from undergoing AS. While current evidence suggests that mpMRI cannot replace the need for prostate biopsy during AS due to the possibility of missing higher-risk disease, the addition of prostate biomarkers may help to reduce the frequency of these biopsies. The role of prostate-specific antigen positron emission tomography/computed tomography is still emerging but has shown promising early results as an adjunct to mpMRI in initial diagnosis.Conclusions and RelevanceImaging in prostate cancer helps to better select patients appropriate for AS, and future studies may strengthen the predictive capabilities of risk calculators. Multiparametric MRI has been shown to be imperative to rationalizing biopsies for patients enrolled in AS. However, heterogeneity in the evidence of mpMRI during AS has suggested that further prospective studies and randomized clinical trials, particularly in homogenizing reporting standards, may reveal a more defined role in monitoring disease progression.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"20 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601964","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}
ImportanceRadical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects.ObjectiveTo assess the feasibility and effects of vagus nerve preservation using neurophysiologic monitoring and ICG labeling during laparoscopic distal gastrectomy in patients with early distal gastric cancer.Design, Setting, and ParticipantsThis open-label, prospective randomized clinical trial initially enrolled 285 patients with clinical stage cT1N0M0 distal gastric cancer from May 2022 to May 2023. This trial was conducted at Qilu Hospital of Shandong University in Jinan, China, and enrolled patients aged 18 to 80 years with histologically proven gastric adenocarcinoma scheduled for distal gastrectomy. The final follow-up examination was performed May 1, 2024.InterventionsEligible participants were randomly assigned 1:1 to vagus nerve preservation distal gastrectomy (VPG) or vagus nerve resection distal gastrectomy (VRG).Main Outcomes and MeasuresThe primary outcome was the incidence of postsurgical gastroparesis. Secondary outcomes included postoperative gallstone formation, quality of life, morbidity, mortality, overall survival, and disease-free survival up to 12 months postoperatively. All analyses were based on both intention-to-treat and per-protocol analyses.ResultsOf 264 patients included in the intention-to-treat analysis, the median (IQR) patient age was 58.0 (52.0-67.0) years, and 67 patients (25.4%) were female. Both the VPG and VRG groups included 132 patients. Postoperative gastroparesis occurred in 1 patient (0.8%) in the VPG group and in 10 patients (7.6%) in the VRG group. Gallstones developed in 0 patients in the VPG group and in 9 patients (6.8%) in the VRG group. As assessed by mean (SD) score on the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the VRG group experienced more nausea and vomiting at 6 months postsurgery (19.38 [7.62]) than the VPG group (17.15 [9.21]) (<jats:italic>P</jats:italic> = .03) and had significantly higher rates of persistent appetite loss, reflux symptoms, and eating difficulties at both 6 months and 12 months than the VPG group. Differences in postoperative complications and metastasis were not significant.Conclusions and RelevanceNeurophysiologic monitoring and ICG labeling during distal laparoscopic gastrectomy for vagus nerve preservation in patients with early distal gastric cancer are safe and feasible. Preserving the perigastric vagus nerve may retain the function of the remnant stomach and improve quality of life.Trial RegistrationChictr.org.cn Identifier: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://www.chictr.org.cn/showproj.html?proj=166485">ChiCTR2200059489</ja
{"title":"Vagus Nerve Preservation for Early Distal Gastric Cancer With Monitoring and Indocyanine Green Labeling","authors":"Zhibo Yan, Meng Wei, Tongchao Zhang, Jinghao Guo, Ao Yu, Yize Liang, Yadi Huang, Xiaohan Cui, Honglei Wang, Kuiquan Zhou, Zikun Dong, Wenbin Yu","doi":"10.1001/jamasurg.2024.5077","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.5077","url":null,"abstract":"ImportanceRadical gastric cancer surgery can cause functional and physiological disorders due to the resection of perigastric vagus nerves. Few studies have used intraoperative neurophysiological monitoring and indocyanine green (ICG) labeling to preserve the perigastric vagus nerve and to evaluate the corresponding effects.ObjectiveTo assess the feasibility and effects of vagus nerve preservation using neurophysiologic monitoring and ICG labeling during laparoscopic distal gastrectomy in patients with early distal gastric cancer.Design, Setting, and ParticipantsThis open-label, prospective randomized clinical trial initially enrolled 285 patients with clinical stage cT1N0M0 distal gastric cancer from May 2022 to May 2023. This trial was conducted at Qilu Hospital of Shandong University in Jinan, China, and enrolled patients aged 18 to 80 years with histologically proven gastric adenocarcinoma scheduled for distal gastrectomy. The final follow-up examination was performed May 1, 2024.InterventionsEligible participants were randomly assigned 1:1 to vagus nerve preservation distal gastrectomy (VPG) or vagus nerve resection distal gastrectomy (VRG).Main Outcomes and MeasuresThe primary outcome was the incidence of postsurgical gastroparesis. Secondary outcomes included postoperative gallstone formation, quality of life, morbidity, mortality, overall survival, and disease-free survival up to 12 months postoperatively. All analyses were based on both intention-to-treat and per-protocol analyses.ResultsOf 264 patients included in the intention-to-treat analysis, the median (IQR) patient age was 58.0 (52.0-67.0) years, and 67 patients (25.4%) were female. Both the VPG and VRG groups included 132 patients. Postoperative gastroparesis occurred in 1 patient (0.8%) in the VPG group and in 10 patients (7.6%) in the VRG group. Gallstones developed in 0 patients in the VPG group and in 9 patients (6.8%) in the VRG group. As assessed by mean (SD) score on the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, the VRG group experienced more nausea and vomiting at 6 months postsurgery (19.38 [7.62]) than the VPG group (17.15 [9.21]) (<jats:italic>P</jats:italic> = .03) and had significantly higher rates of persistent appetite loss, reflux symptoms, and eating difficulties at both 6 months and 12 months than the VPG group. Differences in postoperative complications and metastasis were not significant.Conclusions and RelevanceNeurophysiologic monitoring and ICG labeling during distal laparoscopic gastrectomy for vagus nerve preservation in patients with early distal gastric cancer are safe and feasible. Preserving the perigastric vagus nerve may retain the function of the remnant stomach and improve quality of life.Trial RegistrationChictr.org.cn Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www.chictr.org.cn/showproj.html?proj=166485\">ChiCTR2200059489</ja","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"72 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142601966","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 : 2024-11-06DOI: 10.1001/jamasurg.2024.3400
James McDermott, Sharon S Lum, Christian de Virgilio
{"title":"Finding Time and Energy to Exercise-5 Tips for Surgeons.","authors":"James McDermott, Sharon S Lum, Christian de Virgilio","doi":"10.1001/jamasurg.2024.3400","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.3400","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583026","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 : 2024-11-06DOI: 10.1001/jamasurg.2024.4759
Bang Wool Eom, Mira Han, Hong Man Yoon
{"title":"Stomach-Preserving Surgery for Early Gastric Cancer-Reply.","authors":"Bang Wool Eom, Mira Han, Hong Man Yoon","doi":"10.1001/jamasurg.2024.4759","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4759","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583033","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 : 2024-11-06DOI: 10.1001/jamasurg.2024.5024
Paul C M Andel, Iris W J M van Goor, Simone Augustinus, Frederik Berrevoet, Marc G Besselink, Rajesh Bhojwani, Ugo Boggi, Stefan A W Bouwense, Geert A Cirkel, Jacob L van Dam, Angela Djanani, Dimitri Dorcaratto, Stephan Dreyer, Marcel den Dulk, Isabella Frigerio, Poya Ghorbani, Mara R Goetz, Bas Groot Koerkamp, Filip Gryspeerdt, Camila Hidalgo Salinas, Martijn Intven, Jakob R Izbicki, Rosa Jorba Martin, Emanuele F Kauffmann, Reinhold Klug, Mike S L Liem, Misha D P Luyer, Manuel Maglione, Elena Martin-Perez, Mark Meerdink, Vincent E de Meijer, Vincent B Nieuwenhuijs, Andrej Nikov, Vitor Nunes, Elizabeth Pando Rau, Dejan Radenkovic, Geert Roeyen, Francisco Sanchez-Bueno, Alejandro Serrablo, Ernesto Sparrelid, Konstantinos Tepetes, Rohan G Thakkar, George N Tzimas, Robert C Verdonk, Meike Ten Winkel, Alessandro Zerbi, Vincent P Groot, I Quintus Molenaar, Lois A Daamen, Hjalmar C van Santvoort
Importance: International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide.
Objective: To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA).
Design, setting, and participants: This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging.
Exposures: Symptomatic follow-up or routine imaging in patients who underwent PDAC resection.
Main outcomes and measures: Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS.
Results: Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04).
Conclusion and relevance: In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.
{"title":"Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma.","authors":"Paul C M Andel, Iris W J M van Goor, Simone Augustinus, Frederik Berrevoet, Marc G Besselink, Rajesh Bhojwani, Ugo Boggi, Stefan A W Bouwense, Geert A Cirkel, Jacob L van Dam, Angela Djanani, Dimitri Dorcaratto, Stephan Dreyer, Marcel den Dulk, Isabella Frigerio, Poya Ghorbani, Mara R Goetz, Bas Groot Koerkamp, Filip Gryspeerdt, Camila Hidalgo Salinas, Martijn Intven, Jakob R Izbicki, Rosa Jorba Martin, Emanuele F Kauffmann, Reinhold Klug, Mike S L Liem, Misha D P Luyer, Manuel Maglione, Elena Martin-Perez, Mark Meerdink, Vincent E de Meijer, Vincent B Nieuwenhuijs, Andrej Nikov, Vitor Nunes, Elizabeth Pando Rau, Dejan Radenkovic, Geert Roeyen, Francisco Sanchez-Bueno, Alejandro Serrablo, Ernesto Sparrelid, Konstantinos Tepetes, Rohan G Thakkar, George N Tzimas, Robert C Verdonk, Meike Ten Winkel, Alessandro Zerbi, Vincent P Groot, I Quintus Molenaar, Lois A Daamen, Hjalmar C van Santvoort","doi":"10.1001/jamasurg.2024.5024","DOIUrl":"10.1001/jamasurg.2024.5024","url":null,"abstract":"<p><strong>Importance: </strong>International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide.</p><p><strong>Objective: </strong>To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA).</p><p><strong>Design, setting, and participants: </strong>This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging.</p><p><strong>Exposures: </strong>Symptomatic follow-up or routine imaging in patients who underwent PDAC resection.</p><p><strong>Main outcomes and measures: </strong>Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS.</p><p><strong>Results: </strong>Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04).</p><p><strong>Conclusion and relevance: </strong>In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.</p>","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11541741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583031","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}
Pub Date : 2024-11-06DOI: 10.1001/jamasurg.2024.4756
Tao Jiang, Deng-Chao Wang, Yue-Hua Lei
{"title":"Stomach-Preserving Surgery for Early Gastric Cancer.","authors":"Tao Jiang, Deng-Chao Wang, Yue-Hua Lei","doi":"10.1001/jamasurg.2024.4756","DOIUrl":"https://doi.org/10.1001/jamasurg.2024.4756","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":15.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583032","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}
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