ImportanceModerate to severe postoperative nausea and vomiting (PONV) significantly impedes recovery and is inadequately managed by current pharmacotherapy.ObjectiveTo evaluate the clinical efficacy of a novel wearable transcutaneous electrical acupoint stimulation (TEAS) device targeting the PC6 (Neiguan) acupoint in managing moderate to severe PONV.Design, Setting, and ParticipantsThis randomized, double-dummy, patient-blinded and observer-blinded, parallel-group, and active-controlled clinical trial was conducted at 4 hospitals in Shanghai and Tianjin, China, from May 2024 through May 2025. Eligible participants were female patients aged 25 to 55 years scheduled for thyroidectomy or anterior cervical surgery undergoing general anesthesia who developed moderate to severe PONV (numerical rating score [NRS] ≥4). These data were analyzed during June 2025.InterventionsParticipants were randomized 1:1 to receive either active TEAS via the EmeTerm wristband applied for 2 hours with a saline placebo injection or an identical inactive TEAS device (model stimulator) with intravenous metoclopramide, 10 mg. Participants not achieving symptom relief (NRS ≥4) at 2 hours underwent rerandomization to cross-intervention.Main outcome and measureThe primary outcome was the 2-hour PONV remission rate following initial intervention defined as a significant relief in symptoms (NRS ≤3).ResultsA total of 310 patients were screened for eligibility and 232 (74.8%) were randomized into either TEAS group (n = 116) or control group (n = 116). All participants completed the trial and a per-protocol analysis was conducted. Among 232 total patients, mean (SD) age was 43.5 (5.1) years and 100% were female. The TEAS group demonstrated a significantly higher 2-hour remission rate (77.6%; 95% CI, 69.2%-84.2% vs 55.2%; 95% CI, 46.1%-63.9%; P < .001) and a lower 24-hour relapse rate (12.2%; 95% CI, 7.0%-20.6% vs 56.3%; 95% CI, 44.1%-67.7%; P < .001) compared with controls. No adverse events were reported.Conclusion and relevanceIn this study, wearable TEAS significantly outperformed metoclopramide for moderate to severe PONV, representing an effective nonpharmacological alternative that enhances postanesthesia recovery.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2400084329.
中度至重度术后恶心和呕吐（PONV）严重阻碍恢复，目前的药物治疗无法充分控制。目的评价一种新型可穿戴经皮穴位电刺激装置（TEAS）治疗中重度PONV的临床疗效。设计、环境和参与者这项随机、双虚拟、患者盲和观察者盲、平行组和主动对照的临床试验于2024年5月至2025年5月在中国上海和天津的4家医院进行。符合条件的参与者是年龄在25 - 55岁的女性患者，她们计划接受甲状腺切除术或颈椎前路手术，接受全身麻醉，并出现中度至重度PONV（数值评分[NRS]≥4）。这些数据是在2025年6月进行分析的。干预措施：参与者按1:1随机分配，通过EmeTerm腕带接受活性tea，并注射生理盐水安慰剂2小时，或接受相同的非活性tea装置（模型刺激器），静脉注射甲氧氯普胺，10mg。在2小时未达到症状缓解（NRS≥4）的参与者被重新随机分配到交叉干预。主要结局和测量主要结局是初始干预后2小时PONV缓解率，定义为症状显著缓解（NRS≤3）。结果共筛选合格患者310例，其中232例（74.8%）随机分为TEAS组（n = 116）和对照组（n = 116）。所有参与者都完成了试验，并进行了每个方案的分析。232例患者中，平均（SD）年龄为43.5（5.1）岁，100%为女性。tea组2小时缓解率显著高于对照组(77.6%;95% CI, 69.2%-84.2% vs 55.2%; 95% CI, 46.1%-63.9%; P <。24小时复发率较低（12.2%;95% CI, 7.0%-20.6% vs 56.3%; 95% CI, 44.1%-67.7%; P < 0.001）。001)。无不良事件报告。结论和相关性在本研究中，可穿戴式tea治疗中度至重度PONV的效果明显优于甲氧氯普胺，是一种有效的非药物替代方法，可增强麻醉后恢复。中国临床试验注册号：ChiCTR2400084329。
{"title":"Transcutaneous Electrical Acupoint Stimulation vs Metoclopramide for Moderate to Severe Postoperative Nausea and Vomiting: A Randomized Clinical Trial.","authors":"Dong-Yu Zheng,Peng Ding,Ming Gong,Hong-Wei Zhu,Hui-Jing Shi,Guang-Li Ren,Ling-Yan Jin,Yong-Qiang Wang,Hong-Bin Yuan,Yong-Hua Li","doi":"10.1001/jamasurg.2025.6394","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6394","url":null,"abstract":"ImportanceModerate to severe postoperative nausea and vomiting (PONV) significantly impedes recovery and is inadequately managed by current pharmacotherapy.ObjectiveTo evaluate the clinical efficacy of a novel wearable transcutaneous electrical acupoint stimulation (TEAS) device targeting the PC6 (Neiguan) acupoint in managing moderate to severe PONV.Design, Setting, and ParticipantsThis randomized, double-dummy, patient-blinded and observer-blinded, parallel-group, and active-controlled clinical trial was conducted at 4 hospitals in Shanghai and Tianjin, China, from May 2024 through May 2025. Eligible participants were female patients aged 25 to 55 years scheduled for thyroidectomy or anterior cervical surgery undergoing general anesthesia who developed moderate to severe PONV (numerical rating score [NRS] ≥4). These data were analyzed during June 2025.InterventionsParticipants were randomized 1:1 to receive either active TEAS via the EmeTerm wristband applied for 2 hours with a saline placebo injection or an identical inactive TEAS device (model stimulator) with intravenous metoclopramide, 10 mg. Participants not achieving symptom relief (NRS ≥4) at 2 hours underwent rerandomization to cross-intervention.Main outcome and measureThe primary outcome was the 2-hour PONV remission rate following initial intervention defined as a significant relief in symptoms (NRS ≤3).ResultsA total of 310 patients were screened for eligibility and 232 (74.8%) were randomized into either TEAS group (n = 116) or control group (n = 116). All participants completed the trial and a per-protocol analysis was conducted. Among 232 total patients, mean (SD) age was 43.5 (5.1) years and 100% were female. The TEAS group demonstrated a significantly higher 2-hour remission rate (77.6%; 95% CI, 69.2%-84.2% vs 55.2%; 95% CI, 46.1%-63.9%; P < .001) and a lower 24-hour relapse rate (12.2%; 95% CI, 7.0%-20.6% vs 56.3%; 95% CI, 44.1%-67.7%; P < .001) compared with controls. No adverse events were reported.Conclusion and relevanceIn this study, wearable TEAS significantly outperformed metoclopramide for moderate to severe PONV, representing an effective nonpharmacological alternative that enhances postanesthesia recovery.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2400084329.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"33 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056869","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 : 2026-01-28DOI: 10.1001/jamasurg.2025.6583
{"title":"Error in Study Name.","authors":"","doi":"10.1001/jamasurg.2025.6583","DOIUrl":"10.1001/jamasurg.2025.6583","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12853275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146063615","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 : 2026-01-28DOI: 10.1001/jamasurg.2025.6214
Mercy Mitei,Agneta Odera,Elizabeth A Stuebing,Britney L Grayson,Keir Thelander,Kathryn M Chu,Robert K Parker,Jane Kayle Lee
{"title":"Perceptions of Gender Discrimination Among Surgical Trainees in Africa.","authors":"Mercy Mitei,Agneta Odera,Elizabeth A Stuebing,Britney L Grayson,Keir Thelander,Kathryn M Chu,Robert K Parker,Jane Kayle Lee","doi":"10.1001/jamasurg.2025.6214","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6214","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"41 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056871","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 : 2026-01-28DOI: 10.1001/jamasurg.2025.6246
Hidenori Tanaka,Shravan Gowrishankar,Eben L Rosenthal
{"title":"Fluorescence-Guided Surgery-Illuminating the Limits of Cancer Therapeutics.","authors":"Hidenori Tanaka,Shravan Gowrishankar,Eben L Rosenthal","doi":"10.1001/jamasurg.2025.6246","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6246","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"77 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056873","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 : 2026-01-21DOI: 10.1001/jamasurg.2025.6155
Jordan Nantais,Refik Saskin,Andrew Calzavara,David Gomez,Nancy N Baxter
ImportanceOutcomes in emergency general surgery vary between hospitals, and models with dedicated resources and personnel have been developed with the aim of improving care. Existing literature is limited in scope and often does not involve nonoperatively treated patients, reducing generalizability.ObjectiveTo use population-level data to determine whether treatment in an emergency general surgery model is associated with clinical outcomes.Design, Setting, and ParticipantsThis was a retrospective cohort study of adults in Ontario, Canada, diagnosed with 1 of 9 emergency general surgery conditions and hospitalized between April 1, 2002, and December 31, 2019, using linked administrative data housed at ICES. Data analysis was conducted from June 24, 2024, to October 24, 2025.ExposureTreatment at a hospital with an emergency general surgery model of care in comparison with a standard surgeon on-call model.Main Outcomes and MeasuresDeath in the hospital or within 30 days of discharge was the primary outcome. Secondary outcomes included death at 90 days and complications, failure to rescue, and readmission at 30 days. Generalized estimating equations were used with a negative binomial distribution for mortality outcomes and a binomial distribution for other secondary outcomes. Clustering at the hospital level was accounted for, and effect modification according to diagnosis risk category (low, medium, or high) was evaluated.ResultsA total of 494 609 patients were included (median [IQR] age, 56 [40-72] years; 263 267 [53.2%] female), with 88 889 (18.0%) treated in an emergency general surgery model hospital. A total of 3069 patients (3.4%) in an emergency general surgery model died within 30 days, compared with 15 013 (3.7%) in a surgeon on-call model. Adjusted analyses showed an association between an emergency general surgery model and decreased adjusted relative risk (aRR) of 30-day death for patients with high-risk conditions (aRR, 0.85; 95% CI, 0.77-0.95) but not for those with low- or medium-risk conditions. Death at 90 days was likewise lower in emergency general surgery models for high-risk conditions (aRR, 0.82; 95% CI, 0.74-0.92). The odds of complications in patients with high-risk conditions showed a similar association (adjusted odds ratio, 0.68; 95% CI, 0.53-0.87), but there was no association with failure to rescue or readmission.Conclusions and RelevanceThis cohort study demonstrated that death and complications were lower for patients with high-risk conditions in an emergency general surgery model of care. These findings suggest that these patients would benefit from formal systems to prioritize management at emergency general surgery model centers but that patients with lower-risk conditions are less likely to benefit from this care.
{"title":"A Population-Level Evaluation of Emergency General Surgery Models of Care and Clinical Outcomes.","authors":"Jordan Nantais,Refik Saskin,Andrew Calzavara,David Gomez,Nancy N Baxter","doi":"10.1001/jamasurg.2025.6155","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6155","url":null,"abstract":"ImportanceOutcomes in emergency general surgery vary between hospitals, and models with dedicated resources and personnel have been developed with the aim of improving care. Existing literature is limited in scope and often does not involve nonoperatively treated patients, reducing generalizability.ObjectiveTo use population-level data to determine whether treatment in an emergency general surgery model is associated with clinical outcomes.Design, Setting, and ParticipantsThis was a retrospective cohort study of adults in Ontario, Canada, diagnosed with 1 of 9 emergency general surgery conditions and hospitalized between April 1, 2002, and December 31, 2019, using linked administrative data housed at ICES. Data analysis was conducted from June 24, 2024, to October 24, 2025.ExposureTreatment at a hospital with an emergency general surgery model of care in comparison with a standard surgeon on-call model.Main Outcomes and MeasuresDeath in the hospital or within 30 days of discharge was the primary outcome. Secondary outcomes included death at 90 days and complications, failure to rescue, and readmission at 30 days. Generalized estimating equations were used with a negative binomial distribution for mortality outcomes and a binomial distribution for other secondary outcomes. Clustering at the hospital level was accounted for, and effect modification according to diagnosis risk category (low, medium, or high) was evaluated.ResultsA total of 494 609 patients were included (median [IQR] age, 56 [40-72] years; 263 267 [53.2%] female), with 88 889 (18.0%) treated in an emergency general surgery model hospital. A total of 3069 patients (3.4%) in an emergency general surgery model died within 30 days, compared with 15 013 (3.7%) in a surgeon on-call model. Adjusted analyses showed an association between an emergency general surgery model and decreased adjusted relative risk (aRR) of 30-day death for patients with high-risk conditions (aRR, 0.85; 95% CI, 0.77-0.95) but not for those with low- or medium-risk conditions. Death at 90 days was likewise lower in emergency general surgery models for high-risk conditions (aRR, 0.82; 95% CI, 0.74-0.92). The odds of complications in patients with high-risk conditions showed a similar association (adjusted odds ratio, 0.68; 95% CI, 0.53-0.87), but there was no association with failure to rescue or readmission.Conclusions and RelevanceThis cohort study demonstrated that death and complications were lower for patients with high-risk conditions in an emergency general surgery model of care. These findings suggest that these patients would benefit from formal systems to prioritize management at emergency general surgery model centers but that patients with lower-risk conditions are less likely to benefit from this care.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"2 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005278","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 : 2026-01-21DOI: 10.1001/jamasurg.2025.6171
Rohun Bhagat,Laura Young,Eugene H Blackstone,Faisal G Bakaeen
{"title":"Internal Mammary Artery Grafting-A Therapy Like No Other.","authors":"Rohun Bhagat,Laura Young,Eugene H Blackstone,Faisal G Bakaeen","doi":"10.1001/jamasurg.2025.6171","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6171","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"231 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005277","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 : 2026-01-21DOI: 10.1001/jamasurg.2025.6164
Evelyn I Truong, Graciela Bauza, Brian S Zuckerbraun
{"title":"Precision in Emergency Surgery.","authors":"Evelyn I Truong, Graciela Bauza, Brian S Zuckerbraun","doi":"10.1001/jamasurg.2025.6164","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6164","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":" ","pages":""},"PeriodicalIF":14.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010143","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 : 2026-01-21DOI: 10.1001/jamasurg.2025.5890
Adom Bondzi-Simpson,Vaibhav Gupta,Tiago Ribeiro,Michael Ko,Steven H Lin,Natalie G Coburn,Julie Hallet,Biniam Kidane
ImportanceThe Surgery as Needed for Oesophageal Cancer (SANO) trial introduced active surveillance as a noninferior alternative to esophagectomy for patients with esophageal cancer who achieve a clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT). However, concerns remain about recurrence risk, long-term survival, and quality-of-life trade-offs with organ-preserving strategies.ObjectiveTo evaluate the long-term comparative effectiveness of active surveillance vs standard esophagectomy in patients with cCR following nCRT for locally advanced esophageal cancer, using updated data from the SANO trial.Design, Setting, and ParticipantsThis decision analytical model used Markov modeling and probabilities and utility inputs derived from the SANO trial and existing literature. The base case was a 60-year-old male with good functional status and cT3N1M0 esophageal cancer achieving cCR after nCRT.ExposuresStandard routine esophagectomy vs active surveillance after neoadjuvant chemoradiation.Main Outcomes and MeasuresThe primary outcome was quality-adjusted life-years (QALYs); the secondary outcome was life-years. Additional model scenarios explored (1) quality-of-life impacts of esophagectomy modeled as a time-varying covariate and (2) 2-year outcomes to align with the SANO trial time horizon. Sensitivity analyses evaluated recurrence probabilities and surgery-related quality-of-life trade-offs.ResultsAt 5 years, standard surgery yielded greater QALYs (1.74 vs 1.34; incremental gain of 0.40 QALYs or ~4.8 months in perfect health) and life-years (3.11 vs 2.41; incremental gain of 0.70 life-years or ~8.4 months) compared with active surveillance. However, at a 2-year horizon, active surveillance was preferred for QALYs (incremental gain of ~15 days), consistent with the SANO trial. Sensitivity analyses revealed the model favored active surveillance when the recurrence probability was less than 43%, the likelihood of local/resectable recurrence was greater than 94%, or the negative quality-of-life impact of esophagectomy was substantial. Modeling esophagectomy's quality-of-life impact as time limited further strengthened surgery's long-term QALY benefit.Conclusions and RelevanceThis study found that while active surveillance offers short-term quality-of-life benefits and may be appropriate in select patients, particularly those at low recurrence risk or with high surgical risk, esophagectomy remains the preferred strategy for maximizing long-term survival and QALYs. These findings support a nuanced, individualized approach to post-nCRT management, balancing organ preservation with long-term oncologic outcomes.
食管癌按需手术（SANO）试验将主动监测作为食管癌患者在新辅助放化疗（nCRT）后达到临床完全缓解（cCR）的非次优选择。然而，对器官保存策略的复发风险、长期生存和生活质量权衡的担忧仍然存在。目的利用SANO试验的最新数据，评估主动监测与标准食管切除术对局部晚期食管癌nCRT后cCR患者的长期比较效果。设计、设置和参与者这个决策分析模型使用了马尔可夫模型以及从SANO试验和现有文献中获得的概率和效用输入。基本病例为60岁男性，功能状态良好，cT3N1M0食管癌在nCRT后达到cCR。标准常规食管切除术与新辅助放化疗后的主动监测。主要结局和测量：主要结局为质量调整生命年（QALYs）；次要结果是生命年。其他模型场景探讨了(1)食管切除术作为时变协变量建模的生活质量影响和(2)与SANO试验时间范围一致的2年结果。敏感性分析评估了复发概率和手术相关的生活质量权衡。结果5年后，与主动监测相比，标准手术获得更高的QALYs （1.74 vs 1.34；完全健康时增加0.40 QALYs或约4.8个月）和生命年（3.11 vs 2.41；增加0.70生命年或约8.4个月）。然而，与SANO试验一致，在2年的期限内，主动监测是QALYs（增量增益约15天）的首选。敏感性分析显示，当复发概率小于43%，局部/可切除复发的可能性大于94%，或食管切除术对生活质量的负面影响很大时，该模型更倾向于主动监测。模拟食管切除术在时间限制下对生活质量的影响，进一步加强了手术的长期质量效益。结论和相关性本研究发现，虽然主动监测可以提供短期的生活质量益处，并且可能适用于特定的患者，特别是那些复发风险低或手术风险高的患者，但食管切除术仍然是最大化长期生存率和QALYs的首选策略。这些发现支持一种微妙的、个性化的ncrt后管理方法，平衡器官保存与长期肿瘤预后。
{"title":"Esophagectomy vs Active Surveillance in Clinical Complete Responders After Neoadjuvant Chemoradiation.","authors":"Adom Bondzi-Simpson,Vaibhav Gupta,Tiago Ribeiro,Michael Ko,Steven H Lin,Natalie G Coburn,Julie Hallet,Biniam Kidane","doi":"10.1001/jamasurg.2025.5890","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.5890","url":null,"abstract":"ImportanceThe Surgery as Needed for Oesophageal Cancer (SANO) trial introduced active surveillance as a noninferior alternative to esophagectomy for patients with esophageal cancer who achieve a clinical complete response (cCR) after neoadjuvant chemoradiation (nCRT). However, concerns remain about recurrence risk, long-term survival, and quality-of-life trade-offs with organ-preserving strategies.ObjectiveTo evaluate the long-term comparative effectiveness of active surveillance vs standard esophagectomy in patients with cCR following nCRT for locally advanced esophageal cancer, using updated data from the SANO trial.Design, Setting, and ParticipantsThis decision analytical model used Markov modeling and probabilities and utility inputs derived from the SANO trial and existing literature. The base case was a 60-year-old male with good functional status and cT3N1M0 esophageal cancer achieving cCR after nCRT.ExposuresStandard routine esophagectomy vs active surveillance after neoadjuvant chemoradiation.Main Outcomes and MeasuresThe primary outcome was quality-adjusted life-years (QALYs); the secondary outcome was life-years. Additional model scenarios explored (1) quality-of-life impacts of esophagectomy modeled as a time-varying covariate and (2) 2-year outcomes to align with the SANO trial time horizon. Sensitivity analyses evaluated recurrence probabilities and surgery-related quality-of-life trade-offs.ResultsAt 5 years, standard surgery yielded greater QALYs (1.74 vs 1.34; incremental gain of 0.40 QALYs or ~4.8 months in perfect health) and life-years (3.11 vs 2.41; incremental gain of 0.70 life-years or ~8.4 months) compared with active surveillance. However, at a 2-year horizon, active surveillance was preferred for QALYs (incremental gain of ~15 days), consistent with the SANO trial. Sensitivity analyses revealed the model favored active surveillance when the recurrence probability was less than 43%, the likelihood of local/resectable recurrence was greater than 94%, or the negative quality-of-life impact of esophagectomy was substantial. Modeling esophagectomy's quality-of-life impact as time limited further strengthened surgery's long-term QALY benefit.Conclusions and RelevanceThis study found that while active surveillance offers short-term quality-of-life benefits and may be appropriate in select patients, particularly those at low recurrence risk or with high surgical risk, esophagectomy remains the preferred strategy for maximizing long-term survival and QALYs. These findings support a nuanced, individualized approach to post-nCRT management, balancing organ preservation with long-term oncologic outcomes.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"11 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005275","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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