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}
Pub Date : 2026-01-21DOI: 10.1001/jamasurg.2025.6145
Forrest Bohler,Aaquib Noorani,Jesse C Selber,Karam Hadid,Angelis Lau,George A Flores,Sergey G Toshinskiy,Kongkrit Chaiyasate
ImportanceAs part of an effort to boost physician supply and opportunity, several US states have recently enacted laws permitting internationally trained physicians to practice without completing an Accreditation Council for Graduate Medical Education-accredited residency or fellowship, representing a major departure from long-standing licensure norms. Little is known about how the public perceives these laws, particularly in surgical fields in which technical competency and patient trust are paramount.ObjectiveTo assess public perceptions of state laws permitting internationally trained surgeons to practice in the US without US-based residency training.Design, Setting, and ParticipantsThis cross-sectional study involving perspectives of US adults on state licensure of internationally trained surgeons to address surgical workforce shortages was conducted in July 2025 using an online crowdsourcing platform (Amazon Mechanical Turk; Amazon Mechanical Turk, Inc). A 21-item survey was administered through Qualtrics (Qualtrics, LLC). Quality control included definitional understanding, attention checks, and time-based screening.Main Outcomes and MeasuresPrimary outcomes included support for licensure laws for internationally trained surgeons, ethical concerns regarding international brain drain, perceived training equivalence, personal comfort with internationally trained surgeon care, hospital trust, and preferences for regulatory oversight. Subgroup analyses were performed by sex and self-defined political views using χ2 testing.ResultsOf 1270 initial responses, 1066 (83.9%) passed quality criteria and were analyzed. Among 1066 respondents (634 male [59.5%], median [IQR] age 33 [29-35] years), 906 (85.0%) supported state licensure laws for internationally trained surgeons. Most respondents (991; 93.0%) believed such laws would improve access and 856 (80.3%) felt diversity would improve, yet 755 (70.8%) expressed ethical concerns about international brain drain. Regarding training, a majority of respondents (787; 73.8%) did not view international training as equivalent to US training, and 831 (78.0%) reported they would be less likely to select an internationally trained surgeon for surgery. Regarding informed consent, nearly all respondents (1005; 94.3%) supported mandatory disclosure of training background. Males (575 of 634 [90.7%], P < .001) and conservatives (512 of 569 [89.9%], P < .001) were significantly more supportive of the laws, whereas liberals were more likely to express ethical concern (248 of 301 [82.4%], P < .001) and discomfort with internationally trained surgeon care (257 of 301 [85.3%], P = .02). The majority of respondents (817 [76.6%]) supported restricting internationally trained surgeon practice to underserved areas.Conclusions and RelevanceFindings of this study suggest that the US public generally supports licensure laws for internationally trained surgeons but with important caveats, including geographic restriction of prac
{"title":"Public Views on State Licensure of Internationally Trained Surgeons Without US Residency.","authors":"Forrest Bohler,Aaquib Noorani,Jesse C Selber,Karam Hadid,Angelis Lau,George A Flores,Sergey G Toshinskiy,Kongkrit Chaiyasate","doi":"10.1001/jamasurg.2025.6145","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6145","url":null,"abstract":"ImportanceAs part of an effort to boost physician supply and opportunity, several US states have recently enacted laws permitting internationally trained physicians to practice without completing an Accreditation Council for Graduate Medical Education-accredited residency or fellowship, representing a major departure from long-standing licensure norms. Little is known about how the public perceives these laws, particularly in surgical fields in which technical competency and patient trust are paramount.ObjectiveTo assess public perceptions of state laws permitting internationally trained surgeons to practice in the US without US-based residency training.Design, Setting, and ParticipantsThis cross-sectional study involving perspectives of US adults on state licensure of internationally trained surgeons to address surgical workforce shortages was conducted in July 2025 using an online crowdsourcing platform (Amazon Mechanical Turk; Amazon Mechanical Turk, Inc). A 21-item survey was administered through Qualtrics (Qualtrics, LLC). Quality control included definitional understanding, attention checks, and time-based screening.Main Outcomes and MeasuresPrimary outcomes included support for licensure laws for internationally trained surgeons, ethical concerns regarding international brain drain, perceived training equivalence, personal comfort with internationally trained surgeon care, hospital trust, and preferences for regulatory oversight. Subgroup analyses were performed by sex and self-defined political views using χ2 testing.ResultsOf 1270 initial responses, 1066 (83.9%) passed quality criteria and were analyzed. Among 1066 respondents (634 male [59.5%], median [IQR] age 33 [29-35] years), 906 (85.0%) supported state licensure laws for internationally trained surgeons. Most respondents (991; 93.0%) believed such laws would improve access and 856 (80.3%) felt diversity would improve, yet 755 (70.8%) expressed ethical concerns about international brain drain. Regarding training, a majority of respondents (787; 73.8%) did not view international training as equivalent to US training, and 831 (78.0%) reported they would be less likely to select an internationally trained surgeon for surgery. Regarding informed consent, nearly all respondents (1005; 94.3%) supported mandatory disclosure of training background. Males (575 of 634 [90.7%], P < .001) and conservatives (512 of 569 [89.9%], P < .001) were significantly more supportive of the laws, whereas liberals were more likely to express ethical concern (248 of 301 [82.4%], P < .001) and discomfort with internationally trained surgeon care (257 of 301 [85.3%], P = .02). The majority of respondents (817 [76.6%]) supported restricting internationally trained surgeon practice to underserved areas.Conclusions and RelevanceFindings of this study suggest that the US public generally supports licensure laws for internationally trained surgeons but with important caveats, including geographic restriction of prac","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"87 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005276","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.2025.6152
Kamal M F Itani,Marco G Patti
{"title":"A Window on the Public's Perception of Internationally Trained Surgeons.","authors":"Kamal M F Itani,Marco G Patti","doi":"10.1001/jamasurg.2025.6152","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6152","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"16 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146005279","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 : 2026-01-14DOI: 10.1001/jamasurg.2025.6035
Jayson S Marwaha,Daniel A Hashimoto
{"title":"Preempting the Trough of Disillusionment in Surgical AI.","authors":"Jayson S Marwaha,Daniel A Hashimoto","doi":"10.1001/jamasurg.2025.6035","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6035","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"20 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961492","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 : 2026-01-14DOI: 10.1001/jamasurg.2025.6029
Melissa Thornton,Benjamin A Y Cher,Cameron Macdonald,Jocelyn G Baker,Elisa L Marten,Don Mai,Ganesh Sankaranarayanan,Courtney J Balentine
ImportanceHaving significant gaps between the expectations and reality of artificial intelligence-based programs can be a major barrier to successful implementation. This is the first multisite implementation assessment of gaps between surgeon expectations and real-world effects of the Operating Room Black Box, a novel intervention that leverages artificial intelligence to improve surgical outcomes.ObjectiveTo identify barriers and facilitators to implementing artificial intelligence-based interventions that improve intra- and postoperative care.Design, Setting, and ParticipantsThis qualitative study was conducted at 3 large academic centers via semistructured interviews with surgeons and implementation leaders of the AI intervention to identify areas where expectations of the technology misaligned with their experiences. Thirty surgeons and 17 implementation leaders from 3 centers that implemented the AI intervention were interviewed. Data were collected and analyzed between 2021 and 2024.ExposureImplementation of the AI intervention.Main Outcomes and MeasuresThe primary outcome was areas of misalignment between participant expectations of the AI intervention technology and actual program deliverables.ResultsOf 30 surgeons and 17 implementation leaders interviewed, most surgeons (17 [57%]) were between the ages of 35 and 50 years, and implementation leaders were older, typically between 51 and 80 years old (6 [35%]). Eight surgeons (27%) and 4 implementation leaders (24%) were female. Most surgeons (17 [57%]) had neutral views of the technology, 11 (37%) expressed positive views, and 2 (7%) had negative views. Interviewees identified the following 4 major themes that highlighted misalignment between user expectations and the experience of using the technology: (1) the artificial intelligence model needed considerable additional training to be usable; (2) accessing data on surgical cases was difficult and time consuming; (3) the program showed limited ability to predict postoperative complications; and (4) the program generated few academic deliverables.Conclusions and RelevancePer the results of this multisite qualitative study, successfully implementing interventions based on artificial intelligence may require deliberate efforts to minimize gaps between what surgeons expect from the interventions and what they can deliver. Our evaluation of this study's AI intervention offers lessons for addressing this critical barrier to implementation.
{"title":"Expectations vs Reality of an Intraoperative Artificial Intelligence Intervention.","authors":"Melissa Thornton,Benjamin A Y Cher,Cameron Macdonald,Jocelyn G Baker,Elisa L Marten,Don Mai,Ganesh Sankaranarayanan,Courtney J Balentine","doi":"10.1001/jamasurg.2025.6029","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.6029","url":null,"abstract":"ImportanceHaving significant gaps between the expectations and reality of artificial intelligence-based programs can be a major barrier to successful implementation. This is the first multisite implementation assessment of gaps between surgeon expectations and real-world effects of the Operating Room Black Box, a novel intervention that leverages artificial intelligence to improve surgical outcomes.ObjectiveTo identify barriers and facilitators to implementing artificial intelligence-based interventions that improve intra- and postoperative care.Design, Setting, and ParticipantsThis qualitative study was conducted at 3 large academic centers via semistructured interviews with surgeons and implementation leaders of the AI intervention to identify areas where expectations of the technology misaligned with their experiences. Thirty surgeons and 17 implementation leaders from 3 centers that implemented the AI intervention were interviewed. Data were collected and analyzed between 2021 and 2024.ExposureImplementation of the AI intervention.Main Outcomes and MeasuresThe primary outcome was areas of misalignment between participant expectations of the AI intervention technology and actual program deliverables.ResultsOf 30 surgeons and 17 implementation leaders interviewed, most surgeons (17 [57%]) were between the ages of 35 and 50 years, and implementation leaders were older, typically between 51 and 80 years old (6 [35%]). Eight surgeons (27%) and 4 implementation leaders (24%) were female. Most surgeons (17 [57%]) had neutral views of the technology, 11 (37%) expressed positive views, and 2 (7%) had negative views. Interviewees identified the following 4 major themes that highlighted misalignment between user expectations and the experience of using the technology: (1) the artificial intelligence model needed considerable additional training to be usable; (2) accessing data on surgical cases was difficult and time consuming; (3) the program showed limited ability to predict postoperative complications; and (4) the program generated few academic deliverables.Conclusions and RelevancePer the results of this multisite qualitative study, successfully implementing interventions based on artificial intelligence may require deliberate efforts to minimize gaps between what surgeons expect from the interventions and what they can deliver. Our evaluation of this study's AI intervention offers lessons for addressing this critical barrier to implementation.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"30 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145961490","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 : 2026-01-14DOI: 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}
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