Pub Date : 2025-10-22DOI: 10.1001/jamasurg.2025.4430
Justine O Chinn,Mark Shacker,Kelly A Brennan,Micaela M Esquivel,Janey S A Pratt
{"title":"Timing of Antiobesity Medications and Adolescent Metabolic and Bariatric Surgery.","authors":"Justine O Chinn,Mark Shacker,Kelly A Brennan,Micaela M Esquivel,Janey S A Pratt","doi":"10.1001/jamasurg.2025.4430","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4430","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"129 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338786","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 : 2025-10-22DOI: 10.1001/jamasurg.2025.4257
Jonathan R Dubin,Houssam Bouloussa,Richard M Schwend
{"title":"FDA Oversight and the Magnetic Expansion Control Rod.","authors":"Jonathan R Dubin,Houssam Bouloussa,Richard M Schwend","doi":"10.1001/jamasurg.2025.4257","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4257","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"09 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338764","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 : 2025-10-22DOI: 10.1001/jamasurg.2025.4437
Ammar Siddiqui,Jeff L Xu,Apolonia E Abramowicz
{"title":"Intercostal and Paravertebral Nerve Blocks vs Thoracic Epidural Analgesia.","authors":"Ammar Siddiqui,Jeff L Xu,Apolonia E Abramowicz","doi":"10.1001/jamasurg.2025.4437","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4437","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"139 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338767","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 : 2025-10-22DOI: 10.1001/jamasurg.2025.4392
Laura H Rosenberger,Richard L White,Lorraine Tafra,Judy C Boughey,Nathalie M Johnson,Helen A Pass,Susan Boolbol,Kris McNiff Landrum,Yiming Gao,Katharine Yao
ImportanceMany patients are diagnosed with benign breast lesions; however, evidence- and consensus-based guidelines for the management of benign breast disease (BBD) are limited.ObservationsThe American Society of Breast Surgeons (ASBrS) and the Society of Breast Imaging (SBI) developed guidelines for the management of benign fibroepithelial lesions (FELs) using a modified Delphi consensus methodology and public comment. There was strong consensus that core biopsy-proven concordant fibroadenomas without atypia only require excision if they were symptomatic, patient preferred, attained a certain size, or demonstrated substantive growth over time on clinical examination. There was strong consensus that when removing a fibroadenoma, complete excision without transection of the mass is recommended and surgeons should consider aesthetics, sensation, and other factors when selecting incision placement. Patients with core biopsy-proven concordant fibroadenomas do not require imaging follow-up and may return to age-appropriate screening. Many benign phyllodes tumors (BPTs) present as an FEL on core biopsy, and these lesions along with any lesions with suspicion of or concern for phyllodes tumors (PTs) require surgical excisional biopsy with complete excision of the mass. Re-excision of a BPT is not required for patients with a positive margin for BPT, but a margin re-excision may be considered if the mass was transected or there is concern of residual disease after excisional biopsy. Patients with BPT who have undergone excision do not require follow-up imaging and may return to age-appropriate screening.Conclusions and RelevanceEvidence-informed, consensus and expert opinion-based guidelines for the management of benign FELs of the breast were developed. These guidelines provide clarification on the controversial management of benign FELs of the breast. Any practicing clinicians who treat patients with benign FELs should integrate these guidelines into treatment of their patients.
{"title":"American Society of Breast Surgeons and Society of Breast Imaging 2025 Guidelines for the Management of Benign Breast Fibroepithelial Lesions.","authors":"Laura H Rosenberger,Richard L White,Lorraine Tafra,Judy C Boughey,Nathalie M Johnson,Helen A Pass,Susan Boolbol,Kris McNiff Landrum,Yiming Gao,Katharine Yao","doi":"10.1001/jamasurg.2025.4392","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4392","url":null,"abstract":"ImportanceMany patients are diagnosed with benign breast lesions; however, evidence- and consensus-based guidelines for the management of benign breast disease (BBD) are limited.ObservationsThe American Society of Breast Surgeons (ASBrS) and the Society of Breast Imaging (SBI) developed guidelines for the management of benign fibroepithelial lesions (FELs) using a modified Delphi consensus methodology and public comment. There was strong consensus that core biopsy-proven concordant fibroadenomas without atypia only require excision if they were symptomatic, patient preferred, attained a certain size, or demonstrated substantive growth over time on clinical examination. There was strong consensus that when removing a fibroadenoma, complete excision without transection of the mass is recommended and surgeons should consider aesthetics, sensation, and other factors when selecting incision placement. Patients with core biopsy-proven concordant fibroadenomas do not require imaging follow-up and may return to age-appropriate screening. Many benign phyllodes tumors (BPTs) present as an FEL on core biopsy, and these lesions along with any lesions with suspicion of or concern for phyllodes tumors (PTs) require surgical excisional biopsy with complete excision of the mass. Re-excision of a BPT is not required for patients with a positive margin for BPT, but a margin re-excision may be considered if the mass was transected or there is concern of residual disease after excisional biopsy. Patients with BPT who have undergone excision do not require follow-up imaging and may return to age-appropriate screening.Conclusions and RelevanceEvidence-informed, consensus and expert opinion-based guidelines for the management of benign FELs of the breast were developed. These guidelines provide clarification on the controversial management of benign FELs of the breast. Any practicing clinicians who treat patients with benign FELs should integrate these guidelines into treatment of their patients.","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"108 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338793","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 : 2025-10-22DOI: 10.1001/jamasurg.2025.4440
Louisa N Spaans,Frank J C van den Broek
{"title":"Intercostal and Paravertebral Nerve Blocks vs Thoracic Epidural Analgesia-Reply.","authors":"Louisa N Spaans,Frank J C van den Broek","doi":"10.1001/jamasurg.2025.4440","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4440","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"15 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338792","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 : 2025-10-22DOI: 10.1001/jamasurg.2025.4399
Tina J Hieken,Michael E Egger,Christina V Angeles,John R Hyngstrom,Erin E Burke,Michael C Lowe,Georgia M Beasley,Edmund K Bartlett,Scott C Bresler,Kelly L Harms,Jonathan S Zager,Julia S Lehman,Nabil Wasif,Sanjay P Bagaria,Kelly M McMasters,David A Wada,Prakash Pandalai,Keith A Delman,Jay Lee,Klaus J Busam,Jane L Messina,Vernon K Sondak
ImportanceContemporary guidelines recommend sentinel lymph node biopsy (SLNB) for patients with melanoma with predicted risk of SLN metastasis greater than 10% and consideration of SLNB when the risk is 5% to 10%. A gene expression profile (GEP)-based test that can accurately identify patients with a low risk of SLN metastasis would refine selection for SLNB.ObjectiveTo establish the predictive capability of the combined clinicopathological factors and GEP (CP-GEP) test to identify patients with primary cutaneous melanoma who can safely forgo SLNB and to investigate the prognostic value of CP-GEP regarding the outcome in patients with cutaneous melanoma after a negative SLNB (not reported herein).Design, Setting, and ParticipantsThis prognostic study was conducted from September 2021 to June 2024 at 9 academic medical centers with experienced melanoma surgeons. Included were patients with biopsy-proven invasive cutaneous melanoma with T1 to T3 tumors and clinically negative regional LNs. All patients were deemed candidates for SLNB using standard clinical criteria. GEP was performed on formalin-fixed, paraffin-embedded tissue from the primary melanoma biopsy. Analyses were performed from December 2024 to August 2025.InterventionCP-GEP testing to determine risk of having a positive SLNB in patients with T1 to T3 cutaneous melanoma who were considered appropriate candidates for the procedure based on standard clinical parameters.Main Outcomes and MeasuresCP-GEP results were reported as low risk or high risk; the primary outcome measure was negative predictive value (NPV) in low-risk cases. Analyses included NPV assessment by tumor (T) subcategory, primary site, and age.ResultsA total of 1761 patients (median [IQR] age, 64 [53-72] years; 997 male [56.6%]) underwent SLNB (310 [17.6%] SLN positive) and had a successful CP-GEP test; GEP was successful in 97.7% of samples. A total of 651 patients (37.0%) were considered low risk by CP-GEP. Among low-risk cases, 46 (7.1%) were SLN positive, and NPV was 92.9% (95% CI, 90.7%-94.8%). High-risk cases had a 23.8% (264 of 1110) SLN-positive rate. The percentage of cases with low-risk CP-GEP declined with increasing T category (T1 = 346 of 507 [68.2%]; T2 = 295 of 897 [32.9%]; T3 = 10 of 357 [2.8%]). CP-GEP results were consistent in discriminating SLN-positive rates across primary sites, histologic subtypes, and mitotic count categories. In 2 large subsets, clinical stage IB (n = 1187) and patients 65 years and older (n = 832), 6.5% (95% CI, 4.6%-8.8%) of low -risk clinical stage IB cases and 6.6% (95% CI, 4.2%-9.7%) of all low-risk cases in patients 65 years and older were SLN positive vs 18.3% (95% CI, 15.3%-21.6%) and 20.3% (95% CI, 16.8%-24.2%) for high-risk cases, respectively.Conclusions and RelevanceIn this multicenter, prospective, blinded, prognostic study, the CP-GEP test reliably identified patients with melanoma with less than 10% SLN metastasis risk. SLN metastasis rates were approximately 3-fold
{"title":"Gene Expression Profile-Based Test to Predict Melanoma Sentinel Node Status: The MERLIN_001 Study.","authors":"Tina J Hieken,Michael E Egger,Christina V Angeles,John R Hyngstrom,Erin E Burke,Michael C Lowe,Georgia M Beasley,Edmund K Bartlett,Scott C Bresler,Kelly L Harms,Jonathan S Zager,Julia S Lehman,Nabil Wasif,Sanjay P Bagaria,Kelly M McMasters,David A Wada,Prakash Pandalai,Keith A Delman,Jay Lee,Klaus J Busam,Jane L Messina,Vernon K Sondak","doi":"10.1001/jamasurg.2025.4399","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4399","url":null,"abstract":"ImportanceContemporary guidelines recommend sentinel lymph node biopsy (SLNB) for patients with melanoma with predicted risk of SLN metastasis greater than 10% and consideration of SLNB when the risk is 5% to 10%. A gene expression profile (GEP)-based test that can accurately identify patients with a low risk of SLN metastasis would refine selection for SLNB.ObjectiveTo establish the predictive capability of the combined clinicopathological factors and GEP (CP-GEP) test to identify patients with primary cutaneous melanoma who can safely forgo SLNB and to investigate the prognostic value of CP-GEP regarding the outcome in patients with cutaneous melanoma after a negative SLNB (not reported herein).Design, Setting, and ParticipantsThis prognostic study was conducted from September 2021 to June 2024 at 9 academic medical centers with experienced melanoma surgeons. Included were patients with biopsy-proven invasive cutaneous melanoma with T1 to T3 tumors and clinically negative regional LNs. All patients were deemed candidates for SLNB using standard clinical criteria. GEP was performed on formalin-fixed, paraffin-embedded tissue from the primary melanoma biopsy. Analyses were performed from December 2024 to August 2025.InterventionCP-GEP testing to determine risk of having a positive SLNB in patients with T1 to T3 cutaneous melanoma who were considered appropriate candidates for the procedure based on standard clinical parameters.Main Outcomes and MeasuresCP-GEP results were reported as low risk or high risk; the primary outcome measure was negative predictive value (NPV) in low-risk cases. Analyses included NPV assessment by tumor (T) subcategory, primary site, and age.ResultsA total of 1761 patients (median [IQR] age, 64 [53-72] years; 997 male [56.6%]) underwent SLNB (310 [17.6%] SLN positive) and had a successful CP-GEP test; GEP was successful in 97.7% of samples. A total of 651 patients (37.0%) were considered low risk by CP-GEP. Among low-risk cases, 46 (7.1%) were SLN positive, and NPV was 92.9% (95% CI, 90.7%-94.8%). High-risk cases had a 23.8% (264 of 1110) SLN-positive rate. The percentage of cases with low-risk CP-GEP declined with increasing T category (T1 = 346 of 507 [68.2%]; T2 = 295 of 897 [32.9%]; T3 = 10 of 357 [2.8%]). CP-GEP results were consistent in discriminating SLN-positive rates across primary sites, histologic subtypes, and mitotic count categories. In 2 large subsets, clinical stage IB (n = 1187) and patients 65 years and older (n = 832), 6.5% (95% CI, 4.6%-8.8%) of low -risk clinical stage IB cases and 6.6% (95% CI, 4.2%-9.7%) of all low-risk cases in patients 65 years and older were SLN positive vs 18.3% (95% CI, 15.3%-21.6%) and 20.3% (95% CI, 16.8%-24.2%) for high-risk cases, respectively.Conclusions and RelevanceIn this multicenter, prospective, blinded, prognostic study, the CP-GEP test reliably identified patients with melanoma with less than 10% SLN metastasis risk. SLN metastasis rates were approximately 3-fold ","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"71 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338766","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 : 2025-10-22DOI: 10.1001/jamasurg.2025.4385
William Y Luo,Ursula C Adams,Andrea D Coviello,Maggie M Hodges,P Osita Udekwu,Timothy M Farrell,Anthony G Charles
{"title":"Costs of Cutting Weight-An Economic Evaluation of GLP-1 Agonists vs Gastric Bypass.","authors":"William Y Luo,Ursula C Adams,Andrea D Coviello,Maggie M Hodges,P Osita Udekwu,Timothy M Farrell,Anthony G Charles","doi":"10.1001/jamasurg.2025.4385","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4385","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"68 12 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338790","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 : 2025-10-15DOI: 10.1001/jamasurg.2025.4319
Norman J Galbraith,Y Nancy You,J Joshua Smith
{"title":"Access to and Delivery of High-Quality Cancer Care.","authors":"Norman J Galbraith,Y Nancy You,J Joshua Smith","doi":"10.1001/jamasurg.2025.4319","DOIUrl":"https://doi.org/10.1001/jamasurg.2025.4319","url":null,"abstract":"","PeriodicalId":14690,"journal":{"name":"JAMA surgery","volume":"1 1","pages":""},"PeriodicalIF":16.9,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145288428","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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