American journal of surgery最新文献

英文中文

Subsequent percutaneous breast biopsies after initial atypia diagnosis: The patient burden of long-term follow up. 初次非典型诊断后的后续经皮乳腺活检：长期随访给患者带来的负担。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-27 DOI: 10.1016/j.amjsurg.2024.115993

Juliet C Dalton, Samantha M Thomas, Akiko Chiba, Ton Wang, E Shelley Hwang, Jennifer K Plichta

Background: Breast atypia increases overall breast cancer risk, potentially necessitating future interventions. This study examines the frequency and outcomes of additional percutaneous biopsies after an atypia diagnosis.

Methods: Adult patients with breast atypia (atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ) at a single institution were reviewed for subsequent core needle biopsies (CNBs) and corresponding malignant outcomes.

Results: Among 432 patients, median age at diagnosis was 54.8 y. Seventy-one (71/432, 16.4 %) patients developed a breast malignancy. During a median follow-up of 7.4 y, 113 patients underwent 149 additional CNBs. Twenty-six patients (26/113, 23.0 %) had >2 additional CNBs. Approximately half (79/149, 53.0 %) of all additional CNBs occurred within 5 years after breast atypia diagnosis.

Conclusion: A considerable number of patients with breast atypia undergo additional percutaneous biopsies, especially within 5 years post-atypia diagnosis. Our study highlights the significant burden of surveillance and the need for tailored follow-up strategies.

背景：乳腺不典型性会增加患乳腺癌的总体风险，因此今后可能有必要采取干预措施。本研究探讨了乳腺不典型增生确诊后进行额外经皮活检的频率和结果：方法：研究人员对一家医疗机构的成年乳腺非典型增生（非典型导管增生、非典型小叶增生、小叶原位癌）患者的后续核心针活检（CNB）和相应的恶性结果进行了回顾性分析：在432名患者中，确诊时的中位年龄为54.8岁。71名患者（71/432，16.4%）罹患乳腺恶性肿瘤。在中位 7.4 年的随访期间，113 名患者又接受了 149 次 CNB。26名患者（26/113，23.0%）接受了2次以上的CNB。大约一半（79/149，53.0%）的额外 CNB 发生在乳腺不典型诊断后的 5 年内：结论：相当多的乳腺不典型增生患者接受了额外的经皮活检，尤其是在确诊乳腺不典型增生后的 5 年内。我们的研究凸显了监测的巨大负担以及制定有针对性的随访策略的必要性。

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引用次数: 0

Emeritus Editorial Board 荣誉编辑委员会

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-26 DOI: 10.1016/j.amjsurg.2024.115965

引用次数: 0

Edgar J. Poth memorial lecture: The power of partnership.

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-26 DOI: 10.1016/j.amjsurg.2024.115990

Annika Kay

引用次数: 0

Exploring consent for animal-derived products in surgery. 探讨手术中动物源性产品的同意问题。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-25 DOI: 10.1016/j.amjsurg.2024.115989

Tega Ebeye, Chantal R Valiquette, Natalia Ziolkowski

引用次数: 0

Grading severity of MVI impacts long-term outcomes after laparoscopic liver resection for early-stage hepatocellular carcinoma: A multicenter study MVI严重程度分级对早期肝细胞癌腹腔镜肝切除术后长期疗效的影响：一项多中心研究。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-24 DOI: 10.1016/j.amjsurg.2024.115988

Purpose

To examine the relationship between microvascular invasion (MVI) grading severity and long-term outcomes in early-stage hepatocellular carcinoma (HCC) patients undergoing laparoscopic liver resection (LLR).

Methods

Patients who had LLR for early-stage HCC were enrolled. According to the grading severity of MVI, patients were classified into M0, M1 and M2. Recurrence-free survival (RFS) and overall survival (OS) among the groups were compared. Univariate and multivariate Cox regression analyses were performed to identify independent risk factors of OS and RFS.

Results

Among 233 patients, MVI grading as M0, M1, and M2 accounts for 122 (52.4 %), 84 (36 %), and 27 (11.6 %) patients, respectively. The median OS and RFS in patients with M0, M1, and M2 were 84.9, 40.1, and 25.2 months; and 76.9, 27.0, and 18.8 months, respectively. Multivariable analyses identified both M1 and M2 to be independent risk factors for OS and RFS.

Conclusion

Grading severity of MVI was independently associated with RFS and OS after LLR for early-stage HCC. Patients with MVI, especially those with M2, should receive stringent recurrence surveillance and active adjuvant therapy.

目的：研究接受腹腔镜肝切除术（LLR）的早期肝细胞癌（HCC）患者微血管侵犯（MVI）分级严重程度与长期预后之间的关系：方法：研究对象为接受腹腔镜肝切除术（LLR）的早期肝细胞癌患者。根据MVI的分级严重程度，将患者分为M0、M1和M2。比较各组的无复发生存率（RFS）和总生存率（OS）。进行单变量和多变量Cox回归分析，以确定OS和RFS的独立风险因素：在233例患者中，MVI分级为M0、M1和M2的患者分别为122例（52.4%）、84例（36%）和27例（11.6%）。M0、M1和M2患者的中位OS和RFS分别为84.9、40.1和25.2个月；76.9、27.0和18.8个月。多变量分析发现，M1和M2是影响OS和RFS的独立危险因素：结论：MVI的严重程度分级与早期HCC LLR后的RFS和OS密切相关。MVI患者，尤其是M2患者，应接受严格的复发监测和积极的辅助治疗。

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引用次数: 0

A single-center prospective analysis of the impact of glucose metabolism on pancreatic fistula onset after pancreaticoduodenectomy for periampullary tumors 单中心前瞻性分析葡萄糖代谢对胰十二指肠切除术治疗胰腺周围肿瘤后胰瘘发病的影响。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-24 DOI: 10.1016/j.amjsurg.2024.115987

Background

Glucose impairment notably affects the postoperative course of gastrointestinal surgeries. However, evidence on its impact on clinically relevant pancreatic fistulas(CR-POPFs) after pancreaticoduodenectomy(PD) is lacking. This study evaluates if and how preoperative glucose metabolism affects the development of CR-POPF after PD.

Methods

One hundred and ten consecutive PDs were included. Patients underwent preoperative metabolic profiling using the Oral Glucose Tolerance Test(OGTT) and the hyperinsulinemic euglycemic clamp procedure. Accordingly, patients were categorized as normal glucose tolerant (NGT), impaired glucose tolerant (IGT), diabetic (DM), and longstanding-DM. Receiver operating characteristics(ROC) analyses were performed to determine the values of metabolic features in prediction of CR-POPF.

Results

The CR-POPF rate was 36.3 %(40 patients). NGT patients had a higher CR-POPF rate (51.7 %) compared to IGT(45.2 %), DM (15.8 %), and longstanding-DM (25.8 %) (p = 0.03). CR-POPF patients had lower median fasting glucose levels (p = 0.01) and higher c-peptide values at all OGTT time points (p < 0.05). Fasting glucose and c-peptide levels had high diagnostic accuracy for CR-POPF (AUC>0.8) and were independent risk factors for CR-POPF (OR: 24.7[95%CI: 3.7–165.3] for fasting glucose; OR: 19.9[95%CI: 3.2–125.3] for c-peptide).

Conclusion

Normoglycemia and normal beta cell function may be risk factors for CR-POPF after PD. Fasting glucose and c-peptide levels effectively predicted CR-POPF development following PD.

ClinicalTrials gov Identifier

NCT02175459

背景：血糖损害对胃肠道手术的术后过程有显著影响。然而，目前尚缺乏证据表明葡萄糖障碍对胰十二指肠切除术（PD）后临床相关性胰瘘（CR-POPFs）的影响。本研究评估了术前糖代谢是否以及如何影响胰十二指肠切除术后 CR-POPF 的发生：方法：研究纳入了 110 例连续的 PD 患者。方法：纳入了 110 例连续腹腔镜手术患者。患者术前接受了口服葡萄糖耐量试验（OGTT）和高胰岛素血糖钳夹法的代谢分析。因此，患者被分为糖耐量正常（NGT）、糖耐量受损（IGT）、糖尿病（DM）和长期糖尿病（DM）。为确定代谢特征在预测 CR-POPF 中的价值，进行了接收者操作特征（ROC）分析：结果：CR-POPF 率为 36.3%（40 名患者）。NGT患者的CR-POPF率（51.7%）高于IGT（45.2%）、DM（15.8%）和长期DM（25.8%）（P = 0.03）。CR-POPF 患者的空腹血糖中位数较低（p = 0.01），在所有 OGTT 时间点的 c 肽值较高（p 0.8），是 CR-POPF 的独立风险因素（空腹血糖 OR：24.7[95%CI：3.7-165.3]；c 肽 OR：19.9[95%CI：3.2-125.3]）：结论：血糖正常和β细胞功能正常可能是PD后CR-POPF的风险因素。空腹血糖和 c 肽水平可有效预测 PD 后 CR-POPF 的发生：NCT02175459。

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引用次数: 0

Professional identity formation for all physicians on the surgery clerkship 为所有参加外科实习的医生培养职业认同感。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-21 DOI: 10.1016/j.amjsurg.2024.115971

No abstract is necessary for an invited commentary.

特邀评论无需摘要。

引用次数: 0

Empowered or abandoned: Immediate information without explanation. 被授权或被遗弃：即时信息，无需解释。

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-21 DOI: 10.1016/j.amjsurg.2024.115985

Ashley B Simpson, Amanda L Amin

引用次数: 0

Does surgeon-performed intraoperative wire localization allow for lower margin positivity rates compared to radiologist-performed preoperative localization in early breast cancer? 在早期乳腺癌中，外科医生进行的术中导线定位与放射科医生进行的术前定位相比，边缘阳性率是否更低？

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-21 DOI: 10.1016/j.amjsurg.2024.115986

Reeta Asmai, Tess Huy, Jennifer L Baker, Hong-Ho Yang, Carlie K Thompson, Nimmi S Kapoor

Background: This study compares positive margin rates in breast conserving surgery (BCS) for early breast cancer using two localization techniques: surgeon-performed intraoperative ultrasound-guided wire localization (IOWL) versus radiologist-performed preoperative wire localization (POWL).

Methods: Patients with unifocal breast cancer undergoing BCS with follow-up at a single institution were retrospectively identified. Factors associated with positive margins were identified.

Results: 177 patients underwent IOWL (N = 85) or POWL (N = 92). There was a significantly lower rate of positive margins for IOWL vs. POWL (7.1 % vs. 23.9 %, p = 0.002) and a corresponding lower rate of re-excision for IOWL vs. POWL (5.9 % vs. 18.5 %, p = 0.011). Presence of DCIS was associated with positive margins (p = 0.015). After adjusting for presence of DCIS, tumor size, and volume of tissue removed, the positive margin rate was significantly lower in the IOWL group compared to the POWL group (aOR 0.34, 95 % CI 0.13-0.93).

Conclusions: In this study, adjusted analysis favored IOWL in achieving negative tumor margins. Prospective studies are needed to further explore the impact of IOWL on quality, cost-effectiveness, and patient experience.

背景：本研究比较了早期乳腺癌保乳手术（BCS）中两种定位技术的阳性边缘率：外科医生术中超声引导线定位（IOWL）与放射科医生术前线定位（POWL）：方法：对在一家医疗机构接受BCS手术并进行随访的单灶乳腺癌患者进行回顾性鉴定。结果：177 名患者接受了 IOWL 术：177名患者接受了IOWL（85人）或POWL（92人）。IOWL与POWL相比，边缘阳性率明显较低（7.1% vs. 23.9%，p = 0.002），IOWL与POWL相比，再次切除率也相应较低（5.9% vs. 18.5%，p = 0.011）。DCIS的存在与边缘阳性相关（p = 0.015）。在对DCIS、肿瘤大小和切除组织量进行调整后，IOWL组的边缘阳性率明显低于POWL组（aOR 0.34, 95 % CI 0.13-0.93）：在这项研究中，调整后的分析结果显示，IOWL更有利于实现肿瘤边缘阴性。需要进行前瞻性研究，进一步探讨 IOWL 对质量、成本效益和患者体验的影响。

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引用次数: 0

Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT) 腹部创伤手术后实施改良的术后强化恢复（ERAS）；可行性和结果评估：随机对照试验 (RCT)

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery

Pub Date : 2024-09-19 DOI: 10.1016/j.amjsurg.2024.115975

Background

Enhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy.

Study design

Prospective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo).

Results

Fifty patients were randomized into ERAS(n = 25) and conventional care(n = 25) groups. Ninety-two percent of patients were young males, 58 % had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 %). ERAS group had a reduced median LOH(days) (6 versus 8, p = 0.007), early recovery of bowel function(p = 0.010) and shorter times for nasogastric tube(p = 0.001), urinary catheter(p = 0.007) and drain(p = 0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p = 0.009)].

Conclusion

ERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy.

研究背景术后强化恢复（ERAS）是一套多重围手术期护理方案，而非僵化的方案，可改善择期手术的疗效。本研究旨在评估接受开腹手术的创伤患者的可行性和疗效。研究设计前瞻性单中心随机对照试验（RCT）。在创伤后接受紧急开腹手术的患者在手术后24小时被随机分为ERAS组（早期拔除导管、早期活动和开始饮食、使用阿片类稀释多模式镇痛）和常规护理组。结果50名患者被随机分为ERAS组（25人）和常规护理组（25人）。92%的患者为年轻男性，58%的患者为腹部钝性创伤，最常见的手术指征为空腔脏器损伤（88%）。ERAS 组的中位 LOH（天数）减少（6 对 8，p = 0.007），肠道功能恢复早（p = 0.010），鼻胃管（p = 0.001）、导尿管（p = 0.007）和引流管（p = 0.006）拔除时间短。除了深部手术部位感染[ERAS 组明显较低(p = 0.009)]，两组的并发症情况相当。

{"title":"Implementation of modified enhanced recovery after surgery (ERAS) following surgery for abdominal trauma; Assessment of feasibility and outcomes: A randomized controlled trial (RCT)","authors":"","doi":"10.1016/j.amjsurg.2024.115975","DOIUrl":"10.1016/j.amjsurg.2024.115975","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced recovery after surgery(ERAS) is a set of multiple perioperative care component not a rigid protocol with improved outcomes for elective surgeries. This study aimed to assess the feasibility and outcomes in trauma patients undergoing laparotomy.</div></div><div><h3>Study design</h3><div>Prospective single-centre randomized controlled trial(RCT). Patients undergoing emergency laparotomy following trauma were randomized into ERAS(early removal of catheters, early mobilization and initiation of diet, use of opioid-sparing multimodal analgesia) and conventional care groups 24 h post-surgery. Outcome measures included length of hospitalization(LOH), recovery of bowel function, duration of removal of catheters and 30-day complications(Clavien-Dindo).</div></div><div><h3>Results</h3><div>Fifty patients were randomized into ERAS(n = 25) and conventional care(n = 25) groups. Ninety-two percent of patients were young males, 58 % had blunt trauma to the abdomen and the most common indication of surgery was hollow viscus injury(88 %). ERAS group had a reduced median LOH(days) (6 versus 8, p = 0.007), early recovery of bowel function(p = 0.010) and shorter times for nasogastric tube(p = 0.001), urinary catheter(p = 0.007) and drain(p = 0.006) removal. The complications were comparable in both groups except for deep surgical site infection[significantly lower in ERAS group(p = 0.009)].</div></div><div><h3>Conclusion</h3><div>ERAS is safe and significantly reduces LOH in select trauma patients undergoing laparotomy.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":null,"pages":null},"PeriodicalIF":2.7,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142320387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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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