Pub Date : 2025-11-25DOI: 10.1016/j.amjsurg.2025.116749
Brenda Feres , Sofia Wagemaker Viana , Gabriele Eckerdt Lech , Yasmin Biscola Da Cruz , Mecker G. Möller
Background
Inequitable representation on journal editorial boards (EB) may hinder females' career advancement in leadership positions.
Methods
We conducted a cross-sectional study analyzing gender representation in EB of surgical oncology journals. Members were classified as “editor-in-chief”, “senior editorial leadership”, “board and advisory members”, and “editorial management and support”, with first names used to predict female representation.
Results
We included 24 surgical oncology journals and analyzed 2097 names. Females held 33.1 % (694/2097) of EB positions (p < 0.001). A chi-square analysis revealed a significant difference in gender representation across editorial roles (p < 0.001). Females held fewer editor-in-chief roles (17.9 %, 5/28) compared to board and advisory members (30.1 %, 473/1574). Overall, 4/24 journals had a statement about diversity/equity on the EB, despite none showing equal proportion.
Conclusion
Female surgeons remain underrepresented in leadership positions, underscoring the need to improve equity and females’ advancement.
{"title":"Confronting inequality: The Stark disparity of female representation in surgical oncology journals’ editorial boards","authors":"Brenda Feres , Sofia Wagemaker Viana , Gabriele Eckerdt Lech , Yasmin Biscola Da Cruz , Mecker G. Möller","doi":"10.1016/j.amjsurg.2025.116749","DOIUrl":"10.1016/j.amjsurg.2025.116749","url":null,"abstract":"<div><h3>Background</h3><div>Inequitable representation on journal editorial boards (EB) may hinder females' career advancement in leadership positions.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional study analyzing gender representation in EB of surgical oncology journals. Members were classified as “editor-in-chief”, “senior editorial leadership”, “board and advisory members”, and “editorial management and support”, with first names used to predict female representation.</div></div><div><h3>Results</h3><div>We included 24 surgical oncology journals and analyzed 2097 names. Females held 33.1 % (694/2097) of EB positions (p < 0.001). A chi-square analysis revealed a significant difference in gender representation across editorial roles (p < 0.001). Females held fewer editor-in-chief roles (17.9 %, 5/28) compared to board and advisory members (30.1 %, 473/1574). Overall, 4/24 journals had a statement about diversity/equity on the EB, despite none showing equal proportion.</div></div><div><h3>Conclusion</h3><div>Female surgeons remain underrepresented in leadership positions, underscoring the need to improve equity and females’ advancement.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116749"},"PeriodicalIF":2.7,"publicationDate":"2025-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145733227","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}
Pub Date : 2025-11-23DOI: 10.1016/j.amjsurg.2025.116733
Kelsey B. Montgomery , Nicole Rademacher , Joshua S. Richman , Smita Bhatia , Kristy K. Broman
Background
Implementation of evidence-based practices (EBPs) can serve as an indicator of quality for common cancers. This study evaluated the impact of hospital volume on EBP implementation for common cancers.
Methods
This retrospective cohort study of adults who underwent curative-intent treatment for breast, colon, melanoma, and thyroid cancer from 2010 to 2020 used data from the National Cancer Database. Eight EBP measures, two per disease site, were evaluated across facility volume quartiles using mixed-effects logistic regression models adjusted for patient and facility characteristics.
Results
There were 2,893,655 patients (breast n = 1,731,433, colon n = 481,858, melanoma.
n = 418,841, thyroid n = 261,523) (median age 63). EBP implementation was higher at the highest-volume sites compared to lowest (range by measure: 71 %–95 % and 60 %–90 % respectively). The adjusted odds of receiving EBP was greater at higher-volume facilities for six of eight measures.
Conclusion
Volume-associations in EBP implementation may influence system-level decision making around care allocation for common cancers.
{"title":"Healthcare facility volume and evidence-based practice implementation in surgical care of patients with common cancers","authors":"Kelsey B. Montgomery , Nicole Rademacher , Joshua S. Richman , Smita Bhatia , Kristy K. Broman","doi":"10.1016/j.amjsurg.2025.116733","DOIUrl":"10.1016/j.amjsurg.2025.116733","url":null,"abstract":"<div><h3>Background</h3><div>Implementation of evidence-based practices (EBPs) can serve as an indicator of quality for common cancers. This study evaluated the impact of hospital volume on EBP implementation for common cancers.</div></div><div><h3>Methods</h3><div>This retrospective cohort study of adults who underwent curative-intent treatment for breast, colon, melanoma, and thyroid cancer from 2010 to 2020 used data from the National Cancer Database. Eight EBP measures, two per disease site, were evaluated across facility volume quartiles using mixed-effects logistic regression models adjusted for patient and facility characteristics.</div></div><div><h3>Results</h3><div>There were 2,893,655 patients (breast n = 1,731,433, colon n = 481,858, melanoma.</div><div>n = 418,841, thyroid n = 261,523) (median age 63). EBP implementation was higher at the highest-volume sites compared to lowest (range by measure: 71 %–95 % and 60 %–90 % respectively). The adjusted odds of receiving EBP was greater at higher-volume facilities for six of eight measures.</div></div><div><h3>Conclusion</h3><div>Volume-associations in EBP implementation may influence system-level decision making around care allocation for common cancers.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116733"},"PeriodicalIF":2.7,"publicationDate":"2025-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616367","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}
Pub Date : 2025-11-22DOI: 10.1016/j.amjsurg.2025.116711
Isabella Faria, Camila R Guetter, Morgan Hopp, Rachna Sridhar, Chantal Reyna, Charlotte Kvasnovsky, Yangyang Ru Yu, Asanthi Ratnasekera, Catherine H Davis
Background: Mentorship, coaching, and sponsorship are critical for professional advancement in surgical careers. This study examines these different forms of support among surgeons and trainees.
Methods: An electronic survey was developed and disseminated on social media and was hosted by the Association of Women Surgeons (AWS). Members and non-members of the AWS from diverse backgrounds, including trainees and students and those in academic and community practices were queried on various demographic and professional characteristics. The primary outcome of interest was access to mentorship, sponsorship and coaching. Chi-square, Fisher's exact tests, and logistic regression models were applied to analyze survey responses.
Results: Of 93 respondents, 48 % reported knowing the difference between mentors, coaches, and sponsors. 65 % of participants reported having a mentor, 28 % a sponsor, and 17 % a coach. Community-based surgeons were less likely to have mentors compared to academic surgeons (OR 0.09, 95 % CI 0.01-0.69, p = 0.02). Administrative leaders were more likely to have sponsors (admin leaders 44.8 % vs. non admin 21.3 %, p = 0.02) and coaches (admin leaders 31 % vs. non admin 11.5 %, p = 0.02). Identifying people within one's organization and time constraints were the most common barriers to having that support.
Conclusions: Efforts by institutions and surgical societies are needed to increase the availability of mentors, sponsors and coaches, particularly for community-based and early-career surgeons.
背景：指导、指导和赞助是外科职业发展的关键。本研究考察了外科医生和实习生之间这些不同形式的支持。方法：由女性外科医生协会（AWS）主办的电子调查在社交媒体上进行了开发和传播。来自不同背景的AWS会员和非会员，包括学员和学生以及从事学术和社区实践的人员，被问及各种人口和专业特征。兴趣的主要结果是获得指导、赞助和指导。采用卡方检验、Fisher精确检验和逻辑回归模型对调查结果进行分析。结果：在93名受访者中，48%的人表示知道导师、教练和赞助商之间的区别。65%的参与者报告有导师，28%的人有赞助商，17%的人有教练。社区外科医生比学术外科医生更不可能有导师（OR 0.09, 95% CI 0.01-0.69, p = 0.02）。行政领导更有可能有赞助者（行政领导44.8%，非行政领导21.3%,p = 0.02）和教练（行政领导31%，非行政领导11.5%,p = 0.02）。确定组织内的人员和时间限制是获得这种支持的最常见障碍。结论：机构和外科学会需要努力增加导师、赞助者和教练的可用性，特别是对社区和早期职业外科医生。
{"title":"Mapping pathways to professional support: The role of mentorship, coaching, and sponsorship in surgical careers.","authors":"Isabella Faria, Camila R Guetter, Morgan Hopp, Rachna Sridhar, Chantal Reyna, Charlotte Kvasnovsky, Yangyang Ru Yu, Asanthi Ratnasekera, Catherine H Davis","doi":"10.1016/j.amjsurg.2025.116711","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116711","url":null,"abstract":"<p><strong>Background: </strong>Mentorship, coaching, and sponsorship are critical for professional advancement in surgical careers. This study examines these different forms of support among surgeons and trainees.</p><p><strong>Methods: </strong>An electronic survey was developed and disseminated on social media and was hosted by the Association of Women Surgeons (AWS). Members and non-members of the AWS from diverse backgrounds, including trainees and students and those in academic and community practices were queried on various demographic and professional characteristics. The primary outcome of interest was access to mentorship, sponsorship and coaching. Chi-square, Fisher's exact tests, and logistic regression models were applied to analyze survey responses.</p><p><strong>Results: </strong>Of 93 respondents, 48 % reported knowing the difference between mentors, coaches, and sponsors. 65 % of participants reported having a mentor, 28 % a sponsor, and 17 % a coach. Community-based surgeons were less likely to have mentors compared to academic surgeons (OR 0.09, 95 % CI 0.01-0.69, p = 0.02). Administrative leaders were more likely to have sponsors (admin leaders 44.8 % vs. non admin 21.3 %, p = 0.02) and coaches (admin leaders 31 % vs. non admin 11.5 %, p = 0.02). Identifying people within one's organization and time constraints were the most common barriers to having that support.</p><p><strong>Conclusions: </strong>Efforts by institutions and surgical societies are needed to increase the availability of mentors, sponsors and coaches, particularly for community-based and early-career surgeons.</p>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116711"},"PeriodicalIF":2.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145666792","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}
Pub Date : 2025-11-22DOI: 10.1016/j.amjsurg.2025.116739
Cornelia L Griggs, Andrea L Merrill
{"title":"The hidden reason many women are leaving surgery: They're being pushed out.","authors":"Cornelia L Griggs, Andrea L Merrill","doi":"10.1016/j.amjsurg.2025.116739","DOIUrl":"https://doi.org/10.1016/j.amjsurg.2025.116739","url":null,"abstract":"","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":" ","pages":"116739"},"PeriodicalIF":2.7,"publicationDate":"2025-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676085","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}
Pub Date : 2025-11-21DOI: 10.1016/j.amjsurg.2025.116729
Tyler J. Johnston , Dina M. Filiberto , Peter B. DePhillips , Chandler E. Morel , Peter E. Fischer , Andy J. Kerwin , Emily K. Lenart , Saskya E. Byerly
Background
Pre-hospital triage is critical for resource-allocation and patient-outcomes. This study aimed to assess the sensitivity (SN) of updated 2021 Field Triage Guidelines (FTGs) and trauma center activation criteria (TAC) related to Need for Trauma Intervention (NFTI).
Methods
Data were collected to identify FTGs Red Criteria (RC) and Yellow Criteria (YC) and NFTI: pRBC within 4 h, operating room within 90 min, interventional radiology, ICU length-of-stay ≥3 days, mechanical ventilation within 3 days, or death within 60 h. SN was analyzed for RC and TAC. Lastly, logistic regressions assessed covariates associated with under-triage (UT).
Results
319 patients were included. SN of RC and TAC were 79 % and 77 %, respectively. Regression analysis showed UT by RC and TAC was associated with blunt mechanism.
Conclusions
FTGs did not meet ACS goals of ≤5 % UT and ≤35 % OT with blunt mechanism being associated with UT.
{"title":"Assessing the performance of the updated 2021 Field Triage Guidelines with the Need For Trauma Intervention (NFTI) metric","authors":"Tyler J. Johnston , Dina M. Filiberto , Peter B. DePhillips , Chandler E. Morel , Peter E. Fischer , Andy J. Kerwin , Emily K. Lenart , Saskya E. Byerly","doi":"10.1016/j.amjsurg.2025.116729","DOIUrl":"10.1016/j.amjsurg.2025.116729","url":null,"abstract":"<div><h3>Background</h3><div>Pre-hospital triage is critical for resource-allocation and patient-outcomes. This study aimed to assess the sensitivity (SN) of updated 2021 Field Triage Guidelines (FTGs) and trauma center activation criteria (TAC) related to Need for Trauma Intervention (NFTI).</div></div><div><h3>Methods</h3><div>Data were collected to identify FTGs Red Criteria (RC) and Yellow Criteria (YC) and NFTI: pRBC within 4 h, operating room within 90 min, interventional radiology, ICU length-of-stay ≥3 days, mechanical ventilation within 3 days, or death within 60 h. SN was analyzed for RC and TAC. Lastly, logistic regressions assessed covariates associated with under-triage (UT).</div></div><div><h3>Results</h3><div>319 patients were included. SN of RC and TAC were 79 % and 77 %, respectively. Regression analysis showed UT by RC and TAC was associated with blunt mechanism.</div></div><div><h3>Conclusions</h3><div>FTGs did not meet ACS goals of ≤5 % UT and ≤35 % OT with blunt mechanism being associated with UT.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116729"},"PeriodicalIF":2.7,"publicationDate":"2025-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145659833","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}
Pub Date : 2025-11-20DOI: 10.1016/j.amjsurg.2025.116730
Erika T. Shock, Brooke E. Porter, Farrell K. Landwehr, Angela V. Atkinson, Natalie S. Raatz, Kevin M. Klifto, Thomas D. Willson
Objective
Microsurgical free tissue transfer (FTT) is essential in reconstructive surgery, but thromboembolic events are a leading cause of flap failure. This study evaluates how perioperative anticoagulation, antiplatelet therapy, and ambulation affect postoperative complications in FTT.
Study design
A retrospective cohort study of 497 free flap procedures assessed associations between antiplatelet and anticoagulation therapy, ambulation timing, and postoperative outcomes. The cohort included pediatric and adult patients who underwent a free tissue transfer from 2012 to 2021. Multivariable logistic regression identified predictors of flap-related complications.
Results
Controlling for age, sex, and nicotine use, ambulation on postoperative day 1 was linked to reduced arterial/venous thrombosis (OR 0.34, p = 0.003) and fewer operating room takebacks (OR 0.56, p = 0.006). Anticoagulation on day 6 increased takeback odds (OR 1.64, p = 0.029). Antiplatelet therapy on day 7 decreased takeback odds (OR 0.65, p = 0.04). Day 7 ambulation lowered odds of any complication (aOR 0.67, p = 0.042).
Conclusions
Early mobilization and appropriately timed antithrombotic therapy reduce FTT complications, supporting standardized postoperative care.
目的显微外科游离组织移植（FTT）在重建手术中是必不可少的，但血栓栓塞事件是皮瓣失败的主要原因。本研究评估围手术期抗凝、抗血小板治疗和活动对FTT术后并发症的影响。研究设计一项497例游离皮瓣手术的回顾性队列研究评估了抗血小板和抗凝治疗、下床时间和术后结果之间的关系。该队列包括2012年至2021年接受免费组织移植的儿科和成人患者。多变量逻辑回归确定了皮瓣相关并发症的预测因素。结果在控制年龄、性别和尼古丁使用的情况下，术后第1天的活动与减少动脉/静脉血栓形成（OR 0.34, p = 0.003）和减少手术室回头率（OR 0.56, p = 0.006）有关。第6天抗凝治疗增加了药物收回的几率（OR 1.64, p = 0.029）。抗血小板治疗第7天降低了不良反应发生率（OR 0.65, p = 0.04）。第7天的活动降低了任何并发症的发生率（aOR 0.67, p = 0.042）。结论早期活动和适时抗栓治疗可减少FTT并发症，支持术后规范化护理。
{"title":"Strategies to minimize postoperative complications in microsurgical free tissue transfer: The role of anticoagulation, antiplatelets, and ambulation","authors":"Erika T. Shock, Brooke E. Porter, Farrell K. Landwehr, Angela V. Atkinson, Natalie S. Raatz, Kevin M. Klifto, Thomas D. Willson","doi":"10.1016/j.amjsurg.2025.116730","DOIUrl":"10.1016/j.amjsurg.2025.116730","url":null,"abstract":"<div><h3>Objective</h3><div>Microsurgical free tissue transfer (FTT) is essential in reconstructive surgery, but thromboembolic events are a leading cause of flap failure. This study evaluates how perioperative anticoagulation, antiplatelet therapy, and ambulation affect postoperative complications in FTT.</div></div><div><h3>Study design</h3><div>A retrospective cohort study of 497 free flap procedures assessed associations between antiplatelet and anticoagulation therapy, ambulation timing, and postoperative outcomes. The cohort included pediatric and adult patients who underwent a free tissue transfer from 2012 to 2021. Multivariable logistic regression identified predictors of flap-related complications.</div></div><div><h3>Results</h3><div>Controlling for age, sex, and nicotine use, ambulation on postoperative day 1 was linked to reduced arterial/venous thrombosis (OR 0.34, p = 0.003) and fewer operating room takebacks (OR 0.56, p = 0.006). Anticoagulation on day 6 increased takeback odds (OR 1.64, p = 0.029). Antiplatelet therapy on day 7 decreased takeback odds (OR 0.65, p = 0.04). Day 7 ambulation lowered odds of any complication (aOR 0.67, p = 0.042).</div></div><div><h3>Conclusions</h3><div>Early mobilization and appropriately timed antithrombotic therapy reduce FTT complications, supporting standardized postoperative care.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116730"},"PeriodicalIF":2.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616368","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}
Pub Date : 2025-11-20DOI: 10.1016/j.amjsurg.2025.116728
Justin Dourado , Matthew Bilotti , Sameh Hany Emile , Anjelli Wignakumar , Cameron Perrone , Spencer Barnes , Nir Horesh , Steven D. Wexner
Introduction
The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) Program are major national cancer databases. While widely used, it is unclear if studies from each yield consistent conclusions on similar questions. This study compared findings from NCDB and SEER studies on rectal adenocarcinoma care to assess concordance.
Methods
This PRISMA-compliant systematic review included studies evaluating rectal adenocarcinoma care using NCDB or SEER data. The main outcome was concordance or discordance between studies with overlapping topics.
Results
Of 310 screened studies, 30 addressed overlapping questions, with nine areas of overlap, and major disagreements in four. SEER studies showed a survival benefit of neoadjuvant radiation therapy (NRT) in mucinous adenocarcinoma, unlike NCDB studies. Other differences involved adjuvant therapy for stage T3N0 and stage II disease, and lymph node yield cutoffs.
Conclusion
Most NCDB and SEER study conclusions were consistent, with discrepancies limited to controversial areas.
{"title":"Consistency of outcomes of studies on rectal cancer from the NCDB and SEER databases: A systematic review","authors":"Justin Dourado , Matthew Bilotti , Sameh Hany Emile , Anjelli Wignakumar , Cameron Perrone , Spencer Barnes , Nir Horesh , Steven D. Wexner","doi":"10.1016/j.amjsurg.2025.116728","DOIUrl":"10.1016/j.amjsurg.2025.116728","url":null,"abstract":"<div><h3>Introduction</h3><div>The National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) Program are major national cancer databases. While widely used, it is unclear if studies from each yield consistent conclusions on similar questions. This study compared findings from NCDB and SEER studies on rectal adenocarcinoma care to assess concordance.</div></div><div><h3>Methods</h3><div>This PRISMA-compliant systematic review included studies evaluating rectal adenocarcinoma care using NCDB or SEER data. The main outcome was concordance or discordance between studies with overlapping topics.</div></div><div><h3>Results</h3><div>Of 310 screened studies, 30 addressed overlapping questions, with nine areas of overlap, and major disagreements in four. SEER studies showed a survival benefit of neoadjuvant radiation therapy (NRT) in mucinous adenocarcinoma, unlike NCDB studies. Other differences involved adjuvant therapy for stage T3N0 and stage II disease, and lymph node yield cutoffs.</div></div><div><h3>Conclusion</h3><div>Most NCDB and SEER study conclusions were consistent, with discrepancies limited to controversial areas.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116728"},"PeriodicalIF":2.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676154","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}
Pub Date : 2025-11-20DOI: 10.1016/j.amjsurg.2025.116734
Jennifer Den, Caroline Baughn, V. Suzanne Klimberg
Objective
In 2002, the ATAC trial (Arimidex, Tamoxifen, Alone or in Combination) established anastrozole as the preferred adjuvant treatment over tamoxifen in postmenopausal women (disease-free survival at 89.4 % vs. 87.4 %) with hormone receptor-positive breast cancer (BC). The efficacy demonstrated in the ATAC trial led to the broader adoption of aromatase inhibitors in younger women. This practice necessitates using GnRH agonists or ovarian ablation to induce menopause, which causes significant side effects such as bone deterioration. Our study aimed to compare local recurrence (LR) and overall survival (OS) between anastrozole and tamoxifen for low Oncotype Recurrence Scores (RS). We hypothesize that there is little to no difference in LR and OS between the two medications in both pre- and postmenopausal women.
Methods
The TriNetX database was used to create retrospective cohort studies based on low (0–17) Oncotype RS. We conducted two studies comparing women <50 or >50 years old who were treated with either anastrozole or tamoxifen. All studies excluded Stage 4 or T4 tumors and had propensity scores matched by age, tumor stage, tumor size (T), and nodal status (N). Outcomes of interest were 10-year OS and LR.
Results
For patients aged >50, there were 1734 patients on anastrozole and 682 on tamoxifen, with 582 patients per cohort after matching. Within 10 years, 10 or fewer patients died, with no statistically significant difference in 10-year OS (KM analysis: 98 % vs. 97 %, p = 0.6). LR was 7.2 % in the anastrozole group and 7.6 % in the tamoxifen group, with no statistically significant difference (HR 1, 95 % CI, 0.69–1.65).
For patients aged <50, 94 received anastrozole and 270 received tamoxifen, with 82 matched patients included in the analysis. Within 10 years, no patients died, and 10 or fewer experienced LR. There was no significant difference in both 10-year OS (KM analysis: 100 % vs. 100 %, p = 1) and LR (12 % vs. 12 %, HR 2, 95 % CI, 0.59–6.56).
Conclusions
In both pre- and postmenopausal women, there is no difference in 10-year OS or LR between anastrozole and tamoxifen for BC patients with low Oncotype RS. We conclude that Stage 1–3, T1-T3 pre- and postmenopausal BC patients with Oncotype RS between 0 and 17 can safely choose either medication. This finding is of particular importance for premenopausal women who wish to avoid the adverse side effects of medically induced menopause and bone deterioration associated with the anastrozole and ovarian suppression approach.
目的2002年，ATAC试验（Arimidex，他莫昔芬，单独或联合）确定阿那曲唑是激素受体阳性乳腺癌（BC）绝经后妇女（无病生存率分别为89.4%和87.4%）的首选辅助治疗，而不是他莫昔芬。在ATAC试验中显示的疗效导致芳香酶抑制剂在年轻女性中的广泛应用。这种做法需要使用GnRH激动剂或卵巢消融术来诱导绝经，这会导致严重的副作用，如骨质恶化。我们的研究旨在比较阿那曲唑和他莫昔芬对低肿瘤复发评分（RS）的局部复发（LR）和总生存（OS）。我们假设两种药物对绝经前和绝经后妇女的LR和OS几乎没有差异。方法利用TriNetX数据库建立基于低（0-17）癌型RS的回顾性队列研究。我们进行了两项研究，比较了50岁和50岁的女性接受阿那曲唑或他莫昔芬治疗。所有的研究都排除了4期或T4期肿瘤，并且倾向评分与年龄、肿瘤分期、肿瘤大小(T)和淋巴结状态(N)相匹配。感兴趣的结果是10年OS和LR。结果50岁患者中，阿那曲唑组1734例，他莫昔芬组682例，配对后每组582例。10年内，10例或更少患者死亡，10年OS无统计学差异（KM分析：98% vs 97%， p = 0.6）。阿那曲唑组LR为7.2%，他莫昔芬组为7.6%，差异无统计学意义（HR 1, 95% CI, 0.69-1.65）。对于50岁的患者，94例接受阿那曲唑治疗，270例接受他莫昔芬治疗，其中82例匹配患者纳入分析。在10年内，没有患者死亡，10例或更少的患者经历了LR。10年OS （KM分析：100% vs 100%， p = 1）和LR （12% vs 12%, HR 2, 95% CI, 0.59-6.56）均无显著差异。结论在绝经前和绝经后女性中，阿那曲唑和他莫昔芬对于低RS Oncotype的BC患者的10年OS和LR没有差异，我们认为1-3期、T1-T3期绝经前和绝经后RS Oncotype在0- 17之间的BC患者可以安全地选择任何一种药物。这一发现对绝经前妇女特别重要，她们希望避免药物引起的绝经和与阿那曲唑和卵巢抑制方法相关的骨质退化的不良副作用。
{"title":"Is anastrozole really better than tamoxifen for low-risk breast cancer?","authors":"Jennifer Den, Caroline Baughn, V. Suzanne Klimberg","doi":"10.1016/j.amjsurg.2025.116734","DOIUrl":"10.1016/j.amjsurg.2025.116734","url":null,"abstract":"<div><h3>Objective</h3><div>In 2002, the ATAC trial (Arimidex, Tamoxifen, Alone or in Combination) established anastrozole as the preferred adjuvant treatment over tamoxifen in postmenopausal women (disease-free survival at 89.4 % vs. 87.4 %) with hormone receptor-positive breast cancer (BC). The efficacy demonstrated in the ATAC trial led to the broader adoption of aromatase inhibitors in younger women. This practice necessitates using GnRH agonists or ovarian ablation to induce menopause, which causes significant side effects such as bone deterioration. Our study aimed to compare local recurrence (LR) and overall survival (OS) between anastrozole and tamoxifen for low Oncotype Recurrence Scores (RS). We hypothesize that there is little to no difference in LR and OS between the two medications in both pre- and postmenopausal women.</div></div><div><h3>Methods</h3><div>The TriNetX database was used to create retrospective cohort studies based on low (0–17) Oncotype RS. We conducted two studies comparing women <50 or >50 years old who were treated with either anastrozole or tamoxifen. All studies excluded Stage 4 or T4 tumors and had propensity scores matched by age, tumor stage, tumor size (T), and nodal status (N). Outcomes of interest were 10-year OS and LR.</div></div><div><h3>Results</h3><div>For patients aged >50, there were 1734 patients on anastrozole and 682 on tamoxifen, with 582 patients per cohort after matching. Within 10 years, 10 or fewer patients died, with no statistically significant difference in 10-year OS (KM analysis: 98 % vs. 97 %, p = 0.6). LR was 7.2 % in the anastrozole group and 7.6 % in the tamoxifen group, with no statistically significant difference (HR 1, 95 % CI, 0.69–1.65).</div><div>For patients aged <50, 94 received anastrozole and 270 received tamoxifen, with 82 matched patients included in the analysis. Within 10 years, no patients died, and 10 or fewer experienced LR. There was no significant difference in both 10-year OS (KM analysis: 100 % vs. 100 %, p = 1) and LR (12 % vs. 12 %, HR 2, 95 % CI, 0.59–6.56).</div></div><div><h3>Conclusions</h3><div>In both pre- and postmenopausal women, there is no difference in 10-year OS or LR between anastrozole and tamoxifen for BC patients with low Oncotype RS. We conclude that Stage 1–3, T1-T3 pre- and postmenopausal BC patients with Oncotype RS between 0 and 17 can safely choose either medication. This finding is of particular importance for premenopausal women who wish to avoid the adverse side effects of medically induced menopause and bone deterioration associated with the anastrozole and ovarian suppression approach.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116734"},"PeriodicalIF":2.7,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616370","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}
Pub Date : 2025-11-19DOI: 10.1016/j.amjsurg.2025.116738
Natasha A. Sioda , Valerie L. Armstrong , Grace Madura , Marko A. Laitinen , Elisabeth S. Lim , Yu-Hui H. Chang , Kristi Harold , David Pearson , Enrique Elli , Todd Kellogg , James A. Madura
Background
The obesity epidemic has resulted in an accompanied increase in bariatric surgery volumes in the United States. The present study aims to analyze trends and indications for revision of bariatric operations.
Methods
A retrospective review of patients who underwent revisional bariatric surgery at a multi-site single institution from 2000 to 2022.
Results
901 patients were identified; the primary operations leading to revision was Roux-en-Y gastric bypass (RYGB) (n = 413), gastric banding (n = 276), sleeve gastrectomy (SG) (n = 157), and other (N = 55); with mean follow-up of 2.6 years.
Conclusions
Bariatric revisions have varied over time related to the incidence and outcomes of the most popular primary operations. SG has become the most common operation undergoing revision. Weight regain or inadequate weight loss was the most common reason for revision, with majority of patients undergoing revision to RYGB. At our institution, revision to RYGB yielded the most significant improvement in results at most recent follow up.
{"title":"22-year experience with bariatric revision surgery; What have we learned?","authors":"Natasha A. Sioda , Valerie L. Armstrong , Grace Madura , Marko A. Laitinen , Elisabeth S. Lim , Yu-Hui H. Chang , Kristi Harold , David Pearson , Enrique Elli , Todd Kellogg , James A. Madura","doi":"10.1016/j.amjsurg.2025.116738","DOIUrl":"10.1016/j.amjsurg.2025.116738","url":null,"abstract":"<div><h3>Background</h3><div>The obesity epidemic has resulted in an accompanied increase in bariatric surgery volumes in the United States. The present study aims to analyze trends and indications for revision of bariatric operations.</div></div><div><h3>Methods</h3><div>A retrospective review of patients who underwent revisional bariatric surgery at a multi-site single institution from 2000 to 2022.</div></div><div><h3>Results</h3><div>901 patients were identified; the primary operations leading to revision was Roux-en-Y gastric bypass (RYGB) (n = 413), gastric banding (n = 276), sleeve gastrectomy (SG) (n = 157), and other (N = 55); with mean follow-up of 2.6 years.</div></div><div><h3>Conclusions</h3><div>Bariatric revisions have varied over time related to the incidence and outcomes of the most popular primary operations. SG has become the most common operation undergoing revision. Weight regain or inadequate weight loss was the most common reason for revision, with majority of patients undergoing revision to RYGB. At our institution, revision to RYGB yielded the most significant improvement in results at most recent follow up.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116738"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616364","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}
Pub Date : 2025-11-19DOI: 10.1016/j.amjsurg.2025.116731
Matthew T. Parrish , Katie Bews , Stephanie F. Polites , Elizabeth B. Habermann
Background
Transfusion within 72 h after surgery (BT) is associated with increased postoperative morbidity in pediatric patients, but the impact of preoperative transfusion (PBT), given within 48 h before surgery, is unclear. We hypothesize that PBT is associated with lower morbidity than BT.
Methods
Pediatric (<18-years-old) general surgery patients who received PBT or BT were identified from the 2012–2022 NSQIP-P files, excluding those with preoperative hematocrit <21 %. PBT and BT patients were propensity-score matched with rates of postoperative infection (PI) and surgical site infections (SSI) compared using logistic regression.
Results
Among 15,401 patients, 4559 (30 %) received PBT and 10,842 (70 %) received BT. After matching, 3439 PBT patients were compared to 3439 BT patients. PBT was associated with fewer PI (8 % vs 10 %; OR = 0.75, 95 % CI 0.64–0.89) and SSI (5 % vs 8 %, OR = 0.72, 95 % CI 0.59–0.87).
Conclusions
PBT was associated with lower odds of postoperative infections compared to BT in matched pediatric general surgery patients.
背景：儿科患者术后72小时内输血与术后发病率增加有关，但术前48小时内输血的影响尚不清楚。方法从2012-2022年NSQIP-P文件中确定接受PBT或BT的儿科（18岁）普外科患者，不包括术前红细胞压积21%的患者。采用logistic回归比较PBT和BT患者的倾向评分与术后感染（PI）和手术部位感染（SSI）的发生率相匹配。结果15401例患者中，4559例（30%）接受PBT治疗，10842例（70%）接受BT治疗，配对后，PBT患者3439例，BT患者3439例。PBT与较低的PI （8% vs 10%; OR = 0.75, 95% CI 0.64-0.89）和SSI （5% vs 8%, OR = 0.72, 95% CI 0.59-0.87）相关。结论在匹配的儿童普外科患者中，与BT相比，spbt与术后感染的发生率较低相关。
{"title":"Rethinking transfusion timing: Evaluating preoperative transfusion morbidity using a national pediatric database","authors":"Matthew T. Parrish , Katie Bews , Stephanie F. Polites , Elizabeth B. Habermann","doi":"10.1016/j.amjsurg.2025.116731","DOIUrl":"10.1016/j.amjsurg.2025.116731","url":null,"abstract":"<div><h3>Background</h3><div>Transfusion within 72 h after surgery (BT) is associated with increased postoperative morbidity in pediatric patients, but the impact of preoperative transfusion (PBT), given within 48 h before surgery, is unclear. We hypothesize that PBT is associated with lower morbidity than BT.</div></div><div><h3>Methods</h3><div>Pediatric (<18-years-old) general surgery patients who received PBT or BT were identified from the 2012–2022 NSQIP-P files, excluding those with preoperative hematocrit <21 %. PBT and BT patients were propensity-score matched with rates of postoperative infection (PI) and surgical site infections (SSI) compared using logistic regression.</div></div><div><h3>Results</h3><div>Among 15,401 patients, 4559 (30 %) received PBT and 10,842 (70 %) received BT. After matching, 3439 PBT patients were compared to 3439 BT patients. PBT was associated with fewer PI (8 % vs 10 %; OR = 0.75, 95 % CI 0.64–0.89) and SSI (5 % vs 8 %, OR = 0.72, 95 % CI 0.59–0.87).</div></div><div><h3>Conclusions</h3><div>PBT was associated with lower odds of postoperative infections compared to BT in matched pediatric general surgery patients.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"252 ","pages":"Article 116731"},"PeriodicalIF":2.7,"publicationDate":"2025-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145616361","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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