American Surgeon最新文献

This article is a review of the characteristics of bilateral breast cancer (BBC). Synchronous bilateral breast cancer (SBBC) and metachronous bilateral breast cancer (MBBC) account for 2.9-3.9% and 4.1-4.6% of all new breast cancer cases, respectively. The risk factors for SBBC include older patient age and lobular histology. On the other hand, younger age, lobular histology, and positive family history (or genetic factors) are the risk factors for MBBC. Contralateral prophylactic mastectomy in patients with mutations in the BRCA1/2 genes has been reported to increase survival rates. The prognosis of patients with SBBC is worse than the prognosis of patients with unilateral breast cancer (UBC). The prognosis of patients with MBBC compared to patients with UBC remains undetermined because the ages of patients and the intervals between the occurrence of two primary breast cancers appear to have a major impact on survival outcomes. The differences between SBBC and MBBC need clarification to increase our understanding of BBCs.

Purpose: Bariatric surgery is a widely used treatment for obesity; however, it may be associated with certain complications. Effective postoperative management, including lifestyle interventions and exercise training, is essential for optimal outcomes. This study explores the effectiveness of exercise training in postoperative care.

Methods: We searched PubMed, Web of Science, Cochrane, and Embase up to April 3, 2024. Articles were screened and data extracted based on inclusion/exclusion criteria. Risk of bias was assessed using RoB 2.0, and data were analyzed with Stata 15.0.

Results: Twenty-three articles involving 1940 patients were included; 16 were analyzed quantitatively. Exercise training did not significantly reduce body weight compared to routine care (WMD: -0.26; 95% CI, -2.11 to 1.58; I² = 54%), but it significantly reduced fat mass (WMD: -2.42; 95% CI, -3.50 to -1.34; I² = 42.9%) and maintained lean mass (WMD: 1.40; 95% CI, 0.32 to 2.48; I² = 0.0%). Additionally, it reduced waist circumference (WMD: -2.58; 95% CI, -4.43 to -0.73; I² = 13.4%) and improved exercise capacity (VO₂ max: WMD: 1.88; 95% CI, 0.64 to 3.13; I² = 0.0%).

Conclusion: While exercise training did not significantly lower body weight post-surgery, it effectively reduced fat mass, maintained lean mass, and improved waist circumference and exercise capacity. Given the limited sample sizes in most studies, further large-scale controlled trials are warranted for more definitive conclusions, along with further consideration of their long-term impact on health metrics.

Significant disparities exist in women with endometrial cancer. Disparate incidence and mortality rates affect many populations including racial/ethnic minority women and women who live in rural communities. These populations are more likely to experience delays in care due to multi-dimensional factors ranging from lack of awareness between the women and their non-gynecologic providers to lack of access to health care and/or to gynecologic oncologists. Multiple layers of intervention will be needed to mitigate the inequities, including policy changes, advocacy to change insurance coverage, and network inclusion of gynecologic oncologists. There are opportunities for non-gynecological surgical specialists who take care of women at risk of endometrial cancer to facilitate multidisciplinary care and to refer as appropriately to gynecologic specialty care.

Pneumatosis and portal venous gas are radiological findings that have been historically associated with 70% mortality, and usually trigger surgical intervention. This is due to their association with acute mesenteric ischemia. As cross-sectional imaging usage has increased in recent years, these findings have also been observed in patients with indolent symptoms, the true mortality among patients with pneumatosis or portal venous gas is now theorized to be significantly lower than previously stated. This systematic review was designed to assess the mortality rate among patients with pneumatosis and portal venous gas on initial imaging. We systematically searched Embase, Web of Science, PubMed, and Scopus. Eleven articles were included for final analysis. Ten articles assessed mortality, and included a total of 308 patients, with an overall mortality rate of 31%. Eight articles reported on both ischemia and mortality (n = 233). Of the patients with confirmed ischemia (n = 74), a mortality rate of 69% (n = 51) was noted. Of those without ischemia (n = 159), a mortality rate of 14% (n = 22) was seen. Four studies reported pneumatosis and ischemia (n = 45), in which 64% (n = 29) had ischemia. Four articles reported on portal venous air and ischemia (n = 78). Ischemia was confirmed in 44% of these patients (n = 34). Given an overall mortality of 31% vs prior estimates of 70% for patients with these findings, the decision for surgery on patients with these imaging findings should be made utilizing the overall clinical picture of the patient.

Background: The American Board of Surgery (ABS) In-Training Examination (ABSITE) scores are predictive of passing the ABS qualifying exam and have become a marker of residency education success. A competitive team-based approach to encourage self-studying and didactic participation is a novel method of ABSITE preparation. We aimed to determine if this method significantly improves residents' percentile performances on the ABSITE.

Methods: Retrospective review of ABSITE percentile scores were compared before and after implementation of a purchased online question bank (TrueLearn LLC, Mooresville, NC), a team-based competition, and a virtual format of the team-based competition.

Results: The median ABSITE percentile at the program level increased from 40.0 (IQR 21.0-67.0) in 2011 to 77.0 by 2022 (IQR 60.0-91.0) (P < 0.0001). After implementation of the team-based competition, ABSITE median percentile rose significantly from 67.0 (IQR 31.5-85.5) to 84.5 (IQR 60.8-91.0) (P = 0.026). This did not change significantly after a transition to a virtual format of the team-based competition in 2021 (P = 0.146) and 2022 (P = 0.335). There was no significant relationship between the number of TrueLearn questions taken and ABSITE scores specifically before and after implementation of the team-based competition (AUC = 0.0002, Spearman's r (67) 0.064, P = 0.605). Furthermore, the team-based competition was well received by residents and was believed to be beneficial to their studying.

Discussion: The team-based competition is easy to implement and improves ABSITE performance through means other than encouraging residents to take more practice questions. The team-based competition is well-received by residents and may prove beneficial to board examination preparation and pass rates.

Background: A difficult laparoscopic cholecystectomy (LC) confers an increased risk of bile duct injury. Traditionally, surgeons convert to open cholecystectomy (OC) as a bailout procedure for safer dissection. Laparoscopic subtotal cholecystectomy (LSC) has recently gained favor with comparable short-term complication rates, but differences in long-term outcomes remain unknown. We sought to compare long-term biliary outcomes between OC and LSC.

Study design: We performed a single-center retrospective cohort study of adults who underwent non-elective LC converted to OC or LSC due to difficult dissection from 1/1/2015 to 12/31/2019. The primary outcome was a composite measure of postoperative biliary events, and we used time-to-event analysis to compare the 2 groups. We evaluated secondary outcomes using Chi-squared or independent t-tests as appropriate.

Results: Of 1089 patients who underwent non-elective LC, 68 (6%) underwent a bailout procedure (30 OC vs 38 LSC). There were no differences in demographics or comorbidities between the groups. Most patients (84%) had acute cholecystitis. Average follow-up times were 40 ∓ 29 months in OC and 54 ∓ 21 months in LSC. Biliary events occurred in 13 total patients (19%) with OC most commonly suffering bile leak (17%) and LSC most commonly having choledocholithiasis (11%). Kaplan-Meier analysis demonstrated no significant difference in biliary events between the groups (P = 0.71). Secondary outcomes were all similar between groups, except LSC had a shorter length of stay (2.9 ∓ 2.3 vs 5.1 ∓ 3.6 days, P = 0.002).

Conclusions: OC and LSC demonstrated comparable long-term biliary outcomes. In a difficult LC, surgeons may perform either bailout procedure to safely manage the gallbladder.

While there is agreement on the indications for intracranial pressure monitoring (ICPm) in patients with sTBI, there continues to be controversy concerning the ideal timing of its implementation. It is within this context that we decided to investigate whether a protocolization approach could optimize the timeliness of ICPm implementation. Neurosurgical and SICU providers agreed to a 3-tier protocol to identify patients with sTBI who could benefit from timelier ICPm implementation. The monthly compliance was monitored for a 9-month period. The study included a pre-protocolization group of 11 patients (2022) and a post-protocolization group of 9 patients (2023-2024). There was a trend toward earlier use of ICPm but the difference did not achieve statistical significance; there was no difference in the mortality rates between groups. A protocolization approach to the treatment of patients with sTBI developed with a consensus strategy may lead to earlier implementation of ICPm and possibly improved functional outcome.