JAMA Surgery

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IMPORTANCE: Evidence of implementation of laparoscopic gastrectomy for locally advanced gastric cancer is currently insufficient, as the primary end point in previous prospective studies was evaluated at a median follow-up time of 3 years. More robust evidence is necessary to verify noninferiority of laparoscopic gastrectomy. OBJECTIVE: To compare 5-year survival outcomes between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) with D2 lymph node dissection for locally advanced gastric cancer...

IMPORTANCE: Pseudomyxoma peritoni, a rare condition characterized by mucinous ascites and peritoneal deposits, mainly originates from a ruptured mucinous appendix tumor and is considered an indolent disease but can progress and become fatal. Optimal treatment to improve cure and survival rates involves complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Accurate predictive models are useful in supporting and informing treatment strategies and stratifying patient follow-up...

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IMPORTANCE: Understanding how to translate workplace-based assessment (WBA) ratings into metrics that communicate the ability of a surgeon to perform a procedure would represent a critical advancement in graduate medical education. OBJECTIVE: To evaluate the association between past and future performance in a comprehensive assessment system for the purpose of assessing point-in-time competence among general surgery trainees. DESIGN, SETTING, AND PARTICIPANTS: This case series included WBA ratings from September 2015 to September 2021 from the WBA system of the Society for Improving Medical Professional Learning (SIMPL) for all general surgery residents who were provided a rating following an operative performance across 70 programs in the US...

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IMPORTANCE: It has been reported that women undergoing coronary artery bypass have higher mortality and morbidity compared with men but it is unclear if the difference has decreased over the last decade. OBJECTIVE: To evaluate trends in outcomes of women undergoing coronary artery bypass in the US from 2011 to 2020. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study at hospitals contributing to the Adult Cardiac Surgery Database of the Society of Thoracic Surgeons included 1 297 204 patients who underwent primary isolated coronary artery bypass from 2011 to 2020...

IMPORTANCE: There is a need for a new, less invasive breast reconstruction option for patients who undergo mastectomy in their breast cancer treatment. OBJECTIVE: To investigate quality of life (QoL) among patients undergoing a new breast reconstruction technique, autologous fat transfer (AFT), compared with that among patients undergoing implant-based reconstruction (IBR). DESIGN, SETTING, AND PARTICIPANTS: The BREAST trial was a randomized clinical trial conducted between November 2, 2015, and October 31, 2021, performed in 7 hospitals across the Netherlands...

IMPORTANCE: Although longer times from breast cancer diagnosis to primary surgery have been associated with worse survival outcomes, the specific time point after which it is disadvantageous to have surgery is unknown. Identifying an acceptable time to surgery would help inform patients, clinicians, and the health care system. OBJECTIVE: To examine the association between time from breast cancer diagnosis to surgery (in weeks) and overall survival and to describe factors associated with surgical delay...