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In This Issue of JAMA Surgery
April 2015


JAMA Surg. 2015;150(4):287. doi:10.1001/jamasurg.2014.2498


In an attempt to answer questions about surgical approaches for esophagectomy, Li and colleagues at the Shanghai Cancer Center in China conducted a randomized clinical trial of 300 patients. Patients were assigned to receive either Sweet or Ivor-Lewis esophagectomy. Early results provide evidence for the superiority of the Ivor-Lewis esophagectomy over the Sweet procedure with regard to short-term outcomes, including lymph node retrieval and overall morbidity for patients with cancer in the middle and lower thoracic esophagus. Both procedures are safe with low operative mortalities.

An inclusive list of high-risk operations may be helpful for surgeons, researchers, and policy makers. Schwarze and colleagues used 2 large hospital-based data sets and a modified Delphi procedure to generate and cross-validate a list of 227 surgical procedures with inpatient mortality of at least 1% for patients 65 years and older. These results provide a standard to define high-risk surgery that can be used in clinical and research settings.

Continuing Medical Education

The role of orthotopic liver transplantation for the treatment of benign liver tumors is not well defined. Sundar Alagusundaramoorthy et al performed a retrospective analysis of the United Network of Organ Sharing database and identified 147 liver transplants with overall 1-, 3-, and 5-year survival rates of 90.9%, 85.2%, and 81.8%, respectively. This analysis shows that liver transplantation is a valid therapeutic option in selected patients with benign solid liver tumors who are not amenable to resection.

Human immunodeficiency virus (HIV)/AIDS is a chronic condition, and patients are increasingly undergoing a variety of surgical procedures. King et al used nationwide VA databases to compare adjusted postoperative mortality in 1641 HIV-infected patients and 3282 procedure-matched uninfected controls. Mortality was inversely correlated with CD4 cell count, particularly at levels of less than 50/μL; however, other factors such as age and albumin level had equal or stronger associations with postoperative mortality.

The preferred bariatric procedure for patients with a body mass index (BMI) above 50 is not defined. Risstad et al compared 5-year outcomes after Roux-en-Y gastric bypass and biliopancreatic diversion with duodenal switch in a Scandinavian randomized clinical open-label trial of 60 patients with a BMI of 50 to 60. Duodenal switch resulted in greater weight loss and greater improvements in low-density lipoprotein cholesterol, triglyceride, and glucose levels 5 years after surgery compared with gastric bypass, while improvements in health-related quality of life were similar. However, duodenal switch was associated with more surgical, nutritional, and gastrointestinal adverse effects.

Invited Commentary

Continuing Medical Education