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In This Issue of JAMA Surgery
December 2018

Highlights

JAMA Surg. 2018;153(12):1069. doi:10.1001/jamasurg.2017.3711
Research

Poor functional status creates considerable burden on patients receiving esophagogastric care. Few data exist on prehabilitation via preoperative exercise and nutrition for this disease category. Minnella and colleagues conducted a randomized clinical trial at McGill University Health Centre (Montréal, Québec, Canada), involving 51 patients undergoing surgery for esophagogastric cancer. Compared with standard care, prehabilitation improved preoperative physical status and significantly attenuated functional decline associated with surgery.

Invited Commentary

Breast cancer surgery is the most common cancer operation performed in residents of nursing homes. Tang and colleagues used data from the 2003-2012 Medicare files and Minimum Dataset to examine functional and mortality outcomes of 5969 residents of long-term stay nursing homes who were 67 years or older and had undergone breast cancer surgery. Among this cohort, 30-day and 1-year all-cause mortality and functional decline are high.

Invited Commentary

The association of a mandatory prescription drug monitoring program (PDMP) use on opioid prescribing by surgeons is unclear. Stucke and colleagues compared opioid prescribing before and after PDMP use was mandated in New Hampshire. The authors found that this burdensome requirement did not change the proportion of patients prescribed opioids or the number of pills prescribed for patients undergoing general surgical procedures.

Continuing Medical Education

The eighth edition of the American Joint Committee on Cancer TNM staging system for pancreatic cancer made changes in the T classification and N classification, but lacks international validation. Van Roessel and colleagues retrospectively staged 1525 patients from Europe and the United States with resected pancreatic cancer according to the seventh and eighth editions of the TNM staging system. They found that the eighth edition demonstrated increased prognostic accuracy. The incremental value of the new T classification is limited, whereas the new N classification is highly prognostic.

Invited Commentary

Clinical Review & Education

This is to our knowledge the first systematic review addressing inguinal hernias specifically in women. Schmidt and colleagues reviewed a total of 55 studies that included 43 870 women with primary inguinal hernia to investigate rates and types of recurrences in women who had undergone repair of primary inguinal hernia. The crude recurrence rate was lower after laparoscopic repair than open repair, and a substantial number of recurrences after open repair were femoral hernias.

Continuing Medical Education

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