Tag: pubmed

Obes Surg. 2025 Aug 8. doi: 10.1007/s11695-025-08144-5. Online ahead of print.

ABSTRACT

BACKGROUND: Roux-en-Y gastric bypass (RYGB) has long been established as one of the most efficient therapeutic options for patients with obesity and associated medical conditions. However, the impact of concurrent vagal transection during pouch creation on postoperative outcomes remains underreported.

METHODS: This retrospective cohort study examined patients who underwent RYGB between January 2011 and December 2023, with 1 to 5 years of follow-up. Patients were stratified into two groups: vagal sparing RYGB (VS) and non-vagal sparing RYGB (NVS). Data collected included postoperative complications, intraoperative characteristics, weight trajectories, resolution of obesity-related medical conditions, and mortality. Statistical analysis methods included paired t-tests, multivariate regression, and Cox regression models.

RESULTS: Out of 1521 patients, 374 (24.6%) underwent VS-RYGB and 1147 (75.4%) had NVS-RYGB. Patients were predominantly female (80.8%), with a mean age of 47.6 ± 12.1 years and body mass index (BMI) of 46.0 ± 7.7 kg/m². NVS had significantly longer operative times (p < 0.001) and a higher lysis of adhesions rate (p < 0.001). Marginal ulcer rate was also significantly higher in NVS compared to VS (p = 0.03). In contrast, the rate of dumping syndrome (p = 0.13) and cholelithiasis (p = 0.65) was not significantly different between groups. While overall weight outcomes were similar, VS reached maximum percentage of total weight loss (%TWL) earlier (p = 0.02). Both groups showed comparable obesity-related condition outcomes.

CONCLUSION: NVS-RYGB was associated with higher operative time. Additionally, vagal transection was significantly associated with marginal ulcer occurrence. Our findings support the potential advantage of vagal-sparing RYGB.

PMID:40779279 | DOI:10.1007/s11695-025-08144-5

JAMA Netw Open. 2025 Aug 1;8(8):e2525252. doi: 10.1001/jamanetworkopen.2025.25252.

ABSTRACT

IMPORTANCE: Clostridioides difficile is a leading cause of health care-associated infections. Understanding the association among C difficile carriage, antibiotic use, and infection hazard is essential for infection prevention.

OBJECTIVE: To evaluate the hazard of C difficile infection (CDI) among asymptomatic carriers vs noncarriers of C difficile and whether it is associated with antibiotic exposure.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study conducted between June 18, 2017, and June 21, 2023, analyzed hospitalizations from Sheba Medical Center in Ramat Gan, Israel, which routinely screens for C difficile in high-risk patients admitted to internal medicine. Adult patients (aged >18 years) without active CDI at admission were included.

EXPOSURE: Antibiotic exposure during hospitalization, including specific classes.

MAIN OUTCOMES AND MEASURES: The primary outcome was the development of CDI, as confirmed by laboratory testing for C difficile. Antibiotic exposure was assessed as a time-varying variable.

RESULTS: The study included 33 756 hospitalizations among 23 001 patients (median [IQR] age, 78 [68-87] years; 52.8% men). C difficile infection occurred in 67 of 1624 hospitalizations (4.1%) with positive screening results and in 47 of 32 132 hospitalizations (0.1%) with negative screening results. A positive C difficile screening result at admission was associated with a high hazard of infection (hazard ratio [HR], 27.5; 95% CI, 18.7-40.3). Antibiotic exposure was associated with an increased hazard for CDI (HR, 1.98; 95% CI, 1.24-3.16). Piperacillin and tazobactam showed the most pronounced hazard for CDI (HR, 2.18; 95% CI, 1.41-3.36). Among asymptomatic carriers, antibiotic exposure was not significantly associated with a further increase in CDI hazard (HR, 1.07; 95% CI, 0.73-1.58).

CONCLUSIONS AND RELEVANCE: In this cohort study, carriers of C difficile had a substantially higher baseline hazard for hospital-onset CDI. Antibiotic exposure was associated with an increased hazard among noncarriers but was not significantly associated with additional hazard among carriers. These findings suggest that while antibiotic stewardship may reduce CDI risk in noncarriers, additional strategies may be needed for carriers given their elevated baseline risk.

PMID:40779269 | DOI:10.1001/jamanetworkopen.2025.25252

JAMA Netw Open. 2025 Aug 1;8(8):e2525809. doi: 10.1001/jamanetworkopen.2025.25809.

ABSTRACT

IMPORTANCE: Suicide is a leading cause of death in the US. Suicide-specific cognitive behavior therapy (CBT) is effective for reducing suicide attempts but is difficult to implement.

OBJECTIVE: To evaluate the efficacy of a smartphone-based digital therapeutic intervention designed to deliver suicide-focused CBT in reducing suicidal behavior among patients hospitalized for a suicide attempt or suicidal ideation.

DESIGN, SETTING, AND PARTICIPANTS: This multisite, double-blind, randomized clinical trial was conducted in 6 psychiatric inpatient units across the US. Adult patients admitted with elevated suicide risk from April 2022 to April 2024 were included. Participants completed a baseline assessment and were randomly assigned to either the digital therapeutic group or control application group. The trial was stopped early by the Data Management Safety Board because it surpassed the prespecified futility boundary for the primary end point. Statistical analysis followed the intention-to-treat principle.

INTERVENTIONS: The digital therapeutic intervention includes 12 sessions of smartphone-based educational modules (lasting 10-15 minutes each) drawn from CBT for suicide prevention. The active control is a 12-session smartphone-based application that delivers safety planning and psychoeducation about suicide. For both interventions, the first session was completed prior to hospital discharge and the remaining self-paced sessions could be completed after discharge. All participants also received treatment as usual, which included suicide risk assessment, supportive listening, crisis resources, clinician assessment, safety planning, and referral to outpatient treatment.

MAIN OUTCOMES AND MEASURES: The primary end point was time (days) to first actual suicide attempt during follow-up. The secondary end points were change in suicidal ideation from baseline to week 24 (quantified as a change in the Scale for Suicide Ideation total score) and clinician-rated clinical improvement at week 24. The nonprespecified sensitivity analysis end point for suicide attempts was the rate of suicide attempts (actual, aborted, and interrupted). Prespecified subgroup analyses were also conducted to examine treatment effects among patients with vs without prior suicide attempts.

RESULTS: A total of 339 participants (mean [SD] age, 27.9 [10.7] years; 224 females [66.1%]) were included. Follow-up data were available from 266 participants (78.5%). Time to first actual suicide attempt, the primary end point, was not significantly different across treatment groups (log-rank χ21 = 3.6; P = .06). Among the 170 participants with prior suicide attempts, nonprespecified sensitivity analyses indicated that the adjusted rate of follow-up suicide attempts was 58.3% lower in the digital therapeutic group than the control application group (0.70 vs 1.68 attempts per person-year; rate ratio [RR], 0.42 [95% CI, 0.18-0.95]; P = .04), and the odds of clinical improvement were higher in the digital therapeutic group than the control application group (97.9% vs 87.5%; odds ratio, 7.59; 95% CI, 1.14-153.62; P = .04). Trajectories of suicidal ideation significantly differed between the digital therapeutic and control application groups (F3,206 = 2.9, P = .04), with decreased suicidal ideation through week 24 in the digital therapeutic group, but in the control application group, suicidal ideation decreased through week 12 and then increased at week 24. Nonprespecified dose-response analyses indicated the suicide attempt rate among patients with a prior suicide attempt decreased by 14.0% for every digital therapeutic module completed (adjusted RR, 0.86; 95% CI, 0.76-0.98; P = .02).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the digital therapeutic intervention did not change the time to first actual suicide attempt but helped to sustain reductions in suicidal ideation among inpatients with elevated suicide risk. However, among patients with prior suicide attempts, the digital therapeutic intervention helped reduce recurrent suicide attempts and increased the percentage of inpatients with clinician-rated clinical improvement.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05144685.

PMID:40779267 | DOI:10.1001/jamanetworkopen.2025.25809

JAMA Netw Open. 2025 Aug 1;8(8):e2526013. doi: 10.1001/jamanetworkopen.2025.26013.

ABSTRACT

IMPORTANCE: Semaglutide, a glucagon-like peptide-1 receptor agonist, has demonstrated substantial weight reduction and cardiovascular benefits in clinical trials. However, its association with clinical outcomes and health care expenditures remains underexplored.

OBJECTIVE: To evaluate changes in cardiovascular risk factors and health care expenditures among patients prescribed semaglutide across multicenter cohorts.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included 23 522 adults (≥18 years) who received an initial semaglutide prescription between January 1, 2018, and January 1, 2025, at Sentara Healthcare and between January 1, 2018, and May 1, 2025, at Yale New Haven Health System.

EXPOSURE: The first prescription of semaglutide identified at the ingredient level, stratified by type 2 diabetes status.

MAIN OUTCOMES AND MEASURES: Primary outcomes included changes in weight (% baseline), blood pressure (BP), total cholesterol, and hemoglobin A1c. Secondary outcomes assessed health care expenditures using Medicare-based cost estimates. A staggered difference-in-differences design compared outcomes of patients after the first semaglutide prescription with those of patients who had not yet received their prescription during the same period.

RESULTS: The study cohort included 23 522 patients (mean [SD] age at initiation of semaglutide, 56.2 [12.9] years; 66.7% female; 68.6% with diabetes). In the overall cohort, initiation of semaglutide was significantly associated with a -3.8% (95% CI, -3.9% to -3.7%) reduction in weight at 13 to 24 months, with a -5.1% (95% CI, -5.5% to -4.7%) reduction in weight among patients without diabetes. Significant reductions in diastolic BP (-1.5 mm Hg; 95% CI, -1.7 to -1.4 mm Hg), systolic BP (-1.1 mm Hg; 95% CI, -1.4 to -0.8 mm Hg), and total cholesterol (-12.8 mg/dL; 95% CI, -14.3 to -11.4 mg/dL) were also observed. Hemoglobin A1c reductions were greater among patients with diabetes (-0.3%; 95% CI, -0.3% to -0.2%) compared with patients without diabetes (-0.1%; 95% CI, -0.2% to -0.01%). Imputed health care expenditures, excluding the cost of semaglutide, increased by $80 per month (95% CI, $68-$92 per month) during the 13- to 24-month period, which was associated with inpatient stays shifting to more expensive circulatory and metabolic diagnoses.

CONCLUSIONS AND RELEVANCE: In this cohort study of adults prescribed semaglutide, initiation was associated with reductions in weight and cardiovascular risk factors but increases in health care expenditures, excluding semaglutide costs. These findings suggest potential clinical benefits in routine practice, while highlighting the need to evaluate the long-term impact of semaglutide on economic outcomes.

PMID:40779264 | DOI:10.1001/jamanetworkopen.2025.26013

JAMA Netw Open. 2025 Aug 1;8(8):e2526912. doi: 10.1001/jamanetworkopen.2025.26912.

ABSTRACT

IMPORTANCE: Rural patients face unique barriers in obtaining high-quality cancer care. Research is lacking in determining whether these disparities translate to negative clinical outcomes.

OBJECTIVE: To determine if there are differences in the rate of biochemical recurrence in prostate cancer between rural and urban men.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study used patient data that was abstracted from the North Carolina Prostate Cancer Comparative Effectiveness and Survivorship Study, a population-based cohort that prospectively followed patients with newly diagnosed prostate cancer from the Rapid Case Ascertainment system of the North Carolina Central Cancer Registry from January 1, 2011, to June 30, 2013. Patients were identified who had received either surgery or radiation within 1 year of diagnosis. Data were analyzed from January 2011 to December 2022.

EXPOSURE: Patients were categorized as rural or urban using the Rural-Urban Continuum Code.

MAIN OUTCOME AND MEASURES: Recurrence was determined by prostate-specific antigen testing. Demographic differences between rural and urban patients were assessed using 2-sample independent t test and χ2 test. Prostate cancer recurrence was analyzed using Cox proportional hazard models.

RESULTS: A total of 778 patients were included with a median (IQR) follow-up of 4.6 (2.0 to 6.9) years and a mean (SD) age of 63 (7.4) years. Additionally, 213 were Black men (27.4%), 565 were White men (72.6%), 350 were Medicare insured (45.1%), 324 had an income ranging from $40 000 to $90 000 (43.1%), 370 were a National Comprehensive Cancer Network (NCCN) intermediate risk group (47.6%), 449 were treated with radical prostatectomy (57.7%), and 690 were in good to excellent health (88.7%) with 191 living in a rural setting (24.6%). On univariable analysis, rural residence (hazard ratio [HR], 2.19 [95% CI, 1.38 to 3.46]; P < .001), NCCN risk group (HR, 4.13 [95% CI, 2.25 to 7.57]; P < .001), and having had fewer than 12 biopsies (HR, 1.70 [95% CI, 1.08 to 2.67]; P = .02) were significantly associated with biochemical recurrence. On multivariable analysis adjusted for location of residence, marital status, overall health, number of cores biopsied, NCCN risk group, and treatment type, rural residence was significantly associated with recurrence (HR, 1.74 [95% CI, 1.07 to 2.82]; P = .03), while radiation therapy was inversely associated with recurrence (HR, 0.51 [95% CI, 0.31 to 0.85]; P = .01).

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with newly diagnosed prostate cancer, rural patients with prostate cancer had higher rates of biochemical recurrence. The etiology of this disparity is unclear but is likely multifactorial. Factors that may play a role include socioeconomic status, delay and disruptions in care, and access to multidisciplinary cancer care.

PMID:40779263 | DOI:10.1001/jamanetworkopen.2025.26912

JAMA Health Forum. 2025 Aug 1;6(8):e252284. doi: 10.1001/jamahealthforum.2025.2284.

ABSTRACT

IMPORTANCE: Patient cost sharing liability has risen in recent years, increasing the costs associated with care for patient households and imposing collections challenges for hospitals and clinicians.

OBJECTIVE: To measure patient repayment of cost sharing over recent years, and how that varies across patient, hospital, and service characteristics.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of billing and payment data from a revenue cycle management company examined patient accounts at 217 US hospitals from 2018 to 2024. Participants included 24.5 million and 6.2 million patient episodes of care with positive patient out-of-pocket liability for individuals with private insurance and Medicare Advantage, respectively.

MAIN OUTCOMES AND MEASURES: Percentage of owed patient cost sharing actually paid among patients with private insurance and Medicare Advantage measured over time, for inpatient and outpatient care and by bill size.

RESULTS: Across the full sample of 217 US hospitals (30.7 million patient episodes), mean (SD) patient liability per person, including those with no liability, was higher for individuals with private insurance ($375.41 [$51.55]) than those with Medicare Advantage ($172.50 [$14.84]). Consistent with high-deductible plan design with annual resetting, mean patient liability was higher for visits in January than December, particularly among the privately insured (eg, mean [SD] patient liability for visits among the privately insured in January: $479.44 [$29.21] vs December: $321.63 [$14.29]). Prior to the COVID-19 pandemic (January 2018-February 2020), mean repayment rates were 53.9% and 54.0% for patients with private or Medicare Advantage insurance, respectively, and repayment rates declined in more recent years. Across the entire sample, patients with private or Medicare Advantage insurance paid either 0% or 100% of their owed cost sharing in 92.2% and 94.1% of cases, respectively. Repayment rates varied by bill size with lower repayment rates on the largest bills and the smallest bills, and higher repayment rates on midsized bills.

CONCLUSIONS AND RELEVANCE: This cross-sectional study found that patient cost sharing repayments were incomplete and have fallen in more recent years, which result in both medical debts for patients and collections shortfalls for hospitals and clinicians. These findings suggest that changes to insurance plan design or the treatment of medical debt are among several factors that may contribute to observed results; if declines in cost sharing repayment continue, hospitals and clinicians may increasingly seek payment of cost sharing ahead of service, when allowable.

PMID:40779258 | DOI:10.1001/jamahealthforum.2025.2284

JAMA Health Forum. 2025 Aug 1;6(8):e252329. doi: 10.1001/jamahealthforum.2025.2329.

ABSTRACT

IMPORTANCE: Achieving equitable access to medicines requires understanding of how pharmaceutical use and spending vary by race and ethnicity across the US.

OBJECTIVE: To quantify variation in prescription drug utilization and spending per capita and per prevalent case by race, ethnicity, health condition, payer, and US state.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, the US Disease Expenditure project was extended to incorporate disaggregation by race and ethnicity for state-level retail prescription drug utilization and spending-in addition to 143 health conditions, 38 age and sex groups, and 4 payers (Medicare, Medicaid, private insurance, and out of pocket)-across the 2019 population in all 50 states and Washington, DC. Data were analyzed from October 2023 to April 2025.

EXPOSURE: Four mutually exclusive racial and ethnic groups (Asian or Pacific Islander, Black, Hispanic, and White).

MAIN OUTCOME AND MEASURES: Outcomes include prescriptions dispensed and spending for retail pharmaceuticals. Estimates were standardized by population size, population age, and-where data permitted-by disease burden (52 conditions). Das Gupta decomposition was used to estimate the relative contribution of 3 factors (disease prevalence, prescriptions per prevalent case, and spending per prescription) on observed disparities in age-standardized per capita pharmaceutical spending.

RESULTS: In 2019, age-standardized pharmaceutical utilization and spending per person with a given disease was substantially lower than the all-population mean for Black populations, close to the mean for Hispanic populations, and often higher than the mean for Asian or Pacific Islander and White populations. These trends-particularly those for the Black population-were generally consistent across 52 health conditions but varied widely across payers and US states. The decomposition analysis for these 52 conditions showed that differences in per capita pharmaceutical spending across race and ethnicity groups were primarily explained by disease prevalence for Black populations (associated with increased per capita spending) and by utilization rates per prevalent case for Hispanic populations (also associated with increased spending). In contrast, differences in drug price or product type (spending per prescription) contributed less to observed spending disparities.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study, racial and ethnic disparities in medication use persisted, most notably the underutilization of medicines relative to disease burden among Black populations. These patterns varied by state, highlighting the need for local- and condition-specific approaches to advancing pharmacoequity in the US.

PMID:40779257 | DOI:10.1001/jamahealthforum.2025.2329

JAMA Health Forum. 2025 Aug 1;6(8):e252999. doi: 10.1001/jamahealthforum.2025.2999.

ABSTRACT

IMPORTANCE: Temporary Assistance for Needy Families (TANF) is a major federal cash assistance program for low-income families, but the program has strict eligibility criteria, meager cash benefits, and cumbersome administrative burdens that limit its effect. However, during the COVID-19 pandemic state TANF programs implemented policy changes to expand program access, including relaxed work requirements and additional income. Few studies have examined the association of these policy changes with health outcomes.

OBJECTIVE: To analyze the association between TANF policy changes during the COVID-19 pandemic and breastfeeding initiation and duration.

DESIGN, SETTING, AND PARTICIPANTS: This study used serial cross-sectional national data from the Pregnancy Risk Assessment Monitoring System (2017-2020) and a quasi-experimental difference-in-differences analysis to examine whether TANF policy changes affected breastfeeding behaviors among likely TANF participants compared with likely nonparticipants. Multivariable linear regression analyses were conducted that adjusted for individual and state-level covariates. The study was conducted between November 2024 and May 2025.

EXPOSURES: Gave birth in a state that implemented TANF policy changes (eg, 1-time cash payments, waiving in-person interviews and work requirements, and extending time limits).

MAIN OUTCOMES AND MEASURES: Self-reported measures of whether breastfeeding was initiated and breastfeeding duration in weeks.

RESULTS: The sample included 138 700 individuals; the likely TANF participants were less likely to be White (~33%) or married (~37%), were younger (~29% were 20-24 years of age), had lower incomes (~$30 000), and were more likely to have 2 or more previous births (~39%) compared with the likely nonparticipants. The TANF policy changes that expanded eligibility and decreased administrative burdens were associated with increased breastfeeding initiation and duration; eg, waiving sanctions was associated with increased breastfeeding initiation (2.59 percentage points [95% CI, 0.13-5.06 percentage points]) and automatic recertification was associated with increased breastfeeding duration (0.49 weeks [95% CI, 0.04-0.94 weeks]). Providing 1-time cash payments was also associated with increased breastfeeding duration (1 week [95% CI, 0.42-1.58 weeks]). These positive associations were found across all racial and ethnic groups, although some 95% CIs included the null.

CONCLUSIONS AND RELEVANCE: In this quasi-experimental study, state TANF policies that expanded eligibility, increased cash payments, and decreased administrative burdens were associated with increased breastfeeding initiation and duration. These findings inform active policymaking on antipoverty policies.

PMID:40779256 | DOI:10.1001/jamahealthforum.2025.2999

Int J Clin Oncol. 2025 Aug 8. doi: 10.1007/s10147-025-02846-7. Online ahead of print.

ABSTRACT

BACKGROUND: A post-marketing surveillance (PMS) study was conducted in Japan to assess real-world outcomes with radium-223 treatment in men with metastatic castration-resistant prostate cancer (mCRPC). Results from the treatment period showed that radium-223 was generally well tolerated. Follow-up was subsequently extended to 3 years to collect data on fracture events. Results of the extended follow-up are now reported.

METHODS: This prospective, non-interventional, multicenter, single-cohort PMS study enrolled men with CRPC and bone metastases treated with radium-223 under clinical practice. Extended follow-up lasted until 3 years after the first administration of radium-223. Data on clinical fractures and survival were collected.

RESULTS: A total of 334 patients were enrolled, with a median follow-up of 15.3 months (range 1-50). The overall incidence proportion of fractures reported as adverse events was 7.76% (95% confidence interval [CI] 5.09-11.25%), with a fracture incidence rate of 5.22 patients [with fracture]/100 person-years (PY). Patients who received bone-modifying agents (BMAs) had a numerically lower incidence of fractures (5.85%; 3.46/100PY vs 9.93%; 7.92/100PY). Median overall survival was 26.32 months (95% CI 21.65-not reached).

CONCLUSION: Compared with existing reference data, there was no obvious increase in the incidence of clinical fractures in Japanese patients with mCRPC who were treated with radium-223 under clinical practice. As is already well known for androgen deprivation, BMAs may also be useful in reducing bone fracture after radium-223.

PMID:40779218 | DOI:10.1007/s10147-025-02846-7

Int J Colorectal Dis. 2025 Aug 8;40(1):173. doi: 10.1007/s00384-025-04975-x.

ABSTRACT

PURPOSE: To assess the effect of computed tomography angiography (CTA) and three-dimensional (3D) reconstruction on laparoscopic colectomy in patients with colon cancer.

METHODS: Patients with colon cancer who were treated at Zhejiang Cancer Hospital between August 2020 and December 2022 were included in this pilot, randomized controlled trial. The participants were randomly assigned to either the CTA group, in which patients underwent preoperative CTA and 3D reconstruction, or the control group, in which patients underwent preoperative enhanced abdominal and pelvic CT examinations. The primary outcome was the duration of the operation. The secondary outcomes included intraoperative blood loss, length of hospital stay, number of lymph node dissections, fasting duration, duration of tube drainage, overall survival (OS), and progression-free survival (PFS). To minimize statistical bias, patients were stratified into subgroups on the basis of tumor location (left colon or right colon). Additionally, variations in the middle colonic artery (MCA), inferior mesenteric artery (IMA), and colonic branches of superior mesenteric artery (cbSMA) classifications were documented.

RESULTS: A total of 82 patients (41 in each group) were included in the analysis. The CTA group had significantly shorter operation durations (123.68 ± 26.09 vs. 154.12 ± 33.15 min, P < 0.001) and fasting durations (median 4.00 vs. 5.00 days, P < 0.001) as well as reduced intraoperative blood loss (median 50.00 vs. 100.00 mL, P = 0.001) compared to the control group; these differences were observed in the overall colon cancer cohort and in the left and right colon subgroups. However, no significant differences were observed between the two groups in terms of lymph node dissection, tube drainage duration, hospitalization duration, OS or PFS. In the CTA group, the proportions of patients with different IMA types were as follows: Type A (60.97%), Type B (9.76%), Type C (17.07%), and Type D (12.20%); the proportions of patients with different MCA types were as follows: Type A (78.05%), Type B (12.20%), Type C (7.31%), and Type D (2.44%); and the proportions of patients with different cbSMA types were as follows: Type A (65.85%), Type B (7.32%), Type C (17.07%), and Type D (9.76%). Patients with a tumor size ≥ 5 cm, preoperative intestinal obstruction, postoperative pathological serosal invasion, lymph node metastasis, and stage III disease had significantly worse OS and PFS than those with a tumor size < 5 cm (P = 0.007, P = 0.026), no preoperative intestinal obstruction (P = 0.015, P = 0.019), no serosal invasion (P = 0.001, P = 0.001), no lymph node metastasis (P = 0.016, P = 0.001), and stage I-II disease (P = 0.013, P = 0.001). However, no significant differences in OS or PFS were observed between patients who underwent preoperative CTA examination and the control group (P = 0.551, P = 0.591), between male and female patients (P = 0.402, P = 0.361), or between patients with and without postoperative complications (P = 0.561, P = 0.520). Finally, multivariate Cox proportional hazards regression analysis revealed that serosal invasion (P = 0.013; P = 0.009), lymph node metastasis (P = 0.029; P = 0.043), and tumor stage (P = 0.002; P = 0.001) were independent prognostic factors that affected the OS and PFS of patients with colon cancer.

CONCLUSION: Preoperative CTA and 3D reconstruction provide essential information for laparoscopic surgery, facilitate the optimization of surgical procedures, and support improved postoperative recovery for patients with colon cancer, suggesting promising clinical applications.

PMID:40779208 | DOI:10.1007/s00384-025-04975-x