Journal of the American College of Surgeons
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About 75% of medullary thyroid cancers (MTCs) are sporadic with 45-70% being driven by a RET mutation. Selpercatinib is an approved treatment for RET-mutated (mutRET) MTC, however, treatments are needed for wild-type RET MTC (wtRET). Genomic alterations and transcriptomic signatures of wtRET MTC may reveal new therapeutic insights. ⋯ We identified molecular alterations and immune-related features that distinguish wtRET from mutRET MTC. While RET mutation drives MTC in the absence of other alterations, we showed that wtRET MTC frequently harbors MAPK pathway mutations. These findings may indicate a potential basis for MAPK-targeted therapy, possibly in combination with oncology immune-oncology agents for selected patients with wtRET MTC.
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While the widespread adoption of minimally invasive surgery has led to improved cosmesis for abdominal operations, visible scars on the abdomen may still have a negative psychosocial impact on patients, especially for those with poor healing. We have developed a cosmetically favorable, safe, and easily adaptable robotic technique for common foregut and hepatopancreatobiliary procedures with hidden incisions at the level of the pubic hairline to minimize visibility. ⋯ In our experience, this technique of hiding port site incisions at the level of the pubic hairline can be easily adopted for improved patient quality of life and cosmesis. We especially recommend this technique in patients with a history of hypertrophic or keloid scars.
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After traumatic injury, 13-14% of patients utilize the emergency department (ED) and 11% are readmitted within 30 days. Decreasing ED visits and readmission represents a target for quality improvement. This cohort study evaluates risk factors for ED visits and readmission after trauma, focusing on outpatient follow-up. ⋯ Emphasizing outpatient follow-up in trauma patients is not an effective target to decrease ED use or readmission. Future studies should focus on supporting patients with mental health comorbidities and investigating interventions to optimally engage with trauma patients after hospital discharge.
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Contralateral prophylactic mastectomy (CPM) remains a personal decision, influenced by psychosocial factors including cosmesis and peace of mind. While utilization of CPM is disproportionately low among Black patients, the degree to which these disparities are driven by patient- vs hospital-level factors remains unknown. ⋯ Hospitals serving a greater proportion of Black patients are less likely to utilize CPM, suggestive of disparities in access to CPM at the institutional level. Further research and education are needed to characterize surgeon-specific and institutional practices in patient counseling and shared decision-making that shape disparities in access to CPM.