Artificial intelligence (AI) for surgical workflow analysis often fails to generalize because surgical actions lack a standardized, fine-grained representation. Gesture-level “tokenization” of surgery, capturing instrument–tissue interactions as the smallest intentional functional units, offers greater technical specificity than phase- or step-level labels and has demonstrated associations with proficiency and clinical outcomes. However, the field remains fragmented by heterogeneous gesture terminology, limiting dataset interoperability and model reproducibility. We conducted a SAGES-led, accelerated Delphi consensus process to establish a standardized surgical gesture taxonomy. Starting with 270 literature-derived gesture terms, we employed a novel hybrid pipeline combining large language model (LLM)-assisted semantic clustering with multi-round expert review. The process involved two Delphi surveys (open-ended, then structured agreement) with a predefined ≥ 80
BACKGROUND:The efficacy of teclistamab, a bispecific antibody targeting B-cell maturation antigen and CD3, as early-line monotherapy in relapsed or refractory multiple myeloma is unclear. METHODS:We randomly assigned patients with relapsed or refractory multiple myeloma who had previously received one, two, or three lines of therapy, including an anti-CD38 monoclonal antibody and lenalidomide, to receive teclistamab or the investigator's choice of pomalidomide, bortezomib, and dexamethasone (PVd) or carfilzomib and dexamethasone (Kd). Antimicrobial prophylaxis and immune globulin replacement were recommended. The primary end point was progression-free survival as assessed by an independent review committee. RESULTS:A total of 296 patients were assigned to teclistamab and 297 to PVd or Kd. At the interim analysis (median follow-up, 17.3 months), teclistamab significantly improved progression-free survival as compared with PVd or Kd (estimated 18-month progression-free survival, 69.8% vs. 26.9%; hazard ratio for disease progression or death, 0.29; 95% confidence interval [CI], 0.23 to 0.38; P<0.001). The percentage of patients with a complete response or better was higher with teclistamab than with PVd or Kd (65.9% vs. 16.8%, P<0.001). Overall survival was improved with teclistamab as compared with PVd or Kd (estimated 18-month overall survival, 79.2% vs. 68.6%; hazard ratio for death, 0.60; 95% CI, 0.43 to 0.83; P = 0.002). Adverse events of grade 3 or 4 occurred in 84.9% of teclistamab recipients and in 76.3% of PVd or Kd recipients, with grade 5 adverse events in 6.5% and 3.5%, respectively. Cytokine release syndrome, mostly of grade 1 or 2, occurred in 66.0% of teclistamab recipients, and immune effector cell-associated neurotoxicity syndrome occurred in 4.1%. Grade 3 or 4 infection occurred in 41.6% of teclistamab recipients and in 29.0% of PVd or Kd recipients. CONCLUSIONS:Among patients with multiple myeloma and one to three previous lines of therapy, teclistamab significantly improved progression-free and overall survival as compared with PVd or Kd. Infections of grade 3 or 4 were common. (Funded by Johnson & Johnson; MajesTEC-9 ClinicalTrials.gov number, NCT05572515.).
Cancer is a leading cause of morbidity and mortality in the U.S., with significant financial implications for patients, especially those with limited access to resources. Particularly, the rising costs of cancer treatment have placed considerable strain on cancer survivors. This study evaluates the impact of the Affordable Care Act (ACA) on healthcare costs for cancer survivors. Using data from the Medical Expenditure Panel Survey (2010–2019), we analyzed data for 9,041 U.S. adult cancer survivors aged 18–64. ACA implementation (post- vs. pre-ACA period) was the primary exposure. We examined changes in out-of-pocket (OOP) healthcare spending and its proportion to total healthcare spending and family income of cancer survivors. Our findings indicate that post-ACA, mean OOP spending decreased significantly across various income groups: by 48.3
BACKGROUND:Early onset colorectal cancer and mucinous adenocarcinoma histology in young patients is an challenging scenario, made more unfortunate due to absence of specific guidelines. Accordingly, we aimed to assess cancer-specific survival (CSS) and identify survival predictors in patients aged ≤50 with stage IV mucinous adenocarcinoma. METHODS:Retrospective cohort analysis using Surveillance, Epidemiology, and End Results data (2000-2022) identified patients ≤50 years with stage IV colorectal cancer mucinous adenocarcinoma. Multivariable Cox regression and Kaplan-Meier analyses assessed CSS and identified independent predictors. RESULTS:Median survival of 1,542 patients was 18 months; 5-year CSS was 14.3%. Metatstatic lung disease was associated with significantly reduced 5-year CSS (13.9% vs 17.4%; P < .001); distant metastasectomy was associated with significantly higher 5-year CSS (20.3% vs 12.1%; P < .001). Neoadjuvant and adjuvant systemic therapy was associated with significantly higher 5-year CSS than adjuvant therapy alone (18.5%) and similar 5-year CSS to neoadjuvant therapy alone (cancer-specific survival: 28.9% vs 27.1%). Independent predictors of reduced cancer-specific survival included household income <$50,000 (hazard ratio, 2.70; 95% confidence interval, 1.20-6.06) and $50,000-$74,999 (hazard ratio, 2.08; 95% confidence interval, 1.05-4.10), a greater number of positive lymph nodes (hazard ratio, 1.02; 95% confidence interval, 1.01-1.04), and the presence of lung metastases (hazard ratio, 1.93; 95% confidence interval, 1.22-3.04). Conversely, distant metastasectomy (hazard ratio, 0.71; 95% confidence interval, 0.53-0.97), neoadjuvant systemic therapy (hazard ratio, 0.41; 95% confidence interval, 0.18-0.92), and combined neoadjuvant and adjuvant systemic therapy (hazard ratio, 0.42; 95% confidence interval, 0.20-0.90) were independently associated with improved cancer-specific survival. CONCLUSION:Stage IV early onset mucinous adenocarcinoma presents with advanced disease and poor outcomes. Socioeconomic factors and metastatic burden significantly influence survival. Systemic therapy and distant metastasectomy offer the most significant survival benefits.
Low anterior resection syndrome (LARS) is a common postoperative sequala affecting up to 70
