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
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.
BACKGROUND:Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography. METHODS:Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021-2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography-associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration. RESULTS:Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million. CONCLUSION:For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.
BACKGROUND:Transanal total mesorectal excision (taTME) facilitates sphincter preservation in low rectal cancer. Preliminary results and functional outcomes from the North American multicenter phase II taTME trial (NCT03144765) have been published. Three-year outcomes are reported. METHODS:Patients with stage I to III rectal adenocarcinoma were enrolled across 11 centers (2017-2022). Endpoints included TME grade, 3-year overall survival, disease-free survival, cancer-specific survival, recurrence, late (beyond 90 d) complications, and stoma-free survival. Surveillance followed National Comprehensive Cancer Network guidelines, with pelvic magnetic resonance imaging (MRI) at 3 years to assess for pelvic sidewall recurrence when possible. Kaplan-Meier analysis assessed oncologic outcomes. RESULTS:One hundred patients underwent taTME for tumors at a median of 5.8 cm from the anal verge, with intersphincteric resection in 36% and handsewn anastomosis in 54%. Median follow-up was 50.9 months. Late complications occurred in 32 patients, including 21 severe (Clavien-Dindo ≥3). Late anastomotic complications occurred in 5 patients; one required surgical revision. Estimated 3-year overall survival, cancer-specific survival, and disease-free survival were 93.7%, 96.6%, and 84.6%, respectively. Distant recurrence occurred in 15 patients (median: 17.6 months), most commonly in the lung and liver. Locoregional recurrence occurred in 2 patients. Preoperative N stage, lymph node yield, tumor deposits, and perineural invasion were associated with recurrence. Among 100 patients diverted at taTME, 97% were stoma-free at 3 years; 4 patients later underwent secondary diversion. CONCLUSIONS:Three-year outcomes of this multicenter trial support the safety and efficacy of taTME in resectable mid and low rectal tumors, with outcomes comparable to contemporary studies. Longer-term oncologic and functional outcomes are needed.
