Current Literature

Risk of Diverticulitis Increases with Family History, Study Finds

Cohan J, Horns JJ, Ramsay JM, et al. Diverticulitis Familiarity: A Statewide Case-Control Study. J Am Coll Surg. 2023, in press.

The etiologies of diverticulitis are not completely defined. Several genetic variants have been associated with increased risk for the disease, supporting the conclusion that the disease may be familial. Additional data cited in this article suggest that the heterogeneity of the disease results from genetic and environmental interactions.

Whether there is an increased risk for diverticulitis in family members of affected patients is unknown. Using data from a state medical database, the authors examined the risk for diverticulitis in family members of patients diagnosed with the disease (n = 9,563 patients and 229,647 relatives). Age of onset and severity of disease were also assessed. Matched patients without a history of diverticulitis served as a control group (n = 10,588 with 265,693 relatives).

The data analysis showed that risk of diverticulitis in family members was significantly increased in first-, second-, and third-degree relatives of patients with a history of diverticulitis compared with control patients. Severity of disease was also increased in relatives of patients with a diagnosis of diverticulitis. Age of onset of the diverticulitis episodes was similar in patients and family members in the study group and the control group.

These data will be potentially useful to facilitate patient counseling conversations.

AI Has Significant Potential Value for Improving Surgical Decision-Making, but More Data Are Needed

Loftus TJ, Altieri MS, Balch JA, et al. Artificial Intelligence-enabled Decision Support in Surgery: State-of-the-Art and Future Directions. Ann Surg 2023;278(1):51-58. doi: 10.1097/SLA.0000000000005853 [published Online First: 20230321]

Surgeons are faced with the need to make important decisions about patient care daily. Continuing education resources and dedicated study are techniques surgeons use to ensure that decisions are as accurate, effective, and focused on patient well-being as possible.

Despite these efforts, errors are made. Artificial intelligence (AI) has the potential to improve the surgical decision process. These authors conducted a systematic review of the literature to examine the quality of data supporting the use of AI to improve surgical decision-making. 36 articles were suitable for inclusion in the analysis.

Several limitations of existing data were discovered; these included small sample size, below average accuracy, and less than optimum use of validation techniques. Only 13 of the included articles presented a framework that could be used to implement artificial intelligence decision support programs.

The authors concluded that AI has significant potential value for improving surgical decision-making, but the scientific quality of the research available to support this effort needs significant improvement.

Pathologic Complete Response May Help Guide Treatment of Localized Soft Tissue Sarcoma

Wang D, Harris J, Kraybill WG, et al. Pathologic Complete Response and Clinical Outcomes in Patients With Localized Soft Tissue Sarcoma Treated With Neoadjuvant Chemoradiotherapy or Radiotherapy: The NRG/RTOG 9514 and 0630 Nonrandomized Clinical Trials. JAMA Oncol 2023;9(5):646-55. doi: 10.1001/jamaoncol.2023.0042

Dian Wang, MD, and coauthors used outcomes data from prospective, randomized studies performed by the Radiation Therapy Oncology Group (RTOG) to determine short- (n = 143) and long-term (n = 79) relationships of pathologic complete response (pCR) to improved outcomes for patients with soft tissue sarcoma treated with preoperative neoadjuvant chemoradiotherapy or radiotherapy alone.

The data analysis showed that pCR occurred in 19% to 27% of patients in the three trials and was associated with a significant improvement in overall survival and disease-free survival. At 5 years of follow up, pCR patients had a local recurrence rate of 0%. The highest rates of pCR and best overall outcomes were seen in patients with leiomyosarcoma, liposarcoma, and myxofibrosarcoma.

The authors concluded that pCR should be used to guide future studies of preoperative chemotherapy and radiotherapy.

Editorial

Spina CS, DeLaney TF. The Significance of a Pathologic Complete Response in Patients With Soft Tissue Sarcoma. JAMA Oncol 2023;9(5):619-21. doi: 10.1001/jamaoncol.2022.7940

The editorial by Catherine S. Spina, MD, PhD, and Thomas F. DeLaney, MD, that accompanied the article noted that pCR can potentially be used as a surrogate marker for treatment efficacy and should be included when investigators plan research on treatment strategies that focus on lower doses of radiation and, possibly, elimination of chemotherapy.