Current Literature

State Firearm Laws Affect Firearm Deaths, Study Finds

Kawano B, Agarwal S, Krishnamoorthy V, et al. State Firearm Laws and Rates of Assault-Related Firearm Death. J Am Coll Surg. 2023, in press.

Bradley Kawano and coauthors queried the Centers for Disease Control and Prevention Epidemiologic Research database to obtain information on the rates of firearm deaths in states with and without laws that determine legal ownership of firearms (background checks) and uses of firearms for self-defense, such as “stand your ground” laws. The outcome of interest was the rate of firearm assault deaths per 100,000 persons in all 50 states and Washington, DC.

The data from states with “stand your ground” and background check laws were compared with data from states without the laws. The analysis showed that “stand your ground” laws were associated with a significant increase in firearm related deaths, while background checks were associated with reduced death rates due to firearms. Data cited in the article showed that while “stand your ground” laws were associated with increased death rates, there was no evidence that crimes were deterred by the laws.

The authors recommended that additional studies be performed to determine if laws designed to provide improved opportunities for self-defense or reduce firearm violence are showing the intended results.

Editorial

Freeman, J. Gun Control and the United States: What Works? J Am Coll Surg. 2023, in press.

In the editorial by Freeman that accompanied this article, the author stressed the fact that the diversity of wording in “stand your ground” laws in various states prevents researchers from obtaining precise data to define the effects of these laws on firearm related deaths. Future research will need to consider this diversity in order to obtain meaningful evidence.

Study Examines Breast Cancer Recurrence by Subtype in Young Women

Vuong B, Darbinian J, Savitz A, et al. Breast Cancer Recurrence by Subtype in a Diverse, Contemporary Cohort of Young Women. J Am Coll Surg. 2023, in press.

Breast cancer is the most common malignancy diagnosed in women younger than 40 years of age and is the most common cause of death in this age group. Data cited in this article showed that young women were 90% more likely to die from this disease compared to women older than 51 years of age.

Challenges for women diagnosed with breast cancer at a young age include reduced fertility and sexuality due to chemotherapy and endocrine therapy; many patients are also choosing more extensive surgical treatment due to fears of recurrence. In addition, young women are underrepresented in breast cancer clinical trials leading to suboptimal treatment decisions due to lack of accurate data on outcomes of various treatment patterns. To provide treatments that minimize the risks of adverse events while producing optimal outcomes, it is necessary to have dependable information on treatment patterns and oncologic outcomes.

This study analyzed data from a large diverse cohort of patients (n = 1,431) treated in a single healthcare system in California. Nearly two-thirds of the patients presented with stage II/III disease. The recurrence rate after treatment was 16.1%, and most recurrences were due to distant metastases. The most common tumor subtypes were HR+HER2-. Local-regional recurrence rates were similar following breast conservation therapy or mastectomy.

The authors noted that breast conservation therapy appeared to be a safe choice in young women and recommended that additional studies be done to help determine predictors of local and distant recurrence.

Surgeons Comment on New Guideline for Treatment of GERD

Dimou FM, Lidor A, Velanovich V. Commentary on the Multi-society Consensus Conference and Guideline on the Treatment of Gastroesophageal Reflux Disease (GERD). J Gastrointest Surg 2023;27(3):650-52. doi: 10.1007/s11605-023-05613-z [published Online First: 20230131]

The article by Francesca M. Dimou, MD, MS, and coauthors provided expert commentary on the recent Multi-Society Consensus Conference and Guideline on the Treatment of Gastroesophageal Reflux Disease (GERD), published in Surgical Endoscopy by Bethany Slater and colleagues.

The guideline recommended endoscopy, pH testing, and manometry for diagnosis of GERD; the commentary authors noted that pH testing may not contribute to diagnostic accuracy if erosive esophagitis or Barrett esophagus is diagnosed on endoscopy. The main benefit of pH testing is the provision of objective evidence of acid reflux before and after treatment so that identification of the etiology of post-treatment symptoms can be facilitated.

The authors also emphasized the fact that articles comparing proton pump inhibitor therapy with endoscopic interventions were not included in the analysis of evidence supporting early treatment options. Data were presented in the article supporting the conclusion that the choice of partial over full fundoplication needs to be based on a careful, detailed consideration of the available evidence since research supporting advantages of partial fundoplication (reduced dysphagia) was mostly from short-term outcome studies.

The final point made by the authors was that counseling of obese patients with GERD should include consideration of Roux-en-Y gastric bypass even for patients with a body mass index (BMI) of 35–39; the authors recommended that fundoplication alone not be offered to patients with BMI >50.

Although the guideline was well researched, surgeons will need to adjust the recommendations based on individual patient characteristics.