Many factors go into the success of surgery. A new analysis suggests that women may do better with female surgeons.There are many important issues to consider before going into surgery: your overall health and the necessity of the operation, the complexity of the surgery, how experienced the surgeon is, the quality of the hospital and its reputation for good follow-up care.But does it matter if your surgeon is a man or a woman? It might. A new study suggests that overall, female surgeons may get better results, and that choosing a female surgeon may be especially beneficial if you are a woman.For the study, an international team of scientists studied records of 559,903 men and 760,205 women who were operated on by 2,937 surgeons in Ontario, Canada, over a 12-year period. Among the men, roughly 91 percent had male surgeons and 9 percent had female surgeons. Of the women, 88 percent had male surgeons and 12 percent had female surgeons.The female surgeons were, on average, younger, performed fewer surgeries and operated on patients who were generally healthier than those treated by the men. The researchers controlled for these factors, and for patient characteristics such as age, income and whether they lived in a rural or urban area. They also considered whether the surgery was done at a community hospital or a major academic medical center.The study, published in JAMA Surgery, covered 21 common elective and emergency surgeries, including cardiac, orthopedic, urological, head and neck, thoracic, vascular, neurological and plastic surgery. Operations included coronary artery bypass grafting, appendectomy, carpal tunnel release, gastric bypass, spinal surgery, thyroid surgery and knee and hip replacement.Overall, about 15 percent of patients had postoperative problems: 8.7 percent had significant complications within 30 days of the operation; 6.7 percent were readmitted to the hospital; and 1.7 percent died. The researchers found that when the sex of the surgeon and patient were different, the surgery was slightly less successful: There was a roughly 8 percent increase in complications or death, although no difference in readmissions to the hospital. This trend was consistent across different types of surgery and patient characteristics.But the researchers also found that on the whole, women surgeons tended to be more successful than male surgeons. And the worst surgical outcomes occurred when female patients were treated by male surgeons. Compared with a female patient treated by a female surgeon, a woman treated by a male surgeon was about 15 percent more likely to have complications, be readmitted to the hospital or die within 30 days of the operation.The authors acknowledge that the study had limitations. It was observational, and the researchers were unable to control for the role of nurses and other operating room staff. In addition, the data excluded robotic operations, which were uncommon in Ontario at the time.Still, Dr. Margaret G. Mueller, a surgeon and associate professor of gynecology at Northwestern University who was not involved in the research, noted the study had a “smart design” and was well controlled, with a large database. “We now have some objective data showing that there are superior outcomes with female surgeons,” she said. “We just don’t know the reasons.”The lead author, Dr. Christopher J.D. Wallis, an assistant professor of urology at the University of Toronto, said that there was no reason to believe that there is any difference in technical skills between male and female surgeons. Rather, he suggested, the problem may lie in part in differing styles of communication and the ways that doctors talk to male and female patients.The second author on the study, Dr. Angela Jerath, an associate professor of anesthesiology at the University of Toronto, said that when she is working as an anesthesiologist with a woman surgeon, the atmosphere in the operating room tends to be different, more collegial, which may foster better communication and improve teamwork.“Female surgeons ask me more questions,” she said. “Maybe women are more collaborative. Maybe they are more detail oriented. Maybe they are more meticulous. We can’t answer these questions with our data.”Dr. Wallis said that after the surgery, too, doctors may treat men and women patients differently.“We know that women’s pain is not given as much credence as men’s pain,” he said. “In postoperative care, this can be complex. To some degree, pain is an expected outcome of surgery, but it can also suggest an early sign of a complication. Doctors must be able to read the symptoms and at the same time have a demeanor that welcomes patients to present information in a way that we can head off problems before they happen.”It is not only in surgery that the sex of the doctor and patient can make a difference. There are many studies, Dr. Wallis said, demonstrating that in various specialties higher death rates occur when male doctors treat female patients. As one example, he mentioned a 2018 study that found higher mortality among female heart attack patients treated by male physicians.Dr. Jerath had some advice for her colleagues. “I’d like surgeons to be able to take a step back,” she said. “ Be thoughtful — something is happening here. Let’s look at it and be open to solutions.”

They don’t eat the bugs, and they’re definitely applying them to wounds, so some scientists think the primates may be treating one another’s injuries.A chimp, Suzee, catches an insect and puts it on a wound on the foot of her son, Sia. Video by Alessandra Mascaro.Tobias DeschnerChimpanzees design and use tools. That is well known. But is it possible that they also use medicines to treat their own and others’ injuries? A new report suggests they do.Since 2005, researchers have been studying a community of 45 chimpanzees in the Loango National Park in Gabon, on the west coast of Africa. Over a period of 15 months, from November 2019 to February 2021, the researchers saw 76 open wounds on 22 different chimpanzees. In 19 instances they watched a chimp performing what looked like self-treatment of the wound using an insect as a salve. In a few instances, one chimp appeared to treat another. The scientists published their observations in the journal Current Biology on Monday.The procedure was similar each time. First, the chimps caught a flying insect; then they immobilized it by squeezing it between their lips. They placed the insect on the wound, moving it around with their fingertips. Finally, they took the insect out, using either their mouths or their fingers. Often, they put the insect in the wound and took it out several times.The researchers do not know what insect the chimps were using, or precisely how it may help heal a wound. They do know that the bugs are small flying insects, dark in color. There’s no evidence that the chimps are eating the insects — they are definitely squeezing them with their lips and then applying them to the wounds.There have been other reports of self-medication in animals, including dogs and cats that eat grass or plants, probably to help them vomit, and bears and deer that consume medicinal plants, apparently to self-medicate. Orangutans have been seen applying plant material to soothe muscle injuries. But the researchers know of no previous report of nonhuman mammals using insects for a medicinal purpose.In three instances, the researchers saw chimps using the technique on another chimp. In one case, they saw an adult female named Carol grooming around a flesh wound on the leg of an adult male, Littlegrey. She grabbed an insect, and gave it to Littlegrey, who put it between his lips, and transferred it to his wound. Later, Carol and another adult male were seen moving the insect around on Littlegrey’s wound. Another adult male approached, took the insect out of the wound, put it between his own lips, then reapplied it to Littlegrey’s leg.One chimp, an adult male named Freddy, was a particularly enthusiastic user of insect medicine, treating himself numerous times for injuries of his head, both arms, his lower back, his left wrist and his penis. One day, the researchers watched him treat himself twice for the same arm wound. The researchers don’t know how Freddy got these injuries, but some of them probably involved fighting with other males.There are some animals that cooperate with others in similar ways, said Simone Pika, who leads an animal cognition lab at the University of Osnabrück in Germany and is an author of the study. “But we don’t know of any other instances in mammals,” she said. “This may be a learned behavior that exists only in this group. We don’t know if our chimps are special in this regard.”Aaron Sandel, an anthropologist at the University of Texas, Austin, found the work valuable, but at the same time expressed some doubts. “They don’t offer an alternative explanation for the behavior, and they make no connection to what insect it might be,” he said. “The jump to a potential medical function? That’s a stretch at this point.”Still, he said, “attending to their own wounds or the wounds of others using a tool, another object — that’s very rare.” Their documentation of chimps paying such attention to other chimps is, he added, “an important contribution to the study of social behavior in apes. And it’s still interesting to ask whether there is empathy involved in this, as it is in humans.”In some forms of ape social behavior, it is clear that there is an exchange of value. For example, grooming another chimp provides relief from parasites for the groomed animal, but also an insect snack for the groomer. But in the instances she observed, Dr. Pika said, the chimp gets nothing tangible in return. To her, this shows the apes are engaging in an act that increases “the welfare of another being,” and teaches us more about the primates’ social relationships.“With every field site we learn more about chimps,” she said. “They really surprise us.”

Older adults who had cataract removal to restore their vision had a lower risk of Alzheimer’s disease and other forms of dementia.Surgery to remove cataracts, which cause the eye’s normally clear lens to become cloudy, can restore vision almost instantaneously. New research suggests cataract surgery may have another benefit as well: a reduced risk for Alzheimer’s disease and other forms of dementia.For the study, scientists looked at 3,038 men and women with cataracts who were 65 or older and free of dementia at the time of their diagnosis. Of these, 1,382 had cataract surgery, and the rest did not. All of the subjects were part of a decades-long memory study that followed them over decades.The researchers found that the overall risk for dementia was 29 percent lower in those who had cataract surgery compared with those who did not.The researchers also looked at glaucoma surgery, another type of eye operation that does not restore vision but can help prevent vision loss. It had no effect on dementia risk.The study, in JAMA Internal Medicine, adjusted for age at first diagnosis of cataracts as well as various risk factors for dementia, including few years of education, smoking, a high body mass index and hypertension. The only trait that had a bigger impact on dementia risk than cataract surgery was not carrying a gene called APOE-e4 that is linked to increased risk of Alzheimer’s disease.“The authors were incredibly thoughtful in how they approached the data and considered other variables,” said Dr. Nathaniel A. Chin, an assistant professor of medicine at the University of Wisconsin, who was not involved in the study. “They compared cataract surgery to non-vision-improving surgery — glaucoma surgery — and controlled for many important confounding variables.” Dr. Chin is the medical director of the Wisconsin Alzheimer’s Disease Research Center.“We were astounded by the magnitude of the effect,” said the lead author, Dr. Cecilia S. Lee, an associate professor of ophthalmology at the University of Washington.The authors note that this is an observational study that does not prove cause and effect. But they suggest that this may be the best kind of evidence attainable, since a randomized trial in which only some people are allowed to get cataract surgery would be both practically and ethically impossible.“People might say that those who are healthy enough to have surgery are healthier in general, and therefore less likely to develop dementia in any case,” Dr. Lee said. “But when we see no association in glaucoma surgery, that supports the idea that it isn’t just eye surgery, or being healthy enough to undergo surgery, but rather that the effect is specific to cataract surgery.”The findings bolster earlier research showing that vision loss — as well as hearing loss — are important risk factors for cognitive decline. People who have trouble seeing or hearing, for example, may withdraw from activities like exercise, social interactions, reading or intellectual pursuits, all of which are tied to a lower risk of dementia.But the researchers also suggested a possible physiological mechanism. The visual cortex undergoes changes with vision loss, they wrote in the paper, and impaired vision may lessen input to the brain, leading to brain shrinkage, also a risk factor for dementia. At least one previous study found an increase in the brain’s gray matter volume after cataract surgery.While the exact mechanism for the benefits of cataract surgery remains unknown, Dr. Lee said it’s not surprising that some of the changes we see in the eye might reflect processes in the brain. “The eye is very strongly connected to the brain,” he said. “The eye develops in utero from the brain and shares the same neural tissue. The eye in development comes out of the forebrain.”Dr. Chin said that the most important question for him going forward is what this means for doctors and patients. Doctors in primary care clinics or those who treat memory need to screen more for visual decline, he said, adding that, “We can talk to people about potential brain health improvements with cataract surgery as well as the need to address vision throughout one’s life as a means of protecting cognition.”

For many common problems of the knee, hip, shoulder, spine and wrist, nonsurgical options may be just as good.Considering bone or joint surgery? In many cases, surgery may be no more effective than options like exercise, physical therapy and drug treatments. Hip and knee replacements, surgery for carpal tunnel syndrome and other orthopedic procedures are among the most common elective surgeries performed today, but they involve cost, risk and sometimes weeks or months of recovery. Many of these surgeries are not supported by evidence from randomized trials, a review found. Even when surgery has been shown to be effective, the review concluded, it may not be significantly better than nonsurgical care.British researchers looked at studies of 10 common orthopedic operations, including surgeries of the knee, hip, shoulder, spine and wrist. They found good evidence of the superiority of surgery over other treatments for carpal tunnel syndrome and total knee replacement. For six other common surgeries, randomized trials found little advantage over interventions like exercise, weight management, physical therapy and drug treatment. The researchers found no controlled trials that had compared hip replacement or knee cartilage repair with nonsurgical care. The study is in The BMJ.“Our study doesn’t show that these operations don’t make patients better,” said the lead author, Dr. Ashley W. Blom, a professor of orthopedic surgery at the University of Bristol in England. “And it does not say that treatments do not work if they have not undergone testing by randomized controlled trials. It’s just that some don’t work any better than the best nonsurgical treatments.”Dr. Saam Morshed, a professor of orthopedic surgery at the University of California, San Francisco, who was not involved in the study, said, “I think it’s fair that we hold the mirror up to ourselves and scrutinize effectiveness for some of these operations. It’s important to understand where we have gaps in knowledge of the efficacy or nonefficacy of common surgical treatments.”At the same time, he said, “It’s also important to understand that just because there isn’t a randomized trial supporting a given treatment, that doesn’t mean that the treatment is not effective.” Hip surgery, he said, is a good example. There may be no randomized trials of hip surgery, but there is overwhelming observational evidence for its effectiveness compared with nonsurgical treatment.In other common procedures, the picture may be different. An arthroscopic operation to repair the anterior cruciate ligament, or ACL, in the knee, among the most common sports-injury surgeries in the United States, has a rate of success as high as 97 percent in some studies. But when the operation was compared with nonsurgical treatments, the review found, there was little difference in pain scores or the need for further surgical or nonsurgical treatment.The researchers describe a large review of studies of the operation to repair the rotator cuff, the group of tendons and muscles that keeps the upper arm bone in the shoulder socket. Compared with exercise and steroid injections, the review found, there was little or no clinically significant difference in pain, function, quality of life or patient satisfaction with the results.Some studies were randomized controlled trials, giving one group of patients real surgery and a matched group a placebo operation. In two such studies of surgery for shoulder impingement, a condition that causes pain on raising the arm, there was no difference between surgery and placebo surgery in patient-reported outcomes or adverse events.Lumbar spine decompression is an operation to relieve the pain caused by a ruptured or bulging disk, sometimes called a pinched nerve, in the lower spine. Although the quality of the evidence was low, three analyses showed that surgery and nonsurgical treatments provided equivalent improvements.There were no studies that compared surgical repair of the meniscus, the cartilage that covers the knee, with nonoperative care or a placebo. But in 10 randomized trials comparing a different procedure known as meniscectomy, or partial removal of the meniscus, with more conservative treatment, the operation did not provide meaningful improvement in knee pain, function or quality of life.“The best nonoperative care is often multimodal and may involve a combination of physical, medical and psychological interventions, and it should not be assumed that these are necessarily the easiest or most cost-effective options for patients,” Dr. Blom said. “Clinicians should discuss both operative and the best nonoperative care with patients so that patients can consider all options and thereby make informed choices.”Patient outcomes from these surgeries vary greatly, and these differences are important, Dr. Morshed said. “Future research is going to provide more nuanced inferences on the effect of surgery as we begin to understand on a patient level those characteristics that make them more or less likely to respond to a procedure,” he said.

Grieving parents were at high risk of a heart attack in the days following the death of a child, and an increased risk may persist for years.Losing a child is one of the most emotionally wrenching experiences a parent can go through. New research suggests it may also literally damage the heart. The study found that in the days following the death of a child, a parent is at greatly increased risk for a heart attack, and the increased risk may persist for years.Researchers used birth registries and medical records to study 6,711,952 parents from Denmark and Sweden from 1973 to 2014. Among them, 126,522 had lost at least one child at some point during that time. The study looked not only at the loss of infants and children, but also adolescents and adult children up to age 29.The scientists found that the death of a child was associated with a 21 percent increased risk of ischemic heart disease, or reduced blood flow to the heart. The risk for a heart attack in the first week after the death was more than triple the rate of people who had not experienced the loss of a child, and there was a 20 to 40 percent increased risk over the long course of the study. The association was present even in cases of an adult child’s death.Other studies suggest that in middle or old age, the death of a spouse, sibling or close friend increases the risk for heart attack, stroke, atrial fibrillation and death. The risk appears to be especially high in the months immediately following the loss. But studies on the impact of the loss of children on the heart health of parents have been very limited.This observational study, published in PLOS Medicine, was large and rigorous. The researchers controlled for age, marital status, education, income, hypertension and other factors than can affect the risk for cardiovascular disease. They also considered such factors as the cause of a child’s death. For example, the researchers found that there was an association with heart problems in parents even when the child’s death was a result of unnatural causes — such as a car crash or other accident — suggesting that a family history of heart disease or other genetic factors were unlikely to fully explain the increased cardiovascular risk in parents.The study did not investigate the exact ways in which the stress of extreme bereavement might damage the heart. But the lead author of the study, Dang Wei, a doctoral candidate at the Karolinska Institute in Stockholm, proposed several possible mechanisms.“Stress activates the autonomic nervous system,” he said, which controls involuntary functions in our bodies such as heart rate and blood pressure, and “induces biological changes” that may raise cholesterol levels.“Changes like this,” he added, “may trigger a heart attack.”Bereavement can also induce depression, anxiety and other psychiatric disorders, leading to alcohol abuse, drug abuse, smoking, and lifestyle behaviors that are also risk factors for cardiovascular disease.Dr. Erica S. Spatz, an associate professor of cardiovascular medicine at Yale who was not involved in the study, said that the finding was based on “pretty amazing data” available only in Scandinavian countries, which maintain detailed birth and health registries that span decades.“The loss of a child plays out in every aspect of a patient’s life, including their cardiovascular health,” she said. “We need to screen for a history of trauma, whether it’s related to a death of a child, racial discrimination, poor work environment — these are well-known factors that affect cardiovascular health.”The senior author, Krisztina D. Laszlo, an associate professor of epidemiology at the Karolinska Institute, said that while parents should know about the increased heart risks, it may be difficult to approach them with this kind of information during the grieving period.“It’s a delicate topic,” she said. “This is a very special type of bereavement, one of the greatest stresses that one can experience, and it is often associated with complicated grief that does not resolve in the usual ways.”“One doesn’t want to burden these parents even further,” she continued, “by telling them about their cardiovascular risks.”Still, it would be important for doctors, friends and family members of a person who has lost a child to be on the lookout for things like chest pain, shortness of breath or other signs of heart problems or an impending heart attack.

The longer you have high levels of “bad” LDL cholesterol, the greater your risk of a heart attack.LDL, or “bad” cholesterol, is a major risk factor for coronary heart disease. Now a new study suggests that, like smoking, it has a cumulative effect over a lifetime: The longer a person has high LDL, the greater their risk of suffering a heart attack or cardiac arrest.Coronary heart disease, also known as “hardening of the arteries,” is the leading cause of death in the United States. It is caused by a buildup of plaque in the arteries that narrows the vessels and blocks the flow of oxygenated blood to the heart. Often, people have no symptoms and remain unaware they have the disease for years until they develop chest pain or suffer a catastrophic event like a heart attack.Using data from four large prospective health studies, researchers calculated LDL levels over time in 18,288 people who had multiple LDL tests taken at different ages. They calculated their cumulative exposure to LDL and followed their health for an average of 16 years. The study is in JAMA Cardiology.The researchers found that the longer a person had high levels of LDL — no matter what their LDL level is in young adulthood or middle age — the greater the risk for coronary heart disease. Compared with those in the lowest quarter for cumulative exposure, those in the highest had a 57 percent increased risk.They found no increased risk for stroke or heart failure associated with cumulative LDL exposure. The researchers suggest that many factors can contribute to heart failure, and their study had too few cases of stroke to achieve statistical significance.The study controlled for race and ethnicity, sex, year of birth, body mass index, smoking, high-density lipoprotein (HDL, or “good” cholesterol), blood pressure, Type 2 diabetes and the use of lipid-lowering and blood pressure medicines.In people under 40, current guidelines recommend treatment with cholesterol-lowering statin drugs only with LDL readings higher than 190, but the researchers found that the increased risk for coronary heart disease may start at a much lower level. (LDL levels below 100 are generally considered normal.)“Our figures suggest that the risk starts at LDL levels as low as 100,” said the lead author, YiYi Zhang, an assistant professor of medical sciences at Columbia. “That doesn’t necessarily mean that a person under 40 with an LDL of 100 should immediately start treatment. We need more evidence to determine the optimal combination of age and LDL level.”Dr. Tamara Horwich, a cardiologist and professor of medicine at the University of California, Los Angeles, who was not involved in the study, noted that medical guidelines on choosing who needs statin therapy are heavily weighted toward older people, since advancing age is a major risk factor for complications from heart disease.Still, she said, “From autopsy studies, we have known for some time that atherosclerosis begins to develop in the arteries of young individuals, as early as the teens and 20s. I think this study may entice physicians to move the needle back on the age of starting, or at least thinking about starting, statin therapy.”Young people have a low short-term risk, Dr. Zhang said, but a high long-term risk. “The main message is to try to maintain low LDL through middle age. That will reduce your heart disease risk.”

Electroconvulsive therapy can effectively treat depression, and is as safe as antidepressant drugs along with psychotherapy, a new analysis found.Electroconvulsive therapy, or ECT, can be effective for the treatment of major depression and is just as safe that a large new study concludes.The procedure, once referred to as electroshock therapy, has a controversial and largely unfavorable history. This was partly due to inaccurate portrayals in popular books and films like “One Flew Over the Cuckoo’s Nest,” and partly the result of real problems with the earliest versions of the procedure, which used strong electrical currents and no anesthesia.Today, ECT is performed under general anesthesia, and the doctor, working with an anesthesiologist and a nurse, applies a weak electric current to the brain (usually about 0.8 amperes at 120 volts) for one to six seconds. This causes a seizure inside the brain, but because of the anesthesia, the patient does not experience muscular contractions. The seizure leads to brain changes that relieve symptoms of depression and certain other mental illnesses. Usually, doctors administer a series of ECT treatments over a period of days or weeks.The only painful part of the procedure is the insertion of an intravenous line before anesthesia. There can be side effects afterward, including temporary memory loss, confusion or transitory headaches and muscle aches. Doctors debate whether ECT can cause long-term memory problems distinct from the memory problems that can be caused by depression itself.For this new study, published in Lancet Psychiatry, Canadian researchers used the records of 10,016 adults whose depression was severe enough that they spent three or more days in the hospital. Half of them had received ECT, while the other half were treated with drugs and psychotherapy. Their average age was 57, and about two-thirds were women. The researchers tracked how each group fared in the 30 days after they were discharged from the hospital.The study carefully matched patients with controls, adjusting for more than 75 factors, including sociodemographic characteristics, medication use, other medical diseases, behavioral and cognitive status, and the use of psychiatric and other health services. This thorough methodology helped overcome some of the limitations of previous studies.ECT did not seem to increase the risk of serious medical problems, including circulatory, respiratory or genitourinary issues that require a hospital stay, or deaths that were not a result of suicide. In the 30 days after discharge, 105 of the ECT patients had a serious medical problem, compared with 135 among the controls, a statistically insignificant difference. The researchers did not track minor medical problems treated in outpatient settings. Suicides were rare in both groups, but were significantly lower in those treated with ECT.“This is an interesting and well-performed study,” said Dr. Martin Balslev Jorgensen, a professor of psychiatry at the University of Copenhagen who has published widely on ECT but was not involved in this study. “Since ECT is surrounded by lots of negative opinions, we need all the help we can get from real-life research.”Dr. Jacob P. Feigal, the medical director of the ECT program at Duke who also had no part in the work, said the study could be helpful in talking to people for whom the best treatment is ECT but who have fears about complications. “As a clinician,” he said, “this helps me frame the argument. It contributes a really important element to the discussion about the risk of doing ECT compared to the risk of not doing it in people with severe depression.”Dr. Jorgensen said this study shows that patients don’t have to worry about medical complications and can focus on the real problems of ECT: that you have to be anesthetized, and that after several treatments you may have some loss of memory in the time leading up to and during ECT.Dr. Irving M. Reti, a professor of psychiatry and director of the brain stimulation program at Johns Hopkins who was not involved in the report, said that it is “an important, substantial study” that adds to the literature showing that ECT is safe. “This puts it in a medical context — thousands of patients with no significant medical complications.”The lead author of the study, Dr. Tyler S. Kaster, a brain stimulation fellow at the University of Toronto, agreed that ECT has risks, but, he said, so does major depression, which can lead to serious problems — among them, cardiovascular disease, dementia, substance use and suicide. Deciding to undergo ECT is a “complex and serious decision,” he said. “The hope in this study is that it provides important information that allows patients, their loved ones and their doctors to understand the risks and make a decision they are comfortable with.”

Robot-assisted surgeries have only modest advantages over other approaches, a large analysis found. Surgical procedures performed with the aid of a robot is sometimes marketed as the “best” form of surgery. But a recent review of 50 randomized controlled trials, testing robot-assisted surgeries against conventional methods for abdominal or pelvic procedures, suggests that while there may be some benefits to robotic surgery, any advantages over other approaches are modest.Robotic surgery is performed by surgeons, not robots. But instead of conventional hand-held tools used in laparoscopic surgery, which involves tiny incisions, and open surgery, in which the surgeon enters the body through a large incision, the doctor uses a machine. The surgeon controls the machine’s tools remotely by using joysticks and foot controls while viewing the surgical site through a high-definition monitor that provides a three-dimensional image of the procedure.Some surgeons believe that these robots allow more precision during the operation, shorter recovery time, and generally better clinical outcomes for patients. But the review found that in many ways, compared outcomes from the robotic and conventional procedures showed little difference. For example, in 39 studies that reported the incidence of complications requiring further surgical interventions, up to 9 percent of conventional laparoscopies led to such problems, but so did as much as 8 percent of robotic operations. In studies of gastrointestinal surgery, life-threatening complications ranged from 0 to 2 percent for robot-assisted surgery, from 0 to 3 percent for laparoscopy and from 1 to 4 percent for open surgeries. The findings were published in Annals of Internal Medicine.For various reasons, sometimes robot-assisted or laparoscopic surgeries do not work, and the surgeon must switch to doing an open operation. Overall, this happened up to 8 percent of the time in robotic operations and as much as 12 percent in laparoscopies. In urologic and gynecologic surgeries, there was almost no difference between robot-assisted operations and laparoscopies in the number of operations that had to be switched to open procedures.Long-term outcomes of at least two years were reported in eight of the reviewed studies, and they found that mortality rates were similar in all three techniques. In up to 3 percent of robotic surgeries and 5 percent of open surgeries, the patient died. There were no deaths in laparoscopic procedures.The researchers did find some time differences between the procedures, however. In short, robot-assisted surgeries generally take longer. In studies of gynecological robotic surgeries, duration ranged as high as 265 minutes, compared with maximums of 226 minutes for laparoscopy and 187 for open procedures. In both urologic and colorectal operations, robot-assisted surgeries were consistently longer than comparable laparoscopic and open operations.The lead author, Dr. Naila H. Dhanani, a surgical resident at UT Health in Houston, said that for a patient, there is no reason to choose robotic surgery over other modes.“Just because something’s new and fancy doesn’t mean it’s the better technique,” she said. “Yes, robotic is safe, we’ve proven that. But we haven’t proven it’s better. There were four studies that showed a benefit with robotic surgery, so that’s quite modest. Forty-six showed no difference at all.”Dr. James A. Eastham, chief of urology at Memorial Sloan Kettering Cancer Center, who was not involved in the study, agreed.“No one would argue with the primary conclusions,” he said. “The intra-operative complication rates and postoperative outcomes are similar regardless of surgical approach. It is far more important to select an experienced surgeon with specialization in a particular field rather than picking a technique.”But there are certainly practical benefits for the surgeon. Operations can last for hours, and in conventional procedures the surgeon has to remain standing, bending, twisting and turning to move the tools into the right position. Not so with a robotic procedure.“There is this ergonomic advantage,” said Dr. Gerard M. Doherty, surgeon-in-chief at Brigham and Women’s Hospital in Boston who had no part in the study. “We move the arms of the robot while sitting comfortably. I have one surgeon who told me it will extend his career by a decade.”But robotic surgery is more expensive than other methods. The initial cost of the machines, the disposable instruments they require, the contracts for servicing the devices and the extra time spent in operating rooms make them so expensive that many hospitals cannot use them. The average initial cost of a robotic setup is about $2 million.Even in large health care centers, robots have their limitations. “We have 64 operating rooms, and only four of them have robots in them,” Dr. Doherty said.One company, Intuitive Surgery, which makes the da Vinci robots, has such a dominant market presence in the United States that they are essentially without competition, and this may be a factor in keeping the prices high. But more competition may be coming.“I’ve seen robots made by other companies,” Dr. Doherty said. “Everyone’s hope is that if someone can bring a new platform in, then prices will come down. But we’ve been saying that for a decade. Intuitive has been pretty aggressive about maintaining their market.”In any case, according to Dr. Eastham, the future of surgery is robotic. “Despite the lack of evidence that robotics is ‘better’ than true laparoscopy or open surgery,” he said, “there is no question that in the U.S., the shift to robotics has already occurred.”

People with heart failure may live for many years and should continue to get regular cancer screenings, experts say.People with heart failure may be at increased risk for cancer.Cancer patients are usually monitored for heart failure because some cancer drugs can damage the heart. Now a new study suggests that heart failure patients, who may live for many years with the condition, might benefit by being monitored for cancer.Researchers used a German health database to track 100,124 patients with heart failure, comparing them with the same number of controls who did not have heart failure. All were cancer-free at the start, and the scientists tracked their incidence of cancer over the following 10 years. The study is in the journal ESC Heart Failure.The two groups were matched for age, sex, age, obesity and the incidence of diabetes, although the researchers lacked data on socioeconomic status, smoking, alcohol consumption and physical activity, which are all known to affect the risk for cancer.Still, the differences in cancer incidence between the two groups were significant. Overall, 25.7 percent of patients with heart failure were diagnosed with some form of cancer, compared with 16.2 percent of those without.The increased rate of cancer among heart patients has been found in other studies, but the large sample in this analysis allowed the researchers to note differences between types of cancer. Patients with heart failure had more than double the risk for cancers of the lip, oral cavity and pharynx. The risk was 91 percent higher for lung cancer and other respiratory cancers, 86 percent higher for female genital cancers, and 83 percent higher for skin cancers. People with heart failure had a 75 percent higher risk for colon cancer, stomach cancer and other cancers of the digestive system. Women with heart failure had a 67 percent higher risk for breast cancer, and men a 52 percent higher risk for cancer of the genital organs.“I think it is an interesting retrospective cohort study,” said Dr. Girish L. Kalra, a senior cardiology fellow at the David Geffen School of Medicine at U.C.L.A., who was not involved in the work. “The primary shortcoming of the study is that the database did not allow investigators to control for the single greatest risk for developing cancer and heart disease: smoking. Cigarette smoking may be the common thread in this study.”Still, while the strong connection with oropharyngeal and respiratory cancers suggests that smoking may be one explanation, the association remained robust for a broad range of cancers. The study also controlled for other factors linked to various cancers, including obesity, diabetes and advancing age, as well as frequency of medical consultations, which might lead to increased detection of cancers.In addition to smoking, there are other possible mechanisms that could explain the link. For example, a previous study found that a well-known protein biomarker of heart disease that appears even before symptoms occur is also correlated with an increase in the risk for cancer. It is also possible, the researchers write, that chronic inflammation may be involved in both heart failure and cancer. Alcohol use has also been tied to a variety of cancers.“There are more correlations between heart failure and cancer than just common risk factors,” said the senior author, Mark Luedde, a cardiologist at the University of Kiel in Germany. “Heart failure is not a disease of the heart. It is almost always a disease of the heart and other organs. The importance of comorbidities for the prognosis and quality of life of those affected cannot be overestimated.”Dr. Kalra agreed. “Ultimately, the heart is a bellwether for all health,” he said. “This study supports the notion that people with heart failure are a high-risk group and warrant our closest attention. As physicians, we should make sure that our cardiac patients are getting screened for cancer at the recommended time intervals. And we should continue to nag our smokers to quit.”

As consumption of sugar-laden drinks rose in the 1980s and ’90s, so did colorectal cancer rates among younger adults, a study in nurses found.Colon and rectal cancers are rising in younger adults, though researchers aren’t sure why. A new study of women and diet suggests that sugar-sweetened drinks may play a role.Rates of colorectal cancer in people under 50 have increased sharply in recent years. Compared with people born around 1950, those born around 1990 have twice the risk for colon cancer and four times the risk for rectal cancer.While sales of sugar-sweetened drinks have been decreasing in recent years, the percentage of calories consumed in sugary drinks rose dramatically between 1977 and 2001. During those years, the figure rose from 5.1 percent of total calories consumed to 12.3 percent among 19- to 39-year-olds, and from 4.8 percent to 10.3 percent among children 18 and under. By 2014 those figures had dropped, but 7 percent of calories consumed by Americans overall were still from sugary drinks.The new study, published in the medical journal Gut, examined the link between colorectal cancer and sweet drinks in 94,464 female registered nurses who were enrolled in a long-term prospective health study between 1991 and 2015, when they were 25 to 42 years old. They also looked at a subset of 41,272 nurses who reported their intake of sugary drinks at ages 13 to 18.The study included intakes of soft drinks, sports drinks and sweetened teas. The researchers also recorded fruit-juice consumption — apple, orange, grapefruit, prune and others.Over an average 24 years of follow-up, they found 109 cases of colorectal cancer among the nurses (the absolute risk for colon cancer in younger people is still small). But compared with women who averaged less than one eight-ounce serving of sugar-sweetened drinks a week, those who drank two or more had more than double the relative risk for the disease. Each additional serving of sweet drinks increased the risk by 16 percent. A serving a day in adolescence was linked to a 32 percent higher risk, and replacing sugary drinks with coffee or reduced-fat milk led to a 17 to 36 percent relative risk reduction. (They had no data on coffee sweetened with sugar.)“I was really interested to see that the study was on women,” said Caroline H. Johnson, an epidemiologist at the Yale School of Public Health who has published widely on the environmental risks for colon cancer but was not involved in this work. “The focus has mostly been on males. It will be interesting to see if it’s confirmed in men.”There was no association of the consumption of fruit juice or artificially sweetened drinks with early-onset colorectal cancer. The analysis controlled for various factors that can affect colon cancer risk, including race, B.M.I., menopausal hormone use, smoking, alcohol consumption and physical activity.The study showed only an association, so could not prove cause and effect. But Nour Makarem, an assistant professor of epidemiology at the Columbia Mailman School of Public Health who was not involved in the research, said, “This is robust evidence, novel evidence that higher intakes of soda are involved in a higher risk for colorectal cancer. We know that sugar-sweetened beverages have been linked to weight gain, glucose dysregulation and so on, which are also risk factors. So there’s a plausible mechanism that underlies these relationships.”The senior author of the study, Yin Cao, an associate professor of surgery at the Washington University School of Medicine in St. Louis, said that metabolic problems, such as insulin resistance and high cholesterol, as well as inflammation in the gut could play a larger role as a cause of cancer in the younger population than in older people, but that the exact potential mechanisms have not yet been pinpointed.“One hypothesis is that increased weight gain is causing the increase in risk,” she said, “but we controlled for obesity. Still, it might be one of the things contributing. In studies in mice, high fructose corn syrup has been found to contribute to cancer risk independent of obesity.“This is the first time sugar-sweetened beverages have been linked to early-onset colorectal cancer,” she continued, “and this study still needs to be replicated. But researchers and clinicians should be aware of this largely ignored risk factor for cancer at younger ages. This is an opportunity to revisit policies about how sugar-sweetened beverages are marketed, and how we can help reduce consumption.”