Journal of the American College of Surgeons

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No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: The rising incidence of thyroid cancer has been attributed to increased detection of papillary thyroid microcarcinoma (PTMC). Although some PTMCs are thought to harbor aggressive pathologic features, the clinical significance of these features remains unclear. This study examines factors associated with survival in this patient population. STUDY DESIGN: Adults with PTMC, defined as papillary thyroid carcinoma ≤1.0 cm, who underwent thyroidectomy between 2004-2016 were identified in the National Cancer Database...

BACKGROUND: Despite the major advances in analgesic techniques, pain relief on coughing after abdominal surgery remains challenging. Cough-related pain causes postoperative respiratory complications by impairing sputum clearance; nevertheless, an effective technique to abolish it is not yet available. We devised the bilateral flank compression (BFC) maneuver, in which the flanks are compressed medially using both hands. We conducted a prospective, single-center, single arm, non-randomized, open-label, interventional trial, to investigate whether the BFC maneuver relieves cough-related pain after abdominal surgery, and examine the efficacy of this maneuver in relation to patient characteristics and surgical factors...

BACKGROUND: Increasingly surgeons are adopting broader roles in emergency response, both on a clinical and executive levels. These have highlighted the need to develop healthcare-specific crisis management systems. Cross-professional research between safety-critical industries is a valuable method for learning crisis control. Commercial aviation, in particular, has been used to drive innovation in surgical safety. This study aimed to identify, adapt and operationalize a surgical crisis management framework based on current practice in commercial aviation...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

BACKGROUND: HPB Fellowship training in the Americas consists of three distinctive routes with variable curricula: Surgical Oncology Fellowship via the Society of Surgical Oncology (SSO), Abdominal Transplant Surgery Fellowship via the American Society of Transplant Surgeons (ASTS), and HPB Fellowship via the Americas Hepato-Pancreato-Biliary Association (AHPBA). Our objective was to establish a pan-American consensus among hepatopancreatobiliary (HPB) surgeons, surgical oncologists, abdominal transplant surgeons, and general surgery residency program directors (GSPDs) on a core knowledge curriculum for HPB fellowship and to identify topics appropriate for general surgery residency and subspecialty beyond HPB fellowship...

INTRODUCTION: Pancreatic cysts are incidentally detected in up to 13% of patients undergoing radiographic imaging. Of the most frequently encountered types, mucin-producing (mucinous) pancreatic cystic lesions may develop into pancreatic cancer, while non-mucinous ones have little or no malignant potential. Accurate preoperative diagnosis is critical for optimal management but has been difficult to achieve, resulting in unnecessary major surgery. Here, we aim to develop an Algorithm based upon biomarker risk scores to improve risk stratification...

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BACKGROUND: Informed consent is an ethical and legal requirement that differs from informed decision-making-a collaborative process that fosters participation and provides information to help patients reach treatment decisions. The objective of this study was to measure informed consent and informed decision-making prior to major surgery. METHODS: We audio-recorded 90 preoperative patient-surgeon conversations prior to major cardiothoracic, vascular, oncologic, and neurosurgical procedures at 3 centers in the U...

BACKGROUND: Understanding of signaling pathways has not been fully incorporated into prognostication and therapeutic options. We evaluated the hypothesis that information about cancer-related signaling pathways can improves prognostic stratification and explains some of the clinical heterogeneity in patients with metastatic colorectal cancer. STUDY DESIGN: We analyzed prognostic relevance of signaling pathways in patients undergoing colorectal liver metastases (CLM) resection during 2004-2017 and clinical actionability of gene alterations in seven signaling pathways: p53, Wnt, RTK-RAS, PI3K, TGFβ, Notch, and cell cycle...

BACKGROUND: High scores in Medically Necessary, Time-sensitive (MeNTS) scoring system, used for elective surgical prioritization during Coronavirus Disease 2019 pandemic, are assumed to be associated with worse outcomes. We aimed to evaluate the MeNTS scoring system in patients undergoing elective surgery during restricted capacity of our institution with or without moderate or severe postoperative complications. STUDY DESIGN: In this prospective observational study, MeNTS scores of patients undergoing elective operations during May-June 2020 were calculated...

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BACKGROUND: Repairs of primary ventral hernias are common procedures but associated with high recurrence rates. Therefore, it is important to investigate risk factors for recurrence to optimize current treatments. The aim of this study was to assess the impact of annual surgeon volume on the risk of reoperation for recurrence after primary ventral hernia repair. STUDY DESIGN: We conducted a nationwide register-based study with data from the Danish Ventral Hernia Database and the Danish Patient Safety Authority's Online Register linked via surgeons' authorization ID...

Despite the near-universal acceptance of the benefits of a sound peer-review process (PRP), the topic of peer review remains a source of controversy among surgeons. The current PRP is plagued by heterogeneity across different hospital and institutional systems. These inconsistencies, combined with a perceived lack of fairness inherent to the PRP in some institutions lead to concerns among practicing surgeons. In the following review of the relevant literature on the PRP, we attempt to provide some context and insight into the history of the PRP, its role, its shortcomings, its potential abuses, and some key requirements for its successful execution...

BACKGROUND: The present study aimed to assess performance of the three-level complexity classification which stratified liver resection procedures into three complexity grades (grade I, low; grade II, intermediate; grade III, high complexity) and to evaluate whether the enhanced recovery after surgery (ERAS) protocol improves postoperative outcomes for each complexity grade. STUDY DESIGN: Consecutive patients undergoing open liver resection (OLR) and laparoscopic liver resection (LLR) at Lausanne University Hospital during 2010-2020 were assessed...

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BACKGROUND: Bile duct injury sustained during laparoscopic cholecystectomy is associated with high morbidity and mortality and can be a devastating complication for a General Surgeon. We introduce a novel individualized surgical coaching program for surgeons who recently injured a bile duct in laparoscopic cholecystectomy. We aim to explore the perception of coaching among these surgeons and to assess surgeons' experiences in the coaching program. STUDY DESIGN: Six General Surgeons who injured a bile duct at an emergency laparoscopic cholecystectomy participated in a one-on-one coaching session with an Hepatopancreatobiliary surgeon...