Alessandro Cucchetti, Benjamin Djulbegovic, Stefano Crippa, Iztok Hozo, Monica Sbrancia, Athanasios Tsalatsanis, Cecilia Binda, Carlo Fabbri, Roberto Salvia, Massimo Falconi, Giorgio Ercolani
BACKGROUND: When treating potentially resectable pancreatic adenocarcinoma, therapeutic decisions are left to the sensibility of treating clinicians who, faced with a decision that post hoc can be proven wrong, may feel a sense of regret that they want to avoid. A regret-based decision model was applied to evaluate attitudes toward neoadjuvant therapy versus upfront surgery for potentially resectable pancreatic adenocarcinoma. METHODS: Three clinical scenarios describing high-, intermediate-, and low-risk disease-specific mortality after upfront surgery were presented to 60 respondents (20 oncologists, 20 gastroenterologists, and 20 surgeons)...
March 15, 2023: Surgery
Arjun Verma, Joseph Hadaya, Catherine Williamson, Elsa Kronen, Sara Sakowitz, Syed Shahyan Bakhtiyar, Nikhil Chervu, Peyman Benharash
BACKGROUND: A paradoxical increase in mortality following extracorporeal membrane oxygenation at high-volume centers has previously been demonstrated. We examined the association between annual hospital volume and outcomes within a contemporary, national cohort of extracorporeal membrane oxygenation patients. METHODS: All adults requiring extracorporeal membrane oxygenation for postcardiotomy syndrome, cardiogenic shock, respiratory failure, or mixed cardiopulmonary failure were identified in the 2016 to 2019 Nationwide Readmissions Database...
March 11, 2023: Surgery
Adityabikram Singh, Neal S Panse, Vishnu Prasath, Simran Arjani, Ravi J Chokshi
BACKGROUND: Laparoscopic cholecystectomy is the current standard of care treatment for benign gallbladder disease. Robotic cholecystectomy is another approach for performing cholecystectomy that offers a surgeon better dexterity and visualization. However, robotic cholecystectomy may increase cost without sufficient evidence to suggest an improvement in clinical outcomes. The purpose of this study was to construct a decision tree model to compare cost-effectiveness of laparoscopic cholecystectomy and robotic cholecystectomy...
March 11, 2023: Surgery
Zorays Moazzam, Henrique A Lima, Yutaka Endo, Laura Alaimo, Aslam Ejaz, Mary Dillhoff, Jordan Cloyd, Timothy M Pawlik
BACKGROUND: Familiarity with the surgical work environment has been demonstrated to improve outcomes. We sought to investigate the impact of the rate of fragmented practice on textbook outcomes, a validated composite outcome representing an "optimal" postoperative course. METHODS: Patients who underwent a hepatic or pancreatic surgical procedure between 2013 and 2017 were identified from the Medicare Standard Analytic Files. The rate of fragmented practice was defined as the surgeon's volume over the study period relative to the number of facilities practiced at...
March 10, 2023: Surgery
Aaron Scott, Paul Wong, Laleh G Melstrom
Intrahepatic cholangiocarcinoma is an aggressive tumor that commonly presents at an advanced stage requiring multimodal treatment. Surgical resection remains the only curative option; however, only 20% to 30% of patients present with resectable disease as these tumors remain asymptomatic at an early stage. Diagnostic workup for intrahepatic cholangiocarcinoma includes contrast-enhanced cross-sectional imaging (eg, computed tomography, magnetic resonance imaging) to determine resectability and percutaneous biopsy for patients receiving neoadjuvant therapy or with unresectable disease...
March 9, 2023: Surgery
Thomas C Hydrick, Chi Zhang, Brianna Ruch, Josiah Wagler, Kayla Kumm, Jack W Harbell, Winston R Hewitt, Caroline C Jadlowiec, Nitin N Katariya, Adyr A Moss, Michelle C Nguyen, Kunam S Reddy, Andrew L Singer, Amit K Mathur
BACKGROUND: The Centers for Medicare and Medicaid Services is a major payer for abdominal transplant services. Reimbursement reductions could have a major impact on the transplant surgical workforce and hospitals. Yet government reimbursement trends in abdominal transplantation have not been fully characterized. METHODS: We performed an economic analysis to characterize changes in inflation-adjusted trends in Medicare surgical reimbursement for abdominal transplant procedures...
March 7, 2023: Surgery
Helen J Madsen, Riley A Gillette, Kathryn L Colborn, William G Henderson, Adam R Dyas, Michael R Bronsert, Anne Lambert-Kerzner, Robert A Meguid
BACKGROUND: The number of obese surgical patients continues to grow, and yet obesity's association with surgical outcomes is not totally clear. This study examined the association between obesity and surgical outcomes across a broad surgical population using a very large sample size. METHODS: This was an analysis of the 2012 to 2018 American College of Surgeons National Surgical Quality Improvement database, including all patients from 9 surgical specialties (general, gynecology, neurosurgery, orthopedics, otolaryngology, plastics, thoracic, urology, and vascular)...
March 3, 2023: Surgery
Mary Kate Skalitzky, Peige P Zhou, Paolo Goffredo, Kristina Guyton, Scott K Sherman, Irena Gribovskaja-Rupp, Imran Hassan, Muneera R Kapadia, Jennifer E Hrabe
BACKGROUND: The incidence of colorectal cancer in patients <50 years has rapidly risen recently. Understanding the presenting symptoms may facilitate earlier diagnosis. We aimed to delineate patient characteristics, symptomatology, and tumor characteristics of colorectal cancer in a young population. METHODS: A retrospective cohort study was conducted evaluating patients <50 years diagnosed between 2005 and 2019 with primary colorectal cancer at a university teaching hospital...
March 3, 2023: Surgery
Joshua P Schiff, Alden D'Souza, Lauren E Henke
The role of radiation therapy in the management of liver cancers, both primary and metastatic, has changed drastically over the past several decades. Although conventional radiation was limited by technology, the advent of advanced image-guided radiotherapy and the rise in evidence for and popularity of stereotactic body radiotherapy have expanded the indications for radiation in these two distinct disease types. Magnetic resonance imaging-guided radiation therapy, daily online adaptive radiotherapy, and proton radiotherapy are some of many modern radiotherapy techniques that allow for increasingly efficacious treatment of intrahepatic disease while simultaneously allowing for increased normal tissue sparing, including sparing of the normal liver and the radiosensitive luminal gastrointestinal tract...
March 3, 2023: Surgery
J Annelie Suurmeijer, Anouk M Emmen, Bert A Bonsing, Olivier R Busch, Freek Daams, Casper H van Eijck, Susan van Dieren, Ignace H de Hingh, Tara M Mackay, J Sven Mieog, I Quintus Molenaar, Martijn W Stommel, Vincent E de Meijer, Hjalmar C van Santvoort, Bas Groot Koerkamp, Marc G Besselink
BACKGROUND: The International Study Group of Pancreatic Surgery 4-tier (ie, A-D) risk classification for postoperative pancreatic fistula grade B/C is based on pancreatic texture and pancreatic duct size: A (not-soft texture and pancreatic duct >3 mm), B (not-soft texture and pancreatic duct ≤3 mm), C (soft texture and pancreatic duct >3 mm), and D (soft texture and pancreatic duct ≤3 mm). This study aimed to validate the International Study Group of Pancreatic Surgery risk classification for postoperative pancreatic fistula after pancreatoduodenectomy...
February 27, 2023: Surgery
Rutger T Theijse, Thomas F Stoop, Niek J Geerdink, Freek Daams, Babs M Zonderhuis, Joris I Erdmann, Rutger Jan Swijnenburg, Geert Kazemier, Olivier R Busch, Marc G Besselink
BACKGROUND: For logistical reasons, some high-volume centers have developed surgical programs wherein 1 surgical team performs 2 pancreatoduodenectomies on a single day. It is unclear whether this practice has a negative impact on surgical outcome. METHODS: We conuducted a retrospective analysis including all consecutive open pancreatoduodenectomies in a single high-volume center (2014-2021). Pancreatoduodenectomies were grouped as the first (pancreatoduodenectomy-1) or second (pancreatoduodenectomy-2) pancreatoduodenectomy on a single day (ie, paired pancreatoduodenectomies) and as pancreatoduodenectomy-3 whenever 1 pancreatoduodenectomy was performed per day (ie, unpaired)...
February 24, 2023: Surgery
Zorays Moazzam, Laura Alaimo, Henrique A Lima, Yutaka Endo, Timothy M Pawlik
BACKGROUND: The impact of upward economic mobility and race/ethnicity on achieving quality metrics such as textbook outcomes remains ill-defined. As such, we sought to define the impact of race and county-level upward economic mobility on the ability to achieve a textbook outcome among patients undergoing hepatic and pancreatic surgery. METHODS: Patients who underwent hepatic or pancreatic procedures between 2013 and 2017 were identified from the Medicare Standard Analytic Files...
February 24, 2023: Surgery
Nicolò Fabbri, Antonio Pesce, Salvatore Greco, Carlo Vittorio Feo
No abstract text is available yet for this article.
February 23, 2023: Surgery
Gilbert Sterling Octavius, Michelle Patricia Muljono, Charista Lydia Budiputri
BACKGROUND: Acute appendicitis is one of many common reasons for acute abdominal pain, and its exact diagnosis is still debatable amongst clinicians. This systematic review and meta-analysis of diagnostic test accuracy aim to look at serum pentraxin-3 performance in diagnosing acute appendicitis in patients with acute abdominal pain. METHODS: This systematic review is registered on the International Prospective Register of Systematic Reviews (CRD42022338296). The primary outcome of this study is to examine the sensitivity, specificity, and post-test probability of serum pentraxin-3 (the index test) in patients with acute appendicitis...
February 22, 2023: Surgery
Maximiliano Servin-Rojas, Zhi Ven Fong, Carlos Fernandez-Del Castillo, Cristina R Ferrone, Dario M Rocha-Castellanos, Jorge Roldan, Piotr J Zelga, Andrew L Warshaw, Keith D Lillemoe, Motaz Qadan
BACKGROUND: Mucinous cystic neoplasms of the pancreas are uncommon tumors that have the potential of becoming cancer. There is no consensus regarding the high-risk features of these tumors. Our study aimed to identify the preoperative demographic, clinical, or radiologic factors that can predict the presence of high-grade dysplasia or invasive carcinoma in mucinous cystic neoplasms of the pancreas. METHODS: We identified 157 patients who underwent resection and fulfilled the pathologic criteria for mucinous cystic neoplasms of the pancreas in a prospectively maintained database spanning 3 decades (1990-2020)...
February 21, 2023: Surgery
Junya Oguma, Koshiro Ishiyama, Daisuke Kurita, Kyohei Kanematsu, Kentaro Kubo, Daichi Utsunomiya, Seiichiro Abe, Mai Makiguchi, Satoru Nonaka, Haruhisa Suzuki, Shigetaka Yoshinaga, Ichiro Oda, Yutaka Saito, Hiroyuki Daiko
BACKGROUND: The clinicopathological features and the distribution of lymph node metastasis in patients with T1a-MM and T1b-SM1 superficial esophageal squamous cell carcinoma remain unclear; therefore, the optimal treatment strategy is still controversial. METHODS: One hundred and ninety-one patients who had undergone a thoracic esophagectomy with 3-field lymphadenectomy and who were pathologically confirmed to have thoracic superficial esophageal squamous cell carcinoma that had reached the T1a-MM or T1b-SM1 stage were retrospectively reviewed...
February 15, 2023: Surgery
Atif Iqbal, Aimal Khan, Steven Hughes, Thomas J George, Sanda Tan, Hector Garcia-Chavez, Thomas Read
BACKGROUND: We previously developed the Pelvic Surgery Difficulty Index for predicting intraoperative events and postoperative outcomes associated with rectal mobilization with or without proctectomy ("deep pelvic dissection"). The aim of this study was to validate the scoring system as a prognostic tool for outcomes of pelvic dissection, regardless of the cause of dissection. METHODS: Consecutive patients who underwent elective deep pelvic dissection at our institution from 2009 to 2016 were reviewed...
February 15, 2023: Surgery
Tadeusz D Witek, Arjun Pennathur, Daniel Brynien, James D Luketich, Mark Scaife, David Azar, Matthew J Schuchert, William E Gooding, Omar Awais
BACKGROUND: With the increasing use of computed tomography scans for lung cancer screening and surveillance of other cancers, thoracic surgeons are being referred patients with lung lesions for biopsies. Electromagnetic navigational bronchoscopy-guided lung biopsy is a relatively new technique for bronchoscopic biopsy. Our objective was to evaluate the diagnostic yields and safety of electromagnetic navigational bronchoscopy-guided lung biopsy. METHODS: We conducted a retrospective review of patients who underwent an electromagnetic navigational bronchoscopy biopsy, performed by a thoracic surgical service, and evaluated its safety and diagnostic accuracy...
February 14, 2023: Surgery
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