Journal of surgical oncology
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Preoperative axillary ultrasound (AUS) in clinically node-negative patients may increase axillary lymph node dissection (ALND) in ACoSOG Z0011-eligible patients. We hypothesize that AUS identifies operative axillary disease (>3 positive nodes) in women undergoing breast conserving surgery (BCS). ⋯ AUS/FNA has a high NPV for axillary metastasis and remarkable sensitivity for three or more positive axillary nodes, therefore AUS-identified metastasis should be treated as clinically node-positive disease, and is appropriate even in patients planning breast conserving surgery.
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Racial disparity is often identified as a factor in survival from breast cancer in the United States. Current data regarding survival in patients treated in the Department of Defense Military Healthcare System is lacking. ⋯ Survival from early stage breast cancer is equivalent between white and black patients in the Department of Defense Healthcare System. This finding is contrary to reports from our civilian counterparts and may be indicative of improved access to care and overall improved cancer surveillance.
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The purpose of this study was to determine the learning curve for robot-assisted gastrectomy using the Cumulative Summation (CUSUM) technique. ⋯ The CUSUM method is a useful tool for objective evaluation of practical skills for surgeons during the learning phase of robotic surgery training. The robotic gastrectomy is found to have a short learning curve for experienced laparoscopic surgeons and the popularity of this new technology won't reduce because of its difficulty to learn.
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Optimal perioperative fluid administration in major gastrointestinal surgery remains a challenging clinical problem. Traditional dogma of a liberal approach to fluid administration in order to counteract potential hypovolemia and decreased end-organ perfusion can often result in fluid overload, perhaps negatively impacting perioperative outcomes. This hypothesis has been investigated in several types of gastrointestinal surgery. We discuss the current literature on perioperative fluid administration in colorectal and pancreatic surgery and highlight the controversies that still exist.
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The effect of postmastectomy radiation therapy (PMRT) on immediately reconstructed abdominal wall-based tissue remains imprecisely defined. We evaluated evidence from all fields involved in care of the breast cancer patient in order to advance a unified recommendation regarding this therapeutic sequence. ⋯ There is mixed evidence for the utility of PMRT with immediate autologous abdominal wall breast reconstruction. Further investigation requires prospective studies with collaboration among surgical oncologists, radiation oncologists, and plastic surgeons.