Surgical oncology clinics of North America
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Surg. Oncol. Clin. N. Am. · Jul 2012
Variation in mortality after high-risk cancer surgery: failure to rescue.
Surgical mortality with oncologic surgery varies widely in the United States. Patients, providers, and payers are paying closer attention to these variations and a way of reducing them. Although different hospital and surgical technologies and processes of care may account for some of this variation, there is an increasing awareness of the role of hospital safety culture. There is a growing body of evidence suggesting the importance of reducing mortality rates after major complications as a means to reducing the disparate mortality rates with oncologic surgery.
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Clinical trial data show that radiation enhances local tumor control of extremity sarcomas with acceptable morbidity when sophisticated radiation techniques are combined with limb-sparing resections performed by oncologic surgeons with sarcoma expertise. Similar controlled data is not available for retroperitoneal sarcomas but some studies suggest a benefit for radiotherapy. Radiation can be delivered by external beam or brachytherapy; it can be given pre-operatively, post-operatively, or intra-operatively. Indications for and advances in radiation therapy are discussed in this article.
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Surg. Oncol. Clin. N. Am. · Oct 2011
ReviewEpidemiology of lung cancer: smoking, secondhand smoke, and genetics.
The link between smoking and development of lung cancer has been demonstrated, not only for smokers but also for those exposed to secondhand smoke. Despite the obvious carcinogenic effects of tobacco smoking, not all smokers develop lung cancer, and conversely some nonsmokers can develop lung cancer in the absence of other environmental risk factors. A multitude of genetic factors are beginning to be explored that interact with environmental exposure to alter the risk of developing this deadly disease. By more fully appreciating the complex interrelationship between genetics and other risks the development of lung cancer can be more completely understood.
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Adjuvant therapy is commonly used in melanoma because recurrence after surgery usually results in the patient's eventual death. Surgeons have a profound influence on patients' decisions regarding adjuvant therapy, beginning with providing a clear understanding of the risk of specific types of recurrence. This review summarizes the potential oncologic benefits and relevant toxicities of adjuvant systemic therapies for melanoma that are currently available and under investigation.
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Several large case series and single-institution trials have shown that laparoscopy is feasible for rectal cancer. Pending the results of the UK CLASICC, COLOR II, Japanese JCOG 0404, and ACOSOG Z6051 trials, the oncologic and long-term safety of laparoscopic rectal cancer surgery is unclear and the technique is best used at centers that can effectively collect and analyze outcomes data. Robotic and endoluminal techniques may change our approach to the treatment of rectal cancer in the future. Training, credentialing, and quality control are important considerations as new and innovative surgical treatments for rectal cancer are developed.