Annals of surgical oncology
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Multicenter Study
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis in the Elderly: A Case-Controlled, Multicenter Study.
This study was designed to identify factors associated with morbidity and mortality in patients older than 70 years who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis (PC). ⋯ CRS and HIPEC appear feasible for selected patients older than aged 70 years, albeit with a higher risk of medical complications associated with increased mortality.
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Comparative Study
Changing Odds of Survival Over Time among Patients Undergoing Surgical Resection of Gallbladder Carcinoma.
While survival after malignancies is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant by accounting for "accrued" survival time as time progresses. We sought to compare actuarial and CS among patients with gallbladder carcinoma (GBC) . ⋯ CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients. CS estimates can be used to accurately predict survival and guide clinical decision making.
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Chemotherapeutic advances have enabled successful cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) expansion in treating metastatic colorectal cancer. ⋯ Simultaneous surgery for colorectal LM and PC is both feasible and safe, with low postoperative morbidity. Further longer-term studies would help determine its impact on patient survival.
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Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a new procedure aimed at promoting the overgrowth of small future liver remnants (FLR). The role of ALPPS in hilar cholangiocarcinoma (h-CCA) is currently considered marginal because liver split in the presence of bile duct obstruction increases postoperative morbidity and mortality (Schadde et al. in Ann Surg 260:829-836,2014; Nadalin et al. in Z Gastroenterol 52:35-42,2014). Virtual liver split (Gall et al. in Ann Surg 261:e45-e46,2015) could improve the outcome of ALPPS in h-CCA. ⋯ Laparoscopic ALPPS (Machado et al. in Ann Surg 256:e13,2012) and MWA on the intended split line (Gringeri and Boetto in Ann Surg 261:e42-e43,2015) have been recently described. The combination of these techniques with PBD allowed successful ALPPS in a patient with h-CCA.
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Case Reports
Fluorescent Angiography Used to Evaluate the Perfusion Status of Anastomosis in Laparoscopic Anterior Resection.
Anastomotic leakage after gastrointestinal surgery is associated with significant morbidity and mortality.1 Insufficient vascular supply is one cause.2 Recent reports of using intraoperative indocyanine green (ICG) fluorescent angiography to evaluate whether perfusion of the anastomosis is adequate has yielded positive outcomes.3 - 6 The authors describe their use of ICG-enhanced fluorescence angiography in a laparoscopic anterior resection. ⋯ The study showed that ICG fluorescent angiography is a simple and quick intraoperative tool for evaluating the perfusion of the anastomosis. The authors' experience with ICG fluorescent angiography has shown promising results, with a 0 % anastomotic leak rate.