Annals of surgical oncology
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The role of magnetic resonance imaging (MRI) in preoperative planning for women diagnosed with breast cancer remains controversial. The risks and benefits in women with newly diagnosed ductal carcinoma in situ (DCIS) are largely unknown. ⋯ Our data show that MRI does not significantly decrease reexcision rates or conversion to mastectomy after attempted breast-conservation surgery. Based on our findings, we do not believe preoperative MRI adds benefit to the care of this patient population. Prospective trials are necessary to further investigate the risks and benefits of preoperative MRI in women with DCIS.
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Nipple-sparing mastectomy (NSM) improves cosmetic outcome of mastectomy, but many patients are not candidates for this procedure because of concerns about nipple-areolar viability. Surgical delay is a technique that has been used for more than 400 years to improve survival of skin flaps. We used a surgical delay procedure to improve nipple viability in patients who were identified to be at high risk for nipple necrosis following NSM. ⋯ A procedure to surgically delay the NAC 7-21 days prior to NSM is demonstrated to ensure viability of NAC in patients previously thought to be at high risk for nipple loss.
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Transparency and accountability are becoming more important, and publically reported quality measures will be used increasingly to determine how surgeons are viewed and reimbursed. That is a good thing if it is done correctly, but poorly designed quality measures might actually interfere with patient care. It will be necessary for ASBrS to remain involved in the development of relevant, true data-based measures of quality that have appropriate benchmarks and no unintended consequences. Importantly, the quality measures need to include all reasonable treatment options so that quality care is enhanced and not impeded.
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Biography Historical Article
Society of Surgical Oncology Heritage Award: honoring William C. Wood, MD.
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Pathologic response to preoperative chemotherapy for colorectal liver metastases (CLM) is associated with survival after hepatectomy. Histologically, dominant response patterns include fibrosis, necrosis and/or acellular mucin, but some of these changes can appear without previous chemotherapy and their individual correlation with outcome is unknown. ⋯ Fibrosis is the predominant chemotherapy-related pathologic alteration driving the association of treatment response with survival after CLM resection. Necrosis in CLM is not related to chemotherapy or outcome.