Annals of surgical oncology
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The American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) has improved operative outcomes in the USA. However, its applicability to oncologic resections at ACS NSQIP hospitals has not been fully explored. We assessed the ability of factors currently collected by ACS NSQIP to predict adverse operative events after major cancer surgery. ⋯ Current ACS NSQIP variables show low predictive ability for major complications after major oncologic resections. Addition of some disease- and operation-specific variables may be an important consideration in the further evolution of the NSQIP to allow for more accurate predictions of adverse outcomes for major oncologic resections.
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Breast cancer is increasingly considered a heterogeneous disease. The aim of this study was to assess the differences between histological and receptor-based subtypes in breast-conserving surgery and pathological complete response (pCR) after neoadjuvant chemotherapy. ⋯ In lobular tumors the benefit with regard to breast-conserving surgery of neoadjuvant chemotherapy is questionable. Although in ER-positive tumors the pCR rate is low, the increase in breast-conserving surgery was remarkable in ductal ER-positive tumors.
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Editorial Comment
Predicting adverse outcomes after complex cancer surgery.
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Whether the TNM staging system is applicable after neoadjuvant chemoradiation in esophageal cancer is controversial. The aim of this study was to evaluate the prognostic value of histopathological regression of the primary tumor in postchemoradiated patients. ⋯ In patients who underwent neoadjuvant chemoradiation therapy, histopathological regression of the primary tumor indicated by percentage of residual viable cells is an important prognostic factor in addition to nodal status and gender.
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Preoperative staging of patients with colorectal carcinoma (CRC) has the potential benefit of altering treatment options when metastases are present. The clinical value of chest computed tomography (CT) in staging remains unclear. ⋯ The low incidence of pulmonary metastases and minimal consequences for the treatment plan limits the clinical value of routine staging chest CT before operation. It has several disadvantages such as costs, radiation exposure, and prolonged uncertainty because of the frequent finding of indeterminate lesions. Based on this study, a routine staging chest CT in CRC patients is not advocated.