Annals of surgical oncology
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Comparative Study Clinical Trial
Why do patients with low-grade soft tissue sarcoma die?
The patterns of failure and mechanisms of sarcoma-specific death are poorly characterized among the minority of patients with low-grade soft tissue sarcoma (STS) who succumb to disease. ⋯ Among patients with low-grade STS, DOD occurs in approximately 9% of patients. Nonextremity site, larger size, and less than R0 resection are the most important risk factors for DOD, and distinct patterns of recurrence and death are predicted by primary tumor site.
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Despite the widespread use of endoscopic biliary stenting in patients presenting with potentially resectable pancreatic cancer, there is no general consensus regarding whether this represents a superior management approach over expeditious surgical intervention. The objective of this study was to investigate the influence of preoperative biliary stenting and resolution of jaundice on subsequent postoperative survival following resection for pancreatic cancer. ⋯ These results suggest that the presence of jaundice at the time of resection has an adverse impact on early, but not overall, postoperative survival in pancreatic cancer patients undergoing preoperative biliary drainage.
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Preoperative diagnosis of pancreatic cystic neoplasms is problematic. We evaluated our experience with endoscopic ultrasound (EUS) to determine the utility of fine-needle aspiration cytology (FNAC) in surgical decision-making. ⋯ The decision to proceed with nonoperative management should not be based on a negative or nondiagnostic FNAC alone, as 67% of negative and 92% of nondiagnostic specimens were associated with malignant or premalignant pathology.
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Multicenter Study
Age-, race-, and ethnicity-related differences in the treatment of nonmetastatic rectal cancer: a patterns of care study from the national cancer data base.
Recent studies suggest that older patients and minorities are less likely to receive surgical and adjuvant therapy for rectal cancer. We analyzed the independent effect of age and race/ethnicity on treatment for rectal cancer controlling for comorbidity and socioeconomic status using a nationwide sample ⋯ A high proportion of older patients with rectal cancer do not receive appropriate surgical or adjuvant therapy, even when controlling for comorbidity. African American patients are also less likely to undergo resection, but are equally likely to undergo sphincter preservation and adjuvant therapy compared with whites. Efforts are needed to uncover the root causes underlying these observations and optimize treatment of rectal cancer.
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The use of adjuvant radiotherapy after lymph node dissection for metastatic melanoma remains controversial. This study examined the effectiveness of adjuvant radiotherapy in controlling regional disease in high-risk patients. ⋯ This large, nonrandomized retrospective study found no evidence to support the use of adjuvant radiotherapy for high-risk melanoma. A multicenter randomized, controlled trial investigating this important clinical dilemma is advocated.