Journal of the American College of Surgeons
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Melanoma liver metastasis is most often fatal, with a 4- to 6-month median overall survival (OS). Over the past 20 years, surgical techniques have improved in parallel with more effective systemic therapies. We reviewed our institutional experience of hepatic melanoma metastases. ⋯ In this largest single-institution experience, patients selected for surgical therapy experienced markedly improved survival relative to those receiving only medical therapy. Patients whose disease stabilized on medical therapy enjoyed particularly favorable results, regardless of the number or size of their metastases. The advent of more effective systemic therapy in melanoma may substantially increase the fraction of patients who are eligible for surgical intervention, and this combination of treatment modalities should be considered whenever it is feasible in the context of a multidisciplinary team.
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There is a paucity of information about the frequency and timing of reversal after stoma creation for trauma. In addition, the barriers to reversal faced by those patients are largely unknown. We hypothesize that the rate of stoma creation and reversal are low among trauma patients. Additionally, we sought to identify patient-related barriers to stoma reversal. ⋯ The stoma reversal rate appears to be higher than we hypothesized; this is most likely due to the high rate of patient migration between hospitals. The factors that posed substantial barriers to reversal after initial admission were lack of health insurance and black and Hispanic race/ethnicity.
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Observational Study
Validating trauma-specific frailty index for geriatric trauma patients: a prospective analysis.
The Frailty Index has been shown to predict discharge disposition in geriatric patients. The aim of this study was to validate the modified 15-variable Trauma-Specific Frailty Index (TSFI) to predict discharge disposition in geriatric trauma patients. We hypothesized that TSFI can predict discharge disposition in geriatric trauma patients. ⋯ II Prognostic Studies-Investigating the Effect of a Patient Characteristic on the Outcome of Disease.
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Although the natural history of intraductal papillary mucinous neoplasm (IPMN) remains unclear, large surgical series have reported malignancy in 40% to 90% of main pancreatic duct (MPD)-involved IPMN. Accordingly, the 2012 International Consensus Guidelines recommend surgical resection in patients with suspected MPD involvement. We hypothesized that nonoperative management of select patients with suspected MPD-involved IPMN might be indicated. ⋯ Patients with suspected MPD-involved IPMN have a highly variable rate of malignancy. Despite recent International Consensus Guidelines recommendations, these data suggest that MPD diameter is not an optimal gauge of malignant risk. Nonoperative management of suspected MPD-involved IPMN in select patients, particularly double negatives, might be indicated. Depending on age and comorbidity, operative risk might outweigh the risk of malignant progression in these patients.