Journal of the American College of Surgeons
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The incidence of histopathologic organ invasion (HOI) in retroperitoneal sarcoma (RPS) is not well described. We reviewed our experience to investigate the rate and prognostic implications of HOI. ⋯ The likelihood of organ invasion can be predicted by histologic subtype of primary RPS. To the best of our knowledge, this is the first study to demonstrate that HOI is associated with worse overall survival. These data can help guide the minimal extent of surgical resection required for RPS.
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We sought to determine whether aggressive resuscitation in trauma patients presenting without vital signs, or "dead on arrival," was futile. We also sought to determine whether organ donation was an unexpected benefit of aggressive resuscitation. ⋯ Trauma patients presenting dead on arrival rarely (1.5%) achieve functional independence. However, organ donation appears to be an under-recognized outcomes benefit (3.6%) of the resuscitation of injury victims arriving without vital signs.
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Comparative Study
Comparative Effectiveness of Minimally Invasive Surgery and Conventional Approaches to Major or Challenging Hepatectomy.
The benefits of minimally invasive surgery (MIS) for low-risk or minor liver resection are well established. There is growing interest in MIS for major hepatectomy (MH) and other challenging resections, but there remain unanswered questions of safety that prevent broad adoption of this technique. ⋯ In this large study of minimally invasive MH, we found safety outcomes that are equivalent or superior to conventional open surgery. Although the decision to offer MIS might be influenced by factors not included in this evaluation (eg surgeon experience and other patient factors), these findings support its current use in MH.
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Comparative Study Observational Study
Outcomes of Laparoscopic vs Open Common Bile Duct Exploration: Analysis of the NSQIP Database.
Common bile duct exploration (CBDE) is an available option in the management of choledocholithiasis. We aimed to analyze outcomes comparing laparoscopic and open approaches to CBDE using the American College of Surgeons (ACS) NSQIP database. ⋯ Patients undergoing open CBDE suffer from a statistically significantly higher rate of mortality and overall complications compared with patients undergoing the laparoscopic approach. Laparoscopic CBDE should be considered as the preferred procedure whenever possible.