Journal of the American College of Surgeons
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Randomized Controlled Trial
Enhancing Patient Outcomes while Containing Costs after Complex Abdominal Surgery: A Randomized Controlled Trial of the Whipple Accelerated Recovery Pathway (WARP).
This study was designed to determine whether a standardized recovery pathway could reduce post-pancreaticoduodenectomy hospital length of stay to 5 days without increasing complication or readmission rates. ⋯ The WARP can safely reduce hospital length of stay, time to adjuvant therapy, and cost in selected pancreaticoduodenectomy patients without increasing readmission risk.
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Although diverting stomas have reduced anastomotic leak rates after sphincter-preserving proctectomy in some series, the effectiveness of routine diversion among a broad population of rectal cancer patients remains controversial. We hypothesized that routine temporary diversion is not associated with decreased rates of leak or reintervention in cancer patients at large undergoing sphincter-sparing procedures. ⋯ No association between diversion and anastomotic leak was found. However, temporary diversion was associated with increased incidence of nonelective reinterventions, readmissions, and higher costs. We therefore challenge the paradigm of routine diversion in rectal cancer operations. Additional study is needed to identify which patients would benefit most from diversion.
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Multicenter Study
Real World Outcomes of Talimogene Laherparepvec Therapy: A Multi-Institutional Experience.
Talimogene laherparepvec (TVEC) is an FDA-approved oncolytic herpes virus used to treat unresectable stage IIIB to IV metastatic melanoma via intralesional injection. This study aims to characterize the efficacy TVEC in patients with unresectable stage IIIB to IV melanoma. ⋯ Talimogene laherparepvec is a well-tolerated, durable treatment option for patients with unresectable locoregional melanoma, particularly in stage IIIB/C disease. Additionally, we found that TVEC can be administered safely across anatomic sites that are otherwise not amenable to other local therapies.
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Clinical Trial
Robotic Pancreaticoduodenectomy Is the Future: Here and Now.
This study was undertaken to examine our outcomes after robotic pancreaticoduodenectomy and to compare our outcomes with predicted outcomes using the American College of Surgeons (ACS) NSQIP Surgical Risk Calculator and with outcomes reported through ACS NSQIP. ⋯ Our patients were not a select group, they were like those reported in ACS NSQIP. Their outcomes after robotic pancreaticoduodenectomy were like or better than predicted outcomes or national data. Our mortality was high because of preoperative ill health (eg renal failure) and cardiac risk. Although we believe our results will continue to improve, our current data document the salutary benefits of minimally invasive robotic pancreaticoduodenectomy.
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Simultaneous liver-kidney transplantation is lifesaving, however, the utility of allocating 2 organs to a single recipient remains controversial, particularly in the face of potentially inferior survival. This study aims to determine the effect of renal indication for transplantation on simultaneous liver-kidney transplantation outcomes. ⋯ Despite a lower acuity of illness, HTN/DM patients have inferior survival after simultaneous liver-kidney transplantation than those with ATN/HRS. This should be considered in risk adjustment and allocation schemes.