Journal of the American College of Surgeons
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The role of neoadjuvant chemotherapy in the management of colorectal liver metastases remains controversial. We sought to investigate whether neoadjuvant systemic chemotherapy contributes to clinically significant increases in postoperative morbidity and mortality using a population-based cohort. ⋯ In this propensity-matched population-based cohort study, the use of neoadjuvant systemic chemotherapy was not associated with higher rates of complications, biliary fistula, post-hepatectomy liver failure, or mortality among patients with colorectal liver metastases undergoing liver resection.
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Multicenter Study
Impact of Immunotherapy after Resection of Pancreatic Cancer.
Adjuvant immunotherapy has improved outcomes in patients with advanced melanoma; however, the potential benefit for patients with pancreatic ductal adenocarcinoma (PDAC) remains unknown. The aim of this study was to determine the impact of adjuvant chemotherapy and immunotherapy (CTx-IT) compared with CTx alone on patient survival after resection of PDAC. ⋯ The addition of adjuvant immunotherapy to chemotherapy is associated with improved survival compared with chemotherapy alone after curative-intent resection of pancreatic adenocarcinoma. Future research is warranted to match specific immunotherapy agents with susceptible patient populations to improve outcomes for this aggressive disease.
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Multicenter Study
Sex-Based Differences in Ten-Year Nationwide Outcomes of Carotid Revascularization.
We compared the rates of stroke, death, and/or MI between men and women, stratified by symptomatic status and procedure type (carotid endarterectomy [CEA] or carotid artery stent [CAS]). ⋯ This is the largest cohort study to date that demonstrates asymptomatic women undergoing CEA or CAS do not have a higher risk of perioperative stroke, death, or MI. Symptomatic men experience lower rates of stroke after CEA or CAS.
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Multicenter Study
Competing Risk of Death in Elderly Patients with Newly Diagnosed Stage I Breast Cancer.
The majority of newly diagnosed breast cancers in the US are in women aged older than 65 years who can have additional comorbidities. Balancing the risks and benefits of treatment should take into account these competing risks of death. ⋯ To aid clinical decision making, we quantify competing risks of death in patients with stage I breast cancer by taking into account patient age, comorbidity, and estrogen receptor status.
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Multicenter Study
Impact of the Society of Surgical Oncology-American Society for Radiation Oncology Margin Guidelines on Breast-Conserving Surgery and Mastectomy Trends.
In 2014, the Society of Surgical Oncology and American Society for Radiation Oncology guidelines defined negative margin for stage I and II breast cancer as "no tumor on ink." We hypothesized that repeat operation rates have decreased since the guideline introduction and would be associated with changes in overall surgical trends. ⋯ Repeat operation rates are decreasing after 2014, which is also associated with a rise in BCS and decrease in BM rates. Dissemination of margin guidelines for early-stage breast cancer might be impacting overall surgical trends.