Journal of the American College of Surgeons
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The frequency and significance of the germline variants in DNA damage repair genes still need to be elucidated in patients with sporadic pancreatic ductal adenocarcinoma (PDAC). Our purpose was to determine whether germline variants in DNA damage repair genes were associated with survival of patients with sporadic PDAC. ⋯ Having a deleterious variant in a DNA damage repair gene is associated with improved survival after resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma.
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Indiscriminate use of adjuvant therapy in stage IIIA melanoma is controversial. We sought to model the clinical impact and cost of implementing a gene expression profile (GEP) test to guide adjuvant therapy. ⋯ Routine adjuvant pembrolizumab for stage IIIA melanoma is costly, and risk-stratification by GEP only marginally improves the value of therapy.
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Minimally invasive surgery techniques have evolved remarkably over the past few decades in the field of surgical oncology, including nascent techniques for pancreatic malignancies. The emergence of the robotic surgery platform has accelerated widespread implementation of minimally invasive pancreatectomy. However, whether minimally invasive approaches can maintain the quality of oncologic surgical procedures, particularly in superior mesenteric artery (SMA) dissection during pancreatoduodenectomy, remains unknown. ⋯ Specifically, vessel loops encircling the superior mesenteric vein are ligated with Endoloops, and the ends of the Endoloops are carefully retracted externally on the patient’s left side. This maneuver provides critical exposure of the SMA that allows safe, high-quality oncologic dissection. We describe our external retraction techniques in the video presentation, which can improve the safety and quality of robotic pancreatoduodenectomy.
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Incisional hernia develops in up to 20% of patients undergoing abdominal operations. We sought to identify characteristics associated with poor outcomes after acute incisional hernia incarceration. ⋯ Comparison of predicted elective repair and observed emergent repair mortality in patients with acute incarceration suggests that acceptable outcomes could have been achieved with elective repair. Almost one-half of acute incarceration patients had no earlier surgical evaluation, therefore, targeted interventions to address surgical referral can potentially result in fewer incarceration-related deaths.