Journal of the American College of Surgeons
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Male breast cancer (MBC) is a rare disease, accounting for 1% of all breast cancers diagnosed in the United States. The rarity of MBC has limited the development of treatment algorithms specific to men. Thus, the standard of care has been mastectomy. The safety and feasibility of breast-conserving surgery (BCS) in MBC are unclear. This study assessed whether overall survival outcomes, local recurrence, and postoperative complications differed between MBC patients who underwent conservative surgery or mastectomy. ⋯ There is no difference in the 5-year OS and LR rate between MBC patients who undergo BCS or mastectomy. The postoperative complication rate was higher with mastectomies. We conclude that BCS for unicentric male breast cancer is feasible and preferred for T1 and T2 cancers.
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In response to the opioid epidemic, prescribing guidelines and statewide surgical opioid management programs were initiated in 2018-19. This analysis aims to document the sustainability of a regional opioid stewardship consortium through the pandemic and beyond. ⋯ From 2019 to 2023, the percentage of patients taking opioids preoperatively decreased significantly, and the utilization of intraoperative blocks also increased significantly. The PENNJ-SOS program played a key role in combatting the opioid crisis over the four years of data collection, adapting effectively to the challenges posed by the Coronavirus Disease 2019 pandemic.
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The ACS-NSQIP Colectomy-Targeted database provides valuable metrics on surgical outcomes by utilizing clinical data to enhance quality improvement efforts. However, the quality measures offered in the ACS-NSQIP semiannual report do not stratify for the indication for colectomy. We aim to compare postoperative outcomes in patients undergoing colectomy for colon cancer, infectious causes, and inflammatory bowel disease (IBD). ⋯ This study demonstrates that the indication for colectomy impacts postoperative outcomes. Reporting risk-adjusted outcomes based on the underlying disease etiology could lead to identifying high-risk patients, improving benchmarking outcomes, and developing targeted quality initiatives.
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Pathway-driven, post-pancreatectomy opioid reduction interventions have proven effective and sustainable and may have a "halo effect" on other major abdominal cancer operations. This study's aim was to analyze the sequential effects of expanding opioid reduction efforts from pancreatectomy on opioids prescribed after hepatectomy. ⋯ Directed opioid reduction efforts for pancreatectomy influenced clinically meaningful post-hepatectomy reductions in inpatient and discharge opioid volumes. A "halo effect" of intradepartmental opioid reduction efforts is attainable and corresponds to measurable increases in opioid-free or nearly opioid-free discharges after major abdominal cancer surgery.
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Breast conservation therapy for patients with DCIS includes breast conserving surgery (BCS) with post-operative radiotherapy (RT). Because RT does not impact overall survival, identifying women who do not benefit from RT would allow de-escalation of therapy. We evaluated the impact of a novel 7-gene DCIS biosignature on adjuvant radiation recommendations for patients undergoing BCS for DCIS. ⋯ 7-gene biosignature test resulted in a 35% reduction in patients treated with adjuvant RT. Patients with higher decision scores were more likely to receive RT and to receive a greater RT dose.