Journal of the American College of Surgeons
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Multicenter Study
Management of anastomotic leakage in a nationwide cohort of colonic cancer patients.
The mortality associated with anastomotic leakage (AL) after colonic cancer surgery is high and management often results in permanent fecal diversion. Preservation of bowel continuity in combination with proximal loop diversion (salvage) may reduce the number of permanent ostomies without jeopardizing safety. ⋯ Patients with Hinchey I-II and small anastomotic defect were safely managed by anastomotic salvage, which reduced the risk of permanent fecal diversion. Anastomotic salvage is a viable option for this subset of patients.
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Multicenter Study Comparative Study
Portal vein resection in borderline resectable pancreatic cancer: a United Kingdom multicenter study.
Until recently, in the United Kingdom, borderline resectable pancreatic cancer with invasion into the portomesenteric veins often resulted in surgical bypass because of the presumed high risk for complications and the uncertainty of a survival benefit associated with a vascular resection. Portomesenteric vein resection has therefore remained controversial. We present the second largest published cohort of patients undergoing portal vein resection for borderline resectable (T3) adenocarcinoma of the head of the pancreas. ⋯ This study, the second largest to date on borderline resectable pancreatic cancer, demonstrates no significant difference in perioperative mortality in the 3 groups and a similar overall survival between PD and PDVR; significantly better compared with SB.
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Multicenter Study Comparative Study
Operative vs nonoperative management for blunt pancreatic transection in children: multi-institutional outcomes.
The management of traumatic pancreatic transection remains controversial. ⋯ In children with blunt pancreatic injury, distal pancreatectomy is superior to nonoperative management with more rapid resumption of diet, fewer repeat interventions, and a shorter period to complete resolution. When the main duct is involved, the benefits to operative resection also include lower morbidity and fewer days of hospitalization. Therefore, assessing the status of the pancreatic duct is paramount in determining management.
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Multicenter Study Comparative Study
Effects of resident involvement on complication rates after laparoscopic gastric bypass.
Although resident involvement has been shown to be safe for most procedures, the impact of residents on outcomes after complex laparoscopic procedures is not well understood. We sought to examine the impact of resident involvement on outcomes after bariatric surgery using a population-based clinical registry. ⋯ Resident involvement in laparoscopic gastric bypass is independently associated with wound infections and venous thromboembolism. The effect appears to be mediated in part by longer operative times. These findings highlight the importance of strategies to assess and improve resident technical proficiency outside the operating room.
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Multicenter Study Comparative Study
Treatment and prognosis of patients with fibrolamellar hepatocellular carcinoma: a national perspective.
Surgery remains the only potentially curative option for patients with hepatocellular carcinoma (HCC) and fibrolamellar carcinoma (FLC). We sought to investigate the differences over time in surgically managed FLC compared with conventional HCC using population-based data. ⋯ Patients with FLC have many clinicopathologic features that are different from those of patients with HCC, including younger age and female sex. Despite a higher likelihood of advanced disease at the time of diagnosis, surgically treated FLC patients had better long-term outcomes than patients with conventional HCC.