Journal of the American College of Surgeons
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Comparative Study
Comparison of outcomes of breast conserving therapy in multifocal and unifocal invasive breast cancer.
There is controversy about whether breast conserving therapy (BCT) should be contraindicated in multifocal (MF) breast cancer. Few studies have reported on the oncologic safety of BCT in MF breast cancer. ⋯ Our data suggest that BCT in MF breast cancer is oncologically safe but may result in a slightly inferior outcome compared with BCT in unifocal breast cancer.
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The balance between patient treatment risks and training residents to proficiency is confounded by duty-hour limits. Stricter limits have been recommended to enhance quality and safety, although supporting data are scarce. ⋯ Most categorical surgery residents do not perceive that reduced duty hours will noticeably improve quality of care. Resident perceptions of causes of medical errors suggest that system changes are more likely to enhance patient safety than further hour limits.
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Many laparoscopic procedures are currently performed on an outpatient basis. Laparoscopic appendectomy, however, continues to require postoperative hospitalization at most institutions. A treatment protocol for outpatient laparoscopic appendectomy was developed to determine if this could be successfully performed without increasing postoperative complications. We hypothesized that adopting an outpatient protocol for laparoscopic appendectomy will significantly increase the rate of outpatient management for uncomplicated appendicitis, without an increase in morbidity or mortality. ⋯ An outpatient protocol for laparoscopic appendectomy significantly increased the rate of outpatient management with no increase in morbidity or mortality. This practice has now become standard of care at our institution.
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Regionalization of trauma care reduces mortality and has clear guidelines for transport to the highest level of trauma care. Whether prehospital providers follow the CDC triage algorithm remains to be determined. ⋯ Prehospital providers follow physiologic, anatomic, and mechanistic parameters in steps 1 to 3 of the CDC field triage guidelines. However, contrary to the special considerations guideline in step 4, older age was associated with transport to the lower level of trauma care in our region.
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The surgical treatment of metastatic, nonfunctional pancreatic neuroendocrine carcinoma (nPNEC) is not well defined. Existing series are confounded by inclusion of patients with metastatic functional tumors or gastrointestinal carcinoid. Our hypothesis was that the surgical treatment of metastatic nPNEC provides favorable perioperative and oncologic outcomes. ⋯ Surgical treatment of metastatic nPNEC to the liver with curative intent or for palliative ≥ 90% debulking provides favorable oncologic outcomes. Despite a high incidence of tumor recurrence, 5-year survival rates are encouraging and appear to justify an aggressive surgical approach in these patients.