Journal of the American College of Surgeons
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Negative surgical margins are vital to achieve cure and prolong survival in patients with pancreatic cancer. We inquired if fluorescence-guided surgery (FGS) could improve surgical outcomes and reduce recurrence rates in orthotopic mouse models of human pancreatic cancer. ⋯ Surgical outcomes were improved in pancreatic cancer using fluorescence-guidance. This novel approach has significant potential to improve surgical treatment of cancer.
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Neoadjuvant chemoradiotherapy followed by operative staging and liver transplantation is an effective treatment for patients with unresectable hilar cholangiocarcinoma (CCA) and CCA arising in the setting of primary sclerosing cholangitis (PSC). Pathologic confirmation of CCA is notoriously difficult, and many patients have been treated based on clinical criteria without pathological confirmation. ⋯ Rates of residual CCA in liver explants and recurrences after transplantation are comparable for patients with and without pretreatment pathological confirmation of CCA and attest to the accuracy of clinical diagnostic criteria. Pretreatment pathological confirmation of CCA is desirable but should not be a requirement for treatment.
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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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Multicenter Study Comparative Study
Adoption of laparoscopy for elective colorectal resection: a report from the Surgical Care and Outcomes Assessment Program.
The purpose of this study was to evaluate the adoption of laparoscopic colon surgery and assess its impact in the community at large. ⋯ The use of laparoscopic colorectal resection increased in the Northwest. Increased adoption of laparoscopic colectomies was associated with greater use of all types of colorectal surgery.