Annals of surgery
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Multicenter Study Comparative Study
Laparoscopic versus open left pancreatectomy: can preoperative factors indicate the safer technique?
Laparoscopic left pancreatectomy (LLP) is associated with favorable outcomes compared with open left pancreatectomy (OLP). However, it is unclear if the risk factors associated with operative morbidity differ between these two techniques. Guidelines for determining which patients should undergo OLP versus LLP do not exist. ⋯ Risk factors for complications and pancreatic fistulae after left pancreatectomy differ when open versus laparoscopic techniques are employed. Preoperative characteristics may identify cohorts of patients who will benefit more from LLP, and no patient cohorts had higher postoperative complication rates after LLP than OLP. These observations suggest that LLP may be the operative procedure of choice for most patients with left-sided pancreatic lesions; a more definitive prospective and randomized comparison may be warranted.
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To examine the relation between hospital teaching status and surgical outcomes for both emergency and elective general surgery cases using a national database. ⋯ Teaching status is associated with increased risk of IHM after emergency cases. POC profiles also differ by TH status. Investigation of the way in which systems-level variables that differ between TH and NTH contribute to postoperative outcomes may identify novel targets for performance improvement.
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Comparative Study
How to diagnose acute left-sided colonic diverticulitis: proposal for a clinical scoring system.
The aim of this study was to assess and compare the diagnostic value of elements of the disease history, physical examination, and routine laboratory tests in patients with suspected acute left-sided colonic diverticulitis (ALCD). ⋯ This study showed that the clinical diagnosis of diverticulitis is difficult to make but can be improved using a clinical scoring system. In case of a high chance of ALCD based on the nomogram, additional imaging may not be needed.
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Comparative Study
The management of synchronous bilateral Wilms tumor: a report from the National Wilms Tumor Study Group.
To provide guidelines for future trials, we reviewed the outcomes of children with synchronous bilateral Wilms tumors (BWT) treated on National Wilms Tumor Study-4 (NWTS-4). ⋯ The current analysis of patients with BWT treated on NWTS-4 shows that preservation of renal parenchyma is possible in many patients after initial preoperative chemotherapy. The incidence of end-stage renal disease remains significantly higher in children with BWT. Future studies are warranted to address the need for earlier biopsy in nonresponsive tumors and earlier definitive surgery to recognize unfavorable histology in these high-risk patients.
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Review Meta Analysis
Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis.
To examine the long-term oncological impact of anastomotic leakage (AL) after restorative surgery for colorectal cancer using meta-analytical methods. Outcomes evaluated were local recurrence, distant recurrence, and survival. ⋯ AL has a negative prognostic impact on local recurrence after restorative resection of rectal cancer. A significant association between colorectal AL and reduced long-term cancer specific survival was also noted. No association between AL and distant recurrence was found.