Annals of surgery
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Comparative Study
Predicting outcome by growth rate of locally recurrent retroperitoneal liposarcoma: the one centimeter per month rule.
To identify the prognostic variables that predict disease-specific survival and second local recurrence-free survival in patients with recurrent retroperitoneal liposarcoma so as to guide clinical management. ⋯ Local recurrence growth rate is strongly associated with disease-specific survival and local control for patients with completely resected locally recurrent retroperitoneal liposarcoma. Despite aggressive operative management patients with a local recurrence growth rate greater than 0.9 cm/mo were associated with poor outcomes and should be considered for enrollment in clinical trials employing novel agents.
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To prospectively compare the accuracy of combined positron emission tomography/computed tomography using F-fluorodeoxyglucose (FDG-PET/CT), multidetector row computed tomography (MDCT), and magnetic resonance imaging (MRI) in the evaluation of patients with suspected pancreatic malignancy. ⋯ FDG-PET/CT was more sensitive than conventional imaging in the diagnosis of both primary pancreatic adenocarcinoma and associated distant metastases. In contrast, the sensitivity of FDG-PET/CT was poor in detecting local lymph node metastasis, which would have been important for an assessment of resectability. We recommend the use of FDG-PET/CT in the evaluation of diagnostically challenging cases, especially in patients with biliary strictures without evidence of malignancy in conventional imaging.
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Comparative Study
Importance of complete pathologic response to prehepatectomy chemotherapy in treating colorectal cancer metastases.
We studied the influence of complete pathologic response of colorectal cancer liver metastases to prehepatectomy chemotherapy on longterm survival after hepatectomy. ⋯ Little correlation was observed between imaging response of colorectal cancer liver metastases to chemotherapy and pathologic response. Liver surgery should be undertaken even after a complete response by imaging. Outcome after hepatectomy was favorable in patients showing complete pathologic response of least one metastasis.
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We sought to understand whether obesity imparts detriment in outcome beyond risk of developing surgical site infection (SSI). ⋯ SSI is associated with detriment to patient and graft survival following renal transplantation. The prevalence of SSI is higher among obese recipients, but those who avoid SSI have comparable outcomes to nonobese recipients. These findings redemonstrate the importance of SSI prevention following renal transplantation.
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Comparative Study
Communication practices on 4 Harvard surgical services: a surgical safety collaborative.
Communication breakdowns between surgical residents and attending physicians in the pre- and postoperative setting are common contributors to patient injury. These communication transactions might offer an opportunity for safety improvement, but it remains unknown how often resident-attending communication fails, what the current level of attending involvement is, and how often attending input changes the plan for patient care. We conducted a prospective study at 4 Harvard teaching hospitals to address these issues. ⋯ In the context of both critical patient events and routine patient care, residents often fail to obtain attending surgeons' input for management decisions. These failures seem to derive more from residents' perception of necessity than from attending physicians' receptiveness or interest in being contacted. Once involved, attending physicians frequently modify resident's management decisions. It seems, therefore, that there is significant potential for communication failure and information loss among our 4 institutions.