Annals of surgery
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Multicenter Study Comparative Study
Sentinel node status prediction by four statistical models: results from a large bi-institutional series (n = 1132).
To improve selection for sentinel node (SN) biopsy (SNB) in patients with cutaneous melanoma using statistical models predicting SN status. ⋯ Using commonly available clinicopathologic variables, predictive models can preoperatively identify a proportion of patients ( approximately 25%) who might be spared SNB, with an acceptable (1%-2%) error. If validated in large prospective series, these models might be implemented in the clinical setting for improved patient selection, which ultimately would lead to better quality of life for patients and optimization of resource allocation for the health care system.
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Randomized Controlled Trial Multicenter Study Comparative Study
Randomized, placebo-controlled, double-blind study of the efficacy of lanreotide 30 mg PR in the treatment of pancreatic and enterocutaneous fistulae.
Continuous intravenous infusion of somatostatin improves the natural course of digestive fistulae. Lanreotide 30 mg PR is a synthetic analogue of somatostatin with pharmacological activity extending to at least 10 days after intramuscular administration. Its effectiveness was assessed in patients with simple externalized digestive fistulae in a randomized, doubleblind, placebo-controlled study. ⋯ Compared with placebo, intramuscular lanreotide 30 mg PR significantly decreases digestive fistulae output at Day 3 and shortens time to fistula closure by 9 days. ClinicalTrials.gov registration number: NCT00729313.
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Multicenter Study Comparative Study
Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients.
We sought to determine whether hospital variations in surgical mortality were due to differences in complication rates or failure to rescue rates (ie, case-fatality rates in patients with a complication). ⋯ Reducing variations in mortality will require strategies to improve the ability of high-mortality hospitals to manage postoperative complications.
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Multicenter Study Comparative Study
Variability in length of stay after colorectal surgery: assessment of 182 hospitals in the national surgical quality improvement program.
Length of postoperative stay (LOS) has gained increasing attention as a potential indicator of surgical efficiency. Our objective was to examine the feasibility of assessing LOS at 182 hospitals to identify institutions with outlying performance. ⋯ ACS NSQIP data can provide individual hospitals with riskadjusted LOS measures that can be used to identify outlying performance and motivate quality improvement efforts.
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Multicenter Study
Minimally invasive liver resection for metastatic colorectal cancer: a multi-institutional, international report of safety, feasibility, and early outcomes.
To evaluate a multicenter, international series on minimally invasive liver resection for colorectal carcinoma (CRC) metastasis. ⋯ Minimally invasive liver resection for colorectal metastasis is safe, feasible, and oncologically comparable to open liver resection for both minor and major liver resections, even with prior intra-abdominal operations, in selected patients and when performed by experienced surgeons.