Surgery
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There is an increasing demand for standardization in the choice of treatments for specific conditions, so-called personalized medicine. The task is far from trivial, because the perspectives from many stakeholders must be respected, including patients and health care providers, as well as payers or governments to better control costs while optimizing quality of care. One approach to provide widely accepted therapies is the consensus conference. ⋯ This novel model of consensus conference allows the construction of consensual, evidence-based, explicit recommendations for therapies in a process that may also identify issues for further research, eventually fostering progress in the field.
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Review Case Reports
Anatomic segmentectomy and brachytherapy mesh implantation for clinical stage I non-small cell lung cancer (NSCLC).
Sublobar wedge resection is associated with an increased risk of locoregional recurrence (15-20%) compared with lobectomy for early non-small cell lung cancer (NSCLC). We have previously shown that the addition of brachytherapy mesh at the time of sublobar resection might decrease the risk of local recurrence in this setting, equivalent to that of lobectomy [Santos et al. Surgery 2003;134:691-7]. In the current study, we evaluated the impact of brachytherapy mesh implantation after formal anatomic segmentectomy on local recurrence rates in the management of clinical stage I NSCLC. ⋯ It appears that the local recurrence noted with non-anatomic wedge resection is not an equivalent concern when anatomic segmentectomy with adequate margins are obtained. This implies that adjuvant brachytherapy after anatomic segmentectomy is not required for local control, thus avoiding the costs of radiation therapy and its associated potential toxicity. These data also suggest that proper anatomic segmentectomy alone may be associated with local recurrence rates similar to those of anatomic lobectomy in the setting of clinical stage I NSCLC.
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Abdominal wall reconstruction (AWR) poses a substantial operative challenge, often in the setting of multiple failed attempts at repair in high-risk patients. Our aim was to assess risk factors for major operative morbidity after AWR using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) patient database. ⋯ Greater operative times and overall patient health are important prognostic factors for individuals undergoing AWR. The increased physiologic stress of a greater operative duration on patients who often have multiple comorbidities seems to play a significant role in predicting negative outcomes after AWR.