Articles: disease.
-
Previous studies have demonstrated the advantages of short-term histopathological outcomes and complications associated with transanal total mesorectal excision (TME) compared with laparoscopic TME. However, the long-term oncological outcomes of transanal TME remain ambiguous. This study aims to compare 3-year disease-free survival of transanal TME with laparoscopic TME. ⋯ In patients with mid-low rectal cancer, 3-year disease-free survival for transanal TME was noninferior to that of laparoscopic TME.
-
Gallbladder specimens from cholecystectomy procedures are a common specimen evaluated by military pathologists. These are often removed for inflammatory causes. Previous studies show that the incidence of gallbladder carcinoma (GBC) is around 3%. Incidentally identified GBC is even less common at 0.36%. Incidentally found GBCs are of little clinical consequence as most are treated by cholecystectomy alone. We hypothesize that a selective approach to histologic evaluation of gallbladders could save time for pathologists to focus on more complex cancer cases and save money for the Defense Health Agency. We propose that for patients under 50 years of age with no clinical or macroscopic concern for neoplasia, histologic evaluation may be omitted with negligible risk of missing a clinically relevant diagnosis. ⋯ The sensitivity of a clinical/macroscopic concern for neoplasia in a patient aged under 50 years is low, identifying only 2 of 3 malignancies in our dataset. However, the case that would have been missed under our proposed guidelines was from metastatic disease of a previously known metastatic malignancy. We consider that if a selective histologic evaluation is established, a history of malignancy should be a qualifier for evaluation regardless of any other factors. A selective approach to histologic evaluation of gallbladders could save our institution $4,716 to $5,240 annually. Additional studies, incorporating prior malignancy as a qualifier, are warranted to further evaluate the potential for harm in patients aged under 50 years and a number needed to harm should be established prior to any changes in practice.