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Essential Surgical Knowledge

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2223 papers 1000+ followers Papers from the recent literature which are of interest to residents and practicing surgeons
https://www.readbyqxmd.com/read/30542840/oncotype-dx-%C3%A2-recurrence-score-as-a-predictor-of-response-to-neoadjuvant-chemotherapy
#1
Alison M Pease, Luis A Riba, Ryan A Gruner, Nadine M Tung, Ted A James
BACKGROUND: The Oncotype DX® assay has been validated in predicting response to adjuvant chemotherapy in breast cancer. Its role in neoadjuvant chemotherapy (NCT) has not been established. METHODS: The National Cancer Database was used to identify all patients with T1-T3, ER-positive, HER2-negative primary invasive breast cancer diagnosed from 2010 to 2015 who had Oncotype DX recurrence scores (RS) and received NCT. RS were classified as low, intermediate, or high...
December 12, 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/30509455/impact-of-frailty-on-outcomes-in-surgical-patients-a-systematic-review-and-meta-analysis
#2
A C Panayi, A R Orkaby, D Sakthivel, Y Endo, D Varon, D Roh, D P Orgill, R L Neppl, H Javedan, S Bhasin, I Sinha
IMPORTANCE: Age has historically been used to predict negative post-surgical outcomes. The concept of frailty was introduced to explain the discrepancies that exist between patients' chronological and physiological age. The efficacy of the modified frailty index (mFI) to predict surgical risk is not clear. OBJECTIVE: We sought to synthesize the current literature to quantify the impact of frailty as a prognostic indicator across all surgical specialties. DATA SOURCES: Pubmed and Cochrane databases were screened from inception to 1 January 2018...
November 27, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30414683/minimally-invasive-surgery-for-palliation
#3
REVIEW
Jordan M Cloyd
Palliative care is the multidisciplinary focus on patient symptoms and quality of life. The emphasis of minimally invasive surgery on reduced pain and faster recovery aligns well with the goals of palliative care. Minimally invasive approaches can be safely and effectively used to address several common complications of solid organ malignancies as well as the complications of cytotoxic therapy. A patient-centered, minimally invasive approach will not only help alleviate disabling symptoms and improve patient quality of life but will also minimize the pain and adverse effects of the intervention itself...
January 2019: Surgical Oncology Clinics of North America
https://www.readbyqxmd.com/read/30476948/association-of-timing-of-colostomy-reversal-with-outcomes-following-hartmann-procedure-for-diverticulitis
#4
Benjamin J Resio, Raymond Jean, Alexander S Chiu, Kevin Y Pei
Importance: The Hartmann procedure (end colostomy) remains a common operation for diverticulitis requiring surgery. However, the timing of subsequent colostomy reversal remains widely varied, and the optimal timing remains unknown. Objective: To investigate the association of the timing of colostomy reversal with operative outcomes. Design, Setting, and Participants: This retrospective analysis of the Healthcare Cost and Utilization Project State Inpatient Databases for California, Florida and Maryland included patients with colostomy for diverticulitis linked to their colostomy reversal...
November 21, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/30481366/prolonged-thromboprophylaxis-with-low-molecular-weight-heparin-for-abdominal-or-pelvic-surgery
#5
REVIEW
Seth Felder, Morten Schnack Rasmussen, Ray King, Bradford Sklow, Mary Kwaan, Robert Madoff, Christine Jensen
BACKGROUND: This an update of the review first published in 2009.Major abdominal and pelvic surgery carries a high risk of venous thromboembolism (VTE). The efficacy of thromboprophylaxis with low molecular weight heparin (LMWH) administered during the in-hospital period is well-documented, but the optimal duration of prophylaxis after surgery remains controversial. Some studies suggest that patients undergoing major abdominopelvic surgery benefit from prolongation of the prophylaxis up to 28 days after surgery...
November 27, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/30481267/a-seven-gene-signature-assay-improves-prognostic-risk-stratification-of-perioperative-chemotherapy-treated-gastroesophageal-cancer-patients-from-the-magic-trial
#6
E C Smyth, G Nyamundanda, D Cunningham, E Fontana, C Ragulan, I B Tan, S J Lin, A Wotherspoon, M Nankivell, M Fassan, A Lampis, J C Hahne, A R Davies, J Lagergren, J A Gossage, N Maisey, M Green, J L Zylstra, W H Allum, R E Langley, P Tan, N Valeri, A Sadanandam
Background: Following neoadjuvant chemotherapy for operable gastroesophageal cancer, lymph node metastasis is the only validated prognostic variable; however, within lymph node groups there is still heterogeneity with risk of relapse. We hypothesized that gene profiles from neoadjuvant chemotherapy treated resection specimens from gastroesophageal cancer patients can be used to define prognostic risk groups to identify patients at risk for relapse. Patients and methods: The Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) trial (n = 202 with high quality RNA) samples treated with perioperative chemotherapy were profiled for a custom gastric cancer gene panel using the NanoString platform...
November 27, 2018: Annals of Oncology: Official Journal of the European Society for Medical Oncology
https://www.readbyqxmd.com/read/30480564/when-things-go-wrong-the-surgeon-as-second-victim
#7
Jordan D Bohnen, Keith D Lillemoe, Elizabeth A Mort, Haytham M A Kaafarani
No abstract text is available yet for this article.
November 22, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/30424839/sarcopenia-predicts-poor-outcomes-in-urgent-exploratory-laparotomy
#8
Lisa M Francomacaro, Charles Walker, Kathryn Jaap, James Dove, Marie Hunsinger, Kenneth Widom, Denise Torres, Mohsen Shabahang, Joseph Blansfield, Jeffrey Wild
BACKGROUND: Emergent laparotomies are associated with higher rates of morbidity and mortality. Recent studies suggest sarcopenia predicts worse outcomes in elective operations. The purpose of this study is to examine outcomes following urgent exploratory laparotomy in sarcopenic patients. METHODS: This was a retrospective review of patients in a rural tertiary care facility between 2010 and 2014. Patients underwent a laparotomy within 72 h of admission and had an abdomen/pelvis CT scan were included...
November 6, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30426190/guidelines-for-perioperative-care-in-elective-colorectal-surgery-enhanced-recovery-after-surgery-eras-%C3%A2-society-recommendations-2018
#9
REVIEW
U O Gustafsson, M J Scott, M Hubner, J Nygren, N Demartines, N Francis, T A Rockall, T M Young-Fadok, A G Hill, M Soop, H D de Boer, R D Urman, G J Chang, A Fichera, H Kessler, F Grass, E E Whang, W J Fawcett, F Carli, D N Lobo, K E Rollins, A Balfour, G Baldini, B Riedel, O Ljungqvist
BACKGROUND: This is the fourth updated Enhanced Recovery After Surgery (ERAS® ) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. METHODS: A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system...
November 13, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/30427983/nonoperative-management-of-uncomplicated-appendicitis-among-privately-insured-patients
#10
Lindsay A Sceats, Amber W Trickey, Arden M Morris, Cindy Kin, Kristan L Staudenmayer
Importance: Health care professionals have shown significant interest in nonoperative management for uncomplicated appendicitis, but long-term population-level data are lacking. Objective: To compare the outcomes of nonoperatively managed appendicitis against appendectomy. Design, Setting, and Participants: This national retrospective cohort study used claims data from a private insurance database to compare patients admitted with uncomplicated appendicitis from January 1, 2008, through December 31, 2014, undergoing appendectomy vs nonoperative management...
November 14, 2018: JAMA Surgery
https://www.readbyqxmd.com/read/30420189/surgical-excision-versus-observation-as-initial-management-of-desmoid-tumors-a-population-based-study
#11
Benjamin Turner, Mohamed Alghamdi, Jan-Willem Henning, Elizabeth Kurien, Don Morris, Antoine Bouchard-Fortier, Daniel Schiller, Shannon Puloski, Michael Monument, Doha Itani, Lloyd A Mack
SYNOPSIS: Desmoid tumors can be safely managed with watchful waiting, including either observation alone or tamoxifen/NSAIDs. Surgery at first presentation can be associated with significant treatment burden. BACKGROUND: Immediate surgery was historically recommended for desmoid tumors. Recently, watchful waiting, (tamoxifen/NSAIDs or observation alone), has been advocated. METHODS: All diagnoses of desmoid tumor within the Alberta Cancer Registry from August 2004 to September 2015 were identified...
October 25, 2018: European Journal of Surgical Oncology
https://www.readbyqxmd.com/read/30414453/outcomes-after-pancreatectomy-with-routine-pasireotide-usage
#12
John W Kunstman, Debra A Goldman, Mithat Gönen, Vinod P Balachandran, Michael I D'Angelica, T Peter Kingham, William R Jarnagin, Peter J Allen
BACKGROUND: Morbidity following pancreatectomy is commonly due to leakage of exocrine secretions resulting in abscess or pancreatic fistula (PF). Previously, we authored a double-blind randomized controlled trial demonstrating perioperative pasireotide administration lowers abscess or PF formation by over 50%. Accordingly, we adopted pasireotide usage as standard practice following pancreatectomy in October 2014 and hypothesized a similar PF/abscess rate reduction would be observed. STUDY DESIGN: A prospectively maintained database was queried for all patients who underwent pancreatectomy between October 2014 and July 2017...
November 7, 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/30348463/espen-guideline-on-clinical-nutrition-in-the-intensive-care-unit
#13
Pierre Singer, Annika Reintam Blaser, Mette M Berger, Waleed Alhazzani, Philip C Calder, Michael P Casaer, Michael Hiesmayr, Konstantin Mayer, Juan Carlos Montejo, Claude Pichard, Jean-Charles Preiser, Arthur R H van Zanten, Simon Oczkowski, Wojciech Szczeklik, Stephan C Bischoff
Following the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also described. The best determination of amount and nature of carbohydrates, fat and protein are suggested...
September 29, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/29957372/borderline-resectable-pancreatic-cancer-challenges-and-controversies
#14
REVIEW
Luis Sabater, Elena Muñoz, Susana Roselló, Dimitri Dorcaratto, Marina Garcés-Albir, Marisol Huerta, Desamparados Roda, María Carmen Gómez-Mateo, Antonio Ferrández-Izquierdo, Antonio Darder, Andrés Cervantes
Pancreatic cancer is a dismal disease with an increasing incidence. Despite the majority of patients are not candidates for curative surgery, a subgroup of patients classified as borderline resectable pancreatic cancer can be selected in whom a sequential strategy of neoadjuvant therapy followed by surgery can provide better outcomes. Multidisciplinary approach and surgical pancreatic expertise are essential for successfully treating these patients. However, the lack of consensual definitions and therapies make the results of studies very difficult to interpret and hard to be implemented in some settings...
July 2018: Cancer Treatment Reviews
https://www.readbyqxmd.com/read/30392164/predictors-of-mortality-after-elective-ventral-hernia-repair-an-analysis-of-national-inpatient-sample
#15
Zhamak Khorgami, Benedict Y Hui, Nasir Mushtaq, Geoffrey S Chow, Guido M Sclabas
PURPOSE: Deciding between surgery and non-operative management of a non-obstructive ventral hernia (VH) in a high-risk patient often poses a clinical challenge. The aim of this study is to evaluate a national series of open and laparoscopic ventral hernia repair (VHR), and to assess predictors of mortality after elective VHR. METHODS: A retrospective analysis of 2008-2014 data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample was performed...
November 3, 2018: Hernia: the Journal of Hernias and Abdominal Wall Surgery
https://www.readbyqxmd.com/read/30377439/small-bowel-obstruction-in-the-elderly-a-plea-for-comprehensive-acute-geriatric-care
#16
REVIEW
Ekin Ozturk, Marianne van Iersel, Martijn Mwj Stommel, Yvonne Schoon, Richard Rpg Ten Broek, Harry van Goor
Small bowel obstruction is one of the most frequent emergencies in general surgery, commonly affecting elderly patients. Morbidity and mortality from small bowel obstruction in elderly is high. Significant progress has been made in the diagnosis and management of bowel obstruction in recent years. But little is known whether this progress has benefitted outcomes in elderly patients, particularly those who are frail or have a malignancy as cause of the obstruction, and when considering quality of life and functioning as outcomes...
2018: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/30389116/did-we-prioritize-quality-improvement-in-general-surgery-time-for-a-focus-on-outcomes-and-enhanced-recovery-care-plans
#17
Byron D Hughes, Eric Sieloff, Hemalkumar B Mehta, Anthony J Senagore
BACKGROUND: In 2008, 2005-2006 National Surgical Quality Improvement Program (NSQIP) data were used to identify surgical operations contributing disproportionately to morbidity and mortality. Since then, numerous enhanced recovery programs have been utilized to augment quality improvement efforts. This study reassesses procedural complication incidence after a decade of quality improvement efforts. METHODS: Data from the 2015 NSQIP were used. The same original 36 general surgery procedure groups were created using Current Procedural Terminology codes...
October 22, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/30374729/hemodynamic-support-in-the-early-phase-of-septic-shock-a-review-of-challenges-and-unanswered-questions
#18
REVIEW
Olivier Lesur, Eugénie Delile, Pierre Asfar, Peter Radermacher
BACKGROUND: Improving sepsis support is one of the three pillars of a 2017 resolution according to the World Health Organization (WHO). Septic shock is indeed a burden issue in the intensive care units. Hemodynamic stabilization is a cornerstone element in the bundle of supportive treatments recommended in the Surviving Sepsis Campaign (SSC) consecutive biannual reports. MAIN BODY: The "Pandera's box" of septic shock hemodynamics is an eternal debate, however, with permanent contentious issues...
October 29, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/30355567/oxygen-therapy-for-acutely-ill-medical-patients-a-clinical-practice-guideline
#19
Reed A C Siemieniuk, Derek K Chu, Lisa Ha-Yeon Kim, Maria-Rosa Güell-Rous, Waleed Alhazzani, Paola M Soccal, Paul J Karanicolas, Pauline D Farhoumand, Jillian L K Siemieniuk, Imran Satia, Elvis M Irusen, Marwan M Refaat, J Stephen Mikita, Maureen Smith, Dian N Cohen, Per O Vandvik, Thomas Agoritsas, Lyubov Lytvyn, Gordon H Guyatt
No abstract text is available yet for this article.
October 24, 2018: BMJ: British Medical Journal
https://www.readbyqxmd.com/read/30316962/surgical-technical-evidence-review-for-acute-appendectomy-conducted-for-the-agency-for-healthcare-research-and-quality-safety-program-for-improving-surgical-care-and-recovery
#20
REVIEW
Melissa A Hornor, Jessica Y Liu, Q Lina Hu, Clifford Y Ko, Elizabeth Wick, Melinda Maggard-Gibbons
No abstract text is available yet for this article.
October 12, 2018: Journal of the American College of Surgeons
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