Journal of surgical oncology
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Goal-directed fluid therapy (GDFT) seeks to improve outcomes through individualized optimization of oxygen delivery using IV fluid and vasoactive infusions. Trials of GDFT show clinical benefits over traditional liberal fluid administration, but fail to demonstrate benefits when compared to a restrictive strategy within an optimized enhanced recovery protocol. The ideal monitors, hemodynamic goals, and fluid administration strategy are not well established but may be less important than rational application of thoughtful fluid management strategies.
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This paper reviews implementation of ERAS and its financial implications. Literature on clinical outcomes and financial implications were reviewed. ⋯ These improvements have major impacts on reducing the cost of care even when costs for implementation, and investment in time for personnel and training is accounted for. The conclusion is that ERAS is an excellent example of value based surgery.
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The therapeutic role of systematic lymph node dissection (LND) remains unclear in advanced epithelial ovarian cancer (EOC), especially during interval debulking surgery (IDS) performed after neoadjuvant chemotherapy (NAC). We analyzed the therapeutic and prognostic roles of systematic LND in advanced EOC patients. ⋯ Systematic LND may have therapeutic value in advanced EOC patients treated with NAC and IDS.
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Robotic distal pancreatectomy (RDP) is considered a safe and feasible alternative to laparoscopic distal pancreatectomy (LDP). However, previous studies have some limitations including small sample size and selection bias. This study aimed to evaluate whether the robotic approach has advantages over laparoscopic surgery in distal pancreatectomy. ⋯ RDP is associated with less rate of conversion to laparotomy, shorter PHS, and improved SP and SVP rates in selected patients than LDP.
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Multicenter Study
Impact of major vascular resection on outcomes and survival in patients with intrahepatic cholangiocarcinoma: A multi-institutional analysis.
Major vascular involvement (IVC or portal vein) for intrahepatic cholangiocarcinoma (ICC) has traditionally been considered a contraindication to resection. We sought to define perioperative outcomes and survival of ICC patients undergoing hepatectomy with major vascular resection in a large international multi-institutional database. ⋯ Among patients with ICC, major vascular resection was not associated with worse perioperative or oncologic outcomes. Concurrent major vascular resection should be considered in appropriately selected patients with ICC undergoing hepatectomy.