American journal of surgery
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Comparative Study
Wide versus narrow margins after partial hepatectomy for hepatocellular carcinoma: Balancing recurrence risk and liver function.
The goal of this study was to compare the outcome after partial hepatectomy for hepatocellular carcinoma (HCC) in which a margin less than or equal to 5 mm or greater than 5 mm was achieved. ⋯ A narrow resection margin (5 mm or less) does not detract from oncologic outcomes after partial hepatectomy for HCC. Tailoring resection margins may lead to greater preservation of hepatic parenchyma. Factors other than margin status represent the driving forces for local and systemic recurrence.
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Recent publications report that perioperative initiation of statin therapy is associated with improved outcomes particularly among patients with increased cardiac risk. However, findings on associations with beta blocker (BB) initiation are mixed. ⋯ Our results suggest that maintaining statin therapy perioperatively is associated with reduced 30 day mortality in stented patients undergoing non-cardiac surgery who have previously been prescribed both beta blockers and statins.
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Abdominoperineal resection (APR) remains the cornerstone treatment for rectal cancers less than 5 cm from the anal verge. The perineal portion of an APR can be done with the patient in lithotomy or repositioned to prone jack-knife position, which influences accessibility, visualization and ability to close the wound. This paper analyses the effect of patient positioning on perineal wound dehiscence and infections. ⋯ Repositioning patients into prone position for the perineal portion of an APR was associated with significantly lower perineal wound infection and dehiscence rates compared to supine positioned patients.
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Acute kidney injury (AKI) is a devastating postoperative complication. Intraoperative urine output is assumed to reflect patient's intravascular volume and kidney function. We thus evaluated the incidence of postoperative AKI and its association with intraoperative urine output and the volume of fluid administered. ⋯ AKI is common in patients undergoing pancreas surgeries and is associated with high mortality. Neither urine output, nor the volume of fluids administered correlate with postoperative AKI. Low diuresis is therefore not a sole marker for fluid administration.
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The impact and efficacy of the World Health Organization Surgery Safety Checklist (SSC) is uncertain. We sought to determine if the SSC decreases complications and examined the attitudes of the surgical team members following implementation of the SSC. ⋯ Implementation of the SSC did not result in a significant decrease in perioperative morbidity or mortality. However, it did improve the perception of safety culture by operating room staff.