The American surgeon
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The American surgeon · Oct 2013
Comparative StudyRate of re-excision after breast-conserving surgery for invasive lobular carcinoma.
Invasive lobular carcinoma (ILC) accounts for approximately 5 to 20 per cent of all breast cancers and is often multicentric. Despite pre- and intraoperative assessments to achieve negative margins, ILC is reported to be associated with higher rates of positive margin. This cross-sectional study examined patients with breast cancer treated at our institution from 2000 to 2010. ⋯ In this single-institution review, BCS for ILC had significantly higher rates of re-excision as a result of positive margins when compared with IDC and DCIS. Tumor size greater than 2 cm and lymph node involvement were identified as factors associated with positive surgical margin in ILC. The higher possibility of positive margins and the need for additional procedures should be discussed with patients undergoing BCS for ILC.
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The American surgeon · Oct 2013
Emergency department thoracotomy: too little, too much, or too late.
Emergency department thoracotomy (EDT) is a dramatic lifesaving procedure demanding timely surgical intervention, technical expertise, and coordinated resuscitation efforts. Inappropriate use is costly and futile. All patients admitted to a Level II trauma center who underwent EDT from January 2003 to July 2012 were studied. ⋯ Surgeons adhered to guidelines more compared with ED physicians (OR, 4.9; P = 0.03) whose patients were more likely to die (OR, 3.52; P = 0.124). Survivors (11 of 13 [84.6%]) were discharged home without significant long-term neurologic disability. EDT is lifesaving when performed for penetrating injury by experienced surgeons following established guidelines but futile in blunt injury or when performed by nonsurgeons regardless of mechanism.
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The American surgeon · Oct 2013
Predictive risk factors of early postoperative enteric fistula in colon and rectal surgery.
Early postoperative enteric fistula (PEF) is a complication associated with a high rate of morbidity and mortality in colon and rectal surgery. We evaluated the effect of patient characteristics, comorbidities, pathology, resection type, surgical technique, lysis of adhesions, and admission type on the rate of PEF in colorectal surgery. Using the National Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2009 to 2010. ⋯ Although teaching hospitals (AOR, 1.69), obesity (AOR, 1.40), male gender (AOR, 1.30), emergent surgery (AOR, 1.27), age older than 65 years (AOR, 1.24), and diabetes mellitus (AOR, 1.21) also had statistically significant impact on rates of PEF, these were less clinically significant than the other factors. The presence of Crohn's disease and lysis of abdominal adhesions are strongly associated with the development of PEF after colorectal surgery. Laparoscopic surgery was associated with a lower rate of PEF; further studies would be needed to evaluate the importance of this finding.
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The American surgeon · Oct 2013
Comparative StudyOutcomes of vascular resection in pancreaticoduodenectomy: single-surgeon experience.
Extension of pancreatic adenocarcinoma into adjacent vasculature often necessitates resection of the portal vein (PV) and/or superior mesenteric vein (SMV) during pancreaticoduodenectomy (PD). The vein is reconstructed primarily by end-to-end anastomosis of vein remnants or venoplasty or by use of autologous or synthetic vein grafts. The objective of this study was to review outcomes in patients undergoing PD for pancreatic adenocarcinoma, specifically comparing the short- and long-term outcomes between the patients undergoing vascular resection and those undergoing standard PD. ⋯ Based on Kaplan-Meier methods, the median recurrence-free survival was 18 versus 23 months (P = 0.37) in the vascular and standard groups, respectively, and the overall survival was almost identical in both groups, each with a median of 31 months (P = 0.91). In our experience, mesenteric and PV resection during PD was performed safely and without compromise of short- or longer-term outcomes. It can be performed safely and patients have no significant difference in perioperative outcomes or overall survival.
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The American surgeon · Oct 2013
When it is not a Spigelian hernia: abdominal cutaneous nerve entrapment syndrome.
Abdominal wall pain at the linea semilunaris is classically the result of a Spigelian hernia. If no hernia is detected, these patients may be left with chronic pain without a diagnosis or treatment. A retrospective review was performed of patients presenting with abdominal wall pain at the linea semilunaris between 2009 and 2012. ⋯ Of the patients with ACNES, five (50%) had resolution of pain with serial nerve blocks alone; another five proceeded to surgical neurectomy with resolution of their pain. Thus, to prevent delay in diagnosis and treatment, patients with chronic abdominal wall pain at the linea semilunaris should first be ruled out for Spigelian hernia. Then, they should be evaluated and treated for ACNES.