Annals of surgical oncology
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Results are conflicting and no population-based studies are available regarding the postoperative mortality after intrathoracic anastomotic leakage. The current study addressed the unselected and independent fatality rate of intrathoracic esophageal anastomotic leaks after resection for cancer. ⋯ Intrathoracic anastomotic leakage after esophageal resection for cancer remains a major risk factor for short-term postoperative death in an unselected, population-based setting.
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Recent results from the ACOSOG Z0011 trial question the use of intraoperative frozen section (FS) during sentinel lymph node (SLN) biopsy and the role of axillary dissection (ALND) for SLN-positive breast cancer patients. Here we present a 10-year trend analysis of SLN-FS and ALND in our practice. ⋯ Over 10 years, we have observed a diminishing rate of SLN-FS and, for patients with low-volume SLN metastases, fewer ALND, trends that suggest a more nuanced approach to axillary management. If the Z0011 selection criteria had been applied to our cohort, 66% of SLN-FS (4159 of 6327) and 48% of ALND (939 of 1953) would have been avoided, sparing 13% of all patients the morbidity of ALND.
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In melanoma patients, we define incomplete sentinel node biopsy (I-SNB) as when fewer lymph nodes are removed during sentinel node biopsy (SNB) than identified on preoperative lymphoscintigraphy (LS). This study quantifies the frequency of I-SNB and evaluates any correlation with patient outcomes. ⋯ This study demonstrates no statistically significant relationship between I-SNB and patient outcomes when adjusting for known prognostic factors. These data do not exclude the possibility that I-SNB may have a weak association with worse outcomes.
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Prophylactic central neck dissection (CND) remains controversial in papillary thyroid carcinoma (PTC). Because postsurgical stimulated thyroglobulin (sTg) level is a good surrogate for recurrence, the study aimed to evaluate the impact of prophylactic CND on preablative and postablative sTg levels after total thyroidectomy. ⋯ Although performing prophylactic CND in total thyroidectomy may offer a more complete initial tumor resection than total thyroidectomy alone by minimizing any residual microscopic disease, such a difference becomes less noticeable 6 months after ablation.
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Venous thromboembolism (VTE) remains a clinical problem in surgical oncology. We report the impact of preoperative initiation of subcutaneous heparin on VTE events after pancreatic surgery. ⋯ Intraoperative ICBs with postoperative initiation of subcutaneous heparin pharmacoprophylaxis may be inadequate for VTE prophylaxis for high risk patients. The use of a preoperative dose of subcutaneous heparin in high-risk pancreatic surgery patients resulted in a statistically significant reduction of VTE events.