Annals of surgical oncology
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Randomized Controlled Trial
Multimodal Enhanced Recovery After Surgery (ERAS) Program is the Optimal Perioperative Care in Patients Undergoing Totally Laparoscopic Distal Gastrectomy for Gastric Cancer: A Prospective, Randomized, Clinical Trial.
The application of ERAS protocol has widely gained acceptance after gastrointestinal surgery. Well-designed, randomized, control trials are needed to evaluate fully its safety and efficacy in the field of gastric cancer. This study aims to compare the enhanced recovery after surgery (ERAS) protocol and the conventional perioperative care program after totally laparoscopic distal gastrectomy (TLDG) in gastric cancer. ⋯ ERAS is safe and enhances postoperative recovery after TLDG in gastric cancer.
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Delays in surgery and adjuvant treatment for breast cancer are associated with decreased survival. However, the time between diagnosis and surgery is rising, partly attributed to the added complexity of immediate breast reconstruction (IBR). We sought to investigate time to treatment and survival outcomes in breast cancer patients undergoing IBR. ⋯ While IBR delays time to definitive surgery, its use did not substantially affect time to adjuvant treatment or survival outcomes. Further research is ongoing to mitigate the effects of potential selection bias in favor of IBR.
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According to the 8th edition American Joint Committee on Cancer staging system, extrathyroidal extension (ETE) and primary tumor size remain the principle determinants of T stage. However, impact of gross ETE into strap muscles on survival remains controversial. ⋯ Gross strap muscle invasion may not be an important survival prognostic factor for staging purposes. Although both gross strap muscle invasion and perithyroidal soft tissue extension may be predictive for locoregional recurrence, the distinction between them may not be as important for postoperative risk stratification.
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Status in terms of major vascular structure invasion is a crucial factor for successful major hepatic resection. In particular, surgery for advanced tumors with inferior vena cava (IVC) invasion is difficult and may even be dangerous for the patient, having high risk of massive bleeding and greater chance of embolic complications such as stroke, bowel ischemia, and pulmonary venous thrombosis. For such reasons, many surgeons hesitate to carry out such surgical resection, and even if they do so, may not totally remove the tumor including the part inside the IVC, achieving R1 resection. For safe and radical surgery, various surgical techniques are required. We report herein three cases of major hepatectomy with IVC invasion and discuss several surgical tips. ⋯ In advanced-stage malignant tumor, the conflict between achieving oncologic R0 resection and patient safety remains an unsolved issue. In particular, more advanced surgical technique is required when the tumor invades large vessels such as the vena cava. Previous reports on cases of advanced tumor invading liver and IVC have described the technical difficulties.1,2 Wakayama et al. reported cases of successful thrombectomy under veno-veno bypass in hepatocellular carcinoma with IVC and right atrium invasion,3 and Vicente et al.4 reported surgical resection of IVC thrombus without cardiopulmonary bypass. Major vascular invasion of the tumor is known to be a poor prognostic factor for survival. However, some reports state that, if the tumor invades major vascular structure, complete tumor removal might be helpful for patient survival due to the biologic features of the tumor.2,5,6 This video report does not describe any new techniques, but is more helpful for junior surgeons in educational terms. The limitation of this report is that we could not show good oncologic long-term survival after surgery. However, no fatal complications related to the surgical procedure occurred, by managing the tumor thrombus during the operation. We present three techniques with differing aggressiveness. The techniques illustrated in this video represent a good option to achieve patient surgical safety.
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Identification and resection of a clipped node was shown to decrease the false-negative rate (FNR) of sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) for patients presenting with initially node-positive breast cancer. ⋯ The study results also suggest that axillary dissection could be omitted for patients presenting initially with N1 disease and with a negative clipped node as the SLN after NAC due to the low FNR.