Journal of the American College of Surgeons
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Level 1 data demonstrate that adjuvant chemotherapy (ACT) improves survival after surgical resection of pancreatic ductal adenocarcinoma (PDAC), (adjuvant gemcitabine, CONKO-001 study; adjuvant 5-FU, ESPAC3 study). The role of adjuvant chemoradiation therapy (ACRT) remains controversial. What is less clear is whether adjuvant therapy influences patterns of recurrence. The purpose of this study was to perform the first multicenter study analyzing patterns of recurrence after adjuvant therapy for PDAC. ⋯ This is the first analysis demonstrating differences in recurrence patterns in PDAC patients based on type of adjuvant therapy. Adjuvant chemotherapy provided an OS advantage likely related to its effect on reducing both LR and DR. Adjuvant chemoradiation therapy appears to decrease LR, but not DR, and therefore has less impact on OS. Future investigations and treatment protocols should consider additional ACT rather than ACRT in the treatment of PDAC.
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Accidental injury of a nearby structure during surgical operations carries a risk of serious morbidity and mortality. Furthermore, it represents a medico-legal liability. We aimed to examine the national distribution, cost, and trend of accidental intraoperative injuries. ⋯ Certain demographic and clinical factors influence the risk of intraoperative injury of nearby structures. The prevalence of intraoperative injuries is increasing at the national level, and these injuries are associated with increased mortality and pose substantial clinical and financial burdens.