Journal of the American College of Surgeons
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The Tokyo Guidelines recommend initial cholecystostomy tube drainage, antibiotics, and delayed cholecystectomy in patients with grade III cholecystitis. ⋯ Since the introduction of the Tokyo Guidelines (2007), use of cholecystostomy tubes in patients with grade III cholecystitis has increased, but the majority of patients do not get cholecystostomy tube drainage as first-line therapy. Cholecystostomy tube placement was associated with lower rates of definitive treatment with cholecystectomy, higher mortality, and higher readmission rates. These data suggest a need for additional evaluation and refinement of the Tokyo Guidelines.
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Neuroendocrine tumors (NETs) are rare neoplasms. Our group has treated more than 2,000 NET patients and has performed more than 1,000 surgical cytoreductive procedures. ⋯ Surgical cytoreduction in NET patients has low morbidity and mortality rates and results in prolonged survival. We believe that surgical cytoreduction should play a major role in the care of patients with NETs.
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In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. ⋯ Policy changes in organ allocation can have a significant impact on perioperative costs and outcomes, which can have a downstream influence on transplantation center perisurgical care processes.