Journal of the American College of Surgeons
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Comparative Study
Lymph Node Positivity in Appendiceal Adenocarcinoma: Should Size Matter?
The management algorithm for appendiceal adenocarcinoma is not well defined. This study sought to determine whether tumor size or depth of invasion better correlates with the presence of lymph node metastases in appendiceal adenocarcinoma, and to compare these rates with colon adenocarcinoma. ⋯ In appendiceal adenocarcinoma, the rate of lymph node metastases is substantial, even for small tumors. Tumor size should play no role in the decision of whether to perform a hemicolectomy. Appendectomy alone does not produce an adequate lymph node sample. Right hemicolectomy should be performed for all appendiceal adenocarcinomas.
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The purpose of this study was to determine the frequency of tumor-related gastrointestinal obstruction and identify variables associated with functional outcomes and survival in patients with advanced malignancy and gastrointestinal obstruction. ⋯ Patients managed with surgery demonstrated improved survival on unadjusted analysis. However, on multivariate analysis that included the imaging extent of disease, surgery was not associated with outcome, which highlights the importance of patient selection and the need for additional research to identify variables critical for treatment selection.
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Malignant primary pediatric hepatic tumors (MPPHTs) are rare and account for approximately 1% of all childhood malignancies. In recent years, liver transplantation has emerged as a viable treatment options for select patients with MPPHTs. ⋯ Liver transplantation is an excellent option for select patients with unresectable MPPHTs, with outcomes comparable to those after transplantation for nonmalignant causes.
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Inpatient treatment of patients with colon diverticulitis represents a significant financial and clinical burden to the health care system and patients. The aim of this study was to compare patients with diverticulitis in the emergency department (ED), who were discharged to home vs admitted to the hospital. ⋯ Patients diagnosed with uncomplicated diverticulitis in the emergency room can be safely discharged home on oral antibiotics, as long as CT findings are included in the decision-making process. Patients with complicated diverticulitis on CT scan should be admitted to the hospital with surgical consultation.