Journal of the American College of Surgeons
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Hemipelvectomy is a complex surgery that is usually performed with curative intent. It is rarely performed for palliation in patients with advanced cancer, and its efficacy in achieving palliation is unknown. ⋯ Palliative-intent hemipelvectomy provided palliation in a minority of patients, did not improve function, and had high morbidity and mortality. Patients with small anterior pelvic tumors may benefit from palliative hemipelvectomy; for others, less invasive approaches should be considered whenever feasible.
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The knowledge required to manage surgical patients has expanded considerably over the past 40 years. Simultaneously, the cost of medical education has increased substantially. Surgical trainees are at particular disadvantage due to the time demands of training. We aim to determine whether surgeon compensation over time has adequately accounted for increasing student debt burden. ⋯ The rate of debt accumulation has outpaced the rate of salary growth for general surgeons to a significant degree.
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Patients older than 65 years have unique needs and treatment outcomes goals. The objective of this study was to evaluate the impact of Geriatric Surgery Verification (GSV) initiative in oncology patients ≥65 years undergoing major abdominal surgeries. ⋯ The GSV initiative intervention in geriatric oncology patients undergoing major abdominal surgeries was associated with reducing postoperative institutionalization and change in primary residence disposition. Further studies to explore different mechanisms within GSV that lead to improved outcomes in geriatric oncologic population will be informative.
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Although T2 gallbladder cancer (GBC) incidentally diagnosed after cholecystectomy requires additional resection, the surgical approaches are technically difficult due to inflammatory adhesion or fibrosis around the hepatoduodenal ligament and gallbladder bed. In this study, we sought to compare the surgical and oncologic outcomes of open and minimally invasive reoperation for postoperatively diagnosed T2 GBC. ⋯ The results indicate that laparoscopic reoperation for postoperatively diagnosed T2 GBC has favorable postoperative outcomes and similar oncologic safety compared with open surgery.