Journal of the American College of Surgeons
-
Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) can improve survival for patients with peritoneal surface malignancy. Completeness of cytoreduction correlates with prognosis. The role of gastrectomy in these patients is not well described. ⋯ 8% of patients who underwent CRS+HIPEC for non-gastric primaries underwent gastrectomy. Gastrectomy patients were more likely to have higher PCI and incomplete resections with increased complications and mortality. PCI, resection status, LN's, tumor grade, and primary site, but not gastrectomy type, are significantly associated with OS.
-
Venous thromboembolism (VTE) remains a major source of morbidity and mortality in severely injured patients despite current methods of risk stratification and prophylaxis, suggesting incomplete understanding of VTE risk factors. Given the liver's role in coagulation, we hypothesized that liver injury (LI) is associated with increased rates of VTE in severely injured patients. ⋯ In severely injured patients, LI is an independent predictor of PE, but not DVT, suggesting LI is the source of either emboli or a more complex locally prothrombotic focus leading to downstream thrombi in the lung without causing upstream systemic venous thrombi. Further work should focus on elucidation of mechanisms including the portal venous blood coagulation profile, endothelial injury in the liver, and the potential for stasis of venous blood traversing an injured liver as well as the role for including LI in VTE risk stratification.
-
Total pancreatectomy and intraportal islet cell auto transplantation (TPIAT) is increasingly being offered to patients with refractory chronic pancreatitis. Understanding factors that impact islet function over time is critical. ⋯ In patients with high islet mass transplanted, islet function improves in the first several years after IAT. Islet function is sustained longer in children than in adults. Overweight/obese body habitus may be detrimental to long-term islet function, highlighting the importance of maintaining a healthy body weight for TPIAT recipients.
-
Irreversible electroporation(IRE) has augmented the effects of certain immunotherapies in pancreatic cancer(PDA). Yeast-derived particulate beta-glucan induces trained innate immunity and has successfully reduces murine PC tumor burden. This is a Phase II study to test the hypothesis that IRE may augment beta-glucan induced trained immunity in patients with PDA. ⋯ Combined beta-glucan with IRE ablated PDA tumor cells elicited a potent trained response and augmented anti-tumor functionality at 12 months post IRE, which translated into an improved DFI and OS.
-
Long-term outcomes of HBV nucleic acid test (NAT)-positive (+) allograft use in seronegative liver transplant (LT) and kidney transplant (KT) recipients remains unknown despite being incorporated into practice by select centers. This study compares long-term outcomes between HBV NAT+ and NAT-negative (-) allografts in seronegative recipients. ⋯ With close surveillance, HBV seronegative recipients transplanted with NAT+ allografts can develop viremia which can be cleared with antiviral therapy. This is the first and largest single-center study reporting longer-term experience with HBV NAT+ allografts in seronegative recipients demonstrating the safe expansion of the donor pool.