Journal of the American College of Surgeons
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Pathway-driven, post-pancreatectomy opioid reduction interventions have proven effective and sustainable and may have a "halo effect" on other major abdominal cancer operations. This study's aim was to analyze the sequential effects of expanding opioid reduction efforts from pancreatectomy on opioids prescribed after hepatectomy. ⋯ Directed opioid reduction efforts for pancreatectomy influenced clinically meaningful post-hepatectomy reductions in inpatient and discharge opioid volumes. A "halo effect" of intradepartmental opioid reduction efforts is attainable and corresponds to measurable increases in opioid-free or nearly opioid-free discharges after major abdominal cancer surgery.
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Breast conservation therapy for patients with DCIS includes breast conserving surgery (BCS) with post-operative radiotherapy (RT). Because RT does not impact overall survival, identifying women who do not benefit from RT would allow de-escalation of therapy. We evaluated the impact of a novel 7-gene DCIS biosignature on adjuvant radiation recommendations for patients undergoing BCS for DCIS. ⋯ 7-gene biosignature test resulted in a 35% reduction in patients treated with adjuvant RT. Patients with higher decision scores were more likely to receive RT and to receive a greater RT dose.
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The Joseph M Donald Endowment for the Archival Collection of the Southern Surgical Association is named for the 73rd President Elect of the Southern Surgical Association (Figure 1), who died in 1961 at age 57 before he had the opportunity to deliver his Presidential Address. Dr Donald's career as a surgeon in Birmingham began in 1931 after the completion of his residency at the Mayo Clinic. He was one of four generations of Donalds to serve Alabama as physicians. ⋯ Two of his sons, Joseph, Jr and Thomas trained as surgeons. From 1854 until the present, twenty-four Donald or Donald-related physicians have practiced in Alabama (personal communication, Dr Thomas T Donald). The present talk is dedicated to the memory of Dr Joseph Marion Donald and his contributions to the field of surgery.
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Neoadjuvant therapy (NT) is increasingly utilized for patients with pancreatic ductal adenocarcinoma (PDAC). Disease progression, toxicity, and failure to undergo surgical resection are common during NT, yet little research has focused on efforts to optimize care delivery. We sought to define and validate a novel composite outcomes metric that characterizes the successful delivery of NT. ⋯ A TNE is infrequently achieved among patients with PDAC undergoing NT but is significantly associated with improved long-term outcomes. Future research aimed at optimizing outcomes of NT delivery should incorporate this novel composite metric that may more accurately reflect patient and provider expectations of treatment.