Journal of the American College of Surgeons
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The Commission on Cancer (COC) of The American College of Surgeons periodically reviews criteria for evaluation of the care of patients with cancer related to diagnosis, treatment, rehabilitation, and follow-up. The COC annually performs a national survey of practices for several cancer sites. ⋯ The distribution of cases by anatomic site was consistent with a hypothesis of rightward migration of colon carcinoma. Colon and rectal carcinomas in African-Americans were reported in more advanced stages and with corresponding decreases in survival rates. Some patterns of nonoptimal diagnostic use were noted. The increasing use of sphincter-sparing surgical alternatives for carcinoma of the rectum was evident. Adjuvant therapy was not widely used during this period. This study suggests evolving patterns of evaluation, increased preservation of continence, and improved but varying survival among ethnic groups. It further suggests that survival as measured across these 943 hospitals may be lower than that attained at some individual centers.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Preliminary report of a prospective randomized study of octreotide in the treatment of severe acute pancreatitis.
Experimental and clinical studies on the effect of octreotide in the treatment of patients with acute pancreatitis have presented controversial results. Since January 1992, we have been conducting a prospective randomized study on the clinical effect of octreotide in severe acute pancreatitis, at three hospitals in Israel. ⋯ Although some of the parameters did not reach statistical significance, these preliminary results suggest that octreotide may have a beneficial effect in the treatment of patients with severe acute pancreatitis. This study is scheduled to continue for two more years.
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The application of video-endoscopy to general thoracic surgery is radically changing the approach to many benign and malignant diseases of the chest. Since July 1991, we have performed 794 purely thoracoscopic and 101 video-assisted thoracic surgical (VATS) procedures on 860 patients. ⋯ These data underscore the flexibility, safety, efficacy, and potential for cost savings of videoscopic surgery in patients with thoracic diseases. The ability to perform excisional biopsy improves diagnostic specificity and sensitivity to nearly 100 percent. Video-assisted thoracic surgical techniques also offer a minimally invasive procedure with acceptable risk to patients heretofore inoperable by standard thoracotomy.
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In the United States of America, the five-year survival rate among patients surviving curative resection for gastric carcinoma will range between 20 and 25 percent. In Japan, early diagnosis and an aggressive surgical approach including planned lymph node dissection has resulted in the five-year survival rate exceeding 50 percent for all patients with newly diagnosed gastric carcinoma. This report is a retrospective review evaluating the effect of extended lymph node dissection (D2) on overall survival in 101 patients with gastric adenocarcinoma who underwent a potentially curative gastric resection from 1975 to 1990 at Roswell Park Cancer Institute. ⋯ Patients treated by extended resection (D2, D2.5) were more likely to survive five years and had prolonged median survival times when compared with patients treated with limited resection (D1, D1.5). For patients with T2-4, N0-1, M0 gastric carcinomas treated with extended resection, their differences reached levels at or approaching statistical significance.
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Although the use of alcohol and drugs by surgery residents is of concern, no large-scale studies of this specific population exist. ⋯ Despite the optimistic findings of the survey, the authors advocate the following: Implementation of educational programs to prevent potential abuse of alcohol and drugs, and establishment of tighter controls on cocaine or use of a cocaine substitute for patient care.