Annals of surgery
-
Meta Analysis
Laparoscopic Versus Open Pancreaticoduodenectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
To compare perioperative outcomes of laparoscopic pancreaticoduodenectomy (LPD) to open pancreaticoduodenectomy (OPD) using evidence from randomized controlled trials (RCTs). ⋯ At current level of evidence, LPD shows no advantage over OPD. Limitations include high risk of bias and moderate to very low certainty of evidence. Further studies should focus on patient safety during LPD learning curves and the potential role of robotic surgery.
-
Multicenter Study
Implications for Breast Cancer Restaging Based on the 8th Edition AJCC Staging Manual.
We assessed the changes that have resulted from the latest breast cancer staging guidelines and the potential impact on prognosis. ⋯ Applying the 8th edition staging criteria resulted in a stage change for >35% of patients diagnosed with invasive breast cancer and refined OS estimates. Overall, the transition to the 8th edition is expected to better drive clinical care, treatment recommendations, and future research.
-
Multicenter Study
Hospital Volume Matters: The Volume-Outcome Relationship in Open Juxtarenal AAA Repair.
We studied whether the volume-outcome relationship would persist in more complex aortic operations. ⋯ Hospitals with low annualized volumes of open juxtarenal repair have higher perioperative mortality, irrespective of their total open aortic volume. Complex open AAA repairs should be performed at experienced centers, and future efforts should focus on centralization of complex aortic care.
-
Randomized Controlled Trial Multicenter Study
Direct Oral Feeding Following Minimally Invasive Esophagectomy (NUTRIENT II trial): An International, Multicenter, Open-label Randomized Controlled Trial.
Patients undergoing an esophagectomy are often kept nil-by-mouth postoperatively out of fear for increasing anastomotic leakage and pulmonary complications. This study investigates the effect of direct start of oral feeding following minimally invasive esophagectomy (MIE) compared with standard of care. ⋯ Direct oral feeding after an esophagectomy does not affect functional recovery and did not increase incidence or severity of postoperative complications.
-
: Surgeons universally overprescribe opioids even in surgeries that are minimally invasive. Despite some drops in opioid prescribing nationally, surgeons and dentists have not changed their prescribing habits. Opioid guidelines are inherently flawed by the anchoring heuristic and efforts should center on decreasing exposures to opioids through a physician-lead response. No-opioid minimally invasive surgery should be the goal rather than the exception.