Annals of surgery
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Comparative Study
Abdominal aortic aneurysm: a 6-year comparison of endovascular versus transabdominal repair.
To test the hypothesis that endovascular repair of abdominal aortic aneurysm (AAA) will result in a significant reduction in mortality and morbidity rates and cost when compared with open transabdominal repair. ⋯ The surgical mortality rate is low for both groups and not statistically different. Endovascular repair significantly reduces resource utilization (surgical time, blood replacement, intensive care unit and hospital stay) and cost when compared to transabdominal aneurysm repair. Long-term survival is equivalent in patients undergoing AAA repair regardless of technique. Although endovascular repair appears durable for up to 6 years, longer follow-up studies are warranted.
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To examine the association of surgeon and hospital case volumes with the short-term outcomes of in-hospital death, total hospital charges, and length of stay for resection of colorectal carcinoma. ⋯ A skewed distribution of case volumes by surgeon was found in this study of patients who underwent resection for large bowel cancer in Maryland. The majority of these surgeons performed very few operations for colorectal cancer per year, whereas a minority performed >10 cases per year. Medium-volume surgeons achieved excellent outcomes similar to high-volume surgeons when operating in medium-volume or high-volume hospitals, but not in low-volume hospitals. The results of low-volume surgeons improved with increasing hospital volume but never equaled those of the high-volume surgeons.
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To summarize the long-term efficacy and safety of tacrolimus in orthotopic liver transplant (OLT) recipients, as well as to examine the factors that influence long-term morbidity and mortality rates. ⋯ Long-term patient and graft survival rates are excellent under tacrolimus immunosuppression. Pediatric patients have a better long-term outcome than adults, in part because of the limited recurrence of the original disease, which was the most common cause of late graft loss (other than patient death, most commonly the result of late de novo malignancies and cardiovascular events). Graft loss from late rejection was rare.
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There is a need for clearly defined and widely applicable clinical criteria for the selection of patients who may benefit from hepatic resection for metastatic colorectal cancer. Such criteria would also be useful for stratification of patients in clinical trials for this disease. ⋯ Resection of hepatic colorectal metastases may produce long-term survival and cure. Long-term outcome can be predicted from five criteria that are readily available for all patients considered for resection. Patients with up to two criteria can have a favorable outcome. Patients with three, four, or five criteria should be considered for experimental adjuvant trials. Studies of preoperative staging techniques or of adjuvant therapies should consider using such a score for stratification of patients.
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Comparative Study
Regional versus systemic delivery of recombinant vaccinia virus as suicide gene therapy for murine liver metastases.
Specific and efficient tumor-targeted gene delivery is the major goal for successful cancer gene therapy. ⋯ Suicide gene therapy using vv with the CD/5-FC system leads to tumor-specific gene expression and improved survival and can result in cure of established liver metastases.