Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
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J. Gastrointest. Surg. · Feb 2015
ReviewEnhanced recovery after surgery protocols for open hepatectomy--physiology, immunomodulation, and implementation.
There has been recent interest in enhanced-recovery after surgery (ERAS®) or "fast-track" perioperative protocols in the surgical community. The subspecialty field of colorectal surgery has been the leading adopter of ERAS protocols, with less data available regarding its adoption in hepato-pancreato-biliary surgery. ⋯ The attenuation of these inflammatory stressors is largely responsible for the improvements in perioperative outcomes due to the implementation of ERAS-based pathways. Collectively, the data suggest that the implementation of ERAS principles should be strongly considered in all patients undergoing hepatectomy.
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J. Gastrointest. Surg. · Feb 2015
Multicenter StudyCan the risk of non-home discharge after resection of gastric adenocarcinoma be predicted: a seven-institution study of the US Gastric Cancer Collaborative.
There are no validated methods to preoperatively identify patients with increased risk of discharge to skilled nursing facilities following resection of gastric cancer. We sought to identify preoperative predictors of non-home discharge to optimize transition of care to skilled nursing facility. ⋯ Older patients with compromised nutritional status have greater risk of NHD following resection of gastric cancer. The prediction tool can augment preoperative planning to optimize transition of care to skilled nursing facility.
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J. Gastrointest. Surg. · Feb 2015
Impact of body mass index on surgical outcomes after esophagectomy for patients with esophageal squamous cell carcinoma.
Patients with overweight reportedly have more comorbidities, including diabetes mellitus and cardiovascular disease, and longer operating times as well as more blood loss during surgery compared with those with normal weight. However, the impact of overweight on the short-term outcome after transthoracic esophagectomy for patients with esophageal squamous cell carcinoma (ESCC) remains unclear. We hypothesized that overweight has a negative impact on short-term surgical outcomes after esophagectomy for patients with ESCC. ⋯ The surgical treatment should not be denied for patients with ESCC due to overweight and underweight. However, intraoperative prevention and postoperative careful monitoring for anastomotic leakage might be required after esophagectomy for overweight patients with ESCC.
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J. Gastrointest. Surg. · Feb 2015
Selection of the surgical approach for reoperation of adult choledochal cysts.
Our purpose was to evaluate the reasons for reoperations and outcomes in patients with choledochal cysts (CCs). ⋯ Radical cyst excision and Roux-en-Y hepaticojejunostomy provide good outcomes in patients with CCs.
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J. Gastrointest. Surg. · Feb 2015
Current recommendations for surveillance and surgery of intraductal papillary mucinous neoplasms may overlook some patients with cancer.
The 2012 Sendai Criteria recommend that patients with 3 cm or larger branch duct intraductal papillary mucinous neoplasms (BD-IPMN) without any additional "worrisome features" or "high-risk stigmata" may undergo close observation. Furthermore, endoscopic ultrasound (EUS) is not recommended for BD-IPMN <2 cm. These changes have generated concern among physicians treating patients with pancreatic diseases. The purposes of this study were to (i) apply the new Sendai guidelines to our institution's surgically resected BD-IPMN and (ii) reevaluate cyst size cutoffs in identifying patients with lesions harboring high-grade dysplasia or invasive cancer. ⋯ Our results suggest that "larger" size on noninvasive imaging can indicate high-grade/invasive cysts, and EUS-FNA may help identify "smaller" cysts with high-grade/invasive pathology.