The British journal of surgery
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Comparative Study
Portal vein embolization improves rate of resection of extensive colorectal liver metastases without worsening survival.
Most patients requiring an extended right hepatectomy (ERH) have an inadequate standardized future liver remnant (sFLR) and need preoperative portal vein embolization (PVE). However, the clinical and oncological impact of PVE in such patients remains unclear. ⋯ PVE enabled curative resection in two-thirds of patients with CLM who had an inadequate sFLR and were unable to tolerate ERH at presentation. Patients who underwent curative resection after PVE had overall and disease-free survival rates equivalent to those of patients who did not need PVE.
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Rates of emergency admission with femoral hernia are high compared with those for other hernias. This study aimed to determine the modes and consequences of presentation to primary care before admission to hospital. ⋯ A large proportion of patients with femoral hernia present late to primary care and are operated on as an emergency, with worse outcomes.
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Comparative Study
Population-based cohort study comparing 30- and 90-day institutional mortality rates after colorectal surgery.
Surgical mortality results are increasingly being reported and published in the public domain as indicators of surgical quality. This study examined how mortality outlier status at 90 days after colorectal surgery compares with mortality at 30 days and subsequent intervals in the first year after surgery. ⋯ Extending mortality reporting to 90 days identifies a greater number of mortality outliers when compared with the 30-day death rate. Ninety-day mortality is proposed as the preferred indicator of perioperative outcome for local analysis and public reporting.
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Peritoneal lavage cytology (CY) is used in the diagnosis and staging of various cancers. The clinical significance of positive cytology results in patients with pancreatic cancer is yet to be determined. ⋯ CY+ status is not clinically equivalent to gross peritoneal metastasis in patients with pancreatic cancer. Curative resection is still recommended regardless of CY status.
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Healthcare professionals can be seriously affected when they are involved in major clinical incidents. The impact of such incidents on staff is of particular relevance to surgery, as the operating room is one of the highest-risk areas for serious complications. This qualitative study aimed to assess the personal and professional impact of surgical complications on surgeons. ⋯ Those involved in the management of surgical services need to consider how to improve support for surgeons in the aftermath of major surgical incidents.