The British journal of surgery
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Gastric cancer surgery is increasingly being centralized in the Netherlands, whereas the diagnosis is often made in hospitals where gastric cancer surgery is not performed. The aim of this study was to assess whether hospital of diagnosis affects the probability of undergoing surgery and its impact on overall survival. ⋯ The large variation in probability of receiving surgery for gastric cancer between hospitals of diagnosis and its impact on overall survival indicates that gastric cancer decision-making is suboptimal.
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The role of prophylactic central neck dissection (CND) in the management of papillary thyroid cancer (PTC) is controversial. This report describes outcomes of an observational approach in patients without clinical evidence of nodal disease in PTC. ⋯ Observation of the central neck is safe and should be recommended for all patients with PTC considered before and during surgery to be free of central neck metastasis.
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One of the major challenges of competency-based training is defining a score representing a competent performance. The objective of this study was to set pass scores for the Objective Structured Assessment of Technical Skill. ⋯ Consistency in pass-fail status between the various methods builds evidence of validity for the set scores. These methods can be applied and studied across a variety of assessment platforms, helping to increase the use of standard setting for competency-based training.
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Observational Study
Impact of delay between imaging and treatment in patients with potentially curable pancreatic cancer.
Locoregional pancreatic ductal adenocarcinoma (PDAC) may progress rapidly and/or disseminate despite having an early stage at diagnostic imaging. A prolonged interval from imaging to resection might represent a risk factor for encountering tumour progression at laparotomy. The aim of this study was to determine the therapeutic window for timely surgical intervention. ⋯ Operation within 32 days of diagnostic imaging reduced the risk of tumour progression to unresectable disease by half compared with a longer waiting time. The results of this study highlight the importance of efficient clinical PDAC management.