Surgery
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High surgeon volume is associated with improved outcomes in adult endocrine surgery. This is the first population-based outcomes study for thyroidectomy/parathyroidectomy in children. ⋯ High-volume surgeons have better outcomes after thyroidectomy/parathyroidectomy in children compared with Pediatric and Other surgeons. Surgeon experience was an independent predictor of LOS and costs. High-volume endocrine and pediatric surgeons could combine expertise to improve outcomes in children.
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Neoadjuvant chemotherapy (NACT) targets lymph node metastasis (LN), as well as the primary tumor (PT) in esophageal squamous cell carcinomas (ESCC). (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) reflects viable tumor volume and may be more useful for evaluating NACT responses than conventional radiography. Moreover, FDG-PET may elucidate the clinical significance of NACT responses for LN, which is not always identical to those for PT. ⋯ PET is superior to CT for evaluating the NACT response from the viewpoint of survival analysis. The NACT response should be evaluated for both LN and PT because of their different behaviors during chemotherapy. Further studies of larger sample number should be conducted in the future.
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Preoperative portal vein embolization (PVE) is increasingly used as a preparation for major hepatectomy in patients with inadequate liver remnant volume or function. However, whether segment 4 (S4) portal veins should be embolized is controversial. The effect of S4 PVE on the volume gain of segments 2 and 3 (S2+3) was examined. ⋯ RPVE+4 significantly improves S2+3 hypertrophy compared with RPVE alone. Extending RPVE to S4 does not increase PVE-associated complications.
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Multicenter Study
Surgical volume impacts bariatric surgery mortality: a case for centers of excellence.
Concerns regarding care quality prompted credentialing processes for bariatric "Centers of Excellence" (COE). It is hypothesized that high-volume surgeons and hospitals have better outcomes. ⋯ In Pennsylvania, high volume is associated with decreased mortality and LOS. The results support the use of surgical volume in the COE credentialing process.