Articles: surgery.
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Randomized Controlled Trial Multicenter Study
Neoadjuvant Nivolumab and Ipilimumab in Resectable Stage III Melanoma.
In phase 1-2 trials in patients with resectable, macroscopic stage III melanoma, neoadjuvant immunotherapy was more efficacious than adjuvant immunotherapy. ⋯ Among patients with resectable, macroscopic stage III melanoma, neoadjuvant ipilimumab plus nivolumab followed by surgery and response-driven adjuvant therapy resulted in longer event-free survival than surgery followed by adjuvant nivolumab. (Funded by Bristol Myers Squibb and others; NADINA ClinicalTrials.gov number, NCT04949113.).
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Anesthesia and analgesia · Nov 2024
Return on Investment of Preoperative Anemia Management Programs in Cardiac Surgery: An Advisory From the Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Committee With Endorsement by the Society for the Advancement of Patient Blood Management.
Despite multiple recent guidelines recommending the diagnosis and treatment of anemia before elective cardiac surgery, few institutions have formal programs or methods in place to accomplish this. A major limitation is the perceived financial shortfall and the leadership buy-in required to undertake such an initiative. The purpose of this advisory from the Society of Cardiovascular Anesthesiologists (SCA) Clinical Practice Improvement Committee with endorsement by the Society for the Advancement of Patient Blood Management (SABM) is to provide an overview of preoperative anemia management programs with an emphasis on the associated financial implications. This advisory reviews the evidence for preoperative anemia management programs in both cardiac and noncardiac surgery, discusses options for managing preoperative anemia, provides novel financial modeling regarding the implementation of preoperative anemia management programs, and describes implementation challenges, potential solutions, and opportunities for improvement.
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To investigate patency and clinical outcomes of alloplastic and other venous interposition graft materials in pancreatic surgery. ⋯ Alloplastic venous vascular grafts are safe and readily available tools in pancreatic surgery, especially for long-segmental mesoportal venous reconstructions.
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The modern generation of trials evaluating the role of adjuvant radiation have turned to genomic profiling as a further risk stratification tool. The LUMINA trial by Whelan et al, published in the New England Journal of Medicine, applied Ki67 testing to identify those with luminal A disease and evaluated locoregional outcomes with Breast Conserving Surgery (BCS) and endocrine therapy (ET) alone. This paper was reviewed at the Canadian Association of General Surgeons' "Evidence-Based Reviews in Surgery" (EBRS) webinar series. ⋯ While the LUMINA study was rigorously designed and executed, there are significant pragmatic limitations to the implementation of the proposed approach using their protocol. We advocate that there is no "one size fits all" approach to early ER+ breast cancer. Choice of treatment strategy should strongly consider patient goals and preferences, with need for incorporation of Quality of Life and patient-reported endpoints into future studies evaluating this population to help guide these nuanced decisions.