Frailty has a dose-response association with complications and FTR, which is apparent after low-risk and high-risk inpatient surgery. Systematic assessment of frailty in preoperative patients may help refine estimates of surgical risk that could identify patients who might benefit from perioperative interventions designed to enhance physiologic reserve and potentially mitigate aspects of procedural risk, and would provide a framework for shared decision-making regarding the value of a given surgical procedure.

ERAS protocols decreased length of stay and cost by not increasing complications or readmission rates. This study adds to the evidence that ERAS protocols are safe to implement and are beneficial to surgical patients and the healthcare system across multiple abdominal procedures.

Synopsis Functional imaging using radiolabeled probes which specifically bind and accumulate in target tissues has improved the sensitivity and specificity of conventional imaging. Positron Emission Tomography using modified glucose probes (FDG-PET) has demonstrated improved diagnostic accuracy in differentiating benign from malignant lesions in the setting of solitary pulmonary nodules. In addition, FDG-PET has become a useful modality in pre-operative staging of patients with lung cancer and is being tested with many other malignancies for its ability to change patient management. This article provides an overview of the current status of FDG-PET and presents the challenges of moving towards routine use.

INTRODUCTION Adoptive immunotherapy for patients with metastatic melanoma has yielded encouraging results. However, methods to expand melanoma-specific T-cells from Stage III are limited. The objective of this study is to determine whether melanoma-specific T-cells could be generated from the melanoma-draining lymph nodes (MDLN) of Stage III patients. METHODS Stage III patients undergoing completion lymphadenectomy were enrolled onto an IRB-approved protocol. MDLN cells were tested for ability to undergo cryopreservation, expand ex vivo in IL-2 or IL-2 and IL-7 and mediate melanoma-specific antitumor responses in vitro. RESULTS Cryopreservation produced no significant differences from fresh cultures in terms of cell growth and cellular phenotype. IL-2 and IL-2/IL-7 cultures resulted in similar growth rates, and functional studies revealed the presence of T cells which secreted interferon gamma in response to melanoma antigen peptides. Both IL-2 and IL-2/IL-7 cultured MDLN cells mediated significant apoptosis of human melanoma cell lines as compared to breast and brain tumor lines in vitro. Overall there did not seem to be a benefit of adding IL-7. Both CD4+ and CD8+ T-cells appear to mediate tumor cell apoptosis. CONCLUSION This study demonstrates that melanoma antigen-specific T-cells can be generated from regional melanoma-draining lymph nodes and expanded ex vivo from patients with Stage III disease.