Hypothesis: Sentinel node (SN) biopsy for breast cancer enhances staging sensitivity, often demonstrating only micrometastases (Ͻ2 mm) or isolated, keratinpositive cells. When SN metastasis is present, the value of additional axillary dissection is unclear and not all patients benefit from axillary lymph node dissection (ALND).
Patients with cutaneous melanoma are at very high risk for development of second primary melanoma. This risk approximates 0.5% per year for the first 5 years of follow-up. Patients aged 15-39 and patients aged 65-79 have a particularly high incidence of second melanoma, suggesting different causes for the development of second primaries. All patients with melanoma should undergo careful surveillance for second melanomas in addition to routine screening for recurrence.
In highly selected patients with melanoma metastatic to intra-abdominal solid organs, aggressive attempts at complete surgical resection may improve OS. It is important that the number of metastatic sites does not seem to affect the OS after complete resection.
In October 2009, an acute care surgery (ACS) model was implemented to facilitate urgent surgical consults. This study examines the impact of ACS on the timeliness of care and length of hospitalization for patients with acute cholecystitis. A retrospective cohort study was performed of patients presenting to the emergency department (ED) with acute cholecystitis who underwent early cholecystectomy. Patients with choledocholithiasis, pancreatitis, biliary colic, or cholelithiasis without cholecystitis were excluded. There were two study cohorts: ACS (October 2009 to July 2010) and pre-ACS (October 2008 to September 2009). Primary outcome measures were length of stay (LOS) and time from the ED to the operating room (OR). One hundred fifty-two cases were identified: 71 in the ACS group and 81 in the pre-ACS group. Patient demographics were similar. The ACS group had a significantly shorter average time from the ED to the OR (24.6 vs 35.0 hours, P = 0.0276). Overall LOS was reduced by a mean of 14.7 hours in the ACS group (mean 3.23 vs 2.63 days, P = 0.11). There was no significant difference in OR time (2.45 vs 2.38 hours, P = 0.562). There was a significant decrease in after-hours cases in the ACS group (5.6 vs 21%, P = 0.004) and a decrease in complication rates (18.5 vs 7.0%, P = 0.032). In conclusion, the ACS model decreased time from the ED to the OR, decreased after-hours cases, decreased length of hospitalization, and decreased complications for patients with acute cholecystitis.
Patients who undergo LH have similar short-term outcomes when compared with those who undergo OH. Laparoscopic hepatectomy was associated with lower intraoperative blood loss, although the clinical significance of this finding is uncertain given the lack of difference in perioperative transfusion or morbidity rates. In addition, we found no difference in margin status between the 2 groups. Future studies are needed to define which patients derive benefit from LH and to determine oncologic equivalence to OH.
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