The future of the Roux-en-Y gastric bypass.

Archaic surgical procedures such as the jejunoileal bypass, vertical banded gastroplasty and duodenal switch have contributed to the current best practice of Roux-en-Y gastric bypass (RYGB) procedure for the treatment of obesity and its consequences. Despite this, RYGB has been blighted with late occurring adverse events such as severe malnutrition, marginal ulcer and reactive hypoglycemia. Despite this, RYGB has given us an opportunity to examine the effect of surgery on gut hormones and the impact on metabolic syndrome which in turn has allowed us to carry out a lower impact but equally, if not more effective, procedure - the vertical sleeve gastrectomy (VSG).

Trends in Bariatric Surgery: Procedure Selection, Revisional Surgeries, and Readmissions.

Background: There are limited data quantifying national trends, post-operative readmissions, and revisional surgeries for bariatric procedures. We hypothesized that there is a trend away from Roux en Y gastric bypass (RYGB) and laparoscopic adjustable gastric bands (LAGB) in favor of vertical sleeve gastrectomies (VSG). We hypothesized that VSG was associated with fewer revisions and readmissions, and that demographics and comorbidities were associated with surgery received.

Does patient rurality predict quality colon cancer care?: A population-based study.

Background: More than 50 million people reside in rural America. However, the impact of patient rurality on colon cancer care has been incompletely characterized, despite its known impact on screening.

Objective: Our study sought to examine the impact of patient rurality on quality and comprehensive colon cancer care.

Does concomitant cholecystectomy at time of Roux-en-Y gastric bypass impact adverse operative outcomes?

Background: We hypothesized that patients undergoing Roux-en-Y gastric bypass (RYGB) with concomitant cholecystectomy (RYGB + C) would be at greater risk for adverse events compared to patients undergoing RYGB alone.

Methods: Patients who underwent a RYGB were identified in the 2005-2009 American College of Surgeons National Surgical Quality Improvement Program Database. Multivariate logistic regression with adjustment for confounding variables was utilized to identify risk factors for mortality at 30 days, major adverse events, and prolonged length of stay (PLOS).

Disparities in pancreas cancer care.

Background: Prior literature shows demographic differences in patients surgically treated for pancreatic cancer (PC). We hypothesized that socioeconomic disparities also exist across all aspects of PC care, in both surgically and non-surgically treated patients.

Methods: We identified a cohort of patients with American Joint Committee on Cancer (AJCC) stage I-IV PC in the 1994-2008 California Cancer Registry.

Cancer surgery among American Indians.

Importance: American Indians (AIs) have the poorest cancer survival rates of any U.S. ethnic group.

Does enrollment in cancer trials improve survival?

Background: Stakeholders derive many benefits from cancer clinical trials, including guidance for future oncologic treatment decisions. However, whether enrollment in cancer trials also improves patient survival independently of trial outcomes remains underinvestigated. We hypothesized that cancer trial enrollment is not associated with patient survival outcomes.

Adjuvant chemotherapy for stage III colon cancer in the oldest old: results beyond clinical guidelines.

Background: Randomized trials demonstrating the benefits of chemotherapy in patients with American Joint Committee on Cancer stage III colon cancer underrepresent persons aged ≥ 75 years. The generalizability of these studies to a growing elderly population remains unknown.

Methods: Using the California Cancer Registry for 1994 through 2008, the authors conducted a population-based study of postcolectomy patients aged 50 years to 94 years with stage III (N1M0) colon adenocarcinoma.

Is there a role for surgery with adequate nodal evaluation alone in gastric adenocarcinoma?

Introduction: The extent of lymphadenectomy and protocol design in gastric cancer trials limits interpretation of survival benefit of adjuvant therapy after surgery with adequate lymphadenectomy. We examined the impact of surgery with adequate nodal evaluation alone on gastric cancer survival.

Methods: Using 2001-2008 California Cancer Registry, we identified 2,229 patients who underwent gastrectomy with adequate nodal evaluation (≥15 lymph nodes) for American Joint Committee on Cancer stage I-IV M0 gastric adenocarcinoma.

Bariatric surgery outcomes in the elderly: an ACS NSQIP study.

Introduction: Mortality and complications following bariatric surgery occur at acceptable rates, but its safety in the elderly population is unknown. We hypothesized that short-term operative outcomes in bariatric surgery patients ≥65 years would be comparable to younger persons.

Methods: Patients with a body mass index ≥35 kg/m(2) who underwent bariatric surgery in the 2005-2009 American College of Surgeons National Surgical Quality Improvement Program were identified.

Wound infection following stoma takedown: primary skin closure versus subcuticular purse-string suture.

Background: Stoma closure has been associated with a high rate of surgical site infection (SSI) and the ideal stoma-site skin closure technique is still debated. The aim of this study was to compare the rate of SSI following primary skin closure (PC) versus a skin-approximating, subcuticular purse-string closure (APS).

Methods: All consecutive patients undergoing stoma closure between 2002 and 2007 by two surgeons at a single tertiary-care institution were retrospectively assessed.

Lymph node evaluation is associated with improved survival after surgery for early stage gallbladder cancer.

Background: Guidelines for the current National Comprehensive Cancer Network recommend radical cholecystectomy, including hepatic resection and portal lymph node (LN) dissection, for patients with early stage gallbladder (GB) cancer. We sought to determine the survival benefit conferred by adequate LN evaluation.

Methods: We used the surveillance, epidemiology and end results (SEER) neoplasm registry to identify patients who had an operation for GB cancer between 1988 and 2004.

Increasing rates of contralateral prophylactic mastectomy among patients with ductal carcinoma in situ.

Purpose: Some women with unilateral ductal carcinoma in situ (DCIS) undergo contralateral prophylactic mastectomy (CPM) to prevent cancer in the opposite breast. The use and trends of CPM for DCIS in the United States have not previously been reported.

Methods: We used the Surveillance, Epidemiology, and End Results database to analyze the initial treatment (within 6 months) of patients with unilateral DCIS diagnosed from 1998 through 2005.

A critical analysis of the surgical management of early-stage gallbladder cancer in the United States.

Background: Radical resection is recommended for selected patients with gallbladder (GB) cancer. We sought to determine whether radical resection improves survival for patients with early-stage cancer and to evaluate surgeon compliance with current treatment recommendations.

Patients And Methods: Patients with stage 0, I, or II GB cancer who underwent surgical resection were identified from the Surveillance, Epidemiology, and End Results (SEER) tumor registry from 1988 through 2004.

Contralateral prophylactic mastectomy for patients with unilateral breast cancer.

Patients with unilateral breast cancer are at increased risk of developing a second cancer in the contralateral breast. Some women choose contralateral prophylactic mastectomy (CPM) to prevent cancer in the contralateral breast. Several studies have demonstrated that CPM significantly decreases the occurrence of contralateral breast cancer.