Early Versus Late Feeding After Percutaneous Endoscopic Gastrostomy Placement in Trauma and Burn.

Introduction: Timing to resume feeds after percutaneous endoscopic gastrostomy (PEG) placement continues to vary among US trauma surgeons. The purpose of this study was to assess differences in meeting nutritional therapy goals and adverse outcomes with early versus late enteral feeding after PEG placement.

Methods: This retrospective review included 364 trauma and burn patients who underwent PEG placement.

Comparing the effect of distance to treatment facility on reconstruction and breast conservation therapy for early-stage invasive ductal carcinoma between the nation and the mountain region.

Background: Our objective is to evaluate the effect of distance to facility on the use of breast conservation therapy and reconstruction for early stage breast cancer.

Methods: Utilizing the National Cancer Database, we identified females, age <65, with Stage I invasive ductal carcinoma from 2004 to 2015. Using logistic regression, we compared radiation, mastectomy, and reconstruction treatment patterns.

Management of early hepatocellular carcinoma: results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association.

Background: There are many potential treatment options for patients with early stage hepatocellular carcinoma (HCC) and practice patterns vary widely. This project aimed to use a Delphi conference to generate consensus regarding the management of small resectable HCC.

Methods: A base case was established with review by members of AHPBA Research Committee.

The role of FDG-PET-CT is limited in initial staging of nodal metastasis for thin cutaneous melanoma.

Introduction: Positron emission tomography computed tomography (PET-CT) is often used to stage nodal metastases in thin cutaneous melanoma, with limited evidence.

Methods: A retrospective review of patients with cutaneous malignant melanoma treated at our institution was performed from 2005 to 2015, identifying those who received a PET-CT prior to lymphadenectomy. Biopsy features, lymph node status, and PET-CT results were collected.

Comparing treatment patterns of hepatocellular carcinoma at academic centers and non-academic centers within the Mountain Region.

Background: Our objective is to explore differences in survival and treatment approaches for hepatocellular carcinoma (HCC) between academic centers (ACs) and non-academic centers (NACs), which may contribute to disparities in the Mountain Region (MR).

Methods: Using the National Cancer Database, HCC cases from 2004 to 2015 in the MR were divided into AC and NAC subgroups. Cox-proportional hazard regression and binary logistic regression were performed to analyze survival, compare treatment patterns, and examine the effect of facility type and surgical approach on margin status.

Management of asymptomatic, well-differentiated PNETs: results of the Delphi consensus process of the Americas Hepato-Pancreato-Biliary Association.

Background: Variation in the management of PNETs exist due to the limited high-level evidence to guide clinical practice. The aim of this work is to generate consensus guidelines with a Delphi process for managing PNETs.

Methods: A panel of experts reviewed the surgical literature and scored a set of clinical case statements using a web-based survey to identify areas of agreement and disagreement.

Efficacy of irreversible electroporation in human pancreatic adenocarcinoma: advanced murine model.

Irreversible electroporation (IRE) is a promising cell membrane ablative modality for pancreatic cancer. There have been recent concerns regarding local recurrence and the potential use of IRE as a debulking (partial ablation) modality. We hypothesize that incomplete ablation leads to early recurrence and a more aggressive biology.

Esophageal anastomotic leak does not affect ability to receive adjuvant treatment.

Background: Esophageal anastomotic leak is associated with high morbidity and mortality and potentially lethal if not recognized promptly and treated aggressively. While many studies have attempted to delineate the surgical techniques associated with lower rates of anastomotic leak, few have attempted to determine its long term effects on adjuvant therapy and patient quality of life.

Methods: We reviewed our prospective 350 patient esophageal-gastric database and found 194 esophageal anastomoses performed from 1994 to 2013.

Health-related quality of life changes following major and minor hepatic resection: the impact of complications and postoperative anemia.

Background: Few studies have evaluated the health-related quality-of-life (QOL) changes in patients following major liver resection for malignancy.

Methods: QOL parameters were recorded prospectively at baseline (preoperative), and through 6 months of follow-up using various instruments.

Results: Major complications occurred in 10 of 41 patients.

Tumor-positive resection margins reflect an aggressive tumor biology in pancreatic cancer.

Background: Resection margin status has been shown to impact outcomes for pancreatic adenocarcinoma (PAC), yet it remains unknown whether margin status is a reflection of tumor biology or surgical technique.

Methods: Two hundred eighty-three consecutive patients with pancreatic adenocarcinoma were identified in a prospectively maintained database. Only patients with R0 (n = 207) or R1 (n = 76) tumors were included.

Negative effects of transfused blood components after hepatectomy for metastatic colorectal cancer.

There has been conflicting evidence regarding negative effects of blood transfusion in oncology patients. This study was undertaken to determine any negative effects of specific blood product transfusion after resection of hepatic colorectal metastases (CRM). Retrospective review of patients undergoing hepatectomy for CRM from 1995 to 2009 at a single institution was performed.

Impact of post-operative complications on quality of life after pancreatectomy.

Context: Pancreatectomies for malignant and benign diseases are increasingly being performed worldwide. Recent studies, that have evaluated quality of life in pancreatectomy, have reported conflicting outcomes.

Objective: This study was undertaken to analyze the quality of life changes reported by patients with pancreatic cancer undergoing pancreatectomy.

Impact of histology on survival in retroperitoneal sarcomas.

Background: The current American Joint Committee on Cancer AJCC staging system applies to all soft-tissue sarcomas and does not allow for consideration of many features unique to retroperitoneal sarcomas (RPSs). The aim of this study was to analyze factors predictive of recurrence and survival for patients with resected RPSs.

Methods: This was a retrospective analysis of consecutive patients with primary RPS who underwent resection.

Lymphovascular invasion as a prognostic factor in melanoma.

The prognostic significance of lymphovascular invasion (LVI) in melanoma remains controversial. Clinicopathologic data from a prospective trial of patients with melanoma were analyzed with respect to LVI. Disease-free survival and overall survival (OS) were evaluated by Kaplan-Meier (KM) analysis.

The Notch regulator Numb links the Notch and TCR signaling pathways.

Both the Notch and TCR signaling pathways play an important role in T cell development, but the links between these signaling pathways are largely unexplored. The adapter protein Numb is a well-characterized inhibitor of Notch and also contains a phosphotyrosine binding domain, suggesting that Numb could provide a link between these pathways. We explored this possibility by investigating the physical interactions among Notch, Numb, and the TCR signaling apparatus and by examining the consequences of a Numb mutation on T cell development.

Necrotizing soft tissue infections: improved outcomes with modern care.

The outcome of necrotizing soft tissue infections (NSTI) remains unchanged despite advances in care. Reasons cited are changing patterns of causative factors, delays in diagnosis, and inadequate antibiotic coverage and surgical treatment. To document outcomes of NSTI after aggressive management and to identify risk factors of mortality and prolonged hospital stay, we reviewed all our patients with NSTI admitted from January 2000 to January 2002.

Necrotizing soft-tissue infections.

It has been more than 130 years since NSTIs were first described. Despite the development of various classification systems and progress in surgical management, these infections continue to have high mortality and pose enormous diagnostic and therapeutic challenges. For optimal outcome, treatment involves rapid institution of appropriate antibiotic coverage and early wide surgical debridement.