Weekend readmissions associated with mortality following pancreatic resection for cancer.

Background: The weekend effect is associated with an increased risk of adverse events, with complex patient populations especially susceptible to its impact. The objective of this study was to determine if outcomes for patients readmitted following pancreas resection differed on the weekend compared to weekdays.

Methods: The Healthcare Cost and Utilization State Inpatient Database for Florida was used to identify patients undergoing pancreas resection for cancer who were readmitted within 30 days of discharge following surgery.

Increased SOX9 Expression in Premalignant and Malignant Pancreatic Neoplasms.

Background: SOX9, a progenitor cell marker, is important for pancreatic ductal development. Our goal was to examine SOX9 expression differences in intraductal papillary mucinous neoplasms (IPMNs) and ductal adenocarcinoma (PDAC) compared with benign pancreatic duct (BP).

Methods: SOX9 expression was evaluated by immunohistochemistry performed on 93 specimens: 37 BP, 24 low grade (LG) IPMN, 12 high grade (HG) IPMN, and 20 PDAC.

Discordance between surgical care improvement project adherence and postoperative outcomes: implications for new Joint Commission standards.

Background: Infectious (INF) and venous thromboembolism (VTE) complication rates are targeted by surgical care improvement project (SCIP) INF and SCIP VTE measures. We analyzed how adherence to SCIP INF and SCIP VTE affects targeted postoperative outcomes (wound complication [WC], deep vein thrombosis, and pulmonary embolism [PE]) using all-payer data.

Materials And Methods: A retrospective review (2007-2011) was conducted using Healthcare Cost and Utilization Project State Inpatient Database Florida and Medicare's Hospital Compare.

Physiologic Response to HIPEC: Sifting Through Perturbation to Identify Markers of Complications.

Context: The postoperative physiologic response to hyperthermic intraperitoneal chemotherapy (HIPEC) has been poorly studied outside of the immediate perioperative time.

Objective: To characterize the physiologic response during the first 5 days after HIPEC and identify variables associated with major complications.

Methods: Patients undergoing HIPEC and cytoreductive surgery during a 14-month interval were retrospectively identified and their records reviewed for demographics, physiologic response, and major complications.

"Take the Volume Pledge" may result in disparity in access to care.

Background: "Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform ≥20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards.

Methods: Using the Healthcare Cost and Utilization Project State Inpatient Database from Florida, we identified patients who underwent pancreatectomy for pancreatic malignancy from 2007-2011.

Characterizing the role of a high-volume cancer resection ecosystem on low-volume, high-quality surgical care.

Background: Our objective was to determine the hospital resources required for low-volume, high-quality care at high-volume cancer resection centers.

Methods: Patients who underwent esophageal, pancreatic, and rectal resection for malignancy were identified using Healthcare Cost and Utilization Project State Inpatient Database (Florida and California) between 2007 and 2011. Annual case volume by procedure was used to identify high- and low-volume centers.

New onset postoperative atrial fibrillation predicts long-term cardiovascular events after gastrectomy.

Background: Recent evidence suggests transient postoperative atrial fibrillation leads to future cardiovascular events, even in noncardiac surgery. The long-term effects of postoperative atrial fibrillation in gastrectomy patients are unknown.

Methods: The Healthcare Cost and Utilization Project State Inpatient Databases identified patients undergoing gastrectomy for malignancy between 2007 and 2010.

The changing spectrum of surgically treated cystic neoplasms of the pancreas.

Introduction. While the incidence of pancreatic cystic lesions has steadily increased, we sought to evaluate the changes in their surgical management. Methods.

Should all branch-duct intraductal papillary mucinous neoplasms be resected?

Background: The relationship between branch-duct intraductal papillary mucinous neoplasms (IPMNs) and malignancy remains controversial and difficult to assess.

Methods: Between January 1, 1999 and January 1, 2013, we identified 84 patients with IPMN who underwent resection.

Results: Preoperatively, 55 patients underwent endoscopic ultrasounds and 58 underwent biopsy.

Does practice make perfect? Resident experience with breast surgery influences excision adequacy.

Background: The adequacy of breast-conserving surgery (BCS) for invasive or in situ disease is largely determined by the final surgical margins. Although margin status is associated with various clinicopathologic features, the influence of resident involvement remains controversial.

Methods: Patients who underwent BCS for malignancy from 2009 to 2012 were identified.

Peri-operative epidural may not be the preferred form of analgesia in select patients undergoing pancreaticoduodenectomy.

Background And Objectives: Epidural analgesia has become the preferred method of pain management for major abdominal surgery. However, the superior form of analgesia for pancreaticoduodenecomy (PD), with regard to non-analgesic outcomes, has been debated. In this study, we compare outcomes of epidural and intravenous analgesia for PD and identify pre-operative factors leading to early epidural discontinuation.

The Association between Survival and the Pathologic Features of Periampullary Tumors Varies over Time.

Introduction. Several histopathologic features of periampullary tumors have been shown to be correlated with prognosis. We evaluated their association with mortality at multiple time points.

Clinical and pathologic features influencing survival in patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma.

Objective: The aim of the study was to determine the clinicopathological features that influence survival in patients with resected pancreatic ductal adenocarcinoma (PDA).

Methods: The study used a single institution retrospective review of patients undergoing pancreaticoduodenectomy (PD) for PDA from 1993 to 2010.

Results: Two hundred forty-six consecutive cases of resected PDA were identified: 128 males (52 %), median age 68 years.

Laparoscopic splenectomy: perioperative management, surgical technique, and results.

Since their introduction in the early 1990s, minimally invasive techniques have gained widespread acceptance because of the significant benefits that patients are able to experience. Some of these benefits include reduced postoperative pain, earlier return to normal activity, and improved cosmesis when compared with open surgery. For these reasons, since its first description by Delaitre and Maignien in 1991, laparoscopic splenectomy (LS) has been increasingly utilized for a safe surgical removal of the spleen with nearly equivalent or superior short- and long-term outcomes when compared with the open approach.

Phase II study of induction fixed-dose rate gemcitabine and bevacizumab followed by 30 Gy radiotherapy as preoperative treatment for potentially resectable pancreatic adenocarcinoma.

Background: Eighty percent of patients with resected pancreatic ductal carcinoma (PDC) experience treatment failure within 2 years. We hypothesized that preoperative fixed-dose rate (FDR) gemcitabine (GEM) combined with the angiogenesis inhibitor bevacizumab (BEV) and accelerated 30 Gy radiotherapy (RT) would improve outcomes among patients with potentially resectable PDC.

Methods: This phase II trial tested induction FDR GEM (1,500 mg/m(2)) plus BEV (10 mg/kg IV) every 2 weeks for three cycles followed by accelerated RT (30 Gy in 10 fractions) plus BEV directed at gross tumor volume plus a 1-2 cm vascular margin.

Robotic-assisted minimally invasive central pancreatectomy: technique and outcomes.

Background: Central pancreatectomy is a definitive treatment for low-grade tumors of the pancreatic neck that preserves pancreatic and splenic function at the potential expense of postoperative pancreatic fistula. We analyzed outcomes after robot-assisted central pancreatectomy (RACP) to reexamine the risk-benefit profile in the era of minimally invasive surgery.

Methods: Retrospective analysis of nine RACP performed between August 2009 through June 2010 at a single institution.

Robot-assisted surgery: improved tool for major liver resections?

Minimally invasive liver surgery has recently undergone an explosion in reported worldwide experience. Given its comparable outcomes to its open counterpart, high-volume centers are utilizing minimal access liver surgery more frequently under well-defined criteria. The recent introduction of robot-assisted surgery has further revolutionized the field of minimally invasive surgery and has expanded the reach of feasibility.

The surgical and systemic management of neuroendocrine tumors of the pancreas.

Neuroendocrine tumors of the pancreas comprise a class of rare tumors that can be associated with symptoms of hormone overproduction. Five distinct clinical endocrinopathies are associated with neuroendocrine tumors; however, most of these tumors remain asymptomatic and follow an indolent course. Complete surgical resection offers the only hope for cure, but understanding the basic biology of the tumors has advanced the medical management in metastatic disease.

Treatment strategies in toxic epidermal necrolysis syndrome: where are we at?

Toxic epidermal necrolysis syndrome (TENS) is a rare, life-threatening medical emergency typically associated with recent drug exposure. Although several theories exist, recent insight has implicated the innate immune system as a significant contributor to the initiation and propagation of this devastating reaction. Standard therapies including transfer to specialized burn units, nutritional support, and protection from infection, remain the mainstay in the treatment of TENS.

Comparison of routine chest radiograph versus clinician judgment to determine adequate central line placement in critically ill patients.

Background: Central venous catheterization (CVC) is routine in the management of critically ill patients. However, this procedure has complications, generally mandating a postprocedural chest radiograph (CXR) to confirm adequate position and to rule out procedure-related complications. We sought to determine whether clinician judgment could reliably predict complications and malpositioning after CVC placement, thus obviating the need for a postprocedural CXR on all lines placed.