Trends and Outcomes of Neoadjuvant Chemotherapy for Clinical Stage T1 Pancreatic Cancer.

Background: Neoadjuvant chemotherapy (NC) for early pancreatic ductal adenocarcinoma (PDAC) remains controversial. We investigate the adoption of NC and its impact on survival in clinical T1 (cT1) PDAC.

Methods: National Cancer Database (2006-2017) was reviewed for cT1 PDAC.

Potential Role for Observation in Small Solid Pseudopapillary Neoplasm (SPN).

Background: Solid pseudopapillary neoplasms (SPN) are rare tumors of the pancreas, typically affecting young women. Resection is the mainstay of treatment but is associated with significant morbidity and potential mortality. We explore the idea that small, localized SPN could be safely observed.

Examination of Intersectionality and the Pipeline for Black Academic Surgeons.

Importance: The lack of underrepresented in medicine physicians within US academic surgery continues, with Black surgeons representing a disproportionately low number.

Objective: To evaluate the trend of general surgery residency application, matriculation, and graduation rates for Black trainees compared with their racial and ethnic counterparts over time.

Design, Setting, And Participants: In this nationwide multicenter study, data from the Electronic Residency Application Service (ERAS) for the general surgery residency match and Graduate Medical Education (GME) surveys of graduating general surgery residents were retrospectively reviewed and stratified by race, ethnicity, and sex.

Ampullary Neuroendocrine Tumors: Insight into a Rare Histology.

Background: Ampullary neuroendocrine tumors (NETs) make up < 1% of all gastroenteropancreatic NETs, and information is limited to case series. This study compares patients with ampullary, duodenal, and pancreatic head NETs.

Methods: The National Cancer Database (2004-2016) was queried for patients with ampullary, duodenal, and pancreatic head NETs.

The Role of Race and Gender in the Career Experiences of Black/African American Academic Surgeons: A Survey of the Society of Black Academic Surgeons and a Call to Action.

Objective: To determine the role of race and gender in the career experience of Black/AA academic surgeons and to quantify the prevalence of experience with racial and gender bias stratified by gender.

Summary Of Background Data: Compared to their male counterparts, Black/African American women remain significantly underrepresented among senior surgical faculty and department leadership. The impact of racial and gender bias on the academic and professional trajectory of Black/AA women surgeons has not been well-studied.

Operable synchronous ampullary carcinoma and hepatocellular carcinoma: a case report and review of the literature.

We report a rare case of synchronous double primary malignancies of the liver and ampulla. A 70-year-old white female was diagnosed with ampullary and hepatocellular carcinoma. The management and outcome of this rare case of synchronous double primary hepatic and periampullary malignancies, amenable to surgical resection is discussed.

Digital communications and social media use in surgery: how to maximize communication in the digital age.

Communication among patients, colleagues, and staff in healthcare has changed dramatically in the last decade. Digital technology and social media sites have allowed instantaneous access to information. The potential for information technology to improve access to healthcare, enhance the quality, and lower the cost is significant.

Association between adipokines and critical illness outcomes.

Background: Adipose tissue is an endocrine organ that plays a critical role in immunity and metabolism by virtue of a large number of hormones and cytokines, collectively termed adipokines. Dysregulation of adipokines has been linked to the pathogenesis of multiple diseases, but some questions have arisen concerning the value of adipokines in critical illness setting. The objective of this review was to evaluate the associations between blood adipokines and critical illness outcomes.

Enlarging Pancreatic Schwannoma: A Case Report and Review of the Literature.

A 72-year-old female presented with dyspepsia for 2 years and an incidental mass in the head of the pancreas on abdominal computed tomography (CT) scan. Patient had multiple negative endoscopic ultrasound guided biopsies. She was followed up for 3 years with serial imaging until an abdominal CT scan showed an increase in size of the pancreatic mass.

Tube cholecystostomy before cholecystectomy for the treatment of acute cholecystitis.

Background And Objectives: Percutaneous cholecystostomy is currently indicated for patients with cholecystitis who might be poor candidates for operative cholecystectomy. We performed a study to evaluate the long-term outcome of patients undergoing emergent tube cholecystostomy.

Methods: This study was a retrospective chart review of patients who underwent tube cholecystostomy from July 1, 2005, to July 1, 2012.

Race/Ethnicity is predictive of lymph node status in patients with early gastric cancer.

Background: Race/ethnicity has long been suspected to affect survival in patients with gastric adenocarcinoma. However, the clinicohistopathological impact of race or ethnicity on early gastric cancer (EGC) is not known.

Methods: From 2000 to 2013, 286 patients underwent gastrectomy and 104 patients had pathological confirmation of EGC.

Evidence-based review of the management of early gastric cancer.

Although standard gastrectomy remains the most definitive locoregional treatment for early gastric cancer, it carries significant perioperative morbidities. Surgical gastrectomy for resection of lymph nodes is not always required and endoscopic resection may be a treatment option for patients at negligible risk of lymph node metastasis. Furthermore, the criteria for endoscopic resection are expanding, along with the development of new technology, in both Eastern and western countries with high prevalence of early gastric cancer, where studies for endoscopic treatment modalities have been conducted.

Palliative treatment and the role of surgical resection in gastric cancer.

Adenocarcinoma of the stomach is often diagnosed in the late stages of the disease. Surgical resection of all gross and microscopic disease is essential for curative treatment. Complete resection is often not achievable when patients present with advanced stage IV cancer.

Intrathoracic splenosis presenting as persistent chest pain.

Thoracic splenosis is a rare entity resulting from splenic and diaphragmatic injury. Patients remain asymptomatic, and surgical intervention is not indicated in the majority of cases. We report a case of a 50-year-old male with a history of splenectomy due to a gunshot wound 30 years previously who presented with vague, progressively worsening chest pain.

Early results of trans-oral endoscopic plication and revision of the gastric pouch and stoma following Roux-en-Y gastric bypass surgery.

Objective: A new technique for endoscopic plication and revision of the gastric pouch (EPRGP) for patients who underwent gastric bypass (RGB) surgery was evaluated in patients with severe GERD, dumping syndrome, failure of weight loss, or all of these.

Patients And Methods: Patients underwent EPRGP over a 12-month period. The StomaphyX device (Endogastric Solutions, Redmond, WA) was utilized over a standard flexible gastroscope.

The role of laparoscopy for gastric surgery in the West.

The only potentially curative treatment available for gastric adenocarcinoma is surgical resection. However, many controversies exist regarding treatment strategy, including whether the laparoscopic approach is appropriate. Many reports of laparoscopic techniques for cancer resection have shown oncologic equivalency to the open technique, with the known benefits of the minimally invasive approach, such as decreased pain, length of hospital stay, blood loss, and complications.

Phenotypic subpopulations of metastatic colon cancer stem cells: genomic analysis.

Background: Human cancer is characterized by high heterogeneity in gene expression, varieties of differentiation phenotypes and tumor-host interrelations. Growing evidence suggests that tumor-initiating, or cancer stem cells (CSCs), may also represent a heterogeneous population. The present study was undertaken to isolate and characterize the different phenotypic subpopulations of metastatic colon cancer and to develop a working colon CSC model for obtaining highly tumorigenic and clonogenic cells in sufficient numbers.

The prognostic impact of isolated tumor cells in lymph nodes of T2N0 gastric cancer: comparison of American and Japanese gastric cancer patients.

Background: The clinical significance of immunohistochemically detected isolated tumor cells (ITC) in lymph nodes of gastric cancer patients is controversial. This study examined the prognostic impact of ITC on patients with early-stage gastric cancer in two large volume centers in the United States and Japan.

Methods: Fifty-seven patients with T2N0M0 gastric carcinoma who underwent gastric resection between January 1987 and January 1997 at Memorial Sloan-Kettering Cancer Center (MSKCC) in New York and 107 patients resected at National Cancer Center Hospital (NCCH) in Tokyo between January 1984 and December 1990 were studied.

Clinical significance of telomerase activity in peritoneal disseminated cells: gastrointestinal cancers.

Early detection and accurate staging of gastrointestinal (GI) cancers are difficult. The aim of this study was to evaluate whether telomerase activity (TA) in exfoliated/disseminated epithelial cells could be used as a reliable marker for GI cancers. TA was evaluated with the real-time RTQ-TRAP in immunomagnetically sorted peritoneal epithelial cells from 60 patients undergoing surgical treatment.

Measuring outcomes in randomized prospective trials in palliative care.

Palliative care aims to improve the quality of life of patients and their families and reduce suffering from life-threatening illness. In assessing palliative care efficacy, researchers must consider a broad range of potential outcomes, including those experienced by the patient's family/caregivers, clinicians, and the health care system. The purpose of this article is to summarize the discussions and recommendations of an Outcomes Working Group convened to advance the palliative care research agenda, particularly in the context of randomized controlled trials.

Evolution of preoperative and postoperative therapies in the management of localized gastroesophageal cancers.

Recent changes in the epidemiology of gastroesophageal cancers in the United States and many parts of Europe require reassessment of traditional surgical and adjuvant treatment approaches to these tumors. Careful preoperative staging and classification aid in the selection of appropriate treatments. While molecular genetic methods to distinguish esophageal from gastric tumor origins are awaited, a practical system that classifies adenocarcinomas of the esophagogastric junction into one of three types is contributing to the understanding of these tumors as well as determining the best surgical approach.