Management of non-curative endoscopic resection of T1 colon cancer.

Endoscopic resection techniques enable en-bloc resection of T1 colon cancers. A complete removal of T1 colon cancer can be considered curative when histologic examination of the specimens shows none of the high-risk factors for lymph nodes metastases. Criteria predicting lymph nodes metastases include deep submucosal invasion, poor differentiation, lymphovascular invasion, and high-grade tumor budding.

Hospital variations in failure to rescue after abdominal surgery: a nationwide, retrospective observational study.

Objectives: This study aims to determine hospital variation and intensive care unit characteristics associated with failure to rescue after abdominal surgery in Norway.

Design: A nationwide retrospective observational study.

Setting: All 52 hospitals in Norway performing elective and acute abdominal surgery.

Use and safety of peripherally inserted central catheters and midline catheters in palliative care cancer patients: a retrospective review.

Purpose: Some cancer patients in palliative care require intravenous administration of symptom relieving drugs. Peripherally inserted central catheters (PICCs) and midline catheters (MCs) provide easy and accessible intravenous access. However, limited evidence supports the use of these devices in palliative care.

Role of preoperative in-hospital delay on appendiceal perforation while awaiting appendicectomy (PERFECT): a Nordic, pragmatic, open-label, multicentre, non-inferiority, randomised controlled trial.

Background: Appendicectomy remains the standard treatment for appendicitis. No international consensus exists on the surgical urgency for acute uncomplicated appendicitis, and recommendations vary from surgery without delay to surgery within 24 h. Longer in-hospital delay has been thought to increase the risk of perforation and further morbidity.

Abdominal surgical trajectories associated with failure to rescue. A nationwide analysis.

Objective: The ability to detect and treat complications of surgery early is essential for optimal patient outcomes. The failure-to-rescue (FTR) rate is defined as the death rate among patients who develop at least one complication after the surgical procedure and may be used to monitor a hospital's quality of surgical care. The aim of this observational study was to explore FTR in Norway and to see if we could identify surgical trajectories associated with high FTR.

Educational value of surgical telementoring.

Educating surgeons is a time-consuming process. In addition to theoretical knowledge, the practical tasks of surgical procedures must be mastered. Translation of such knowledge from mentor to mentee may be efficiently done by surgical telementoring (ST).

Fracture and embolization of an implantable venous access device in patient with atrial septal defect.

Totally implantable venous access devices (TIVADs) are frequently used for the administration of chemotherapy or parenteral nutrition and have proved to be safe and improve patient quality of life during treatment. Catheter-related infections are the most common complication, whereas catheter fracture and embolization is rarely seen. We present a case of a 61-year-old cancer patient in which the TIVAD fractured and embolized to the patient's left knee 18 months after its initial placement.

Management of the positive pathologic circumferential resection margin in rectal cancer: A national cancer database (NCDB) study.

Background: The circumferential resection margin (CRM) is a primary predictor of local recurrence and survival in rectal cancer, and an important consideration in guiding treatment. CRM is usually predicted preoperatively, so optimal management of an unexpected pathologic positive CRM involvement is debatable. We aimed to investigate the postoperative management of T3N0 rectal cancers with a positive pathologic CRM, and the impact of each strategy on survival.

Video-based coaching in surgical education: a systematic review and meta-analysis.

Background: In the era of competency-based surgical education, VBC has gained increased attention and may enhance the efficacy of surgical education. The objective of this systematic review was to summarize the existing evidence of video-based coaching (VBC) and compare VBC to traditional master-apprentice-based surgical education.

Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCT) assessing VBC according to the PRISMA and Cochrane guidelines.

Retromesenteric course of the middle colic artery-challenges and pitfalls in D3 right colectomy for cancer.

Background: The middle colic artery (MCA) is of crucial importance in abdominal surgery, for laparoscopic or open right and transverse colectomies. Against this background, a high number of reports concerning anatomical variations of the MCA have been published intended to contribute to the improvement of operative techniques for the treatment of colon cancer. Despite this extensive literature, briefly reviewed in the present paper, a course of the MCA posterior to the superior mesenteric vein, called a retromesenteric trajectory, has been related to only once, to the best of our knowledge.

The impact of rectal cancer tumor height on recurrence rates and metastatic location: A competing risk analysis of a national database.

Background: The impact of rectal cancer tumor height on local recurrence and metastatic spread is unknown. The objective was to evaluate the impact of rectal cancer tumor height from the anal verge on metastatic spread and local recurrence patterns.

Methods: The Norwegian nationwide surgical quality registry was reviewed for curative rectal cancer resections from 1/1/1996-12/15/2006.

Application of a simple, affordable quality metric tool to colorectal, upper gastrointestinal, hernia, and hepatobiliary surgery patients: the HARM score.

Background: Quality is the major driver for both clinical and financial assessment. There remains a need for simple, affordable, quality metric tools to evaluate patient outcomes, which led us to develop the HospitAl length of stay, Readmission and Mortality (HARM) score. We hypothesized that the HARM score would be a reliable tool to assess patient outcomes across various surgical specialties.

Tailored Treatment of Colorectal Cancer: Surgical, Molecular, and Genetic Considerations.

Colorectal cancer (CRC) is a complex cancer disease, and approximately 40% of the surgically cured patients will experience cancer recurrence within 5 years. During recent years, research has shown that CRC treatment should be tailored to the individual patient due to the wide variety of risk factors, genetic factors, and surgical complexity. In this review, we provide an overview of the considerations that are needed to provide an individualized, patient-tailored treatment.

Analysis of free text in electronic health records for identification of cancer patient trajectories.

With an aging patient population and increasing complexity in patient disease trajectories, physicians are often met with complex patient histories from which clinical decisions must be made. Due to the increasing rate of adverse events and hospitals facing financial penalties for readmission, there has never been a greater need to enforce evidence-led medical decision-making using available health care data. In the present work, we studied a cohort of 7,741 patients, of whom 4,080 were diagnosed with cancer, surgically treated at a University Hospital in the years 2004-2012.

The HARM score for gastrointestinal surgery: Application and validation of a novel, reliable and simple tool to measure surgical quality and outcomes.

Background: The HospitAl length of stay, Readmissions and Mortality (HARM) score is a simple, inexpensive quality tool, linked directly to patient outcomes. We assess the HARM score for measuring surgical quality across multiple surgical populations.

Methods: Upper gastrointestinal, hepatobiliary, and colorectal surgery cases between 2005 and 2009 were identified from the Healthcare Cost and Utilization Project California State Inpatient Database.

Predicting colorectal surgical complications using heterogeneous clinical data and kernel methods.

Objective: In this work, we have developed a learning system capable of exploiting information conveyed by longitudinal Electronic Health Records (EHRs) for the prediction of a common postoperative complication, Anastomosis Leakage (AL), in a data-driven way and by fusing temporal population data from different and heterogeneous sources in the EHRs.

Material And Methods: We used linear and non-linear kernel methods individually for each data source, and leveraging the powerful multiple kernels for their effective combination. To validate the system, we used data from the EHR of the gastrointestinal department at a university hospital.

Effect of laparoscopic surgery on health care utilization and costs in patients who undergo colectomy.

Importance: Laparoscopic colectomy is safe and effective in the treatment of many colorectal diseases. However, the effect of increasing use of laparoscopy on overall health care utilization and costs, especially in the long term, has not been thoroughly investigated.

Objective: To evaluate the effect of laparoscopic vs open colectomy on short- and long-term health care utilization and costs.

Multivisceral resection for advanced rectal cancer: outcomes and experience at a single institution.

Background: Multivisceral resection is often required in the treatment of locally advanced rectal cancers. Such resections are relatively rare and oncologic outcomes, especially when sphincter preservation is performed, are not fully demonstrated.

Methods: A retrospective review was conducted of patients who underwent multivisceral resection for locally advanced rectal cancer with and without sphincter preservation.

Data-driven Temporal Prediction of Surgical Site Infection.

Analysis of data from Electronic Health Records (EHR) presents unique challenges, in particular regarding nonuniform temporal resolution of longitudinal variables. A considerable amount of patient information is available in the EHR - including blood tests that are performed routinely during inpatient follow-up. These data are useful for the design of advanced machine learning-based methods and prediction models.

Data-driven approach for assessing utility of medical tests using electronic medical records.

Objective: To precisely define the utility of tests in a clinical pathway through data-driven analysis of the electronic medical record (EMR).

Materials And Methods: The information content was defined in terms of the entropy of the expected value of the test related to a given outcome. A kernel density classifier was used to estimate the necessary distributions.