Trends, patterns, and outcomes in the management of malignant colonic polyps in the general population of the United States.

Background: Colonoscopic screening has increased detection of malignant colonic polyps (MPs). The goal of this study was to analyze trends and patterns in the surgical treatment of MPs and to assess outcomes as measured by lymph node retrieval and patient survival.

Methods: The Surveillance, Epidemiology, and End Results (SEER) registry was queried to identify 19,743 patients with MPs from 1988 to 2003.

Trends and outcomes of adolescent bariatric surgery in California, 2005-2007.

Objective: The goal of this study was to evaluate trends, and outcomes of adolescents who undergo bariatric surgery.

Patients And Methods: Patients younger than 21 years who underwent elective bariatric surgery between 2005 and 2007 were identified from the California Office of Statewide Health Planning and Development database. Multivariate logistic regression was used to identify factors associated with the type of surgery.

Indications for performing carpal tunnel surgery: clinical quality measures.

Background: Rates of carpal tunnel surgery vary for unclear reasons. In this study, the authors developed measures determining when surgery is necessary (benefits exceed risks), inappropriate (risks outweigh benefits), or optional.

Methods: Measures were developed using a modified-Delphi panel.

Invasive lobular vs. ductal breast cancer: a stage-matched comparison of outcomes.

Background: Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC), more difficult to detect mammographically, and usually diagnosed at a later stage. Does delayed diagnosis of ILC affect survival? We used a national registry to compare outcomes of patients with stage-matched ILC and IDC.

Methods: Query of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry identified 263,408 women diagnosed with IDC or ILC between 1993 and 2003.

Underuse of axillary dissection for the management of sentinel node micrometastases in breast cancer.

Background: Current American Society of Clinical Oncology guidelines for management of sentinel node micrometastases (SNMM) in breast cancer recommend axillary lymph node dissection (ALND) for all patients.

Objective: To assess nationwide use of ALND for SNMM.

Design: Population-based retrospective observational study.

Use of interpreters by physicians treating limited English proficient women with breast cancer: results from the provider survey of the Los Angeles Women's Health Study.

Objective: Little is known about how cancer physicians communicate with limited English proficient (LEP) patients. We studied physician-reported use and availability of interpreters.

Data Sources: A 2004 survey was fielded among physicians identified by a population-based sample of breast cancer patients.

Appropriateness criteria for bariatric surgery: beyond the NIH guidelines.

Careful selection of bariatric patients is critical for successful outcomes. In 1991, the NIH first established patient selection guidelines; however, some surgeons operate on individuals outside of these criteria, i.e.

Pregnancy and fertility following bariatric surgery: a systematic review.

Context: Use of bariatric surgery has increased dramatically during the past 10 years, particularly among women of reproductive age.

Objectives: To estimate bariatric surgery rates among women aged 18 to 45 years and to assess the published literature on pregnancy outcomes and fertility after surgery.

Evidence Acquisition: Search of the Nationwide Inpatient Sample (1998-2005) and multiple electronic databases (Medline, EMBASE, Controlled Clinical Trials Register Database, and the Cochrane Database of Reviews of Effectiveness) to identify articles published between 1985 and February 2008 on bariatric surgery among women of reproductive age.

Readmissions following pancreaticoduodenectomy for pancreas cancer: a population-based appraisal.

Procedure complexity and volume-outcome relationships have led to increased regionalization of pancreaticoduodenectomy (PD) for pancreas cancer. Knowledge regarding outcomes after PD comes from single-institutional series, which may be limited if a significant number of patients follow up at other hospitals. Thus, readmission data may be underreported.

Bariatric surgery in women of reproductive age: special concerns for pregnancy.

Context: The use of bariatric surgery for treating severe obesity has increased dramatically over the past 10 years; about half of patients who undergo these procedures are women of reproductive age. This report was commissioned to measure the incidence of bariatric surgery in this population and review the evidence on the impact of bariatric surgery on fertility and subsequent pregnancy.

Objectives: To measure the incidence of contemporary bariatric surgery procedures in women age 18-45 and to assess its impact on fertility, contraception, prepregnancy risk factors, and pregnancy outcomes, including those of neonates.

What is the rate of small bowel obstruction after colectomy?

The rate of small bowel obstruction (SBO) after colectomy is unknown. Given the large number of colectomies performed in the United States, elucidating SBO rates, outcomes, and identifying predictors of readmission is important. Using the California Inpatient File, we identified all patients readmitted with a principle diagnosis of SBO at least once in the 3 years after colectomy (n = 4555).

Do racial/ethnic disparities exist in the utilization of high-volume surgeons for women with ovarian cancer?

Objective: Determine if racial/ethnic disparities exist for access to high-volume surgeons (HVS) for patients with ovarian cancer.

Methods: Retrospective study of ovarian cancer surgeries identified by the California Cancer Registry (CCR) linked to hospital discharge data (1991-2002). Surgeon volume was defined as HVS (>10 ovarian cancer surgeries/year), middle volume (MVS; 2-9/year), and low volume (LVS; View Article and Find Full Text PDF

Are 12 nodes needed to accurately stage T1 and T2 colon cancers?

Evaluation of 12 lymph nodes has been mandated to prevent colon cancer understaging. Given that the probability of node metastases is largely associated with T-stage, are <12 nodes substandard for T1 and T2 lesions? We evaluated if survival for T1 and T2 tumors varies by nodes examined. In SEER, 61,237 patients undergoing colon cancer resection were identified.

Survival after resection of ampullary carcinoma: a national population-based study.

Background: Ampullary cancer is the second most common periampullary cancer, with a resection and survival rate more favorable than that for pancreatic cancer. However, most reports have been conducted at single institutions with small sample sizes, and results may not reflect the practices and outcomes in the community. Our objective was to complete a population-based analysis of patients undergoing resection for ampullary carcinoma and compare it with outcomes in the published literature.

Do breast columnar cell lesions with atypia need to be excised?

Columnar cell lesion with atypia (CCLA) is a newly recognized pathologic entity seen in breast specimens. The breast cancer risk associated with this finding is unclear, although CCLA had been found adjacent to both in situ and invasive carcinomas, but the incidence is unknown. Breast specimens from patients with a columnar cell lesion were reviewed by a pathologist for atypia.

Is high BMI associated with specific complications after laparoscopic Roux-en-Y gastric bypass?

Controversy remains whether patients with body mass index (BMI) > or =50 kg/m2 experience more complications after laparoscopic Roux-en-y gastric bypass (LRYGB) than those with a lower BMI. Whether BMI > or =50 kg/m2 is associated with specific complications remains unknown. Charts of 152 patients who underwent LRYGB were reviewed.

How much do standardized forms improve the documentation of quality of care?

Background: Chart abstraction is a common method for measuring the quality of surgical care. In this study we examine how the use of standardized operative dictation and history forms improves documentation rates of bariatric quality measures.

Materials And Methods: Two independent reviewers evaluated 201 patient charts from two multi-surgeon bariatric surgery practices for documentation of five intraoperative and seven preoperative bariatric quality measures.

Accuracy of staging node-negative pancreas cancer: a potential quality measure.

Objective: To determine the optimal number of lymph nodes to examine for accurate staging of node-negative pancreatic adenocarcinoma after pancreaticoduodenectomy.

Design, Setting, And Patients: Data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program (1988-2002) were used to identify 3505 patients who underwent pancreaticoduodenectomy for adenocarcinoma of the pancreas, including 1150 patients who were pathologically node negative (pN0) and 584 patients with a single positive node (pN1a). Perioperative deaths were excluded.

Meta-analysis in surgery: methods and limitations.

The growth of new knowledge continues to advance the surgical disciplines, and several types of literature reviews attempt to consolidate this expansion of information. Meta-analysis is one such method that integrates findings on the same subject from different studies. Within surgery, there is a wealth of literature on a given topic, which needs to be considered collectively.

Development of quality indicators: lessons learned in bariatric surgery.

Quality indicators will likely be used in comprehensive surgical quality assessment and improvement programs. Quality indicators are the actions equated with good quality of care. As a case example, bariatric surgery quality indicators were developed using evidence in the literature combined with formal expert opinion validation.

Quality indicators in bariatric surgery: improving quality of care.

Objectives: Bariatric surgery is one of the most common complex intraabdominal operations, and there are reports of variations in outcome among providers. There is a need to standardize the processes of care in this specialty, and, as an attempt to do so, quality indicators were developed.

Methods: Candidate indicators, covering preoperative to follow-up care (5 domains), were developed based on evidence in the literature.

Rare tumors of the colon and rectum: a national review.

Background: Most literature available on rare colorectal cancer (CRC) is from case series reports. This population-based evaluation is the first comprehensive look at four rare histologic types of CRC, allowing comparisons with the more common adenocarcinoma for clinical and pathological features and survival rates.

Materials And Methods: All patients diagnosed with carcinoid (n=2,565), malignant lymphoma (n=955), non-carcinoid neuroendocrine (n=455), squamous cell (n=437), and adenocarcinoma (n=164,638) in SEER cancer database (1991-2000) were analyzed.

Age stratified, perioperative, and one-year mortality after abdominal aortic aneurysm repair: a statewide experience.

Objective: The purpose of this study was to determine the in-hospital, 30-day, and 365-day mortality for the open repair of abdominal aortic aneurysms (AAAs), when stratified by age, in the general population. Age stratification could provide clinicians with information more applicable to an individual patient than overall mortality figures.

Methods: In a retrospective analysis, data were obtained from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1995 to 1999.

Thirty-day mortality statistics underestimate the risk of repair of thoracoabdominal aortic aneurysms: a statewide experience.

Objective: The purpose of this study was to determine the 30-day and 365-day mortality for the repair of thoracoabdominal aortic aneurysms (TAA), when stratified by age, in the general population. These data provide clinicians with information more applicable to an individual patient than mortality figures from a single institutional series.

Methods: Data were obtained from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1991 to 2002.