Hospital Service Volume as an Indicator of Treatment Patterns for Colorectal Cancer.

Introduction: A hospital's approach (volume of cancer treatment services provided) to treating metastatic colorectal cancer influences a patient's treatment as strongly as patient disease status. The implications of hospital-level treatment approaches across disease stages remain understudied. We sought to determine if hospital service volume (SV) for metastatic colorectal cancer could be predictive of nonstandard treatment patterns in stages I-III colon cancer.

Perceptions of general surgery residents at military treatment facilities: Excellent training with crisis of confidence.

Background: The declining operative volume at Military Treatment Facilities (MTFs) has resulted in Program Directors finding alternate civilian sites for resident rotations. The continued shift away from MTFs for surgical training is likely to have unintended negative consequences.

Methods: An anonymous survey was generated and sent to the program directors of military general surgery training programs for distribution to their residents.

Intentional enterotomies: validation of a novel robotic surgery training exercise.

While laparoscopic simulation-based training is a well-established component of general surgery training, no such requirement or standardized curriculum exists for robotic surgery. Furthermore, there is a lack of high-fidelity electrocautery simulation training exercises in the literature. Using Messick's validity framework, we sought to determine the content, response process, internal content and construct validity of a novel inanimate tissue model that utilizes electrocautery for potential incorporation in such curricula.

Outcomes of Partial Versus Total Colectomy in Ulcerative Colitis: A Propensity Score-Matched Analysis.

Introduction: Total abdominal colectomy (TAC) with ileostomy is the standard treatment for severe ulcerative colitis (UC). Partial colectomy (PC) with colostomy may present a less morbid treatment option.

Methods: The 2012-19 ACS-NSQIP database was queried to assess 30-day outcomes among patients undergoing TAC versus PC for UC, utilizing propensity score matching (PSM) techniques to account for differences in disease severity, patient selection, and presentation acuity.

Systematic review of academic robotic surgery curricula.

The use of robotic surgery has increased exponentially in the United States. Despite this uptick in popularity, no standardized training pathway exists for surgical residents or practicing surgeons trying to cross-train onto the platform. We set out to perform a systematic review of existing literature to better describe and analyze existing robotic surgical training curricula amongst academic surgery programs.

Meeting the New Commission on Cancer Operative Standards: Where Do We Stand Now?

Introduction: The 2020 Commission on Cancer accreditation standards 5.7 and 5.8 address total mesorectal excision for rectal cancer and lymph node sampling for lung cancer.

Morbidity and Mortality of Non-pancreatectomy operations for pancreatic cancer: An ACS-NSQIP analysis.

Background: Patients with pancreas cancer may undergo palliative gastrointestinal or biliary bypass. Recent comparisons of post-operative outcomes following such procedures are lacking.

Methods: We analyzed patients undergoing exploration, gastrojejunostomy, biliary bypass or double bypass for pancreatic cancer using data from the 2005-2019 American College of Surgeons National Surgical Quality Improvement Program.

Survival of Locally Advanced MSI-high Gastric Cancer Patients Treated With Perioperative Chemotherapy: A Retrospective Cohort Study.

Objective: To evaluate the efficacy of chemotherapy in patients with microsatellite instability (MSI)-high gastric cancer.

Background: Although MSI-high gastric cancer is associated with a superior prognosis, recent studies question the benefit of perioperative chemotherapy in this population.

Methods: Locally advanced gastric adenocarcinoma patients who either underwent surgery alone or also received neoadjuvant, perioperative, or adjuvant chemotherapy between 2000 and 2018 were eligible.

Model Development of a Novel Robotic Surgery Training Exercise With Electrocautery.

Robot-assisted surgery (RAS) has undergone rapid adoption in general surgery due to features such as three-dimensional visualization, wrist dexterity, improved precision of movement, and operator ergonomics. While many surgical trainees encounter RAS during their residency, robotic skills training programs and curricula vary across institutions and there is broad variation in graduating general surgeons' robotic proficiency levels. Due to a need for a formalized process to achieve competence on the robotic platform, simulation-based training has become instrumental in closing this gap as it provides training in a low-stakes environment while allowing the trainee to improve their psychomotor and basic procedural skills.

Anaplastic Lymphoma Kinase Positive Mesenteric Inflammatory Myofibroblastic Tumor in Adult Woman.

Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal neoplasms containing spindle cells and inflammatory components that can be locally aggressive. They have unclear biological behavior and may recur after resection. A 31-year-old woman presented with three months of cough, fatigue, weight loss, abdominal pain, anemia, and elevated inflammatory markers.

Downstaging of Pancreatic Adenocarcinoma With Either Neoadjuvant Chemotherapy or Chemoradiotherapy Improves Survival.

Background: Neoadjuvant chemotherapy (NAC) or chemoradiation (NAC+XRT) is incorporated into the treatment of localized pancreatic adenocarcinoma (PDAC), often with the goal of downstaging before resection. However, the effect of downstaging on overall survival, particularly the differential effects of NAC and NAC+XRT, remains undefined. This study examined the impact of downstaging from NAC and NAC+XRT on overall survival.

Near Complete Pathologic Response to PD-1 Inhibitor and Radiotherapy in a Patient with Locally Advanced Pancreatic Ductal Adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) remains deadly despite advances in systemic therapies and surgical techniques. While there is increasing utilization of immune therapies across diverse cancer types, PDAC remains generally resistant to these treatments. We report a case of locally advanced PDAC treated with preoperative radiation and anti-PD-1 immunotherapy guided by preoperative PD-L1 tumor analysis.

Proclivity to Explore Locally Advanced Pancreas Cancer Is Not Associated with Surgeon Volume.

Background And Purpose: There is limited high-level evidence to guide locally advanced pancreas cancer (LAPC) management. Recent work shows that surgeons' preferences in LAPC management vary broadly. We sought to examine whether surgeon volume was associated with attitudes regarding LAPC management.

Association of gravity drainage and complications following Whipple: an analysis of the ACS-NSQIP targeted database.

Background: The optimal type of operative drainage following pancreaticoduodenectomy (PD) remains unclear. Our objective is to investigate risk associated with closed drainage techniques (passive [gravity] vs. suction) after PD.

Neoadjuvant Therapy for Pancreatic Ductal Adenocarcinoma: Propensity-Matched Analysis of Postoperative Complications Using ACS-NSQIP.

Background: The use of neoadjuvant therapy (NAT) for pancreatic ductal adenocarcinoma (PDAC) is increasing. While there is an association between NAT and improved post-pancreatectomy complication rates in limited patient populations, the strength of the relationship and its applicability to a broader and modern pancreatectomy cohort remains unclear.

Methods: We used the 2014-2018 American College of Surgeons National Surgical Quality Improvement Project to evaluate NAT use for PDAC patients undergoing pancreatectomy.

Management of Locally Advanced Pancreatic Cancer: Results of an International Survey of Current Practice.

Objective: The aim of this study was to investigate surgeon preferences for the management of patients with locally advanced pancreatic cancer (LAPC).

Background: Select patients with LAPC may become candidates for curative resection following neoadjuvant therapy, and recent reports of survival are encouraging. Yet the optimal management approach remains unclear.

Gallbladder cancer: surgical management.

Gallbladder cancer is the most common biliary tract malignancy. Margin-clearing surgery is a cornerstone of gallbladder cancer management, but several aspects of surgical management are controversial. This review will discuss the current state of surgical management for gallbladder cancer as well as aspects of gallbladder surgery that remain debated, including operative extent, lymphadenectomy extent, and management of incidentally discovered gallbladder cancer.

Treatment sequencing for simultaneous colorectal liver metastases.

Up to 25% of patients with colorectal cancer present with simultaneous metastases and the liver is frequently the only metastatic site. This review will review treatment sequence planning considerations-including metastatic burden, primary tumor site, chemotherapy response, and ability to perform minimally invasive surgery-for patients with simultaneous resectable colorectal liver metastases. In addition, this review will address conversion chemotherapy, combined vs staged surgeries, and their possible sequences.

Insurance Status and Hospital Payer Mix Are Linked With Variation in Metastatic Site Resection in Patients With Advanced Colorectal Cancers.

Background: Despite substantially improved survival with metastatic site resection in colorectal cancers, uptake of aggressive surgical approaches remains low among certain patients. It is unknown whether financial determinants of care, such as insurance status, play a role in this treatment gap.

Objective: We sought to evaluate the effect of insurance status on metastasectomy in patients with advanced colorectal cancers.

Variation in primary site resection practices for advanced colon cancer: a study using the National Cancer Data Base.

Background: Treatment of metastatic colon cancer may be driven as much by practice patterns as by features of disease. To optimize management, there is a need to better understand what is determining primary site resection use.

Methods: We evaluated all patients with stage IV cancers in the National Cancer Data Base from 2002 to 2012 (50,791 patients, 1,230 hospitals).

Abdominal pain and faeculent vomiting in a 64-year-old woman.

A 64-year-old woman with a previous right colectomy presented with severe epigastric abdominal pain and nausea of several weeks' duration, which then escalated to projectile faeculent emesis. During her clinical course, she remained afebrile with normal vital signs. Physical examination revealed abdominal distension, moderate tenderness in the bilateral upper quadrants and provoked voluntary abdominal wall guarding.