Practicing Surgeons' Perception of Barriers to Palliative Care Delivery in British Columbia.

Background: Utilization of palliative care remains low among surgical patients. We aim to characterize general surgeons' perceptions of barriers to access palliative care in British Columbia (BC).

Methods: Semi-structured interviews were carried out with a total of 11 surgeons in BC.

Knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy among surgeons: a scoping review.

Background: The rapid evolution of genetic technologies and utilization of genetic information for clinical decision-making has necessitated increased surgeon participation in genetic counselling, testing, and appropriate referral of patients for genetic services, without formal training in genetics. We performed a scoping review to describe surgeons' knowledge, perceptions, attitudes, and barriers pertaining to genetic literacy in the management of patients who had confirmed cancer or who were potentially genetically at risk.

Methods: We conducted a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews checklist.

Advances in the Surgical Treatment of Breast Cancer.

Breast cancer is the most commonly occurring cancer in women and has become the most common cancer diagnosed worldwide [...

Bone health after RRBSO among mutation carriers: a population-based study.

Objective: Examine the risks of fractures and osteoporosis after risk-reducing bilateral salpingo-oophorectomy (RRBSO) among women with mutations.

Methods: In this retrospective population-based study in British Columbia, Canada, between 1996 to 2017, we compared risks of osteoporosis and fractures among women with mutations who underwent RRBSO before the age of 50 (n=329) with two age-matched groups without known mutations: 1) women who underwent bilateral oophorectomy (BO) (n=3,290); 2) women with intact ovaries who had hysterectomy or salpingectomy (n=3,290). Secondary outcomes were: having dual-energy X-ray absorptiometry (DEXA) scan, and bisphosphonates use.

Risk of cardiovascular disease among women carrying BRCA mutations after risk-reducing bilateral salpingo-oophorectomy: A population-based study.

Objective: Examine the risk of cardiovascular disease (CVD) following risk reducing bilateral salpingo-oophorectomy (RRBSO) among women with BRCA mutations.

Methods: In this retrospective population-based study in British Columbia, Canada, between 1996 and 2017, we compared the risk of CVD among women with known BRCA mutations who underwent RRBSO before the age of 50 (n = 360) with two groups of age-matched women without known BRCA mutations: 1) women who underwent bilateral oophorectomy (BO) for benign conditions (n = 3600); and, 2) women with intact ovaries who had hysterectomy or salpingectomy (n = 3600). Our primary outcome was CVD (a composite (any of) myocardial infarction, heart failure, and/or cerebrovascular disease).

Sentinel Node Biopsy Should Not be Routine in Older Patients with ER-Positive HER2-Negative Breast Cancer Who Are Willing and Able to Take Hormone Therapy.

Background: The SSO Choosing Wisely campaign recommended selective sentinel lymph node biopsy (SLNB) in clinically node-negative women aged ≥ 70 years with ER+ breast cancer. We sought to assess the association of SLNB positivity, adjuvant treatment, and survival in a population-based cohort.

Patients And Methods: Women aged ≥ 70 years treated for ER+ HER2- breast cancer between 2010 and 2016 were identified in our prospective provincial database.

Prophylactic Surgery in the BRCA+ Patient: Do Women Develop Breast Cancer While Waiting?

Breast cancer susceptibility gene (BRCA) mutation carriers have an increased risk of breast cancer. Mitigation of this risk can be achieved via surveillance or prophylactic mastectomy with or without breast reconstruction. Those that choose surgery expect to reduce their chance of developing cancer.

Do surgeons convey all the details? A provincial assessment of operative reporting for breast cancer.

Introduction: A breast cancer synoptic operative report was developed using a modified Delphi process METHODS: Data from the British Columbia Cancer Breast Cancer Outcomes Unit (BCOU) was used to analyze the association between the completion of a synoptic operative report and reporting of operative details and The American Society of Breast Surgeons quality indicators.

Results: 3662 patients had surgery for breast cancer by 185 surgeons. 2281 reports were narrative and 1007 synoptic.

Practice referral patterns and outcomes in patients with primary retroperitoneal sarcoma in British Columbia.

Background: We examined practice referral patterns for primary retroperitoneal sarcoma (PRS) in British Columbia (BC) and associations between the timing of referral to tertiary care and patient outcomes.

Methods: Using ICD-10 coding, the Cancer Agency Information System was used to identify patients with PRS from 2000 to 2009 who had been referred to tertiary care and had undergone a surgical resection.

Results: Eighty-two patients were included.

Effect of systematic education courses on rectal cancer treatments in a population.

Purpose: In a strategy aimed to improve perioperative and operative management of rectal cancer in British Columbia (BC), a series of educational events were provided for BC surgeons, radiation oncologists, and pathologists including teaching on the use of preoperative radiation, surgical technique with total mesorectal excision (TME), and pathology reporting. Seminars were offered during 2002 and 2003 each over 2 days with documented attendance from 30 hospitals in the province. We wished to determine whether frequency of preoperative radiation and TME surgery changed on a population level after the rectal cancer education courses in 2002 and 2003.

Effects of change in rectal cancer management on outcomes in British Columbia.

Background: In a province-wide audit of patients undergoing treatment for rectal cancer in British Columbia in 1996, the 4-year rate of pelvic recurrence for stage 3 rectal cancer was 27%. The management guidelines were changed in 2002 to include adjuvant short-course preoperative radiation and total mesorectal excision surgical techniques. Education workshops were held to implement the protocol change.

Evaluating learning and knowledge retention after a continuing medical education course on total mesorectal excision for surgeons.

The purpose of this study was to determine whether knowledge gained (as determined by a formal course test) by surgeons in a continuing education course on total mesorectal excision and rectal cancer management is retained 1 year later. A formal course test had been previously developed and validated. The test evaluated course content including pelvic anatomy, surgical techniques, imaging, pathology, adjuvant therapies, and cancer and functional outcomes.

Self-assessment during a 2-day laparoscopic colectomy course: can surgeons judge how well they are learning new skills?

Background: The objectives of this study were to (1) establish the utility of an assessment tool for participants in a laparoscopic colectomy course and (2) to determine the accuracy of technical skill self-assessment in this group.

Methods: Twenty-two surgeons enrolled in a 2-day course participated. During the animal laboratory, each participant's operative performance was videotaped.

Can cytology accurately predict benign follicular nodules?

Background: The reliability of fine-needle aspiration (FNA) biopsy in differentiating benign from malignant follicular lesions of the thyroid has been the subject of renewed debate recently. Although surgical excision has been recommended for most follicular lesions identified by cytology, this approach may not be necessary in all cases. The goal of this study was to determine whether FNA could be used as a diagnostic tool to safely identify patients with follicular thyroid nodules who do not require immediate surgical intervention.

Effect of emergent presentation on outcome from rectal cancer management.

Background: We have previously reported outcomes for all rectal cancers in BC in 1996. We found that our local recurrence rates and survival were suboptimal relative to current standards in recent literature.

Methods: In this retrospective, population-based study, we report the influence of emergent presentation (obstruction, perforation, massive hemorrhage) on outcomes, types of surgical procedures and use of staging investigations, and use of adjuvant radiation and chemotherapy.

Effects of positive resection margin and tumor distance from anus on rectal cancer treatment outcomes.

Purpose: Rectal cancer outcome depends on stage, technical aspects of surgical excision, and use of adjuvant chemoradiation. Here, we examine effects of positive resection margin and tumor distance from the anus in stage 2 and 3 cancers on 4-year disease-specific survival and recurrence.

Methods: We reviewed all 495 rectal cancer patients registered in British Columbia in 1996.