Systematic review of long-term effectiveness of endoscopic gastrojejunostomy in patients presenting with gastric outlet obstruction from periampullary malignancies.

Background: Recently, endoscopic ultrasound-guided (EUS) gastrojejunostomy (GJ) has emerged as an alternative option to surgical palliation and endoscopic duodenal stenting for malignant gastric outlet obstruction (GOO). Although early success rates are commonly reported with the technique, there is a paucity of data regarding the long-term efficacy of this approach. In this study, we investigated long-term outcomes in patients that underwent EUS-guided GJ for palliation of periampullary malignancies.

Comparison between transpapillary versus transmural endoscopic ultrasound-guided decompression for biliary obstruction: a meta-analysis.

Background: Recent advances have led to the development of transmural endoscopic ultrasound guided biliary drainage (EUS-BD) for cases where the duodenal papilla cannot be accessed.

Objectives: We performed a meta-analysis comparing efficacy and complications of both approaches for biliary drainage.

Review Methods: English articles were searched in PubMed.

Benefits of EUS-guided gastroenterostomy over surgical gastrojejunostomy in the palliation of malignant gastric outlet obstruction: a large multicenter experience.

Background And Aims: Palliation of malignant gastric outlet obstruction (mGOO) allows resumption of peroral intake. Although surgical gastrojejunostomy (SGJ) provides durable relief, it may be associated with a higher morbidity, interfere with chemotherapy, and require an optimum nutritional status. EUS-guided gastroenterostomy (EUS-GE) has emerged as a minimally invasive alternative.

Clinical and Financial Implications of Consulting Physicians in the Management of Surgical Patients.

Background: The present study was designed to evaluate the immediate consequences that the number of consulting physicians has on length of stay (LOS), in-hospital mortality, 30-day readmission rates, direct health care costs, and contribution margins.

Methods: A retrospective review of administrative databases for the years 2013 and 2014 was performed at the Florida Hospital Adventist Healthcare System.

Results: 11 274 patients were included in the analysis.

Early experience with the Senhance®-laparoscopic/robotic platform in the US.

The introduction of new robotic platforms will grow considerably in the near future as several manufacturers are in the developing stages of different innovative systems. One of the newest systems, the Senhance® platform (TransEnterix Surgical Inc., Morrisville, NC, USA) has been utilized in a variety of cases in Europe but only recently approved for limited clinical use in the United States.

T1R2 receptor-mediated glucose sensing in the upper intestine potentiates glucose absorption through activation of local regulatory pathways.

Objective: Beyond the taste buds, sweet taste receptors (STRs; T1R2/T1R3) are also expressed on enteroendocrine cells, where they regulate gut peptide secretion but their regulatory function within the intestine is largely unknown.

Methods: Using T1R2-knock out (KO) mice we evaluated the role of STRs in the regulation of glucose absorption in vivo and in intact intestinal preparations ex vivo.

Results: STR signaling enhances the rate of intestinal glucose absorption specifically in response to the ingestion of a glucose-rich meal.

Age as a prognostic indicator for adjuvant therapy in patients who underwent pancreatic resections for cancer.

Purpose: In pancreatic cancer, the greatest increase in survival is attained by surgical resection followed by adjuvant chemotherapy. Although surgical complications and functional status are recognized as independent factors for halting adjuvant therapy in patients that undergo pancreatic resections, other elements may play a role in deciding which patients get treated postoperatively. Here we determined demographic and clinical characteristics of patients receiving adjuvant chemotherapy, with the primary intent to investigate if age alone affects rates of adjuvant therapy.

Vagotomy/drainage is superior to local oversew in patients who require emergency surgery for bleeding peptic ulcers.

Objective: To compare early postoperative outcomes of patients undergoing different types of emergency procedures for bleeding or perforated gastroduodenal ulcers.

Background: Although definitive acid-reducing procedures are being used less frequently during emergency ulcer surgery, there is little published data to support this change in practice.

Methods: A retrospective analysis of data for patients from the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program database who underwent emergency operation for bleeding or perforated peptic ulcer disease was performed to determine the association between surgical approach (local procedure alone, vagotomy/drainage, or vagotomy/gastric resection) and 30-day postoperative outcomes.

Beyond cytology: why and when does the oncologist require core tissue?

There are 2 main reasons why oncologists may require additional tissue and a histologic section in addition to cytopathology from FNA specimens: improved diagnostic accuracy and molecular characterization of tumors. Rather than mutually exclusive diagnostic procedures, EUS-FNA and EUS-CNB must be viewed as supplementary techniques and both approaches should be incorporated as essential tools in the current endoscopic armamentarium.

Recent developments in surgery: minimally invasive approaches for patients requiring pancreaticoduodenectomy.

Over the past decade, minimally invasive surgery has been introduced as a means to allow manipulation of delicate tissues with outstanding visualization of the surgical field. The purpose of this article is to review the available literature regarding early postoperative outcomes and the technical challenges of minimally invasive pancreaticoduodenectomy, including robotic techniques. Herein, we provide a retrospective review of all published studies in the English literature in which a minimally invasive pancreaticoduodenectomy was performed.

Functional status determines postoperative outcomes in elderly patients undergoing hepatic resections.

Background: With the aging population and increasing incidence of hepatic malignancies in elderly patients, establishing the safety of hepatic resections is crucial. The present study investigates early postoperative morbidity and mortality in elderly patients undergoing hepatic resection using a nationally validated database.

Methods: The National Surgical Quality Improvement Program Participant User Files (NSQIP-PUF) for 2005-2009 were used for the retrospective analysis of all patients undergoing hepatic resection.

Initial experience from a large referral center with robotic-assisted Ivor Lewis esophagogastrectomy for oncologic purposes.

Background: We report our initial experience of patients undergoing robotic-assisted Ivor Lewis esophagogastrectomy (RAIL) for oncologic purposes at a large-referral center.

Methods: A retrospective review of all consecutive patients undergoing RAIL from 2010-2011 was performed. Basic demographics were recorded.

A comparison between patients with gastrointestinal stromal tumours diagnosed with isolated liver metastases and liver metastases plus sarcomatosis.

Objectives: This study was conducted to compare overall survival (OS) in patients presenting with isolated hepatic metastases with that of patients with synchronous metastatic disease to the liver and sarcomatosis on a background of gastrointestinal stromal tumours (GISTs).

Methods: Patients presenting with metastatic GISTs during 1999-2009 were identified. Survival outcomes were compared between groups.

Primary pancreatic Ewing's sarcoma with portal vein tumor thrombosis.

Background: Extraosseous Ewing's sarcoma (EES) is a mesenchyme-derived small blue cell tumor, which is distinguished by its rarity, aggressiveness, dismal prognosis, and distinct pathogenesis. Occurring almost exclusively among children and young adults, EES can arise from a variety of organs and portends a rapid clinical deterioration and high likelihood of recurrence.

Discussion: We present the first reported case of a primary pancreatic Ewing's sarcoma in a patient with concomitant portal vein thrombosis.

The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database.

Background: Several single-center reports suggest that vascular resection (VR) during pancreaticoduodenectomy (PD) for patients with pancreatic adenocarcinoma is feasible without affecting early postoperative mortality or morbidity. Our objective is to review the outcomes associated with VR during PD using a large multicenter data source.

Methods: A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009.

Ex vivo evaluation of preoperatively treated rectal cancer specimens of patients undergoing radical resection.

Background: Previous reports have suggested that a subset of patients with advanced rectal cancer that demonstrate minimal or no residual disease after neoadjuvant treatment may either be followed closely or may undergo local resection. We prospectively evaluated ex vivo local excision specimens of patients undergoing radical resection after preoperative chemoradiation.

Methods: Patients with newly diagnosed rectal cancer received preoperative chemoradiotherapy followed by total mesorectal excision.

Pre- and intraoperative variables affecting early outcomes in elderly patients undergoing pancreaticoduodenectomy.

Background: Conflicting data exist regarding the safety of pancreatic resections in elderly patients. In this study we compared early complication and mortality rates between patients younger and older than 80 years of age who underwent pancreaticoduodenectomy using a validated national database.

Methods: The National Surgical Quality Improvement Program (NSQIP) database for 2005-2009 was used for this retrospective analysis.

Does protected research time during general surgery training contribute to graduates' career choice?

A number of general surgery training programs offer a dedicated research experience during the training period. There is much debate over the importance of these experiences with the added constraints placed on training surgeons including length of training, Accreditation Council of Graduate Medical Education limitations, and financial barriers. We seek to quantify the impact of a protected research experience on graduates of a university-affiliated general surgery training program.

Evaluation of peri-operative chemotherapy using a prognostic nomogram for survival after resection of colorectal liver metastases.

Introduction: Nomograms are statistical tools designed to predict outcomes. This study evaluates the effects of peri-operative chemotherapy on the accuracy of a prognostic nomogram for disease-specific survival (DSS) after resection of colorectal liver metastases (CRLM) established at Memorial-Sloan Kettering Cancer Center (MSKCC).

Methods: An external cohort of 203 patients who underwent resection of CRLM between 1996 and 2006 was used to assess the nomogram.

Incidence of benign disease in patients that underwent resection for presumed pancreatic cancer diagnosed by endoscopic ultrasonography (EUS) and fine-needle aspiration (FNA).

Introduction: The lack of accurate markers makes preoperative differentiation between pancreatic cancer and non-malignant head lesions clinically challenging. In this study, we investigated the incidence of benign disease in patients that underwent resection for presumed pancreatic cancer diagnosed by EUS and EUS-guided FNA.

Methods: Medical records of consecutive patients who underwent pancreaticoduodenectomy at Duke University were reviewed.

Defining criteria for selective operative management of pancreatic cystic lesions: does size really matter?

Introduction: Proposed criteria for resection of pancreatic cystic lesions have included symptoms, size (>3 cm), and suspicious features by endoscopic ultrasound (EUS). The objective of this study was to evaluate risk factors for malignancy in a large series of patients undergoing resection of suspected pancreatic cystic neoplasms.

Methods: Medical records of patients selected for resection of pancreatic cystic lesions at Duke University Medical Center from 2000 to 2008 were reviewed.

Neoadjuvant chemoradiation for rectal cancer reduces lymph node harvest in proctectomy specimens.

Purpose: The purpose of this study was to compare the number of lymph nodes retrieved following proctectomy for rectal cancer in patients either receiving no neoadjuvant therapy versus those treated with standard preoperative chemoradiation.

Methods: A retrospective review was performed of all consecutive patients that underwent proctectomy for rectal cancer from 1997-2006. Specimens from patients that received neoadjuvant therapy were compared to patients that did not receive preoperative chemoradiation.