Archives of Surgery

Journal Information
ISSN / EISSN : 0272-5533 / 1538-3644
Published by: Rockefeller University Press (10.1001)
Total articles ≅ 23,907
Current Coverage
MEDICUS
MEDLINE
PUBMED
Archived in
SHERPA/ROMEO
Filter:

Latest articles in this journal

, Gianpiero Gravante, Neville Dastur, Roberto Sorge, Jay N. L. Simson
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1093-1100; https://doi.org/10.1001/archsurg.2012.1954

Abstract:
Transanal endoscopic microsurgery (TEMS) is a minimally invasive technique for local excision of some rectal adenomas and other lesions not amenable to traditional endoscopic resection. It was first described by Buess et al1 in 1984 and since then has gained popularity in view of its safety and ability to provide intact full-thickness specimens with low R1 resection and recurrence rates.2-5 However, there is some debate as to the best technique for excision of large (>3 cm), and particularly giant, rectal adenomas in view of the increased risk for occult malignancy in large adenomas5-9 combined with the significant incidence of R1 resections for traditional peranal techniques and piecemeal resection for endoscopic techniques such as endoscopic mucosal resection (EMR) in these lesions.7,10-13
, Loriel Liwanag, Madhulika Varma
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1123-1129; https://doi.org/10.1001/archsurg.2012.1144

Abstract:
Pelvic floor disorders (PFDs) manifested as fecal incontinence or constipation have a profound effect on women's activity and quality of life. Evidence suggests that the prevalence for each PFD is as high as 25%.1,2 In general, fecal incontinence is defined as the accidental loss of stool, whereas constipation refers to infrequent and difficult bowel movements. Specialists evaluating either disorder rely on physiologic assessments of the rectum and anus to determine the pathologic origin and offer proper treatment.3-6 Regardless of the cause, initial management consists of dietary and noninvasive medical management, the success of which partially depends on patient motivation and compliance.7 When first-line treatment fails, other therapies are directed toward mending altered anatomy or physiology using surgery and biofeedback.7-9
David E. Gyorki, Arturo Muyco, , ,
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1135-1140; https://doi.org/10.1001/archsurg.2012.1265

Abstract:
The global burden of cancer is increasingly borne by patients in the developing world. The International Agency for Research on Cancer predicts that by 2030, the global burden of cancer will reach 21.4 million and the annual number of cancer deaths worldwide will reach 13.2 million.1 The World Health Organization (WHO) predicts that by 2020, approximately 60% of all new cancer cases will occur in the least developed nations.2
Daniel Shouhed, Bruce Gewertz, Doug Wiegmann,
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1141-1146; https://doi.org/10.1001/jamasurg.2013.596

Abstract:
Objective To provide a review of human factors research within the context of surgery. Data Sources We searched PubMed for relevant studies published from the earliest available date through February 29, 2012. Study Selection The search was performed using the following keywords: human factors, surgery, errors, teamwork, communication, stress, disruptions, interventions, checklists, briefings, and training. Additional articles were identified by a manual search of the references from the key articles. As 2 human factors specialists, a senior clinician, and a junior clinician, we carefully selected the most appropriate exemplars of research findings with specific relevance to surgical error and safety. Data Extraction Seventy-seven articles of relevance were selected and reviewed in detail. Opinion pieces and editorials were disregarded; the focus was solely on articles based on empirical evidence, with a particular emphasis on prospectively designed studies. Data Synthesis The themes that emerged related to the development of human factors theories, the application of those theories within surgery, a specific interest in the concept of flow, and the theoretical basis and value of human-related interventions for improving safety and flow in surgery. Conclusions Despite increased awareness of safety, errors routinely continue to occur in surgical care. Disruptions in the flow of an operation, such as teamwork and communication failures, contribute significantly to such adverse events. While it is apparent that some incidence of human error is unavoidable, there is much evidence in medicine and other fields that systems can be better designed to prevent or detect errors before a patient is harmed. The complexity of factors leading to surgical errors requires collaborations between surgeons and human factors experts to carry out the proper prospective and observational studies. Only when we are guided by this valid and real-world data can useful interventions be identified and implemented.
Comment
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1122-1122; https://doi.org/10.1001/archsurg.2012.1499

Abstract:
Opinion from JAMA Surgery — Considerations Regarding Technology and Transplant Evaluations Comment on “Evaluation of Potential Renal Transplant Recipients With Computed Tomography Angiography”
Richard W. Holt, Stephen R. T. Evans
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1074-1076; https://doi.org/10.1001/archsurg.2012.2281

Abstract:
Opinion from JAMA Surgery — History and Heritage of the Department of Surgery, Georgetown University
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1107-13; https://doi.org/10.1001/archsurg.2012.1962

Abstract:
OBJECTIVES To examine the outcomes of a hepatectomy for intrahepatic cholangiocarcinoma (IHC) and to clarify the prognostic impact of a lymphadenectomy and the surgical margin. Large series of patients who were surgically treated for IHC are scarce. Thus, prognostic factors and long-term survival after resection of IHC remain uncertain. DESIGN Prospective study of patients who were surgically treated for IHC. Clinicopathologic, operative, and long-term survival data were analyzed. SETTING Prospectively collected data of all consecutive patients with pathologically confirmed IHC who had undergone liver resection with a curative intent at 1 of 16 tertiary referral centers were entered into a multi-institutional registry. PATIENTS All consecutive patients who underwent a hepatectomy with a curative intent for IHC (1990-2008) were identified from a multi-institutional registry. RESULTS A total of 434 patients were included in the analysis. Most patients underwent a major or extended hepatectomy (70.0%) and a systematic lymphadenectomy (62.2%). The incidence of lymph node metastases (overall, 36.9%) increased with increased tumor size, with 24.4% of patients with a small IHC (diameter ≤3 cm) having N1 disease. Almost one-third of patients required an additional major procedure to obtain a R0 resection in 84.6% of the cases. In these patients, the median time of survival was 39 months, and the 5-year survival rate was 39.8%. Lymph node metastases (hazard ratio, 2.21; P < .001), multiple tumors (hazard ratio, 1.50; P = .009), and an elevated preoperative cancer antigen 19.9 level (hazard ratio, 1.62; P = .006) independently predicted an adverse prognosis. Conversely, survival was not influenced by the width of a negative resection margin (P = .61). The potential survival benefit of a lymphadenectomy was assessed with the therapeutic value index, which was calculated to be 5.9 points. CONCLUSIONS Survival rates after a hepatectomy with a curative intent for IHC at tertiary referral centers exceed the survival rates reported in most study series in single institutions, which strengthens the value of an aggressive approach to radical resection. Lymph node metastases and multiple tumors are associated with decreased survival rates, but they should not be considered selection criteria that prevent other patients from undergoing a potentially curative resection. Lymphadenectomy should be considered for all patients
Timothy M. Pawlik, Jean-Nicolas Vauthey
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1092-1092; https://doi.org/10.1001/archsurg.2012.1874

Abstract:
We read with great interest the study by Viganò et al1 regarding the use of preoperative biopsy to evaluate chemotherapy-associated liver injuries (CALIs). With the increasing use of preoperative chemotherapy, concern has grown that CALIs may be more prevalent and, in turn, adversely affect perioperative outcomes. Our group2 has previously shown that patients who undergo a major hepatic resection in the setting of steatohepatitis are at risk for increased perioperative mortality. Other studies, however, found no association between simple steatosis or sinusoidal dilatation and outcome.3,4 The prospective trial by the European Organisation for the Research and Treatment of Cancer examined the use of perioperative chemotherapy and found a small increase in perioperative complications in the treatment arm but no difference in mortality.5
Jonathan Koea
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1084-1084; https://doi.org/10.1001/archsurg.2012.1959

Abstract:
By their own admission, the article by Cairns et al1 will not change current clinical practice but it starkly focuses the issues surrounding the management of gallbladder polyps. More than half of ultrasonographically detected polypoid gallbladder masses are not adenomatous polyps but benign lesions such as cholesterol deposits or gallstones with no malignant potential. Even among adenomatous polyps, the rate of malignant change is unclear. This uncertainty is reflected in referral patterns where nearly 50% of all polyps in their series were neither discussed at a multidisciplinary meeting, referred for hepatobiliary specialist review, or even followed up. Only 7% of polyps that were followed up increased in size. Only 4% of resected polyps were potentially malignant or cancerous.
Kensuke Adachi, Tomohito Minami
Published: 1 December 2012
Archives of Surgery, Volume 147, pp 1147-1147; https://doi.org/10.1001/archsurg.2011.2032a

Back to Top Top