Essential articles: Surgical oncology

Emory users, open this instance of PubMed, then click the links below for full-text article access.

Abdominal (Malignant):

Al-Batran SE, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial Lancet. 2019 May 11;393(10184):1948-1957. doi: 10.1016/S0140-6736(18)32557-1.   

Shapiro J, et al. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial Lancet Oncol. 2015 Sep;16(9):1090-1098. doi: 10.1016/S1470-2045(15)00040-6.   

Degiuli M, et al. Randomized clinical trial comparing survival after D1 or D2 gastrectomy for gastric cancer Br J Surg. 2014 Jan;101(2):23-31. doi: 10.1002/bjs.9345. 

Bang YJ, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial Lancet. 2010 Aug 28;376(9742):687-97. doi: 10.1016/S0140-6736(10)61121-X.   

Continue reading

Essential articles: Colorectal

Emory users, open this instance of PubMed, then click the links below for full-text article access.

Anal fistulas:

Sugrue J, et al. Sphincter-Sparing Anal Fistula Repair: Are We Getting Better? Dis Colon Rectum. 2017 Oct;60(10):1071-1077. doi: 10.1097/DCR.0000000000000885. 

Vogel JD, et al. Clinical Practice Guideline for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula Dis Colon Rectum. 2016 Dec;59(12):1117-1133. doi: 10.1097/DCR.0000000000000733. 

Sirany AM, et al. The ligation of the intersphincteric fistula tract procedure for anal fistula: a mixed bag of results Dis Colon Rectum. 2015 Jun;58(6):604-12. doi: 10.1097/DCR.0000000000000374. 

Continue reading

Essential articles: Critical Care

Emory users, open this instance of PubMed, then click the links below for full-text article access.

Chabot E, et al. Open abdomen critical care management principles: resuscitation, fluid balance, nutrition, and ventilator management Trauma Surg Acute Care Open. 2017 Sep 3;2(1):e000063. doi: 10.1136/tsaco-2016-000063. 

Brown RM, et al. Balanced Crystalloids versus Saline in Sepsis. A Secondary Analysis of the SMART Clinical Trial Am J Respir Crit Care Med. 2019 Dec 15;200(12):1487-1495. doi: 10.1164/rccm.201903-0557OC. 

Essential articles: Endocrine

Emory users, open this instance of PubMed, then click the links below for full-text article access.

Adrenal:

Mpaili E, et al. Laparoscopic Versus Open Adrenalectomy for Localized/Locally Advanced Primary Adrenocortical Carcinoma (ENSAT I-III) in Adults: Is Margin-Free Resection the Key Surgical Factor that Dictates Outcome? A Review of the Literature J Laparoendosc Adv Surg Tech A. 2018 Apr;28(4):408-414. doi: 10.1089/lap.2017.0546.  

Birsen O, et al. A new risk stratification algorithm for the management of patients with adrenal incidentalomas Surgery. 2014 Oct;156(4):959-65. doi: 10.1016/j.surg.2014.06.042. 

Zeiger MA, et al. The American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons medical guidelines for the management of adrenal incidentalomas Endocr Pract. 2009 Jul-Aug;15 Suppl 1:1-20. doi: 10.4158/EP.15.S1.1. 

Continue reading

Should VICRYL mesh be used routinely during abdominal wall closure?

No. Because of its properties, it will render an abdomen impossible to re-enter for a minimum of 3 months. Should you have a need to reenter the abdomen within the ten-day window that surgeons have traditionally considered safe for abdominal re-entry, placement of VICRYL® mesh will render the abdomen ‘hostile’ for a minimum of three months.

Continue reading

Article of interest: Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery

Messias BA, et al. Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery. Sci Rep. 2020 Feb 3;10(1):1687.

Abstract: Anastomotic leakage is a complication of colorectal surgery. C-reactive protein (CRP) is an acute-phase marker that can indicate surgical complications. We determined whether serum CRP levels in patients who had undergone colorectal surgery can be used to exclude the presence of anastomotic leakage and allow safe early discharge. We included 90 patients who underwent colorectal surgery with primary anastomosis. Serum CRP levels were measured retrospectively on postoperative days (PODs) 1 – 7. Patients with anastomotic leakage (n = 11) were compared to those without leakage (n = 79). We statistically analysed data and plotted receiver operating characteristic curves. The incidence of anastomotic leakage was 12.2%. Diagnoses were made on PODs 3 – 24. The overall mortality rate was 3.3% (18.2% in the leakage group, 1.3% in the non-leakage group; P < 0.045). CRP levels were most accurate on POD 4, with a cutoff level of 180 mg/L, showing an area under the curve of 0.821 and a negative predictive value of 97.2%. Lower CRP levels after POD 2 and levels <180 mg/L on POD 4 may indicate the absence of anastomotic leakage and may allow safe discharge of patients who had undergone colorectal surgery with primary anastomosis.

Continue reading

Article of interest: Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction

Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012 Nov;204(5):709-16.

Full-text for Emory users.

Background: Several modifications of the classic retromuscular Stoppa technique to facilitate dissection beyond the lateral border of the rectus sheath recently were reported. We describe a novel technique of transversus abdominis muscle release (TAR) for posterior component separation during major abdominal wall reconstructions.

Methods: Retrospective review of consecutive patients undergoing TAR. Briefly, the retromuscular space is developed laterally to the edge of the rectus sheath. The posterior rectus sheath is incised 0.5-1 cm underlying medial to the linea semilunaris to expose the medial edge of the transversus abdominis muscle. The muscle then is divided, allowing entrance to the space anterior to the transversalis fascia. The posterior rectus fascia then is advanced medially. The mesh is placed as a sublay and the linea alba is restored ventral to the mesh.

Continue reading