This is a phase II, single-center, single-arm study of patients with resectable adenocarcinoma of the pancreas who were treated with adjuvant interferon-based chemoradiation followed by gemcitabine.

Relationships between hospital characteristics and patient outcomes have been described for various diseases. We show increased use of multimodality therapy, including breast-conserving surgery, and improved overall survival for patients with breast cancer treated at teaching hospitals. Quality improvement measures to improve use of chemotherapy and other adjuvant therapies are needed to improve outcomes for community hospital-treated breast cancer.

This article reviews whether skills acquired through simulation training transfer to the operative setting. Study results suggest that trainees who had simulation-based training performed patient-based procedures better than controls, in some but not all measured parameters. More evidence is required to determine the extent to which simulation should become a part of training.

Familiarity with clinical trials' potential biases helps surgeons assess research's credibility and applicability. This article helps surgeons identify and correct for bias when interpreting a trial, and avoid it when designing and conducting a trial. It suggests areas for future exploration to help improve surgical research's internal and external validity.

The integration of unimodality evidence-based perioperative care principles into a multimodal fast-track rehabilitation program is now well documented to accelerate postoperative recovery and decrease hospital stay. Therefore, this multidisciplinary effort should be more widely adopted.

Cervical pharyngostomy tubes are percutaneously placed through the hypopharynx and directed into the stomach or small bowel. They may be used for long-term gastric decompression or enteral nutrition, and are especially useful in patients who have undergone esophagectomy or gastric surgery.

The current study investigated whether standard methods of consenting can be improved using a multimedia-based program. In a prospective, multicenter study, 80 patients were given questionnaires before cholecystectomy to assess the effectiveness of the informed consent process. Use of the multimedia program significantly improved patients' self-reported understanding of disease.

The aim of the study was to assess the clinical effect of immunostimulatory enteral and parenteral nutrition in well-nourished patients undergoing resection for gastrointestinal cancer. Two hundred five subjects were randomly assigned into 4 study groups: standard enteral nutrition, immunomodulating enteral nutrition, standard parenteral nutrition, and immunomodulating enteral nutrition. The study failed to demonstrate any clear advantage of routine postoperative immunonutrition in patients undergoing elective upper gastrointestinal surgery.

Population-based studies suggest a survival benefit of lymph node dissection in some solid tumors. In this retrospective study, we examined the correlation between total number of resected nodes and overall survival in patients with esophageal cancer.

Revision of 151 primary bariatric operations including 14 jejunoileal bypasses, 71 pure restrictive procedures, and 66 gastric bypasses was performed for weight loss failure. Post-revisional weight loss was significantly greater after revision of failed restrictive operations to Roux-en-Y gastric bypass versus weight loss after revision of failed gastric bypass by adding malabsorption. Comorbidities improved or resolved in 95% of patients after revision.

We retrospectively analyzed over 1500 individuals' weight loss outcomes after gastric bypass and gastric band. Gastric bypass was associated with a greater, more rapid, and less varied individual weight loss than gastric band over 2 years post operation. Nearly all patients who achieved meaningful weight loss at early time points post operation maintained their weight loss at 2 years.

Data were analyzed from 397 locally advanced rectal cancer patients who underwent fractionated chemoradiotherapy (CRT) involving 50.4 Gy radiotherapy followed by surgical resection either 4 to 6 or 6 to 8 weeks later. The length of the interval between CRT and surgery was found to have no effect on CRT responses, sphincter-preserving rate, morbidity rate, or local recurrence.

The reliability and validity of the scores from a key feature-based self-assessment examination developed for colon and rectal surgeons were analyzed and confirmed.

In this multivariate study, we identified the significant predictive parameters of 20 potential risk factors for developing intra- and postoperative complications in 1316 patients undergoing laparoscopic colorectal surgery.

Surgical treatment of colorectal diseases leads to improvement in global quality of life. There is, however, a significant decline in sexual function postoperatively, which should be addressed by the health professional. Preoperative counseling is desired by most of the patients.

Outcome of patients with hilar cholangiocarcinoma was evaluated at a tertiary referral center. In patients with resectable tumors, an aggressive operative strategy including major liver resection was associated with improved prognosis, regardless of margin status, and was associated with a decrease in hepatic recurrence. Routine major liver resection should be considered as the standard treatment.

Treatment of breast cancer has significant impact on a patient beyond only operative mortality. The impact of breast surgeons on short-term outcomes in breast cancer care was compared at a single institution.

Prevalence of lymphedema was analyzed in 66 patients after inguinal or ilio-inguinal dissection for melanoma. Two definitions are proposed using full-limb optoelectric perometry or summation of circumferences at set points. Lymphedema was present in 18% or 14% of patients, respectively. Adjuvant radiotherapy was the only risk associated with lymphedema.

Our results indicate that trauma-hemorrhage induces lung injury (edema, neutrophil infiltration, increased cytokines, chemokines, and adhesion molecules expression); however, administration of 17β-estradiol after trauma-hemorrhage increased endothelial nitric oxide (NO) synthase expression/phosphorylation, protein kinase G-I activation, vasodilator-stimulated phosphoprotein phosphorylation and expression, and decreased lung injury. Thus, activation of the endothelial NO synthase-protein kinase G/vasodilator-stimulated phosphoprotein pathway by 17β-estradiol after trauma-hemorrhage protects against lung injury.

After a terrorist bombing attack, victims sustain unique injuries that are more widespread and more severe compared with other forms of trauma. The pattern of intra-abdominal injury is similar to gunshot wounds, whereas the scope of bodily injury resembles blunt trauma.

Transfusion with liposome-encapsulated hemoglobin (LHb) can rescue rats from fatal progressive hemodilution without any potent nitric oxide scavenging effects that have been seen for other hemoglobin-based oxygen carriers. LHb transfusion improves metabolic acidosis, and reduces exaggerated neuroendocrine response and injuries to the heart, liver, and kidney in rats undergoing hemodilution. LHb transfusion also suppresses the expression of hypoxia-inducible factor-1alpha in the liver and kidney.

Efforts to evaluate the quality of surgical care have focused on adjusting complication rates by preoperative risk. We find that, even after carefully controlling for these risks, direct measurement of intraoperative care with the 10-point Surgical Apgar Score identifies more than 5-fold further variation in odds of major postoperative complications.

The Veterans Affairs' (VA) National Surgical Quality Improvement Program (NSQIP) methods and predictive risk models in general and vascular surgery were fully applicable to 14 private sector (PS) academic medical centers. As previously observed in the VA, 30-day postoperative morbidity in PS hospitals was reduced with the implementation of the NSQIP. These findings prompt the establishment of a national outcomes-based surgical QI program and database.

Prospective field observations were used to determine the rate and type of discrepancies encountered in the surgical count. One in 8 cases involves in intraoperative counting discrepancy. The majority of these detect unaccounted-for sponges and instruments, which represent potential retained sponges and instruments and should therefore never be ignored.