World Journal of Surgery

The hook-wire technique is used to guide surgical excision of nonpalpable breast lesions. Recently, isotope has been used to guide the excision, and when sentinel node biopsy is performed during the same operation, the procedure is termed Sentinel Node and Occult Lesion Localization (SNOLL). We evaluated the use of this procedure for nonpalpable cancers in Chinese women. Seventy-four patients underwent SNOLL before breast-conserving surgery. Intratumoral injection of sulfur colloid and lymphoscintigraphy (LSG) were performed. A gamma probe was used for resection planning and localization of the sentinel node (SN). Blue dye mapping was used in patients with negative LSG. Complete excision was defined as a tumor-free margin greater than 1 mm. The primary breast lesion was successfully removed in 73 patients (99%). Complete excision was achieved in 61 patients (82%). Drainage to axilla was detected by LSG in 53 patients (72%). The gamma probe was more sensitive than LSG and had an 82% SN identification rate. Patients with a positive LSG had a higher chance of SN localization by gamma probe than patients with a negative LSG (100% vs. 38%, p < 0.001). In patients with a negative LSG, supplementary blue dye mapping increased the SN localization rate from 38 to 90%. The SN identification rate was 97% in the whole series. Isotope-guided surgery was reliable, with a 99% localization rate for nonpalpable breast lesions and an 82% SN localization rate. The success rate of SN identification could be improved to 97% with the addition of blue dye mapping for patients with negative drainage on lymphoscintigraphy.

Discussions regarding disclosure of funding sources and conflicts of interest (COI) in published peer-reviewed journal articles are becoming increasingly more common and intense. The aim of the present study was to examine whether randomized controlled trials (RCTs) published in leading surgery journals report funding sources and COI. All articles reporting randomized controlled phase III trials published January 2005 through December 2010 were chosen for review from ten international journals. We evaluated the number of disclosed funding sources and COI, and the factors associated with such disclosures. From a review of 657 RCT from the ten journals, we discovered that presence or absence of a funding source and COI was disclosed by 47 % (309) and 25.1 % (165), respectively. Most articles in “International Committee of Medical Journal Editors (ICMJE)-affiliated journals” did not disclose COI. Disclosure of funding was associated with a journal impact factor >3 (51.7 vs 41.6 %; p < 0.01), statistician/epidemiologist involvement (64.2 vs 43.7 %; p < 0.001), publication after 2008 (52.9 vs 41.1 %; p < 0.01), and the journal being ICMJE-affiliated (49.3 vs 40 %; p < 0.05). Conflict of interest disclosure was associated with publication after 2008 (38.7 vs 11.3 %; p < 0.001), and with the journal not being affiliated with ICMJE (36.9 vs 21.3 %; p < 0.001). Of the published studies we investigated, over half did not disclose funding sources (i.e., whether or not there was a funding source), and almost three quarters did not disclose whether COI existed. Our findings suggest the need to adopt best current practices regarding disclosure of competing interests to fulfill responsibilities to readers and, ultimately, to patients.

Rách hậu môn mạn tính được chẩn đoán khi có các triệu chứng kéo dài: Bộ ba điển hình bao gồm một vết rách ở niêm mạc theo chiều dọc, lộ ra các sợi cơ vòng trong, nốt sần hậu môn phì đại và một mảng da định vị. Do đó, rách hậu môn mạn tính có thể được chia thành ba thành phần: vết rách chính nó; nốt sần hậu môn phì đại; mảng da định vị. Không phải tất cả các rách hậu môn mạn tính đều có đủ ba thành phần; một số có hai thành phần, và những cái khác chỉ biểu hiện với một vết rách kéo dài. Tỷ lệ thành công của điều trị y tế đối với rách hậu môn mạn tính được báo cáo là từ 42–86 %. Trong nghiên cứu này, chúng tôi nhằm quan sát tác động của các thành phần như đã nói đến đối với việc chữa lành bằng liệu pháp isosorbide dinitrate. Tổng cộng có 105 bệnh nhân mắc rách hậu môn mạn tính đã được nhập viện và được chia thành ba nhóm. Bệnh nhân ở nhóm I có một thành phần duy nhất (chỉ có vết rách với niêm mạc bị rách lộ ra các sợi cơ vòng trong); nhóm II có hai thành phần (mảng da hoặc nốt phì đại bên cạnh vết rách); nhóm III có đủ ba thành phần (vết rách, mảng da, nốt phì đại). Isosorbide dinitrate 0,25 % được áp dụng ba lần một ngày. Tỷ lệ thành công trong các nhóm nghiên cứu lần lượt là 93, 74 và 64 %. Tỷ lệ thành công ở nhóm I cao hơn rõ rệt so với nhóm II và III. Các thành phần của rách hậu môn mạn tính nên được xem xét khi đánh giá tỷ lệ thành công của các nghiên cứu báo cáo kết quả của các phương pháp điều trị y tế khác nhau. Số lượng thành phần dường như là một yếu tố quan trọng ảnh hưởng đến kết quả của điều trị bằng isosorbide dinitrate.

Radical lymph node (LN) dissection along the recurrent laryngeal nerve (RLN) area carries a substantial morbidity rate, and its usefulness in neoadjuvant chemoradiotherapy (nCRT)-treated esophageal cancer patients remains unclear. This study was conducted in two Asian thoracic surgery centers. Patients with esophageal squamous cell carcinoma (ESCC) who were judged to be ycN-RLN(−) after nCRT and received bilateral RLN LN dissection were eligible. The incidence of unsuspected RLN LN involvement was analyzed, and we used least absolute shrinkage and selection operator (LASSO) regression to identify its predictors. A total of 56 patients (53 males and 3 females; mean age: 55 years) were included. The upper mediastinum—including the bilateral RLN area—was covered by the radiation field in 48 (85.3%) patients. Although all of them were judged as ycN-RLN(−), unsuspected RLN LN involvement was identified on pathological examination in 11 (19.6%) subjects, being the only positive nodal station in seven. LASSO regression identified the pre-nCRT RLN LN(cN-RLN) status as the only independent predictor of ypN-RLN positivity; in contrast, neither the tumor location nor the radiation dose to the upper mediastinum were independently associated with ypN-RLN(+). RLN nodal dissection resulted in positive LN discovery rates of 30.8 and 10% in ycN-RLN(−) patients who had positive and negative cN-RLNs before nCRT, respectively. Consequently, 23.1 and 6.7% of patients in each subgroup would have been understaged in the absence of RLN nodal dissection. Nearly one-fifth of ESCC patients who were judged to be ycN-RLN(−) unexpectedly had positive ypN-RLN. The pre-nCRT cN-RLN status plays a key role in the selection of patients that should undergo RLN LN dissection after nCRT.

Surgical oncology is one of the most frequently studied surgical specialties with regard to disparities in quality of care. There is variation in the care received according to nonclinical factors such as age, race and ethnicity, education, income, and even geographic region. Differences exist with regard to who gets treatment, what treatment is received, and the outcomes of those treatments. Although the existence of such disparities is no longer in doubt, the etiology is still being investigated. Ongoing research and quality improvement initiatives move beyond the mere description of existing disparities in one of three ways: (1) identifying and understanding the factors that lead to disparities; (2) advancing available methods to measure and track disparities; and (3) developing an approach to improvement. In this article, we start out by offering a framework to describe potential factors that lead to disparities, using examples from surgical oncology. We then describe the approaches to measuring and tracking disparities that are being used in research and quality improvement. Finally, we attempt to illustrate how all of these factors interact and offer some potential strategies to close the gap and alleviate disparities within the discipline.