Abstract:
BACKGROUND:The choice between breast-conserving surgery and modified radical mastectomy in the treatment of women with early stage breast cancer in the Department of Defense Healthcare System may be influenced by demographic factors. STUDY DESIGN:The Department of Defense Automated Central Tumor Registry (ACTUR) was queried for women diagnosed with American Joint Committee on Cancer Stage I or II invasive breast carcinoma from January 1, 1986, to December 31, 1996. Univariate analysis and multivariate analysis were applied to the study variables. Year of diagnosis, age at diagnosis, tumor size, type of hospital, geographic region, and local availability of radiation therapy were evaluated with respect to the type of surgical treatment performed. Surgical treatment was either breast conservation therapy (BCT) or modified radical mastectomy. RESULTS:After excluding women for whom the data were incomplete (n = 308), 7,815 women were identified who met study criteria. There was a progressive increase in the use of BCT to treat tumors of all sizes from 16% to 47% over the 11 years of the study (p < 0.0001). BCT was more frequently used for smaller tumors (< 2cm), with an odds ratio of 2.46 (2.20-2.76, 95% CI). In 1996, 54% of women with T1 (< 2 cm) tumors were treated with BCT. Women treated with BCT were nearly the same age as those undergoing modified radical mastectomy (55.5 years versus 56.8 years, p < 0.0001). BCT was used at a slightly greater rate in medical centers than in community hospitals (31% versus 28%, p < 0.0001). Use of BCT varied among geographic regions from a low of 24% in the southwestern USA to a peak of 36% in the Northeast and 40% in hospitals outside of the continental United States (p < 0.0001). Local availability of radiation therapy did not influence choice of treatment. CONCLUSIONS:The use of BCT to treat early stage invasive breast carcinoma in the Department of Defense Healthcare System is increasing. But BCT is used less often to treat larger tumors. Regional differences in the use of BCT persist, even after controlling for other factors. Patient age and type of hospital (community versus academic center) appear to exert little influence on the choice of treatment. Local availability of radiation therapy did not seem to influence the choice of treatment. Our data suggest that efforts to promote the use of BCT should target the central and southwestern USA. Use of BCT should also be emphasized for women with larger tumors (> 2 cm).
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Kelemen JJ 3rd,Poulton T,Swartz MT,Jatoi Idoi
10.1016/s1072-7515(00)00803-6keywords:
subject
Has Abstractpub_date
2001-03-01 00:00:00pages
293-7issue
3eissn
1072-7515issn
1879-1190pii
S1072-7515(00)00803-6journal_volume
192pub_type
杂志文章abstract:BACKGROUND:Head injury is an increasing contributor to death and disability, particularly among the elderly. Older patients are less likely to be treated at trauma centers, and head injury is the most common severe injury treated at non-trauma centers. We hypothesized that patients initially triaged to trauma centers w...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2018.01.055
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:The link between inflammation and cancer is well-established, but the link between Hashimoto thyroiditis (HT) and thyroid cancer remains controversial. The purpose of our study was to determine the incidence of patients with thyroid cancer and associated HT at our institution, to correlate our patient popula...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.12.037
更新日期:2007-05-01 00:00:00
abstract::A technically elegant, fast and reliable method to secure drains and tubes is presented herein. The method can be used with any type of drains and with any suture material. ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00
abstract:BACKGROUND:Injury is the leading cause of childhood morbidity and mortality in the US. The associated costs exceed $20 billion annually. This study examined disparities in disadvantaged populations of critically injured pediatric patients admitted to a level 1 pediatric trauma center. STUDY DESIGN:A retrospective stud...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.02.032
更新日期:2013-08-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine how often patients with ductal carcinoma in situ and T1a/b N0 cancer are offered and accept tamoxifen for secondary chemoprevention. STUDY DESIGN:A retrospective review of 284 patients with T1a/b N0 invasive cancer treated between February 1995 and December 2001 an...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2005.06.195
更新日期:2005-11-01 00:00:00
abstract:BACKGROUND:Voluntary resident attrition remains problematic despite recent changes in postgraduate general surgery training, including reduction of work hours. STUDY DESIGN:We conducted a prospective study of all postgraduate year (PGY)-1 and -2 trainees on the 2008 American Board of Surgery resident roster (ABS-RR) w...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.11.005
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Oxandrolone, an anabolic agent, has been administered for 1 year post burn with beneficial effects in pediatric patients. However, the long-lasting effects of this treatment have not been studied. This single-center prospective trial determined the long-term effects of 1 year of oxandrolone administration in...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamcollsurg.2011.12.038
更新日期:2012-04-01 00:00:00
abstract:BACKGROUND:Neuroendocrine tumors commonly metastasize to the liver. Although surgical resection is considered a treatment option for patients with localized metastases confined to the liver, the longterm survival benefit of liver resection has not been clearly demonstrated. We examined the survival of patients undergoi...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(98)00099-4
更新日期:1998-07-01 00:00:00
abstract:BACKGROUND:Hepatic resection of metastatic carcinoid cancer can prolong survival and control symptomatic endocrinopathy. Decompensated carcinoid heart disease (CHD) can develop in some patients with metastatic carcinoid cancers, which can preclude operation for resectable hepatic metastases. We hypothesized that outcom...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.03.029
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Pilonidal disease is a common condition among young people. Complicated pilonidal surgical wounds are associated with considerable morbidity, including chronic sacral wound, loss of work time, and lifestyle limitation. The aim of our study is to report our experience with Karydakis procedure and explore the ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.04.034
更新日期:2007-09-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to compare the rates of all-cause and breast cancer-specific mortality after breast-conserving surgery (BCS) only, BCS plus radiation therapy (RT), mastectomy, and the receipt of adjuvant tamoxifen in a large population-based cohort of older women with early-stage disease. STUD...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2007.07.015
更新日期:2008-01-01 00:00:00
abstract:BACKGROUND:Pancreatectomy can be complicated by pancreatic anastomotic leakage, causing major morbidity. STUDY DESIGN:Our aim was to determine if vapreotide, a potent long-acting somatostatin analogue, would decrease pancreas-related complications. This prospective, multicenter, randomized, double-blind, placebo-contr...
journal_title:Journal of the American College of Surgeons
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/S1072-7515(03)00104-2
更新日期:2003-04-01 00:00:00
abstract::THE SECOND JOAN L AND JULIUS H JACOBSON PROMISING INVESTIGATOR AWARDEE, EDITH TZENG MD, FACS: In 2005, the Surgical Research Committee of the American College of Surgeons was tasked with selecting the recipient of a newly established award, "The Joan L and Julius H Jacobson Promising Investigator Award." According to ...
journal_title:Journal of the American College of Surgeons
pub_type: 历史文章,杂志文章
doi:10.1016/j.jamcollsurg.2016.09.012
更新日期:2017-01-01 00:00:00
abstract:BACKGROUND:There is increasing interest in surgical outcomes. The Patient Safety in Surgery (PSS) Study database was examined about thyroid and parathyroid procedures to determine risk factors for adverse outcomes and outcomes rates. Relative outcomes performance for the Veterans Affairs (VA) and private-sector populat...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.02.073
更新日期:2007-06-01 00:00:00
abstract:BACKGROUND:Near infrared autofluorescence (NIRAF) can guide intraoperative parathyroid gland (PG) identification. NIRAF detection devices typically rely on imaging and fiber probe-based approaches. Imaging modalities provide NIRAF pictures on adjacent display monitors, and fiber probe-based systems measure tissue NIRAF...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.09.003
更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:Poor access to adequate health care coverage is associated with poor outcomes for many chronic medical conditions. We hypothesized that insurance coverage is also associated with mortality after gunshot trauma. STUDY DESIGN:The trauma records for gunshot victims and their insurance status were reviewed at o...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.12.002
更新日期:2010-03-01 00:00:00
abstract:BACKGROUND:The majority of newly diagnosed breast cancers in the US are in women aged older than 65 years who can have additional comorbidities. Balancing the risks and benefits of treatment should take into account these competing risks of death. STUDY DESIGN:The Surveillance, Epidemiology, and End Results Program-Me...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2019.03.013
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Acute limb ischemia initiates a systemic inflammatory response, including pulmonary polymorphonuclear leukocyte (PMN) sequestration and acute lung injury. Lung injury is partly attributed to release by PMN's of extracellular matrix (ECM) modifying metalloproteinases (MMPs). We hypothesized that acute hindlim...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00134-0
更新日期:2003-05-01 00:00:00
abstract:BACKGROUND:Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an additional analysis to define independent factors associated with improved patient understanding. STUDY DESIGN:Patients sched...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.jamcollsurg.2010.02.049
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:The American College of Surgeons maintains that surgical care in the US has not reached optimal safety and quality. This can be driven partially by higher-risk, emergency operations in geriatric patients. We therefore sought to answer 2 questions: First, to what degree does standardized postoperative mortali...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.10.018
更新日期:2020-06-01 00:00:00
abstract:BACKGROUND:Traumatic flail chest injury is a potentially life threatening condition traditionally treated with invasive mechanical ventilation to splint the chest wall. Longer-term sequelae of pain, deformity, and physical restriction are well described. This study investigated the impact of operative fixation in these...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamcollsurg.2012.12.024
更新日期:2013-05-01 00:00:00
abstract:BACKGROUND:The factors important in determining outcome when managing adult blunt splenic injuries continue to be debated. Whether trauma center level designation (Level I versus Level II) affects patient management has not been evaluated. STUDY DESIGN:We conducted a retrospective analysis of prospectively gathered da...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2003.10.007
更新日期:2004-02-01 00:00:00
abstract:BACKGROUND:To prevent wrong-site surgery, multiple organizations have endorsed the practice of signing the operative site with an indelible marker. Potential contamination of the surgical field and the inability to prepare the area under the ink film raises concerns. The purpose of this study was to determine if the us...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.02.029
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Splenectomy at the time of resection of esophageal, gastric, or colon cancer has been correlated with inferior longterm survival. No such effect has yet been demonstrated for pancreatic cancer. STUDY DESIGN:Patients undergoing resection of pancreatic adenocarcinoma with curative intent at Memorial Sloan-Ket...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(99)00041-1
更新日期:1999-05-01 00:00:00
abstract:BACKGROUND:The mortality rate of bleeding esophageal varices in cirrhosis is highest during the period of acute bleeding. This is a report of a randomized trial that compared endoscopic sclerotherapy (EST) with emergency portacaval shunt (EPCS) in cirrhotic patients with acute variceal hemorrhage. STUDY DESIGN:A total...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jamcollsurg.2009.02.059
更新日期:2009-07-01 00:00:00
abstract:BACKGROUND:Accountable care organizations (ACOs) attempt to provide the most efficient and effective care to patients within a region. We hypothesized that patients who undergo surgery closer to home have improved survival due to proximity of preoperative and post-discharge care. STUDY DESIGN:All (17,582) institutiona...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2016.12.017
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:We compared the rates of stroke, death, and/or MI between men and women, stratified by symptomatic status and procedure type (carotid endarterectomy [CEA] or carotid artery stent [CAS]). STUDY DESIGN:Using the Nationwide Inpatient Sample, crude and propensity-matched rates of the composite end point of stro...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2019.02.054
更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Although established for metastatic colorectal (CR) and neuroendocrine (NE) malignancies, the role of partial hepatectomy in management of metastases from other primaries (NCRNE) is not well-defined. STUDY DESIGN:The objective of this retrospective study is to compare outcomes after partial hepatectomy for ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.12.019
更新日期:2007-03-01 00:00:00
abstract:BACKGROUND:The technique of total mesorectal excision (TME) increases the risk of anastomotic leakage. The impact of postoperative morbidity of TME on longterm survival has never been described. We retrospectively analyzed factors that might influence survival after TME for rectal cancer, including postoperative morbid...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.07.021
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Metabolic syndrome (MetS) increases cardiovascular risk and is associated with poor patient outcomes. We hypothesized that MetS confers an increased risk of morbidity and mortality in severely injured trauma patients. STUDY DESIGN:We performed a retrospective review of trauma patients from 2014 through 2018...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.09.009
更新日期:2020-01-01 00:00:00