Abstract:
BACKGROUND:Molecular staging of sentinel lymph nodes (SLNs) may identify patients who are node-negative by standard microscopic staging but are at increased risk for regional nodal recurrence; such patients may benefit from completion lymph node dissection (CLND). STUDY DESIGN:In a multicenter, randomized clinical trial, patients with tumor-negative SLNs by standard pathology (hematoxylin and eosin [H and E] serial sections and immunohistochemistry [IHC]) underwent reverse transcriptase polymerase chain reaction (PCR) analysis of SLNs for melanoma-specific mRNA. Microscopically negative/PCR+ patients were randomized to observation, CLND, or CLND with high-dose interferon (HDI). For this post-hoc analysis, clinicopathologic features and survival outcomes, including overall survival (OS) and disease-free survival (DFS), were compared between PCR+ patients who underwent CLND vs observation. Microscopic and molecular node-negative (PCR-) patients were included for comparison. RESULTS:A total of 556 patients were PCR+: 180 underwent observation, and 376 underwent CLND. An additional 908 PCR- patients were observed. Median follow-up was 72 months. Disease-free survival (DFS) was significantly better for PCR+ patients who underwent CLND compared with observation (p = 0.0218). No statistically significant differences in OS or distant disease-free survival (DDFS) were seen. Regional lymph node recurrence-free survival (LNRFS) was improved in PCR+ patients with CLND compared to observation (p = 0.0065). The PCR+ patients in the observation group had the worst DFS; those with CLND had similar DFS to that in the PCR- group (p = 0.9044). CONCLUSIONS:Patients with microscopically negative/PCR+ SLN have an increased risk of nodal recurrence that was mitigated by CLND. Although CLND did not affect OS, these data suggest that molecular detection of melanoma-specific mRNA in the SLN predicts a greater risk of nodal recurrence and deserves further study.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Kimbrough CW,Egger ME,McMasters KM,Stromberg AJ,Martin RC,Philips P,Scoggins CRdoi
10.1016/j.jamcollsurg.2015.12.042subject
Has Abstractpub_date
2016-04-01 00:00:00pages
357-63issue
4eissn
1072-7515issn
1879-1190pii
S1072-7515(16)00026-0journal_volume
222pub_type
杂志文章,多中心研究,随机对照试验abstract:BACKGROUND:The clinical management of sterile pancreatic necrosis is still a matter of debate. In this study we analyzed the clinical course and outcome of patients with sterile necrotizing pancreatitis treated surgically versus nonsurgically. STUDY DESIGN:Between May 1982 and December 1993, 249 patients with necrotiz...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-10-01 00:00:00
abstract:BACKGROUND:The concept of hemodilution after blood loss and crystalloid infusion is a surgical maxim that remains unproven in humans. We sought to quantify the effect of hemodilution after crystalloid administration in voluntary blood donors as a model for acute hemorrhage. STUDY DESIGN:A prospective, randomized contr...
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.2018.05.005
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abstract:BACKGROUND:In the present study we evaluated gastrointestinal motility after gastrectomy of a new pylorus-preserving technique that is becoming a popular operation for early stage carcinoma of the stomach. STUDY DESIGN:Using strain-gauge force transducers we studied gastrointestinal motility in control dogs, dogs afte...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract:BACKGROUND:The aim of this study is to evaluate the rate and the clinical outcomes of lymph node involvement in patients treated for borderline ovarian tumor (BOT). STUDY DESIGN:Forty-two patients were treated for BOT with a procedure that included lymphadenectomy. Twenty-four patients underwent a pelvic lymphadenecto...
journal_title:Journal of the American College of Surgeons
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abstract:BACKGROUND:Although sarcoma histology is recognized as a prognostic factor, most studies of retroperitoneal sarcomas report results combining multiple histologies and are inadequately powered to identify prognostic factors specific to a particular histology. We reviewed our experience with retroperitoneal dedifferentia...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.10.009
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abstract:BACKGROUND:There are few reproducible models of blast injury, so it is difficult to evaluate new or existing therapies. We developed a clinically relevant polytrauma model to test the hypothesis that cerebrovascular resuscitation is optimized when intravenous fluid is restricted. STUDY DESIGN:Anesthetized swine (42+/-...
journal_title:Journal of the American College of Surgeons
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doi:10.1016/j.jamcollsurg.2006.11.014
更新日期:2007-02-01 00:00:00
abstract:BACKGROUND:Rib fractures are common among trauma patients and analgesia remains the cornerstone of treatment. Intercostal nerve blocks provide analgesia but are limited by the duration of the anesthetic. This study compares outcomes of epidural analgesia with intercostal nerve block using liposomal bupivacaine for the ...
journal_title:Journal of the American College of Surgeons
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abstract:BACKGROUND:One of the most important criteria indicative of the longterm success of vaginal enlargement is the absence of postoperative contracture. Numerous procedures have been developed for reconstruction of an inadequate vagina. Some are technically complex techniques (myo- and fasciocutaneous flaps) with few posto...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01541-7
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abstract:BACKGROUND:Performance measurement has become central to surgical practice. We systematically reviewed all endorsed performance measures from the National Quality Forum, the national clearing house for performance measures in health care, to identify measures relevant to surgical practice and describe measure stewardsh...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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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...
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abstract:BACKGROUND:Choosing a breast reconstructive modality after mastectomy is an important step in the reconstructive process. The authors hypothesized that autologous tissue is associated with a greater success rate and cost efficacy over time, relative to implant reconstruction. STUDY DESIGN:A retrospective review was pe...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.02.028
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abstract:BACKGROUND:Pancreaticoduodenectomy (PD) is a complex general surgical procedure originally associated with significant perioperative morbidity and mortality. Multiple studies have now shown that this operation can be performed quite safely at high-volume institutions that develop a particular expertise. Critical pathwa...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.01.057
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:Colonic Crohn's disease can be treated surgically by total colonic resection or by segmental colonic resection. The aim of this study was to analyze the outcomes of patients treated by segmental colectomy for colonic Crohn's disease. STUDY DESIGN:Among 413 patients undergoing operations for Crohn's disease,...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
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abstract:BACKGROUND:The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has become an important surgical quality program in the United States, yet few studies describe their methods for handling missing data. Our study examines the impact of missing data on predictive models for short-term...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.05.010
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:In hepatic resection, it is important to control intrahepatic blood flow to minimize blood loss. Intermittent and selective vascular occlusion, if possible, are advisable. STUDY DESIGN:For this purpose, we created the double balloon catheter, which when introduced into a lobar or a smaller branch of the int...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:Severe secondary hyperparathyroidism, which is associated with life-threatening complications, can develop in dialysis-dependent end-stage renal disease patients. The aim of this study was to compare short- and long-term mortality in dialysis patients who underwent near-total parathyroidectomy (NTPTX) and ma...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2011.12.046
更新日期:2012-04-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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doi:10.1016/j.jamcollsurg.2016.12.033
更新日期:2017-04-01 00:00:00
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
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journal_title:Journal of the American College of Surgeons
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journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
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