Abstract:
OBJECTIVE:The COVID-19 pandemic requires to conscientiously weigh "timely surgical intervention" for colorectal cancer against efforts to conserve hospital resources and protect patients and health care providers. SUMMARY BACKGROUND DATA:Professional societies provided ad-hoc guidance at the outset of the COVID-19 pandemic on deferral of surgical and perioperative interventions, but these lack specific parameters to determine the optimal timing of surgery. METHODS:Using the GRADE system, published evidence was analyzed to generate weighted statements for stage, site, acuity of presentation, and hospital setting to specify when surgery should be pursued, the time and duration of oncologically acceptable delays, and when to utilize nonsurgical modalities to bridge the waiting period. RESULTS:Colorectal cancer surgeries-prioritized as emergency, urgent with imminent emergency or oncologically urgent, or elective-were matched against the phases of the pandemic. Surgery in COVID-19-positive patients must be avoided. Emergent and imminent emergent cases should mostly proceed unless resources are exhausted. Standard practices allow for postponement of elective cases and deferral to nonsurgical modalities of stage II/III rectal and metastatic colorectal cancer. Oncologically urgent cases may be delayed for 6(-12) weeks without jeopardizing oncological outcomes. Outside established principles, administration of nonsurgical modalities is not justified and increases the vulnerability of patients. CONCLUSIONS:The COVID-19 pandemic has stressed already limited health care resources and forced rationing, triage, and prioritization of care in general, specifically of surgical interventions. Established guidelines allow for modifications of optimal timing and type of surgery for colorectal cancer during an unrelated pandemic.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
O'Leary MP,Choong KC,Thornblade LW,Fakih MG,Fong Y,Kaiser AMdoi
10.1097/SLA.0000000000004029subject
Has Abstractpub_date
2020-08-01 00:00:00pages
e98-e105issue
2eissn
0003-4932issn
1528-1140pii
00000658-202008000-00030journal_volume
272pub_type
杂志文章abstract:OBJECTIVE:To achieve consensus on the best practices in the management of ventral hernias (VH). BACKGROUND:Management patterns for VH are heterogeneous, often with little supporting evidence or correlation with existing evidence. METHODS:A systematic review identified the highest level of evidence available for each ...
journal_title:Annals of surgery
pub_type: 共识发展会议,杂志文章
doi:10.1097/SLA.0000000000001701
更新日期:2017-01-01 00:00:00
abstract:OBJECTIVE:To prospectively assess the accuracy of gadofosveset-enhanced magnetic resonance imaging (MRI) for nodal staging and restaging in rectal cancer. BACKGROUND:Accurate preoperative assessment of nodal disease in rectal cancer impacts treatment management. Staging with modern imaging techniques (computed tomogra...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31820b01f1
更新日期:2011-03-01 00:00:00
abstract::Is colon cancer surgery justified in the very elderly from the standpoint of cost and 3-year survival rates? Two hundred eighty patients undergoing major surgery for colon cancer during 1981-1983 were divided into a group of 61 with ages greater than or equal to 80 (GE80) and 219 less than 80 (LT80). Although those GE...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198602000-00003
更新日期:1986-02-01 00:00:00
abstract::Thrombotic complications of heparin administration were observed in eight patients during a two year period. At sites of subcutaneous heparin injection, six patients developed areas of the skin and subcutaneous necrosis. Systemic thrombotic events and thrombocytopenia were observed in two of these patients when they r...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197911000-00007
更新日期:1979-11-01 00:00:00
abstract:OBJECTIVE:To determine whether the rates of death and complications of carotid endarterectomy (CE) were different in the octogenarian population than in patients younger than age 80. SUMMARY BACKGROUND DATA:The utility of CE depends on the ability of the surgeon and hospital to attain low rates of death and complicati...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200006000-00001
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:To examine the outcome of technical variant liver transplant techniques relative to whole organ liver transplantation in pediatric liver transplant recipients. BACKGROUND:Technical variant liver transplant techniques comprising split, reduced, and live-donor liver transplantation evolved to address the need ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0b013e3180caa415
更新日期:2007-08-01 00:00:00
abstract::The records of 161 adult patients who underwent a modification of the Witzel gastrostomy without gastropexy at Ellis Fischel State Cancer Hospital, Columbia, Missouri, between 1977 and 1980, are reviewed in detail and form the basis of this report. Six of these patients had gastrostomies on two different occasions. Th...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198206000-00003
更新日期:1982-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the outcome of preoperative gemcitabine-based chemoradiation therapy (CRT) for borderline resectable pancreatic cancer (BRPC), focusing on the associations among the tumor-vascular relationship, surgical outcomes, and pattern of recurrence. SUMMARY BACKGROUND DATA:Among the various multimodal tre...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001547
更新日期:2016-12-01 00:00:00
abstract::Glucose metabolism is affected by various pathologic states including tumors. In this project, glucose turnover and recycling rates in 11 patients with colorectal carcinoma were measured using a double-labelled 3-3H and 1-14C glucose injection technique. Fasting blood glucose, lactate, pyruvate, alanine, glycerol, 3-h...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198311000-00007
更新日期:1983-11-01 00:00:00
abstract:OBJECTIVE:By comparing cohorts in 2 exclusive time frames, the factors that affected the surgical outcomes of patients with hepatocellular carcinoma (HCC) are presented. SUMMARY BACKGROUND DATA:Reportedly, survival results of patients with HCC who underwent hepatectomy have improved in recent years. However, the major...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000217921.28563.55
更新日期:2006-08-01 00:00:00
abstract:OBJECTIVE:To compare the clinical outcome of simultaneous bilateral endoscopic totally extraperitoneal inguinal hernioplasty (TEP) using fibrin sealant (FS) and mechanical stapling for prosthetic mesh fixation. SUMMARY BACKGROUND DATA:Similar efficacy of FS and mechanical stapling for mesh fixation has been demonstrat...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/01.sla.0000186440.02977.de
更新日期:2005-11-01 00:00:00
abstract:OBJECTIVE:The authors review current definition, classification, scoring, microbiology, inflammatory response, and goals of management of secondary peritonitis. SUMMARY BACKGROUND DATA:Despite improved diagnostic modalities, potent antibiotics, modern intensive care, and aggressive surgical treatment, up to one third ...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199607000-00003
更新日期:1996-07-01 00:00:00
abstract:OBJECTIVE:To review the literature on current management of hepatocellular carcinoma (HCC). BACKGROUND:Hepatocellular carcinoma represents one of the most common malignancies worldwide with a rising incidence in western countries. There have been substantial advances in the surgical and medical treatment of HCC within...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/SLA.0b013e31820d944f
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:To determine the incidence of Wnt pathway activation in patients with stage I NSCLC and its influence on lung cancer recurrence. BACKGROUND:Despite resection, the 5-year recurrence with localized stage I nonsmall cell lung cancer (NSCLC) is 18.4%-24%. Aberrant Wnt signaling activation plays an important role...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31826d81fd
更新日期:2013-03-01 00:00:00
abstract::Resting energy expenditure (REE), nutritional parameters, and substrate levels were measured using a technique to minimize artifacts in 11 control patients, nine patients with localized, and four patients with diffuse neoplastic disease. Patients with diffuse disease had significantly increased percentage preillness w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198403000-00008
更新日期:1984-03-01 00:00:00
abstract::From January 1972 through December 1974, at Saint Louis University Medical Center (SLU), 345 patients similar to those of the VA Cooperative Coronary Artery Study received CABG. Operative mortality was SLU 2.3%, VA 5.6% (p < 0.05). Perioperative myocardial infarction rate was SLU 8.4%, VA 18% (p < 0.005). One year gra...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197809000-00008
更新日期:1978-09-01 00:00:00
abstract:OBJECTIVE:Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive approach to removal of the adrenal gland. This anatomically direct approach, popularized by Walz, minimizes dissection and affords early access to the adrenal vein. We report the largest experience to date of PRA in the United States. ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31818a1d2a
更新日期:2008-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the potential benefit of cytology of the peritoneal lavage obtained during diagnostic laparoscopy for staging gastrointestinal (GI) malignancies. SUMMARY BACKGROUND DATA:Peritoneal lavage is a simple procedure that can be performed during laparotomy for GI tumors. Tumor cells in the lavage fluid ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199812000-00002
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:We aimed to determine whether the severity of inhalation injury evokes an immune response measurable at the systemic level and to further characterize the balance of systemic pro- and anti-inflammation early after burn and inhalation injury. BACKGROUND:Previously, we reported that the pulmonary inflammatory ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318275f424
更新日期:2013-06-01 00:00:00
abstract::The late results of brachial thrombectomy following cardiac catheterization were evaluated in 20 patients. All patients had a radial pulse present and no symptoms or signs of ischemia of the hand at the time of discharge from the hospital. Late evaluation of these 20 patients revealed 8 in whom the long-term results w...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197604000-00019
更新日期:1976-04-01 00:00:00
abstract:OBJECTIVE:The authors determined whether radioligand binding of neuropeptide Y (NPY) to hypothalamus taken from nonanorectic and anorectic tumor-bearing rats was altered as compared with similar tissue taken from freely-feeding and food-restricted control rats. SUMMARY BACKGROUND DATA:Previous results indicate that tu...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199505000-00016
更新日期:1995-05-01 00:00:00
abstract::Twenty-one children from the ages of 4 to 12 years old were treated for esophageal hemorrhage by distal splenorenal shunt (DSS). In four patients, thrombosis of the shunt occurred within the first 24 hours after operation. In the other 17 children, long-term shunt patency was verified. Only one thrombosis has occurred...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198204000-00004
更新日期:1982-04-01 00:00:00
abstract:OBJECTIVE:The authors review the general surgical complications of cardiopulmonary bypass, including newer procedures such as heart and lung transplantation, to identify patients at higher risk. SUMMARY BACKGROUND DATA:Although rare, the general surgical complications of cardiopulmonary bypass are associated with high...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199505000-00006
更新日期:1995-05-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to determine whether older adults are at higher risk of lasting functional and cognitive decline after surgery, and the impact of decline on survival and healthcare use. SUMMARY BACKGROUND DATA:Patient-centered outcomes after surgery are poorly characterized. METHODS:Using data fro...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003950
更新日期:2020-05-11 00:00:00
abstract:OBJECTIVE:To determine whether black patients have higher odds of readmission than white patients after major surgery, and to ascertain whether these disparities are related to where black patients receive care. BACKGROUND:Racial disparities are known to exist for many aspects of surgical care. However, it is unknown ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000000326
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVES:The American Joint Committee on Cancer (AJCC) staging system for gastric cancer bases N status on absolute number of metastatic nodes, regardless of the number of examined nodes. We examined a modified staging system utilizing node ratio (Nr), the ratio of metastatic to examined nodes. METHODS:A total of 18...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824857e2
更新日期:2012-03-01 00:00:00
abstract:OBJECTIVE:The authors present an accurate and comprehensive snapshot of appendicitis and the practice of appendectomy in the 1990s. METHODS:Appendectomies were performed on 4950 patients in 147 Department of Defense hospitals worldwide over a 12-month period ending January 31, 1993. RESULTS:The median age was 23 year...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199703000-00003
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVE:The aim of the study was to assess feasibility and outcomes of a multicenter training program in laparoscopic pancreatoduodenectomy (LPD). BACKGROUND:Whereas expert centers have reported promising outcomes of LPD, nationwide analyses have raised concerns on its safety, especially during the learning curve. M...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002563
更新日期:2019-02-01 00:00:00
abstract:UNLABELLED:This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (<20 cases/year) was independently associated with a higher risk of CRM involvement (odds ratio...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001009
更新日期:2016-04-01 00:00:00
abstract:BACKGROUND:The optimal transfusion threshold after surgery in children is unknown. We analyzed the general surgery subgroup of the TRIPICU (Transfusion Requirements in Pediatric Intensive Care Units) study to determine the impact of a restrictive versus a liberal transfusion strategy on new or progressive multiple orga...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e3181c5dc2e
更新日期:2010-03-01 00:00:00