As the year comes to a close, I thought I would highlight some of the more interesting research studies that were conducted in the field of surgery for 2011:
1. Adenocarcinoma in Patients With Barrett’s Esophagus
A study from Denmark showed that although patients with documented Barrett’s esophagus have an 11.3-fold increased risk of developing cancer of the esophagus, the annual risk of cancer development is actually lower than previously thought (0.12% vs. 0.5%). This raises a question on the current guidelines for surveillance in patients with Barrett’s esophagus.
2. Occult Metastases and Survival in Patients With Breast Cancer
A randomized trial comparing women who had sentinel node biopsy alone with women who had a complete axillary lymph node dissection showed only a 1.2% difference in 5-year survival favoring the axillary dissection group. This modest difference continues to fuel the debate on the importance of occult metastatic axillary involvement, and whether axillary lymph node dissection will even be required in the future for patients with positive sentinel lymph nodes.
3. Immediate vs Delayed Appendectomy in Children
This study was aimed at determining the best management strategy for patients with perforated appendicitis. Results favored early rather than delayed operation for acute perforated appendicitis. One concern of this study is that not all patients were correctly diagnosed as having appendicitis initially, which led to delays in surgical intervention with possible interval appendectomy. Looks like there will continue to be little agreement on the best management strategy for perforated appendicitis.
4. Anastomotic Leakage and Survival After Colorectal Surgery
What is the impact Surgeons have always been concerned about the increased short-term morbidity associated with anastomotic leakage (AL) during operations for colorectal cancer. This study looked at 21 reports published over a 44 year period and focused on the long-term complications associated with anastomotic leakage. They found an increase in both local recurrence and cancer-associated mortality. A weakness of this report is that some of the included studies were based on patients treated almost 50 years ago, when chemotherapy was just being developed. However, it reminds all surgeons of the importance of obtaining anastomotic integrity during colorectal surgery as a critical factor leading to superior long-term results.
5. Do We Need Antibiotics for Uncomplicated Diverticulitis?
Diverticulitis is one of the most common colonic diseases. The current initial approach to treatment is nonoperative unless there is disease progression. Most patients with uncomplicated diverticulitis are currently treated with antibiotics with good results. The authors of this study suggested that in immunocompetent individuals the disease may subside spontaneously without requiring antibiotics. Although this hypothesis may be true, most physicians will want to wait for solid evidence before eliminating antibiotics from current treatment plans.
* A list of references for articles can be obtained at Medscape.com General Surgery
Related articles
- Less-invasive Lymph Node Resection Following Breast Cancer Surgery Confirmed as Standard of Care in Eight-year Study Led by AGH Doctors (prweb.com)
- Is It Appendicitis? (everydayhealth.com)
- How is diverticulitis treated? (zocdoc.com)
