Notes

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To compare the oncologic outcomes of liver resection (LR) and local ablation therapies for HCC.

Although several studies have compared LR and local ablation therapies, the optimal treatment of choice for HCC within the Milan criteria remains controversial.

We systemically searched the MEDLINE, Embase, and Cochrane Library databases for randomized control trials (RCTs) and matched nonrandomized trials (NRTs) that compared LR and local ablation therapies for HCC within the Milan criteria. The primary outcome was overall survival (OS). Secondary outcomes were recurrence free survival (RFS) and recurrence pattern.

A total of 7 RCTs and 18 matched NRTs, involving 2865 patients in the LR group and 2764 patients in the local ablation therapy group [RFA, MWA, RFA plus trans-arterial chemoembolization (TACE)], were included. Although there was no significant difference in OS between LR and RFA, LR showed a significantly better 5-year RFS than RFA in the analysis of RCTs (hazards ratio 0.75; 95% confidence interval 0.62-0.92; P = 0.006). The RFA group showed a significantly higher local recurrence than the LR group in both analyses of RCTs and NRTs. Additionally, the LR group showed better OS and RFS than the MWA or RFA plus TACE groups.

Our meta-analysis showed that LR was superior to RFA in terms of RFS and incidence of local recurrence. Moreover, LR showed better oncologic outcomes than MWA or RFA plus TACE.
Our meta-analysis showed that LR was superior to RFA in terms of RFS and incidence of local recurrence. Moreover, LR showed better oncologic outcomes than MWA or RFA plus TACE.
To demonstrate that a semi-automated approach to health data abstraction provides significant efficiencies and high accuracy.

Surgical outcome abstraction remains laborious and a barrier to the sustainment of quality improvement registries like ACS-NSQIP. A supervised machine learning algorithm developed for detecting SSI using structured and unstructured electronic health record data was tested to perform semi-automated SSI abstraction.

A Lasso-penalized logistic regression model with 2011-3 data was trained (baseline performance measured with 10-fold cross-validation). A cutoff probability score from the training data was established, dividing the subsequent evaluation dataset into "negative" and "possible" SSI groups, with manual data abstraction only performed on the "possible" group. Tomivosertib mouse We evaluated performance on data from 2014, 2015, and both years.

Overall, 6188 patients were in the 2011-3 training dataset and 5132 patients in the 2014-5 evaluation dataset. With use of the semi-automated approach, applying the cut-off score decreased the amount of manual abstraction by ≥90%, resulting in <1% false negatives in the "negative" group and a sensitivity of 82%. A blinded review of 10% of the "possible" group, considering only the features selected by the algorithm, resulted in high agreement with the gold standard based on full chart abstraction, pointing towards additional efficiency in the abstraction process by making it possible for abstractors to review limited, salient portions of the chart.

Semi-automated machine learning-aided SSI abstraction greatly accelerates the abstraction process and achieves very good performance. This could be translated to other post-operative outcomes and reduce cost barriers for wider ACS-NSQIP adoption.
Semi-automated machine learning-aided SSI abstraction greatly accelerates the abstraction process and achieves very good performance. This could be translated to other post-operative outcomes and reduce cost barriers for wider ACS-NSQIP adoption.
The aim of this study was to develop and validate a prediction score for internal hernia (IH) after Roux-en-Y gastric bypass (RYGB).

The clinical diagnosis of IH is challenging. A sensitivity of 63% to 92% was reported for computed tomography (CT).

Consecutive patients admitted for abdominal pain after RYGB and undergoing CT and surgical exploration were included retrospectively. Potential clinical predictors and radiological signs of IH were entered in binary logistic regression analysis to determine a predictive score of surgically confirmed IH in the Geneva training set (January 2006-December 2014), and validated in 3 centers, Geneva (January 2015-December 2017) and Neuchâtel and Strasbourg (January 2012-December 2017).

Two hundred twenty-eight patients were included, 80 of whom (35.5%) had surgically confirmed IH, 38 (16.6%) had a negative laparoscopy, and 110 (48.2%) had an alternate diagnosis. In the training set of 61 patients, excess body weight loss >95% (odds ratio [OR] 6.73, 95% confidence interval [CI] 1.13-39.96), swirl sign (OR 8.93, 95% CI 2.30-34.70), and free liquid (OR 4.53, 95% CI 1.08-19.0) were independent predictors of IH. Area under the curve (AUC) of the score was 0.799. In the validation set of 167 patients, AUC was 0.846. A score ≥2 was associated with an IH incidence of 60.7% (34/56), and 5.3% (3/56) had a negative laparoscopy.

The score could be incorporated in the clinical setting. To reduce the risk of delayed IH diagnosis, emergency explorative laparoscopy in patients with a score ≥2 should be considered.
The score could be incorporated in the clinical setting. To reduce the risk of delayed IH diagnosis, emergency explorative laparoscopy in patients with a score ≥2 should be considered.
To examine the independent prognostic value of ALN status in patients with stage III CRC.

Early CRC staging classified nodal involvement by level of involved nodes in the operative specimen, including both locoregional and apical node status, in contrast to the American Joint Committee on Cancer/tumor nodes metastasis (TNM) system where tumors are classified by the number of nodes involved. Whether ALN status has independent prognostic value remains controversial.

Consecutive patients who underwent curative resection for Stage III CRC from 1995 to 2012 at Concord Hospital, Sydney, Australia were studied. ALN status was classified as (i) ALN absent, (ii) ALN present but not histologically involved, (iii) ALN present and involved. Outcomes were the competing risks incidence of CRC recurrence and CRC-specific death. Associations between these outcomes and ALN status were compared with TNM N status results.

In 706 patients, 69 (9.8%) had an involved ALN, 398 (56.4%) had an uninvolved ALN and 239 (33.9%) had no ALN identified.
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