Surgery News - April 2008 - (Page 1)

VOL. 4 • NO. 4 • APRIL 2008 The higher complication rates in patients with the metabolic syndrome indicate that these patients might benefit from less invasive bariatric procedures, said Dr. Javier Esteban Varela. TEXAS SOUTHWESTERN MEDICAL CENTER Database Finds Gap in Dissection For Melanoma Retrospective analysis of 47,643 patients. B Y P AT R I C E W E N D L I N G INSIDE 20/20N VISIO THE Dexterity Demo Some Boston-area hospitals now require surgeons to pass a laparoscopic skills exam. • 7 Else vier Global Medical Ne ws Comorbidities Sway Bariatric Outcomes BY ELIZABETH M E C H C AT I E Else vier Global Medical Ne ws T he presence of the metabolic syndrome, as well as a patient’s gender and ethnicity, affects the risk of death after bariatric surgery but not the risk of in-hospital complications, according to a retrospective study of more than 30,000 patients. The findings “suggest that the presence of the metabolic syndrome negatively affects interethnic and gender-specific outcomes after bariatric surgery,” Dr. Javier Esteban Varela said in an interview. Dr. Varela, of the University of Texas at Dallas, was the lead investigator and presented the study results at the Academic Surgical Congress. The investigators evaluated inhospital clinical data obtained from the University HealthSystem Consortium database on 30,954 patients with and without the metabolic syndrome who underwent bariatric surgery between 2003 and 2007. Procedures included laparoscopic gastric bypass, open gastric bypass, and laparoscopic gastric banding. Most of the patients (85%) were women, 81% were white, 14% See Bariatric • page 8 C H I C A G O — Only half of close to 3,000 patients with a positive sentinel lymph node biopsy underwent a completion lymph node dissection in a controversial retrospective analysis of 47,643 patients with invasive melanoma that suggests common practice is falling far short of guidelines. Even more surprising, 64% of positive patients at National Comprehensive Cancer Network (NCCN)/National Cancer Institute (NCI) centers did not undergo a completion lymph node dissection (CLND), according to findings presented at a symposium sponsored by the Society of Surgical Oncology. Patients were significantly less likely to undergo CLND if they were older than 75 years (odds ratio 0.56), had lower extremity melanomas (OR 0.63), had lesions 1.0 mm or less in thickness (OR 0.80), or under- went surgery at low-volume, community, or academic hospitals compared with high-volume or NCCN/NCI centers (P less than .0001), lead investigator Dr. Karl Y. Bilimoria reported. The presentation by Dr. Bilimoria, a research fellow with the American College of Surgeons, stirred a great debate, as many audience members questioned the accuracy of the data captured from 2004 to 2005 by the National Cancer Data Base, a national oncology outcomes database run by the Commission on Cancer and the American Cancer Society. Critics did not believe that CLND could have been done in only 1,470 of 2,942 patients with a positive sentinel lymph node biopsy (SLNB), or that CLND rates were even lower at NCCI/NCI centers. The findings are provocative because current NCCN guideSee Dissection • page 3 UNIVERSITY OF General Surgery Best for Bile? An endoscopic approach rivals surgery for repair of bile duct injuries. • 8 News From the College Health Policy The surgical workforce issue heads the many initiatives of a new research institute. • 1 4 Breast Scan Plan Preoperative MRI imaging may change the management of nearly 20% of candidates for breast conservation. • 1 6 Future Surgeon Shortage Predicted B Y J E F F E VA N S Else vier Global Medical Ne ws VITAL SIGNS General Surgery Residency Positions Filled By U.S. Seniors Rise 1200 Positions offered Total positions filled Positions filled by U.S. seniors 1000 800 0 2004 2005 2006 2007 2008 Source: National Resident Matching Program C I N C I N N A T I — A predicted shortage of 1,300 general surgeons in the United States in 2010 could burgeon to at least 6,000 in 2050, according to a recent analysis that used specific assumptions about future population growth and physician training. Much depends on what changes occur in the near future to the number of residents who choose to become general surgeons. The predicted shortage could be even worse if the proportion of general surgery residents who go on to specialty surgery training programs increases substantially, Dr. Thomas E. Williams Jr. reported at the annual meeting of the Central Surgical Association. PGY-1 Positions Other surgeons at the meeting echoed Dr. Williams’ concern. His report could actually reflect “a best-case scenario,” according to Dr. Hiram C. Polk, because the current ratio of general surgery residents who stay in the field rather than receive additional specialty training may be “barely 50-50.” A record number of general surgeons also are retiring, said Dr. Polk, an ACS Fellow and professor of SURGERY NEWS surgery at the University of Louisville (Ky.), who was a discussant at the meeting. “Between the Alleghenies and the Rockies, this is the No. 1 problem in medical practice today for general surgeons,” Dr. Polk said. Dr. Williams’ study, which he coauthored with Central Surgical Association president and See Shortage • page 2 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED ELSEVIER GLOBAL MEDICAL NEWS

Table of Contents Feed for the Digital Edition of Surgery News - April 2008

Surgery News - April 2008 Contents Comorbidities Sway Bariatric Outcomes Database Finds Gap in Dissection For Melanoma Future Surgeon Shortage Predicted Dexterity Demo Best for Bile? Health Policy Scan Plan

Surgery News - April 2008

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