Surgery News - September 2007 - (Page 1)
VOL. 3 • NO. 9 • SEPTEMBER 2007 SURGERY NEWS THE OFFICIAL NEWSPAPER OF THE AMERICAN COLLEGE OF SURGEONS ©KENNETH BAEHR/CLEVELAND CLINIC Lymph Node Dissections Fall Short of Mark Failure to comply with 12-node standard. BY BRUCE K. DIXON INSIDE 20/20N What’s VISIO Ahead? Our new section contemplates changes likely to affect the future of surgical practice. • 4 THE Else vier Global Medical Ne ws The use of endoluminal techniques for the primary treatment of obesity is in its infancy, said Dr. Philip Schauer. New Tools Brighten Outlook for Weight Loss BY DOUG BRUNK Else vier Global Medical Ne ws merging endoluminal techniques and devices intended for weight loss therapy may reduce the risk of morbidity and mortality associated with current bariatric surgery approaches, according to the research findings of Dr. Philip Schauer and his associates. The use of endoluminal approaches to avoid any type of abdominal incision and, more importantly, any intra-abdominal dissection “may go a long way to further reduce the morbidity of these operations, making them cheaper and safer,” said Dr. Schauer in an interview. “Potentially, they may expand the access for patients. Only 1% of patients E with severe obesity are actually getting access to surgery, which is the only known therapy to be effective for a large percentage of patients.” Dr. Schauer, director of advanced laparoscopic and bariatric surgery at the bariatric and metabolic institute of the Cleveland Clinic, and his associates categorized the current endoluminal methods for weight loss therapy as presurgical endoluminal therapy, postsurgical endoluminal revision procedures, and primary procedures (Surg. Endosc. 2007; 21:347-56). In the presurgical endoluminal therapy arena, Dr. Michel Gagner and his associates pioneered a two-stage operation See Weight Loss • page 8 C H I C A G O — Lymph node evaluations in colorectal cancer are still falling short of recommended standards, two teams of researchers found in separate investigations that were presented at the annual meeting of the American Society of Clinical Oncology. Dr. Ashwani Rajput reported that fewer than half of colorectal cancer patients in a large population-based sample had 12 or more lymph nodes dissected and evaluated, as is recommended by the American College of Pathology. He and his colleagues analyzed the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database of 14,000 stage I-III colorectal cancer patients diagnosed in 2002. The three cancer stages were equally represented among 7,676 SEER database patients who did not have 12 lymph nodes evaluated. By comparison, the 12-plus lymph node standard was achieved in 90% of 345 patients treated at the eight National Comprehensive Cancer Network (NCCN) centers that participated in the study reported by Dr. Rajput, an attending surgeon at Roswell Park Cancer Institute in Buffalo, New York, and an ACS Fellow. These patients had newly diagnosed stage I-III colon or rectal cancer and underwent primary surgery in 2005-2006. The investigators compared the NCCN patients with the SEER patients. Altogether, 89% of the NCCN sample but only 45% of the SEER sample had at least 12 lymph nodes evaluated. Dr. Rajput called for more intensive education of surgeons and pathologists to increase compliance with the recommended standard. “We need to make sure that surgeons are doing the appropriate resections and that pathologists are spendSee Lymph Nodes • page 16 Practice Trends Graceful Exit A transplant surgeon and other physicians share insights on end-of-life care. • 1 0 News From the College Volunteer Awards Kudos go to three surgeons for domestic, international, and military activities. • 1 2 Oncology Getting the GIST Of Disease Research advances have increased our understanding of gastrointestinal stromal tumors. • 1 6 CMS Won’t Pay for Some Avoidable Events B Y M A RY E L L E N SCHNEIDER Else vier Global Medical Ne ws VITAL SIGNS Medical Schools With the Largest Increase In First-Year Enrollment From 2005 to 2006 Florida State University Brown University Boston University St. Louis University Pennsylvania State University West Virginia University Wayne State University Drexel University University of Alabama University of Nevada 36% 25% 16% 15% 13% ELSEVIER GLOBAL MEDICAL NEWS continuing effort to link payments to In asoon stopquality, Medicare will paying hospitals for certain conditions and infections acquired after admission. The change, mandated by Congress under the Deficit Reduction Act, will go into effect in October 2008. Starting this October, hospitals will have to report on secondary diagnoses that are present upon admission. Officials at the Centers for Medicare and Medicaid Services have identified eight “reasonably preventable” events that can be avoided in most cases by engaging in good medical practice. Hospitals will not receive additional payments for these secondary diagnoses if they de- velop after admission: An object left in the patient during surgery. Air embolism. Blood incompatibility. Catheter-associated urinary tract infections. Pressure ulcers. Vascular catheter–associated infections. Mediastinitis after coronary artery bypass graft surgery. Falls. SURGERY NEWS CMS officials will consider adding three other hospital-acquired conditions next year: Ventilator-associated pneumonia. Staphylococcus aureus septicemia. Deep vein thrombosis/pulmonary embolism. Under the new policy, the costs cannot be passed along to See Errors • page 3 Presorted Standard U.S. Postage PAID Permit No. 384 Lebanon Jct. KY 11% 11% 10% 10% 10% 60 Columbia Rd., Bldg. B Morristown, NJ 07960 CHANGE SERVICE REQUESTED Note: Based on 17,370 first-year enrollees as of Oct. 10, 2006. Source: Association of American Medical Colleges
Table of Contents for the Digital Edition of Surgery News - September 2007
Getting the GIST of Disease
Surgery News - September 2007
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