New research was presented at ACS 2015, the American College of Surgeons’ annual clinical congress, from October 4 to 8 in Chicago. The features below highlight some of the studies emerging from the conference.
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Metastatic Melanoma Resection
The Particulars: Melanoma that has metastasized to the abdomen has been considered incurable and seldom received surgical resection in the past. Recent advances in medicine may allow for successful resection of this cancer type, but few studies have assessed outcomes in this patient population.
Data Breakdown: For a study, the outcomes of melanoma patients with abdominal metastases were compared based on whether or not these individuals underwent surgical resection of the metastases. The surgical patient group had an average survival of 18 months, compared with an average survival of 7 months for the non-surgical group.
Take Home Pearl: Among patients with melanoma and abdominal metastases, surgical resection of the metastases appears to more than double the length of survival when compared with receipt of medical therapy alone.
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Poor Recall in Colonoscopy Patients
The Particulars: Little is known regarding the ability of colonoscopy patients to recall details regarding their last colonoscopy, including when and where it was performed.
Data Breakdown: Colorectal surgeons grouped participants in a study based upon whether it had been 2 months, 1 year, 2 years, or 4 years since their last colonoscopy and compared the results. The table below summarizes key findings:
| Time since colonoscopy | ||||
| 2 months | 1 year | 2 years | 4 years | |
| Remembered date of last scope within 1 month | 94% | 42% | 30% | 28% |
| Knew about presence of polyps on last scope | 65% | 32% | 36% | 38% |
| Accurately recalled number of polyps on last scope | 40% | 11% | 7% | 6% |
Take Home Pearls: Colonoscopy patients appear to be increasingly unlikely to recall details about their colonoscopy with the passage of time since the procedure. Study authors suggest that ensuring patients know who performed their last colonoscopy and where it was performed may help reduce the number of unnecessary repeat procedures.
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Surgeon Volume & Thyroidectomy
The Particulars: Previous research has shown that surgeon experience is highly predictive of patient outcomes following total thyroidectomy. However, the number of cases that defines a high-volume thyroid surgeon remains unclear.
Data Breakdown: Study investigators analyzed the cases of nearly 17,000 adult total thyroidectomy patients. They found that the likelihood of experiencing in-hospital complications decreased as surgeons’ annual volume of thyroidectomy increased. Patients who underwent surgery by surgeons who performed 25 or more thyroidectomies per year (high-volume) had a complication rate of 4.2%, compared with a rate of 6.4% observed among patients of surgeons who performed less than 25 thyroidectomies annually (low-volume). However, only 19.0% of patients underwent a thyroidectomy performed by a high-volume surgeon, with most surgeons only performing seven per year. Patients with low-volume surgeons had longer hospital stays and higher hospital costs.
Take Home Pearl: Patients undergoing total thyroidectomy by surgeons who perform less than 25 of these surgeries per year appear to have a higher complication rate, longer lengths of stay, and higher hospital costs.
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Unilateral Vs Contralateral Prophylactic Mastectomy
The Particulars: Data indicate that American women with unilateral breast cancer are increasingly choosing contralateral prophylactic mastectomy (CPM). However, there is little evidence available to support that CPM improves survival better than unilateral mastectomy.
Data Breakdown: For a study researchers compared the outcomes of patients with unilateral breast cancer who underwent CPM or unilateral mastectomy. At 20 years follow-up, women who underwent unilateral mastectomy had a net gain of 0.21 quality-adjusted life years compared with those who underwent CPM. Single mastectomy plus 20 years of routine mammograms on the remaining breast had an estimated average cost that was $5,052 less than that of CPM.
Take Home Pearl: Women with unilateral breast cancer who undergo unilateral mastectomy appear to have a higher quality of life and lower costs over the following 20 years when compared with those who undergo CPM.
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Simulation Training Improves Trauma Care
The Particulars: Research has shown that a small window of time exists in which to evaluate and stabilize trauma patients in order to prevent mortality. A simulation training program developed by trauma surgeons to reduce times to get patients a CT scan may help reduce the time for assessment and stabilization of trauma patients.
Data Breakdown: A simulation training model was developed by trauma surgeons with the input of an advocacy organization for trauma survivors and their families. Researchers then evaluated its impact on real patients in real trauma emergencies. Times to primary and secondary survey and times from arrival to transport to CT scan were compared for before and after initiation of the training project. After initiating the project, time to primary survey did not improve. However, time to secondary survey decreased from 14 minutes to 6 minutes, and time to CT scan decreased from 23 minutes to 16 minutes.
Take Home Pearl: A simulation training program appears to improve time to secondary survey and time to CT scan for trauma patients when compared with usual trauma care.
For more information on these studies and others that were presented at ACS 2015, visit https://www.facs.org/clincon2015.
