Immunotherapy for Breast Cancer: Current and Future Strategies
AbstractPurpose of ReviewThe breast tumor microenvironment is immunosuppressive and is increasingly recognized to play a significant role in tumorigenesis. A deeper understanding of normal and aberrant interactions between malignant and immune cells has allowed researchers to harness the immune system with novel immunotherapy strategies, many of which have shown promise in breast cancer. This review discusses the application of immunotherapy to the treatment of breast cancer.Recent FindingsBoth basic science and clinical trial data are rapidly developing in the use of immunotherapy for breast cancer. The current clinical t...
Source: Current Surgery Reports - October 10, 2017 Category: Surgery Source Type: research
Training Surgeons in the Current US Healthcare System: A Review of Recent Changes in Resident Education
AbstractPurpose of ReviewThis review highlights research focusing on the quality of surgical education within the current constraints of healthcare delivery in the United States.Recent FindingsThe Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial has provided the first evidence from a randomized controlled trial regarding duty hour regulations. Results of the FIRST trial were instrumental in the 2017 ACGME Common Core Requirement changes that allow for more flexibility in clinical hours to encourage professionalism and accommodate both patient care and educational opportunities. Research focusing on...
Source: Current Surgery Reports - October 10, 2017 Category: Surgery Source Type: research
Frailty in Trauma Patients: An Emerging Geriatric Syndrome
AbstractPurpose of ReviewIn contrast to their younger counterparts, geriatric patients have a decreased physiological reserve. This age-related vulnerability poses unique challenges for clinical decision-making. Additionally, as the population of the United States (U.S.) continues to age at a rapid pace, an increasing number of elderly patients need trauma care. Accordingly, this review examines the relevance of the concept of frailty in trauma cases, as well as its role in identifying vulnerable trauma patients and improving patient care. Moreover, through a process of simplification, we made the fundamental concepts of f...
Source: Current Surgery Reports - October 4, 2017 Category: Surgery Source Type: research
Bowel Anastomosis in Acute Care Surgery
AbstractPurpose of ReviewAcute care surgery encompasses the disciplines of trauma, emergency general surgery, and surgical critical care. Inherent in the disease processes of trauma and emergency general surgery is the potential for profound physiologic and anatomic derangements that make the decision to create an intestinal anastomosis, as well as the technique used, a vital step in having a successful outcome for the patient.Recent FindingsThe trauma literature is rife with conflicting data regarding ideal techniques for anastomosis creation. Two series by Brundage and colleagues suggest that handsewn techniques are supe...
Source: Current Surgery Reports - September 15, 2017 Category: Surgery Source Type: research
Tumor-homing Stem Cell Therapy for Brain Cancer
AbstractPurpose of ReviewEmerging evidence has demonstrated that genetically engineered stem cells have unique tumor-homing capacity that allows them to deliver anticancer gene products directly into local and invasive glioblastoma foci. New clinical trials have been launched based on the strength of promising preclinical studies. As such, the focus of the present review is to illustrate how stem cells can be used for the treatment of glioblastoma, various features of the stem cell that make them ideal drug delivery vehicles, modes of action, and recent clinical applications.Recent FindingsIncreasingly, mesenchymal, and ne...
Source: Current Surgery Reports - September 2, 2017 Category: Surgery Source Type: research
Robot-Assisted Thoracoscopic Surgery: Pros and Cons
AbstractPurpose of ReviewIn the last two decades, minimally invasive approaches for thoracic surgery have become the major challenge in the field of thoracic surgery. These techniques became preferable over open surgery (thoracotomy) in terms of reducing pain and having aesthetic advantages. However, patient selection is one of the most important factors for minimally invasive surgery because of related limitations and insufficiency of video-assisted thoracoscopic surgery (VATS).Recent FindingsRobot-assisted thoracoscopic surgery (RATS) has been developed to overcome the limitations of VATS. Better flexibility and transmis...
Source: Current Surgery Reports - September 1, 2017 Category: Surgery Source Type: research
Psychological Outcomes in Face Transplant Recipients: A Literature Review
AbstractPurpose of ReviewTo synthesize findings regarding the psychological outcomes of face transplantation.Recent FindingsThirty-seven face transplants have been done since the world ’s debutant case was featured in 2005. In spite of impressive clinical success, little has been achieved to date in terms of understanding the mental health, quality of life, and psychosocial outcomes of face transplant recipients.SummaryWe conducted a literature search in PubMed for studies reporting any psychosocial measure in face transplant recipients, between 2005 and 2017. We identified 20 articles: 11 articles reported qualitative e...
Source: Current Surgery Reports - August 29, 2017 Category: Surgery Source Type: research
Pectus Excavatum Repair in Adults: Indications and How To Do It
AbstractPurpose of ReviewThe minimally invasive Nuss procedure has been effectively used for surgical correction of pediatric and adolescent pectus patients. In the past, the use of this less invasive technique was believed to be limited to young patients. This approach with technique modifications has been successfully extended to the treatment of even advanced aged adults. The presentation, evaluation and minimally invasive surgical treatment of adult pectus excavatum patient is reviewed.Recent FindingsAdult pectus excavatum patients may present with new onset or worsening of symptoms. Repair of the deformity has been sh...
Source: Current Surgery Reports - August 21, 2017 Category: Surgery Source Type: research
Modern Metrics for Evaluating Surgical Technical Skills
AbstractPurpose of reviewAssessment of surgical technical skills has traditionally occurred through informal means using sporadic and subjective feedback. Recent trends in patient safety, simulation training, and technological advances have generated a need for accurate and objective assessment of surgical technical skills. This review is intended to identify the breadth and scope of recent approaches to surgical skill assessment and metrics and define gaps for further development.Recent findingsSurgical skill assessment methods can be broadly categorized as (1) assessments by expert observations using validated task-speci...
Source: Current Surgery Reports - August 18, 2017 Category: Surgery Source Type: research
The Current Status of REBOA in Traumatic Shock
AbstractPurpose of ReviewHemorrhagic shock remains a major cause of potentially preventable death in civilian and military trauma. Balloon occlusion of the aorta has emerged as a viable technique to address non-compressible torso hemorrhage. The purpose of this review is to describe the current state of translational and clinical data on REBOA and help define its role in modern trauma algorithms.Recent FindingsRecent findings suggest that REBOA is feasible in many clinical areas including prehospital. Robust animal data define a reasonable safety profile and current clinical data suggest that there are subset(s) of patient...
Source: Current Surgery Reports - August 7, 2017 Category: Surgery Source Type: research
Surgical Stabilization of Rib Fractures
AbstractPurpose of ReviewSurgical stabilization of rib fractures (aka rib plating) is underutilized, partly due to a perceived lack of evidence of benefit and unfamiliarity with the operation. The goal of this review is to identify and summarize the evidence surrounding surgical stabilization of chest wall injury in flail and non-flail injury patterns and highlight the limitations of our current knowledge.Recent FindingsRecent meta-analyses and prior trials have provided evidence that rib fixation in flail chest injuries decreases the need for mechanical ventilation, decreases risk of pneumonia, and decreases mortality. Ad...
Source: Current Surgery Reports - August 3, 2017 Category: Surgery Source Type: research
Surgical Management of Flail Chest: State of Art and Future Perspectives
AbstractPurpose of ReviewRib fractures are common among trauma patients with both blunt chest wall and thoraco-abdominal trauma, seen in up to 39% of patients following blunt chest trauma and present in 10% of all trauma admissions and, in these individuals, mortality rates can reach 9 –16%. Notwithstanding, the objective of surgical stabilization is to recover thoracic wall rigidity and restore normal ventilation and functions, thus decreasing mortality and morbidity.Recent FindingsCurrently, all possible indications for surgical rib fixation are far away from a consensus statement backed up with strong evidence.Summary...
Source: Current Surgery Reports - July 25, 2017 Category: Surgery Source Type: research
Simulation Training in Surgical Education
AbstractPurpose of ReviewOur review aims to describe the use of simulation-based training throughout the continuum of surgical education.Recent FindingsIn addition to well-known procedural-based surgical simulation modalities like the Fundamentals of Laparoscopic Surgery and Fundamentals of Endoscopic Surgery, there are several novel uses of simulation including its use for preparing medical students for surgical residency, resident interviews and onboarding, residency training, mental skills training, and continuing education for practicing surgeons.SummarySimulation is a cost effective and useful method to improve traine...
Source: Current Surgery Reports - July 21, 2017 Category: Surgery Source Type: research
Transoral Robotic Thyroidectomy
AbstractPurpose of ReviewTransoral approach is nowadays gaining the enormous attention among the thyroid surgeons, as it showed definite merits over the previously developed remote-access approaches for thyroidectomy, such as the ideal cosmetic outcome without remaining the postoperative scars, and the lesser dissection of the flap resulting in the decreased operation time and lesser postoperative pain.Recent FindingsInstead of using the conventional endoscopic operation apparatus and instruments, we could successfully introduce the robotic surgical system to this novel surgical approach, and, in turn, could have the optim...
Source: Current Surgery Reports - July 17, 2017 Category: Surgery Source Type: research
Evidence-Based Support for Nutrition Therapy in Head and Neck Cancer
This article aims to review the current nutrition literature pertaining to H&N cancer patients and to present evidence-based strategies for nutritional support specific to this population.Recent FindingsAggressive nutritional intervention is frequently required in the H&N cancer patient population. Rehabilitating nutrition during operative and nonoperative treatment improves compliance with treatment, quality of life, and clinical outcomes. When and whether to establishing alternative enteral access are points of controversy, although recent evidence suggests prophylactic enteral feeding tube placement should not b...
Source: Current Surgery Reports - July 6, 2017 Category: Surgery Source Type: research
