Impact of hospital size on the outcomes of appendectomy in children: an analysis of a comprehensive nationwide pediatric dataset
ConclusionThe number of hospital visits and the length of hospital stay was higher in small-sized hospitals in comparison to large-sized hospitals. Appendectomy performed in the larger hospital showed better outcomes in pediatric patients. We recommend that pediatric surgical procedures be performed in large hospitals, and that proper incentives be given for procedures to be performed by pediatric specialists. (Source: Surgery Today)
Source: Surgery Today - May 30, 2020 Category: Surgery Source Type: research

Impact of marginal resection for hepatocellular carcinoma
AbstractPurposeThe surgical margin for liver resection to treat hepatocellular carcinoma (HCC) is occasionally  
Source: Surgery Today - May 29, 2020 Category: Surgery Source Type: research

Conversion surgery for initially unresectable biliary malignancies: a multicenter retrospective cohort study
AbstractPurposeFew studies have focused on conversion surgery for biliary malignancy; thus, it is not clear if this treatment modality can extend the survival of patients with unresectable biliary malignancy. We conducted a multicenter retrospective cohort study to evaluate the surgical outcomes of conversion surgery in this setting and analyze long-term survival.MethodsWe collected clinical data retrospectively on patients who underwent conversion surgery for biliary malignancy.ResultsTwenty-four patients met our inclusion criteria. Preoperative chemotherapy regimens or chemoradiation therapy regimens were administered ba...
Source: Surgery Today - May 28, 2020 Category: Surgery Source Type: research

The COVID-19 Pandemic in Japan
AbstractSince its initial outbreak in China, in December, 2019, COVID-19 has spread rapidly across the globe. At the time of writing, on April 29, 2020, infections had been confirmed in more than 200 countries and regions and 3,018,681 infections and 207,973 deaths had been recorded. In Japan, the first confirmed case of SARS-CoV-2 infection was reported on January 16, 2020, since when, the number of domestic infections and the death toll have reached 13,852 and 389, respectively, representing exponential increases. Moreover, both domestically and internationally, the shortage of medical resources and the spread of infecti...
Source: Surgery Today - May 27, 2020 Category: Surgery Source Type: research

Can plain chest X-ray replace computed tomography for the follow-up of children who have undergone the Nuss procedure?
AbstractPurposeTo establish whether new indices on plain chest X-ray (CXR) can replace those on computed tomography (CT) for the follow-up of children who have undergone the Nuss procedure.MethodsThe subjects of this retrospective study were 45 children who underwent the Nuss procedure between 2000 and 2016. The Haller index (HI) was measured by preoperative CT. Preoperative and postoperative chest deformities were evaluated by two CXR measurements: the concave rate on the lateral view (CR; the depth of the concavity divided by the anterior –posterior diameter of the rib cage) and the tracheal bifurcation angle (TBA)...
Source: Surgery Today - May 26, 2020 Category: Surgery Source Type: research

The off-hour effect among severe trauma patients: a nationwide cohort study in Japan
ConclusionsWe did not find a negative off-hour effect on in-hospital mortality among severe trauma patients. (Source: Surgery Today)
Source: Surgery Today - May 26, 2020 Category: Surgery Source Type: research

Serum p53 antibody: useful for detecting gastric cancer but not for predicting prognosis after surgery
ConclusionsBased on our findings, s-p53-Abs improve the overall rate of positivity for detecting gastric cancer, but the prognostic value of a high s-p53-Ab titer for predicting overall survival is limited. (Source: Surgery Today)
Source: Surgery Today - May 26, 2020 Category: Surgery Source Type: research

Clinical outcomes of radical gastrectomy following trastuzumab-based chemotherapy for stage IV HER2-positive gastric or gastroesophageal junction cancer
ConclusionCombined preoperative T-mab-based chemotherapy and surgery appears to be safe and effective for stage IV HER2-positive gastric or gastroesophageal junction cancer, with a clinically meaningful impact on RFS and OS. (Source: Surgery Today)
Source: Surgery Today - May 26, 2020 Category: Surgery Source Type: research

D2 lymph node dissection confers little benefit on the overall survival of older patients with resectable gastric cancer: a propensity score-matching analysis of a multi-institutional dataset
AbstractPurposeAging societies comprise an increasing number of elderly gastric cancer (GC) patients. We herein attempted to determine whether D2 lymphadenectomy is beneficial for older GC patients.MethodsWe retrospectively analyzed a multi-institutional dataset including 3484 patients who received surgical resection for GC. For the analysis, we selected patients aged  ≥ 80 years who were clinically diagnosed with T1N + or T2-4 GC. To balance the essential variables including the type of gastrectomy and the stage of progression, propensity score matching was conducted, and we compared th...
Source: Surgery Today - May 25, 2020 Category: Surgery Source Type: research

Correlation between indocyanine green visualization time in the gastric tube and postoperative endoscopic assessment of the anastomosis after esophageal surgery
ConclusionDelay in the ICG visualization time of pulled-up GT was associated with ulcer formation on the anastomosis and AL after esophageal surgery. (Source: Surgery Today)
Source: Surgery Today - May 22, 2020 Category: Surgery Source Type: research

Verification of the Japanese staging system for rectal cancer, focusing on differences with the TNM classification
ConclusionsThe 9th JSCCR, which includes the concepts of jN3 and ND, is useful for the risk stratification of rectal cancer, and the contributes to precise decision-making for follow-up management and adjuvant therapy. (Source: Surgery Today)
Source: Surgery Today - May 22, 2020 Category: Surgery Source Type: research

Anastomotic bleeding following ileocolic end-to-side anastomosis using a circular stapler: incidence and risk factors
ConclusionEnd-to-side anastomosis is safe and feasible, but must be performed carefully in the elderly, who are at higher risk of anastomotic bleeding. (Source: Surgery Today)
Source: Surgery Today - May 20, 2020 Category: Surgery Source Type: research

Low metabolic activity in primary gastric adenocarcinoma is associated with resistance to chemoradiation and the presence of signet ring cells
ConclusionA high SUVmax was associated with sensitivity to chemoradiation and pCR in GAC, and signet ring cells seemed to confer resistance. (Source: Surgery Today)
Source: Surgery Today - May 14, 2020 Category: Surgery Source Type: research

Prognostic value of plasma fibrinogen and d -dimer levels in patients with surgically resected non-small cell lung cancer
AbstractPurposeA high plasma level of either fibrinogen ord-dimer has been shown to correlate with a poor prognosis in patients with surgically resected non-small-cell lung cancer (NSCLC). The present study aimed to identify whether or not both markers combined had a superior prognostic value to either alone.MethodsOf the 1344 patients who underwent surgical resection for NSCLC at our institution between January 2007 and December 2016, 1065 had preoperative plasma fibrinogen andd-dimer data available and were included in the analysis.ResultsThe recurrence-free survival (RFS) and overall survival (OS) rates were similar for...
Source: Surgery Today - May 14, 2020 Category: Surgery Source Type: research

Correction to: Predictors of nodal upstaging in patients with cT1-3N0 non-small cell lung cancer (NSCLC): results from the Italian VATS Group Registry
In the original publication, Carlo Curcio was not included in the author list. The correct author list is included in this Correction. (Source: Surgery Today)
Source: Surgery Today - May 10, 2020 Category: Surgery Source Type: research

Impact of a board certification system and implementation of clinical practice guidelines for pancreatic cancer on mortality of pancreaticoduodenectomy
ConclusionsThe measurement of the appropriate QIs is suggested to help improve the mortality in pancreaticoduodenectomy. Masamichi Mizuma and Hiroyuki Yamamoto equally contributed (Source: Surgery Today)
Source: Surgery Today - May 7, 2020 Category: Surgery Source Type: research

Ribcage procedure after neoadjuvant chemoradiotherapy for non-small cell lung cancer involving the chest wall
ConclusionOur findings suggest that the ribcage procedure is the preferable surgical option as it can prevent chest wall deformities as well as local recurrence. (Source: Surgery Today)
Source: Surgery Today - May 5, 2020 Category: Surgery Source Type: research

Robotic surgery for rectal cancer as a platform to build on: review of current evidence
AbstractLaparoscopy in colorectal surgery reduces the rate of postoperative complications, shortens the length of stay in hospital, and improves the quality of patient care. Despite these established benefits, the technical challenges of rectal resection for cancer have resulted in most operations being performed through open surgery in the USA. Moreover, controversy in the current literature questions the oncologic safety of a laparoscopic approach for rectal cancer. How then can surgeons innovate to overcome the technical challenges while preserving the critical oncological outcomes of high-quality rectal cancer surgery?...
Source: Surgery Today - May 4, 2020 Category: Surgery Source Type: research

Human-scale lung regeneration based on decellularized matrix scaffolds as a biologic platform
AbstractLung transplantation is currently the only curative treatment for patients with end-stage lung disease; however, donor organ shortage and the need for intense immunosuppression limit its broad clinical application. Bioartificial lungs created by combining native matrix scaffolds with patient-derived cells might overcome these problems. Decellularization involves stripping away cells while leaving behind the extracellular matrix scaffold. Cadaveric lungs are decellularized by detergent perfusion, and histologic examination confirms the absence of cellular components but the preservation of matrix proteins. The resul...
Source: Surgery Today - May 4, 2020 Category: Surgery Source Type: research

Comment on “The psoas muscle index as a predictor of mortality and morbidity of geriatric trauma patients: experience of a major trauma center in Kobe.”
(Source: Surgery Today)
Source: Surgery Today - May 1, 2020 Category: Surgery Source Type: research

Influence of endoscopic resection on additional laparoscopic distal gastrectomy: a propensity score-matching analysis
ConclusionER prior to surgical resection showed no significant influence on postoperative complications or mortality. LDG can be safely performed to achieve radical resection after incomplete ER. (Source: Surgery Today)
Source: Surgery Today - May 1, 2020 Category: Surgery Source Type: research

Feasibility of preserving the remnant stomach during distal pancreatectomy after distal gastrectomy
ConclusionOur study suggested that the remnant stomach may be safely preserved when performing DP in patients with a history of DG with respect to short-term morbidities. However, there are some concerns about the long-term nutritional status in patients with a history of DG. (Source: Surgery Today)
Source: Surgery Today - May 1, 2020 Category: Surgery Source Type: research

Hepatectomy using a novel cart-based indocyanine green fluorescence imaging system
We report our initial experience of performing hepatic resection using the novel cart-based ICG fluorescence device LIGHTVISION®. This device has several promising features, including the fact that there is no need to switch off the room light, it has hands-free operability, and it can be located away from the workspace to facilitate a good field of vision. We used the LIGHTVISION® for 15 patients and detected 59 nodules (86.8%) in a total of 68 tumors in the resected specimens during surgery. The LIGHTVISION® was used to identify the hepatic segments in ten patients, and the boundaries of the segment were clea...
Source: Surgery Today - April 29, 2020 Category: Surgery Source Type: research

Reply to the letter
(Source: Surgery Today)
Source: Surgery Today - April 29, 2020 Category: Surgery Source Type: research

The prognostic value of the prognostic nutritional index and inflammation-based markers in obstructive colorectal cancer
AbstractPurposeInflammation-based markers predict long-term outcomes of various malignancies. We investigated the relationship between these markers and the long-term survival in obstructive colorectal cancer (OCRC) patients with self-expandable metallic colonic stents (SEMSs) who subsequently received curative surgery.MethodsWe retrospectively analyzed 72 consecutive pathological stage II and III OCRC patients between 2013 and 2019. The prognostic significance of the prognostic nutritional index (PNI), neutrophil –lymphocyte ratio (NLR), lymphocyte–monocyte ratio (LMR), and platelet–lymphocyte ratio (PLR...
Source: Surgery Today - April 28, 2020 Category: Surgery Source Type: research

An outcome analysis of predictive factors for portal or splenic vein thrombosis after distal pancreatectomy
AbstractPurposesThe aim of this study was to explore predictive factors for portal or splenic vein thrombosis (VT) that might cause serious problems after distal pancreatectomy (DP).MethodsA total of 230 patients who underwent DP between 2008 and 2017 were retrospectively reviewed to identify predictive factors for portal or splenic VT.ResultsUltimately, 164 patients were analyzed. Portal or splenic VT was significantly correlated with age  
Source: Surgery Today - April 28, 2020 Category: Surgery Source Type: research

Open colectomy vs. laparoscopic colectomy in Japan: a retrospective study using real-world data from the diagnosis procedure combination database
AbstractPurposeTo compare the short-term outcomes of conventional open colectomy with those of laparoscopic colectomy for colon cancer.MethodsWe retrieved data between January 2014 and March 2016 from the Diagnosis Procedure Combination database. A total of 69,418 patients who underwent colectomy for colon cancer were analyzed from among 15,901,766 cases of colorectal cancer. We applied a multilevel logistic regression model using a 2-level structure of individuals nested from 1065 hospitals.ResultsA total of 22,440 open colectomy and 46,978 laparoscopic colectomy procedures were performed. The in-hospital mortality rate w...
Source: Surgery Today - April 25, 2020 Category: Surgery Source Type: research

Modified left subsuperior segmentectomy via 2-cm uniportal video-assisted thoracoscopic surgery
We describe our modified technique of performing simplified left subsuperior segmentectomy for a lung nodule, via 2-cm uniportal VATS. The uniportal approach was different from the traditional approach made by blunt separation into the thorax without electrocautery. Our modified technique minimizes damage to the intercostal nerves and muscles. We also simplified the subsuperior segmentectomy procedure according to the findings of three-dimensional (3D) computed tomography angiography and bronchography. Combining these two techniques achieves a new more minimally invasive method for subsuperior segmentectomy. (Source: Surgery Today)
Source: Surgery Today - April 23, 2020 Category: Surgery Source Type: research

The duodenal tube test is more specific than hepatobiliary scintigraphy for identifying bile excretion in the differential diagnosis of biliary atresia
ConclusionsThe DTT could be more a specific method than HS to detect bile excretion. Thus, the DTT should be incorporated into the multidisciplinary diagnostic approach for the differential diagnosis of BA to prevent unnecessary intraoperative cholangiography in patients who do not have BA. (Source: Surgery Today)
Source: Surgery Today - April 20, 2020 Category: Surgery Source Type: research

Scheduled intravenous acetaminophen versus nonsteroidal anti-inflammatory drugs (NSAIDs) for better short-term outcomes after esophagectomy for esophageal cancer
AbstractPurposeTo evaluate the effect of scheduled intravenous acetaminophen administration versus nonsteroidal anti-inflammatory drugs on postoperative pain and short-term outcomes after esophagectomy.MethodsThe subjects of this study were 150 consecutive patients who underwent esophagectomy for esophageal cancer. Seventy-seven patients received scheduled intravenous acetaminophen and the other 73 received NSAIDs enterally for postoperative pain management. We compared the postoperative pain and short-term outcomes between the groups. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to...
Source: Surgery Today - April 16, 2020 Category: Surgery Source Type: research

Liver transplantation in elderly patients: what do we know at the beginning of 2020?
AbstractAn aging population has prompted us to evaluate the indications of liver transplantation (LT) in elderly patients more frequently. In this review, we summarize the short- and long-term results after LT in elderly patients and also discuss the criteria used to select patients and how recipient age can challenge current allocation systems. Briefly, the feasibility and early outcomes of LT in elderly patients compare favorably with those of younger patients. Although long-term survival is less than satisfactory, large-scale studies show that the transplant survival benefit is similar for elderly and younger patients. ...
Source: Surgery Today - April 11, 2020 Category: Surgery Source Type: research

Association between preoperative tumor necrosis factor alpha inhibitor and surgical site infection after surgery for inflammatory bowel disease: a systematic review and meta-analysis
AbstractTumor necrosis factor-alpha inhibitor (TNFi) treatment is effective for ulcerative colitis (UC) and Crohn ’s disease (CD). Although several meta-analyses have been performed to evaluate the association between TNFi treatment and surgical morbidity, the results are controversial. We conducted a systematic review and meta-analysis of the prevention of surgical site infection (SSI) after surgery for UC a nd CD in patients on TNFis, based on literature published between January 2000 and May 2019 (registered on PROSPERO, No. CRD42019134156). Overall, 2175 UC patients in 13 observational studies (OBSs) and 7084 CD ...
Source: Surgery Today - April 10, 2020 Category: Surgery Source Type: research

Clinically applicable cases of anti-programmed cell death protein 1 immunotherapy for colorectal cancer patients
AbstractWe investigated the prevalence and characteristics of defective mismatch repair (dMMR) in colorectal cancer (CRC) patients who would potentially benefit from anti-programmed cell death protein 1 (PD-1) immunotherapy. Medical records were obtained and reviewed for 1147 patients who underwent surgical resection of stage I –IV CRC, in whom universal screening for Lynch syndrome using immunohistochemistry for MMR proteins had been undertaken. The molecular characteristics of dMMR CRCs were also investigated. Defective MMR accounted for 5.2% of stage I–IV CRC patients, including 12 (1.0% of all CRC patients)...
Source: Surgery Today - April 6, 2020 Category: Surgery Source Type: research

Etiology and impact on outcomes of polycystic kidney disease in abdominal aortic aneurysm
AbstractPurposeWe investigated the etiology and impact on outcomes of polycystic kidney disease in patients with abdominal aortic aneurysm.MethodsEight-hundred patients who underwent open (n = 603) or endovascular aortic repair (n = 197) were divided into three groups: no cyst (n = 204), non-polycystic kidney (n = 503), and polycystic kidney (≥ 5 cysts in the bilateral kidneys,n = 93). The characteristics and outcomes were compared among the groups.ResultsIn the polycystic kidney group, the age was increased and the proportions of patients with...
Source: Surgery Today - April 6, 2020 Category: Surgery Source Type: research

Near-infrared fluorescence-guided surgery using indocyanine green facilitates secure infrapyloric lymph node dissection during laparoscopic distal gastrectomy
This study enrolled patients with early gastric cancer scheduled for laparoscopic distal gastrectomy. After intraoperative submucosal injection of ICG (0.1  mg/mL), LN dissection was conducted under near-infrared ICG fluorescence guidance. The operation time, bleeding events during infrapyloric LN dissection were analyzed. Cases were retrospectively 1:3 propensity-score matched to patients who underwent laparoscopic distal gastrectomy without ICG inje ction.ResultsThe mean time from midline omentectomy to exposure of the right gastroepiploic vein was significantly shorter in the ICG group (n = 20) than i...
Source: Surgery Today - April 3, 2020 Category: Surgery Source Type: research

Facilitated completion of 1-year adjuvant S-1 monotherapy for pathological stage II or III gastric cancer by medical oncologists
ConclusionsMedical oncologists may facilitate completion of adjuvant S-1 monotherapy. (Source: Surgery Today)
Source: Surgery Today - April 2, 2020 Category: Surgery Source Type: research

The novel mechanism of valproate to prevent peritoneal adhesion formation
ConclusionThe chymase inhibitory effect of valproate may contribute to prevent adhesion formation after abdominal injury. (Source: Surgery Today)
Source: Surgery Today - April 1, 2020 Category: Surgery Source Type: research

Correction to: Safety and efficacy of preoperative chemotherapy followed by esophagectomy versus upfront surgery for resectable esophageal squamous cell carcinoma
In the original publication, in Abstract, the second sentence of Results has been incorrectly published as. (Source: Surgery Today)
Source: Surgery Today - March 31, 2020 Category: Surgery Source Type: research

Clinical significance of preoperative CA19-9 and lymph node metastasis in intrahepatic cholangiocarcinoma
This study aimed to identify prognostic factors for patients with ICC after a curative resection and clarify the appropriate indications for surgical resection and postoperative adjuvant chemotherapy.MethodsThis retrospective study included 81 patients who underwent curative resection for ICC between April 1995 and December 2014. Kaplan –Meier and Cox regression models were used to analyze the effects of clinicopathological features on overall and recurrence-free survival.ResultsThe cumulative 5-year overall survival of 81 patients was 57.2%, and the 5-year recurrence-free survival was 24.0%. The multivariate analysi...
Source: Surgery Today - March 27, 2020 Category: Surgery Source Type: research

Reply to comment on “Is surgical resection superior to proton beam therapy for operable hepatocellular carcinoma?”
(Source: Surgery Today)
Source: Surgery Today - March 26, 2020 Category: Surgery Source Type: research

Correction to: The enhanced recovery after surgery (ERAS) protocol to promote recovery following esophageal cancer resection
The original article has been corrected. (Source: Surgery Today)
Source: Surgery Today - March 25, 2020 Category: Surgery Source Type: research

Pulmonary vessels and bronchial anatomy of the left lower lobe
ConclusionWe identified various bronchovascular patterns in the LLL of a large number of patients. Our results provide useful information for anatomic pulmonary resection, especially segmentectomy. (Source: Surgery Today)
Source: Surgery Today - March 21, 2020 Category: Surgery Source Type: research

Neuroendocrine tumors of the lung: clinicopathological and molecular features
AbstractIn 1970, neuroendocrine tumors of the lung were classified into three categories: typical carcinoid (TC), atypical carcinoid (AC), and small cell lung carcinoma (SCLC). The third edition of the World Health Organization (WHO) classification in 1999 defined large cell neuroendocrine carcinoma (LCNEC) as a variant of large cell carcinomas, whereas the fourth edition of the WHO classification redefined LCNEC as a neuroendocrine tumor. Currently, neuroendocrine tumors of the lung are classified into four main categories: TC, AC, LCNEC, and SCLC. Although the treatments for TC, AC, and SCLC have not changed remarkably, ...
Source: Surgery Today - March 19, 2020 Category: Surgery Source Type: research

Prognostic factors and a new preliminary scoring system for remission of type 2 diabetes mellitus after laparoscopic sleeve gastrectomy
ConclusionOur preliminary scoring system attains a good level of accuracy for predicting T2DM remission. (Source: Surgery Today)
Source: Surgery Today - March 13, 2020 Category: Surgery Source Type: research

Diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration to assess tumor-programmed cell death ligand-1 expression in mediastinal lymph nodes metastasized from non-small cell lung cancer
AbstractPurposeWe investigated the utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to evaluate programmed cell death ligand-1 (PD-L1) expression in patients with advanced non-small cell lung cancer (NSCLC).MethodsA retrospective chart review of patients who underwent EBUS-TBNA between April 2017 and April 2019 was conducted. Among patients diagnosed with NSCLC, we investigated the rate of successful evaluation of tumor PD-L1 expression, compared the relevant factors between patients with evaluable and those with unevaluable PD-L1 expression, and examined the response to immune checkp...
Source: Surgery Today - March 12, 2020 Category: Surgery Source Type: research

Laparoscopic multivisceral resection for locally advanced colon cancer: a single-center analysis of short- and long-term outcomes
AbstractPurposeWe evaluated the technical and oncological safety of laparoscopic multivisceral resection (MVR) in selected patients with locally advanced colon cancer (LACC).MethodsWe compared the clinical backgrounds, and short- and long-term outcomes of patients who underwent laparoscopic vs. those who underwent open MVR for LACC en bloc at our hospital.ResultsBetween January, 2004 and December, 2015, 140 patients underwent MVR of the primary tumor en bloc via laparoscopic surgery (laparoscopic group; LG,n = 69) or open surgery (open group; OG,n = 71). Laparoscopic surgery was selected mainly ...
Source: Surgery Today - March 9, 2020 Category: Surgery Source Type: research

Perioperative pirfenidone treatment as prophylaxis against acute exacerbation of idiopathic pulmonary fibrosis: a single-center analysis
ConclusionsAlthough perioperative pirfenidone treatment did not obviously prevent postoperative AE-IPF, it may reduce the mortality of lung cancer patients with IPF. (Source: Surgery Today)
Source: Surgery Today - March 6, 2020 Category: Surgery Source Type: research

A nodal diagnosis by computed tomography is unreliable for patients who need additional gastrectomy after endoscopic submucosal dissection
ConclusionsA nodal diagnosis by CT is unreliable for patients who need additional gastrectomy after ESD. (Source: Surgery Today)
Source: Surgery Today - March 4, 2020 Category: Surgery Source Type: research

Are graduating residents sufficiently competent? Results of a national gap analysis survey of program directors and graduating residents in Japan
ConclusionMore than half of the GRs in Japan lacked the confidence in their skill to perform one-third of the surgical procedures selected for evaluation in this study. These findings should be used to update the surgical education curriculum in Japan. (Source: Surgery Today)
Source: Surgery Today - March 3, 2020 Category: Surgery Source Type: research

An integrated analysis of host- and tumor-derived markers for predicting high-grade dysplasia and associated invasive carcinoma of intraductal papillary mucinous neoplasms of the pancreas
ConclusionsThe combination of multiple markers of host-derived inflammation and tumor-derived focal hypermetabolism can serve as a predictor for the presence of HGD/INV. (Source: Surgery Today)
Source: Surgery Today - March 2, 2020 Category: Surgery Source Type: research