Latest Updates

Principles in Reconstruction after Resection of Extremity and Truncal Sarcomas

Evan Matros, MD, MPH, Jonas A. Nelson, MD
    • Resection and reconstruction of sarcoma defects require a multidisciplinary effort to achieve the oncologic and reconstructive result with the goal of negative margins and stable bony and soft tissue coverage with appropriate function.
    • Although the reconstructive ladder still applies to postresection defects, advances in microsurgical techniques offer options that, although potentially more complex, provide a more stable long-term solution to complex reconstructive challenges.
    • Advances in perforator techniques for reconstruction have afforded improved donor sites with less donor site morbidity as muscle units are not sacrificed.
    • Limb salvage is now the standard of care following lower extremity sarcoma resection and reconstruction.

Estrogen Receptor–Positive, HER-2 Nonamplified Breast Cancer

Leisha C Elmore, MD, MPHS, Julie A. Margenthaler, MD
    • • Estrogen receptor (ER)-positive tumors represent 70% of all breast cancers and generally have a good prognosis but are heterogeneous, and biological behavior can be more closely predicted by luminal subtype.
    • • Endocrine therapy reduces locoregional and distant failure in ER-positive tumors, with tamoxifen being the drug of choice in premenopausal women and tamoxifen or an aromatase inhibitor alone or in sequence being used in postmenopausal women.
    • • Although clinicopathologic features, such as patient risk factors, pathologic stage, and lymphovascular invasion, guide therapy selection, genomic profiling of the tumor provides insight into the risk of recurrence and is a commonly used tool to determine the need for adjuvant chemotherapy. Oncotype DX is the most broadly used molecular profiling tool.
    • • Ovarian suppression, either reversibly or irreversibly, in addition to hormone therapy reduces the risk of recurrence in premenopausal women who are at high risk for recurrence indicated by the need for chemotherapy.
    • • Neoadjuvant and adjuvant chemotherapy have equivalent long-term outcomes, but neoadjuvant therapy can be used to downstage a tumor to make it amenable to breast-conserving therapy or to evaluate tumor response to systemic therapy and provide prognostic information.

Basic Concepts of Anesthesia

Pooja Pandya, MD, George P. Yang, MD, PhD
    • Increasing adoption of risk calculators to assess operative risks
    • Use of regional anesthesia approaches to decrease narcotic usage
    • Impact of ERAS pathways on approaches to perioperative management

Basic Concepts of Anesthesia

Pooja Pandya, MD, George P. Yang, MD, PhD
    • Increasing adoption of risk calculators to assess operative risks
    • Use of regional anesthesia approaches to decrease narcotic usage
    • Impact of ERAS pathways on approaches to perioperative management

Antiepileptic and Antidepressant Drugs Used in the Treatment of Pain

Lucia Daiana Voiculescu, MD
    • Gabapentinoids
    • Antiepileptic and antidepressant drugs used in pain therapy: approved indications and off-label use
    • Antiepileptic drugs used as adjuvant analgesics in the perioperative period

Parenteral Nutrition–Associated Liver Toxicity: Prevention, Diagnosis, and Management

Lorenzo Anez-Bustillos, MD, Meredith A. Baker, MD, Duy T. Dao, MD, Gillian L. Fell, MD, Kathleen M. Gura, PharmD, Mark Puder, MD, PhD
    • Fish oil–based lipid emulsions may be efficacious in the treatment of parenteral nutrition–associated liver disease (PNALD).
    • Lipid reduction (e.g., to 1 g/kg/day) does not decrease the incidence of PNALD but does slow its progression.
    • Patients whose cholestasis reverses with fish oil therapy or achievement of enteral autonomy may have stable rather than progressive cirrhosis and should not be transplanted based on biopsy alone.

Extent of Gastrectomy and Lymphadenectomy for Gastric Adenocarcinoma

Kevin K. Chang, MD, Sam S. Yoon, MD
    • The eighth edition of the AJCC Cancer Staging Manual now includes prognostic information for clinical TNM staging and post–neoadjuvant therapy staging.
    • A D2 lymphadenectomy is frequently recommended as the nodal dissection of choice for locally advanced gastric adenocarcinoma.
    • Laparoscopy-assisted operations are associated with improved overall morbidity and comparable lymph node yield.

Pathologic Evaluation of Soft Tissue Sarcoma

Narasimhan P. Agaram, MBBS
    • Concepts of pathologic examination and grading
    • Important diagnostic criteria for each soft tissue sarcoma
    • Latest molecular diagnostic methods used in the diagnosis of sarcomas
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