Latest Updates

The Immunocompromised Surgical Patient and Opportunistic Infections

Kiran Gajurel, MD, Aruna K Subramanian, MD
    • Solid-organ transplant recipients may not present with classic signs and symptoms of infections due to their immunosuppressive state
    • Due to overlapping radiologic and clinical features of various opportunistic infections, a tissue biopsy should be obtained, if feasible, to establish diagnosis.
    • Mycobacterium chimaera,associated with heater cooler devices used during cardiac surgery, has recently emerged as an important pathogen in post cardiac surgery patients.
    • Rapamycins cause delayed wound healing and should be avoided in the immediate postoperative period.
    • Isavuconazole is  as efficacious as voriconazole in the treatment of invasive aspergillosis.

Chronic Allograft Dysfunction 

Lakshman Gunaratnam, MD, MSc, Juliya Hemmett, MD, FRCPC, Anthony M Jevnikar, MD, FRCPC, MSc
    • Redefining chronic allograft nephropathy, which is an overly broad and somewhat imprecise pathologic diagnosis, to chronic allograft dysfunction to describe a clinical diagnosis of late graft failure from various causes
    • Development of donor-specific antibodies and chronic antibody rejection emerging as the major pathophysiologic mechanisms responsible for this entity
    • Use of donor-specific antibody in the diagnosis and prognostication of chronic allograft dysfunction

Metabolic Alkalosis

Fouad T Chebib, MD
    • Metabolic alkalosis, one of the most common electrolytes disorders, is characterized by an increase in pH, a decrease in [H+], and an increase in [HCO3–].
    • The pathogenesis of metabolic alkalosis involves a generative and a maintenance phase. The generative phase involves either loss of acid, gain of bicarbonate, or cellular shift. The maintenance phase involves impairment of the renal handling of bicarbonate.
    • The etiologies of metabolic alkalosis can be divided into categories of chloride depletion, potassium depletion, and hypercalcemic states.
    • A diagnostic approach using volume status and urine chloride can be useful.
    • Management of metabolic alkalosis is best achieved by correcting the factor responsible for maintenance. Treatment options differ if the metabolic alkalosis was chloride responsive or chloride resistant. 

Management of Pancreatic Adenocarcinoma

David A Kooby, MD, FACS, Alexandra G Lopez-Aguiar, MD, Shishir K Maithel, MD, FACS
    • New AJCC staging model for pancreatic adenocarcinoma
    • Use of neoadjuvant FOLFIRINOX in resectable pancreatic cancer
    • Laparoscopic and robotic pancreaticoduodenectomy
    • Laparoscopic and robotic distal pancreatectomy

Management of Pancreatic Adenocarcinoma

David A Kooby, MD, FACS, Alexandra G Lopez-Aguiar, MD, Shishir K Maithel, MD, FACS
    • New AJCC staging model for pancreatic adenocarcinoma
    • Use of neoadjuvant FOLFIRINOX in resectable pancreatic cancer
    • Laparoscopic and robotic pancreaticoduodenectomy
    • Laparoscopic and robotic distal pancreatectomy

Dermatofibrosarcoma Protuberans

Benjamin Deschner, MD, Jeffrey Wayne, MD, FACS
    • Recognition of the characteristic tentaclelike projections resulting in an acentric growth pattern requiring horizontal sectioning with meticulous margin analysis
    • Appreciation of fibrosarcomatous change as a poor prognostic indicator carrying an increased risk of metastasis and death
    • Use of the targeted tyrosine kinase receptor inhibitor imatinib as an adjuvant treatment strategy

Dermatofibrosarcoma Protuberans

Benjamin Deschner, MD, Jeffrey Wayne, MD, FACS
    • Recognition of the characteristic tentaclelike projections resulting in an acentric growth pattern requiring horizontal sectioning with meticulous margin analysis
    • Appreciation of fibrosarcomatous change as a poor prognostic indicator carrying an increased risk of metastasis and death
    • Use of the targeted tyrosine kinase receptor inhibitor imatinib as an adjuvant treatment strategy

Merkel Cell Carcinoma

Giorgos Karakousis, MD, Andrew J Sinnamon, MD, Charles C Vining, MD
    • Merkel cell polyomavirus (MCV) is a nonenveloped circular dsDNA virus belonging to the Polyomaviridae family discovered in 2008 and found in approximately 80% of Merkel cell carcinomas (MCCs) in the United States. The integration of viral DNA into the cell genome prior to clonal expansion suggests that the virus may be oncogenic.
    • Sentinel lymph node biopsy (SLNB) at the time of wide local excision has been recognized as an important staging tool and should generally be offered to all medically fit patients with clinically localized MCC.
    • Adjuvant radiation to the primary tumor site is generally recommended for MCC at least 1 cm in size as reduced rates of local recurrence have been shown in multiple studies.
    • Radiation therapy to the regional lymph node basin may be considered after negative SLNB in patients at high risk for recurrence (i.e., immunosuppressed) or for false negative SLNB (i.e., head and neck tumors).
    • Radiation therapy to the regional lymph node basin may also be considered in patients following lymphadenectomy with multiple involved or matted nodes.
    • Immunotherapy such as monoclonal antibodies specific to PD1 and PD1 ligand show promise for MCC. PD1 ligand is expressed on MCC tumor cells and peritumoral immune cells that confer immunologic evasion. Avelumab and pembrolizumab are being investigated for the treatment of MCC.
    • Checkpoint inhibitors targeting CTLA-4 such as ipilimumab and tremelimumab combined with poly-ICLC, a Toll-like receptor–3 ligand, are under investigation.
    • Intratumoral injection of IL-12 plasmid vaccine followed by electroporation is currently under clinical trial for MCC.
« Previous | Next »
Updates per yearSpecialty updatesNumber of sections