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Become a member and receive career-enhancing benefits

Our top priority is providing value to members. Your Member Services team is here to ensure you maximize your ACS member benefits, participate in College activities, and engage with your ACS colleagues. It's all here.

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Literature Selections

Current Literature

February 20, 2024

Surgical “Pearls” Help Form a Surgeon’s Career Values

Meinke A, Longo W. Revisiting Pearls that Epitomize the Principles of Surgery. J Am Coll Surg. 2024, in press.

This article describes a variety of statements (pearls) that form the unique system of values every surgeon carries throughout their practice career.

Although the content and structure of these statements will vary, reflecting on these statements in times of exhaustion and stress and sharing these with colleagues, especially those who are in the early stages of learning to provide the best patient care, offers all surgeons an opportunity to reinforce our consciousness of the fundamental purpose of surgical care: to treat all (patients and their families, colleagues, team members) with skill and compassion.

The “pearls” described in the article are important to remember. Examples of the ones that struck a chord include “the only way to know your patient’s goals and expectations is to ask them”; “even experts need a respected coach”; “be welcoming and supportive of every member of your team”; “a well-executed time out saves lives, limbs, and reputation”; and, finally, “the evolution of traditional surgical education characterized by a more collegial relationship between professor and student opens new opportunities for mastering the perspectives and knowledge upon which rests surgical excellence”.

Surgeons are encouraged to review the full content of the article.

Article Reviews Presentation, Treatment, and Outcomes of Paget’s Disease of the Breast

Mousa-Doust D, Warburton R, Pao J-S. Paget’s Disease of the Breast: Presentation, Treatment and Outcomes in a Modern Cohort. Am J Surg. 2024, in press.

Paget’s disease accounts for 1% to 3% of all breast tumors; most cases of Paget’s disease are associated with a premalignant or malignant process making careful clinical evaluation and confirmation of the histology of the lesion by pathologic examination critically important features of the management of these patients.

This article reports data from a retrospective review of clinical and pathologic data in 30 patients; total mastectomy was performed in 21 patients and breast conserving therapy was performed in nine patients. Final pathologic examination confirmed invasive cancer in 56.7% of patients. Concordance between operative findings and interpretations from preoperative mammography and ultrasound examinations was poor (31.6% of patients).

The data showed that MRI had potential to improve accuracy of breast lesion assessment and preoperative diagnosis. After confirmation of complete removal of all premalignant or malignant tissue, there were no local recurrences in patients treated with complete mastectomy or breast conserving therapy over 3 years of follow-up.

The authors concluded that preoperative imaging limitations should be recognized, and breast conserving therapy was safe in carefully selected patients.

Recovery of Enterococcus Organisms Are Predictive of Mortality, Morbidity following Pancreatic Head Resections

Stein-Thoeringer CK, Renz BW, De Castilhos J, et al. Microbiome Dysbiosis with Enterococcus Presence in the Upper Gastrointestinal Tract Is a Risk Factor for Mortality in Patients Undergoing Surgery for Pancreatic Cancer. Ann Surg. 2024.

There is increasing recognition of the importance of the intestinal microbiome in determining the nature and severity of postoperative complications. Resultantly, the authors of this article performed a prospective study of patients undergoing pancreatic head resection (n = 101) to determine if microbiome profiles defined by biomarker sequencing with 16S rRNA and cultures obtained from the stomach, bile duct, pancreatic duct, stool, and saliva would be predictive of postoperative mortality and morbidity.

The data analysis showed that appearance of Enterococcus sp in the microbiome profiles was associated with increased risk of surgical site infection (SSI). Elevated levels of these microorganisms in the upper GI tract were associated with increased risk for mortality within 6 months of operation, and recovery of Enterococcus from bile aspirates was associated with increased risk for severe SSI, pancreatic fistula, and mortality over a 24-month follow-up interval. The highest mortality rates were recorded in patients with positive Enterococcus faecalis cultures and a history of preoperative endoscopic retrograde cholangiopancreatogram.

The authors concluded that recovery of Enterococcus organisms was predictive of mortality and morbidity following pancreatic head resections and that these findings suggested use of piperacillin-tazobactam for antimicrobial prophylaxis.

Upcoming Selected Readings in General Surgery (SRGS) Features More Surgical Infections Content

The upcoming issue of SRGS provides a detailed discussion of surgical infections. Important topics covered in the overview include bacterial resistance to antimicrobial drugs, surgical site infections, and nosocomial infections. The associated Surgical Readings from SRGS podcast episode will contain an informative, lively conversation between the Associate Editor for the issue, Lillian Kao, MD, FACS, and podcast host Rick Greene, MD, FACS. The episode is expected to be available on Friday, March 1.