Advances in Surgery RSS feed: Current Issue. Each year, Advances in Surgery brings you the best current thinking from the preeminent practitioners in your field. A distinguished editorial board identifies current areas of major progress and controversy and invites specialists to contribute original articles on these topics. These insightful overviews bring concepts to a clinical level and explore their everyday impact on patient care. Volume 44 Highlights (coming Fall 2010) Does NSQIP Improve Surgical Quality? Endovascular Repair of Traumatic Aortic Injuries What Should be the Extent of Neck Dissection for Thyroid Cancer? Burnout Amongst U.S. Surgeons Which is Best? Laparoscopic Gastric Reoperative Surgery for the Zollinger-Ellison Syndrome Does the Type of Pancreaticojejunostomy After Whipple Alter the Leak Rate? Outcomes in Over 2000 Limb Revascularizations Ductal Anatomy Predicts Major Complications from Pancreatitis The Diagnosis of a Ruptured Appendix Preoperatively in the Pediatric Patient Adjuvant Therapy for Pancreatic Cancer: Who Benefits? Screening Criteria for Breast Cancer Detecting Leaks Following Roux-en-Y Gastric Bypass Impact of a Computerized Physician Order Entry System Real Time Glucose Monitoring? Future or Now? Update on Familial Pancreatic Cancer What's New in the ICU? Minimally Invasive Thryoid and Parathyroid Operations Impact of Future Liver Remnant Volume on Outcome Following Extended Right Hepatectomy The Impact of "Fraility" on the Outcome of Surgery In the Aged Cancer Survivorship - What Are the Long-Term Consequences? Role of Chemotherapy in Downstaging Metastases What's New in Neoadjuvant Therapy for Breast Cancer? Laparoscopic Esophagectomy Editor-in-Chief: John L. Cameron Associate Editors: B. Mark Evers, Yuman Fong, David Herndon, Keith Lillemoe, John A. Mannick, John Wong, and Charles J. Yeo http://www.advancessurgery.com/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Advances in Surgery0065-3411451September 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.advancessurgery.com/article/PIIS0065341111000327/abstract?rss=yesContributors10.1016/S0065-3411(11)00032-7Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7xiiixvihttp://www.advancessurgery.com/article/PIIS0065341111000339/abstract?rss=yesContents10.1016/S0065-3411(11)00033-9Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7xviixxvhttp://www.advancessurgery.com/article/PIIS0065341111000182/abstract?rss=yesAlthough common, small bowel obstruction (SBO) remains one of the most challenging clinical problems treated by surgeons. Responsible for up to 300,000 hospital admissions every year in North America, SBO arises from multiple etiologies and manifests as a diverse panoply of clinical presentations . Initial evaluation should center on differentiating those patients who need urgent exploration from those who may undergo a safe, nonoperative trial. The wide range of etiologies, however, combined with specific, and often unique, patient parameters, renders this decision difficult. Traditionally, the decision between urgent operative intervention and initial nonoperative management has hinged on the distinction between complete and partial obstruction. However, the clinical diagnosis of complete obstruction is imprecise, and the complete/partial dichotomy has not eliminated avoidable obstruction-associated ischemia and necrosis. Rather than trying to predict those patients at risk for ischemic complications, we may do better to define clinical parameters that predict failure of nonoperative management and offer prompt operation to patients demonstrating these parameters. Hopefully, such an approach, codified into practice management guidelines, will minimize both ischemia and hospital length of stay associated with SBO. After reviewing the pathogenesis and pathophysiology of SBO, this article outlines newly developed and refined management and surgical techniques to reach these goals.Current Management of Small Bowel ObstructionMartin Donald Zielinski, Michael Patrick Bannon10.1016/j.yasu.2011.03.017Advances in Surgery 45, 1 (2011)2011-07-04Advances in Surgery2011-07-04451S0065-3411(11)X0002-7129http://www.advancessurgery.com/article/PIIS0065341111000078/abstract?rss=yesColorectal cancer (CRC) is a leading cause of death from cancer in the United States. In 2010 there are 143,000 new cases of CRC expected with more than 51,000 people dying from the disease. More than a million individuals worldwide are diagnosed with CRC every year and half a million die of CRC in the same time period .Screening for Colorectal CancerJin He, Jonathan E. Efron10.1016/j.yasu.2011.03.006Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-73144http://www.advancessurgery.com/article/PIIS0065341111000066/abstract?rss=yesChronic venous insufficiency can be found in 15% to 20% of the population. The prevalence goes up to 50% if small telangiectasias are included . Venous ulcers are observed in 2% of patients with chronic venous insufficiency, and the treatments of these ulcers alone carry a significant cost . Several risk factors for the development of varicose veins have been identified, which include age, female gender, multiparity, family history, obesity, and job activities that involve prolonged standing. Obesity seems to be a risk factor only in women but not in men. Exercise activity seems to be protective in men but not in women. In at least one study, however, trunk varices were observed to be more prevalent in men .Varicose Vein: Current ManagementBeejay A. Feliciano, Michael C. Dalsing10.1016/j.yasu.2011.03.005Advances in Surgery 45, 1 (2011)2011-07-04Advances in Surgery2011-07-04451S0065-3411(11)X0002-74562http://www.advancessurgery.com/article/PIIS0065341111000054/abstract?rss=yesOn March 30, 2010, President Obama signed the Patient Protection and Affordable Care Act into law. While many conceptual themes contributed to its formulation, none was more pervasive than the notion of geographic variation in health care, which was fostered by researchers associated with the Dartmouth Atlas. It has been taken as “proof” that health care spending is wasted in regions that spend more and that if practices everywhere were as efficient as those in regions that spend the least, 30% of health care expenditures could be saved, enough to finance health care reform: the “30% solution.”Geographic Variation in Health Care and the Affluence-Poverty NexusRichard A. Cooper10.1016/j.yasu.2011.03.004Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-76382http://www.advancessurgery.com/article/PIIS0065341111000121/abstract?rss=yesAn arteriovenous fistula (AVF) is any abnormal connection between an artery and a vein that bypasses the normal capillary bed and shunts blood directly to the venous circulation. These abnormal communications may occur in any area of the body and affect blood vessels of any size. Any discussion of treatment of these conditions requires a clear understanding of their cause, pathophysiology, and physiologic consequences. This article reviews these topics as they relate to the timing and role of endovascular therapy. Arteriovenous connections constructed for the purpose of dialysis access are not considered.Endovascular Approaches to Arteriovenous FistulaJennifer A. Sexton, John J. Ricotta10.1016/j.yasu.2011.03.011Advances in Surgery 45, 1 (2011)2011-07-04Advances in Surgery2011-07-04451S0065-3411(11)X0002-783100http://www.advancessurgery.com/article/PIIS0065341111000169/abstract?rss=yesBreast cancer is the most common malignancy and the second most common cause of cancer deaths in American women. The American Cancer Society estimates that 207,090 new cases of invasive breast cancer and 40,230 breast cancer deaths are expected in 2010 . In patients with primary breast cancer, axillary lymph node status remains one of the most important prognostic indicators.Local and Regional Control in Breast Cancer: Role of Sentinel Node BiopsyArmando E. Giuliano, Soo Hwa Han10.1016/j.yasu.2011.03.015Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7101116http://www.advancessurgery.com/article/PIIS0065341111000029/abstract?rss=yesThe potential use of stem cells as therapy for failing organ systems is being explored in diverse organ and tissue injury areas. It has been shown that bone marrow-derived stem cells can transdifferentiate into a variety of adult cell types, including hepatocytes . Applications for hematopoietic stem cells and cytokines aimed at mobilizing stem cells in other organs have been assessed with benefit shown in myocardial ischemia and acute kidney injury . The aim of this review is to assess the emerging evidence for the role of stem cells in assisting the acutely failing liver.Stem Cells in Acute Liver FailureRussell N. Wesson, Andrew M. Cameron10.1016/j.yasu.2011.03.001Advances in Surgery 45, 1 (2011)2011-07-13Advances in Surgery2011-07-13451S0065-3411(11)X0002-7117130http://www.advancessurgery.com/article/PIIS0065341111000091/abstract?rss=yesOver the past 90 years, colorectal resection has been associated with a progressive increase in safety for what is still a major and frequently performed operation. It has often been stated that the wide use of antibiotics after World War II was associated with increasing survival after colon surgery ; as a matter of fact, the broad application and use of blood banks in the late 1930s and the improved care overall associated with the proliferation of intensive care units in the 1990s correlate better with those improvements. Although there are still outliers in institutional mortality rates in colon surgery, the mortality rate for a large number of voluntarily reporting university teaching and affiliated hospitals is just under 2% for elective operations. Interestingly, even after anastomotic leak, rescue by an early diagnosis and appropriate systemic management, often including diversion, is so much the rule that death rates are still low () .Is There a Role for Bowel Preparation and Oral or Parenteral Antibiotics In Infection Control in Contemporary Colon Surgery?Susan Galandiuk, Donald E. Fry, Hiram C. Polk10.1016/j.yasu.2011.03.008Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7131140http://www.advancessurgery.com/article/PIIS006534111100025X/abstract?rss=yesFor more than two centuries, surgeons have been performing operations on the colon and rectum. This year more than 100,000 colorectal operations will be performed in the United States alone . Despite the abundant collective knowledge and experience of generations of surgeons, colon operations continue to carry significant risks. Contemporary mortality rates range from 1% to 2% for elective colorectal procedures . Surgical site infections (SSIs), one of many sources of postoperative morbidity, occur in nearly 10% of patients . The authors’ experience with the Michigan Surgical Quality Collaborative (MSQC) has shown that the range of morbidity rates across centers is broad, some centers achieving rates 50% better than the average. While the etiology of this variation in morbidity is likely multifactorial, it may be explained in part by difference in practice patterns. Among the many aspects of the practice of colon surgery that merit examination, preoperative bowel preparation has been the subject of particular and long-standing controversy. Further investigation, informed by the body of data amassed over the past 50 years, has the potential to define the optimal preoperative bowel preparation, and so reduce the morbidity of colorectal surgery.Oral Antibiotics to Prevent Surgical Site Infections Following Colon SurgeryDanielle Fritze, Michael J. Englesbe, Darrell A. Campbell10.1016/j.yasu.2011.05.002Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7141153http://www.advancessurgery.com/article/PIIS006534111100011X/abstract?rss=yesAcute pancreatitis is a significant cause of morbidity and mortality in the United States, occurring in approximately 44 per 100,000 adults and accounting for more than 200,000 hospital admissions each year . Of those patients, more than 80% have a benign course and recover without significant morbidity or recurrence . However, in the minority of patients who suffer complications, the outcomes can be devastating. The most feared complication is the development of pancreatic necrosis, which is estimated to occur in 10% to 25% of all cases of acute pancreatitis . The risk of mortality from necrotizing pancreatitis has been estimated between 10% and 20% compared with an overall mortality of at most 5% to 10% for acute pancreatitis in general . In those patients who develop necrosis, mortality is bimodal in its temporal distribution . Early deaths are attributed mostly to severe multisystem organ failure within the first few days of onset , whereas late deaths tend to occur in the setting of infection and systemic sepsis .Pancreatic NecrosectomyJordan R. Stern, Jeffrey B. Matthews10.1016/j.yasu.2011.03.010Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7155176http://www.advancessurgery.com/article/PIIS0065341111000145/abstract?rss=yesI recently had the opportunity to critique the 2010 Affordable Care Act (ACA) . I documented that the 3 pillars of health care delivery—quality, cost, and access—were flawed in the old health care model. Unfortunately, the ACA does not adequately address these 3 issues. I also pointed out that cost is the number one problem, not quality. Cost is negatively affected by the bureaucracy of our health care system because of waste, fraud, and loss of value. The cost of the medical bureaucracy is staggering. In the United States, it is $1059 per capita per year. In contrast, in Canada it is $307. In the US health care system, administrative workers account for 27.3% of total health care costs. In Canada this figure is 3.1%. If the United States had a single-payer system, this would save $375 billion a year in health care costs according to a 2003 article in the New England Journal of Medicine . The authors of this study estimated there are 1 million workers (specifically middlemen) who are doing unneeded work.The Impact of Health Care Reform on SurgeryDonald D. Trunkey10.1016/j.yasu.2011.03.013Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7177185http://www.advancessurgery.com/article/PIIS0065341111000170/abstract?rss=yesStress hyperglycemia, defined as a transient plasma glucose level above 200 mg/dL, is associated with adverse outcomes among the critically ill, including increased mortality . Since the landmark study conducted by Van den Berghe and colleagues in Leuven, Belgium, first demonstrated improved survival in ICU patients treated with intensive insulin therapy, there has been considerable attention dedicated toward defining the ideal therapy required to optimize outcome for critically ill patients with hyperglycemia. Although subsequent studies have failed to replicate the findings of the Leuven group, these investigations lacked the methodologic rigor of the initial studies and have provided few data that can be effectively extrapolated to the care of ICU populations, including victims of trauma. The largest body of work examining the risks and treatment of hyperglycemia after injury has been conducted at the University of Maryland R Adams Cowley Shock Trauma Center . Data from the authors’ group have demonstrated that hyperglycemia has a significant association with adverse outcomes after trauma and that intervention with insulin therapy may significantly improve outcomes for these patients.Glucose Elevations and Outcome in Critically Injured Trauma PatientsJoseph J. DuBose, Thomas M. Scalea10.1016/j.yasu.2011.03.016Advances in Surgery 45, 1 (2011)2011-07-04Advances in Surgery2011-07-04451S0065-3411(11)X0002-7187196http://www.advancessurgery.com/article/PIIS0065341111000194/abstract?rss=yesGastrointestinal stromal tumor (GIST) is a mesenchymal tumor that typically arises from the alimentary tract . In the past, these tumors were classified as leiomyomas, leiomyosarcomas, or leiomyoblastomas. Only recently has it become evident that GIST is a separate entity and the most common sarcoma of the gastrointestinal (GI) tract, with an annual incidence in the United States of approximately 5000 .Advances in the Surgical Management of Gastrointestinal Stromal TumorUmer I. Chaudhry, Ronald P. DeMatteo10.1016/j.yasu.2011.03.018Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7197209http://www.advancessurgery.com/article/PIIS0065341111000200/abstract?rss=yesCholedochal cysts are abnormal dilatations of the biliary tree, generally believed to be congenital in origin. Choledochal cysts are more common in Asian populations (reported incidence of 1 in 1000) than in the Western hemisphere, where the incidence is only 1 in 100,000 to 150,000 live births . Despite their rarity, choledochal cysts represent an important biliary condition, because this disease must be recognized and treated appropriately to prevent the development of biliary malignancy . Several subtypes of choledochal cysts have been described, including the choledochocele, which is an abnormal dilatation of the distal common bile duct within the ampulla of Vater. The purpose of this review is to contrast the natural history of choledochoceles and choledochal cysts.Choledochoceles: Are They Choledochal Cysts?Kathryn M. Ziegler, Nicholas J. Zyromski10.1016/j.yasu.2011.03.019Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7211224http://www.advancessurgery.com/article/PIIS0065341111000030/abstract?rss=yesUlceration is defined pathologically as the absence of intact epithelium overlying a melanoma. In patients with cutaneous melanoma, ulceration of the primary melanoma is a well-known prognostic factor associated with decreased disease-free survival (DFS) and overall survival (OS); presence or absence of ulceration has been incorporated into the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma since the sixth edition in 2002 . Although the factors underlying the prognostic significance of ulceration are still largely unknown, ulceration is undoubtedly a marker of unfavorable tumor biology. Recent data suggest that ulceration may be a predictive marker for response to adjuvant interferon (IFN) alfa-2b therapy. This article reviews the data surrounding the prognostic implications of ulceration in cutaneous melanoma.What Does Ulceration of a Melanoma Mean for Prognosis?Glenda G. Callender, Kelly M. McMasters10.1016/j.yasu.2011.03.002Advances in Surgery 45, 1 (2011)2011-07-04Advances in Surgery2011-07-04451S0065-3411(11)X0002-7225236http://www.advancessurgery.com/article/PIIS0065341111000042/abstract?rss=yesParathyroidectomy is the mainstay of treatment for hyperparathyroidism. Operative intervention in a previously unexplored neck can yield cure rates greater than 95% . However, once a patient has undergone neck surgery, such as in the case of failed parathyroidectomy, reoperation leads to cure rates of only 80% . Similarly, complication rates associated with parathyroidectomy have been found to be much greater during reoperations than during initial surgeries . This significantly lower success rate for reoperation combined with the higher complication rate illustrates the need for a surgeon to achieve eucalcemia at the initial operation.Influence of Surgical Volume on Operative Failures for HyperparathyroidismBarbara Zarebczan, Herbert Chen10.1016/j.yasu.2011.03.003Advances in Surgery 45, 1 (2011)2011-07-13Advances in Surgery2011-07-13451S0065-3411(11)X0002-7237248http://www.advancessurgery.com/article/PIIS006534111100008X/abstract?rss=yesPerioperative hypothermia (PH), usually defined as a temperature of less than 36.0°C during the perioperative period, can result from anesthesia-induced thermoregulatory inhibition combined with exposure to a cold operating room environment and is estimated to occur in 50% to 70% of patients undergoing anesthesia and major surgery . Almost all anesthetics, including opioids, propofol, inhalational agents, and spinal/epidural anesthetics, have been shown to impair thermoregulatory mechanisms through their effects on the brain/hypothalamus, impairment of peripheral vasoconstriction, and the shivering response. As a result, patients (particularly the very young and the elderly) exposed to these agents become poikilothermic and body temperature decreases to less than 36.0°C in a cool operating room environment . Return to normothermia often requires several hours, which in turn increases exposure to PH (and its attendant morbidities) beyond the immediate intraoperative period.Perioperative Normothermia During Major Surgery: Is It Important?Nestor F. Esnaola, David J. Cole10.1016/j.yasu.2011.03.007Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7249263http://www.advancessurgery.com/article/PIIS0065341111000108/abstract?rss=yesHereditary nonpolyposis colorectal cancer (HNPCC), often called Lynch syndrome, may be described as a hereditary predisposition to developing colorectal and extracolonic cancers. Accounting for approximately 3% of all colorectal malignancies, it is the most common cause of hereditary colorectal cancer . The diagnosis is based on clinical criteria related to family history of certain HNPCC-defining cancers, such as those of the colorectum, uterus, stomach, ovaries, urinary epithelium, and small bowel. The syndrome is characterized by early onset of cancer, and an elevated clinical suspicion is needed to make a timely diagnosis so that appropriate surveillance and intervention can be performed to decrease deaths from cancer. This review provides a brief background on HNPCC and reviews the surgical management of the disease.Surgical Management of Hereditary Nonpolyposis Colorectal CancerMatthew F. Kalady10.1016/j.yasu.2011.03.009Advances in Surgery 45, 1 (2011)2011-07-04Advances in Surgery2011-07-04451S0065-3411(11)X0002-7265274http://www.advancessurgery.com/article/PIIS0065341111000133/abstract?rss=yesThe training of general surgeons in the United States can trace its roots back to the system introduced by William Stewart Halsted at the Johns Hopkins Hospital, and many of the unique components persist today . The training was hospital based, university sponsored, with the expectation that residents would gain knowledge and understanding of the scientific basis of surgical principles, ultimately resulting in increased responsibility over several years of training . This training culminated in a final period of near-total independence and autonomy. The results of this training under Halsted were quite remarkable, and those who completed the Halsted training went on to direct departments of surgery at the leading institutions of the day .How to Change General Surgery Residency TrainingSteven C. Stain10.1016/j.yasu.2011.03.012Advances in Surgery 45, 1 (2011)2011-07-04Advances in Surgery2011-07-04451S0065-3411(11)X0002-7275284http://www.advancessurgery.com/article/PIIS0065341111000157/abstract?rss=yesCarcinoid tumors were first described by Lubarsch in 1888 . In 1907, Oberndorfer was the first to recognize these tumors as distinct from carcinomas and coined the term, Karzinoide, to describe the carcinoma-like appearance of these tumors as well as what was originally thought a relatively benign course. Since that time, the malignant potential of carcinoid tumors has become apparent. Currently, carcinoid tumors account for 0.49% of all malignancies . Although these tumors are relatively uncommon, their incidence has been increasing. A recent database analysis of 13,715 carcinoid tumors revealed a 43.1% increase in carcinoid tumors compared proportionally with other cancers . The most common location for carcinoid tumors is the gastrointestinal tract followed by the pulmonary system. Within the gastrointestinal tract, the highest frequency of tumors occurs in the small intestine followed by the rectum, colon, and appendix .Recent Advances in the Diagnosis and Treatment of Gastrointestinal CarcinoidsJoseph Valentino, B. Mark Evers10.1016/j.yasu.2011.03.014Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7285300http://www.advancessurgery.com/article/PIIS0065341111000224/abstract?rss=yesPancreatic ductal adenocarcinoma (PDA) is one of the most lethal cancers. It is the fourth leading cause of cancer-related death in the United States . Nearly 40,000 Americans are affected by this disease every year and more than half of these individuals succumb to cancer-related complications . Even with cases that are identified early and undergo surgical resection, the diagnosis of PDA is associated with an overall 5-year survival rate of only 6% to 25% . Although many resources and large genome-profiling studies have been completed () , the clinical management of this disease has still made only modest strides in the past 2 decades.The Past, Present, and Future of Biomarkers: A Need for Molecular Beacons for the Clinical Management of Pancreatic CancerJonathan R. Brody, Agnieszka K. Witkiewicz, Charles J. Yeo10.1016/j.yasu.2011.04.002Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7301321http://www.advancessurgery.com/article/PIIS0065341111000212/abstract?rss=yesThe first published report of a successful pancreaticoduodenectomy was published by Allen O. Whipple in 1935 . Whipple reported 3 patients who underwent a 2-stage procedure with pancreatic duct ligation: one patient died in the perioperative period; another died 8 months later from cholangitis, and the last from metastases after 28 months. This initial report was followed by a series describing a single-stage procedure , the fundamentals of which we recognize today as the Whipple procedure. These fundamentals included (1) resection and reconstruction in one stage; (2) avoidance of cholecystoenterostomy by implantation of the bile duct into the jejunum, and (3) implantation of the pancreatic duct into the jejunum. Following the modification of pylorus preservation by Traverso and Longmire , the technical aspects of pancreaticoduodenectomy have remained essentially unchanged since Whipple described the procedure in 1935.Robotic-Assisted Major Pancreatic ResectionH.J. Zeh, David L. Bartlett, A. James Moser10.1016/j.yasu.2011.04.001Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7323340http://www.advancessurgery.com/article/PIIS0065341111000236/abstract?rss=yesThe overwhelming majority of metastatic solid cancers cannot be cured by current systemic chemotherapies. Immunotherapy, a modality able to mediate durable and sometimes complete tumor regression in patients with metastatic melanoma and kidney cancer, is emerging as an alternative or an adjunct to current cancer treatments. Recent developments have enabled the application of immunotherapy to additional cancer types.Immunotherapy for Metastatic Solid CancersSimon Turcotte, Steven A. Rosenberg10.1016/j.yasu.2011.04.003Advances in Surgery 45, 1 (2011)2011-07-04Advances in Surgery2011-07-04451S0065-3411(11)X0002-7341360http://www.advancessurgery.com/article/PIIS0065341111000248/abstract?rss=yesGuidelines for venous thromboembolism (VTE) prevention in the surgical patient have been published by the American College of Chest Physicians (ACCP), the American College of Physicians, the American Academy of Orthopaedic Surgery, and the International Society of Angiology . The ongoing challenge is to balance the risk of bleeding versus the benefit of VTE prevention because studies have suggested that there is an increased bleeding risk associated with more effective pharmacologic prophylaxis. The purpose of this article is to review the cause and risk factors for VTE as well as to discuss the methods of prophylaxis for various procedures as recommended by the guidelines. The article concludes with a more detailed overview of the pharmacology and clinical trial results of the new oral anticoagulants that have already been approved in Europe and Canada for VTE prevention in the orthopedic patient population.Prophylaxis for Deep Vein Thrombosis and Pulmonary Embolism in the Surgical PatientTaki Galanis, Walter K. Kraft, Geno J. Merli10.1016/j.yasu.2011.05.001Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7361390http://www.advancessurgery.com/article/PIIS0065341111000352/abstract?rss=yesIndex10.1016/S0065-3411(11)00035-2Advances in Surgery 45, 1 (2011)2011-09-01Advances in Surgery2011-09-01451S0065-3411(11)X0002-7391396