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Touch

Touch

Surgery is a contact sport. It seems obvious that surgeons touch their patients. We enter their bodies in a way that is both impersonal and incredibly intimate. But beyond the act of operating on someone, touch is a therapeutic tool. I never leave a patient’s room or the exam room without touching my patient in a nonclinical way. It may be a handshake, a light touch on the arm, a reassuring squeeze to the top of a foot as I pass the end of their bed. It has become so internalized that I hardly notice. But the patient does. They tell me that it helps them recognize that they are still a person and not totally consumed by their disease. The longer the patient is ill, the more important the touch becomes. I always knew I wanted to be a surgeon. From the time I started grade school, it’s all I ever wanted to be. It was one thing to want to be something but another to really understand what it meant to reach inside another body. The first time, as a third year medical student, that a cardiac surgeon invited me to lay my hand on the beating heart, I fell in love. The feel of the life pumping through the chambers was intoxicating. “Touch is a therapeutic tool. It may be a handshake, a light touch on the arm, a reassuring squeeze to the top of a foot as I pass the end of their bed.”   Over time, with training, I learned to distinguish the feel of diseased from healthy tissue; the hard scabrous feel of...
Colorectal Cancer Resections in the Aging Population

Colorectal Cancer Resections in the Aging Population

According to recent estimates, about half of all cancers and 70% of all cancer deaths occur in people aged 65 and older. Gastrointestinal cancers, especially colorectal cancer (CRC), are among the most common to afflict the elderly, with peak incidences occurring when they reach their 60s and 70s. However, while the population continues to age, clinical research trials often exclude these individuals. This raises a concern that data from these investigations may not accurately reflect the true morbidity and mortality in the elderly. “The surgical community needs to recognize the aging shift that’s occurring in the United States and prepare accordingly,” says Mehraneh D. Jafari, MD. Efforts have increased to screen more patients for CRC, but it remains the third-leading type of cancer and second-leading cause of cancer-related deaths. Surgical resection is a curative modality for CRC, but studies suggest that most patients seek treatment after they have reached their 70s. Examining Trends “Few national studies have assessed the effects of age on morbidity and mortality in CRC and analyze the latest trends in surgical resection in the elderly,” says Dr. Jafari. In JAMA Surgery, Dr. Jafari teamed with Michael J. Stamos, MD, and colleagues to publish a study that sought to address this knowledge gap. The study was unique in that it assessed trends among CRC patients undergoing surgical resection while also examining small incremental age increases and the effects on overall morbidity and mortality over the past decade. For the analysis, operative outcomes after CRC surgery were reviewed using data from the Nationwide Inpatient Sample. Patients were stratified within age groups, and postoperative complications and yearly trends...
Diagnosing & Staging Esophageal Cancer

Diagnosing & Staging Esophageal Cancer

The overall 5-year survival rates for esophageal cancer are less than 15%. Although esophagectomy has been the traditional gold standard for early stage disease, optimal treatment for localized disease has generated debate in light of the overall poor survival rate. In 2013, the Society of Thoracic Surgeons (STS) published a set of clinical practice guidelines for the diagnosis and treatment of localized esophageal cancer in Annals of Thoracic Surgery. “The guidelines are the first of a series by the thoracic surgical community to use evidence-based practices for evaluating and treating these complex patients,” says Thomas K. Varghese Jr., MD, MS, who was the corresponding author of the STS guidelines. “They set a precedent for surgeons to play a pivotal role. Diagnosing and staging are critical steps in the decision-making process when selecting optimal therapy.” The recommendations were developed to help clinicians deliver evidence-based best practices for all patients at all times. Important Recommendations on Esophageal Cancer A key recommendation in the STS guidelines is that CT of the chest and abdomen or PET-CT are recommended tests for staging locoregionalized esophageal cancer. In addition, endoscopic ultrasonography is recommended for patients who are surgical candidates to determine the locoregional extent of disease, but diagnostic endoscopic mucosal resection should be considered for a more accurate diagnosis in early stages. Flexible endoscopy with biopsy is the diagnostic test of choice in order to determine the presence and location of the cancer and to biopsy any suspicious lesions. The location and length of the tumor, the extent of circumferential involvement, and the degree of obstruction should also be noted. The guidelines recommend that the...
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