Opinion 1, 2, and 3 Research 1, 2, and 3 and Patient Page
Surgical resection is the most important treatment modality for rectal cancer, with surgical integrity of the specimen and tumor pathologic staging important prognostic factors. In a multicenter, noninferiority, randomized trial that enrolled 486 patients who had completed neoadjuvant therapy for locally advanced rectal cancer (stage II and stage III), Fleshman and colleagues assessed the efficacy of laparoscopic-assisted resection vs open resection. The authors report that laparoscopic resection failed to meet the study criterion for pathologic noninferiority—a composite outcome of total mesorectal excision completeness and negative distal and circumferential radial margin results. In an Editorial, Strong and Soper discuss minimally invasive operations for colorectal disorders.
Editorial and Related Articles 1 and 2
Author Video Interview and Continuing Medical Education
In a multicenter randomized trial involving 475 patients with T1-T3 rectal tumors located less than 15 cm from the anal verge, Stevenson and colleagues examined whether laparoscopic surgery is noninferior to open surgery—in terms of a composite pathologic outcome defined as complete total mesorectal excision, a clear circumferential margin, and a clear distal resection margin. The authors report that noninferiority for successful resection could not be established for laparoscopic surgery compared with open surgery.
Surgical resection for perforated diverticulitis is associated with significant morbidity. Data from retrospective studies suggest that laparoscopic lavage without resection might be a feasible treatment approach. In a multicenter randomized trial involving 199 patients with perforated diverticulitis requiring urgent surgery, Schultz and colleagues found that compared with primary colon resection, laparoscopic lavage did not reduce the rate of severe postoperative complications and resulted in higher rates of reoperation and intra-abdominal infections.
Whether rehabilitation after immobilization for ankle fracture is beneficial is not clear. In a randomized trial involving 214 patients with isolated ankle fracture treated with immobilization, Moseley and colleagues found that compared with advice alone, rehabilitation after immobilization—consisting of a supervised exercise program and advice about self-management—did not result in less activity limitation or improved quality of life at 3 months.
Continuing Medical Education
An article in JAMA Surgery reported results of a systematic review that examined the incidence of 3 surgical “never events” (wrong-site surgery, retained surgical items, and surgical fires), root causes of the events, and the quality of evidence supporting preventive interventions. This From the JAMA Network article by Berger and colleagues discusses a multifaceted approach to reduce the incidence of adverse surgical events.
An article in JAMA Pediatrics reported concussion rates among participants in youth, high school, and collegiate American football in the 2012 and 2013 seasons. In this From the JAMA Network article, Wandling and Guillamondegui discuss challenges in the study and management of sports-related head injuries and highlight the need for standard diagnostic criteria and reliable longitudinal data collection to improve management and prevention of sports-related concussion.
An 80-year-old woman with a history of celiac artery occlusion presented with a painful rash on her flank. She denied systemic symptoms or application of topical agents to the area. Examination revealed an 8-cm erythematous plaque with vesiculation and central erosion. A punch biopsy showed vacuolar interface dermatitis. The plaque resolved with application of clobetasol cream. Ten months later, a plaque with telangiectasias and central ulceration developed at the same location. What would you do next?
Highlights. JAMA. 2015;314(13):1315-1317. doi:10.1001/jama.2014.12005