Medical malpractice litigation against surgical residents does occur and may place trainees at risk of burnout. Thiels et al abstracted 87 malpractice cases involving surgical residents from the US Westlaw legal database (2005-2015). These data highlight the importance of perioperative management, particularly among junior residents, and the importance of appropriate supervision by attending physicians to mitigate litigation risk.
Continuing Medical Education
Various techniques of minimally invasive thyroidectomy have been developed to address patient concerns about scars caused by incisions in the neck. In this study, Anuwong et al compared the safety and outcomes of transoral endoscopic thyroidectomy vestibular approach with those of open thyroidectomy. While operative time was longer with the transoral approach, blood loss and complications rates were similar to the open approach. Thus, transoral surgery can be a safe option for selected patients.
Invited Commentary
Video
Contralateral prophylactic mastectomy (CPM) for treatment of breast cancer is a growing challenge for surgeons. Katz et al examined the influence of attending surgeon on variation in use among 5080 patients. The CPM rate was 34% for surgeons who least favored initial lumpectomy and were least reluctant to perform CPM vs 4% for surgeons who most favored breast conservation and were most reluctant to perform CPM.
Invited Commentary
Information on optimal postsurgical opioid prescribing is lacking. This study used data from over 215 000 TRICARE enrollees to describe prescribing patterns for opiate-naive individuals undergoing any of 8 common surgical procedures. The modeled optimal length of opioid prescription lengths ranged from 4 to 9 days for general surgery, 4 to 13 days for women’s health, and 6 to 15 days for musculoskeletal procedures.
Invited Commentary
Continuing Medical Education
Locoregional failure for patients with locally advanced bladder cancer (LABC) after radical cystectomy is common even with chemotherapy. Adjuvant radiotherapy can decrease such failures, but it has not been studied in the chemotherapy era. In this phase 2 trial, patients with LABC with negative margins after radical cystectomy were randomized to adjuvant sequential chemotherapy plus radiotherapy vs adjuvant chemotherapy alone. The addition of adjuvant radiotherapy significantly improved local control vs chemotherapy alone.
Abstract
Invited Commentary