DR. RAVI JAYENDRA CHOKSHI, M.D.

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Safety net hospitals serve over 28 million uninsured or Medicaid-dependent Americans but disproportionately treat patients with late-stage cancers, which cost 60-80% more to treat than early-stage disease. Only 12% of these hospitals hold cancer-related quality accreditations from the American College of Surgeons, largely due to staffing shortages and funding cuts. Expanding accreditation at these hospitals would improve early detection and standardized care for the country's most vulnerable patients.

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This study found that most of the 322 safety net hospitals in the United States lack American College of Surgeons quality accreditations: only 36% hold cancer care accreditation and just 5% are accredited for rectal cancer programs. Nearly one in five states has no safety net hospital at all, leaving large gaps in access for underserved populations. Pursuing these accreditations would help these hospitals deliver more consistent, guideline-based surgical care to patients who need it most.

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This systematic review examined 40 cases of hemicorporectomy—surgical removal of the lower half of the body—performed between 1990 and 2022, a procedure previously reserved almost exclusively for cancer. The most common reasons were now pelvic bone infection and trauma rather than malignancy, and many patients achieved significant recovery milestones including mobility and return to employment. Despite its extreme nature, the procedure can be life-saving for carefully selected patients with no other options.

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Researchers analyzed DNA collected from stomach fluid during routine upper endoscopy in over 1,000 patients and found that DNA levels were significantly higher in those with gastric cancer compared to those with benign or precancerous conditions. Higher DNA levels also correlated with more advanced tumors, and paradoxically, patients with elevated levels had longer progression-free survival, possibly because of greater immune cell activity in the tumor. This stomach fluid test could become a useful add-on to standard biopsy for diagnosing and tracking gastric cancer.

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This cost-effectiveness analysis compared upfront surgery versus perioperative chemotherapy for locally advanced gastric cancer using a decision tree model based on Medicare reimbursement rates. Perioperative chemotherapy was the dominant strategy at $40,792 for 3.11 quality-adjusted life years, while upfront surgery cost nearly $15,000 more while yielding only a marginal gain in quality-adjusted life years — far exceeding standard cost-effectiveness thresholds. Perioperative chemotherapy is the more cost-effective choice for locally advanced gastric cancer in the U.S. healthcare context.

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This cost-effectiveness analysis evaluated sentinel lymph node biopsy for head and neck skin squamous cell carcinoma staged using the Brigham and Women's Hospital system. The biopsy was cost-effective only for the highest-risk T3 tumors, with an incremental cost-effectiveness ratio of about $18,000, while skipping the biopsy was the dominant strategy for T2a and T2b tumors. Patient selection for this procedure should be individualized based on the specific tumor stage.

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This study analyzed 242 cases of pleomorphic rhabdomyosarcoma—a rare and aggressive muscle-tissue cancer—from a national cancer database and found that age at diagnosis, tumor stage, and whether surgery was performed significantly affected survival, while race, sex, and tumor location did not. Only five prior cases of this tumor arising from the abdominal wall had been reported in the literature. These findings help clarify which patient and tumor factors drive outcomes in this poorly understood malignancy.

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This cost-effectiveness analysis compared four methods of reconstructing the perineum after radical pelvic surgery: primary closure, and three flap techniques. The gluteal thigh flap provided the best quality of life at the lowest overall cost, with an incremental cost-effectiveness ratio of about $5,600, making it the dominant strategy in nearly all scenarios. Surgeons should use the gluteal thigh flap as their first choice when it is technically feasible.

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A decision-tree model evaluated whether giving chemotherapy and radiation before surgery is more cost-effective than going straight to surgery for resectable pancreatic cancer. Neoadjuvant chemoradiation cost about $45,500 and yielded more quality-adjusted life years, with an incremental cost-effectiveness ratio of roughly $48,000—well within accepted thresholds—and was favored in 94% of simulations. Preoperative chemoradiation should be the default approach unless there is a specific contraindication.

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This decision-tree analysis compared the costs and outcomes of robotic versus laparoscopic cholecystectomy for gallbladder disease using Medicare reimbursement data. Robotic surgery cost about $3,000 more while adding only a negligible quality-of-life benefit, producing an incremental cost-effectiveness ratio of nearly $1.8 million per quality-adjusted life year—far exceeding accepted thresholds. Standard laparoscopic cholecystectomy remains the more cost-effective treatment for the vast majority of patients.

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This study uncovered how cancer cells escape a natural anti-tumor defense called oncogene-induced senescence, a dormant state that normally halts abnormal cell growth. The transcription factor POU2F2 drives this escape by activating a precoded set of gene enhancers, and its elevated activity was detected in precancerous colon lesions and associated with worse patient survival. POU2F2 and associated chromatin signatures may serve as early diagnostic and prognostic biomarkers in colorectal cancer.

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Analyzing over 150,000 bariatric surgery cases, this study found that Black patients were significantly more likely to receive open rather than minimally invasive surgery for both gastric bypass and sleeve gastrectomy, and they experienced higher rates of complications and unplanned readmissions. For gastric bypass, reduced access to the laparoscopic approach partially explained the racial gap in complications. These findings point to systemic barriers upstream of the operating room that drive unequal surgical outcomes.

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A cost-effectiveness model compared robotic versus laparoscopic repair of paraesophageal hernias using Medicare cost data and found that robotic repair costs about $500 more while providing almost no additional benefit, yielding an incremental cost-effectiveness ratio of roughly $779,000 per quality-adjusted life year. Laparoscopic repair was favored in every sensitivity analysis and 100% of simulations. Robotic hernia repair is not cost-effective at most institutions unless surgeons have already surpassed the learning curve and capital costs are excluded.

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This study characterized colon cancer trends at a Newark, NJ hospital serving a predominantly Black and Hispanic population and found higher rates of both late-stage and early-onset diagnoses compared to state and national averages. Across New Jersey, Black, Hispanic, and Asian/Pacific Islander patients had significantly greater odds of being diagnosed with advanced or young-onset colon cancer compared to White patients, and counties with greater social vulnerability had higher colorectal cancer death rates. These findings highlight where targeted screening and access interventions are most needed.

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This analysis of nearly 13,000 esophageal and gastric cancer surgeries found that Black patients were significantly more likely to undergo open gastrectomy rather than minimally invasive surgery, and Black patients undergoing esophagectomy had higher rates of complications, severe complications, and 30-day mortality regardless of surgical approach. These disparities were independent of other patient factors, pointing to structural inequities in access to advanced surgical techniques. The findings call for targeted efforts to identify and remove the barriers preventing minority patients from receiving minimally invasive care.

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A decision-tree analysis compared endoscopic and laparoscopic drainage of symptomatic pancreatic pseudocysts. Endoscopic drainage was the dominant strategy, producing better outcomes while saving nearly $24,000 per patient compared to laparoscopic drainage, with results confirmed across all sensitivity analyses. Endoscopic drainage should be the first-line treatment for pancreatic pseudocysts when both approaches are available.

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This cost-effectiveness model compared two strategies for guiding adrenal gland removal in primary aldosteronism: using adrenal vein sampling to confirm which gland is overactive versus relying on CT scan alone. Adrenal vein sampling cost only $308 more but yielded 0.78 additional quality-adjusted life years, giving an incremental cost-effectiveness ratio of under $400. The findings strongly support using adrenal vein sampling as the standard approach before adrenalectomy.

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This small case series examined staging laparoscopy with peritoneal fluid testing in eight patients with non-metastatic pancreatic cancer before starting treatment. One patient with positive cytology avoided unnecessary surgery, while those with negative cytology who did not receive timely chemotherapy had very poor survival. The findings suggest peritoneal cytology can help spare some patients from futile operations, but prompt systemic treatment after staging remains critical.

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This cost-effectiveness analysis compared three management strategies for infected necrotizing pancreatitis — open surgery, endoscopic step-up, and minimally invasive surgical step-up — using a decision tree model with Medicare costs. Endoscopic step-up was the dominant strategy, delivering the most quality-adjusted life years at the lowest cost, with 65.5% of simulations favoring it. The analysis supports endoscopic step-up as the standard approach for infected necrotizing pancreatitis at centers with the necessary expertise.

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This decision-tree analysis compared endoscopic stent placement versus emergency surgery for patients with bowel obstruction from advanced colorectal cancer. Stenting cost about $5,900 less while yielding more quality-adjusted life years, making it the dominant palliative strategy and favored in over 96% of simulations. Emergency surgery should only be preferred if stenting reintervention rates are very high or if surgical survival improves substantially.

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A cost-effectiveness model compared two approaches to administering radioactive iodine after thyroid surgery: using a diagnostic whole-body scan to guide the dose versus giving a standard empiric dose. Empiric dosing produced nearly one additional quality-adjusted life year while costing $1,250 less, making it the dominant strategy in virtually all scenarios. For most patients with differentiated thyroid cancer, a pre-ablation diagnostic scan adds cost without improving outcomes.

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Researchers analyzed 39 cases of pancreatic carcinosarcoma—a rare tumor combining features of both carcinoma and sarcoma—from a national database spanning over four decades. Metastatic disease was the only factor that independently predicted worse survival, while surgery improved outcomes in patients with localized disease. The rarity and aggressiveness of this cancer argue for reserving surgery for localized cases and pursuing novel therapies for advanced disease.

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This case report describes a patient whose retroperitoneal liposarcoma recurred 20 years after what appeared to be a complete surgical removal, with different microscopic features at recurrence than at the original diagnosis. Molecular testing confirmed the diagnosis through MDM2 amplification and CDK4 positivity. The case illustrates that even aggressive fat-cell tumors can lie dormant for decades and underscores the need for very long-term surveillance after resection.

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This study of 1,270 COVID-19 patients admitted to two New Jersey hospitals found that patients who died were far more likely to have had a do-not-resuscitate order at admission than survivors. Patients with DNR orders had more than twice the hazard of dying, a relationship that held after adjusting for other risk factors. DNR status was a strong and independent predictor of mortality during the early COVID-19 pandemic.

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This case report describes a 42-year-old woman diagnosed with pancreatic carcinosarcoma—a rare tumor type combining carcinoma and sarcoma—who underwent extensive surgery removing part of the pancreas, spleen, colon, and adrenal gland. Pathology and immunostaining confirmed the rare diagnosis. Despite aggressive resection followed by 20 cycles of chemotherapy, the disease progressed and the patient transitioned to comfort care at 16 months.

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This is a published correction to an earlier article on pancreatic carcinosarcoma treatment and contains no independent scientific content.

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This single-institution retrospective study examined whether insurance status affected survival after cytoreductive surgery plus heated intraperitoneal chemotherapy (CRS-HIPEC) for peritoneal cancers in a safety-net hospital context. In 31 patients, statistical analysis found no significant survival difference between insured and underinsured patients, but all six long-term survivors were in the insured group while none were in the underinsured group. The small sample limits conclusions, but the trend suggests insurance disparities may affect long-term outcomes after this aggressive cancer treatment.

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A cost-effectiveness model evaluated sentinel lymph node biopsy for head and neck skin squamous cell carcinoma across all tumor stages. Skipping the biopsy was the more cost-effective strategy at every stage, primarily because the overall rate of lymph node spread and disease-specific death in this cancer type is low. The procedure should not be performed routinely, regardless of tumor stage.

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This proof-of-concept study tested a panel of four protein stains on pancreatic tissue from 27 surgical specimens to improve diagnosis of pancreatic cancer. When three of the markers (VHL, IMP3, and S100A4) were combined into a panel, the test correctly identified cancer with 100% sensitivity and 96% specificity. This biomarker panel warrants prospective testing on biopsy specimens to see if it can improve pre-surgical diagnosis.

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This case report describes a 56-year-old man who presented with painless jaundice caused by a malignant granular cell tumor obstructing the bile duct—an extremely rare diagnosis. The tumor was identified through endoscopy and confirmed by biopsy before surgical removal. Granular cell tumors of the bile duct are so uncommon that this case adds meaningful detail to the small body of literature on their malignant behavior.

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This retrospective study assessed whether adding abdominal wall reconstruction to cytoreductive surgery and heated intraperitoneal chemotherapy increased postoperative risk. Patients who needed abdominal wall repair had longer operations and greater blood loss, but overall survival and serious complication rates were similar to those who did not require reconstruction. Abdominal wall reconstruction can be safely combined with this complex cancer surgery in appropriately selected patients.

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This historical piece profiles Herman Boerhaave, an 18th-century Dutch physician whose contributions to clinical medicine and medical education transformed how doctors examine and treat patients. Best known today only for the esophageal rupture syndrome bearing his name, Boerhaave's broader influence on bedside teaching and systematic diagnosis is largely forgotten. The article argues that medical educators should reintroduce students to his foundational contributions.

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This analysis of 19 malpractice cases involving pancreaticoduodenectomy—a complex abdominal operation—found that the most common allegation was that the surgery was unnecessary, followed by postoperative negligence and misdiagnosis. Physicians prevailed in 68% of cases, but plaintiff awards when they lost averaged over $4 million. Improving surgeon-patient communication and transparency about operative indications and risks is the most actionable step to reduce litigation.

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This study examined over 37,000 cancer-related emergency department visits in New Jersey and found that race, insurance type, age, and cancer type all significantly influenced whether patients were admitted, transferred, or readmitted. Black and Hispanic patients were less likely to be admitted from the ED and had lower readmission rates, a pattern that may reflect barriers to ongoing outpatient care. The authors identify patient navigation, symptom monitoring tools, and standardized care pathways as practical strategies to reduce unnecessary ED visits.

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This meta-analysis of five studies compared robotic and laparoscopic surgery for colorectal cancer and found equivalent overall and disease-free survival between the two approaches. Laparoscopic surgery had a modest advantage in operative time, margin length, and lymph node yield, while the two approaches were otherwise comparable. Larger prospective trials are needed to determine whether either approach offers a meaningful long-term oncologic advantage.

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This is a published correction to an earlier review article on robotic versus laparoscopic colorectal surgery and contains no independent scientific content.

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A decision-tree model compared three strategies for evaluating a bile duct narrowing without an obvious mass: endoscopic retrograde cholangiopancreatography with brushings, endoscopic ultrasound with needle biopsy, or immediate surgery. Both endoscopic approaches were more cost-effective than surgery, and endoscopic ultrasound was the most cost-effective option in the base case, though the best choice between the two endoscopic approaches depends on institutional expertise. Patients with biliary strictures should undergo investigation before any surgical intervention.

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This review of 122 colorectal surgery malpractice cases found that the most common allegation was failure to recognize a complication in time, followed by damage to surrounding tissue, with physicians winning about two-thirds of cases. Plaintiff jury awards were significantly larger than settlement payments. Understanding which failures most commonly lead to litigation can help surgeons prioritize communication, documentation, and early complication recognition.

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This systematic review analyzed 77 studies published over a decade to compare the accuracy of various tests for diagnosing cancers of the bile duct and pancreas. Standard endoscopic brushing had only 42% sensitivity, but a panel combining the protein stain IMP3 with the marker KOC, S100A4, and standard cytology achieved sensitivities and specificities above 85%. The review provides a practical roadmap for building a more accurate diagnostic panel for these difficult-to-detect cancers.

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An analysis of 59 jury verdicts and settlements involving esophageal perforation found that gastroenterologists, general surgeons, and anesthesiologists were the most commonly named defendants, with two-thirds of cases decided in the physician's favor. Delayed diagnosis and the need for surgical repair were the most common factors in cases resulting in payment, with median plaintiff awards of $1.2 million. Explicitly listing esophageal perforation in informed consent for relevant procedures is a straightforward step to reduce litigation exposure.

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This 10-year literature review pooled data from 16 studies to determine how accurately standard endoscopic brushing detects bile duct and pancreatic cancers. The combined sensitivity was only 42%, meaning more than half of cancers would be missed by this test alone. The findings question the value of relying on endoscopic brushings to guide surgical decisions when clinical and imaging findings already strongly suggest malignancy.

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This study analyzed 234 malpractice cases related to appendicitis and appendectomy and found that delayed diagnosis was by far the most common allegation, cited in 67% of cases, with physicians winning about 60% of verdicts. Average plaintiff awards exceeded $794,000, while settlements averaged more than $1.4 million. Prompt evaluation, efficient cross-specialty communication, and thorough informed consent are the most important steps to reduce liability in appendicitis care.

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Doctors treated a rare and dangerous skin cancer called sebaceous carcinoma that kept coming back in multiple spots on a patient's body and spreading aggressively; they removed the main tumor and used a surgical flap to cover the large wound it left behind. The cancer in this patient was particularly aggressive because of a combination of factors: the patient's genetics made them more susceptible to the disease, there was a delay in getting definitive treatment, and the cancer itself is inherently aggressive by nature. This case matters because sebaceous carcinoma is so rare that doctors don't fully understand why it sometimes behaves so aggressively and comes back repeatedly, and studying real-world cases like this one helps doctors recognize the warning signs and treat it more effectively.