Linking Emotional Intelligence to Successful Health Care Leadership: The Big Five Model of Personality.

Research has identified emotional intelligence as the ability to understand and manage emotions. This is especially important for surgical leaders who must interact constructively with teams, administrators, patients, colleagues, and the community. Conventional intelligence emphasizes the rational and analytical brain. When one becomes aware of emotional intelligence, it adds to the repertoire of the surgical leader. It gives them insight into the dynamics of interpersonal relationships. This will allow the surgeon to control the emotional side of communication. Specifically, emotional intelligence focuses on self-awareness, self-management, social skills, and resiliency. With these skills, they are able to modulate their leadership style, allowing for increased conflict management and persuasiveness, more effective change management, and consensus-building. Emotional intelligence is not innate; these are learned skills. With practice and attention, it is possible to acquire the skills to enhance relationships.

Locally advanced carcinosarcoma of the pancreas.

Carcinosarcoma is a rare subtype of pancreatic neoplasm including both carcinomatous and sarcomatous components. Fewer than 30 cases have been reported to the Surveillance, Epidemiology, and End Results Program database. Given such rarity, definitive treatment guidelines are not well defined. We report a case of pancreatic carcinosarcoma diagnosed in our institution, review tumor clinicopathological characteristics, and describe our medical and surgical management strategy.

Liver Resection and Transplantation for Patients With Hepatocellular Carcinoma Beyond Milan Criteria.

OBJECTIVES: To assess survival after liver resection and transplantation in patients with hepatocellular carcinoma (HCC) beyond Milan criteria. BACKGROUND: The role of liver resection and transplantation remains controversial for patients with HCC beyond Milan criteria. Resection of advanced tumors and transplantation using extended-criteria are pursued at select high-volume center. METHODS: Patients from 5 liver cancer centers in the United States who had liver resection or transplantation for HCC beyond Milan criteria between 1990 and 2011 were included in the study. Multivariable and propensity-matching analyses estimated the effects of clinical factors and operative selection on survival. RESULTS: Of 608 patients beyond Milan without vascular invasion, 480 (79%) patients underwent resection and 128 (21%) underwent transplantation. Clinicopathologic profiles between resection and transplant patients differed significantly. Hepatitis C and cirrhosis were more prevalent in transplantation group (P < 0.001). Resection patients had larger tumors [median 9 cm, interquartile range (IQR): 6.5-12.9 cm vs. median 4.1, IQR: 3.4-5.3 cm, P < 0.001]; transplant patients were more likely to have multiple tumors (78% vs 28%, P < 0.001).Overall (OS) and disease-free survival (DFS) were both greater after tumor downstaging and transplantation than resection (all P < 0.001). OS did not differ between liver transplant recipients who were not pretreated or pretreated and failed to downstage compared with propensity-matched liver resection patients (P ≥ 0.176); DFS in this propensity matched cohort was greater after liver transplantation (P ≤ 0.017). CONCLUSIONS: Liver resection and transplantation provide curative options for patients with HCC beyond Milan criteria. Further treatment strategies aimed at the efficiency and durability of tumor downstaging and expansion of the role of transplantation among suitable candidates could improve outcomes in patients with large or multifocal HCC.

Surgical treatment of hepatocellular carcinoma in North America: can hepatic resection still be justified?

BACKGROUND: The incidence of hepatocellular cancer (HCC) is increasing dramatically worldwide. Optimal management remains undefined, especially for well-compensated cirrhosis and HCC. STUDY DESIGN: This retrospective analysis included 5 US liver cancer centers. Patients with surgically treated HCC between 1990 and 2011 were analyzed; demographics, tumor characteristics, and survival rates were included. RESULTS: There were 1,765 patients who underwent resection (n = 884, 50.1%) or transplantation (n = 881, 49.9%). Overall, 248 (28.1%) resected patients were transplant eligible (1 tumor <5 cm or 2 to 3 tumors all <3 cm, no major vascular invasion); these were compared with 496 transplant patients, matched based on year of transplantation and tumor status. Overall survivals at 5 and 10 years were significantly improved for transplantation patients (74.3% vs 52.8% and 53.7% vs 21.7% respectively, p < 0.001), with greater differences in disease-free survival (71.8% vs 30.1% at 5 years and 53.4% vs 11.7% at 10 years, p < 0.001). Ninety-seven of the 884 (11%) resected patients were within Milan criteria and had cirrhosis; these were compared with the 496 transplantation patients, with similar results to the overall group. On multivariate analysis, type of surgery was an independent variable affecting all survival outcomes. CONCLUSIONS: The increasing incidence of HCC stresses limited resources. Although transplantation results in better long-term survival, limited donor availability precludes widespread application. Hepatic resection will likely remain a standard therapy in selected patients with HCC. In this large series, only about 10% of patients with cirrhosis were transplant-eligible based on tumor status. Although liver transplantation results are significantly improved compared with resection, transplantation is available only for a minority of patients with HCC.

Biochemical prognostic indicators for pancreatic neuroendocrine tumors and small bowel neuroendocrine tumors.

Pancreatic neuroendocrine tumors (PNETs) and small bowel neuroendocrine tumors (SBNETs) are rare tumors that are frequently diagnosed late in the course of the disease. Several biomarkers have been proposed in the literature as prognostic factors for patients with these tumors. This article discusses a recent publication in Annals of Surgical Oncology from the University of Iowa analyzing the effect of different biomarkers on survival in patients with PNETs and SBNETs.

The extraperitoneal laparoscopic TRAM flap delay procedure: an alternative approach.

INTRODUCTION: Ligation of the deep inferior epigastric vessels prior to transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction (delay procedure) was introduced to augment vascularity to the island flap through improved superior epigastric flow, thus decreasing flap morbidity. There are various surgical approaches described, including open and laparoscopic approaches, for ligation of inferior epigastric arteries. We describe an extraperitoneal laparoscopic technique (EPLT) and the outcomes of the procedure. METHODS: All patients who underwent EPLT prior to TRAM flap construction between July 2006 and December 2008 were included in the study. Data were analyzed retrospectively from a prospectively collected database. RESULTS: The study group included 11 female patients with mean age of 55 years and mean body mass index (BMI) of 34.4 kg/m(2). There were no conversions to open procedure. Ten patients had bilateral ligation of inferior epigastric arteries, and one patient had it only on one side. There were no complications related to the procedure. CONCLUSION: Extraperitoneal laparoscopic technique as a delay procedure for TRAM flap reconstruction is safe and feasible with no morbidity related to surgery.