Mucinous neoplasms of the appendix were found in 5 of 17 patients (29.4%) undergoing interval appendectomy. Interval appendectomies should be considered in all adult patients, especially those 40 years or older, to determine the underlying cause of appendicitis. A multi-institutional study to determine the generalizability of these findings is warranted.

Cancer recurrence after complete resection of the primary tumor is dreaded by patients and physicians alike. Intensive follow-up after curative resection is considered a marker of good practice and frequently perceived as an antidote against recurrence by patients and families. In the United States, there is abiding faith in frequent imaging and blood tests as the best tools for the job. Thoughtful practice, clinical guidelines, retrospective reviews of prospectively gathered data, and clinical trials of follow-up have focused on the number, frequency, and sequence of modalities. 1,2 A different perspective on which to predicate follow-up of patients with curatively treated cancer is to consider whether meaningful treatment options exist for recurrence. In cancers for which there are meaningful treatment options, it is reasonable to expect that moreintensive follow-up may improve survival. This commentary discusses this perspective in the context of the established literature in patients with colorectal and breast cancers, two cancers considered to have effective treatments for metastatic and recurrent disease as compared with non-small-cell lung cancer (NSCLC) and pancreatic cancer, which do not. Colorectal CancerEffective treatments for advanced colorectal cancer have evolved over the past 20 years. Life-prolonging therapies exist for metastatic disease. 3,4 Some, such as resection of isolated hepatic and lung metastases, have curative potential. [5][6][7] These data suggest that intensive follow-up of patients with curatively treated colorectal cancer could improve overall survival.However, the current literature is not definitive. In 2000, Berman et al 8 published a systematic review in Lancet on the use of many different tests for colorectal cancer surveillance. The review concluded that "after baseline colonoscopy to rule out synchronous and metachronous tumors, data support surveillance restricted to review of clinical symptoms and physical examination." 8(p398) This conclusion stimulated published objections that the analysis reflected older practices, less willingness to resect metastatic disease, and lesseffective chemotherapy. 9In 2002, Kievit et al 10 performed a meta-analysis addressing the impact of intensity of surveillance strategies for colorectal cancer. This study, including 267 published articles, calculated that 360 positive follow-up tests and 11 surgeries would be needed to provide one patient with colorectal cancer long-term survival. The authors concluded that cost-effective follow-up should be of limited intensity and duration, consisting of carcinoembryonic antigen testing and hepatic ultrasound.

ObjectiveThe authors reviewed the results of endoscopic retrograde cholangiopancreatography (ERCP) and intraoperative cholangiography in a series of patients who underwent laparoscopic cholecystectomy. Summary Background DataThe indications for preoperative and postoperative ERCP and intraoperative cholangiography as adjuncts to laparoscopic cholecystectomy are evolving. The debate regarding the use of selective or routine intraoperative cholangiography has intensified with the advent of laparoscopic cholecystectomy. MethodsThe authors reviewed the records of 343 consecutive patients who underwent laparoscopic cholecystectomy during a 1 -year period. Historical, biochemical, and radiologic findings for the patients who underwent ERCP and intraoperative cholangiography were analyzed. ResultsThree hundred forty-three patients underwent laparoscopic cholecystectomy during the period reviewed. Preoperative ERCP was performed in 42 patients. Twenty-seven of these patients (64%) had common bile duct (CBD) stones, which were cleared with a sphincterotomy.Intraoperative cholangiography was performed for 101 patients (29%). Three cholangiograms had false-positive results (3%), leading to two CBD explorations, in which no CBD stones were found, and one normal ERCP. Six patients underwent postoperative ERCP, three for the removal of retained CBD stones (0.9%), all of which were cleared with a sphincterotomy. Fifteen patients had gallstone pancreatitis, six of whom had CBD stones (40%) that were cleared by ERCP. There were 33 complications (10%) and no CBD injuries. ConclusionThe use of routine intraoperative cholangiography is discouraged in view of its low yield and the significant rate of false positive cholangiogram results. 212

There is a minimum flow rate required to reach goal temperature during HIPEC. Flow rate is an important variable in achieving and maintaining goal temperatures during HIPEC.

We have described the process of creating the first pMCC guideline. A key component of this guideline is that pMCCs should serve as a link between the hospital and community.