Collective wisdom and decision making in surgical oncology

AIM

To describe systems for capturing and optimising collective knowledge and insight in areas of complexity and uncertainty in surgical oncology, with particular reference to the Delphi process and related systems.

METHODS

Internet search engines (Google, Google Scholar) and four databases (SCOPUS, PubMed, Medline and Embase) were searched to find English language articles on the use of The Delphi Process and related systems in surgical oncology, using a variety of search terms.

FINDINGS

There are a number of established systems for co-opting group knowledge and facilitating collective decision-making. These find applications in commerce, industry, government and defence. They have also been applied to problems in surgical oncology, for example using the Delphi process to optimise the management of colorectal cancers and metastases.

CONCLUSIONS

Collective decision making tools find practical applications in the allocation of resources and in clinical decision making in fields of surgical oncology practice where there is a wide range of evidence and expert opinion. Such methodologies set new standards for the collating of professional expertise and for the writing of "best clinical practice" guidelines in the cancer subspecialities.

Staging the axilla in breast cancer: an audit of lymph-node retrieval in one U.K. regional centre

AIMS

Many surgeons undertake a level 1 axillary dissection in patients with invasive breast cancer. This dissection yields a variable number of lymph nodes for histological study. In this study, we report the consequences of this policy for staging of the axilla.

METHODS

Between January 1995 and December 1995, 236 patients with a diagnosis of invasive breast cancer underwent axillary surgery.

RESULTS

A median of eight nodes was identified (range 0-30). In only 11 patients less than four nodes were identified. An increase in the number of nodes harvested was associated with a higher proportion of node-positive patients and a higher number of metastatic nodes identified.

CONCLUSIONS

We concluded that a standardized approach to axillary dissection consistently yields an adequate sample of lymph nodes for staging purposes. Most importantly, larger node samples yield higher detection rates for metastasis. This has a significant bearing on patient selection for adjuvant chemotherapy when compared with more limited sampling practices, including solitary sentinel node detection and biopsy.

Antimicrobial activity of viridiofungins

A family of aminoacyl alkyl citrate compounds called viridiofungins, are novel squalene synthase inhibitors. The compounds have broad spectrum fungicidal activity but lack antibacterial activity. Although the compounds inhibit squalene synthase, the first committed step in ergosterol biosynthesis, results presented in this paper show that inhibition of fungal growth is not related to inhibition of ergosterol synthesis.

Zaragozic acids D and D2: potent inhibitors of squalene synthase and of Ras farnesyl-protein transferase

Two new zaragozic acids, D and D2, have been isolated from the keratinophilic fungus Amauroascus niger. Zaragozic acids D [4] and D2 [5] are related to the previously described zaragozic acids A [1], B [2], and C [3] and are potent inhibitors of squalene synthase. Furthermore, all the zaragozic acids (A, B, C, D, and D2) are also active against farnesyl transferase. Zaragozic acids D and D2 inhibit farnesyl transferase with IC50 values of 100 nM, while zaragozic acids A and B are less potent.