1. Surgical Oncology Ali Raza Omar M. Rashid Jeff Stromberg Krista Terracina Andrew Maloney Jacob Riis Anthony Feghali 2/4/2013 – 2/8/2013

2. ATTDRESDATEPATIENTPROCEDUREINDICATION Kaplan Raza Rashid 2/4/13Pylorus preserving whipple IPMN Kaplan Rashid 2/4/13Resection ofRecurrent left retroperitoneal sarcoma Bear Terracina 2/4/13Right segmental mastectomy IDC Bear Riis 2/4/13Portacath placementBreast Cancer Grover Stromberg 2/4/13Left inferior parathyroidectomy, FNA of Left thyroid nodule Primary hyperparathyoroidism, Left thyroid nodule Neifeld Maloney 2/4/13WLE of and STSGLeft foot porocarcinoma Vu Feghali 2/4/13Vaginal and anal exam under anesthesia with biopsies SCC

3. ATTDRESDATEPATIENTPROCEDUREINDICATION Kaplan Raza Stromberg 2/6/13Lap hand assisted sigmoid colectomy Colon cancer Kaplan Rashid 2/6/13APRRectal Cancer Kaplan Stromberg Riis 2/6/13Wide excision ofRight shoulder sarcoma Grover Maloney 2/6/13Excision ofLeft breast fibroadenoma Grover Terracina 2/6/13Right total mastectomy, SLN bx Breast cancer Grover Riis 2/7/13Cervical LN biopsiesPapillary thyroid cancer Kaplan Raza Rashid 2/7/13Ex Lap, repair of colotomy Hepatic flexure leak

4. ATTDRESDATEPATIENTPROCEDUREINDICATION Vu2/7/13Removal ofPortacath Vu Stromberg 2/7/13Ex Lap, left hemicolectomy Colonic inflammatory mass (diverticulitis) Kaplan Raza Stromberg 2/8/13Lap hand assisted sigmoid colectomy Colon cancer Kaplan Riis 2/8/13Removal of portacath Colon cancer completed chemotherapy Kaplan Raza Maloney 2/8/13WLE of melanoma of the back, lipoma excision Melanoma (0.6mm), Lipoma Kaplan Stromberg Raza 2/8/13Excisional biopsy of thigh mass Thigh mass Kaplan Maloney 2/8/13Removal of portacath Colonc ca completed chemotherapy Kaplan Rashid Terracina 2/8/13Wide excision of scalp sarcoma Scalp sarcoma

5. ATTDRESDATEPATIENTPROCEDUREINDICATION Bear Raza Terracina 2/8/13Left mastectomy, SLNBx Breast Cancer Bear Feghali 2/8/13Left IJ portacath placement Breast cancer

6. ATTDRESDATEPATIENTPROCEDURESCOMPLICATIONS Kaplan Raza Rashid 2/4/13Pylorus preserving whipple EtOH withdrawal Kaplan Rashid 2/4/13Resection of left retroperitoneal sarcoma Delayed diagnosis of left ureteral transection Kaplan Raza Wesson 1/31/13Ex Lap, LOA, intraop U/S Hepatic flexure leak COMPLICATIONS

7. Case presentation 71yr male h/o CAD, AAA, Hep A/B/C, bladder Ca, s/p ex lap 7/18/12 for retroperitoneal sarcoma that was bilobed with one lesion (13.7 x 13.3 x 14.1cm) resected and second lesion unresectable (6x5.7x6.2cm) who underwent XRT and on 1/30/12 underwent Ex Lap, LOA, intraop ultrasound and the mass was unresectable (IVC/SMA/SMV involvement). Hepatic flexure was deserosalized.

9. POD#8 SOB and Tachypnea, hypontesive to 80’s which responded to fluid bolus, PE CT was negative PE However, free air present under diaphragm

13. Complication On exploration, the de-serosalized hepatic flexure was leaking, it was repaired, abthera applied 48hrs later he was washed out and closed He has been extubated and has a controled fistula

15. Analysis of Complication Was the complication avoidable? Would avoiding the complication have changed the outcome? What factors contributed to the complication? Take home points