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Zarate Rodriguez JG, Raper L, Sanford DE, Trikalinos NA, Hammill CW. Race and Odds of Surgery Offer in Small Bowel and Pancreas Neuroendocrine Neoplasms. Ann Surg Oncol 2024; 31:3249-3260. [PMID: 38294612 DOI: 10.1245/s10434-024-14906-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Despite existing society guidelines, management of pancreatic (PanNEN) and small bowel (SBNEN) neuroendocrine neoplasms remains inconsistent. The purpose of this study was to identify patient- and/or disease-specific characteristics associated with increased odds of being offered surgery for PanNEN and SBNEN. PATIENTS AND METHODS The Surveillance, Epidemiology, and End Results (SEER) Program database and the National Cancer Database (NCDB) were queried for patients with PanNEN/SBNEN. Demographic and pathologic data were compared between patients who were offered surgery and those who were not. Multivariate logistic regression was performed to identify factors independently associated with being offered surgery. RESULTS In SEER, there were 3641 patients with PanNEN (54.7% were offered surgery) and 5720 with SBNEN (86.0% were offered surgery). On multivariate analysis of SEER, non-white race was associated with decreased odds of surgery offer for SBNEN [odds ratio (OR) 0.58, p < 0.001], but not PanNEN (p = 0.187). In NCDB, there were 28,483 patients with PanNEN (57.5% were offered surgery) and 42,675 with SBNEN (86.9% were offered surgery). On multivariate analysis of NCDB, non-white race was also associated with decreased odds of surgery offer for SBNEN (OR 0.61, p < 0.001) but not PanNEN (p = 0.414). CONCLUSIONS This study's findings suggest that, in addition to previously reported disparities in surgical resection and surgery refusal rates, racial/ethnic disparities also exist earlier in the course of treatment, with non-white patients being less likely to be offered surgery for SBNEN but not for PanNEN; this is potentially due to discrepancies in rates of referral to academic centers for pancreas and small bowel malignancies.
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Affiliation(s)
- Jorge G Zarate Rodriguez
- Division of Hepatobiliary, Pancreatic & Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Lacey Raper
- Division of Hepatobiliary, Pancreatic & Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- University of Missouri-Columbia School of Medicine, Columbia, MO, USA
| | - Dominic E Sanford
- Division of Hepatobiliary, Pancreatic & Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Nikolaos A Trikalinos
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Chet W Hammill
- Division of Hepatobiliary, Pancreatic & Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
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Zarate Rodriguez JG, Hammill CW. Race Affects Patients' Likelihood of Being Offered Surgical Resection for Small Bowel Neuroendocrine Neoplasms. Ann Surg Oncol 2024; 31:3261-3262. [PMID: 38361093 DOI: 10.1245/s10434-024-15056-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Jorge G Zarate Rodriguez
- Department of Surgery, Division of Hepatobiliary, Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | - Chet W Hammill
- Department of Surgery, Division of Hepatobiliary, Pancreatic and Gastrointestinal Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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3
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Li S, Lu D, Li S, Liu J, Xu Y, Yan Y, Rodriguez JZ, Bai H, Avila R, Kang S, Ni X, Luan H, Guo H, Bai W, Wu C, Zhou X, Hu Z, Pet MA, Hammill CW, MacEwan MR, Ray WZ, Huang Y, Rogers JA. Bioresorbable, wireless, passive sensors for continuous pH measurements and early detection of gastric leakage. Sci Adv 2024; 10:eadj0268. [PMID: 38640247 PMCID: PMC11029800 DOI: 10.1126/sciadv.adj0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 03/18/2024] [Indexed: 04/21/2024]
Abstract
Continuous monitoring of biomarkers at locations adjacent to targeted internal organs can provide actionable information about postoperative status beyond conventional diagnostic methods. As an example, changes in pH in the intra-abdominal space after gastric surgeries can serve as direct indicators of potentially life-threatening leakage events, in contrast to symptomatic reactions that may delay treatment. Here, we report a bioresorbable, wireless, passive sensor that addresses this clinical need, designed to locally monitor pH for early detection of gastric leakage. A pH-responsive hydrogel serves as a transducer that couples to a mechanically optimized inductor-capacitor circuit for wireless readout. This platform enables real-time monitoring of pH with fast response time (within 1 hour) over a clinically relevant period (up to 7 days) and timely detection of simulated gastric leaks in animal models. These concepts have broad potential applications for temporary sensing of relevant biomarkers during critical risk periods following diverse types of surgeries.
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Affiliation(s)
- Shuo Li
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Di Lu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- School of Microelectronics, University of Science and Technology of China, Hefei, Anhui 230026, China
| | - Shupeng Li
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jiaqi Liu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Yameng Xu
- The Institute of Materials Science and Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Ying Yan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jorge Zárate Rodriguez
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Hedan Bai
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Shuming Kang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Xinchen Ni
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Haiwen Luan
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Hexia Guo
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Wubin Bai
- Department of Applied Physical Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Changsheng Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, National University of Singapore, Singapore 117575, Singapore
| | - Xuhao Zhou
- Department of Chemistry, Northwestern University, Evanston, IL 60208, USA
| | - Ziying Hu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Mitchell A. Pet
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Chet W. Hammill
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Matthew R. MacEwan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Wilson Z. Ray
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Yonggang Huang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - John A. Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Holzer KJ, Bartosiak KA, Calfee RP, Hammill CW, Haroutounian S, Kozower BD, Cordner TA, Lenard EM, Freedland KE, Tellor Pennington BR, Wolfe RC, Miller JP, Politi MC, Zhang Y, Yingling MD, Baumann AA, Kannampallil T, Schweiger JA, McKinnon SL, Avidan MS, Lenze EJ, Abraham J. Perioperative mental health intervention for depression and anxiety symptoms in older adults study protocol: design and methods for three linked randomised controlled trials. BMJ Open 2024; 14:e082656. [PMID: 38569683 DOI: 10.1136/bmjopen-2023-082656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Preoperative anxiety and depression symptoms among older surgical patients are associated with poor postoperative outcomes, yet evidence-based interventions for anxiety and depression have not been applied within this setting. We present a protocol for randomised controlled trials (RCTs) in three surgical cohorts: cardiac, oncological and orthopaedic, investigating whether a perioperative mental health intervention, with psychological and pharmacological components, reduces perioperative symptoms of depression and anxiety in older surgical patients. METHODS AND ANALYSIS Adults ≥60 years undergoing cardiac, orthopaedic or oncological surgery will be enrolled in one of three-linked type 1 hybrid effectiveness/implementation RCTs that will be conducted in tandem with similar methods. In each trial, 100 participants will be randomised to a remotely delivered perioperative behavioural treatment incorporating principles of behavioural activation, compassion and care coordination, and medication optimisation, or enhanced usual care with mental health-related resources for this population. The primary outcome is change in depression and anxiety symptoms assessed with the Patient Health Questionnaire-Anxiety Depression Scale from baseline to 3 months post surgery. Other outcomes include quality of life, delirium, length of stay, falls, rehospitalisation, pain and implementation outcomes, including study and intervention reach, acceptability, feasibility and appropriateness, and patient experience with the intervention. ETHICS AND DISSEMINATION The trials have received ethics approval from the Washington University School of Medicine Institutional Review Board. Informed consent is required for participation in the trials. The results will be submitted for publication in peer-reviewed journals, presented at clinical research conferences and disseminated via the Center for Perioperative Mental Health website. TRIAL REGISTRATION NUMBERS NCT05575128, NCT05685511, NCT05697835, pre-results.
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Affiliation(s)
- Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Kimberly A Bartosiak
- Department of Orthopaedics, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Ryan P Calfee
- Department of Orthopaedics, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Chet W Hammill
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Simon Haroutounian
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Benjamin D Kozower
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Theresa A Cordner
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Emily M Lenard
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Bethany R Tellor Pennington
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Rachel C Wolfe
- Department of Pharmacy, Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - J Philip Miller
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| | - Mary C Politi
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Yi Zhang
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Michael D Yingling
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Ana A Baumann
- Department of Surgery, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
| | - Julia A Schweiger
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Sherry L McKinnon
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
| | - Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine in Saint Louis, St Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine in Saint Louis, St. Louis, Missouri, USA
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5
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Edgley CR, Rodriguez JGZ, Hammill CW. Decreasing Perioperative Opiate Use During Pancreaticoduodenectomy Using Transversus Abdominus Plane Blocks: A Review of the Literature. Surg Technol Int 2024; 44:sti44/1765. [PMID: 38527331 DOI: 10.52198/24.sti.44.gs1765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
BACKGROUND Pancreatoduodenectomy is a highly complex surgical procedure associated with high postoperative morbidity and mortality. Treatment of postoperative pain is crucial to preventing chronic pain and further complications. Opioids are the leading treatment modality for acute postoperative pain for all surgical procedures in the US, contributing to the opioid epidemic, a crisis causing death and lifelong impairment in many patients. Multimodal analgesia techniques, such as the transversus abdominis plane (TAP) block, are suggested to reduce perioperative opioid usage. This exploratory literature review aims to investigate the use of TAP block in postoperative pain and opioid use in patients undergoing pancreatoduodenectomy. MATERIALS AND METHODS A search strategy developed from Cochrane best practice recommendations was applied to a comprehensive search of PubMed, Scopus, and PsycINFO databases, yielding three articles of relevance in patients having pancreatic surgery. RESULTS Previous research demonstrates TAP block efficacy in decreasing opiate consumption after major abdominal surgery; however, there is a paucity of data regarding opioid consumption in pancreatoduodenectomy patients. CONCLUSION Research in relation to TAP block analgesia is varied given the variety of approaches, techniques, and timing of the TAP block procedure. Future research should seek to elucidate the role of TAP blocks in reducing postoperative pain and opioid consumption in pancreatoduodenectomy patients.
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Affiliation(s)
- Carla R Edgley
- School of Medicine, Ucd Health Sciences Centre, University College Dublin, Belfield, Dublin, Ireland
| | | | - Chet W Hammill
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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6
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Liu J, Liu N, Xu Y, Wu M, Zhang H, Wang Y, Yan Y, Hill A, Song R, Xu Z, Park M, Wu Y, Ciatti JL, Gu J, Luan H, Zhang Y, Yang T, Ahn HY, Li S, Ray WZ, Franz CK, MacEwan MR, Huang Y, Hammill CW, Wang H, Rogers JA. Bioresorbable shape-adaptive structures for ultrasonic monitoring of deep-tissue homeostasis. Science 2024; 383:1096-1103. [PMID: 38452063 DOI: 10.1126/science.adk9880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024]
Abstract
Monitoring homeostasis is an essential aspect of obtaining pathophysiological insights for treating patients. Accurate, timely assessments of homeostatic dysregulation in deep tissues typically require expensive imaging techniques or invasive biopsies. We introduce a bioresorbable shape-adaptive materials structure that enables real-time monitoring of deep-tissue homeostasis using conventional ultrasound instruments. Collections of small bioresorbable metal disks distributed within thin, pH-responsive hydrogels, deployed by surgical implantation or syringe injection, allow ultrasound-based measurements of spatiotemporal changes in pH for early assessments of anastomotic leaks after gastrointestinal surgeries, and their bioresorption after a recovery period eliminates the need for surgical extraction. Demonstrations in small and large animal models illustrate capabilities in monitoring leakage from the small intestine, the stomach, and the pancreas.
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Affiliation(s)
- Jiaqi Liu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Naijia Liu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Yameng Xu
- The Institute of Materials Science and Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mingzheng Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Haohui Zhang
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Yue Wang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Ying Yan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Angela Hill
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ruihao Song
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Zijie Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Minsu Park
- Department of Polymer Science and Engineering, Dankook University, Yongin 16890, Republic of Korea
| | - Yunyun Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Joanna L Ciatti
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jianyu Gu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Haiwen Luan
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Yamin Zhang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Tianyu Yang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Hak-Young Ahn
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Shupeng Li
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Wilson Z Ray
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Colin K Franz
- Regenerative Neurorehabilitation Laboratory, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- The Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Matthew R MacEwan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Yonggang Huang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Chet W Hammill
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Heling Wang
- Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
- Institute of Flexible Electronics Technology of THU Zhejiang, Jiaxing 314000, China
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Zarate Rodriguez JG, Raper L, Sanford DE, Trikalinos NA, Hammill CW. ASO Visual Abstract: Race and Odds of Surgery Offer in Small Bowel and Pancreas Neuroendocrine Neoplasms. Ann Surg Oncol 2024:10.1245/s10434-024-15064-8. [PMID: 38374467 DOI: 10.1245/s10434-024-15064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Affiliation(s)
- Jorge G Zarate Rodriguez
- Division of Hepatobiliary, Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
| | - Lacey Raper
- Division of Hepatobiliary, Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
- University of Missouri-Columbia School of Medicine, Columbia, MO, USA
| | - Dominic E Sanford
- Division of Hepatobiliary, Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA
| | - Nikolaos A Trikalinos
- Division of Oncology, Department of Medicine, Washington University School of Medicine in St Louis, St. Louis, MO, USA
| | - Chet W Hammill
- Division of Hepatobiliary, Pancreatic and Gastrointestinal Surgery, Department of Surgery, Washington University School of Medicine in St Louis, St. Louis, Missouri, USA.
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8
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Pothuri VS, Anzelmo M, Gallaher E, Ogunlana Y, Aliabadi-Wahle S, Tan B, Crippin JS, Hammill CW. Transgender Males on Gender-Affirming Hormone Therapy and Hepatobiliary Neoplasms: A Systematic Review. Endocr Pract 2023; 29:822-829. [PMID: 37286102 DOI: 10.1016/j.eprac.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/21/2023] [Accepted: 05/29/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Behavioral therapy, gender-affirming hormone therapy (GAHT), and surgery are all components of a successful gender transition, but due to a historical lack of access, there is paucity of long-term data in this population. We sought to better characterize the risk of hepatobiliary neoplasms in transgender males undergoing GAHT with testosterone. METHODS In addition to the 2 case reports, a systematic literature review of hepatobiliary neoplasms in the setting of testosterone administration or endogenous overproduction across indications was conducted. The medical librarian created search strategies using keywords and controlled vocabulary in Ovid Medline, Embase.com, Scopus, Cochrane Database of Systematic Reviews, and clinicaltrials.gov. A total of 1273 unique citations were included in the project library. All unique abstracts were reviewed, and abstracts were selected for complete review. Inclusion criteria were articles reporting cases of hepatobiliary neoplasm development in patients with exogenous testosterone administration or endogenous overproduction. Non-English language articles were excluded. Cases were collated into tables based on indication. RESULTS Forty-nine papers had cases of hepatocellular adenoma, hepatocellular carcinoma, cholangiocarcinoma, or other biliary neoplasm in the setting of testosterone administration or endogenous overproduction. These 49 papers yielded 62 unique cases. CONCLUSION Results of this review are not sufficient to conclude that there is an association between GAHT and hepatobiliary neoplasms. This supports current evaluation and screening guidelines for initiation and continuation of GAHT in transgender men. The heterogeneity of testosterone formulations limits the translation of risks of hepatobiliary neoplasms in other indications to GAHT.
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Affiliation(s)
| | | | - Emily Gallaher
- Washington University School of Medicine, St. Louis, Missouri
| | | | | | - Benjamin Tan
- Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, Washington University in St Louis, St Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri
| | - Jeffrey S Crippin
- Washington University School of Medicine, St. Louis, Missouri; Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Chet W Hammill
- Washington University School of Medicine, St. Louis, Missouri; Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, Missouri; Department of Surgery, Washington University in St Louis, St Louis, Missouri.
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9
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Zarate Rodriguez JG, Cos H, Koenen M, Cook J, Kasting C, Raper L, Guthrie T, Strasberg SM, Hawkins WG, Hammill CW, Fields RC, Chapman WC, Eberlein TJ, Kozower BD, Sanford DE. Impact of Prehabilitation on Postoperative Mortality and the Need for Non-Home Discharge in High-Risk Surgical Patients. J Am Coll Surg 2023; 237:558-567. [PMID: 37204138 DOI: 10.1097/xcs.0000000000000763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND The preoperative period is an important target for interventions (eg Surgical Prehabilitation and Readiness [SPAR]) that can improve postoperative outcomes for older patients with comorbidities. STUDY DESIGN To determine whether a preoperative multidisciplinary prehabilitation program (SPAR) reduces postoperative 30-day mortality and the need for non-home discharge in high-risk surgical patients, surgical patients enrolled in a prehabilitation program targeting physical activity, pulmonary function, nutrition, and mindfulness were compared with historical control patients from 1 institution's American College of Surgeons (ACS) NSQIP database. SPAR patients were propensity score-matched 1:3 to pre-SPAR NSQIP patients, and their outcomes were compared. The ACS NSQIP Surgical Risk Calculator was used to compare observed-to-expected ratios for postoperative outcomes. RESULTS A total of 246 patients were enrolled in SPAR. A 6-month compliance audit revealed that overall patient adherence to the SPAR program was 89%. At the time of analysis, 118 SPAR patients underwent surgery with 30 days of follow-up. Compared with pre-SPAR NSQIP patients (n = 4,028), SPAR patients were significantly older with worse functional status and more comorbidities. Compared with propensity score-matched pre-SPAR NSQIP patients, SPAR patients had significantly decreased 30-day mortality (0% vs 4.1%, p = 0.036) and decreased need for discharge to postacute care facilities (6.5% vs 15.9%, p = 0.014). Similarly, SPAR patients exhibited decreased observed 30-day mortality (observed-to-expected ratio 0.41) and need for discharge to a facility (observed-to-expected ratio 0.56) compared with their expected outcomes using the ACS NSQIP Surgical Risk Calculator. CONCLUSIONS The SPAR program is safe and feasible and may reduce postoperative mortality and the need for discharge to postacute care facilities in high-risk surgical patients.
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Affiliation(s)
- Jorge G Zarate Rodriguez
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Heidy Cos
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Melanie Koenen
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Jennifer Cook
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Christina Kasting
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Lacey Raper
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Tracey Guthrie
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Steven M Strasberg
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
- the Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO (Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - William G Hawkins
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
- the Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO (Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Chet W Hammill
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
- the Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO (Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Ryan C Fields
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
- the Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO (Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - William C Chapman
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
- the Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO (Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Timothy J Eberlein
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
- the Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO (Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Benjamin D Kozower
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
- the Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO (Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
| | - Dominic E Sanford
- From the Department of Surgery, Barnes-Jewish Hospital and Washington University School of Medicine, St Louis, MO (Zarate Rodriguez, Cos, Koenen, Cook, Kasting, Raper, Guthrie, Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
- the Alvin J Siteman Cancer Center, Washington University School of Medicine, St Louis, MO (Strasberg, Hawkins, Hammill, Fields, Chapman, Eberlein, Kozower, Sanford)
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10
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Panni U, Srivastava R, Bewley A, Williams GA, Fields RC, Sanford DE, Hawkins WG, Leigh N, Hammill CW. Postoperative Proton Pump Inhibitors are associated with a significantly higher rate of delayed gastric emptying after pancreatoduodenectomy. HPB (Oxford) 2023; 25:659-666. [PMID: 36872110 DOI: 10.1016/j.hpb.2023.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 12/29/2022] [Accepted: 02/21/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) are effective in reducing marginal ulcers after pancreatoduodenectomy. However, their impact on perioperative complications has not been defined. METHODS We retrospectively analyzed the effect of postoperative PPIs on 90-day perioperative outcomes in all patients who underwent pancreatoduodenectomy at our institution from April 2017 to December 2020. RESULTS 284 patients were included; 206 (72.5%) received perioperative PPIs, 78 (27.5%) did not. The two cohorts were similar in demographics and operative variables. Postoperatively, the PPI cohort had significantly higher rates of overall complications (74.3% vs. 53.8%) and delayed gastric emptying (28.6% vs. 11.5%), p < 0.05. However, no differences in infectious complications, postoperative pancreatic fistula, or anastomotic leaks were seen. On multivariate analysis, PPI was independently associated with a higher risk of overall complications (OR 2.46, CI 1.33-4.54) and delayed gastric emptying (OR 2.73, CI 1.26-5.91), p = 0.011. Four patients developed marginal ulcers within 90-days postoperatively; all were in the group who received PPIs. CONCLUSION Postoperative proton pump inhibitor use was associated with a significantly higher rate of overall complications and delayed gastric emptying after pancreatoduodenectomy.
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Affiliation(s)
- Usman Panni
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Rohit Srivastava
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Alice Bewley
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Natasha Leigh
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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11
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Ladd AD, Zarate Rodriguez J, Lewis D, Warren C, Duarte S, Loftus TJ, Nassour I, Soma D, Hughes SJ, Hammill CW, Zarrinpar A. Low vs Standard-Dose Indocyanine Green in the Identification of Biliary Anatomy Using Near-Infrared Fluorescence Imaging: A Multicenter Randomized Controlled Trial. J Am Coll Surg 2023; 236:711-717. [PMID: 36728303 DOI: 10.1097/xcs.0000000000000553] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Near-infrared fluorescence imaging using intravenous indocyanine green (ICG) facilitates intraoperative identification of biliary anatomy. We hypothesize that a much lower dose of ICG than the standard decreases hepatic and background fluorescence and improves bile duct visualization. STUDY DESIGN In this multicenter randomized controlled trial, 55 adult patients undergoing laparoscopic cholecystectomy were randomized to low-dose (0.05 mg) or standard-dose (2.5 mg) ICG preoperatively on the day of surgery. A quantitative assessment was performed on recorded videos from the operation using ImageJ software to quantify the fluorescence intensity of the bile duct, liver, and surrounding/background fat. Operating surgeons blinded to ICG dose provided a qualitative assessment of various aspects of the visualization of the extrahepatic biliary tree comparing near-infrared fluorescence to standard visible light imaging using a scale of 1 to 5 (1, unsatisfactory; 5, excellent). Quantitative and qualitative scores were compared between the groups to determine any significant differences between the doses. RESULTS The bile duct-to-liver and bile duct-to-background fat fluorescence intensity ratios were significantly higher for the low-dose group compared with the standard-dose group (3.6 vs 0.68, p < 0.0001; and 7.5 vs 3.3, p < 0.0001, respectively). Low-dose ICG had a slightly higher (ie better) mean score on the qualitative assessment compared to the standard dose, although the differences were not statistically significant. CONCLUSIONS Low-dose ICG leads to quantitative improvement of biliary visualization using near-infrared fluorescence imaging by minimizing liver fluorescence; this further facilitates routine use during hepatobiliary operations.
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Affiliation(s)
- Alexandra D Ladd
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Jorge Zarate Rodriguez
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO (Zarate Rodriguez, Hammill)
| | - Duncan Lewis
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Curtis Warren
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Sergio Duarte
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Tyler J Loftus
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Ibrahim Nassour
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Daiki Soma
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Steven J Hughes
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
| | - Chet W Hammill
- Department of Surgery, Washington University in St Louis School of Medicine, St Louis, MO (Zarate Rodriguez, Hammill)
| | - Ali Zarrinpar
- From the Department of Surgery, University of Florida College of Medicine, Gainesville, FL (Ladd, Lewis, Warren, Duarte, Loftus, Nassour, Soma, Hughes, Zarrinpar)
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12
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Hawkins WG, Hammill CW, Ballentine SJ. How Biomarkers of Response to Chemotherapy Might Change Patient Management. Ann Surg Oncol 2023; 30:658-659. [PMID: 36422723 DOI: 10.1245/s10434-022-12707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/11/2022] [Indexed: 11/25/2022]
Affiliation(s)
- William G Hawkins
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
| | - Chet W Hammill
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Samuel J Ballentine
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, MO, USA
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13
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Patel V, Shah P, Ludwig DR, Hammill CW, Ashkar M. Development of de novo nonalcoholic fatty liver disease following pancreatectomy. Medicine (Baltimore) 2023; 102:e32782. [PMID: 36705353 PMCID: PMC9875952 DOI: 10.1097/md.0000000000032782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
De novo non-alcoholic fatty liver disease (NAFLD) after pancreatectomy is a recognized phenomenon; however, its pathophysiology is poorly understood. This study aimed to determine the incidence and identify peri-operative risk factors for the development of de novo NAFLD within various pancreatectomy groups. This single-center retrospective cohort study included patients who underwent pancreatectomy between 2000 and 2020. The incidence rate of de novo NAFLD and time to diagnosis were recorded across patients with malignant versus benign indications for pancreatectomy. The overall incidence of de novo NAFLD after pancreatectomy was 17.5% (24/136). Twenty-one percent (20/94) of patients with malignant indications for surgery developed NAFLD compared to 9.5% (4/42) with benign indications (P = .09). Time to development of hepatic steatosis in the malignant group was 26.4 months and was significantly shorter by an average of 6 months when compared to the benign group (32.8 months, P = .03). Higher pre-operative body mass index was associated with new-onset NAFLD (P = .03). Pre-operative body mass index is a significant predictor for de novo NAFLD and highlights a group that should be closely monitored post-operatively, especially after resections for pancreatic malignancy.
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Affiliation(s)
- Vanisha Patel
- Department of Medicine, Washington University School of Medicine, St. Louis, MO
| | - Parth Shah
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
| | - Daniel R. Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO
| | - Chet W. Hammill
- Department of Surgery, Washington University School of Medicine, St. Louis, MO
| | - Motaz Ashkar
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO
- * Correspondence: Motaz Ashkar, Division of Gastroenterology, Washington University School of Medicine, 660 S Euclid Ave, St Louis, MO 63110 (e-mail: )
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14
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Cos H, Zárate Rodríguez JG, Srivastava R, Bewley A, Raper L, Li D, Dai R, Williams GA, Fields RC, Hawkins WG, Lu C, Sanford DE, Hammill CW. 4,300 steps per day prior to surgery are associated with improved outcomes after pancreatectomy. HPB (Oxford) 2023; 25:91-99. [PMID: 36272956 DOI: 10.1016/j.hpb.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 06/04/2022] [Accepted: 09/28/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Decreased preoperative physical fitness and low physical activity have been associated with preoperative functional reserve and surgical complications. We sought to evaluate daily step count as a measure of physical activity and its relationship with post-pancreatectomy outcomes. METHODS Patients undergoing pancreatectomy were given a remote telemonitoring device to measure their preoperative levels of physical activity. Patient activity, demographics, and perioperative outcomes were collected and compared in univariate and multivariate logistic regression analysis. RESULTS 73 patients were included. 45 (61.6%) patients developed complications, with 17 (23.3%) of those patients developing severe complications. These patients walked 3437.8 (SD 1976.7) average daily steps, compared to 5918.8 (SD 2851.1) in patients without severe complications (p < 0.001). In logistic regression analysis, patients who walked less than 4274.5 steps had significantly higher odds of severe complications (OR = 7.5 (CI 2.1, 26.8), p = 0.002). CONCLUSION Average daily steps below 4274.5 before surgery are associated with severe complications after pancreatectomy. Preoperative physical activity levels may represent a modifiable target for prehabilitation protocols.
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Affiliation(s)
- Heidy Cos
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Jorge G Zárate Rodríguez
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Rohit Srivastava
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Alice Bewley
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Lacey Raper
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Dingwen Li
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Ruixuan Dai
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Chenyang Lu
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA; McKelvey School of Engineering, Washington University, St. Louis, MO, USA.
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15
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Yang Z, Zarate Rodriguez JG, Beck H, Byrnes K, Trikalinos NA, Hammill CW. Acinar cell carcinoma with PRKAR1A and PTEN alterations and paraneoplastic panniculitis. BMJ Case Rep 2022; 15:15/12/e251400. [PMID: 36549753 PMCID: PMC9791417 DOI: 10.1136/bcr-2022-251400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Pancreatic acinar cell carcinoma is a rare type of pancreatic malignancy, which can be confused with pancreatic neuroendocrine neoplasm. Here, we describe a woman in her 80s who presented with abdominal pain and bilateral lower extremity panniculitis. She underwent surgery for a presumed diagnosis of neuroendocrine tumour with PTEN and PRKAR1A alterations; 19 months, later, a recurrence of her pancreatic malignancy was discovered. The patient underwent repeat resection and this time immunohistochemical staining confirmed the diagnosis of acinar cell carcinoma. Staining for acinar cell carcinoma should be prompted based on clinical suspicion in context of PTEN or PRKAR1A mutation when appropriate.
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Affiliation(s)
- Zhizhou Yang
- Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | | | - Haley Beck
- Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Kathleen Byrnes
- Pathology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Nikolaos A Trikalinos
- Medical Oncology, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Chet W Hammill
- Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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16
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Zárate Rodriguez JG, Leigh N, Edgley C, Cos H, Wolfe R, Sanford D, Hammill CW. Preoperative transversus abdominis plane block decreases intraoperative opiate use during pancreatoduodenectomy. HPB (Oxford) 2022; 24:1162-1167. [PMID: 35012875 DOI: 10.1016/j.hpb.2021.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/07/2021] [Accepted: 12/13/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multimodal analgesia and regional anesthetic blocks, such as transversus abdominis plane (TAP) block, decrease postoperative opiate consumption but their effect on intraoperative opiates is unknown. METHODS This was a retrospective review of patients undergoing pancreatoduodenectomy between June 2018 and February 2021, in which perioperative data, operative times, and medication administration data were collected. Intraoperative opiate use was calculated in total morphine equivalent doses (MED) for each patient and adjusted for operative time. Univariate analysis and multivariate linear regression were performed to determine factors affecting intraoperative opiate requirements. RESULTS Of the 169 patients in the study, 51 (30.2%) received pre-surgical TAP blocks and 118 (69.8%) did not. There were no statistically significant differences in intraoperative opiate use with preoperative acetaminophen (p = 0.527), celecoxib (p = 0.553), gabapentin (p = 0.308), intraoperative ketorolac (p = 0.698) or epidural placement (p = 0.086). Minimally invasive surgery had lower intraoperative opiate use compared to open (p = 0.011), as well as pre-surgical TAP block compared to no pre-surgical block (5.24 vs 7.27 MED/hour, p < 0.001). On multivariate linear regression, pre-surgical TAP block (p = 0.001) was independently associated with decreased intraoperative opiate use. CONCLUSION Preoperative TAP blocks were associated with decreased intraoperative opiate use during pancreatoduodenectomy and should be considered for routine use.
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Affiliation(s)
- Jorge G Zárate Rodriguez
- Department of Surgery, Washington University in St Louis, St Louis, MO, USA; Barnes-Jewish Hospital, St Louis, MO, USA
| | - Natasha Leigh
- Department of Surgery, Washington University in St Louis, St Louis, MO, USA; Barnes-Jewish Hospital, St Louis, MO, USA
| | - Carla Edgley
- University College Dublin School of Medicine, Ireland
| | - Heidy Cos
- Department of Surgery, Washington University in St Louis, St Louis, MO, USA; Barnes-Jewish Hospital, St Louis, MO, USA
| | | | - Dominic Sanford
- Department of Surgery, Washington University in St Louis, St Louis, MO, USA; Barnes-Jewish Hospital, St Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Washington University in St Louis, St Louis, MO, USA; Barnes-Jewish Hospital, St Louis, MO, USA.
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17
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Riano I, Pomares-Millan H, Hammill CW, Trikalinos N. Evaluating the quality of clinical evidence in gastrointestinal cancers PubMed searches: How relevant are the results? J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.11037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
11037 Background: Bibliographic repositories have become increasingly important as clinical evidence is more accessible on the internet. Often, oncologists rely on published literature to guide patient care. However, with the proliferation of journals and increasing number of peer reviewed papers, current search strategies have the potential to retrieve large numbers of irrelevant or misleading articles. Moreover, access to current best evidence may require paid subscriptions. Here, we assessed the quality of retrieved medical literature pertaining to treatment of gastrointestinal cancers using the PubMed database. Methods: We interrogated 6 focused-therapy questions in 3 categories: medical oncology (MedOnc), surgical oncology (SurgOnc), and alternative medicine (AltMed). We extracted journal metrics of the first two pages (40 results) from each search. We defined the composite outcome “relevant result” as the product of removing results from 1) predatory journals (Beall’s list), 2) non-English language, and 3) no free access publications. As a sensitivity analysis, we defined 2007 as a cutoff for “relevant” publications and Impact Factor (IF) > 3 or H-index > 50. Results: Two hundred and forty results were retrieved (80 per search type). Forty-eight percent of the journals were European (n = 115), 40% US-based (n = 96), and 94% were in English (n = 225). Most journals (n = 170; 70.8%) had an IF between 1-10, followed by ̃21% with an IF > 10 (n = 51); yet ̃45% (n = 107) were in the Clarivate Analytics top quartile. Sixty percent (n = 139) of articles were free to access. The articles had a median H-index of 117 [IR 59, 168]. When modelling the multivariate association with “relevant result”, year of publication after 2007 had an OR = 1.07 (95% CI = 1.01-1.14; p< 0.02) and availability through GOLD Open Access by Clarivate Analytics had an OR = 1.09 (95% CI = 1.03-1.15; p< 0.0008). MedOnc retrieved more papers published in journals with IF > 10 (n = 31; 38.8%) than SurgOnc searches (n = 12; 15%; p< 0.001). Only the AltMed searches included non-peer reviewed publications (n = 4; 5%) and 4 results were from “predatory journals”, all in MedOnc. Conclusions: Articles had a 7% higher chance of being considered a “relevant result” if they were published after 2007 and a 9% higher chance if available under GOLD Open Access. Publications identified as “relevant results” with an IF or H-index above the established cutoffs, had a 6% higher chance to be in the top 40 PubMed search results. In the sensitivity analysis the results remain virtually unchanged. Importantly, nearly 40% of papers indexed in PubMed do not have free full-text articles, making them unavailable to oncologists without access to a medical library or paid subscription. These results highlight the imperative to deliver relevant, freely accessible information that can impact the care of the cancer patients.
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Affiliation(s)
- Ivy Riano
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Chet W. Hammill
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Nikolaos Trikalinos
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
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Leigh N, Williams GA, Strasberg SM, Fields RC, Hawkins WG, Hammill CW, Sanford DE. Increased Morbidity and Mortality After Hepatectomy for Colorectal Liver Metastases in Frail Patients is Largely Driven by Worse Outcomes After Minor Hepatectomy: It's Not "Just a Wedge". Ann Surg Oncol 2022; 29:5476-5485. [PMID: 35595939 DOI: 10.1245/s10434-022-11830-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Frailty is associated with postoperative mortality, but its significance after hepatectomy for colorectal liver metastases (CRLM) is poorly defined. This study evaluated the impact of frailty after hepatectomy for CRLM. METHODS The study identified 8477 patients in National Surgical Quality Improvement Program databases from 2014 to 2019 and stratified them by frailty score using the risk analysis index as very frail (>90th percentile), frail (75th-90th percentile), or non-frail (< 75th percentile). Multivariate regression models determined the impact of frailty on perioperative outcomes, including by the extent of hepatectomy. RESULTS The procedures performed were 2752 major hepatectomies (left hepatectomy, right hepatectomy, trisectionectomy) and 5725 minor hepatectomies (≤2 segments) for 870 (10.3%) very frail, 1680 (19.8%) frail, and 5927 (69.9%) non-frail patients. Postoperatively, the very frail and frail patients experienced more complications (very frail [41.8%], frail [35.1%], non-frail [31.0%]), which resulted in a longer hospital stay (very-frail [5.7 days], frail [5.8 days], non-frail [5.1 days]), a higher 30-day mortality (very-frail [2.2%], frail [1.3%], non-frail [0.5%]), and more discharges to a facility (very frail [6.8%], frail [3.7%], non-frail [2.6%]) (p < 0.05) although they underwent similarly extensive (major vs. minor) hepatectomies. In the multivariate analysis, frailty was independently associated with complications (very-frail [odds ratio {OR}, 1.70], frail [OR, 1.25]) and 30-day mortality (very-frail [OR, 4.24], frail [OR, 2.41]) (p < 0.05). After minor hepatectomy, the very frail and frail patients had significantly higher rates of complications and 30-day mortality than the non-frail patients, and in the multivariate analysis, frailty was independently associated with complications (very frail [OR, 1.97], frail [OR, 1.27]) and 30-day mortality (very frail [OR, 6.76], frail [OR, 3.47]) (p < 0.05) after minor hepatectomy. CONCLUSIONS Frailty predicted significantly poorer outcomes after hepatectomy for CRLM, even after only a minor hepatectomy.
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Affiliation(s)
- Natasha Leigh
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Steven M Strasberg
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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19
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Leigh N, Williams GA, Strasberg SM, Fields RC, Hawkins WG, Hammill CW, Sanford DE. ASO Visual Abstract: Increased Morbidity and Mortality After Hepatectomy for Colorectal Liver Metastases in Frail Patients is Largely Driven by Worse Outcomes After Minor Hepatectomy: It is Not "Just a Wedge". Ann Surg Oncol 2022. [PMID: 35534757 DOI: 10.1245/s10434-022-11874-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Natasha Leigh
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Steven M Strasberg
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Takchi R, Cos H, Williams GA, Woolsey C, Hammill CW, Fields RC, Strasberg SM, Hawkins WG, Sanford DE. Enhanced recovery pathway after open pancreaticoduodenectomy reduces postoperative length of hospital stay without reducing composite length of stay. HPB (Oxford) 2022; 24:65-71. [PMID: 34183246 PMCID: PMC9446414 DOI: 10.1016/j.hpb.2021.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND/PURPOSE There is no data regarding the impact of enhanced recovery pathways (ERP) on composite length of stay (CLOS) after procedures with increased risk of morbidity and mortality, such as pancreaticoduodenectomy. METHODS Patients undergoing open pancreaticoduodenectomy before and after implementation of ERP were prospectively followed for 90 days after surgery and complications were severity graded using the Modified Accordion Grading System. A retrospective analysis of patient outcomes were compared before and after instituting ERP. 1:1 propensity score matching was used to compare ERP patient outcomes to those of matched pre-ERP patients. CLOS is defined as postoperative length of hospital stay (PLOS) plus readmission length of hospital stay within 90 days after surgery. RESULTS 494 patients underwent open pancreaticoduodenectomy - 359 pre-ERP and 135 ERP. In a 1:1 propensity-score-matched analysis of 110 matched pairs, ERP patients had significantly decreased superficial surgical site infections (5.5% vs 15.5% p = 0.015) and significantly increased rates of urinary retention (29.1% vs 7.3% p < 0.0001) compared to matched pre-ERP patients. However, overall complication rate and 90-day readmission rate were not significantly different between matched groups. Propensity score-matched ERP patients had significantly decreased PLOS (7 days vs 8 days p = 0.046) compared to matched pre-ERP patients, but CLOS was not significantly different (9 days vs 9.5 days p = 0.615). CONCLUSION ERP may reduce PLOS but might not impact the total postoperative time spent in the hospital (i.e. CLOS) within 90 days after pancreaticoduodenectomy.
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Affiliation(s)
- Rony Takchi
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Heidy Cos
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Cheryl Woolsey
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Steven M Strasberg
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
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21
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Leigh N, Hammill CW. Minimally Invasive Distal Pancreatectomy: Are There Long-Term Benefits? J Am Coll Surg 2021; 233:739-741. [PMID: 34823680 DOI: 10.1016/j.jamcollsurg.2021.08.684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 10/19/2022]
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22
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Caldwell KE, Hammill CW. Screening for Pancreatic Ductal Adenocarcinoma: Are We Asking the Impossible?-Response. Cancer Prev Res (Phila) 2021; 14:975-976. [PMID: 34607878 DOI: 10.1158/1940-6207.capr-21-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Katharine E Caldwell
- Division of Hepatobiliary Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
| | - Chet W Hammill
- Division of Hepatobiliary Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
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Cos H, LeCompte MT, Srinivasa S, Zarate Rodriguez J, Woolsey CA, Williams G, Patel S, Khan A, Fields RC, Majella Doyle MB, Chapman WC, Strasberg SM, Hawkins WG, Hammill CW, Sanford DE. Improved outcomes with minimally invasive pancreaticoduodenectomy in patients with dilated pancreatic ducts: a prospective study. Surg Endosc 2021; 36:3100-3109. [PMID: 34235587 PMCID: PMC8262764 DOI: 10.1007/s00464-021-08611-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/14/2021] [Indexed: 12/27/2022]
Abstract
Background Little is known about what factors predict better outcomes for patients who undergo minimally invasive pancreaticoduodenectomy (MIPD) versus open pancreaticoduodenectomy (OPD). We hypothesized that patients with dilated pancreatic ducts have improved postoperative outcomes with MIPD compared to OPD. Methods All patients undergoing pancreaticoduodenectomy were prospectively followed over a time period of 47 months, and perioperative and pathologic covariates and outcomes were compared. Ideal outcome after PD was defined as follows: (1) no complications, (2) postoperative length of stay < 7 days, and (3) negative (R0) margins on pathology. Patients with dilated pancreatic ducts (≥ 3 mm) who underwent MIPD were 1:3 propensity score-matched to patients with dilated ducts who underwent OPD and outcomes compared. Likewise, patients with non-dilated pancreatic ducts (< 3 mm) who underwent MIPD were 1:3 propensity score-matched to patients with non-dilated ducts who underwent OPD and outcomes were compared. Results 371 patients underwent PD—74 (19.9%) MIPD and 297 (80.1%) underwent OPD. Overall, patients who underwent MIPD had significantly less intraoperative blood loss. After 1:3 propensity score matching, patients with dilated pancreatic ducts who underwent MIPD (n = 45) had significantly lower overall complication and 90-day readmission rates compared to matched OPD patients (n = 135) with dilated ducts. Patients with dilated duct who underwent MIPD were more likely to have an ideal outcome than patients with OPD (29 vs 15%, p = 0.035). There were no significant differences in postoperative outcomes among propensity score-matched patients with non-dilated pancreatic ducts who underwent MIPD (n = 29) compared to matched patients undergoing OPD (n = 87) with non-dilated ducts. Conclusions MIPD is safe with comparable perioperative outcomes to OPD. Patients with pancreatic ducts ≥ 3 mm appear to derive the most benefit from MIPD in terms of fewer complications, lower readmission rates, and higher likelihood of ideal outcome. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08611-x.
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Affiliation(s)
- Heidy Cos
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - Michael T LeCompte
- Department of Surgical Oncology, University of North Carolina and Rex Hospital, Raleigh, NC, USA
| | - Sanket Srinivasa
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA
| | - Jorge Zarate Rodriguez
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - Cheryl A Woolsey
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - Gregory Williams
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - Siddarth Patel
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Adeel Khan
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - Ryan C Fields
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - Maria B Majella Doyle
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - William C Chapman
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - Steven M Strasberg
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - William G Hawkins
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - Chet W Hammill
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA.,Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA.,Washington University School of Medicine, Saint Louis, MO, USA
| | - Dominic E Sanford
- Division of Hepatobiliary, Pancreatic, and Gastrointestinal Surgery, Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8109, Saint Louis, MO, 63110, USA. .,Alvin J. Siteman Cancer Center, Washington University School of Medicine, Saint Louis, MO, USA. .,Washington University School of Medicine, Saint Louis, MO, USA.
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Calkins B, Chininis J, Williams GA, Sanford DE, Hammill CW. Development of a novel intraoperative difficulty score for minimally invasive cholecystectomy. HPB (Oxford) 2021; 23:1025-1029. [PMID: 33218950 DOI: 10.1016/j.hpb.2020.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/23/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The rate of biliary injuries from minimally invasive cholecystectomy has remained high for over two decades. To improve outcomes there are multiple bail-out methods described, including aborting the procedure, converting to open, or performing a sub-total cholecystectomy. However, the intraoperative difficulty threshold for when a bail-out method should be implemented is poorly understood. METHODS From 1/2014 to 2/2019 cholecystectomy videos were collected, de-identified, edited to include the 2-3 minutes when the gallbladder was first visualized, and accelerated. They were then rated on a 5-point difficulty scale. Inter-coder reliability was evaluated using Krippendorff's alpha and regression models were used to evaluate the scores ability to predict the need for a bail-out technique. RESULTS 62 videos were analyzed with a median length after editing of 37.5 (29.0-43.3) seconds. A median time of 46.2 (38.3-53.4) seconds was required for grading. The bail-out rate was 42.9%. The inter-coder reliability between 2 surgeons and 8 non-clinical reviewers was 0.675 with an average difficulty score of 3.0 (SD = 1.01). Regression models showed that the scale was able to significantly predict conversion (β=0.56,p<.01). CONCLUSION This novel difficulty score was able to predict conversion to a bail-out technique early in the course of minimally invasive cholecystectomy.
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Affiliation(s)
- Brittany Calkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeff Chininis
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA.
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Ghazizadeh S, Kelly TL, Khajanchee YS, Fleser J, Rozenfeld Y, Neuman M, Hammill CW, Orr L, Aliabadi-Wahle S. Standardization of thyroid ultrasound reporting in the community setting decreases biopsy rates. Clin Endocrinol (Oxf) 2021; 94:1035-1042. [PMID: 33529386 DOI: 10.1111/cen.14431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE With the rising incidence of thyroid cancer, a standardized approach to the evaluation of thyroid nodules is essential. Despite the presence of multiple national guidelines detailing evaluation and management of these nodules, significant variability exists in the information that is collected and reported to clinicians from diagnostic imaging. The aim of this study was to evaluate the impact of thyroid ultrasound standardization on thyroid cancer detection in a community practice setting. DESIGN As part of a physician-driven quality improvement project, a multidisciplinary team created an electronic worksheet to be utilized by sonographers to capture suspicious findings based on societal guidelines and agreed on institutional criteria for recommending fine needle aspiration (FNA) of thyroid nodules. PATIENTS For a one-year period prior to and after the intervention, all ultrasounds performed for suspected thyroid pathology, excluding patients undergoing follow-up imaging, were reviewed at two affiliated community hospitals served by a single radiology and pathology group. MEASUREMENTS The number of fine needle biopsies recommended and performed, as well as the percentage of FNAs positive for malignancy were evaluated. RESULTS A total of 608 and 675 ultrasounds were reviewed in pre- and post-standardization periods, respectively. Following standardization, there was a similar percentage of FNAs recommended (35% vs. 37%, p = .68), fewer FNAs per total ultrasounds performed (36% vs. 31%, p = .03), fewer FNAs performed when FNA was not explicitly recommended (9.9% vs. 2.8%, p = .000046) and an increased detection of cytology consistent with, or suspicious for, malignancy (5% vs. 11.5%, p = .0028). CONCLUSIONS Standardization of thyroid imaging protocol and management recommendations can reduce the number of FNAs performed and increase the percentage of positive tests in a community setting.
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Panni RZ, Panni UY, Liu J, Williams GA, Fields RC, Sanford DE, Hawkins WG, Hammill CW. Re-defining a high volume center for pancreaticoduodenectomy. HPB (Oxford) 2021; 23:733-738. [PMID: 32994102 DOI: 10.1016/j.hpb.2020.09.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/15/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The purpose of this study was to re-evaluate the previously utilized definitions of high volume center for pancreaticoduodenectomy to determine/establish an objective, evidence based threshold of hospital volume associated with improvement in perioperative mortality. METHODS Patients who underwent pancreaticoduodenectomy were identified using the National Cancer Database from 2004 to 2015. The relationship between hospital volume and 90-day mortality was assessed using a logistic regression model. Receiver Operator Characteristic analysis was performed and Youden's statistic was utilized to calculate the optimal cut offs. RESULTS 42,402 patients underwent elective Pancreaticoduodenectomy at 1238 unique hospitals. A logistic regression was performed which showed a significant inverse linear association between institutional volume and overall 90 day mortality. The maximum improvement in 90 day mortality is seen if the average annual hospital volume was greater than 9 (OR = 0.647 (0.595-0.702), p < 0.0001). When analysis is limited to hospitals that performed >9 cases per year, the maximum improvement in 90 day mortality was noticed at 36 cases per year (OR = 0.458 (0.399-0.525), p < 0.0001). CONCLUSIONS Based on our results, we recommend defining low, medium, and high volume centers for pancreaticoduodenectomy as hospitals with average annual volume less than 9, 9 to 35, and more than 35 cases per year, respectively.
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Affiliation(s)
- Roheena Z Panni
- Department of Surgery, Washington University in Saint Louis, USA.
| | - Usman Y Panni
- Department of Surgery, Washington University in Saint Louis, USA; Division of Hepatobiliary & Pancreatic Surgery, Washington University in Saint Louis, USA
| | - Jingxia Liu
- Department of Surgery, Washington University in Saint Louis, USA; Division of Public Health Sciences, Washington University in Saint Louis, USA
| | - Gregory A Williams
- Department of Surgery, Washington University in Saint Louis, USA; Division of Hepatobiliary & Pancreatic Surgery, Washington University in Saint Louis, USA
| | - Ryan C Fields
- Department of Surgery, Washington University in Saint Louis, USA; Division of Surgical Oncology, Washington University in Saint Louis, USA
| | - Dominic E Sanford
- Department of Surgery, Washington University in Saint Louis, USA; Division of Hepatobiliary & Pancreatic Surgery, Washington University in Saint Louis, USA
| | - William G Hawkins
- Department of Surgery, Washington University in Saint Louis, USA; Division of Hepatobiliary & Pancreatic Surgery, Washington University in Saint Louis, USA
| | - Chet W Hammill
- Department of Surgery, Washington University in Saint Louis, USA; Division of Hepatobiliary & Pancreatic Surgery, Washington University in Saint Louis, USA
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27
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Zarate Rodriguez JG, Cos H, Williams GA, Woolsey CA, Fields RC, Strasberg SM, Doyle MB, Khan AS, Chapman WC, Hammill CW, Hawkins WG, Sanford DE. Inability to manage non-severe complications on an outpatient basis increases non-white patient readmission rates after pancreaticoduodenectomy: A large metropolitan tertiary care center experience. Am J Surg 2021; 222:964-968. [PMID: 33906729 DOI: 10.1016/j.amjsurg.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Pancreaticoduodenectomy (PD) has a high rate of readmission, and racial disparities in care could be an important contributor. METHODS Patients undergoing PD were prospectively followed, and their complications graded using the Modified Accordion Grading System (MAGS). Patient factors and perioperative outcomes for patients with and without postoperative readmission were compared in univariate and multivariate analysis by severity. RESULTS 837 patients underwent PD, the overall 90-day readmission rate was 27.5%. Non-white race was independently associated with readmission (OR 1.83, p = 0.007). 51.3% of readmissions were for non-severe complications (MAGS <3). Non-white race was independently associated with MAGS non-severe readmission (OR 2.13, p = 0.006), but not MAGS severe readmission. CONCLUSIONS Non-white patients are more likely to be readmitted, particularly for non-severe complications. Follow up protocols should be tailored to address race disparities in the rates of readmission as readmission for less severe complications could potentially be avoidable.
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Affiliation(s)
- Jorge G Zarate Rodriguez
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Heidy Cos
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Gregory A Williams
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Cheryl A Woolsey
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Steven M Strasberg
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Majella B Doyle
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Adeel S Khan
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - William C Chapman
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - William G Hawkins
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Dominic E Sanford
- Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA.
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Brauer DG, Wu N, Keller MR, Humble SA, Fields RC, Hammill CW, Hawkins WG, Colditz GA, Sanford DE. Care Fragmentation and Mortality in Readmission after Surgery for Hepatopancreatobiliary and Gastric Cancer: A Patient-Level and Hospital-Level Analysis of the Healthcare Cost and Utilization Project Administrative Database. J Am Coll Surg 2021; 232:921-932.e12. [PMID: 33865977 DOI: 10.1016/j.jamcollsurg.2021.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 02/19/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hepatopancreatobiliary (HPB) and gastric oncologic operations are frequently performed at referral centers. Postoperatively, many patients experience care fragmentation, including readmission to "outside hospitals" (OSH), which is associated with increased mortality. Little is known about patient-level and hospital-level variables associated with this mortality difference. STUDY DESIGN Patients undergoing HPB or gastric oncologic surgery were identified from select states within the Healthcare Cost and Utilization Project database (2006-2014). Follow-up was 90 days after discharge. Analyses used Kruskal-Wallis test, Youden index, and multilevel modeling at the hospital level. RESULTS There were 7,536 patients readmitted within 90 days of HPB or gastric oncologic surgery to 636 hospitals; 28% of readmissions (n = 2,123) were to an OSH, where 90-day readmission mortality was significantly higher: 8.0% vs 5.4% (p < 0.01). Patients readmitted to an OSH lived farther from the index surgical hospital (median 24 miles vs 10 miles; p < 0.01) and were readmitted later (median 25 days after discharge vs 12; p < 0.01). These variables were not associated with readmission mortality. Surgical complications managed at an OSH were associated with greater readmission mortality: 8.4% vs 5.7% (p < 0.01). Hospitals with <100 annual HPB and gastric operations for benign or malignant indications had higher readmission mortality (6.4% vs 4.7%, p = 0.01), although this was not significant after risk-adjustment (p = 0.226). CONCLUSIONS For readmissions after HPB and gastric oncologic surgery, travel distance and timing are major determinants of care fragmentation. However, these variables are not associated with mortality, nor is annual hospital surgical volume after risk-adjustment. This information could be used to determine safe sites of care for readmissions after HPB and gastric surgery. Further analysis is needed to explore the relationship between complications, the site of care, and readmission mortality.
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Affiliation(s)
- David G Brauer
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO.
| | - Ningying Wu
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Matthew R Keller
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO
| | - Sarah A Humble
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Chet W Hammill
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - William G Hawkins
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Graham A Colditz
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO
| | - Dominic E Sanford
- Department of Surgery, Washington University School of Medicine, Saint Louis, MO
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29
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Cos H, Li D, Williams G, Chininis J, Dai R, Zhang J, Srivastava R, Raper L, Sanford D, Hawkins W, Lu C, Hammill CW. Predicting Outcomes in Patients Undergoing Pancreatectomy Using Wearable Technology and Machine Learning: Prospective Cohort Study. J Med Internet Res 2021; 23:e23595. [PMID: 33734096 PMCID: PMC8074869 DOI: 10.2196/23595] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/18/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023] Open
Abstract
Background Pancreatic cancer is the third leading cause of cancer-related deaths, and although pancreatectomy is currently the only curative treatment, it is associated with significant morbidity. Objective The objective of this study was to evaluate the utility of wearable telemonitoring technologies to predict treatment outcomes using patient activity metrics and machine learning. Methods In this prospective, single-center, single-cohort study, patients scheduled for pancreatectomy were provided with a wearable telemonitoring device to be worn prior to surgery. Patient clinical data were collected and all patients were evaluated using the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator (ACS-NSQIP SRC). Machine learning models were developed to predict whether patients would have a textbook outcome and compared with the ACS-NSQIP SRC using area under the receiver operating characteristic (AUROC) curves. Results Between February 2019 and February 2020, 48 patients completed the study. Patient activity metrics were collected over an average of 27.8 days before surgery. Patients took an average of 4162.1 (SD 4052.6) steps per day and had an average heart rate of 75.6 (SD 14.8) beats per minute. Twenty-eight (58%) patients had a textbook outcome after pancreatectomy. The group of 20 (42%) patients who did not have a textbook outcome included 14 patients with severe complications and 11 patients requiring readmission. The ACS-NSQIP SRC had an AUROC curve of 0.6333 to predict failure to achieve a textbook outcome, while our model combining patient clinical characteristics and patient activity data achieved the highest performance with an AUROC curve of 0.7875. Conclusions Machine learning models outperformed ACS-NSQIP SRC estimates in predicting textbook outcomes after pancreatectomy. The highest performance was observed when machine learning models incorporated patient clinical characteristics and activity metrics.
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Affiliation(s)
- Heidy Cos
- Washington University in St Louis, St Louis, MO, United States
| | - Dingwen Li
- Washington University in St Louis, St Louis, MO, United States
| | | | - Jeffrey Chininis
- Washington University in St Louis, St Louis, MO, United States.,Barnes-Jewish Hospital and the Alvin J Siteman Cancer Center, St Louis, MO, United States
| | - Ruixuan Dai
- Washington University in St Louis, St Louis, MO, United States
| | - Jingwen Zhang
- Washington University in St Louis, St Louis, MO, United States
| | | | - Lacey Raper
- Washington University in St Louis, St Louis, MO, United States
| | - Dominic Sanford
- Washington University in St Louis, St Louis, MO, United States.,Barnes-Jewish Hospital and the Alvin J Siteman Cancer Center, St Louis, MO, United States
| | - William Hawkins
- Washington University in St Louis, St Louis, MO, United States.,Barnes-Jewish Hospital and the Alvin J Siteman Cancer Center, St Louis, MO, United States
| | - Chenyang Lu
- Washington University in St Louis, St Louis, MO, United States
| | - Chet W Hammill
- Washington University in St Louis, St Louis, MO, United States.,Barnes-Jewish Hospital and the Alvin J Siteman Cancer Center, St Louis, MO, United States
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Caldwell KE, Conway AP, Hammill CW. Screening for Pancreatic Ductal Adenocarcinoma: Are We Asking the Impossible? Cancer Prev Res (Phila) 2021; 14:373-382. [PMID: 33148677 PMCID: PMC8089111 DOI: 10.1158/1940-6207.capr-20-0426] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/30/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
Abstract
Pancreatic cancer is projected to become the second leading cause of cancer-related death in the United States by 2020. Because of this, significant interest and research funding has been devoted to development of a screening test to identify individuals during a prolonged asymptomatic period; however, to date, no such test has been developed. We evaluated current NIH spending and clinical trials to determine the focus of research on pancreatic cancer screening as compared with other cancer subtypes. Using statistical methodology, we determined the effects of population-based pancreatic cancer screening on overall population morbidity and mortality. Population-based pancreatic cancer screening would result in significant harm to non-diseased individuals, even in cases where a near-perfect test was developed. Despite this mathematical improbability, NIH funding for pancreatic cancer demonstrates bias toward screening test development not seen in other cancer subtypes. Focusing research energy on development of pancreatic screening tests is unlikely to result in overall survival benefits. Efforts to increase the number of patients who are candidates for surgery and improving surgical outcomes would result in greater population benefit.Prevention Relevance: For patients with pancreatic cancer, early stage detection offers the greatest survival benefit. However, the incidence of pancreatic cancer and associated mortality of pancreatic resections make development of a screening test a difficult, if not impossible, challenge.
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Affiliation(s)
| | - Alexander P Conway
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Chet W Hammill
- Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
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Srinivasa S, Hammill CW, Strasberg SM. How to do laparoscopic subtotal fenestrating cholecystectomy. ANZ J Surg 2020; 91:740-741. [PMID: 33200510 DOI: 10.1111/ans.16435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/08/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Sanket Srinivasa
- Section of HPB and GI Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Chet W Hammill
- Section of HPB and GI Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St Louis, Missouri, USA
| | - Steven M Strasberg
- Section of HPB and GI Surgery, Washington University School of Medicine/Barnes-Jewish Hospital, St Louis, Missouri, USA
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32
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James CA, Williams GA, Jin LX, Liu J, Sanford DE, Fields RC, Doyle MMB, Strasberg SM, Hawkins WG, Hammill CW. Thunderbeat™ Integrated Bipolar and Ultrasonic Forceps in the Whipple Procedure: A Prospective Randomized Trial. Mo Med 2020; 117:559-562. [PMID: 33311789 PMCID: PMC7721432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Thunderbeat™ is a device that uses both ultrasonic and advanced bipolar energies to achieve hemostasis. It has been evaluated in a variety of clinical contexts, but no literature exists regarding its application to pancreatic surgery. Using a prospective, randomized controlled trial, we evaluated its safety and efficacy in the Whipple procedure. Thirty-two participants were enrolled in the study. The Thunderbeat™ device during the Whipple procedure showed similar safety profile compared to standard of care.
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Affiliation(s)
- C Alston James
- Resident Physician, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Gregory A Williams
- Research Manager, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Linda X Jin
- Resident Physician, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Jingxia Liu
- Associate Professor of Surgery, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Dominic E Sanford
- Assistant Professor of Surgery, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan C Fields
- Professor of Surgery, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Majella M B Doyle
- Professor of Surgery, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Steven M Strasberg
- Professor of Surgery, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - William G Hawkins
- Professor of Surgery, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Chet W Hammill
- Associate Professor of Surgery, Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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Williams GA, Liu J, Chapman WC, Hawkins WG, Fields RC, Sanford DE, Doyle MB, Hammill CW, Khan AS, Strasberg SM. Composite Length of Stay, An Outcome Measure of Postoperative and Readmission Length of Stays in Pancreatoduodenectomy. J Gastrointest Surg 2020; 24:2062-2069. [PMID: 31845140 PMCID: PMC7295670 DOI: 10.1007/s11605-019-04475-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/12/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE Postoperative length of stay (PLOS) and readmission rate are pancreatoduodenectomy (PD) outcome measures, which are reported individually but may be interrelated. The purpose of this study was to evaluate how well a composite length of stay measure (CLOS) that included PLOS and readmission length of stay describes outcomes. To do so, we evaluated how well CLOS correlated to postoperative complications absolutely and compared to PLOS. METHODS A total of 668 PDs performed between 2011 and 2018 were evaluated. CLOS was calculated from PLOS and readmission length of stay. Complication severity was judged by the Modified Accordion Grading System (MAGS). Multinomial logistical regression models (MLRM) were used to investigate the relationship between either PLOS or CLOS and complications. Multilevel and pairwise area under curves (AUC) using SAS macro %MultAUC were provided for both models. RESULTS A total of 432 of 668 patients (65%) developed complications. One hundred seventy-seven patients (27%) were readmitted. Mean PLOS was 10.2 days (7.1 SD) and mean CLOS was 12.3 days (10.1 SD). PLOS and CLOS both were correlated linearly to MAGS grade. Spearman correlation coefficient for CLOS vs. MAGS of 0.68 was higher than that of 0.49 for PLOS vs. MAGS. Multilevel AUC from MLRM using PLOS was 0.66, but multilevel AUC from MLRM using CLOS was 0.71. DISCUSSION CLOS provides an accurate estimate of hospital day utilization per patient for PD, reflecting not only the basal hospital recovery time for PD but the added time needed because of readmissions due to complications. It is tightly correlated to number and severity of postoperative complications.
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Affiliation(s)
- Gregory A Williams
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jingxia Liu
- Division of Public Health Sciences, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - William C Chapman
- Section of Transplant Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - William G Hawkins
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ryan C Fields
- Section of Surgical Oncology, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Dominic E Sanford
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Majella B Doyle
- Section of Transplant Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Chet W Hammill
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Adeel S Khan
- Section of Transplant Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA
| | - Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, Saint Louis, MO, USA.
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Noda C, Williams GA, Foltz G, Kim H, Sanford DE, Hammill CW, Fields RC. The safety of hepatectomy after transarterial radioembolization: Single institution experience and review of the literature. J Surg Oncol 2020; 122:1114-1121. [PMID: 32662066 DOI: 10.1002/jso.26115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES The liver is a frequent site of malignancy, both primary and metastatic. The treatment goal of patients with liver cancer may include transarterial radioembolization (TARE). There are limited reports on the safety of hepatectomy following TARE. Our study's purpose is to review patients who have received TARE followed by hepatectomy. METHODS A retrospective study was performed on patients diagnosed with any liver cancer from 2013 to 2019 who underwent TARE followed by hepatectomy. Postoperative complications were prospectively collected. Descriptive statistics and the Kaplan-Meier test were used to assess survival outcomes. RESULTS Twelve patients were treated with a TARE followed by a hepatectomy (nine with ≥4 segments resected). Diagnoses included: six HCC, four cholangiocarcinoma, one metastatic neuroendocrine tumor, and one metastatic colorectal cancer. There were no 90-day post-hepatectomy mortalities and the overall morbidity was 66% (16% severe ≥MAGS 3). Hepatectomy-specific complications after hepatectomy included two (16%) bile leaks and no post-hepatectomy liver failures. The median recurrence free survival was 26 months. Overall survival at 1-year was 78% and at 3 years was 47%. CONCLUSIONS Our results support the safety of hepatectomy in select patients after TARE. Additional comparison to patients who receive hepatectomy as a first-line treatment for liver cancers should be investigated.
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Affiliation(s)
- Christopher Noda
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Gretchen Foltz
- Department of Radiology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Hyun Kim
- Department of Radiation Oncology, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
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LeCompte MT, Robbins KJ, Williams GA, Sanford DE, Hammill CW, Fields RC, Hawkins WG, Strasberg SM. Less is more in the difficult gallbladder: recent evolution of subtotal cholecystectomy in a single HPB unit. Surg Endosc 2020; 35:3249-3257. [PMID: 32601763 DOI: 10.1007/s00464-020-07759-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/23/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Subtotal cholecystectomy (SC) is a technique to manage the difficult gallbladder and avoid hazardous dissection and biliary injury. Until recently it was used infrequently. However, because of reduced exposure to open total cholecystectomy in resident training, we recently adopted subtotal cholecystectomy as the bail-out procedure of choice for resident teaching. This study reports our experience and outcomes with subtotal cholecystectomy in the years immediately preceding adoption and since adoption. METHODS A retrospective analysis was conducted of patients undergoing SC from July 2010 to June 2019. Outcomes, including bile leak, reoperation and need for additional procedures, were analyzed. Complications were graded by the Modified Accordion Grading Scale (MAGS). RESULTS 1571 cholecystectomies were performed of which 71 were SC. Subtotal cholecystectomy patients had several indicators of difficulty including prior attempted cholecystectomy and previous cholecystostomy tube insertion. The most common indication for SC was marked inflammation in the hepatocystic triangle (51%). As our experience increased, fewer patients required open conversion to accomplish SC and SC was completed laparoscopically, usually subtotal fenestrating cholecystectomy (SFC). Most patients (85%) had a drain placed and 28% were discharged with a drain. The highest MAGS complication observed was grade 3 (11 patients, 15%). Six patients had a bile leak from the cystic duct resolved by ERCP. At mean follow-up of about 1 year no patient returned with recurrent symptoms. CONCLUSIONS Subtotal fenestrating cholecystectomy is a useful technique to avoid biliary injury in the difficult gallbladder and can be performed with very satisfactory rates of bile fistula, ERCP, and reoperation.
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Affiliation(s)
- Michael T LeCompte
- Division of Surgical Oncology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. .,University of North Carolina, 2800 Blue Ridge Rd Suite 300, Raleigh, NC, 27607, USA.
| | - Keenan J Robbins
- Section of Hepato-Pancreato-Biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Greg A Williams
- Section of Hepato-Pancreato-Biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Dominic E Sanford
- Section of Hepato-Pancreato-Biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Chet W Hammill
- Section of Hepato-Pancreato-Biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Ryan C Fields
- Section of Hepato-Pancreato-Biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - William G Hawkins
- Section of Hepato-Pancreato-Biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Steven M Strasberg
- Section of Hepato-Pancreato-Biliary Surgery, Siteman Cancer Center, Barnes-Jewish Hospital, and Washington University School of Medicine in St. Louis, St Louis, MO, USA.
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Kusakabe J, Anderson B, Liu J, Williams GA, Chapman WC, Doyle MMB, Khan AS, Sanford DE, Hammill CW, Strasberg SM, Hawkins WG, Fields RC. Long-Term Endocrine and Exocrine Insufficiency After Pancreatectomy. J Gastrointest Surg 2019; 23:1604-1613. [PMID: 30671791 PMCID: PMC6646099 DOI: 10.1007/s11605-018-04084-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/13/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To identify peri-operative risk factors and time to onset of pancreatic endocrine/exocrine insufficiency. METHODS We retrospectively analyzed a single institutional series of patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) between 2000 and 2015. Endocrine/exocrine insufficiencies were defined as need for new pharmacologic intervention. Cox proportional modeling was used to identify peri-operative variables to determine their impact on post-operative pancreatic insufficiency. RESULTS A total of 1717 patient records were analyzed (75.47% PD, 24.53% DP) at median follow-up 17.88 months. Average age was 62.62 years, 51.78% were male, and surgery was for malignancy in 74.35% of patients. Post-operative endocrine insufficiency was present in 20.15% (n = 346). Male gender (p = 0.015), increased body mass index (BMI) (p < 0.001), tobacco use (p = 0.011), family history of diabetes (DM) (p < 0.001), personal history of DM (p ≤ 0.001), and DP (p ≤ 0.001) were correlated with increased risk. Mean time to onset was 20.80 ± 33.60 (IQR: 0.49-28.37) months. Post-operative exocrine insufficiency was present in 36.23% (n = 622). Race (p = 0.014), lower BMI (p < 0.001), family history of DM (p = 0.007), steatorrhea (p < 0.001), elevated pre-operative bilirubin (p = 0.019), and PD (p ≤ 0.001) were correlated with increased risk. Mean time to onset was 14.20 ± 26.90 (IQR: 0.89-12.69) months. CONCLUSIONS In this large series of pancreatectomy patients, 20.15% and 36.23% of patients developed post-operative endocrine and exocrine insufficiency at a mean time to onset of 20.80 and 14.20 months, respectively. Patients should be educated regarding post-resection insufficiencies and providers should have heightened awareness long-term.
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Affiliation(s)
- Jiro Kusakabe
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Blaire Anderson
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Jingxia Liu
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - William C Chapman
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Majella MB Doyle
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Adeel S Khan
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Dominic E Sanford
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Steven M Strasberg
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
| | - Ryan C Fields
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
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Grossman JG, Johnston WR, Fowler KJ, Williams GA, Hammill CW, Hawkins WG. A diagnosis reconsidered: the symptomatic gallbladder remnant. J Hepatobiliary Pancreat Sci 2019; 26:137-143. [PMID: 30821072 DOI: 10.1002/jhbp.613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Patients can present with symptomatic gallbladder disease after cholecystectomy due to a remnant gallbladder. This is a rare problem and challenging diagnosis with limited prior characterization; thus, we present a large series of patients with a gallbladder remnant. METHODS A retrospective review was performed of all patients presenting with symptomatic gallbladder remnant at a tertiary care center from 2002 to 2016. Data on presenting symptoms, diagnostic tests, treatments, and follow-up were collected. RESULTS Thirty-one patients diagnosed and treated for a symptomatic gallbladder remnant were identified. The most common presenting symptoms included right upper quadrant pain (87%) and nausea (55%). The median time from symptom presentation to definitive diagnosis was 60 days. Diagnostic modalities utilized in the evaluation of these patients demonstrated that endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography were effective with sensitivities of 85% and 90%, respectively. Twenty-three (76.2%) patients underwent completion cholecystectomy, which proved to be definitive treatment. Additionally, eight (25.8%) patients were non-operative candidates and underwent endoscopic retrograde cholangiopancreatography and sphincterotomy, three of whom developed recurrent symptoms. CONCLUSION A symptomatic gallbladder remnant after cholecystectomy is infrequently seen; however, the diagnosis should be considered in patients with recurrent biliary symptoms after cholecystectomy. Completion cholecystectomy can be challenging but is highly effective for definitive treatment.
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Affiliation(s)
- Julie G Grossman
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA
| | - William R Johnston
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA
| | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, San Diego, CA, USA
| | - Gregory A Williams
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA
| | - Chet W Hammill
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA
| | - William G Hawkins
- Department of Surgery, Barnes-Jewish Hospital and the Alvin J. Siteman Cancer Center at Washington University School of Medicine, 660 South Euclid Avenue, Box 8109, St. Louis, MO, 63110, USA
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Krasnick BA, Sindram D, Simo K, Goss R, Bharadwaj J, Howk K, Herdina KA, Hammill CW. Tumor Ablation Using 3-Dimensional Electromagnetic-Guided Ultrasound Versus Standard Ultrasound in a Porcine Model. Surg Innov 2019; 26:420-426. [DOI: 10.1177/1553350619825717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction. The objective of this study was to compare the placement of ablation needles using 3-dimensional electromagnetic-guided ultrasound (guided) to standard ultrasound guidance (standard) in both laparoscopic surgery and open surgery. Endpoints for this study included targeting accuracy and number of required needle withdrawals and reorientations. Methods. Using a porcine model, fiducial markers were placed into the kidney and liver to represent tumors. Navigation and identification of target sites was achieved using standard or guided ultrasound. Intraprocedural observations as well as the number of needle placement attempts per target were recorded. Three board-certified general surgeons performed the navigation and ablation procedures. After completion of the navigation and ablation procedures, necropsy was performed. The position of the ablation zones relative to the fiducial markers was recorded. Results. A total of 48 procedures were performed across 6 animals (50% open and 50% laparoscopic). Overall, the guided ablations required 50% fewer attempts to successfully target the marker ( P = .01). There was a 62% reduction of attempts for guided laparoscopic ablation ( P = .006). On subgroup analysis of laparoscopic ablation, the benefit remained for liver ( P = .041) ablations, but not for renal ablations ( P = .093). There was no significant difference between the groups with regard to targeting accuracy (91.3% guided vs 95.4% standard, P = .58). Conclusions. The number of targeting attempts required during laparoscopic ablation procedures was significantly less with guided than with standard ultrasound, particularly for laparoscopic ablation of liver lesions. These findings suggest that the guided ultrasound can potentially reduce complications during laparoscopic ablation procedures.
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Abdelmoaty WF, Dunst CM, Neighorn C, Swanstrom LL, Hammill CW. Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: a comprehensive cost analysis. Surg Endosc 2018; 33:3436-3443. [PMID: 30535936 DOI: 10.1007/s00464-018-06606-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 11/28/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cost-effectiveness of robotic-assisted surgery is still debatable. Robotic-assisted inguinal hernia repair has no clear clinical benefit over laparoscopic repair. We performed a comprehensive cost-analysis comparison between the two approaches for evaluation of their cost-effectiveness in a large healthcare system in the Western United States. METHODS Health records in 32 hospitals were queried for procedural costs of inguinal hernia repairs between January 2015 and March 2017. Elective robotic-assisted or laparoscopic unilateral inguinal hernia repairs were included. Cost calculations were done using a utilization-based costing model. Total cost included: fixed cost, which comprises medical device and personnel costs, and variable cost, which comprises disposables and reusable instruments costs. Other outcome measures were length of stay (LOS), conversion to open, and operative times. Statistics were done using t test for continuous variables and χ2 test for categorical variables. A p-value < 0.05 was considered significant. RESULTS A total of 2405 cases, 734 robotic-assisted (633 Primary: 101 recurrent) and 1671 laparoscopic (1471 Primary: 200 recurrent), were included. The average total cost was significantly higher (p < 0.001) in the robotic-assisted group ($5517) compared to the laparoscopic group ($3269). However, the average laparoscopic variable cost ($1105) was significantly higher (p < 0.001) than the robotic-assisted cost ($933). Whereas there was no significant difference between the two groups for LOS and conversion to open, average operative times were significantly higher in the robotic-assisted group (p < 0.001). Subgroup analysis for primary and recurrent inguinal hernias matched the overall results. CONCLUSIONS Robotic-assisted inguinal hernia repair has a significantly higher cost and significantly longer operative times, compared to the laparoscopic approach. The study has shown that only fixed cost contributes to the cost difference between the two approaches. Medical device cost plus the longer operative times are the main factors driving the cost difference. Laparoscopic unilateral inguinal hernia repair is more cost-effective compared to a robotic-assisted approach.
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Affiliation(s)
- Walaa F Abdelmoaty
- Providence St. Joseph Health, Portland, OR, USA.,The Foundation for Surgical Innovation and Education, Portland, OR, USA
| | - Christy M Dunst
- The Foundation for Surgical Innovation and Education, Portland, OR, USA.,The Oregon Clinic, Portland, OR, USA
| | | | - Lee L Swanstrom
- The Foundation for Surgical Innovation and Education, Portland, OR, USA.,The Oregon Clinic, Portland, OR, USA
| | - Chet W Hammill
- Washington University School of Medicine, Box 8109, St. Louis, MO, 63110, USA.
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40
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Strasberg SM, Bhalla S, Hammill CW. The Pucker sign: an operative and radiological indicator of impending operative difficulty due to severe chronic contractive inflammation in cholecystectomy. J Hepatobiliary Pancreat Sci 2018; 25:455-459. [DOI: 10.1002/jhbp.583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Steven M. Strasberg
- Section of Hepato-Pancreato-Biliary Surgery; Siteman Cancer Center; Barnes-Jewish Hospital; Washington University School of Medicine in St. Louis; 660 S. Euclid Avenue, CB 8109 St. Louis MO 63110 USA
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology; Siteman Cancer Center; Barnes-Jewish Hospital; Washington University School of Medicine in St. Louis; St. Louis MO USA
| | - Chet W. Hammill
- Section of Hepato-Pancreato-Biliary Surgery; Siteman Cancer Center; Barnes-Jewish Hospital; Washington University School of Medicine in St. Louis; 660 S. Euclid Avenue, CB 8109 St. Louis MO 63110 USA
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41
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Brauer DG, Fields RC, Tan BR, Doyle MBM, Hammill CW, Hawkins WG, Colditz GA, Chapman WC. Optimal extent of surgical and pathologic lymph node evaluation for resected intrahepatic cholangiocarcinoma. HPB (Oxford) 2018; 20:470-476. [PMID: 29370972 PMCID: PMC6934159 DOI: 10.1016/j.hpb.2017.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/23/2017] [Accepted: 11/26/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lymph node (LN) status is an important predictor of overall survival for resected IHCC, yet guidelines for the extent of LN dissection are not evidence-based. We evaluated whether the number of LNs resected at the time of surgery is associated with overall survival for IHCC. METHODS Patients undergoing curative-intent (R0 or R1) resection for IHCC between 2004 and 2012 were identified within the US National Cancer Database. LN thresholds were evaluated using maximal chi-square testing and five-year overall survival was modeled using Kaplan-Meier and Cox regressions. RESULTS 57% (n = 1,132) of 2,000 patients had one or more LNs resected and pathologically examined. In the 631 patients undergoing R0 resection with pN0 disease, maximal chi-square testing identified ≥3 LNs as the threshold most closely associated with overall survival. Only 39% of resections reached this threshold. On multivariable survival analysis, no threshold of LNs was associated with overall survival, including ≥3 LNs (p = 0.186) and the current American Joint Committee on Cancer recommendation of ≥6 LNs (p = 0.318). CONCLUSION In determining the extent of lymphadenectomy at the time of curative-intent resection for IHCC, surgeons should carefully consider the prognostic yield in the absence of overall survival benefit.
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Affiliation(s)
- David G Brauer
- Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, USA
| | - Ryan C Fields
- Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, USA
| | - Benjamin R Tan
- Division of Oncology, Department of Medicine, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, USA
| | - M B Majella Doyle
- Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, USA
| | - Chet W Hammill
- Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, USA
| | - William G Hawkins
- Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, USA
| | - Graham A Colditz
- Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, USA
| | - William C Chapman
- Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St Louis, MO, USA.
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42
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Jutric Z, Grendar J, Brown WL, Cassera MA, Wolf RF, Hansen PD, Hammill CW. Novel Simulation Device for Targeting Tumors in Laparoscopic Ablation: A Learning Curve Study. Surg Innov 2017. [DOI: 10.1177/1553350617715833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction. A novel 3-dimensional (3D) guidance system was developed to aid accurate needle placement during ablation. Methods. Five novices and 5 experienced hepatobiliary surgeons were recruited. Using an agar block with analog tumor, participants targeted under 4 conditions: in-line with the ultrasound plane using ultrasound, in-line using 3D guidance, 45° off-axis using ultrasound, and off-axis using 3D guidance. Time to target the tumor, number of withdrawals, and the National Aeronautics and Space Administration Task Load Index were collected. Initial and final parameters for each of the conditions were compared using a within-subjects paired t test. Results. A significant reduction was seen in the number of required withdrawals in all situations when using the 3D guidance (0.75 vs 3.65 in-line and 0.25 vs 3.6 for off-axis). Mental workload was significantly lower when using 3D guidance compared with ultrasound both for novices (29.85 vs 41.03) and experts (31.98 vs 44.57), P < .001 for both. The only difference in targeting time between first and last attempt was in the novice group during off-axis targeting using 3D guidance (115 vs 32.6 seconds, P = .03). Conclusion. Though 3D guidance appeared to decrease time to target, this was not statistically significant likely as a result of lack of power in our trial. Three-dimensional guidance did reduce the number of required withdrawals, potentially decreasing complications, as well as mental workload after proficiency was achieved. Furthermore, novices without experience in ultrasound were able to learn targeting with the 3D guidance system at a faster pace than targeting with ultrasound alone.
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Affiliation(s)
- Zeljka Jutric
- Portland Providence Cancer Institute, Portland, OR, USA
| | - Jan Grendar
- Portland Providence Cancer Institute, Portland, OR, USA
| | - William L. Brown
- The Oregon Clinic, Portland, OR, USA
- Meharry Medical College, Nashville, TN, USA
| | | | - Ronald F. Wolf
- Portland Providence Cancer Institute, Portland, OR, USA
- The Oregon Clinic, Portland, OR, USA
| | - Paul D. Hansen
- Portland Providence Cancer Institute, Portland, OR, USA
- The Oregon Clinic, Portland, OR, USA
| | - Chet W. Hammill
- Washington University School of Medicine in St Louis, St Louis, MO, USA
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43
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Worth PJ, Turner M, Hammill CW. Incidental Angiosarcoma of the Pancreas: A Case Report of a Rare, Asymptomatic Tumor. J Pancreat Cancer 2017. [DOI: 10.1089/crpc.2017.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Patrick J. Worth
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Michael Turner
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Chet W. Hammill
- Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
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44
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Grendar J, Jutric Z, Leal JN, Ball CG, Bertens K, Dixon E, Hammill CW, Kastenberg Z, Newell PH, Rocha F, Visser B, Wolf RF, Hansen PD. Validation of Fistula Risk Score calculator in diverse North American HPB practices. HPB (Oxford) 2017; 19:508-514. [PMID: 28233672 DOI: 10.1016/j.hpb.2017.01.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 01/09/2017] [Accepted: 01/21/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Fistula Risk Score (FRS) is a previously developed tool to assess the risk of clinically relevant postoperative pancreatic fistula (CR-POPF) following pancreatoduodenectomy (PD). METHODS Prospectively collected databases from 4 university affiliated and non-affiliated HPB centers in United States and Canada were used. The influence of individual baseline characteristics, FRS and FRS group on CR-POPF was assessed in univariate and multivariate analyses. FRS calculator performance was assessed using a C-statistic. RESULTS 444 patients were identified. Pathology, soft pancreas texture and pancreatic duct size were associated with CR-POPF rates (p < 0.001 for each); EBL was not (p = 0.067). The negligible risk group consisted of 50 (11.3%) patients, low risk of 118 (26.6%), moderate 234 (52.7%) and high risk group of 42 (9.5%) patients. The overall rate of CR-POPF was 20%. Of the patients in the negligible risk group, 2% developed CR-POPF, 13.6% of the low risk, 23.1% moderate and 42.9% in the high risk group (p < 0.001). Overall C-statistic was 0.719. CONCLUSION FRS is robust and able to stratify the risk of developing CR-POPF following PD in diverse North American academic and non-academic institutions. The FRS should be used in research and to guide clinical management of patients post PD in these institutions.
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Affiliation(s)
- Jan Grendar
- Providence Portland Medical Center, Portland, OR, USA
| | - Zeljka Jutric
- Providence Portland Medical Center, Portland, OR, USA
| | - Julie N Leal
- Stanford Medical Center, Stanford University, Stanford, CA, USA
| | - Chad G Ball
- Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | | | - Elijah Dixon
- Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | | | | | | | | | - Brendan Visser
- Stanford Medical Center, Stanford University, Stanford, CA, USA
| | - Ronald F Wolf
- Providence Portland Medical Center, Portland, OR, USA
| | - Paul D Hansen
- Providence Portland Medical Center, Portland, OR, USA.
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Abstract
Background: Angiosarcoma of the pancreas is a very rare neoplasm accounting for 0.1% of pancreatic malignancies. This tumor is biologically very aggressive and frequently diagnosed at an unresectable stage. Case Presentation: Herein, we report a case of an incidentally discovered angiosarcoma that was removed with a robotic distal pancreatectomy and discuss the current literature on this rare disease. Conclusion: This is the fifth reported case of primary angiosarcoma of the pancreas and the first case to be identified incidentally. Unlike the other cases where survival was limited due to advanced disease, the patient presented here underwent surgical resection and remains disease free after 1 year of follow-up.
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Affiliation(s)
- Patrick J Worth
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Michael Turner
- Department of Surgery, Oregon Health and Science University, Portland, Oregon
| | - Chet W Hammill
- Department of Surgery, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri
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46
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Jutric Z, Rozenfeld Y, Grendar J, Hammill CW, Cassera MA, Newell PH, Hansen PD, Wolf RF. Analysis of 340 Patients with Solid Pseudopapillary Tumors of the Pancreas: A Closer Look at Patients with Metastatic Disease. Ann Surg Oncol 2017; 24:2015-2022. [PMID: 28299507 DOI: 10.1245/s10434-017-5772-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Current literature addressing the treatment of solid pseudopapillary neoplasms (SPNs) of the pancreas is limited, particularly for patients with distant metastases. We aimed to define predictive indicators of survival in a large series of patients and assess the outcome of patients with distant metastases. METHODS The National Cancer Database was queried for patients diagnosed with SPNs of the pancreas between 1998 and 2011. Single predictor univariate analyses were performed on variables including demographics, tumor characteristics, and surgery outcomes, and multivariate Cox proportional hazards survival analysis was then completed with backward elimination. RESULTS Overall, 340 patients were identified: 82% were female, median age was 39 years, and 84% had no comorbidities. Patients undergoing any type of surgical resection experienced long-term survival (85% 8-year survival). Patients undergoing surgical resection (n = 296) had superior survival (hazard ratio [HR] 21 for no surgery, p < 0.0001), as did patients treated at academic centers and those with private insurance (HR 3.9, p = 0.009; HR 4.9, p = 0.007). Sex, age, tumor size, presence of lymph node metastases, positive surgical margins, and presence of distant metastases were not significant predictors of survival in multivariate analysis. Of 24 patients with distant metastases, seven were treated surgically and experienced long-term survival similar to that of patients without metastases treated surgically (HR 2, p = 0.48). CONCLUSION SPNs of the pancreas are rare neoplasms with excellent overall survival; however, in a low number of patients they metastasize. Of the few patients with metastatic disease selected for resection, most experienced long-term survival.
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Affiliation(s)
- Zeljka Jutric
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA
| | | | - Jan Grendar
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA
| | - Chet W Hammill
- Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA
| | - Maria A Cassera
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA
| | - Pippa H Newell
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA.,Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA
| | - Paul D Hansen
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA.,Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA
| | - Ronald F Wolf
- Liver and Pancreas Surgery, Portland Providence Cancer Institute, Portland, OR, USA. .,Division of Liver and Pancreas Surgery, The Oregon Clinic, Portland, OR, USA.
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Abstract
The failure to follow national guidelines in management of various diseases has been previously established. We sought to quantify primary care providers’ familiarity with primary hyperparathyroidism as it affects adherence to the 2009 National Institute of Health (NIH) consensus recommendations in treatment of primary hyperparathyroidism. A large primary care group was surveyed to determine their familiarity with the 2009 NIH consensus recommendations for management of primary hyperparathyroidism (PHPT). Retrospective review of the group's records (2009–2011) was performed to verify compliance. Survey responders included 109 clinicians, 31 per cent were familiar with all criteria for surgical intervention in asymptomatic patients and 34 per cent correctly identified appropriate surveillance testing for patients undergoing observation. Chart review identified 124 patients with PHPT. Of the patients who met NIH criteria, 34 per cent had a parathyroidectomy. Younger age, higher intact parathyroid hormone, hypercalciuria, and history of nephrolithiasis were associated with surgery in multivariable analysis. Of the observed patients, 16 per cent had appropriate surveillance studies. In conclusion, this study confirms suboptimal adherence with consensus recommendations in management of PHPT. A minority of clinicians demonstrated solid familiarity with management strategies, paralleling their treatment approach. Educational efforts may improve adherence with upcoming national recommendations.
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Affiliation(s)
| | | | | | - Chet W. Hammill
- The Oregon Clinic, Portland, Oregon
- Providence Health System, Portland, Oregon
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48
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Sharata A, Kelly TL, Rozenfeld Y, Hammill CW, Schuman E, Carlisle JR, Aliabadi-Wahle S. Management of Primary Hyperparathyroidism: Can We Do Better? Am Surg 2017; 83:64-70. [PMID: 28234128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The failure to follow national guidelines in management of various diseases has been previously established. We sought to quantify primary care providers' familiarity with primary hyperparathyroidism as it affects adherence to the 2009 National Institute of Health (NIH) consensus recommendations in treatment of primary hyperparathyroidism. A large primary care group was surveyed to determine their familiarity with the 2009 NIH consensus recommendations for management of primary hyperparathyroidism (PHPT). Retrospective review of the group's records (2009-2011) was performed to verify compliance. Survey responders included 109 clinicians, 31 per cent were familiar with all criteria for surgical intervention in asymptomatic patients and 34 per cent correctly identified appropriate surveillance testing for patients undergoing observation. Chart review identified 124 patients with PHPT. Of the patients who met NIH criteria, 34 per cent had a parathyroidectomy. Younger age, higher intact parathyroid hormone, hypercalciuria, and history of nephrolithiasis were associated with surgery in multivariable analysis. Of the observed patients, 16 per cent had appropriate surveillance studies. In conclusion, this study confirms suboptimal adherence with consensus recommendations in management of PHPT. A minority of clinicians demonstrated solid familiarity with management strategies, paralleling their treatment approach. Educational efforts may improve adherence with upcoming national recommendations.
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Khajanchee YS, Johnston WC, Cassera MA, Hansen PD, Hammill CW. Characterization of Pancreaticojejunal Anastomotic Healing in a Porcine Survival Model. Surg Innov 2016; 24:15-22. [DOI: 10.1177/1553350616674638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: Anastomotic leak after pancreaticoduodenectomy is the most important cause of postoperative morbidity and mortality. Histological studies of bowel anastomoses have provided valuable insights regarding causes of anastomotic failure. However, this crucial information is lacking for pancreatico-enteric anastomoses. Methods: Pancreaticoduodenectomy was performed in a porcine model. Animals were survived up to 10 days and then the pancreatico-enteral anastomosis specimen was resected en bloc. Anastomotic bursting pressure was measured and histological sections of the anastomoses were examined. Results: Six out of 8 animals had excellent healing of the anastomoses. One animal developed a clinically significant leak at the pancreaticoduodenal anastomosis (12.5%) and one animal had a subclinical duodeno-duodenal leak discovered on necropsy (12.5%). Both anastomoses that failed had a collagen-to-tissue ratio less than 40%. In contrast, none of the anastomoses with a ratio greater than 40% showed any evidence of disruption. Conclusion: Our results indicate that quantitative measurement of collagen deposition at the pancreatic anastomosis provides objective assessment of healing of the pancreatic anastomosis. A survival porcine model of pancreaticoduodenectomy results in a similar leak rate to published data on pancreaticoduodenectomy in humans and will be useful for future studies assessing novel pharmacologic or technical interventions aimed at improving outcomes.
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Affiliation(s)
| | | | - Maria A. Cassera
- Providence Portland Medical Center, Portland, OR, USA
- The Oregon Clinic, Portland, OR, USA
| | - Paul D. Hansen
- Providence Portland Medical Center, Portland, OR, USA
- The Oregon Clinic, Portland, OR, USA
| | - Chet W. Hammill
- Providence Portland Medical Center, Portland, OR, USA
- The Oregon Clinic, Portland, OR, USA
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50
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Galen DI, Brown WL, Cassera MA, Jutric Z, Hammill CW. Novel Device for Targeting Tumors in Laparoscopic Radiofrequency Ablation: A Learning Curve Study. J Minim Invasive Gynecol 2016; 22:S224-S225. [PMID: 27679104 DOI: 10.1016/j.jmig.2015.08.792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- D I Galen
- Department of Surgery, Aspen Surgery Center, San Ramon, California
| | - W L Brown
- Department of Surgery, The Oregon Clinic, Portland, Oregon
| | - M A Cassera
- Department of Surgery, The Oregon Clinic, Portland, Oregon
| | - Z Jutric
- Department of Surgery, The Oregon Clinic, Portland, Oregon
| | - C W Hammill
- Department of Surgery, The Oregon Clinic, Portland, Oregon
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