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Ebertz DP, Steinhagen E, Alvarado CE, Bingmer K, Asher D, Berardinelli A, Ammori J. Eliminating Hands off Handoffs: Improvement in Perioperative Handoff Communication With a Multidisciplinary Tool Initiative. J Healthc Qual 2024:01445442-990000000-00060. [PMID: 38214596 DOI: 10.1097/jhq.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Handoffs between the operating room (OR) and post-anesthesia care unit (PACU) require a high volume and quality of information to be transferred. This study aimed to improve perioperative communication with a handoff tool. METHODS Perioperative staff at a quaternary care center was surveyed regarding perception of handoff quality, and OR to PACU handoffs were observed for structured criteria. A 25-item tool was implemented, and handoffs were similarly observed. Staff was then again surveyed. A multidisciplinary team led this initiative as a collaboration. RESULTS After implementation, nursing reported improved perception of time spent (2.63-3.68, p = .02) and amount of information discussed (2.85-3.73, p = .05). Anesthesia also reported improved personal communication (3.69-4.43, p = .004), effectiveness of handoffs (3.43-3.82, p = .02), and amount of information discussed (4.26-4.76, p = .05). After implementation, observed patient information discussed during handoffs increased for both surgical and anesthesia team members. The frequency of complete and near-complete handoffs increased (40%-74%, p < .001). CONCLUSIONS A structured handoff tool increased the amount of essential information reported during handoffs between the OR and PACU and increased team members' perception of handoffs.
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Sawaf T, Gudipudi R, Ofshteyn A, Sarode AL, Bingmer K, Bliggenstorfer J, Stein SL, Steinhagen E. Disparities in Clinical Trial Enrollment and Reporting in Rectal Cancer: A Systematic Review and Demographic Comparison to the National Cancer Database. Am Surg 2024; 90:130-139. [PMID: 37670471 DOI: 10.1177/00031348231191175] [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] [Indexed: 09/07/2023]
Abstract
BACKGROUND Cancer care guidelines based on clinical trial data in homogenous populations may not be applicable to all rectal cancer patients. The aim of this study was to evaluate whether patients enrolled in rectal cancer clinical trials (CTs) are representative of United States (U.S.) rectal cancer patients. METHODS Prospective rectal cancer CTs from 2010 to 2019 in the United States were systematically reviewed. In trials with multiple arms reporting separate demographic variables, each arm was considered a separate CT group in the analysis. Demographic variables considered in the analysis were age, sex, race/ethnicity, facility location throughout the United States, rural vs urban geography, and facility type. Participant demographics from trial and the National Cancer Database (NCDB) participants were compared using chi-squared goodness of fit and one-sample t-test where applicable. RESULTS Of 50 CT groups identified, 42 (82%) studies reported mean or median age. Trial participants were younger compared to NCDB patients (P < .001 all studies). All but three trials had fewer female patients than NCDB (48.2% female, P < .001). Less than half the CT groups reported on race or ethnicity. Eighteen out of 22 trials (82%) had a smaller percentage of Black patients and 4 out of 8 (50%) trials had fewer Hispanic or Spanish origin patients than the NCDB. No CTs reported comorbidities, socioeconomic factors, or education. CT primary sites were largely at academic centers and in urban areas. CONCLUSION The present study supports the need for improved demographic representation and transparency in rectal cancer clinical trials.
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Affiliation(s)
- Tuleen Sawaf
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Rachana Gudipudi
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Asya Ofshteyn
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Anuja L Sarode
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Sharon L Stein
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Bliggenstorfer JT, Hashmi A, Bingmer K, Chang C, Liu JC, Ginesi M, Stein SL, Steinhagen E. Sarcopenia in Patients With Rectal Adenocarcinoma: An Opportunity for Preoperative Rehabilitation. Am Surg 2023; 89:5631-5637. [PMID: 36896832 DOI: 10.1177/00031348231160849] [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] [Indexed: 03/11/2023]
Abstract
BACKGROUND Sarcopenia, defined as low skeletal muscle mass, affects up to 60% of rectal adenocarcinoma patients receiving neoadjuvant chemoradiation (NACRT), with negative impact on patient outcomes. Identifying modifiable risk factors may decrease morbidity and mortality. METHODS A retrospective review of rectal cancer patients from a single academic center from 2006 to 2020 was performed. Sixty-nine patients with pre- and post-NACRT CT imaging were included. Skeletal muscle index (SMI) was calculated as total L3 skeletal muscle divided by height squared. Sarcopenia thresholds were 52.4 cm2/m2 for men and 38.5 cm2/m2 for women. Student T-test, chi-square test, multivariable regression, and multivariable Cox hazard analysis were performed. RESULTS 62.3% of patients lost SMI from pre- to post-NACRT imaging, with a mean change of -7.8% (±19.9%). Eleven (15.9%) patients were sarcopenic at presentation, increasing to 20 (29.0%) following NACRT. Mean SMI decreased from 49.0 cm2/m2 (95% CI: 42.0 cm2/m2-56.0 cm2/m2) to 38.2 cm2/m2 (95% CI: 33.6 cm2/m2-42.9 cm2/m2) (P = .003). Pre-NACRT sarcopenia correlated with post-NACRT sarcopenia (OR 20.6, P = .002). Percent decrease in SMI was associated with a 5% increased mortality risk. CONCLUSION The presence of sarcopenia at diagnosis and its association with post-NACRT sarcopenia suggests an opportunity for a high-impact intervention.
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Affiliation(s)
- Jonathan T Bliggenstorfer
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland OH, USA
| | - Ahmad Hashmi
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland OH, USA
| | - Carolyn Chang
- Case Western Reserve University School of Medicine, Cleveland OH, USA
| | - Jessica C Liu
- Case Western Reserve University School of Medicine, Cleveland OH, USA
| | - Meridith Ginesi
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland OH, USA
| | - Sharon L Stein
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland OH, USA
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland OH, USA
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Chang C, Bliggenstorfer JT, Liu J, Shearer J, Dreher P, Bingmer K, Stein SL, Steinhagen E. Not All Patients With Locally Advanced Rectal Cancer Benefit From Neoadjuvant Therapy. Am Surg 2023; 89:4327-4333. [PMID: 35722940 DOI: 10.1177/00031348221109476] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND While neoadjuvant combined modality therapy (NA-CMT) is beneficial for most patients with locally advanced rectal cancer some patients may experience disease progression during treatment. The purpose of this study is to identify characteristics associated with progression during NA-CMT. METHODS A single institution retrospective review of patients with stage II-III rectal cancer receiving NA-CMT was conducted from 2008-2019. Patients with incomplete or unknown NA-CMT treatment and those who received chemotherapy in addition to NA-CMT were excluded. Initial staging MRI was compared to post-operative pathology to determine progression. Definitions: responders (complete response or regression) and non-responders (stable disease or progression). RESULTS 156 patients were included: 25 (16.1%) complete responders, 79 (50.6%) had evidence of regression, 34 (21.8%) were stable non-responders, and 18 (11.5%) were progressors. Those who progressed had worse overall survival. Factors associated with non-responders included black race (OR 4.5, 95% CI: 1.10-18.7) and increasing distance from the anal verge (OR 1.2, 95% CI: .2-2.9). Distance from the anal verge was determined via MRI. Recurrence was significantly more common among non-responders (15, 30.61%) when compared to responders (14, 13.46%), P = .012. CONCLUSION Patients who progress despite NA-CMT have overall worse survival compared to patients who do respond. While this study failed to identify modifiable or predictive risk factors for progression, the multivariate logistic regression model suggests that race and tumor biology may play a role in progression. Future studies should focus on early identification of patients who may not benefit from NA-CMT in an effort to develop alternative treatment algorithms.
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Affiliation(s)
- Carolyn Chang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Jessie Liu
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jennifer Shearer
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Paul Dreher
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Katherine Bingmer
- University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, OH, USA
| | - Sharon L Stein
- University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, OH, USA
| | - Emily Steinhagen
- University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, OH, USA
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Brady JT, Bingmer K, Bliggenstorfer J, Xu Z, Fleming FJ, Remzi FH, Monson JRT, Wexner SD, Dietz DW. Could meeting the standards of the National Accreditation Program for Rectal Cancer in the National Cancer Database improve patient outcomes? Colorectal Dis 2023; 25:916-922. [PMID: 36727838 DOI: 10.1111/codi.16503] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/17/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
AIM The National Accreditation Program for Rectal Cancer (NAPRC) was developed to improve rectal cancer patient outcomes in the United States. The NAPRC consists of a set of process and outcome measures that hospitals must meet in order to be accredited. We aimed to assess the potential of the NAPRC by determining whether achievement of the process measures correlates with improved survival. METHODS The National Cancer Database was used to identify patients undergoing curative proctectomy for non-metastatic rectal cancer from 2010 to 2014. NAPRC process measures identified in the National Cancer Database included clinical staging completion, treatment starting <60 days from diagnosis, carcinoembryonic antigen level measured prior to treatment, tumour regression grading and margin assessment. RESULTS There were 48 669 patients identified with a mean age of 62 ± 12.9 years and 61.3% of patients were men. The process measure completed most often was assessment of proximal and distal margins (98.4%) and the measure completed least often was the serum carcinoembryonic antigen level prior to treatment (63.8%). All six process measures were completed in 23.6% of patients. After controlling for age, gender, comorbidities, annual facility resection volume, race and pathological stage, completion of all process measures was associated with a statistically significant mortality decrease (Cox hazard ratio 0.88, 95% CI 0.81-0.94, P < 0.001). CONCLUSION Participating institutions provided complete datasets for all six process measures in less than a quarter of patients. Compliance with all process measures was associated with a significant mortality reduction. Improved adoption of NAPRC process measures could therefore result in improved survival rates for rectal cancer in the United States.
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Affiliation(s)
- Justin T Brady
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Zhaomin Xu
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Fergal J Fleming
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Feza H Remzi
- Department of Surgery, New York University Langone Medical Center, New York, New York, USA
| | - John R T Monson
- AdventHealth Surgical Health Outcomes Consortium, AdventHealth, Orlando, Florida, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center Cleveland Clinic Florida, Weston, Florida, USA
| | - David W Dietz
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Ginesi M, Bingmer K, Bliggenstorfer JT, Ofshteyn A, Steinhagen E, Stein SL. Functional Not Medical Frailty Is Associated With Long-Term Disability After Surgery for Colorectal Cancer. Cureus 2022; 14:e23216. [PMID: 35449639 PMCID: PMC9012557 DOI: 10.7759/cureus.23216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Frailty has been associated with increased morbidity after surgery. However, few studies investigate long-term functional outcomes. Methods: Patients ≥ 65 years old who underwent surgery for colorectal cancer were surveyed regarding their ability to perform activities of daily living, measured by Barthel Index, before and after surgery. Patients also reported time to return to their functional baseline. Results: Pre-operative moderate dependency was associated with declining function at six months (OR: 8.8; CI: 1.8-42.6) and one year post-operatively (OR: 17.5; CI: 2.8-109.8). Pre-operative functional frailty was associated with subjective failure to return to baseline (OR: 4.8 and 4.2) for slightly and moderately dependent patients and a longer time to return to baseline. Medical frailty, based on the modified Frailty Index, was not significantly associated with failure to return to baseline. Conclusions: Measures of functional frailty are better predictors of failure to return to baseline, than measures of medical frailty.
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Ginesi M, Ofshteyn A, Bliggenstorfer J, Bingmer K, Juza R, Stein SL, Steinhagen E. General Surgery Residents' Retention of Knowledge After an Anorectal Skills Workshop. J Surg Res 2022; 274:102-107. [PMID: 35144040 DOI: 10.1016/j.jss.2021.12.018] [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: 05/20/2021] [Revised: 10/29/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Studies have demonstrated suboptimal resident exposure to anorectal pathology. A workshop was developed at an academic general surgery residency. This study assesses durability of learning from the workshop. METHODS Thirty-six residents participated in a skills laboratory addressing diagnosis and management of anorectal complaints. The skills laboratory was broken into didactic and hand-on skills stations. Residents completed pre-, post- and 6-mo after workshop assessments to evaluate knowledge and confidence. Knowledge and confidence-based scores pre-, post- and 6-mo after workshop were compared. RESULTS Scores demonstrated retention of information. Knowledge-based question median scores improved from 63.2% pre-workshop to 73.7% post-workshop and 76.3% at 6 mo (P = 0.0005). Median confidence scores improved from 31 pre-workshop to 40 post-workshop, and were stable at 6 mo (P = 0.0001). CONCLUSIONS Knowledge and confidence gained from an anorectal skills workshop was stable or improved at 6 mo. These results suggest that an anorectal curriculum is effective at improving general surgery resident background knowledge and confidence when managing anorectal complaints.
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Affiliation(s)
- Meridith Ginesi
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Asya Ofshteyn
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Jonathan Bliggenstorfer
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Ryan Juza
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Sharon L Stein
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Cleveland Medical Center, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland, Ohio.
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Hue J, Paukovits J, Bingmer K, Sugumar K, Ocuin L, Rothermel L, Ammori J, Winter J, Hardacre J, Chen H. MEDICARE REIMBURSEMENT FOR COMMON GENERAL SURGERY PROCEDURES HAS DECLINED OVER THE LAST DECADE. Am J Surg 2022; 223:554. [DOI: 10.1016/j.amjsurg.2022.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bliggenstorfer J, Bingmer K, Ofshteyn A, Sarode AL, Ginesi M, Stein SL, Steinhagen E. Evaluation of Demographics and Management of Rectal Cancer by Age Group: A Retrospective Propensity Matched Cohort Analysis of the National Cancer Database. Cureus 2021; 13:e19412. [PMID: 34926010 PMCID: PMC8654076 DOI: 10.7759/cureus.19412] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/20/2022] Open
Abstract
Background Data suggests there are demographic and biological differences in colon cancer between young and typical-onset patients. However, it is unclear if these differences persist in rectal cancer patients, exclusive of colon cancer. This is a retrospective review of a large national database to evaluate age-based differences in demographics, tumor features, and treatment among patients with rectal adenocarcinoma. Methods The National Cancer Database from 2004-2014 was queried for rectal adenocarcinoma. Patients were grouped by age at diagnosis: early-onset, defined as <40 years, mid-onset 40-49, and late-onset ≥50. Propensity matching controlled for demographic variation among cohorts. Pairwise Chi-square with Bonferroni correction was used for analysis. Results Thirty thousand nine hundred seventy-eight patients were included: 1,249 (4%) early-onset, 4,156 (13%) middle-onset, and 25,573 (83%) late-onset. Significant differences existed between all three cohorts in nearly all demographic and pathologic metrics. Control for demographic variation revealed early-onset and middle-onset cohorts differed only with respect to the stage at presentation, while early-onset and late-onset cohorts differed more significantly on the basis of stage, histology, and oncologic management. Conclusion The demographic differences observed demonstrate that patients under 50 should not be considered one cohort. Propensity matching led to a decrease in tumor trait differences among cohorts, suggesting that demographics other than age drive variation in tumor biology. Young patients received more aggressive management, implying the presence of an age bias. Age-based screening is likely insufficient and may exclude the rising proportion of young patients at risk for disease, while age-based management may lead to under- or overtreatment of patients at either end of the age spectrum.
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Affiliation(s)
- Jonathan Bliggenstorfer
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, USA
| | - Asya Ofshteyn
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, USA
| | - Anuja L Sarode
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, USA
| | - Meridith Ginesi
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, USA
| | - Sharon L Stein
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, USA
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Research in Surgical Outcomes and Effectiveness (UH RISES), Cleveland, USA
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Hue JJ, Ahorukomeye P, Bingmer K, Drapalik L, Ammori JB, Wilhelm SM, Rothermel LD, Towe CW. A comparison of robotic and laparoscopic minimally invasive adrenalectomy for adrenal malignancies. Surg Endosc 2021; 36:5374-5381. [PMID: 34724582 DOI: 10.1007/s00464-021-08827-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/05/2021] [Accepted: 10/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although guidelines recommend open adrenalectomy for most resectable adrenal malignancies, minimally invasive adrenalectomies are performed. Robotic adrenalectomies have become more popular recently, but there is a paucity of literature comparing laparoscopic and robotic resections. METHODS Patients who underwent a planned minimally invasive adrenalectomy for adrenal malignancies (adrenocortical carcinoma, malignant pheochromocytoma, other carcinoma) were identified in the National Cancer Database. The primary outcome was the conversion rate from minimally invasive to open. Other post-operative outcomes and survival were compared. RESULTS 416 patients (76.5%) underwent a laparoscopic adrenalectomy and 128 (23.5%) underwent a robotic operation. Demographics and clinical characteristics were similar. Approximately 19% of tumors resected by a minimally invasive approach were > 10 cm. The intra-operative conversion rate was decreased among robotic adrenalectomies relative to laparoscopic on univariate (7.8% vs. 18.3%, p = 0.005) and multivariable (odds ratio 0.39, p = 0.01) analyses. Using marginal standardization, there was a stepwise increase in the conversion rate as tumor size increased (< 5, 5-10, > 10 cm) for laparoscopic (7.5%, 18.0%, 33.2%) and robotic (3.1%, 8.3%, 17.3%) adrenalectomies. Operations which required conversion had a greater margin positivity rate, greater length of stay, and an association with poor overall survival. CONCLUSION In contrast to most clinical guidelines, minimally invasive adrenalectomies are being performed on large malignant tumors. A laparoscopic approach was associated with a greater conversion rate and subsequent poor outcomes. If a surgeon is not planning an open adrenalectomy, but adrenal malignancy is a possibility, robotic adrenalectomy may be the preferred approach for resectable adrenal tumors.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Peter Ahorukomeye
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Lauren Drapalik
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Scott M Wilhelm
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Luke D Rothermel
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106-5011, USA.
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Hue JJ, Bingmer K, Sugumar K, Ocuin LM, Rothermel LD, Winter JM, Ammori JB, Hardacre JM. Mortality and Survival Among Octogenarians with Localized Pancreatic Head Cancer: a National Cancer Database Analysis. J Gastrointest Surg 2021; 25:2582-2592. [PMID: 33634421 DOI: 10.1007/s11605-021-04949-8] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) has historically poor outcomes. Difficult decisions must be made by patients and providers, especially in the elderly for whom treatment morbidities may not be tolerable. Herein, we report treatment-dependent outcomes of octogenarians with localized PDAC. METHODS The National Cancer Database identified patients ≥60 years with localized PDAC of the pancreatic head (2011-2016). Patients were grouped by age (60-79 and ≥80 years) and categorized by treatment regimen: no treatment, chemotherapy, pancreaticoduodenectomy, pancreaticoduodenectomy with perioperative chemotherapy, or pancreaticoduodenectomy with adjuvant chemotherapy. Postoperative outcomes and survival were analyzed. RESULTS A total of 35,409 patients were included, 8745 (24.7%) of which were ≥80 years. Over 52% of octogenarians did not receive any treatment, compared to 19.1% of younger patients (p<0.001). Patients ≥80 years who underwent a pancreaticoduodenectomy had a significantly greater 90-day mortality rate compared to patients 60-79 years (11.0% vs. 6.7%, p<0.001). Only 42.2% of octogenarians who underwent upfront pancreatectomy received adjuvant chemotherapy. Median survival for octogenarians was 3.3 months without any treatment, 9.7 months with chemotherapy, 12.0 months with pancreaticoduodenectomy, and greater than 20 months with either perioperative or adjuvant chemotherapy in addition to pancreaticoduodenectomy. Age ≥80 was associated with poor survival relative to ages 60-79 when adjusting for treatment regimen (HR=1.19, p<0.001). CONCLUSION Increasing age is associated with worse overall survival in PDAC, but select octogenarians can achieve reasonable survival with multimodal therapy. Given the poor survival and increased perioperative mortality of octogenarians, patient selection for surgery and consideration of neoadjuvant therapy may be increasingly important.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Katherine Bingmer
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Kavin Sugumar
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Lee M Ocuin
- Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, Atrium Health
- , Charlotte, NC, USA
| | - Luke D Rothermel
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Jordan M Winter
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - John B Ammori
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Jeffrey M Hardacre
- Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
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Bliggenstorfer JT, Bingmer K, Ofshteyn A, Stein SL, Charles R, Steinhagen E. Neoadjuvant radiation above NCCN guidelines for rectal cancer is associated with age under 50 and early clinical stage. Surg Endosc 2021; 36:2925-2935. [PMID: 34114070 DOI: 10.1007/s00464-021-08585-w] [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: 05/11/2020] [Accepted: 06/02/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Recent data suggest patients with early-onset rectal cancer (EORC) receive neoadjuvant radiation above recommended doses without oncologic benefit. The use of excessive radiation may lead to worse outcomes and patient harm. We sought to evaluate predictors of aggressive neoadjuvant radiation (A-XRT) use in EORC patients and compare this to late-onset rectal cancer (LORC) patients. METHODS The National Cancer Database from 2004 to 2014 was queried for rectal adenocarcinoma patients undergoing surgical resection. Patients with stage 0 or IV disease, positive margins, and incomplete data were excluded. Standard neoadjuvant radiation (S-XRT) was based upon NCCN guidelines: 25-50.4 Gray for stage II/III patients and none for stage I. Excess radiation was considered A-XRT. Patients diagnosed at age < 50 years were labeled EORC; those ≥ 50 years were LORC. Categorical data were analyzed with chi-square test. Logistic regression was used to analyze clinicodemographic associations with A-XRT. RESULTS 45,403 patients were included: 7999 (17.6%) EORC and 37,404 (82.4%) LORC. Multivariable logistic regression demonstrated that A-XRT use among stage I patient was associated with male gender, age under 50, urban location, mucinous histology, and poor tumor differentiation. Among stage II and III patients, A-XRT use was associated with male gender, age under 50, higher education and income, and urban location. Cox hazards did not demonstrate a significant association of A-XRT use with survival. CONCLUSION Our data reaffirm that EORC patients more frequently receive A-XRT and that use is based on demographic features independent of tumor characteristics. Reasons for A-XRT, particularly in EORC patients, should be clarified to promote adherence to guidelines and minimize patient harm.
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Affiliation(s)
- Jonathan T Bliggenstorfer
- Department of Surgery, UH-RISES: University Hospitals Research in Surgical Outcomes and Effectiveness, 11100 Euclid Avenue, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, UH-RISES: University Hospitals Research in Surgical Outcomes and Effectiveness, 11100 Euclid Avenue, Cleveland, OH, USA
| | - Asya Ofshteyn
- Department of Surgery, UH-RISES: University Hospitals Research in Surgical Outcomes and Effectiveness, 11100 Euclid Avenue, Cleveland, OH, USA
| | - Sharon L Stein
- Department of Surgery, UH-RISES: University Hospitals Research in Surgical Outcomes and Effectiveness, 11100 Euclid Avenue, Cleveland, OH, USA
| | - Ronald Charles
- Department of Surgery, UH-RISES: University Hospitals Research in Surgical Outcomes and Effectiveness, 11100 Euclid Avenue, Cleveland, OH, USA
| | - Emily Steinhagen
- Department of Surgery, UH-RISES: University Hospitals Research in Surgical Outcomes and Effectiveness, 11100 Euclid Avenue, Cleveland, OH, USA.
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Narang J, Hue JJ, Bingmer K, Hardacre JM, Winter JM, Ocuin LM, Ammori JB, Mangla A, Bordeaux J, Rothermel LD. Sentinel lymph node biopsy guideline concordance in melanoma: Analysis of the National Cancer Database. J Surg Oncol 2021; 124:669-678. [PMID: 34109633 DOI: 10.1002/jso.26565] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVES This study investigated the impact of treating facility type on guideline-concordant sentinel lymph node biopsy (SLNB) management in T1a* (defined as a Breslow depth <0.76 mm without ulceration or mitoses) and T2/T3 melanoma. METHODS This was a retrospective cohort study utilizing the National Cancer Database from 2012 to 2016. RESULTS Our cohort included 109,432 patients. For T1a* melanomas, 85% of patients received guideline-concordant SLNB management at community and academic facilities versus 75% of patients at integrated network facilities (p < .001). Over 83% of patients with T2/T3 melanoma treated at an academic facility received guideline-concordant SLNB management versus 77% treated at a community facility (p < .001). Adjusting for demographic and clinical factors, integrated (adjusted odds ratio, aOR = 0.54), and comprehensive community (aOR = 0.74) facilities were less likely to provide guideline-concordant SLNB management in patients with T1a* melanoma compared to academic facilities. Community facilities (aOR = 0.72) were less likely to provide guideline-concordant SLNB management in patients with T2/T3 melanoma compared to academic facilities. CONCLUSION Academic facilities provide the highest rate of guideline-concordant sentinel lymph node management. Comparatively, community programs may underutilize SLNB in T2/T3 disease, while integrated and comprehensive community facilities may over-utilize SLNB in T1a* disease.
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Affiliation(s)
- Jatin Narang
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, USA
| | - Jonathan J Hue
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | | | - Jordan M Winter
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lee M Ocuin
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John B Ammori
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ankit Mangla
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeremy Bordeaux
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luke D Rothermel
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Hue JJ, Bingmer K, Sugumar K, Markt SC, Rothermel LD, Hardacre JM, Ammori JB, Winter JM, Ocuin LM. Immunotherapy Is Associated with a Survival Benefit in Patients Receiving Chemotherapy for Metastatic Pancreatic Cancer. J Pancreat Cancer 2021; 7:31-38. [PMID: 33937617 PMCID: PMC8080907 DOI: 10.1089/pancan.2021.0003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Immunotherapy (IT) has led to improved survival in several common cancers but success in pancreatic ductal adenocarcinoma (PDAC) has been limited. We analyzed if combination IT-chemotherapy (IT-CT) is associated with improved survival compared with chemotherapy alone (CT) in patients with metastatic PDAC. Methods: The National Cancer Database (2004-2016) was queried for patients who were diagnosed with metastatic PDAC. Patients were categorized by treatment group: CT only and IT-CT. Patients were excluded if they received radiation or a surgical procedure. The primary outcome was overall survival. Results: A total of 59,289 patients were identified, of whom 58,947 (99.4%) received CT and 342 (0.6%) received IT-CT. The IT-CT group was younger, had fewer comorbidities, and was more often treated at an academic center. The utilization of multiagent CT was similar between the groups. Median survival of patients treated with IT-CT was longer than CT alone (7.9 months vs. 6.3 months, p = 0.005). On multivariable analysis, receipt of IT-CT was associated with a survival advantage as compared with CT (hazard ratio = 0.86, 95% confidence intervals 0.76-0.97) when adjusting for demographics and type of CT regimen. Conclusion: In patients with metastatic PDAC, it appears that combination IT-CT may perhaps be associated with a survival advantage compared with CT alone.
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Affiliation(s)
- Jonathan J Hue
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Katherine Bingmer
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Kavin Sugumar
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sarah C Markt
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Luke D Rothermel
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jeffrey M Hardacre
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John B Ammori
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Jordan M Winter
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Lee M Ocuin
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Ofshteyn A, Bingmer K, Tseng E, Times M, Miller M, Ammori J, Steinhagen E. Effect of "Residents as Teachers" Workshop on Learner Perception of Trainee Teaching Skill. J Surg Res 2021; 264:418-424. [PMID: 33848841 DOI: 10.1016/j.jss.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 06/24/2020] [Revised: 02/21/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Surgical residencies use variable structures for formal training in education. We hypothesized that a one-day workshop intervention would improve resident teaching ability measured by self-assessment and learner evaluation. MATERIALS AND METHODS Faculty educators delivered a Residents as Teachers (RAT) workshop to general surgery residents on setting expectations, positive learning environment, difficult feedback and the 1-min preceptor model. For three months before and after the workshop, junior residents and medical students evaluated their supervising residents' teaching skill monthly using a Likert scale questionnaire. Pre- and postworkshop surveys were administered to resident participants to assess their knowledge of the material and teaching confidence. Results were analyzed using Wilcoxon rank sum tests. This study was conducted at a tertiary academic center with a large surgical residency program. RESULTS Thirty-nine PGY 1-5 residents participated in the Residents as Teachers workshop and were included in the study. Pre- and post- workshop survey results demonstrated significant improvements in participants' knowledge and teaching confidence. On monthly assessments of seniors by junior residents, significant improvements were noted in three domains. Medical student ratings did not reflect significant improvements in resident teaching skill. CONCLUSIONS This is the first study using learner evaluation of a comprehensive surgical RAT program. Despite a significant increase in surgery residents' self-assessment following participation in an education workshop, no improvement was seen in resident teaching skill as perceived by medical students.
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Affiliation(s)
- Asya Ofshteyn
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio
| | - Katherine Bingmer
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio
| | - Esther Tseng
- MetroHealth Medical Center, Department of General Surgery, Cleveland Ohio
| | - Melissa Times
- MetroHealth Medical Center, Department of General Surgery, Cleveland Ohio
| | - Megan Miller
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio
| | - John Ammori
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio
| | - Emily Steinhagen
- University Hospitals Cleveland Medical Center, Department of General Surgery, Cleveland Ohio; University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Cleveland Ohio.
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Hue JJ, Bingmer K, Zhao H, Ammori JB, Wilhelm SM, Towe CW, Rothermel LD. Reassessing the impact of tumor size on operative approach in adrenocortical carcinoma. J Surg Oncol 2021; 123:1238-1245. [PMID: 33577722 DOI: 10.1002/jso.26418] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Adrenocortical carcinoma (ACC) is often a contraindication to minimally invasive adrenalectomy (MIA). We used an administrative data set to analyze postoperative outcomes. We hypothesized that small tumors would have better short- and long-term outcomes, independent of the operative approach. METHODS The National Cancer Database (2010-2016) identified patients with ACC who underwent adrenalectomy. Tumors were grouped: <5 cm (n = 125), 5-10 cm (n = 431), and >10 cm (n = 443). The primary and secondary outcomes were margin positivity and overall survival, respectively. RESULTS Nine hundred and ninety-nine patients were analyzed: 37% MIA and 63% open adrenalectomy (OA). As the size increased, the rate of attempted MIA decreased. Larger tumors were associated with conversion to open. Although tumors with local invasion and those which required conversion to open were associated with an increased likelihood of a positive margin, tumor size was not. Although "complete" MIA (vs. OA) and tumor size were not associated with differences in survival, conversion (HR = 1.83, p = .02), positive margins (HR = 1.54, p = .01), and local invasion (HR = 1.84, p < .001) were associated with poor survival. CONCLUSION Positive margins are associated with poor survival in ACC. Tumors ≥ 5 cm were associated with an increased conversion rate and subsequent increase in margin positivity. MIA may be considered for select patients with small tumors but adequate oncologic resection is critical.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Heming Zhao
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Scott M Wilhelm
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luke D Rothermel
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Hue JJ, Sugumar K, Bingmer K, Ammori JB, Winter JM, Hardacre JM. Neoadjuvant chemoradiation may be associated with improved pathologic response in pancreatic cancer. Am J Surg 2020; 221:500-504. [PMID: 33234234 DOI: 10.1016/j.amjsurg.2020.11.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/30/2020] [Revised: 10/12/2020] [Accepted: 11/14/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neoadjuvant therapy is increasingly utilized in the management of pancreatic adenocarcinoma. The type of neoadjuvant therapy and its effect on pathologic response remains understudied. METHODS A retrospective review was performed on patients who underwent neoadjuvant therapy followed by pancreatectomy. Multivariable regressions were used to determine associations between neoadjuvant therapy regimens and pathologic response. RESULTS Seventy-five patients with pathologic responses available for review received FOLFIRINOX (61%) or gemcitabine with nab-paclitaxel (39%). Demographics, histologic differentiation, and utilization of chemoradiation were similar between the groups. Multivariable logistic regression demonstrated that chemoradiation was associated with an increased likelihood of a complete or near-complete pathologic response and a decreased rate of lymphovascular invasion and lymph node positivity. Neither chemotherapy regimen nor number of cycles administered were associated with pathologic response. CONCLUSIONS Neoadjuvant chemoradiation may be associated with complete or near-complete pathologic response regardless of chemotherapy regimen in pancreatic cancer patients.
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Affiliation(s)
- Jonathan J Hue
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kavin Sugumar
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - John B Ammori
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jordan M Winter
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey M Hardacre
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Bliggenstorfer J, Ofshteyn A, Bingmer K, Steinhagen E, Stein SL. Young Patients with Advanced Rectal Cancer are Less Likely to Receive Palliative Care. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Ofshteyn A, Bliggenstorfer J, Bingmer K, Lisa Stein S, Brian Ammori J, Steinhagen E. Formal Resident-as-Teacher Programs Lacking in General Surgery Programs. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Bingmer K, Kazimi M, Wang V, Ofshteyn A, Steinhagen E, Stein SL. Population demographics in geographic proximity to hospitals with robotic platforms do not correlate with disparities in access to robotic surgery. Surg Endosc 2020; 35:4834-4839. [PMID: 32959179 DOI: 10.1007/s00464-020-07961-2] [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: 05/13/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Disparities in access to robotic surgery have been shown on the local, regional, and national level. This study aims to see if the location of hospitals with robotic platforms (HWR) correlates with population trends to explain the disparity in access to robotic surgery. METHODS Hospitals with da Vinci surgical systems were identified by compiling data from the publicly available da Vinci surgeon locator website. Demographic, and economic data were compiled. Multivariate logistic regression and place-based analysis were used to determine population characteristics associated with geographic proximity to HWR. RESULTS The United States has 1971 HWR (5.93 hospitals with robots per 1 million people). The states with the most HWR are Texas (203), California (175), and Florida (162). Multivariate logistic regression analysis of Texas counties determined population (OR 1.97, 95% CI 1.40-3.38) education level (OR 1.64, 95% CI 1.07-3.21), and urban designation (OR 1.15, 95% CI 1.05-1.31) remained significantly associated with HWR. When applied to a national level, population remained associated with higher numbers of HWR (R = 0.945), however level of education and urbanization were not. CONCLUSIONS Based on this study of population-level data, disparities in access to robotic surgery seen in prior literature cannot be explained exclusively by sociodemographic factors related to the geographic proximity of HWR. This suggests other biases are involved in the lack of robotic procedures performed among minority and underprivileged populations.
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Affiliation(s)
- Katherine Bingmer
- Department of Surgery, UH-RISES, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, LKS 5047, Cleveland, OH, 44106, USA
| | - Maher Kazimi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Victoria Wang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Asya Ofshteyn
- Department of Surgery, UH-RISES, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, LKS 5047, Cleveland, OH, 44106, USA
| | - Emily Steinhagen
- Department of Surgery, UH-RISES, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, LKS 5047, Cleveland, OH, 44106, USA
| | - Sharon L Stein
- Department of Surgery, UH-RISES, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, LKS 5047, Cleveland, OH, 44106, USA.
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Bingmer K, Ofshteyn A, Bliggenstorfer JT, Kethman W, Ammori JB, Charles R, Stein SL, Steinhagen E. Primary tumor location impacts survival in colorectal cancer patients after resection of liver metastases. J Surg Oncol 2020; 122:745-752. [PMID: 32524637 DOI: 10.1002/jso.26061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/28/2020] [Accepted: 05/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Right-sided colon cancers (R-CC) are associated with worse outcomes compared to left-sided colon cancers (L-CC). We hypothesize that R-CC with synchronous liver metastases who undergo resection of primary and metastatic sites have worse survival and that survival will vary significantly among R-CC, L-CC, and rectal cancer (ReC). METHODS The Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2016 was used to identify colorectal cancer patients with liver metastases who underwent surgical resection of both primary and metastatic disease. Survival was analyzed by multivariate Cox regression. RESULTS A total of 2275 patients were included; 38% R-CC, 46% L-CC, and 16% ReC. R-CC primary tumors tended to be larger than 5 cm, higher grade, and mucinous (all P < .001). Compared to patients with R-CC, both L-CC and ReC had improved overall (HR 0.72; P < .001; HR 0.75, P = .006) and disease-specific (HR 0.71, P < .001; HR 0.73, P = .008) survival. There was no difference in survival between L-CC and ReC. CONCLUSIONS Patients with R-CC have significantly worse survival than L-CC or ReC. This provides additional evidence that R-CC tumors are fundamentally different from L-CC and ReC tumors. Future studies should determine factors responsible for this disparity, and identify targeted treatment based on primary tumor location.
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Affiliation(s)
- Katherine Bingmer
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Asya Ofshteyn
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jonathan T Bliggenstorfer
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - William Kethman
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - John B Ammori
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ronald Charles
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sharon L Stein
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Ofshteyn A, Bingmer K, Dorth J, Dietz D, Steinhagen E, Stein SL. Adding Boost to Standard Neoadjuvant Radiation for Rectal Cancer Improves Likelihood of Complete Response. J Gastrointest Surg 2020; 24:1655-1662. [PMID: 32323253 DOI: 10.1007/s11605-020-04594-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/04/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pathologic tumor response is a prognostic factor for survival in patients with rectal cancer. Standard neoadjuvant radiation (nRT) dosing for locally advanced rectal cancer ranges from 4500 to 5400 centigray (cGy), but it is unknown if tumor regression differs as a consequence adding a boost to the tumor bed. METHODS The National Cancer Database (NCDB) 2006-2016 was used to identify patients 18 years of age and older with clinical stage II and III rectal cancer who received pelvic nRT dosed between 4500 and 5400 cGy. Standard nRT dose (no boost, NB) and dose with boost (DWB) were defined respectively as 4500 and 5040-5400 cGy. Complete pathologic response (pCR) was defined as postoperative pathologic stage of zero. A multivariate logistic regression was performed to evaluate the association between radiation dosing and pCR. RESULTS The study cohort was 28,841 patients; the majority received DWB 22,701 (78.7%), while 6140 (21.3%) received NB. pCR was achieved in 3135 (14.4%) patients. On multivariate analysis, patients who received NB were significantly less likely to have complete tumor response (OR 1.41, 95% CI 1.2-1.66, p < 0.001). Other factors significantly associated with pCR included insurance, facility type, tumor characteristics, clinical stage, and time between radiation and surgery. CONCLUSIONS This is the first investigation demonstrating that standard dose neoadjuvant radiation for rectal cancer was associated with a lower likelihood of pCR compared with standard dose with boost. Past studies demonstrate that rectal cancer patient survival is strongly correlated with pCR. Prospective trials should focus on examining neoadjuvant radiation dosing to evaluate if DWB improves outcomes.
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Affiliation(s)
- Asya Ofshteyn
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Jennifer Dorth
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Dietz
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Sharon L Stein
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, 11100 Euclid Ave, Cleveland, OH, 44106, USA.
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Bingmer K, Ofshteyn A, Bliggenstorfer JT, Steinhagen E, Stein SL. Where is the leak in the surgeon pipeline? Am J Surg 2020; 220:1174-1178. [PMID: 32654766 DOI: 10.1016/j.amjsurg.2020.06.048] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 02/15/2020] [Revised: 04/10/2020] [Accepted: 06/25/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In order to care for an increasingly diverse population, the surgical workforce must improve in gender, racial, and ethnic diversity. We aim to identify deficiencies in the surgical pipeline. METHODS Data from the United States Census, Bureau of Labor Statistics, and Association of American Medical Colleges were collected from 2004 to 2018, and evaluated for changing population over time. RESULTS Women comprise 51% of the population, 32% of surgeons, and representation is increasing at a rate of 0.4% per year. 13% of the population and 6% of surgeons are black, and representation is decreasing at a rate of -0.1% per year. Hispanics represent 18% of the population, 6% of surgeons, and representation is increasing at a rate of 0.04% per year. CONCLUSIONS While the proportion of women and Hispanic surgeons is slowly increasing, the proportion of black surgeons is decreasing. Recruitment methods need to be focused to improve surgical workforce diversity.
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Affiliation(s)
- Katherine Bingmer
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Asya Ofshteyn
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jonathan T Bliggenstorfer
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sharon L Stein
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Bingmer K, Walsh DS, Gantt NL, Sanfey HA, Stein SL. Surgeon Experience with Parental Leave Policies Varies Based on Practice Setting. World J Surg 2020; 44:2144-2161. [DOI: 10.1007/s00268-020-05447-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bingmer K, Kondray V, Ofshteyn A, Bliggenstorfer JT, Dietz DW, Charles R, Stein SL, Paspulati R, Steinhagen E. Sarcopenia is associated with worse overall survival in patients with anal squamous cell cancer. J Surg Oncol 2020; 121:1148-1153. [PMID: 32133665 DOI: 10.1002/jso.25887] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 01/14/2020] [Accepted: 02/24/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Sarcopenia is associated with poor long-term outcomes in many gastrointestinal cancers, but its role in anal squamous cell carcinoma (ASCC) is not defined. We hypothesized that patients with sarcopenic ASCC experience worse long-term outcomes. METHODS A retrospective review of patients with ASCC treated at an academic medical center from 2006 to 2017 was performed. Of 104 patients with ASCC, 64 underwent PET/computed tomography before chemoradiation and were included in the analysis. The skeletal muscle index was calculated as total L3 skeletal muscle divided by height squared. Sarcopenia thresholds were 52.4 cm2 /m2 for men and 38.5 cm2 /m2 for women. Cox regression analysis was performed to assess overall and progression-free survival. RESULTS Twenty-five percent of the patients were sarcopenic (n = 16). Demographics were similar between groups. There was no difference in the clinical stage or comorbidities between groups. On multivariate analysis, factors associated with worse overall survival were male gender (hazard ratio [HR] 3.7, P = .022) and sarcopenia (HR 3.6, P = .019). Male gender was associated with worse progression-free survival (HR 2.6, P = .016). CONCLUSIONS Sarcopenia is associated with worse overall survival in patients with anal cancer. Further studies are indicated to determine if survival can be improved with increased attention to nutritional status in sarcopenic patients.
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Affiliation(s)
- Katherine Bingmer
- Department of Surgery, Research in Surgical Outcomes and Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Victor Kondray
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Asya Ofshteyn
- Department of Surgery, Research in Surgical Outcomes and Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jonathan T Bliggenstorfer
- Department of Surgery, Research in Surgical Outcomes and Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - David W Dietz
- Department of Surgery, Research in Surgical Outcomes and Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Ronald Charles
- Department of Surgery, Research in Surgical Outcomes and Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sharon L Stein
- Department of Surgery, Research in Surgical Outcomes and Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Raj Paspulati
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Emily Steinhagen
- Department of Surgery, Research in Surgical Outcomes and Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Ofshteyn A, Bingmer K, Dorth J, Dietz D, Steinhagen E, Stein SL. Disparities in neoadjuvant radiation dosing for treatment of rectal cancer. Am J Surg 2020; 220:987-992. [PMID: 31959352 DOI: 10.1016/j.amjsurg.2020.01.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Certain patients are less likely to undergo appropriate cancer treatment, worsening their overall cancer survival. The purpose of this investigation was to identify factors associated with inadequate neoadjuvant radiation for rectal cancer. METHODS The National Cancer Database was queried for patients with locally advanced rectal cancer who received neoadjuvant radiation 2006-2014. Adequate radiation was considered to be 4,500-5,040 cGy. Demographic, hospital and clinical variables were analyzed for association with inadequate radiation. RESULTS The study cohort was 34,391 patients; 1,842(5.4%) received inadequate radiation. On multivariate analysis, female gender, older age, other race, government-provided insurance, lower clinical stage and rural location correlated with inadequate radiation. CONCLUSIONS Women were 50% less likely than men to receive correct neoadjuvant radiation dosing. Other factors including age, race, insurance, clinical stage, geographic location and neoadjuvant chemotherapy were significantly associated with radiation dosing. These factors should be evaluated to determine if they can be modified to improve outcomes.
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Affiliation(s)
- Asya Ofshteyn
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jennifer Dorth
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - David Dietz
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sharon L Stein
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
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Abstract
BACKGROUND Recent literature has shown disparities in diagnosis and treatment of anal cancer. Common perception is that many anal cancer patients may experience a delay in diagnosis and this may contribute to poor outcomes. METHODS Patients diagnosed with anal cancer at a single academic institution from 2006 to 2017 were retrospectively reviewed. Patients were stratified according to time from symptom onset to diagnosis and divided into three groups: diagnosed within 6 weeks, between 6 weeks and 6 months, and greater than 6 months. RESULTS A total of 93 patients were included in this study. Twenty-two (23.7%) were diagnosed within 6 weeks, 48 (51.6%) between 6 weeks and 6 months, and 23 (24.7%) were diagnosed more than 6 months after the onset of symptoms. Over half (57%) of all patients were initially diagnosed with a benign condition. Stage did not vary significantly between groups. Patient diagnosed within 6 weeks had the highest rates of completion of chemotherapy (90%), radiation (95%), and complete response to chemoradiation (77%) but these did not reach statistical significance. There was no difference in recurrence, or overall survival between the groups. CONCLUSIONS Over half of anal cancer patients were initially misdiagnosed, and 25% were symptomatic for more than 6 months prior to diagnosis. Those patients diagnosed earlier tended to be more likely to receive complete chemoradiation therapy. We were unable to show a statistical difference in outcomes between groups. Further investigation into provider education and awareness of anal cancer is warranted to improve the care of these patients.
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Affiliation(s)
- Katherine Bingmer
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Asya Ofshteyn
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Sharon L Stein
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Emily Steinhagen
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
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Bingmer K, Wojnarski CM, Brady JT, Stein SL, Ho VP, Steinhagen E. A Model for a Formal Mentorship Program in Surgical Residency. J Surg Res 2019; 243:64-70. [DOI: 10.1016/j.jss.2019.04.068] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/08/2019] [Accepted: 04/25/2019] [Indexed: 11/25/2022]
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Lyons J, Bingmer K, Ammori J, Marks J. Utilization of a Novel Program-Specific Evaluation Tool Results in a Decidedly Different Interview Pool Than Traditional Application Review. J Surg Educ 2019; 76:e110-e117. [PMID: 31668694 DOI: 10.1016/j.jsurg.2019.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 10/04/2019] [Accepted: 10/13/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND There are almost twice as many applicants as there are general surgery internships, each utilizing a common application with standard components. These elements are frequently not useful in determining affinity for a program or overall ability, and resultant poor fit may be partially responsible for program attrition. Alternative evaluation instruments would be beneficial to both programs and applicants. METHODS An application review committee comprised of resident representatives, faculty representing all program-affiliated institutions, and program leadership completed a written evaluation developed by a third party (SurgWise Consulting) that specializes in industrial and organizational psychology. The responses were compiled to create a standardized assessment tool. This assessment was sent to applicants who were subsequently ranked according to fit with our program. The pool of applicants was separately evaluated using our traditional application review. Two residents independently graded each applicant on a 5-point Likert scale to evaluate common application elements; applicants were subsequently assigned an overall score. RESULTS The assessment was completed by 507 (99%) of 512 qualifying applicants. Separately, 378 applications were reviewed by the traditional method for a total of 756 reviews. Of the 96 applicants identified by the assessment tool to invite for interviews, 22 (23%) qualified for interview invitations according to the traditional review method. The assessment produced 74 applicants that otherwise would not have been interviewed. CONCLUSION Traditional application review strategies have many shortcomings. A competency-based assessment tool in the residency application selection process identifies a pool of applicants not identified by traditional review methods.
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Affiliation(s)
- Joshua Lyons
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - John Ammori
- University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Jeffrey Marks
- University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Bingmer K, Walsh DS, Gantt NL, Sanfey HA, Stein SL. Surgeon Experience with Parental Leave Policies Varies Based on Practice Setting. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ofshteyn A, Bingmer K, Steinhagen E, Stein SL. Lack of Response to Neoadjuvant Treatment for Locally Advanced Rectal Cancer Is Associated with Resection Margin Positivity. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bingmer K, Ofshteyn A, Stein SL, Steinhagen E. Hypoalbuminemia Predicts Poor Outcomes in Anal Cancer. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bingmer K, Ofshteyn A, Dietz DW, Stein SL, Steinhagen E. Outcomes in immunosuppressed anal cancer patients. Am J Surg 2019; 219:88-92. [PMID: 31477240 DOI: 10.1016/j.amjsurg.2019.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 06/27/2019] [Revised: 08/07/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Immunosuppressed patients have an increased risk of developing anal cancer, but little data exists regarding outcomes of this population. METHODS A retrospective review of anal cancer patients at a single academic institution from 2006 to 2017 was performed. RESULTS 19 (14%) of 136 anal cancer patients were immunosuppressed. Immunosuppressed patients were more likely to be hypoalbuminemic (21% vs. 6%, p = 0.025), less likely to complete chemotherapy (58% vs. 80%, p = 0.031) or exhibit a complete response to chemoradiation (57% vs. 82%, p = 0.037), and more likely to experience recurrence (53% vs. 25%, p = 0.013). Hypoalbuminemia was significantly associated with worse overall (HR 6.4, CI 2.2-19.2, p < 0.001) and progression-free (HR 4.4, CI 1.8-10.4, p < 0.001) survival. CONCLUSIONS Immunosuppressed patients have poor tolerance of chemotherapy and response to chemoradiation, and an increased rate of recurrence. This finding is possibly due to the relationship between immunosuppression and hypoalbuminemia, which was associated with worse overall and progression-free survival.
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Affiliation(s)
- Katherine Bingmer
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Asya Ofshteyn
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - David W Dietz
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Sharon L Stein
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA.
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Ofshteyn A, Terry M, Bingmer K, Stein SL, Steinhagen E. General surgery resident experience with anorectal surgery. Am J Surg 2019; 219:993-997. [PMID: 31445669 DOI: 10.1016/j.amjsurg.2019.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/29/2019] [Revised: 08/07/2019] [Accepted: 08/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous studies have suggested that general surgery residents graduate with suboptimal anorectal experience. However, competence in anorectal procedures is an important part of general surgery training. METHODS ACGME general surgery resident case logs from 1999 to 2017 were reviewed. Mean number of anorectal procedures were evaluated, comparing Period 1 (1999-2008) and Period 2 (2009-2017). RESULTS Between 1999 and 2017, the mean number of all anorectal procedures performed by each general surgery resident has increased from 25.9 to 32.4 (by 25%). Between Period 1 and 2, mean numbers of total anorectal procedures, abscess drainage, fistula repair, hemorrhoidectomy, prolapse repair, other anorectal procedures all increased (p ≤ 0.01). Mean numbers of sphincterotomy/sphincteroplasty and other procedures for fecal incontinence significantly decreased (p ≤ 0.01). CONCLUSIONS General surgery residents have gained more experience in some anorectal procedures over time. The required number of procedures to establish competence is not well defined and should be formally evaluated.
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Affiliation(s)
- Asya Ofshteyn
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA
| | - Morgan Terry
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA
| | - Katherine Bingmer
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA
| | - Sharon L Stein
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA
| | - Emily Steinhagen
- Department of Surgery, University Hospitals Research in Surgical Outcomes & Effectiveness Center (UH-RISES), University Hospital, Cleveland Medical Center, Cleveland, OH, USA.
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Bingmer K, Ofshteyn A, Stein SL, Marks JM, Steinhagen E. Decline of open surgical experience for general surgery residents. Surg Endosc 2019; 34:967-972. [DOI: 10.1007/s00464-019-06881-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 05/29/2019] [Indexed: 11/24/2022]
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Price RL, Song J, Bingmer K, Kim TH, Yi JY, Nowicki MO, Mo X, Hollon T, Murnan E, Alvarez-Breckenridge C, Fernandez S, Kaur B, Rivera A, Oglesbee M, Cook C, Chiocca EA, Kwon CH. Cytomegalovirus contributes to glioblastoma in the context of tumor suppressor mutations. Cancer Res 2014; 73:3441-50. [PMID: 23729642 DOI: 10.1158/0008-5472.can-12-3846] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To study the controversial role of cytomegalovirus (CMV) in glioblastoma, we assessed the effects of murine CMV (MCMV) perinatal infection in a GFAP-cre; Nf1(loxP/+); Trp53(-/+) genetic mouse model of glioma (Mut3 mice). Early on after infection, MCMV antigen was predominantly localized in CD45+ lymphocytes in the brain with active viral replication and local areas of inflammation, but, by 7 weeks, there was a generalized loss of MCMV in brain, confirmed by bioluminescent imaging. MCMV-infected Mut3 mice exhibited a shorter survival time from their gliomas than control Mut3 mice perinatally infected with mock or with a different neurotropic virus. Animal survival was also significantly shortened when orthotopic gliomas were implanted in mice perinatally infected with MCMV versus controls. MCMV infection increased phosphorylated STAT3 (p-STAT3) levels in neural stem cells (NSC) harvested from Mut3 mice subventricular zone, and, in vivo, there was increased p-STAT3 in NSCs in MCMV-infected compared with control mice. Of relevance, human CMV (HCMV) also increased p-STAT3 and proliferation of patient-derived glioblastoma neurospheres, whereas a STAT3 inhibitor reversed this effect in vitro and in vivo. These findings thus associate CMV infection to a STAT3-dependent modulatory role in glioma formation/progression in the context of tumor suppressor mutations in mice and possibly in humans.
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Affiliation(s)
- Richard L Price
- Department of Neurological Surgery, Dardinger Neuro-oncology Center, Solid Tumor Program at the James Comprehensive Cancer Center, Center for Biostatistics, Departments of Pathology, Veterinary Biosciences, and Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA
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Price RL, Bingmer K, Harkins L, Iwenofu H, Kwon CH, Cook C, Pelloski C, Chiocca EA. Abstract 4777: Cytomegalovirus infection leads to pleomorphic rhabdomyosarcomas in Trp53 +/- mice. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-4777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Abstract
Despite not being considered oncogenic, cytomegalovirus (CMV) has been detected in an increasing number of malignancies. However, recent studies have suggested mechanisms through which CMV may modulate the tumor environment, encouraging its study as a positive modifier of tumorigenesis. In this study, we investigated the effects of CMV infection in Trp53 heterozygous mice. Animals were infected with murine CMV (MCMV) after birth at 2 days (P2) or 4 weeks of age via intraperitoneal injection and then monitored for tumor formation. Additional control cohorts were mock-infected (saline vehicle) or infected with HSV-1, a similar herpes virus. Following MCMV infection, widespread systemic infection ensued followed by immune clearance of the virus resulting in seroconversion. Mice infected at P2 developed tumors at a high frequency (43%) by 9 months of age. In contrast, only 3% of mock-infected or mice infected at 4 weeks developed tumors. The majority of tumors from P2 MCMV-infected mice were pleomorphic rhabdomyosarcomas (RMS) as evidenced by MyoD1, Desmin, and Myogenin staining. Importantly, MCMV-infected tumors contained MCMV DNA, RNA, and protein. An examination of clinical cases revealed that human RMS (embryonal, alveolar, and pleomorphic) harbored human CMV IE1 and pp65 protein as well as viral RNA. All of the cases (n=18) tested positive for CMV genetic material. CMV protein was found throughout the tumor including pleomorphic cells. Additionally, perivascular areas demonstrated intense staining consistent with other reports of linking CMV with angiogenesis. To confirm the selective presence of HCMV DNA in human RMS, quantitative PCR analysis showed that tumors expressed an average of 81.1 copies/ng of HCMV-UL83 and of 22.2 copies/ng of HCMV-UL146 compared to 0 and 0.49 copies/ng in normal muscle, respectively. The amplified products’ nucleotide sequence was greater than 95% identical to that of a clinical strain Taken together, our findings offer support for the hypothesis that CMV contributes to the development of pleomorphic RMS in the context of Trp53 mutation, a situation which occurs with high frequency in human RMS.
Citation Format: Richard L. Price, Katherine Bingmer, Lualhati Harkins, Hans Iwenofu, Chang-Hyuk Kwon, Charles Cook, Christopher Pelloski, E Antonio Chiocca. Cytomegalovirus infection leads to pleomorphic rhabdomyosarcomas in Trp53 +/- mice. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4777. doi:10.1158/1538-7445.AM2013-4777
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Kijima N, Hosen N, Kagawa N, Hashimoto N, Chiba Y, Kinoshita M, Sugiyama H, Yoshimine T, Kim YZ, Kim KH, Lee EH, Hu B, Sim H, Mohan N, Agudelo-Garcia P, Nuovo G, Cole S, Viapiano MS, McFarland BC, Hong SW, Rajbhandari R, Twitty GB, Kenneth Gray G, Yu H, Langford CP, Yancey Gillespie G, Benveniste EN, Nozell SE, Nitta R, Mitra S, Bui T, Li G, Munoz JL, Rodriguez-Cruz V, Rameshwar P, Rodriguez-Cruz V, Munoz JL, Rameshwar P, See WL, Mukherjee J, Shannon KM, Pieper RO, Floyd DH, Xiao A, Purow BW, Lavon I, Zrihan D, Refael M, Bier A, Canello T, Siegal T, Zrihan D, Granit A, Siegal T, Lavon I, Xie Q, Wang X, Gong Y, Mao Y, Chen X, Zhou L, Lee SX, Tunkyi A, Wong ET, Swanson KD, Zhang K, Chen L, Zhang J, Shi Z, Han L, Pu P, Kang C, Cho WH, Ogawa D, Godlewski J, Bronisz A, Antonio Chiocca E, Mustafa DAM, Sieuwerts AM, Smid M, de Weerd V, Martens JW, Foekens JA, Kros JM, Zhang J, McCulloch C, Graff J, Sui Y, Dinn S, Huang Y, Li Q, Fiona G, Ogawa D, Nakashima H, Godlewski J, Antonio Chiocca E, Leiss L, Manini I, Enger PO, Yang C, Iyer R, Yu ACH, Li S, Ikejiri BL, Zhuang Z, Lonser R, Massoud TF, Paulmurugan R, Gambhir SS, Merrill MJ, Sun M, Chen M, Edwards NA, Shively SB, Lonser RR, Baia GS, Caballero OL, Orr BA, Lal A, Ho JS, Cowdrey C, Tihan T, Mawrin C, Riggins GJ, Lu D, Leo C, Wheeler H, McDonald K, Schulte A, Zapf S, Stoupiec M, Kolbe K, Riethdorf S, Westphal M, Lamszus K, Timmer M, Rohn G, Koch A, Goldbrunner R, Edwards NA, Lonser RR, Merrill MJ, Ruggieri R, Vanan I, Dong Z, Sarkaria JN, Tran NL, Berens ME, Symons M, Rowther FB, Dawson T, Ashton K, Darling J, Warr T, Okamoto M, Palanichamy K, Gordon N, Patel D, Walston S, Krishanan T, Chakravarti A, Kalinina J, Carroll A, Wang L, Yu Q, Mancheno DE, Wu S, Liu F, Ahn J, He M, Mao H, Van Meir EG, Debinski W, Gonzales O, Beauchamp A, Gibo DM, Seals DF, Speranza MC, Frattini V, Kapetis D, Pisati F, Eoli M, Pellegatta S, Finocchiaro G, Maherally Z, Smith JR, Pilkington GJ, Zhu W, Wang Q, Clark PA, Yang SS, Lin SH, Kahle KT, Kuo JS, Sun D, Hossain MB, Cortes-Santiago N, Gururaj A, Thomas J, Gabrusiewicz K, Gumin J, Xipell E, Lang F, Fueyo J, Yung WKA, Gomez-Manzano C, Cook NJ, Lawrence JE, Rovin RA, Belton RJ, Winn RJ, Ferluga S, Debinski W, Lee SH, Khwaja FW, Zerrouqi A, Devi NS, Van Meir EG, Drucker KL, Lee HK, Bier A, Finniss S, Cazacu S, Poisson L, Xiang C, Rempel SA, Mikkelsen T, Brodie C, Chen M, Shen J, Edwards NA, Lonser RR, Merrill MJ, Kenchappa RS, Valadez JG, Cooper MK, Carter BD, Forsyth PA, Lee JS, Erdreich-Epstein A, Song HR, Lawn S, Kenchappa R, Forsyth P, Lim KJ, Bar EE, Eberhart CG, Blough M, Alnajjar M, Chesnelong C, Weiss S, Chan J, Cairncross G, Wykosky J, Cavenee W, Furnari F, Brown KE, Keir ST, Sampson JH, Bigner DD, Kwatra MM, Kotipatruni RP, Thotala DK, Jaboin J, Taylor TE, Wykosky J, Schinzel AC, Hahn WC, Cavenee WK, Furnari FB, Kapoor GS, Macyszyn L, Bi Y, Fetting H, Poptani H, Ittyerah R, Davuluri RV, O'Rourke D, Pitter KL, Hosni-Ahmed A, Colevas K, Holland EC, Jones TS, Malhotra A, Potts C, Fernandez-Lopez A, Kenney AM, Cheng S, Feng H, Hu B, Jarzynka MJ, Li Y, Keezer S, Johns TG, Hamilton RL, Vuori K, Nishikawa R, Sarkaria JN, Fenton T, Cheng T, Furnari FB, Cavenee WK, Mikheev AM, Mikheeva SA, Silber JR, Horner PJ, Rostomily R, Henson ES, Brown M, Eisenstat DD, Gibson SB, Price RL, Song J, Bingmer K, Oglesbee M, Cook C, Kwon CH, Antonio Chiocca E, Nguyen TT, Nakashima H, Chiocca EA, Lukiw WJ, Culicchia F, Jones BM, Zhao Y, Bhattacharjee S. LAB-CELL BIOLOGY AND SIGNALING. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Price RL, Bingmer K, Harkins L, Iwenofu OH, Kwon CH, Cook C, Pelloski C, Chiocca EA. Cytomegalovirus infection leads to pleomorphic rhabdomyosarcomas in Trp53+/- mice. Cancer Res 2012; 72:5669-74. [PMID: 23002204 DOI: 10.1158/0008-5472.can-12-2425] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cytomegalovirus (CMV) has been detected in several human cancers, but it has not proven to be oncogenic. However, recent studies have suggested mechanisms through which cytomegalovirus may modulate the tumor environment, encouraging its study as a positive modifier of tumorigenesis. In this study, we investigated the effects of cytomegalovirus infection in Trp53 heterozygous mice. Animals were infected with murine cytomegalovirus (MCMV) after birth at 2 days (P2) or 4 weeks of age and then monitored for tumor formation. Mice injected at 2 days of age developed tumors at a high frequency (43%) by 9 months of age. In contrast, only 3% of mock-infected or mice infected at 4 weeks developed tumors. The majority of tumors from P2 MCMV-infected mice were pleomorphic rhabdomyosarcomas (RMS) harboring MCMV DNA, RNA, and protein. An examination of clinical cases revealed that human RMS (embryonal, alveolar, and pleomorphic) harbored human cytomegalovirus IE1 and pp65 protein as well as viral RNA. Taken together, our findings offer support for the hypothesis that cytomegalovirus contributes to the development of pleomorphic RMS in the context of Trp53 mutation, a situation that occurs with high frequency in human RMS.
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Affiliation(s)
- Richard L Price
- Department of Neurological Surgery, Dardinger Neuro-oncology Center, Solid Tumor Program at the James Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio, USA
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Price RL, Song J, Bingmer K, Yi J, Rivera A, Ogelsbee M, Cook C, Kwon CH, Chiocca EA. Abstract 4815: Cytomegalovirus enhances glioblastoma via PDGF-B/STAT3 pathway activation. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-4815] [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: 11/16/2022]
Abstract
Abstract
Recently several groups have demonstrated cytomegalovirus (CMV) protein and DNA in a large majority of glioblastomas (GBMs), though the exact role of CMV in tumors remains controversial. Although CMV is capable of activating several oncogenic pathways, it has never been shown to be a transforming virus. Because of this, we hypothesize that CMV infection can modify the rate of gliomagenesis in the context of genetic mutations known to predispose to tumor formation. To test this, we used the Smith strain mouse CMV (MCMV) to infect Mut3 (GFAP-cre; Nf1loxP/+; Trp53-/+) mice that develop normally but eventually develop spontaneous gliomas at an adult age After intraperitoneal viral inoculation, mice exhibited multisystemic infection throughout the body, including the brain. Mut3 mice infected perinatally (103 plaque forming units) developed gliomas significantly sooner than mock-infected Mut3 mice. MCMV-infected mice developed GBMs (WHO grade IV) at a higher rate than less severe tumors, whereas, mock-infected mice developed less severe gliomas (WHO grade III). Since MCMV preferentially infected the neural stem cell (NSC) niche, an area shown to generate gliomas, we interrogated changes in signaling in this population via microarray of cultured NSCs in MCMV- versus Mock-infected mice. Ingenuity Pathway Analysis identified a PDGF-B network as the highest scoring differentially regulated network between MCMV-and Mock-infected neurospheres. In vitro infection of mouse tumorspheres and human GBM tumorspheres with CMV validated the observed upregulation of PDGF-B, a molecule shown to cause gliomas de novo. Additionally, in vitro infection of human glioma stem cells with HCMV (Towne strain) or exogenous PDGF-B activated STAT3, a key regulator of gliomas. In mice infected with MCMV, PDGF-B is upregulated in CA2/3 neurons and STAT3 is activated in the subventricular zone and dentate gyrus suggesting a paracrine effect of MCMV-induced PDGF-B. Also, infected human brain tumor stem cells demonstrated an increase in proliferation via flow cytometry. Taken together, our data suggest that CMV in gliomas may accelerate GBM progression by activating PDGF-B/STAT3 signaling in the NSC population.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4815. doi:1538-7445.AM2012-4815
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Affiliation(s)
| | - Jieun Song
- 1The Ohio State University, Columbus, OH
| | | | - JiYeun Yi
- 1The Ohio State University, Columbus, OH
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Keir ST, Reardon DA, Friedman HS, Bigner DD, Lee DY, Kaul A, Pong WW, Gianino SM, White CR, Emnett RJ, Gutmann DH, Robinson JP, VanBrocklin M, Jydstrup-McKinney A, Saxena L, Holmen SL, Price RL, Song J, Bingmer K, Zimmerman P, Rivera A, Oglesbee M, Yi JY, Kaur B, Cook C, Kwon CH, Chiocca EA, Hu Y, Chaturbedi A, Nelson J, Linskey ME, Zhou YH, Sarabia-Estrada R, Molina CA, Jimenez-Estrada I, Gokaslan ZL, Witham TF, Wolinsky JP, Bydon A, Sciubba DM, Luchman A, Stechishin O, Weljie A, Blough M, Kelly J, Nguyen S, Hassam R, Livingstone D, Cseh O, Hoc HD, Cairncross JG, Weiss S, Monje M, Mitra SS, Freret ME, Edwards MS, Weissman IL, Beachy PA, Ozawa T, Charles NA, Huse JT, Helmy K, Squatrito M, Holland EC, Kennedy BC, Sonabend A, Lei L, Guarnieri P, Leung R, Soderquist C, Yun J, Bruce J, Canoll P, Castelli M, Lei L, Sonabend A, Kennedy B, Guarnieri P, Rosenfeld S, Bruce J, Canoll P, Balvers RK, Kloezeman JJ, Heijsman D, Kremer A, French PJ, Dirven CM, Leenstra S, Lamfers ML, Lazovic J, Soto H, Piccioni D, Chou A, Li S, Prins R, Liau L, Cloughesy T, Lai A, Pope W, Johns TG, Day B, Wilding A, Stringer B, Boyd AW, Li P, Mcellin B, Maddie M, Wohlfeld B, Kernie S, Kim R, Maher EA, Bachoo R. TUMOR MODELS (IN VIVO/IN VITRO). Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Joshi K, Gupta S, Mazumder S, Okemoto Y, Angenieux B, Kornblum H, Nakano I, Synowitz M, Kumar J, Petrosino S, Imperatore R, Smith E, Wendt P, Erdmann B, Nuber U, Nuber U, Matiash V, Chirasani S, Cristino L, DiMarzo V, Kettenmann H, Glass R, Soroceanu L, Matlaf L, Cobbs C, Kim YW, Kim SH, Kwon C, Han DY, Kim EH, Chang JH, Liu JL, Kim YH, Kim S, Long PM, Viapiano MS, Jaworski DM, Kanemura Y, Shofuda T, Kanematsu D, Matsumoto Y, Yamamoto A, Nonaka M, Moriuchi S, Nakajima S, Suemizu H, Nakamura M, Okada Y, Okano H, Yamasaki M, Price RL, Song J, Bingmer K, Zimmerman P, Rivera A, Yi JY, Cook C, Chiocca EA, Kwon CH, Kang SG, Shin HD, Mok HS, Park NR, Sim JK, Shin HJ, Park YK, Jeun SS, Hong YK, Lang FF, McKenzie BA, Zemp FJ, Lun X, Narendran A, McFadden G, Kurz E, Forsyth P, Talsma CE, Flack CG, Zhu T, He X, Soules M, Heth JA, Muraszko K, Fan X, Chen L, Guerrero-Cazares H, Noiman L, Smith C, Beltran N, Levchenko A, Quinones-Hinojosa A, Peruzzi P, Godlewski J, Lawler SE, Chiocca EA, Sarkar S, Doring A, Lun X, Wang X, Kelly J, Hader W, Dunn JF, Kinniburgh D, Robbins S, Forsyth P, Cairncross G, Weiss S, Yong VW, Vollmann-Zwerenz A, Velez-Char N, Jachnik B, Ramm P, Leukel P, Bogdahn U, Hau P, Kim SH, Lee MK, Chwae YJ, Yoo BC, Kim KH, Kristoffersen K, Stockhausen MT, Poulsen HS, Kaluzova M, Machaidze R, Wankhede M, Hadjipanayis CG, Romane AM, Sim FJ, Wang S, Chandler-Militello D, Li X, Al Fanek Y, Walter K, Johnson M, Achanta P, Quinones-Hinojosa A, Goldman SA, Shinojima N, Hossain A, Takezaki T, Gumin J, Gao F, Nwajei F, Cheung V, Figueroa J, Lang FF, Pellegatta S, Orzan F, Anghileri E, Guzzetti S, Porrati P, Eoli M, Finocchiaro G, Fu J, Koul D, Wang S, Yao J, Gumin JG, Sulman E, Lang F, Aldape KK, Colman H, Yung AW, Koul D, Fu J, Yao J, Wang S, Gumin J, Sulman E, Lang F, Aldape K, Colman H, Yung AW, Alonso MM, Manterola L, urquiza L, Cortes-Santiago N, Diez-Valle R, Tejada-Solis S, Garcia-foncillas J, Fueyo J, Gomez-Manzano C, Nguyen S, Stechishin O, Luchman A, Weiss S, Lathia JD, Gallagher J, Li M, Myers J, Hjelmeland A, Huang A, Rich J, Bhat K, Vaillant B, Balasubramaniyan V, Ezhilarasan R, Sulman E, Colman H, Aldape K, Lathia JD, Hitomi M, Gallagher J, Gadani S, Li M, Adkins J, Vasanji A, Wu Q, Soeda A, McLendon R, Chenn A, Hjelmeland A, Park D, Rich J, Yao J, Fu J, Koul D, Weinstein JN, Alfred Yung WK, Zagzag D, Esencay M, Klopsis D, Liu M, Narayana A, Parker E, Golfinos J, Clark PA, Kandela IK, Weichert JP, Kuo JS, Fouse SD, Nagarajan RP, Nakamura J, James CD, Chang S, Costello JF, Gong X, Kankar G, Di K, Reeves A, Linskey M, Bota DA, Schmid RS, Bash RE, Vitucci M, Werneke AM, Miller CR, Kim E, Kim M, Kim K, Lee J, Du F, Li P, Wechsler-Reya R, Yang ZJ. STEM CELLS. Neuro Oncol 2011. [DOI: 10.1093/neuonc/nor163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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