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Messaris E. Expert Commentary on Small Bowel Neuroendocrine Tumors. Dis Colon Rectum 2024:00003453-990000000-00646. [PMID: 38772016 DOI: 10.1097/dcr.0000000000003390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2024]
Affiliation(s)
- Evangelos Messaris
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Ore AS, Areán-Sanz R, Liu BS, Arndt KR, Hernandez Alvarez A, Ponce CJ, Bain PA, Messaris E. United States-Based Colorectal Cancer Surgical Trials Lack Representation and Adequate Reporting of Racially and Ethnically Diverse Participants: Systematic Review and Regression Analysis. Dis Colon Rectum 2024; 67:624-633. [PMID: 38276952 DOI: 10.1097/dcr.0000000000003217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
BACKGROUND Despite the established National Institute of Health Revitalization Act, which aims to include ethnic and racial minority representation in surgical trials, racial and ethnic enrollment disparities persist. OBJECTIVE To assess the proportion of patients from minority races and ethnicities that are included in colorectal cancer surgical trials and reporting characteristics. DATA SOURCES Search was performed using MEDLINE (Ovid), Embase, Web of Science, and Cochrane Central. STUDY SELECTION Inclusion criteria included 1) trials performed in the United States between January 1, 2000, and May 30, 2022; 2) patients with colorectal cancer diagnosis; and 3) surgical intervention, technique, or postoperative outcome. Trials evaluating chemotherapy, radiotherapy, or other nonsurgical interventions were excluded. INTERVENTIONS Pooled proportion and regression analysis was performed to identify the proportion of patients by race and ethnicity included in surgical trials and the association of year of publication and funding source. MAIN OUTCOME MEASURES Proportion of trials reporting race and ethnicity and proportion of participants by race and ethnicity included in surgical trials. RESULTS We screened 10,673 unique publications, of which 80 were examined in full text. Fifteen studies met our inclusion criteria. Ten (66.7%) trials did not report race, 3 reported races as a proportion of White participants only, and 3 reported 3 or more races. There was no description of ethnicity in 11 (73.3%) trials, with 2 describing "non-Caucasian" as ethnicity and 2 describing only Hispanic ethnicity. Pooled proportion of White participants was 81.3%, of Black participants was 6.2%, of Asian participants was 3.6%, and of Hispanic participants was 3.5%. LIMITATIONS A small number of studies was identified that reported racial or ethnic characteristics of their participants. CONCLUSIONS Both race and ethnicity are severely underreported in colorectal cancer surgical trials. To improve outcomes and ensure the inclusion of vulnerable populations in innovative technologies and novel treatments, reporting must be closely monitored.
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Affiliation(s)
- Ana Sofia Ore
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rodrigo Areán-Sanz
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Betty S Liu
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Kevin R Arndt
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Angelica Hernandez Alvarez
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Cristina J Ponce
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Whitlock AE, Arndt KR, Zakopoulos I, Wong DJ, Kaul S, Feuerstein J, Crowell KT, Messaris E. Safety and Efficacy of Inpatient Infliximab Rescue Therapy for Acute Crohn's Disease Flares. Am Surg 2024:31348241246160. [PMID: 38597300 DOI: 10.1177/00031348241246160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
PURPOSE Describe the safety, complications, and need for urgent surgery in patients requiring inpatient rescue infliximab for acute Crohn's disease (CD) flare. BACKGROUND Infliximab is increasingly used for patients hospitalized with acute severe ulcerative colitis as rescue therapy; however, optimal management for patients hospitalized for CD flares remains unclear. METHODS A single-institution retrospective study of patients aged 18+ admitted from 2008 to 2020 with acute Crohn's flare requiring induction of rescue infliximab therapy. Outcomes included postoperative and medication-related complications and need for urgent surgery. RESULTS 52 patients were included in analysis; 8% required surgery on index admission, and 19% required surgery within 90 days of infliximab. Postoperative complications included 1 anastomotic leak, 3 superficial wound infections, 3 prolonged ileus, and 1 urinary infection. There were no adverse reactions to infliximab infusion, and medical complication rates were low. Patients with penetrating disease were more likely to undergo surgery within 90 days of infliximab (43% vs 8%; P = .01). Mean LOS was longer for patients undergoing surgery within 90 days of therapy compared to those who did not (13.4 vs 8.3 days, P = .04). CONCLUSION Inpatient rescue infliximab is safe for treating acute Crohn's disease flare in addition to standard steroid therapy. The majority of patients hospitalized with Crohn's flare requiring rescue infliximab avoided surgery with low postoperative and medication-related complications. More research is needed to clarify the optimal rescue infliximab therapy dosage.
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Affiliation(s)
- Ashlyn E Whitlock
- Division of Colorectal Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kevin R Arndt
- Division of Colorectal Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Iordanis Zakopoulos
- Division of Colorectal Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel J Wong
- Division of Colorectal Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sumedh Kaul
- Division of Colorectal Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joseph Feuerstein
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kristen T Crowell
- Division of Colorectal Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Areán-Sanz R, Ore AS, Vigna C, Cataldo G, Lynch AW, Cataldo TE, Messaris E. Role of Age as a Predictor of Major Complications After Elective Surgery for Ulcerative Colitis. Am Surg 2024; 90:887-896. [PMID: 38124317 DOI: 10.1177/00031348231216496] [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: 12/23/2023]
Abstract
BACKGROUND The incidence of ulcerative colitis (UC) in the elderly population is increasing. The aim of this study was to assess the degree to which age and other factors increase the risk of developing major complications in patients undergoing elective surgery for UC. METHODS Using the ACS-NSQIP database from 2016 to 2020, patients undergoing elective surgery for UC were divided into four categories: younger than 30, 30-49, 50-69, and 70 or older. A composite outcome was created including major complications and multivariable analysis was performed to identify factors associated with composite major complications. RESULTS 5946 patients diagnosed with ulcerative colitis who underwent elective surgery were included in the analysis. 14.1% of all patients developed a major complication. For patients with UC, factors associated with the development of a major complication were age 50-69 (OR 1.31, P = .034), male sex (OR 1.38, P < .001), Black race (OR 1.47, P = .049), dependent status (OR 2.06, P = .028), hypoalbuminemia (OR 1.92, P < .001), preoperative steroid treatment (OR 1.27, P = .038), preoperative transfusion (OR 1.91, P < .001), open surgical approach (OR 1.44, P = .002), and partial colectomy (OR 1.51, P = .007). Specifically in patients aged 70 or older, hypoalbuminemia (OR 3.20, P < .001) and preoperative transfusion (OR 2.78, P = .019) were associated with a major complication. CONCLUSION Age is a risk factor for the development of a major complication in UC patients undergoing elective surgery. However, it is not the only risk factor nor is it the one that increases the risk the most.
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Affiliation(s)
- Rodrigo Areán-Sanz
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ana Sofía Ore
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giulio Cataldo
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrew W Lynch
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas E Cataldo
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Whitlock AE, Arndt KR, Allar BG, Fakler MN, Cataldo TE, Crowell KT, Fabrizio AC, Messaris E. Mental health disorders as a risk factor in young patients with rectal prolapse. Langenbecks Arch Surg 2024; 409:72. [PMID: 38393458 DOI: 10.1007/s00423-024-03262-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Rectal prolapse (RP) typically presents in the elderly, though it can present in younger patients lacking traditional risk factors. The current study compares medical and mental health history, presentation, and outcomes for young and older patients with RP. METHODS This is a single-center retrospective review of patients who underwent abdominal repair of RP between 2005 and 2019. Individuals were dichotomized into two groups based on age greater or less than 40 years. RESULTS Of 156 patients, 25 were < 40. Younger patients had higher rates of diagnosed mental health disorders (80% vs 41%, p < 0.001), more likely to take SSRIs (p = .02), SNRIs (p = .021), anxiolytics (p = 0.033), and antipsychotics (p < 0.001). Younger patients had lower preoperative incontinence but higher constipation. Both groups had low rates of recurrence (9.1% vs 11.6%, p = 0.73). CONCLUSIONS Young patients with RP present with higher concomitant mental health diagnoses and represent unique risk factors characterized by chronic straining compared to pelvic floor laxity.
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Affiliation(s)
- Ashlyn E Whitlock
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Kevin R Arndt
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA.
| | - Benjamin G Allar
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Michelle N Fakler
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Thomas E Cataldo
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Kristen T Crowell
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Anne C Fabrizio
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Suite 9B, Boston, MA, 02215, USA
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Ore AS, Ryou M, Messaris E. Sutureless laparoscopic intracorporeal ileocolic anastomosis using self-forming magnets. Tech Coloproctol 2023; 27:1379-1380. [PMID: 37594603 DOI: 10.1007/s10151-023-02854-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023]
Affiliation(s)
- A S Ore
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, MA, USA
| | - M Ryou
- Division of Endoscopic Innovation, Gastroenterology, Brigham and Women's Hospital - Harvard Medical School, Boston, MA, USA
| | - E Messaris
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center - Harvard Medical School, Boston, MA, USA.
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Arndt KR, Dombek GE, Allar BG, Storino A, Fleishman A, Quinn J, Fabrizio A, Cataldo TE, Messaris E. Impact of National Accreditation Program for Rectal Cancer guidelines on surgical margin status. Surg Oncol 2023; 51:101921. [PMID: 36898906 DOI: 10.1016/j.suronc.2023.101921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/13/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND The American College of Surgeons established the National Accreditation Program for Rectal Cancer (NAPRC) to standardize rectal cancer care. We sought to assess the impact of NAPRC guidelines at a tertiary care center on surgical margin status. MATERIALS AND METHODS The Institutional NSQIP database was queried for patients with rectal adenocarcinoma undergoing surgery for curative intent two years prior to and following implementation of NAPRC guidelines. Primary outcome was surgical margin status before (pre-NAPRC) versus after (post-NAPRC) implementation of NAPRC guidelines. RESULTS Surgical pathology in five (5%) pre-NAPRC and seven (8%) post-NAPRC patients had positive radial margins (p = 0.59); distal margins were positive in three (3%) post-NAPRC and six (7%) post-NAPRC patients (p = 0.37). Local recurrence was observed in seven (6%) pre-NAPRC patients, there were no recurrences to date in post-NAPRC patients (p = 0.15). Metastasis was observed in 18 (17%) pre-NAPRC patients and four (4%) post-NAPRC patients (p = 0.55). CONCLUSION NAPRC implementation was not associated with a change in surgical margin status for rectal cancer at our institution. However, the NAPRC guidelines formalize evidence-based rectal cancer care and we anticipate that improvements will be greatest in low-volume hospitals which may not utilize multidisciplinary collaboration.
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Affiliation(s)
- Kevin R Arndt
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
| | - Gabrielle E Dombek
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Benjamin G Allar
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alessandra Storino
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jeanne Quinn
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Anne Fabrizio
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Thomas E Cataldo
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Evangelos Messaris
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Arndt K, Ore AS, Quinn J, Fabrizio A, Crowell K, Messaris E, Cataldo T. Outcomes Following Recent and Distant Neoadjuvant Radiation in Rectal Cancer: An Institutional Retrospective Review and Analysis of NSQIP. Clin Colorectal Cancer 2023; 22:474-484. [PMID: 37863792 DOI: 10.1016/j.clcc.2023.07.006] [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: 05/15/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy (nCRT) is the standard of care in locally advanced rectal cancer (LARC). However, radiation therapy is thought to increase operative difficulty due to induction of fibrosis. Total neoadjuvant therapy (TNT) protocols increase the time between completion of radiation and surgical resection which may lead to increased operative difficulty and complications. METHODS A single institution retrospective review of patients ≥18 years with LARC undergoing nCRT from 2015 to 2022. Patients were dichotomized in 2 cohorts: <90 days from radiation to surgery (recent radiation), and ≥90 days from radiation to surgery (distant radiation). Institutional data was compared to National Surgical Quality Improvement Program (NSQIP) rectal cancer data from 2016 to 2020. Outcomes included intraoperative complications, 30-day morbidity, and oncologic outcomes. RESULTS One hundred forty-six institutional patients included, 120 had recent radiation, 26 had distant radiation. Thirty-day morbidity and intraoperative complications did not differ. There was greater radial margin positivity (7% vs. 24%), fewer lymph nodes harvested (17 ± 5 vs. 15 ± 6), and a lower rate of complete mesorectal dissection (88% vs. 65%,) in distant radiation patients 3059 patients were included in NSQIP analysis, 2029 completed radiation <90 days before surgery and 1030 without radiation 90 days before surgery. Patients without radiation 90 days preoperatively had more radial margin positivity (9.2% vs. 4.6%), organ space infection (8.6% vs. 6.4%), and pneumonia (2.2% vs. 0.9%). CONCLUSION The present study suggests that increased time between radiation and surgery results in more challenging dissection with less complete mesorectal dissection and increased radial margin positivity without increasing technical complications.
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Affiliation(s)
- Kevin Arndt
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Ana Sofia Ore
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Jeanne Quinn
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Anne Fabrizio
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Kristen Crowell
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Thomas Cataldo
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Ore AS, Allar BG, Fabrizio A, Cataldo TE, Messaris E. Trends in the Management of Non-emergent Surgery for Diverticular Disease and the Impact of Practice Parameters. Am Surg 2023; 89:4590-4597. [PMID: 36044675 DOI: 10.1177/00031348221124319] [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: 11/16/2022]
Abstract
BACKGROUND Due to the rise in diverticular disease, the ASCRS developed practice parameters to ensure high-quality patient care. Our study aims to evaluate the impact of the 2014 practice parameters on the treatment of non-emergent left-sided diverticular disease. METHODS This is a retrospective cohort study using the ACS-National Surgical Quality Improvement Project (ACS-NSQIP). Elective sigmoid resections performed by year were evaluated and compared before and after practice parameters were published. RESULTS Overall, 46,950 patients met inclusion criteria. There was a significant decrease in the number of non-emergent operations when evaluating before and after guideline implementation (P < .001). There was a significant decrease in the number of patients younger than 50 years of age operated electively for diverticular disease (25.8% vs. 23.9%, P = .005). Adoption of minimally invasive surgery continued to increase significantly throughout the study period. CONCLUSIONS Publication of the 2014 ASCRS practice parameters is associated with a change in management of diverticular disease in the non-emergent setting.
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Affiliation(s)
- Ana Sofia Ore
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Benjamin G Allar
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas E Cataldo
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colon & Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Ore AS, Vigna C, Arean-Sanz R, Quinn JF, Crowell K, Fabrizio A, Messaris E. Beyond the Expected Postoperative Period: Are We Underdiagnosing Low Anterior Resection Syndrome? J Gastrointest Surg 2023; 27:2586-2588. [PMID: 37468734 DOI: 10.1007/s11605-023-05767-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/20/2023] [Indexed: 07/21/2023]
Affiliation(s)
- Ana Sofia Ore
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Carolina Vigna
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Rodrigo Arean-Sanz
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jeanne F Quinn
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Kristen Crowell
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Anne Fabrizio
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery , Department of Surgery - Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
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Arndt K, Vigna C, Kaul S, Fabrizio A, Cataldo T, Smith M, Messaris E. Magnetic resonance imaging accuracy in staging early and locally advanced rectal cancer. Surg Oncol 2023; 50:101987. [PMID: 37717374 DOI: 10.1016/j.suronc.2023.101987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Magnetic Resonance Imaging (MRI) is the standard pretreatment staging in patients with rectal cancer. Accurate tumor staging is paramount to determining the appropriate treatment course for patients diagnosed with rectal cancer. The current study aims to re-evaluate the accuracy of pre-operative MRI in staging of both early and locally advanced rectal cancer following completion of neoadjuvant therapy (NAT) compared to the pathologic stage. METHODS A retrospective review of patients treated for rectal cancer between 2015 and 2020 at a single academic institution. All patients underwent rectal cancer protocol MRIs before surgical resection. Analysis was carried out in two groups: early rectal cancer: T1/2 N0 tumors with upfront surgical resection (N = 40); and locally advanced disease: T3 or greater or N+ disease receiving NAT, with restaging MRI following NAT (n = 63). RESULTS 103 patients were included in analysis. MRI accuracy in early tumors was 35% ICC = 0.52 (95% CI 0.25-0.71) T stage and 66% ICC = 0 (95% CI -0.24, 0.29) for 29 patients with nodal data for N stage. There was 28% understaging of T2 tumors and 34% understaging of N0 stage by MRI. Post NAT MRI had 44% accuracy ICC = 0.57 (95% CI -0.15-0.20) T stage and 60% accuracy ICC = 0.32 (95% CI 0.08-0.52) N stage. Tumor invasion was overstaged on MRI: 40% T2, 29% T3, 90% T4. Nodal inaccuracy was due to overstaging, 61% N1, 90% N2. CONCLUSIONS In locally advanced rectal cancer MRI overstaged tumors, this could be due to the continued effect of NAT from MRI to resection. This overstaging is of little clinical significance as it doesn't alter the treatment plan, except in cases of complete clinical response. In early rectal cancer, MRI had limited accuracy compared to pathology, understaging a quarter of patients who would benefit from NAT before surgery. Other adjunct imaging modalities should be considered to improve accuracy in staging early rectal cancer and consideration of complete response and enrollment in watch and wait protocols.
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Affiliation(s)
- Kevin Arndt
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Carolina Vigna
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sumedh Kaul
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas Cataldo
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Martin Smith
- Department of Diagnostic Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Lynch A, Arean-Sanz R, Ore AS, Cataldo G, Crowell K, Fabrizio A, Cataldo TE, Messaris E. Impact of neoadjuvant chemotherapy for locally advanced colon cancer on postoperative complications. Langenbecks Arch Surg 2023; 408:365. [PMID: 37726584 DOI: 10.1007/s00423-023-03094-x] [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: 07/23/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Although not considered standard therapy, neoadjuvant chemotherapy (NAC) is an encouraging alternative for selected patients with locally advanced colon cancer (LAC). The aim of this study was to compare 30-day postoperative outcomes between patients undergoing upfront surgery and those undergoing NAC for LAC. METHODS Using the ACS-NSQIP data from 2016 to 2020, 11,498 patients with LAC were divided into those who underwent upfront colectomy (96.2%) and those who received NAC (3.8%). The primary outcome was a composite outcome encompassing 30-day major postoperative complications. Propensity score matched (PSM) analysis and multivariable logistic regression were performed. RESULTS After PSM analysis, there was no statistically significant difference in the development of a major complication. NAC was not significantly associated with the primary outcome. Risk factors for postoperative complications were T4 stage, older age, male sex, black race, smoking, dependent status, severe COPD, hypoalbuminemia, and preoperative transfusion. Laparoscopic and robotic surgery was protective. CONCLUSION NAC did not increase the odds of developing a major complication.
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Affiliation(s)
- Andrew Lynch
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rodrigo Arean-Sanz
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ana Sofia Ore
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giulio Cataldo
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kristen Crowell
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas E Cataldo
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Colon and Rectal Surgery Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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13
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Raje P, Allar BG, Arndt KR, Crowell KT, Messaris E. Early C-reactive protein after colorectal surgery is not predictive of anastomotic leak: a retrospective cohort study. Langenbecks Arch Surg 2023; 408:142. [PMID: 37036567 DOI: 10.1007/s00423-023-02884-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/04/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE Prior studies suggest postoperative C-reactive protein (CRP) trends are sensitive for predicting anastomotic leak (AL) after elective colorectal surgery. However, in the setting of enhanced recovery pathways, multi-day CRP trends may not be feasible. This study aimed to assess the realistic and clinical utility of CRP in prediction of AL. METHODS A retrospective review of patients who underwent elective colectomy or proctectomy from January 2019 to October 2020 at a single institution was performed. Comorbidities, operative characteristics, and perioperative outcomes were recorded. CRP was checked routinely on POD1 and on a clinical basis subsequently. The association between 10-point change in CRP-POD1 and AL was evaluated using multivariable logistic regression. The relationships between CRP-POD3, CRP-POD1, and AL were assessed using exploratory analyses. RESULTS Among 332 patients, 23 (6.9%) developed AL, of which 9 cases (39%) were diagnosed upon readmission. AL was not associated with mortality. Median length of stay was 3 days (IQR 2-5). Median days to AL diagnosis was 7 (IQR 4-15). Adjusting for diverting stoma, steroid use, diagnosis, and open surgery, each 10-point increase in CRP was associated with increased odds of AL (OR 1.12, 95% CI 1.03-1.21, p=0.008). CRP-POD1 had poor discriminant utility for detecting AL (AUC 0.62, 95% CI = 0.494-0.746; p=0.061). CONCLUSION CRP on POD1 is not a reliable method to predict a leak, and trending CRP may not be practical with decreasing lengths of stay in colorectal surgery.
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Affiliation(s)
- Praachi Raje
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA.
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA.
| | - Benjamin G Allar
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Kevin R Arndt
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Kristen T Crowell
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02115, USA
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
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Vogel JD, Fleshner PR, Holubar SD, Poylin VY, Regenbogen SE, Chapman BC, Messaris E, Mutch MG, Hyman NH. High Complication Rate After Early Ileostomy Closure: Early Termination of the Short Versus Long Interval to Loop Ileostomy Reversal After Pouch Surgery Randomized Trial. Dis Colon Rectum 2023; 66:253-261. [PMID: 36627253 DOI: 10.1097/dcr.0000000000002427] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In patients with ulcerative colitis who undergo IPAA, a diverting ileostomy is used to diminish the severity of anastomotic complications. Typically, the ileostomy is closed after an interval of 2 to 4 months. The safety of earlier closure of the ileostomy after pouch surgery is unknown. OBJECTIVE This study aimed to compare postoperative outcomes in patients randomly assigned to early (7-12 days) or late (≥8 weeks) ileostomy closure after ileal pouch construction. DESIGN This was a multicenter, prospective randomized trial. SETTING The study was conducted at colorectal surgical units at select United States hospitals. PATIENTS Adults with ulcerative colitis who underwent 2- or 3-stage proctocolectomy with IPAA were included. MAIN OUTCOME MEASURES The primary outcomes included Comprehensive Complication Index at 30 days after ileostomy closure. The secondary outcomes included complications, severe complications, reoperations, and readmissions within 30 days of ileostomy closure. RESULTS The trial was stopped after interim analysis because of a high rate of complications after early ileostomy closure. Among 36 patients analyzed, 1 patient (3%) had unplanned proctectomy with end-ileostomy. Of the remaining 35 patients, 28 patients (80%) were clinically eligible for early closure and underwent radiologic assessment. There were 3 radiologic failures. Of the 25 remaining patients, 22 patients (88%) were randomly assigned to early closure (n = 10) or late closure (n = 12), and 3 patients were excluded. Median Comprehensive Complication Index was 14.8 (0-54) and 0 (0-23) after early and late closure (p = 0.02). One or more complications occurred in 7 patients (70%) after early closure and in 2 patients (17%) after late closure (p = 0.01)' and complications were severe in 3 patients (30%) after early closure and 0 patients after late closure (p = 0.04). Reoperation was required in 1 patient (10%) and 0 patients (p = 0.26) after early closure and readmission was required in 7 patients (70%) and 1 patient (8%) after late closure (p = 0.003). LIMITATIONS This study was limited by early study closure and selection bias. CONCLUSIONS Early closure of a diverting ileostomy in patients with ulcerative colitis who underwent IPAA is associated with an unacceptably high rate of complications. See Video Abstract at http://links.lww.com/DCR/C68. ALTA TASA DE COMPLICACIONES DESPUS DEL CIERRE PRECOZ DE LA ILEOSTOMA TERMINACIN TEMPRANA DEL ENSAYO ALEATORIZADO DE INTERVALO CORTO VERSUS LARGO PARA LA REVERSIN DE LA ILEOSTOMA EN ASA DESPUS DE LA CIRUGA DE RESERVORIO ILEAL ANTECEDENTES:En los pacientes con colitis ulcerosa que se someten a una anastomosis del reservorio ileoanal, se utiliza una ileostomía de derivación para disminuir la gravedad de las complicaciones de la anastomosis. Por lo general, la ileostomía se cierra después de un intervalo de 2 a 4 meses. Se desconoce la seguridad del cierre más temprano de la ileostomía después de la cirugía de reservorio.OBJETIVO:Comparar los resultados posoperatorios en pacientes asignados al azar al cierre temprano (7-12 días) o tardío (≥ 8 semanas) de la ileostomía después de la construcción de un reservorio ileal.DISEÑO:Este fue un ensayo aleatorizado prospectivo multicéntrico.ESCENARIO:El estudio se realizó en unidades quirúrgicas colorrectales en hospitales seleccionados de los Estados Unidos.PACIENTES:Se incluyeron adultos con colitis ulcerosa que se sometieron a proctocolectomía en 2 o 3 tiempos con anastomosis ileoanal con reservorio.PRINCIPALES MEDIDAS DE RESULTADO:Los resultados primarios incluyeron el Índice Integral de Complicaciones a los 30 días después del cierre de la ileostomía. Los resultados secundarios incluyeron complicaciones, complicaciones graves, reoperaciones y readmisiones dentro de los 30 días posteriores al cierre de la ileostomía.RESULTADOS:El ensayo se detuvo después del análisis interino debido a una alta tasa de complicaciones después del cierre temprano de la ileostomía. Entre los 36 pacientes analizados, 1 (3%) tuvo una proctectomía no planificada con ileostomía terminal. De los 35 pacientes restantes, 28 (80%) fueron clínicamente elegibles para el cierre temprano y se sometieron a una evaluación radiológica. Hubo 3 fracasos radiológicos. De los 25 pacientes restantes, 22 (88 %) se asignaron al azar a cierre temprano (n = 10) o tardío (n = 12) y 3 fueron excluidos. La mediana del Índice Integral de Complicaciones fue de 14,8 (0-54) y 0 (0-23) después del cierre temprano y tardío (p = 0,02). Una o más complicaciones ocurrieron en 7 pacientes (70%) después del cierre temprano y 2 (17%) pacientes después del cierre tardío (p = 0,01) y fueron graves en 3 (30%) y 0 pacientes, respectivamente (p = 0,04). Requirieron reintervención en 1 (10%) y 0 (p = 0,26) y reingreso en 7 (70%) y 1 (8%) pacientes (p = 0,003).LIMITACIONES:Este estudio estuvo limitado por el cierre temprano del estudio; sesgo de selección.CONCLUSIONES:El cierre temprano de una ileostomía de derivación en pacientes con colitis ulcerosa con anastomosis de reservorio ileoanal se asocia con una tasa inaceptablemente alta de complicaciones. Consulte Video Resumen en http://links.lww.com/DCR/C68. (Traducción-Dr. Felipe Bellolio).
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Affiliation(s)
- Jon D Vogel
- Department of Surgery, University of Colorado, Aurora, Colorado
| | - Phillip R Fleshner
- Cedars-Sinai Medical Center, Colorectal Surgery Program, Los Angeles, California
| | - Stefan D Holubar
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Vitaliy Y Poylin
- Department of Surgery, Northwestern University, Chicago, Illinois
| | | | | | - Evangelos Messaris
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Matthew G Mutch
- Washington University, Department of Surgery, St. Louis, Michigan
| | - Neil H Hyman
- University of Chicago, Department of Surgery, Chicago, Illinois
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15
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Ore AS, Vigna C, Fabrizio A, Cataldo TE, Messaris E, Crowell K. Are IBD Patients Underscored when Determining Postoperative VTE Risk? J Gastrointest Surg 2023; 27:347-353. [PMID: 36394799 DOI: 10.1007/s11605-022-05525-4] [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: 08/02/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients with inflammatory bowel disease (IBD) have an increased risk of venous thromboembolism (VTE) following colorectal surgery and there is currently no consensus on post-surgical VTE prevention or specific VTE risk assessment tools. We sought to evaluate VTE risk after colorectal surgery and determine if known risk factors used in risk assessment tools adequate correlate with VTE risk in IBD patients. METHODS Retrospective cohort study using the National Surgical Quality Improvement Project (NSQIP) Participant User File from 2010 to 2018. RESULTS A total of 27,679 patients were included; 19,015 (68.7%) had Crohn's disease (CD) and 8664 (31.3%) ulcerative colitis (UC). Of these, 16,749 (60.5%) underwent abdominopelvic procedures, 10,178 (36.8%) complex pelvic procedures, and 752 (2.7%) small bowel operations. The overall VTE rate was 2.3%. The VTE rate in patients with CD and UC was 1.8% and 3.6% (p < 0.001) respectively. Overall median time to VTE was 9 days after surgery. VTE rate was highest in patients who underwent complex pelvic procedures (3.6%; 361/10,178). A risk score was calculated using 16/40 available variables from the Caprini VTE Risk Assessment tool; risk score ranged from 3 to 12 points. Most patients that developed a VTE had a score between 3 and 5 points (75.6%), and only 24.5% had a score of 6 or higher. Patients with higher risk scores did not have a higher VTE incidence. CONCLUSION Post-surgical VTE rates are high in IBD patients. Over half of the events occurred following discharge and in patients with an apparent low-risk score. Additional studies are warranted to define a recommended postoperative VTE prophylaxis regimen for patients with IBD.
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Affiliation(s)
- Ana Sofia Ore
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Anne Fabrizio
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Thomas E Cataldo
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Kristen Crowell
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
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Allar BG, Mahmood R, Ortega G, Joseph T, Libaridian LN, Messaris E, Sheth K, Rayala HJ. Colorectal cancer screening in a safety-net health system: The intersectional impact of race, ethnicity, language, and mental health. Prev Med 2023; 166:107389. [PMID: 36529404 DOI: 10.1016/j.ypmed.2022.107389] [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: 05/12/2022] [Revised: 10/22/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022]
Abstract
Though rates of colorectal cancer (CRC) screening continue to improve with increased advocacy and awareness, there are numerous disparities that continue to be defined within different health systems and populations. We aimed to define associations between patients' socio-demographic characteristics and CRC screening in a well-resourced safety-net health system. A retrospective review was performed from 2018 to 2019 of patients between 50 and 75-years-old who had a primary care visit within the last two years. Numerous patient characteristics were extracted from the medical record, including self-reported race, self-reported ethnicity, insurance, preferred language, severe mental health diagnoses (SMHD), and substance use disorder (SUD). Multivariate logistic regression assessed characteristics associated with CRC screening. Of 22,145 included patients, 16,065 (72.5%) underwent CRC screening. <40% of the population was White or of North American/European ethnicity and 38% had limited English proficiency. Hispanic patients had the highest screening rate while White patients had the lowest among races (78.1% vs 68.5%, respectively). White patients had higher rates of SMHD and SUD (p < 0.001). In multivariable analysis, most other races (Black, Asian, and Hispanic), ethnicities, and languages had significantly higher odds of screening, ranging from 20% to 55% higher, when White, North American/European, English-speakers are used as reference. In a well-resourced safety-net health system, patients who were non-White, non-North American/European, and non-English-speaking, had higher odds of CRC screening. This data from a unique health system may better guide screening outreach and implementation strategies in historically under-resourced communities, leading to strategies for equitable colorectal cancer screening.
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Affiliation(s)
- Benjamin G Allar
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America; Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Rumel Mahmood
- Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States of America
| | - Gezzer Ortega
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Taïsha Joseph
- Center for Cancer Research, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Lorky N Libaridian
- Department of Internal Medicine, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States of America
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Ketan Sheth
- Department of Surgery, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, United States of America
| | - Heidi J Rayala
- Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America.
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17
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Gaytan-Fuentes IA, Ore AS, Vigna C, Cordova-Cassia CA, Crowell KT, Fabrizio AC, Cataldo TE, Messaris E. Perioperative use of NSAIDs and the risk of short-term endoscopic recurrence in Crohn's disease patients: A retrospective cohort study. Am J Surg 2022; 225:1045-1049. [PMID: 36509584 DOI: 10.1016/j.amjsurg.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND More evidence is needed on the use of NSAID based postoperative pain regimens for Crohn's disease (CD) and its association with recurrence. Our goal is to assess the impact of perioperative use of NSAIDs on endoscopic disease recurrence in patients with CD. METHODS A retrospective cohort study was conducted. The primary outcome measured was endoscopic disease recurrence within 24 months of surgery, defined as a Rutgeerts score ≥ i2. RESULTS We identified 107 patients with CD that underwent index ileocolectomy with primary anastomosis between January 2009 and July 2019. Endoscopic disease recurrence was identified in 28 (26.2%) and clinical recurrence in 18 (16.8%) patients. Exposure to NSAIDs did not increase 24-month endoscopic recurrence risk (22.2% vs. 38.5% patients, p = 0.12). CONCLUSION In patients with CD undergoing elective ileocolic resection and primary ileocolic anastomosis, NSAID use in the perioperative period did not impact endoscopic or clinical disease recurrence rate.
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Affiliation(s)
- Israel A Gaytan-Fuentes
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Ana Sofia Ore
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
| | - Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Carlos A Cordova-Cassia
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kristen T Crowell
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Anne C Fabrizio
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Thomas E Cataldo
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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Dombek GE, Ore AS, Cheng J, Matsumoto Y, Glickman JN, Fleishman A, Heimburg-Molinaro J, Poylin VY, Fabrizio A, Cataldo T, Messaris E, Cummings RD. Immunohistochemical analysis of Tn antigen expression in colorectal adenocarcinoma and precursor lesions. BMC Cancer 2022; 22:1281. [PMID: 36476111 PMCID: PMC9730631 DOI: 10.1186/s12885-022-10376-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Tn antigen (CD175) is an O-glycan expressed in various types of human adenocarcinomas, including colorectal cancer (CRC), though prior studies have relied heavily upon poorly characterized in-house generated antibodies and lectins. In this study, we explored Tn expression in CRC using ReBaGs6, a well-characterized recombinant murine antibody with high specificity for clustered Tn antigen. METHODS Using well-defined monoclonal antibodies, expression patterns of Tn and sialylated Tn (STn) antigens were characterized by immunostaining in CRC, in matched peritumoral [transitional margin (TM)] mucosa, and in normal colonic mucosa distant from the tumor, as well as in adenomas. Vicia villosa agglutinin lectin was used to detect terminal GalNAc expression. Histo-scoring (H scoring) of staining was carried out, and pairwise comparisons of staining levels between tissue types were performed using paired samples Wilcoxon rank sum tests, with statistical significance set at 0.05. RESULTS While minimal intracellular Tn staining was seen in normal mucosa, significantly higher expression was observed in both TM mucosa (p < 0.001) and adenocarcinoma (p < 0.001). This pattern was reflected to a lesser degree by STn expression in these tissue types. Interestingly, TM mucosa demonstrates a Tn expression level even higher than that of the adenocarcinoma itself (p = 0.019). Colorectal adenomas demonstrated greater Tn and STn expression relative to normal mucosa (p < 0.001 and p = 0.012, respectively). CONCLUSIONS In summary, CRC is characterized by alterations in Tn/STn antigen expression in neoplastic epithelium as well as peritumoral benign mucosa. Tn/STn antigens are seldom expressed in normal mucosa. This suggests that TM mucosa, in addition to CRC itself, represents a source of glycoproteins rich in Tn that may offer future biomarker targets.
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Affiliation(s)
- Gabrielle E Dombek
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, CLS 11090, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Ana Sofia Ore
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, CLS 11090, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Jane Cheng
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, CLS 11090, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Yasuyuki Matsumoto
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, CLS 11090, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Jonathan N Glickman
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, E106, Boston, MA, 02115, USA
| | - Aaron Fleishman
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Deaconess 207, Boston, MA, 02115, USA
| | - Jamie Heimburg-Molinaro
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, CLS 11090, 3 Blackfan Circle, Boston, MA, 02115, USA
| | - Vitaliy Y Poylin
- Department of Surgery, Northwestern Medical Group, Feinberg School of Medicine, Arkes Family Pavilion, 676 North St Clair Street, Suite 650, Chicago, IL, 60611, USA
| | - Anne Fabrizio
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Gryzmish 6, Boston, MA, 02215, USA
| | - Thomas Cataldo
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Gryzmish 6, Boston, MA, 02215, USA
| | - Evangelos Messaris
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Gryzmish 6, Boston, MA, 02215, USA
| | - Richard D Cummings
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, CLS 11087, 3 Blackfan Circle, Boston, MA, 02115, USA.
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19
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Ore AS, Vigna C, Fabrizio A, Messaris E. Evaluation of Racial/Ethnic Disparities in the Surgical Management of Inflammatory Bowel Disease. J Gastrointest Surg 2022; 26:2559-2568. [PMID: 36253503 DOI: 10.1007/s11605-022-05483-x] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/25/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Disparities in managing inflammatory bowel disease (IBD) are multifactorial and occur at all stages of treatment, including surgical management. We aim to evaluate postoperative morbidity after abdominopelvic surgery among different racial/ethnic groups after surgical management of CD and UC and account for preoperative characteristics that may impact outcomes. METHODS Patients were identified using the National Surgical Quality Improvement Project (NSQIP) file and merged with the targeted proctectomy (2016-2019) and colectomy file (2012-2019). All patients undergoing elective surgical management for ICD9/10 codes for CD and UC were included. The primary outcome was composite postoperative morbidity (CPM), a metric that identifies postoperative morbidity with available variables. Multivariable logistic regression modeling was performed to test the association between race/ethnicity and other risk factors with CPM. Postoperative outcomes were evaluated using propensity score modeling with 1:1 matching without replacement as a secondary analysis. RESULTS In both CD and UC, CPM was highest for Black patients with 27.5% (326) and 26.1% (81), respectively. Followed by Hispanic patients with a CPM of 21.1% (73) after surgery for CD (p < 0.001) and 21.2% (31) for Asian patients after resection for UC (p = 0.005). After regression modeling, we found increased odds of CPM for Black patients after surgery for UC (OR 1.48, p = 0.013) and CD (OR 1.17, p < 0.001). Following propensity score matching (PSM), stoma creation rates were higher in Asian (10.4%, p = 0.010) and Hispanic patients (11.9%, p = 0.030) undergoing surgery for CD. CONCLUSIONS Black patients are at increased risk of morbidity after surgery for both UC and CD. Increased morbidity in an already vulnerable population warrants targeted interventions, specifically focusing on faster access to specialized care, preoperative optimization, and culturally competent discussions on the benefits of MIS approaches are warranted in order to improve postoperative outcomes.
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Affiliation(s)
- Ana Sofia Ore
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA
| | - Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA
| | - Anne Fabrizio
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, USA.
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20
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Storino A, Vigna C, Polanco-Santana JC, Park E, Crowell K, Fabrizio A, Cataldo TE, Messaris E. Disparities in industry funding among Colorectal Surgeons: a cross-sectional study. Surg Endosc 2022; 36:6592-6600. [PMID: 35103858 DOI: 10.1007/s00464-022-09062-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health Industry and physician collaboration generates innovation. Colorectal Surgeon (CRS) selection to collaborate might not be random. We aim to identify CRS personal and professional characteristics that facilitate collaboration with the Industry. METHOD Cross-sectional study of Industry payments to CRS (2014-2018) using Open Payments Database from Centers for Medicare & Medicaid Services. Multivariable regression compared variables predicting payment amount including gender, years in practice, leadership positions, H-index, Twitter presence and geographic location. RESULTS Surgeons who were male received 3.1 times the amount in Industry payments as compared to females (p = 0.014). Chairs and Division Chiefs received 2.7 times the amount in payments as compared to those without these leadership positions (p = 0.003). Surgeons with an H-index ≥ 8 received 2.2 times the amount in payments as compared to those with H-index < 8 (p = 0.001). Surgeons in practice for 12-19 and 20-30 years received 3 times and 4.4 times the amount in payments as compared to surgeons in practice for 1-11 years (p = 0.036 and p = 0.017, respectively). Surgeons in the South received 3.2 times and 2 times the amount in payments as compared to surgeons in the Northeast (p < 0.0005) and in the Midwest (p = 0.006). Surgeons with Twitter accounts received 1.7 times the amount in payments as compared to surgeons without Twitter (p = 0.036). Among Twitter users, those with 321-17,200 followers received 4.7 times and 9.5 times the amount in payments as compared to those with 0-15 and 16-79 followers, respectively (p = 0.008 and p = 0.009). CONCLUSION Industry payments are more commonly addressed to male, senior surgeons in leadership tracks with strong social media outreach. With the increasing gender and racial variety in the CRS field, it is expected that collaborations between industry and surgeons will become more diverse and inclusive.
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Affiliation(s)
- Alessandra Storino
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Carolina Vigna
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - John C Polanco-Santana
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Ernest Park
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Kristen Crowell
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Anne Fabrizio
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Thomas E Cataldo
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215-5400, USA.
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21
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Allar BG, Messaris E, Poylin VY, Schlechter BL, Cataldo TE. Oncotype DX testing does not affect clinical practice in stage IIa colon cancer. Med Oncol 2022; 39:59. [PMID: 35150339 DOI: 10.1007/s12032-022-01660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 01/18/2022] [Indexed: 11/24/2022]
Abstract
Although studies have demonstrated the 12-gene Oncotype DX Colon Recurrence Score's (RS) validity in predicting recurrence and influence on physician-patient decision-making, its discriminatory power and inability to predict response to treatment make its clinical impact uncertain. We sought to evaluate the influence of RS in the decision to offer adjuvant chemotherapy after resection of stage IIa colon cancer. A review of patients with stage IIa colon cancer who obtained the RS at a tertiary academic medical center was conducted. The main study outcome was decision to start adjuvant chemotherapy. The association between RS and the decision to obtain adjuvant chemotherapy was evaluated utilizing the Wilcoxon rank-sum test and area under the receiver operating characteristic curve. 52 of 105 patients with stage IIa colon cancer underwent RS testing. Overall, seven of 52 patients (13%) received adjuvant chemotherapy. 34 (65%) patients obtained the RS test despite having multiple other recurrence risk factors. There were no significant associations between any patient/tumor characteristic and RS score (all p > 0.08) or starting adjuvant chemotherapy (all p > 0.15). On multivariable analysis, there was no significant effect of RS on the odds of undergoing chemotherapy (OR 1.07, 95% CI 0.98-1.19; p = 0.14). There was no clear association between RS and starting adjuvant chemotherapy (AUC 0.64, 95% CI 0.36-0.91; p = 0.25). RS was not associated with the decision to start adjuvant chemotherapy. Given its lack of association with clinical decision-making and inability to predict clinical outcome, our data suggest the RS should not be obtained in patients with stage IIa colon cancer.
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Affiliation(s)
- Benjamin G Allar
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA
| | - Vitaliy Y Poylin
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.,Division of Gastrointestinal Surgery, Northwestern Medicine, Feinberg School of Medicine, Chicago, IL, USA
| | - Benjamin L Schlechter
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Gastrointestinal Cancer Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Thomas E Cataldo
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
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22
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Vigna C, Arndt K, Dressler J, Loehner D, Messaris E. Single Center Experience with Umbilical Stomas Following Colorectal Surgery. J Laparoendosc Adv Surg Tech A 2022; 32:432-437. [PMID: 35119309 DOI: 10.1089/lap.2021.0809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The umbilicus is commonly used as an access site to perform minimally invasive colorectal surgery. Umbilical stomas are becoming an attractive option as an alternative site for temporary stomas since they reduce the need for additional abdominal incisions. Methods: We retrospectively evaluated patients who underwent umbilical stoma creation after colorectal resection for diagnosis of rectal cancer, diverticulitis, or ulcerative colitis between January 2020 and July 2021. Surgical technique, clinical and perioperative outcomes, complications, and cosmetic end results were described. Results: A total of 11 patients underwent umbilical stoma creation. There were no major surgical complications. Peristomal skin irritation was secondary to difficulties with the management of the pouching system. One patient presented with ostomy prolapse. Three patients experienced incisional hernia after stoma reversal. There were no wound infections. Conclusion: Umbilical stomas appear to be a safe alternative to conventional stomas and provide superior cosmetic outcomes.
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Affiliation(s)
- Carolina Vigna
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Kevin Arndt
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeremy Dressler
- Division of Colorectal Surgery, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Donna Loehner
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Ore Carranza AS, Vigna C, Messaris E, Crowell K. Validity of Caprini Score in Postoperative Venous Thromboembolism in Inflammatory Bowel Disease. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.113] [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: 10/20/2022]
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24
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Storino A, Wong D, Ore AS, Gaytan-Fuentes IA, Fabrizio A, Cataldo T, Messaris E. Recurrence and Survival of Neuroendocrine Neoplasms of the Rectum: Single-Center Experience. J Gastrointest Surg 2021; 25:2398-2400. [PMID: 33269457 DOI: 10.1007/s11605-020-04854-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND In 2010, the World Health Organization proposed that rectal neuroendocrine neoplasms (NENs) be considered malignant. We hypothesized that patients with small, low-grade, locally excised tumors have a low risk of recurrence and death. METHODS Retrospective review of institutional database 2006-2017 including consecutive adults with newly diagnosed rectum NENs. Outcome measures included risk of recurrence and 5-year overall survival. RESULTS A total of 122 patients were diagnosed with rectal NENs. Most patients were asymptomatic and diagnosed during screening colonoscopy (80, 66.1%), had small tumors (median 0.6 cm, IQR 0.5-1) with intact muscularis propria on EUS (62/65, 95.4%), and were low grade (2017 WHO grades 1-2, n = 116, 95.1%). Lymph node and distant metastasis were found in 4 (3.3%) and 4 (3.3%) of patients, respectively. Patients were treated with local excision in 93.4% of cases with polypectomy (52, 42.6%), endoscopic mucosal resection (48, 39.3%), and transanal excision (14, 11.5%). Three patients (2.5%) required abdominoperineal resection or low anterior resection, and five patients (4.1%) received adjuvant chemotherapy. Of 87 patients surveilled, 4 (4.6%) recurred at a median time of 1 year (IQR 0.6-8). Death from neuroendocrine neoplasms occurred in 5 (4.1%) patients, all with lymph node (1/4) or metastatic disease (4/5) on presentation. Median time to death from NEN was 0.8 years (0.7-2.4). Overall 5-year survival for patients with localized disease was 98.2% (95% CI 93-99.5, Fig. 1). CONCLUSION Patients with small, low grade rectal NENs treated with local excision have excellent oncologic outcomes.
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Affiliation(s)
- Alessandra Storino
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. .,Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Gryzmish Building, 6th Floor, Boston,, MA, 02215, USA.
| | - Daniel Wong
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Ana Sofia Ore
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Israel A Gaytan-Fuentes
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Anne Fabrizio
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Thomas Cataldo
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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Kulaylat AN, Kulaylat AS, Schaefer EW, Mirkin K, Tinsley A, Williams E, Koltun WA, Hollenbeak CS, Messaris E. The Impact of Preoperative Anti-TNFα Therapy on Postoperative Outcomes Following Ileocolectomy in Crohn's Disease. J Gastrointest Surg 2021; 25:467-474. [PMID: 31965440 DOI: 10.1007/s11605-019-04334-6] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/16/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Controversy remains regarding the impact of anti-TNFα agents on postoperative outcomes in Crohn's disease. METHODS Patients (≥ 18 years) with Crohn's disease (ICD-9, 555.0-555.2, 555.9) undergoing ileocolectomy between 2005 and 2013 were identified using the Truven MarketScan® database and stratified by receipt of anti-TNFα therapy. Multivariable logistic regression was performed to evaluate anti-TNFα use on emergency department (ED) visits, postoperative complications, and readmissions at 30 days, adjusting for potential confounders. Relationships between timing of anti-TNFα administration and outcomes were examined. RESULTS The sample contained 2364 patients with Crohn's disease undergoing ileocolectomy, with 28.5% (n = 674) who received biologic therapy. Median duration between anti-TNFα therapy and surgery was 33 days. Postoperative ED visits and readmission rates did not significantly differ among those receiving biologics and those that did not. Overall 30-day complication rates were higher among those receiving biologic therapy, namely related to wound and infectious complications. In multivariable analysis, anti-TNFα inhibitors were associated with increased odds of postoperative complications at 30 days (aggregate complications [OR 1.6], infectious complications [OR 1.5]). There was no significant association between timing of anti-TNFα administration and occurrence of postoperative outcomes. CONCLUSION Anti-TNFα therapy is independently associated with increased postoperative infectious complications following ileocolectomy in Crohn's disease. However, in patients receiving anti-TNFα therapy within 90 days of operative intervention, further delaying surgery may not attenuate risk of postoperative complications.
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Affiliation(s)
- Afif N Kulaylat
- Department of Surgery, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Audrey S Kulaylat
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Eric W Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Katelin Mirkin
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Andrew Tinsley
- Department of Medicine, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Emmanuelle Williams
- Department of Medicine, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Walter A Koltun
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Christopher S Hollenbeak
- Department of Health Policy and Administration, College of Health and Human Development, The Pennsylvania State University, State College, PA, USA
| | - Evangelos Messaris
- Department of Surgery, Harvard Medical School Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
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26
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Affiliation(s)
- Benjamin G Allar
- Division of Colon and Rectal Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Fakler M, James Wong D, Marie Sokas C, Sofia Ore A, Fleishman A, Fabrizio AC, Cataldo TE, Messaris E. Elderly, Functionally Dependent Patients Undergoing Laparoscopic Rectopexy for Rectal Prolapse Do Not Have Increased Morbidity Relative to Patients Undergoing Perineal Repairs. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.07.086] [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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Morrell DJ, McKenna KJ, Messaris E, Pauli EM. Endoscopic management of recurrent anastomotic leak following chemotherapy after colorectal surgery - a video vignette. Colorectal Dis 2020; 22:1451-1452. [PMID: 32281713 DOI: 10.1111/codi.15072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/25/2020] [Indexed: 02/08/2023]
Affiliation(s)
- D J Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - K J McKenna
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - E Messaris
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - E M Pauli
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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James Wong D, Marie Sokas C, Fakler M, Fleishman A, Cataldo TE, Fabrizio AC, Feuerstein JD, Messaris E. Increased Morbidity for the Elderly in IBD Surgery is Context Dependent. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.259] [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: 11/24/2022]
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Luo WY, Holubar SD, Bordeianou L, Cosman BC, Hyke R, Lee EC, Messaris E, Saraidaridis J, Scow JS, Shaffer VO, Smith R, Steinhagen RM, Vaida F, Eisenstein S. Better characterization of operation for ulcerative colitis through the National surgical quality improvement program: A 2-year audit of NSQIP-IBD. Am J Surg 2020; 221:174-182. [PMID: 32928540 DOI: 10.1016/j.amjsurg.2020.05.035] [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: 04/04/2020] [Revised: 05/04/2020] [Accepted: 05/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is little consensus of quality measurements for restorative proctocolectomy with ileal pouch-anal anastomosis(RPC-IPAA) performed for ulcerative colitis(UC). The National Surgical Quality Improvement Program(NSQIP) cannot accurately classify RPC-IPAA staged approaches. We formed an IBD-surgery registry that added IBD-specific variables to NSQIP to study these staged approaches in greater detail. METHODS We queried our validated database of IBD surgeries across 11 sites in the US from March 2017 to March 2019, containing general NSQIP and IBD-specific perioperative variables. We classified cases into delayed versus immediate pouch construction and looked for independent predictors of pouch delay and postoperative Clavien-Dindo complication severity. RESULTS 430 patients received index surgery or completed pouches. Among completed pouches, 46(28%) and 118(72%) were immediate and delayed pouches, respectively. Significant predictors for delayed pouch surgery included higher UC surgery volume(p = 0.01) and absence of colonic dysplasia(p = 0.04). Delayed pouch formation did not significantly predict complication severity. CONCLUSIONS Our data allows improved classification of complex operations. Curating disease-specific variables allows for better analysis of predictors of delayed versus immediate pouch construction and postoperative complication severity. SHORT SUMMARY We applied our previously validated novel NSIP-IBD database for classifying complex, multi-stage surgical approaches for UC to a degree that was not possible prior to our collaborative effort. From this, we describe predictive factors for delayed pouch formation in UC RPC-IPAA with the largest multicenter effort to date.
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Affiliation(s)
- William Y Luo
- University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Stefan D Holubar
- Department of Colon & Rectal Surgery, Cleveland Clinic, 9500 Euclid Avenue A30, Cleveland, OH, 44195, USA.
| | - Liliana Bordeianou
- Colorectal Surgery Program, Massachusetts General Hospital, 15 Parkman Street, Boston, MA, 02114-3117, USA.
| | - Bard C Cosman
- University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA; Department of Surgery, Veteran Affairs San Diego Healthcare System, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA.
| | - Roxanne Hyke
- Stanford Health Care, 500 Pasteur Dr, Palo Alto, CA, 94304, USA.
| | - Edward C Lee
- Division of General Surgery, Albany Medical Center, 50 New Scotland Avenue MC-193, 5th Floor, Albany, NY, 12208, USA.
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Shapiro Building, 3rd Floor, Boston, MA, 02215-5400, USA.
| | - Julia Saraidaridis
- Department of Colon and Rectal Surgery, Lahey Hospital and Medical Center, 41 Mall Road Burlington, MA, 01805, USA.
| | - Jeffrey S Scow
- Department of Surgery, Penn State Health, 200 Campus Dr, Suite 3100
- Entrance 4, Hershey, PA, 17033, USA.
| | - Virginia O Shaffer
- Department of Surgery, Emory University School of Medicine, Room B206, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA.
| | - Radhika Smith
- Department of Surgery, Washington University School of Medicine in St. Louis, 5201 Midamerica Plaza, St. Louis, MO, 63141, USA.
| | - Randolph M Steinhagen
- Department of Surgery, The Mount Sinai Hospital, 5 East 98th Street, 14th Floor, Suite D, Box 1259, New York, NY, 10029, USA.
| | - Florin Vaida
- University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Samuel Eisenstein
- University of California, San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
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Eisenstein S, Holubar SD, Hilbert N, Bordeianou L, Crawford LA, Hall B, Hull T, Hyman N, Keenan M, Kunitake H, Lee EC, Lewis WD, Maron D, Messaris E, Miller R, Mutch M, Ortenzi G, Ramamoorthy S, Smith R, Steinhagen RM, Wexner SD. The ACS National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative: Design, Implementation, and Validation of a Disease-specific Module. Inflamm Bowel Dis 2019; 25:1731-1739. [PMID: 31622979 DOI: 10.1093/ibd/izz044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Surgery for inflammatory bowel disease (IBD) involves a complex interplay between disease, surgery, and medications, exposing patients to increased risk of postoperative complications. Surgical best practices have been largely based on single-institution results and meta-analyses, with multicenter clinical data lacking. The American College of Surgeons National Surgical Quality Improvement Project (ACS-NSQIP) has revolutionized the way in which large-volume surgical outcomes data have been collected. Our aim was to employ the ACS-NSQIP to collect disease-specific variables relevant to surgical outcomes in IBD. STUDY DESIGN A collaborative of 13 high-volume IBD surgery centers was convened to collect 5 IBD-specific variables in NSQIP. Variables included biologic and immunomodulator medications usage, ileostomy utilization, ileal pouch anastomotic technique, and colonic dysplasia/neoplasia. A sample of the Surgical Clinical Reviewer collected data was validated by a colorectal surgeon at each institution, and kappa's agreement statistics generated. RESULTS Over 1 year, data were collected on a total of 956 cases. Overall, 41.4% of patients had taken a biologic agent in the 60 days before surgery. The 2 most commonly performed procedures were laparoscopic ileocolic resections (159 cases) and subtotal colectomies (151 cases). Overall, 56.8% of cases employed an ileostomy, and 134 ileal pouches were constructed, of which 92.4% used stapled technique. A sample of 214 (22.4%) consecutive cases was validated from 8 institutions. All 5 novel variables were shown to be reliably collected, with excellent agreement for 4 variables (kappa ≥ 0.70) and very good agreement for the presence of colonic dysplasia (kappa = 0.68). CONCLUSION We report the results of the initial year of implementation of the first disease-specific collaborative within NSQIP. The selected variables were demonstrated to be reliably collected, and this collaborative will facilitate high-quality, large case-volume research specific to the IBD patient population.
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Affiliation(s)
| | | | - Nicholas Hilbert
- Department of Surgery, UC San Diego Health System,La Jolla, CA, USA
| | | | | | - Bruce Hall
- Department of Surgery, Washington University,Saint Louis, St. Louis, MO, USA
| | - Tracy Hull
- Department of Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Neil Hyman
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Megan Keenan
- Department of Surgery, Albany Medical College, Albany, NY, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachussetts General Hospital, Boston, MA, USA
| | - Edward C Lee
- Department of Surgery, Albany Medical College, Albany, NY, USA
| | | | - David Maron
- Department of Surgery, Cleveland Clinic Florida, Weston, MA, USA
| | - Evangelos Messaris
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Reba Miller
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matthew Mutch
- Department of Surgery, Washington University,Saint Louis, St. Louis, MO, USA
| | - Gail Ortenzi
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Radhika Smith
- Department of Surgery, Washington University,Saint Louis, St. Louis, MO, USA
| | | | - Steven D Wexner
- Department of Surgery, Cleveland Clinic Florida, Weston, MA, USA
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Robinson K, Duncan SG, Messaris E, Brat G. Anorectal Disease and Post-Discharge Consumption of Opioids. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.126] [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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Kulaylat AS, Schaefer EW, Messaris E, Hollenbeak CS. Truven Health Analytics MarketScan Databases for Clinical Research in Colon and Rectal Surgery. Clin Colon Rectal Surg 2019; 32:54-60. [PMID: 30647546 DOI: 10.1055/s-0038-1673354] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The MarketScan databases are a family of administrative claims databases that contain data on inpatient and outpatient claims, outpatient prescription claims, clinical utilization records, and healthcare expenditures. The three main databases available for use are each composed of a convenience sample for one of the following patient populations: (1) patients with employer-based health insurance from contributing employers, (2) Medicare beneficiaries who possess supplemental insurance paid by their employers, and (3) patients with Medicaid in one of eleven participating states. Eleven supplemental databases are available, which are utilized to overcome the limited clinical data available in the core MarketScan databases. There are several limitations to this database, primarily related to the fact that individuals or their family members within two of the core databases mandatorily possess some form of employer-based health insurance, which prevents the dataset from being nationally representative. Nonetheless, this database provides detailed and rigorously maintained claims data to identify healthcare utilization patterns among this cohort of patients.
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Affiliation(s)
- Audrey S Kulaylat
- Department of Surgery, Division of Colon and Rectal Surgery, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | - Eric W Schaefer
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
| | | | - Christopher S Hollenbeak
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
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Gorrepati VS, Yadav S, Stuart A, Koltun W, Messaris E, Williams ED, Coates MD. Anxiety, depression, and inflammation after restorative proctocolectomy. Int J Colorectal Dis 2018; 33:1601-1606. [PMID: 29959529 DOI: 10.1007/s00384-018-3110-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Accepted: 06/21/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Anxiety and depression (A&D) are more common in inflammatory bowel disease (IBD) and in IBD patients who undergo proctocolectomy with ileal pouch-anal anastomosis (IPAA). Our aim was to test the hypothesis that chronic inflammatory conditions in IPAA are associated with increased incidence of A&D. METHODS Retrospective cohort study at a single tertiary care referral center using a consented IBD and colon cancer natural history registry. Demographic and clinical factors, including surgical and psychiatric history, were abstracted. RESULTS We compared A&D rate in three cohorts: (1) ulcerative proctocolitis with IPAA (UC) (n = 353), (2) Crohn's disease/indeterminate proctocolitis with IPAA (CDIC) (n = 49), and (3) familial adenomatous polyposis with IPAA (FAP) (n = 33). Forty-six CDIC patients (93.9%) demonstrated pouch-related inflammation, while 126 UC patients (35.7%) and 2 FAP patients (6.1%) developed pouchitis. CDIC had a higher rate of A&D co-diagnosis compared to UC and FAP (20.4 vs.12.7 vs.12.1% respectively; p < 0.05). UC patients with pouchitis also exhibited a higher rate of A&D than UC without pouchitis (19.8 vs.8.8%; p < 0.05). Multivariable analysis demonstrated that pre-operative corticosteroid use (OR = 4.46, CI = 1.34-14.87, p < 0.05), female gender (OR = 2.19, CI = 1.22-3.95, p < 0.01), tobacco use (OR = 2.92, CI = 1.57 = 5.41, p < 0.001), and pouch inflammation (OR = 2.37, CI = 1.28-4.39, p < 0.05) were each independently associated with A&D in these patients. CONCLUSIONS Anxiety and depression were more common in patients experiencing inflammatory conditions of the pouch. UC without pouchitis and FAP patients demonstrated lower rates of A&D (that were comparable to the general population), implying that having an IPAA alone was not enough to increase risk for A&D. Factors independently associated with A&D in IPAA included an inflamed pouch, corticosteroid use, smoking, and female gender.
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Affiliation(s)
| | - Sanjay Yadav
- Department of Psychiatry, Penn State College of Medicine, Hershey, PA, USA
| | - August Stuart
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State College of Medicine, Hershey, PA, USA
| | - Walter Koltun
- Department of Surgery, Division of Colorectal Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Evangelos Messaris
- Department of Surgery, Division of Colorectal Surgery, Penn State College of Medicine, Hershey, PA, USA
| | - Emmanuelle D Williams
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State College of Medicine, Hershey, PA, USA
| | - Matthew D Coates
- Department of Medicine, Division of Gastroenterology and Hepatology, Penn State College of Medicine, Hershey, PA, USA.
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Crowell KT, Tinsley A, Williams ED, Coates MD, Bobb A, Koltun WA, Messaris E. Vedolizumab as a rescue therapy for patients with medically refractory Crohn's disease. Colorectal Dis 2018; 20:905-912. [PMID: 29673053 DOI: 10.1111/codi.14225] [Citation(s) in RCA: 3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/05/2018] [Indexed: 01/21/2023]
Abstract
AIM Vedolizumab, a monoclonal antibody resulting in gut-selective anti-inflammatory activity, was approved by the US Food and Drug Administration in 2014 for use in patients with Crohn's disease (CD). The aim of this study was to investigate the efficacy of vedolizumab as a rescue therapy when other medical therapies have failed. METHOD A retrospective review was performed on consecutive patients with CD receiving vedolizumab at the Penn State Hershey IBD Center between May 2014 and March 2016. These patients were unresponsive or intolerant to tumour necrosis factor (TNF) antagonist therapy, and previously would have been candidates for surgery. Outcomes included surgical intervention, clinical response and endoscopic improvement. RESULTS A total of 48 patients with medically refractory CD receiving vedolizumab were included. The median length of follow-up was 69 weeks (range 15-113 weeks). A majority (81%) of patients previously failed at least two TNF antagonists, and 77% had prior surgery for CD. Surgical intervention was required in 21 (44%) patients and 13 (27%) patients required intra-abdominal operations. At the conclusion of the study, 23 (48%) patients reported continued improvement of symptoms, and 22 of 37 (59%) patients undergoing endoscopy showed improvement. Patients with the inflammatory CD phenotype were more likely to improve clinically and avoid surgery. CONCLUSION Vedolizumab alone or in combination with immunomodulators or steroids may be used as a rescue therapy in patients with medically refractory CD and may decrease the rate of surgical intervention. Patients with the inflammatory CD phenotype had the best clinical response and decreased need for surgery, suggesting that vedolizumab is most effective in the inflammatory phenotype.
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Affiliation(s)
- K T Crowell
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - A Tinsley
- Department of Gastroenterology, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - E D Williams
- Department of Gastroenterology, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - M D Coates
- Department of Gastroenterology, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - A Bobb
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - W A Koltun
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - E Messaris
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania, USA
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Mirkin KA, Kulaylat AS, Hollenbeak CS, Messaris E. Prognostic Significance of Tumor Deposits in Stage III Colon Cancer. Ann Surg Oncol 2018; 25:3179-3184. [PMID: 30083832 DOI: 10.1245/s10434-018-6661-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The American Joint Committee on Cancer includes extranodal tumor deposits in the tumor-node-metastasis classification of colon cancer. However, it is unclear how tumor deposits compare with lymph node metastases in prognostic significance. This study evaluated the survival impact of tumor deposits relative to lymph node metastases in stage III colon cancer. METHODS The US National Cancer Database (2010-2012) was reviewed for resectable stage III adenocarcinoma of the colon, and stratified by presence of tumor deposits and lymph node metastases. Univariate and multivariate survival analyses were performed. RESULTS Of 6424, 10.1% had both tumor deposits and lymph node metastases [5-year survival (5YS) 40.2%], 2.5% had tumor deposits alone (5YS 68.1%), and 87.4% had lymph node metastases alone (5YS 55.4%). Patients with lymph node metastases alone tended to have a greater number of lymph nodes retrieved (20.9 versus 18.8, p = 0.0126) and were more likely to receive adjuvant therapy (66.9 vs 58.0%, p = 0.003) than those with only tumor deposits. Patients with both had significantly worse survival at all T stages (p < 0.05, all). There was no significant difference in survival between tumor deposits alone and lymph node metastases alone at any T stage (p > 0.8, all). After controlling for patient, disease, and treatment characteristics, patients with tumor deposits alone [hazard ratio (HR) 0.56, p = 0.001] or only lymph node metastases (HR 0.64, p < 0.001) were associated with improved survival relative to patients with both. CONCLUSIONS Concomitant presence of tumor deposits and lymph node invasion carries poor prognostic significance. Tumor deposits alone appear to have prognostic implications similar to lymph node invasion alone.
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Affiliation(s)
- Katelin A Mirkin
- Division of Colon and Rectal Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Audrey S Kulaylat
- Division of Colon and Rectal Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Christopher S Hollenbeak
- Division of Colon and Rectal Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.,Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Evangelos Messaris
- Division of Colon and Rectal Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
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Kulaylat AS, Jung J, Hollenbeak CS, Messaris E. Readmissions, penalties, and the Hospital Readmissions Reduction Program. Seminars in Colon and Rectal Surgery 2018. [DOI: 10.1053/j.scrs.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Kulaylat AS, Mirkin KA, Puleo FJ, Hollenbeak CS, Messaris E. Robotic versus standard laparoscopic elective colectomy: where are the benefits? J Surg Res 2018; 224:72-78. [DOI: 10.1016/j.jss.2017.11.059] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 01/09/2023]
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Mirkin KA, Kulaylat AS, Hollenbeak CS, Messaris E. Robotic versus laparoscopic colectomy for stage I–III colon cancer: oncologic and long-term survival outcomes. Surg Endosc 2017; 32:2894-2901. [DOI: 10.1007/s00464-017-5999-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/02/2017] [Indexed: 01/26/2023]
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Moyer MT, Mathew A, Chintanaboina J, Williams E, Puleo F, Messaris E, Tinsley A. Restoration of colonic patency of a completely obstructed Crohn's stricture using the combined antegrade-retrograde dilation procedure. VideoGIE 2017; 2:359-360. [PMID: 29917019 PMCID: PMC6003249 DOI: 10.1016/j.vgie.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Matthew T Moyer
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Abraham Mathew
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jayakrishna Chintanaboina
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Emmanuelle Williams
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Frances Puleo
- Division of Colorectal Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Evangelos Messaris
- Division of Colorectal Surgery, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Andrew Tinsley
- Division of Gastroenterology and Hepatology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
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Mirkin KA, Hollenbeak CS, Mohamed A, Jia Y, El-Deiry WS, Messaris E. Impact of perineural invasion on survival in node negative colon cancer. Cancer Biol Ther 2017; 18:740-745. [PMID: 28475454 PMCID: PMC5663408 DOI: 10.1080/15384047.2017.1323602] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 04/23/2017] [Indexed: 10/19/2022] Open
Abstract
Perineural invasion (PNI) has been implicated as a poor prognostic indicator in many cancers. The National Comprehensive Cancer Network recommends consideration of observation or adjuvant therapy in the presence of PNI in early colon cancer. These recommendations are based on single institutional studies that fail to evaluate PNI within the context of adjuvant chemotherapy. The US National Cancer Database (2004-2012) was reviewed for patients with node negative colon cancer, and stratified by PNI and receipt of chemotherapy. Of 21,488 patients evaluated, 55.2% had T3 disease (n = 11,852), 23.1% had T2 (n = 4,971), 14.4% had T1 (n = 3,088), and 7.3% had T4 disease (n = 1,577); 4.6% (n = 987) had PNI. Most patients (86.8%, n = 18,641) did not have PNI and did not receive chemotherapy; 8.7% (n = 1,860) did not have PNI but received chemotherapy; 3.7% (n = 785) had PNI and did not receive chemotherapy, and 0.9% (n = 202) had PNI and received chemotherapy. Among those with PNI, patients who received chemotherapy tended to be younger (P<0.001), covered by private insurance (P<0.001), with fewer comorbidities (P<0.001), and greater T stage disease (P<0.001). Those with PNI who received chemotherapy had significantly improved survival over those who did not in T3-4 disease (P<0.001), but not in T1-2 disease. On multivariate analysis, those with PNI had a 38% greater hazard of mortality (HR 1.38, P<0.001). Additionally, chemotherapy decreased the hazard of mortality by 43% (HR 0.57, P<0.001). PNI appears to be an independent poor prognostic indicator in stage T3-4 node negative colon cancer. Chemotherapy administered to this patient population is associated with improved survival.
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Affiliation(s)
- Katelin A. Mirkin
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Christopher S. Hollenbeak
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Ali Mohamed
- Department of Medicine, Division of Hematology/Oncology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Yuxia Jia
- Department of Medicine, Division of Hematology/Oncology, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Wafik S. El-Deiry
- Department of Hematology/Oncology and Molecular Therapeutics Program, Fox Chase Cancer Center, Philadelphia, PA, USA
| | - Evangelos Messaris
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Kulaylat AS, Kulaylat AN, Schaefer EW, Tinsley A, Williams E, Koltun W, Hollenbeak CS, Messaris E. Association of Preoperative Anti-Tumor Necrosis Factor Therapy With Adverse Postoperative Outcomes in Patients Undergoing Abdominal Surgery for Ulcerative Colitis. JAMA Surg 2017; 152:e171538. [PMID: 28614561 DOI: 10.1001/jamasurg.2017.1538] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Importance Despite the increasing use of anti-tumor necrosis factor (TNF) therapy in ulcerative colitis, its effects on postoperative outcomes remain unclear, with many patients requiring surgical intervention despite optimal medical management. Objective To assess the association of preoperative use of anti-TNF agents with adverse postoperative outcomes. Design, Setting, and Participants This analysis used insurance claims data from a large national database to identify patients 18 years or older with ulcerative colitis. These insured patients had inpatient and/or outpatient claims between January 1, 2005, and December 31, 2013, with Current Procedural Terminology codes for a subtotal colectomy or total abdominal colectomy, a total proctocolectomy with end ileostomy, or a combined total proctocolectomy and ileal pouch-anal anastomosis. Only data regarding the first or index surgical admission within the time frame were abstracted. Use of anti-TNF agents, corticosteroids, and immunomodulators within 90 days of surgery was identified using Healthcare Common Procedure Coding System codes. Inclusion in the study required the patient to have an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code for ulcerative colitis. Exclusion occurred if the patient had a secondary ICD-9-CM diagnosis code for Crohn disease or if the patient was not continuously enrolled in an insurance plan for at least 180 days before and after the index surgery. Data were collected and analyzed from February 1, 2015, to June 2, 2016. Main Outcomes and Measures Outcomes included 90-day complications, emergency department visits, and readmissions. Multivariable logistic regression was used to model covariates, including anti-TNF agent use, on the occurrence of outcomes. Results Of the 2476 patients identified, 1379 (55.7%) were men, and the mean (SD) age was 42.1 (12.9) years. Among these, 950 (38.4%) underwent subtotal colectomy or total abdominal colectomy, 354 (14.3%) underwent total proctocolectomy with end ileostomy, and 1172 (47.3%) received ileal pouch-anal anastomoses. In univariate analyses, increased postoperative complications were observed among patients in the ileal pouch cohort who received anti-TNF agents preoperatively vs those who did not (137 [45.2%] vs 327 [37.6%]; P = .02) but not among those in the colectomy or proctocolectomy cohorts. An increase in complications was also observed on multivariable analyses among patients in the ileal pouch cohort (odds ratio, 1.38; 95% CI, 1.05-1.82). Conclusions and Relevance Unlike preoperative anti-TNF agent use among patients who underwent colectomy or total proctocolectomy and experienced no significant increase in postoperative complications, anti-TNF agent use within 90 days of surgery among patients who underwent ileal pouch-anal anastomosis was associated with higher 90-day postoperative complication rates.
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Affiliation(s)
- Audrey S Kulaylat
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey
| | - Afif N Kulaylat
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey
| | - Eric W Schaefer
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey
| | - Andrew Tinsley
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Pennsylvania State University, Hershey
| | - Emmanuelle Williams
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Pennsylvania State University, Hershey
| | - Walter Koltun
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey
| | - Christopher S Hollenbeak
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey.,Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey
| | - Evangelos Messaris
- Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey
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Kulaylat AN, Kulaylat AS, Schaefer EW, Tinsley A, Williams ED, Koltun WA, Hollenbeak CS, Messaris E. Impact of Anti-Tumor Necrosis Factor Alpha Therapy on Postoperative Outcomes in the Surgical Management of Crohn’s Disease. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.06.093] [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: 10/20/2022]
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Abstract
BACKGROUND The identification of the top 100 papers in ulcerative colitis (UC) using citation analysis provides a unique insight into the advancement of disease understanding and subsequent treatment innovations that have progressed over time. METHODS The Thomson Reuters Web of Knowledge was used to identify the 100 most cited UC manuscripts. Title, first and senior authors, institution and department of first author, journal, country of origin, year and topic of each manuscript were analyzed. RESULTS The top 100 manuscripts were published between 1955-2012. Thirty eight percent of the manuscripts originated from the US followed by the UK (26%). Genetics was the topic with the most publications (n = 27), followed by treatment (n = 22) and immunological pathways (n = 17). Truelove had the highest amount of authorships. The institutions with the highest number of publications were St. Mark's, London and the Radcliffe Infirmary. CONCLUSION This list of highly cited papers identifies the topics and authors that have made the most impact in the study of UC over the last century. This paper provides a reference of what could be considered as the most influential UC papers and serves as a reference of what comprises a 'highly citable' manuscript for both researchers and clinicians.
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Affiliation(s)
- Tara M Connelly
- a Department of Surgery , University Hospital Waterford , Waterford , Ireland
| | - Liam Devane
- a Department of Surgery , University Hospital Waterford , Waterford , Ireland
| | - John C Kelly
- b Department of Surgery , University Hospital Galway , Galway , Ireland
| | - Paula Wrafter
- b Department of Surgery , University Hospital Galway , Galway , Ireland
| | - Evangelos Messaris
- c Division of Colon and Rectal Surgery, Milton Hershey Medical Center , Pennsylvania State College of Medicine , Hershey , PA , USA
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Andrew RE, Messaris E. Update on medical and surgical options for patients with acute severe ulcerative colitis: What is new? World J Gastrointest Surg 2016; 8:598-605. [PMID: 27721922 PMCID: PMC5037332 DOI: 10.4240/wjgs.v8.i9.598] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/01/2016] [Indexed: 02/06/2023] Open
Abstract
Acute severe ulcerative colitis (UC) is a highly morbid condition that requires both medical and surgical management through the collaboration of gastroenterologists and colorectal surgeons. First line treatment for patients presenting with acute severe UC consists of intravenous steroids, but those who do not respond require escalation of therapy or emergent colectomy. The mortality of emergent colectomy has declined significantly in recent decades, but due to the morbidity of this procedure, second line agents such as cyclosporine and infliximab have been used as salvage therapy in an attempt to avoid emergent surgery. Unfortunately, protracted medical therapy has led to patients presenting for surgery in a poorer state of health leading to poorer post-operative outcomes. In this era of multiple medical modalities available in the treatment of acute severe UC, physicians must consider the advantages and disadvantages of prolonged medical therapy in an attempt to avoid surgery. Colectomy remains a mainstay in the treatment of severe ulcerative colitis not responsive to corticosteroids and rescue therapy, and timely referral for surgery allows for improved post-operative outcomes with lower risk of sepsis and improved patient survival. Options for reconstructive surgery include three-stage ileal pouch-anal anastomosis or a modified two-stage procedure that can be performed either open or laparoscopically. The numerous avenues of medical and surgical therapy have allowed for great advances in the treatment of patients with UC. In this era of options, it is important to maintain a global view, utilize biologic therapy when indicated, and then maintain an appropriate threshold for surgery. The purpose of this review is to summarize the growing number of medical and surgical options available in the treatment of acute, severe UC.
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Crowell KT, Messaris E. Risk factors and implications of anastomotic complications after surgery for Crohn’s disease. World J Gastrointest Surg 2015; 7:237-242. [PMID: 26523211 PMCID: PMC4621473 DOI: 10.4240/wjgs.v7.i10.237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/15/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
Anastomotic complications occur more frequently in patients with Crohn’s disease leading to postoperative intra-abdominal septic complications (IASC). Patients with IASC often require re-operation or drainage to control the sepsis and have an increased frequency of disease recurrence. The aim of this article was to examine the factors affecting postoperative IASC in Crohn’s disease after anastomoses, since some risk factors remain controversial. Studies investigating IASC in Crohn’s operations were included, and all risk factors associated with IASC were evaluated: nutritional status, presence of abdominal sepsis, medication use, Crohn’s disease type, duration of disease, prior operations for Crohn’s, anastomotic technique, extent of resection, operative timing, operative length, and perioperative bleeding. In this review, the factors associated with an increased risk of IASC are preoperative weight loss, abdominal abscess present at time of surgery, prior operation, and steroid use. To prevent IASC in Crohn’s patients, preoperative optimization with nutritional supplementation or drainage of abscess should be performed, or a diverting stoma should be considered for patients with multiple risk factors.
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Crowell KT, Winder JS, Wilson MZ, Stewart DB, Messaris E. To What Extent Is Surgical Performance Influenced by Obesity in Single-Site Laparoscopic Colon and Rectal Surgery? J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.07.075] [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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Choi CS, Berg A, Messaris E, Koltun WA. A combined medical and surgical approach improves healing of septic perianal Crohn’s disease. J Am Coll Surg 2015. [DOI: 10.1016/j.jamcollsurg.2015.08.041] [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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Messaris E, Connelly TM, Kulaylat AN, Miller J, Gusani NJ, Ortenzi G, Wong J, Bhayani N. Is a diverting ostomy needed in mid-high rectal cancer patients undergoing a low anterior resection after neoadjuvant chemoradiation? An NSQIP analysis. Surgery 2015; 158:686-91. [DOI: 10.1016/j.surg.2015.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 02/09/2015] [Accepted: 02/14/2015] [Indexed: 12/26/2022]
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Sangster W, Messaris E, Berg AS, Stewart DB. Single-Site Laparoscopic Colorectal Surgery Provides Similar Clinical Outcomes Compared With Standard Laparoscopic Surgery: An Analysis of 626 Patients. Dis Colon Rectum 2015; 58:862-9. [PMID: 26252848 PMCID: PMC4706226 DOI: 10.1097/dcr.0000000000000435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Compared with standard laparoscopy, single-site laparoscopic colorectal surgery may potentially offer advantages by creating fewer surgical incisions and providing a multifunctional trocar. Previous comparisons, however, have been limited by small sample sizes and selection bias. OBJECTIVE The purpose of this study was to compare 60-day outcomes between standard laparoscopic and single-site laparoscopic colorectal surgery patients undergoing elective and urgent surgeries. DESIGN This was an unselected, retrospective cohort study comparing patients who underwent elective and unplanned standard laparoscopic or single-site laparoscopic colorectal resections for benign and malignant disease between 2008 and 2014. Outcomes were compared using univariate analyses. SETTINGS This study was conducted at a single institution. PATIENTS A total of 626 consecutive patients undergoing laparoscopic colorectal surgery were included. MAIN OUTCOME MEASURES Morbidity and mortality rates within 60 postoperative days were measured. RESULTS A total of 318 (51%) and 308 patients (49%) underwent standard laparoscopic and single-site laparoscopic procedures. No significant differences were noted in mean operative time (standard laparoscopy, 182.1 ± 81.3 vs single-site laparoscopy, 177.0 ± 86.5; p = 0.30) or postoperative length of stay (standard laparoscopy, 4.8 ± 3.4 vs single-site laparoscopy, 5.5 ± 6.9; p = 0.14). Conversions to laparotomy and 60-day readmissions were also similar for both cohorts across all of the procedures performed. A significant difference was identified in the number of patients who developed postoperative complications (standard laparoscopy, 19.2% vs single-site laparoscopy, 10.7%; p = 0.004), especially with respect to surgical-site infections (standard laparoscopy, 11.3% vs single-site laparoscopy, 5.8%; p = 0.02). LIMITATIONS This was a retrospective, single institution study. CONCLUSIONS Single-site laparoscopic colorectal surgery demonstrates similar results to standard laparoscopic colorectal surgery with regard to operative time, length of stay, and readmissions. Single-site laparoscopic colorectal surgery may provide advantages in limiting the development of certain complications, such as superficial surgical-site infections.
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Affiliation(s)
- William Sangster
- Surgical Resident, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Evangelos Messaris
- Assistant Professor, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - Arthur S. Berg
- Associate Professor, Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA
| | - David B. Stewart
- Associate Professor, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA
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