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Berger Y, Bard V, Abbas M, Solomon D, Menasherov N, Kashtan H. Thoracic Duct Visualization in Esophageal Resection - a Pilot Trial. Eur Surg Res 2024:000538691. [PMID: 38636484 DOI: 10.1159/000538691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION Inadvertent thoracic duct injury is common during esophagectomy and may result in postoperative chylothorax. This study's objective is to investigate utility of patent-blue injection as a modality for intraoperative thoracic duct visualization. METHODS A prospective, single-arm, interventional study of patients undergoing minimally invasive esophagectomy was performed. Patients were injected with patent-blue dye into both groins prior to thoracic stage of surgery and assessed for duct visualization. Control group was formed by propensity score matching using retrospectively collected data regarding patients who underwent esophagectomy. RESULTS A total of 25 patients were included in analysis, compared to a control of 50 patients after matching. Thoracic duct was visualized in 60% of patients in the study group (15/25 patients). Significant differences were found between study and control groups(p<0.05) with regards to median operative time (422 vs. 285 minutes, respectively), overall complications (16% vs. 34%, respectively) and median postoperative length of stay (13.5 vs. 10 days, respectively). There was a difference in rate of chyle leak between study and control groups, however this was not significant (0% vs. 12%, respectively, p=0.17). CONCLUSION Patent-blue injection represents a simple method for thoracic duct visualization during minimally invasive esophagectomy which may improve surgical outcomes.
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Schiller S, Carmeli I, Orgad R, Kashtan H, Cooper L, Solomon D. Esophagectomy in the Older Adult: A Systematic Review. J Laparoendosc Adv Surg Tech A 2024. [PMID: 38587375 DOI: 10.1089/lap.2024.0087] [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: 04/09/2024] Open
Abstract
Current management of esophageal carcinoma (EC) involves combining different modalities, offering the opportunity of personalized strategies. This is particularly enticing in the geriatric population, where tailoring treatment modalities remains key to achieve good outcomes in terms of both quality of life and survival. Primary outcomes of our review included (1) evidence on short-term outcomes following esophagectomy, and (2) evidence on long-term outcomes following esophagectomy. Secondary review questions compared outcomes of (1) neoadjuvant treatment versus upfront surgery for locally advanced esophageal carcinoma, (2) endoscopic submucosal dissection versus esophagectomy for early esophageal carcinoma, and (3) definitive radiation with or without chemotherapy versus surgery. Twenty-six articles were included in the review for the main review questions. Our systematic review underscores the need for comprehensive geriatric evaluations to guide decision-making. Despite concerns about perioperative risks, well-selected older patients can derive survival benefits from surgical intervention.
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Affiliation(s)
| | - Idan Carmeli
- Division of General Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
- Faculty of Medicine, Ben Gurion University of the Negev, Beersheba, Israel
| | - Ran Orgad
- Division of General Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
| | - Hanoch Kashtan
- Division of General Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
- Faculty of Medicine, Ben Gurion University of the Negev, Beersheba, Israel
| | - Lisa Cooper
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Geriatrics, Rabin Medical Center, Petach Tikva, Israel
| | - Daniel Solomon
- Division of General Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
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Cooper L, Orgad R, Levi Y, Shmilovitch H, Feferman Y, Solomon D, Kashtan H. Esophageal cancer in octogenarians: Should esophagectomy be done? J Geriatr Oncol 2024; 15:101710. [PMID: 38281389 DOI: 10.1016/j.jgo.2024.101710] [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: 07/03/2023] [Revised: 12/23/2023] [Accepted: 01/22/2024] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Esophagectomy is the treatment of choice for esophageal cancer. In octogenarians data is conflicting. We evaluated postoperative outcomes and long-term survival of octogenarians and their younger counterparts. MATERIALS AND METHODS A retrospective analysis of a prospectively maintained database including consecutive patients with esophageal cancer who underwent esophagectomy at a large referral, academic center between 2012 and 2021. Subgroups were designed according to age (<70, 70-79, and ≥ 80). RESULTS A total of 359 patients underwent esophagectomy for esophageal cancer, 223 (62%) aged <70, 107 (30%) aged 70-79 and 29 (8%) aged ≥80. Octogenarians had higher American Society of Anesthesiologists [ASA] scores (p = 0.001), and fewer received neoadjuvant therapy (p = 0.04). Octogenarians experienced more major complications (P < 0.001) with significantly higher 30-day mortality rate (P = 0.001). In a multivariable analysis, major complications were associated with higher risk of being discharged to a rehabilitation center (odds ratio [OR] 14.839, 95% confidence interval [CI] 4.921-44.747, p < 0.001) while age was not. Overall survival was reduced in octogenarians, with a 50th percentile survival of 10 months compared to 32 and 26 months in patients age < 70 and 70-79, respectively (p = 0.014). In a multivariable analysis, age ≥ 80 (hazard ratio [HR] 4.478 95% CI 2.151-9.322, p < 0.001), cancer stage (HR 1.545, 95% CI 1.095-2.179, p = 0.013), and postoperative major complications (HR 2.705 95% CI 1.913-3.823, p < 0.001) were independently associated with reduced survival. DISCUSSION Our study showed that octogenarians had significantly higher postoperative major complications compared to younger age groups. Overall survival was significantly reduced in these patients, probably due to an increased rate of perioperative mortality. Better patient selection and preparation may improve postoperative outcomes and increase long-term survival.
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Affiliation(s)
- Lisa Cooper
- Department of Geriatric Medicine, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel..
| | - Ran Orgad
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yochai Levi
- Department of Geriatric Medicine, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hila Shmilovitch
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yael Feferman
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Daniel Solomon
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Zaslavsky A, Solomon D, Varon D, Israeli T, Amlinsky Y, Tamir S, Kashtan H. Incidence and Impact of Preoperative Hiatal Hernia in Patients with Esophageal Carcinoma Undergoing Curative Surgical Resection. J Gastrointest Surg 2023; 27:2907-2919. [PMID: 38038853 DOI: 10.1007/s11605-023-05872-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/10/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Hiatal hernia (HH) and gastroesophageal reflux disease (GERD) are risk factors for esophageal adenocarcinoma. High positive margin rates and poor survival were described among HH patients undergoing esophagectomy. We sought to describe incidence and impact of HH on outcomes following esophagectomy. METHODS Patients who underwent esophagectomy 2012-2019 for esophago-junctional carcinoma were included. CT studies were blindly reviewed by two radiologists. A third radiologist reviewed cases of disagreement. Hernias ≥ 3 cm were included in the HH group. RESULTS Overall, 66 patients (33%) had HH ≥ 3 cm. The no hernia group included 12 patients (6%) with < 3 cm HH and 106 (53%) without HH. Preoperative variables were comparable among groups. Location of anastomosis was similar among cohorts and predominantly cervical (n = 97, 82.2% vs 61, 92.4%, p = 0.113). Postoperatively, HH patients had higher incidence of atrial dysrhythmia (n = 11, 16.7% vs n = 6, 5.1% p = 0.015). Rates of R0 resections were similar (n = 62, 93.9%, vs n = 113, 95.8%, p = 0.724). HH patients had higher rates of signet ring cell histology (n = 14, 21.2% vs n = 9, 7.6% p = 0.025); this was confirmed on subgroup analysis including only adenocarcinoma patients (n = 14, 28.6% vs n = 8, 12.3%, p = 0.042). On Cox regression analysis, HH was not associated with disease-free or overall survival (HR 1.308, p = 0.274 and HR .905, p = 0.722). CONCLUSIONS Patients with preoperative HH had higher rates of postoperative atrial dysrhythmias and signet ring cell features on pathology. In a population with predominant cervical anastomosis, positive margin rates were low and survival comparable among cohorts.
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Affiliation(s)
- Adi Zaslavsky
- Department of Surgery, Rabin Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv, Israel
| | - Daniel Solomon
- Department of Surgery, Rabin Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv, Israel.
| | - Danielle Varon
- Department of Radiology, Rabin Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv, Israel
| | - Tal Israeli
- Department of Surgery, Rabin Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv, Israel
| | - Yelena Amlinsky
- Department of Radiology, Rabin Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv, Israel
| | - Shlomit Tamir
- Department of Radiology, Rabin Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Affiliated With the Sackler School of Medicine, Tel Aviv, Israel.
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Solomon D, Sarfaty E, Menasherov N, Bard V, Bueno R, Kashtan H. Implementing the first program of minimally invasive esophagectomy for cancer in Israel: shifting the paradigm in a high-volume center - a cohort study. Int J Surg 2023; 109:3467-3475. [PMID: 37678317 PMCID: PMC10651252 DOI: 10.1097/js9.0000000000000646] [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: 12/05/2022] [Accepted: 07/15/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Esophagectomy is associated with significant perioperative morbidity. Limited data are available on the process of implementation of minimally invasive techniques in esophagectomy and related outcomes. The authors sought to describe implementation processes and outcomes following the implementation of the first minimally invasive esophagectomy (MIE) program at a high-volume center in Israel under the mentorship of American early adopters. METHODS Patients who underwent esophagectomy for esophageal carcinoma 2011-2022 were included. Early and late cohorts were created for learning curve analysis. Secondary analysis included patients who underwent open esophagectomy 1997-2011. RESULTS Overall, 300 patients underwent MIE: three-field MIE (3F-MIE) was performed in 242 (80.7%) patients, two-field MIE (2F-MIE) in 58 (19.3%) patients. Following program implementation in 2012, the number of MIE performed increased during the first 3 years ( n =33, 86.8% in 2015). Among 3F-MIE patients, a higher number of retrieved lymph nodes was reported during later cases (median, IQR1-3 17, 12-23 vs. 12, 8-12, P <0.001) while surgeries required a longer time (median, IQR1-3 300 min, 261-355 vs. 262.5, 239-300, P <0.001). Among 2F-MIE patients, the late cohort had lower rates of prolonged ICU admissions than earlier counterparts ( n =2, 6.9% vs. n =9, 31%, P =0.041), overall and severe 30-day complications ( n =12, 41.4% vs. n =23, 79.3%, P <0.001 and n =7, 24.1% vs. n =23, 79.3%, P =0.003). CONCLUSIONS MIE was safely implemented. Nodal yield was higher among MIE patients than open esophagectomy. During the study years, open approach was gradually abandoned in favor of 3F-MIE procedures, while 2F-MIE increased over the course of the last years.
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Affiliation(s)
- Daniel Solomon
- Department of Surgery, Rabin Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Elad Sarfaty
- Department of Surgery, Rabin Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Nikolai Menasherov
- Department of Surgery, Rabin Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Vyacheslav Bard
- Department of Surgery, Rabin Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Raphael Bueno
- Division of Thoracic Surgery, Brigham and Women’s Hospital, Affiliated with the Harvard Medical School, Boston, USA
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv, Israel
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Kundel Y, Kurman N, Sulimani O, Gavrielli S, Nachalon Y, Moore A, Kashtan H, Fenig E, Brenner B, Popovtzer A, Fredman E. The effect of gastric fundus radiation dose on postoperative anastomotic leakage in esophageal cancer. Front Oncol 2023; 13:1080089. [PMID: 36925923 PMCID: PMC10011689 DOI: 10.3389/fonc.2023.1080089] [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: 10/25/2022] [Accepted: 02/10/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Standard-of-care treatment for locally advanced esophageal carcinoma (LAEC) includes neoadjuvant chemoradiotherapy followed by esophagectomy. A potentially catastrophic surgical complication is the development of a postoperative anastomotic leak. To date, the association with radiation dose exposure had been inconclusive. We examined the correlation between radiation exposure to the gastric fundus and risk of postoperative leakage using contemporary radiation doses and fractionation. Methods A total of 69 consecutive patients with LAEC who underwent neoadjuvant chemoradiotherapy followed by esophagectomy in our tertiary center were prospectively followed (median, 27 months). Neoadjuvant regimen included 50.4 Gy in 28 fractions with 5-fluorouracil and cisplatin and 41.4 Gy in 23 fractions with carboplatin and paclitaxel. The gastric fundus was contoured and dosimetric and radiation technique parameters were retrospectively evaluated. Results Of the total number of patients, 71% and 29% had esophageal and gastroesophageal junction (GEJ) tumors, respectively. Fourteen patients (20.3%) experienced anastomotic leaks within a median of 2 days postoperatively, 78.6% of whom had lower third esophagus or GEJ primaries. Mean and minimum fundus dose did not significantly differ between those with and those without leakage (p = 0.42, p = 0.51). Mean fundus V25, V30, and V35 doses were numerically but not statistically higher in those with anastomotic leak (p = 0.58, p = 0.39, and p = 0.30, respectively). No correlation with incidence of leakage was seen between 3D and IMRT treatment modalities. Conclusions In our comparatively large prospectively collected series of patients treated for LAEC, radiation dose to the gastric fundus during neoadjuvant combination therapy prior to surgery did not correlate with the risk of postoperative anastomotic leak.
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Affiliation(s)
- Yulia Kundel
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.,Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noga Kurman
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel
| | - Omri Sulimani
- Department of Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Shlomo Gavrielli
- Department of Radiology, Rabin Medical Center, Petach Tikva, Israel
| | - Yuval Nachalon
- Department of Otolaryngology - Head and Neck Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Assaf Moore
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.,Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Petach Tikva, Israel
| | - Eyal Fenig
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.,Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.,Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aron Popovtzer
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.,Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elisha Fredman
- Department of Radiation Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tikva, Israel.,Tel Aviv School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Wiesel O, Zlotnik O, Morgenstern S, Tsur M, Menasherov N, Feferman Y, Ben-Aharon I, Kashtan H. Predicting Factors for a Favorable Pathologic Response to Neoadjuvant Therapy in Esophageal Cancer. Am J Clin Oncol 2022; 45:514-518. [PMID: 36413681 DOI: 10.1097/coc.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Favorable pathologic response(FPR) is a significant predictor for improved survival following Neoadjuvant therapy(NAT) in esophageal and gastroesophageal cancer(GEJ). Preoperative prediction of FPR could modify treatment plans. No reliable method for predicting FPR exists. We sought to identify preoperative predicting factors for FPR. MATERIALS AND METHODS Retrospective analysis of patients with esophageal and GEJ cancer who underwent esophagectomy following (NAT). Univariate and multivariate analysis was used to identify preoperative predicting factors for FPR. A comparison of Tumor Regression Grade(TRG) was used to assess treatment response on overall survival(OS). RESULTS Out of 121 patients, 82(67.8%) had neoadjuvant chemoradiation. FPR was observed in 60(49.6%). Female sex, Radiation therapy(RT), squamous cell carcinoma(SCC), lack of signet ring feature, and FDG avidity posttreatment were associated with FPR on univariate analysis. RT and SCC were associated with FPR (OR=3.9 and 4.0, respectively) on multivariate analysis. OS was lower among patients who did not achieve FPR to NAT(P=0.027). CONCLUSIONS FPR is a predictor of improved OS. SCC and radiation therapy-based protocol were identified as major prediction factors of FPR in patients with esophageal and GEJ cancers.
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Affiliation(s)
- Ory Wiesel
- Department of Surgery
- Division of Thoracic Surgery, The cardio-Vascular institute, Baruch-Padeh medical center of the North, Poriya, Israel
| | | | - Sarah Morgenstern
- Department of Pathology Rabin Medical Center, Petah Tikva, Israel and The Sackler School of Medicine, Tel-Aviv University
| | | | | | | | - Irit Ben-Aharon
- Division of Oncology, Rambam Health Care Campus, Haifa, Israel and The Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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Brenner B, Kundel Y, Cohen Z, Brand H, Gordon N, Sulkes A, Morgenstern S, Menasherov N, Kashtan H, Groshar D, Domachevsky L, Bernstine H. Early prediction of residual disease after neoadjuvant chemoradiotherapy and cetuximab for locally advanced esophageal cancer using 18F-FDG PET-CT imaging: a prospective cohort study. J Gastrointest Oncol 2022; 13:2721-2735. [PMID: 36636052 PMCID: PMC9830356 DOI: 10.21037/jgo-22-352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background Previous studies in locally advanced esophageal cancer (LAEC) suggested that a change in the tumor's metabolic response, i.e., decrease of its interim 18F-FDG uptake compared with baseline, may predict histopathological response. We evaluated the possible predictive correlation between various PET-CT and histopathological parameters following a neoadjuvant biological-containing chemoradiotherapy (CRT) regimen. Methods Patients with resectable LAEC received neoadjuvant cisplatin/5-fluorouracil-based CRT and cetuximab following one cycle of induction chemotherapy and cetuximab. Changes in maximum and mean standardized uptake values (ΔSUV-max and ΔSUV-mean, respectively) and metabolic tumor volume (ΔMTV), measured by PET-CT at baseline and 2 weeks after the onset of treatment, were compared with histopathological findings at surgery. Histopathological response was defined by tumor regression grade (TRG), pathological complete response (pCR) and microscopic or macroscopic residual disease (RD). Results Of 18 patients, 13 (72%) with adenocarcinoma (AC) and 5 (28%) with squamous cell carcinoma (SCC), were included. None of the changes in the parameters of PET was associated with pCR; only ΔSUV-mean was associated with TRG in the AC cohort. In contrast, both ΔSUV-mean% and ΔSUV-max% were significantly associated with RD, both in the whole cohort and in the AC cohort. Changes in FDG-uptake predicted RD2 at surgery: only patients with less than 13% decrease in SUV-mean% or less than 29% decrease in SUV-max% had RD2, while all patients with RD0 or RD1 had greater reductions [100% specificity and 100% positive predictive value (PPV)]. Conclusions Changes in ΔSUV-max and ΔSUV-mean after two weeks of onset of cetuximab-based neoadjuvant chemotherapy for LAEC may predict macroscopic RD but not TRG or pCR at surgery.
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Affiliation(s)
- Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel;,Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Zoya Cohen
- Felsenstein Medical Research Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Hadar Brand
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel;,Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel
| | - Sara Morgenstern
- Institute of Pathology, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Nikolai Menasherov
- Department of Surgery A, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - Hanoch Kashtan
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Departments of Surgery A and B, Beilinson Hospital, Rabin Medical Center, Petach Tiqva, Israel
| | - David Groshar
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tiqva, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tiqva, Israel;,Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel;,Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital, Petach Tiqva, Israel
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Golany T, Aides A, Freedman D, Rabani N, Liu Y, Rivlin E, Corrado GS, Matias Y, Khoury W, Kashtan H, Reissman P. Artificial intelligence for phase recognition in complex laparoscopic cholecystectomy. Surg Endosc 2022; 36:9215-9223. [PMID: 35941306 PMCID: PMC9652206 DOI: 10.1007/s00464-022-09405-5] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The potential role and benefits of AI in surgery has yet to be determined. This study is a first step in developing an AI system for minimizing adverse events and improving patient's safety. We developed an Artificial Intelligence (AI) algorithm and evaluated its performance in recognizing surgical phases of laparoscopic cholecystectomy (LC) videos spanning a range of complexities. METHODS A set of 371 LC videos with various complexity levels and containing adverse events was collected from five hospitals. Two expert surgeons segmented each video into 10 phases including Calot's triangle dissection and clipping and cutting. For each video, adverse events were also annotated when present (major bleeding; gallbladder perforation; major bile leakage; and incidental finding) and complexity level (on a scale of 1-5) was also recorded. The dataset was then split in an 80:20 ratio (294 and 77 videos), stratified by complexity, hospital, and adverse events to train and test the AI model, respectively. The AI-surgeon agreement was then compared to the agreement between surgeons. RESULTS The mean accuracy of the AI model for surgical phase recognition was 89% [95% CI 87.1%, 90.6%], comparable to the mean inter-annotator agreement of 90% [95% CI 89.4%, 90.5%]. The model's accuracy was inversely associated with procedure complexity, decreasing from 92% (complexity level 1) to 88% (complexity level 3) to 81% (complexity level 5). CONCLUSION The AI model successfully identified surgical phases in both simple and complex LC procedures. Further validation and system training is warranted to evaluate its potential applications such as to increase patient safety during surgery.
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Affiliation(s)
| | | | | | | | - Yun Liu
- Google Health, Tel Aviv, Israel
| | | | | | | | - Wisam Khoury
- Department of Surgery, Rappaport Faculty of Medicine, Carmel Medical Center, Technion, Haifa, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, The Sackler School of Medicine, Tel-Aviv University, Petah Tikva, Israel
| | - Petachia Reissman
- Department of Surgery, The Hebrew University School of Medicine, Sharee Zedek Medical Center, Jerusalem, Israel.
- Digestive Disease Institute, Shaare-Zedek Medical Center, The Hebrew University School of Medicine, P.O. Box 3235, 91031, Jerusalem, Israel.
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Bard V, Solomon D, Raveh G, Menasherov N, Kashtan H. Long‐term Outcomes After Esophagectomy for
End‐Stage
Achalasia: a Bridge to a Better Quality of Life? Surgical Practice 2022. [DOI: 10.1111/1744-1633.12565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Vyacheslav Bard
- Department of General Surgery, Rabin Medical Center, Campus Beilinson, affiliated with Sackler Faculty of Medicine Tel Aviv University Israel
| | - Daniel Solomon
- Department of General Surgery, Rabin Medical Center, Campus Beilinson, affiliated with Sackler Faculty of Medicine Tel Aviv University Israel
| | - Guy Raveh
- Department of General Surgery, Rabin Medical Center, Campus Beilinson, affiliated with Sackler Faculty of Medicine Tel Aviv University Israel
| | - Nikolai Menasherov
- Department of General Surgery, Rabin Medical Center, Campus Beilinson, affiliated with Sackler Faculty of Medicine Tel Aviv University Israel
| | - Hanoch Kashtan
- Department of General Surgery, Rabin Medical Center, Campus Beilinson, affiliated with Sackler Faculty of Medicine Tel Aviv University Israel
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Haddad R, Zlotnik O, Goshen-Lago T, Levi M, Brook E, Brenner B, Kundel Y, Ben-Aharon I, Kashtan H. Tumor Lymphocyte Infiltration Is Correlated with a Favorable Tumor Regression Grade after Neoadjuvant Treatment for Esophageal Adenocarcinoma. J Pers Med 2022; 12:jpm12040627. [PMID: 35455743 PMCID: PMC9029859 DOI: 10.3390/jpm12040627] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 01/01/2023] Open
Abstract
(1) Background: We aimed to explore the association between neoadjuvant treatment, tumor-infiltrating immune lymphocyte (TIL), and tumor-associated macrophage (TAM) and survival in patients with esophageal adenocarcinoma. (2) Methods: Patients who underwent esophagectomy were divided into three groups according to their treatment modality and tumor regression grade (TRG): (i) surgery-only group (SG), (ii) good responders (GR) group (TRG 0−1), and (iii) bad responders (BR) group (TRG 2−3). We then carried out statistical correlations of the immunofluorescence analysis of the immune infiltrate in the esophageal surgical specimens with several clinical and pathological parameters. In addition, we analyzed The Cancer Genomic Atlas (TCGA) dataset for differences in TILs, TAMs, and protein expression in immune pathways. (3) Results: Forty-three patients (SG—15, GR—13, and BR—13) were evaluated. The highest enrichment of CD3+ (p < 0.001), CD8+ (p = 0.001) and CD4+ (p = 0.009) was observed in the stroma of GR patients. On multivariate analysis, only CD8+ T cell and signet-ring features were independent prognostic factors for overall survival. In TCGA analysis, we identified overexpression of TAM and colony-stimulating factor 1 receptor (CSF-1R). (4) Conclusions: High enrichment of lymphocyte subpopulations in the microenvironment of esophageal adenocarcinoma is associated with a favorable response to neoadjuvant treatment and an improved patient outcome.
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Affiliation(s)
- Riad Haddad
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel; (R.H.); (H.K.)
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel
| | - Oran Zlotnik
- Department of Surgery, Rabin Medical Center, Petach Tikva 4941492, Israel;
| | - Tal Goshen-Lago
- Division of Oncology, Rambam Health Care Campus, Haifa 3109601, Israel;
| | - Mattan Levi
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6329302, Israel; (M.L.); (B.B.); (Y.K.)
| | - Elena Brook
- Department of Pathology, Rabin Medical Center, Petach Tikva 4941492, Israel;
| | - Baruch Brenner
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6329302, Israel; (M.L.); (B.B.); (Y.K.)
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Yulia Kundel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6329302, Israel; (M.L.); (B.B.); (Y.K.)
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva 4941492, Israel
| | - Irit Ben-Aharon
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa 3525433, Israel
- Division of Oncology, Rambam Health Care Campus, Haifa 3109601, Israel;
- Correspondence:
| | - Hanoch Kashtan
- Department of Surgery, Carmel Medical Center, Haifa 3436212, Israel; (R.H.); (H.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6329302, Israel; (M.L.); (B.B.); (Y.K.)
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12
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Bard V, Brenner B, Kashtan H. The Dynamic Changing Incidence of Gastric Cancer in Israel: Time for a National Surgical Management Committee? Isr Med Assoc J 2022; 24:112-116. [PMID: 35187901] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There has been a general reduction over the last 20 years in the incidence within Israel of gastric cancer (GC). This has particularly been noted in the Jewish population with a slight increase in the incidence of cancer of the gastroesophageal junction among Jews of Sephardi origin. Given the diversity of individual ethnic subpopulations, the effects of GC incidence in second-generation immigrant Jews, particularly from high prevalence regions (e.g., the former Soviet Union, Iraq, and Iran), awaits determination. There are currently no national data on GC-specific mortality. The most recent available cross-correlated Israeli National Cancer Registry (INCR) and International Association for Cancer Research (IARC) incidence data for GC of the body and antrum in Israel are presented. Some of the challenges associated with GC monitoring in the changing Israeli population are discussed. We propose the establishment of a national GC management committee designed to collect demographic and oncological data in operable cases with the aim of recording and improving GC-specific outcomes. We believe that there is value in the development of a national surgical planning program, which oversees training and accreditation in a dynamic environment that favors the wider use of neoadjuvant therapies, minimally invasive surgery and routine extended (D2) lymphadenectomy. These changes should be supported by assessable enhanced recovery programs.
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Affiliation(s)
- Viacheslav Bard
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Department of Oncology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Siam B, Cooper L, Orgad R, Esepkina O, Kashtan H. Outcomes of surgery in patients 90 years of age and older: A retrospective cohort study. Surgery 2022; 171:1365-1372. [PMID: 35078630 DOI: 10.1016/j.surg.2021.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Important trade-offs of risks versus benefits of surgery need to be discussed with older adults, in particular nonagenarians who are candidates for surgery. Data that examine specific outcomes of surgical interventions in this age group are sparse. We aimed to evaluate the clinical presentation and postoperative outcomes of nonagenarians undergoing surgery. METHODS A retrospective cohort study of consecutive patients 90 years of age and older who underwent surgery between 2014 and 2018 in general surgical ward of a large-volume academic center. Subgroups were designed according to type of surgery (elective versus emergency surgery) and diagnosis (oncology versus non-oncology). Preoperative assessments included Malnutrition Universal Screening Tool, Norton Scale, Morse Scale, Katz, and Lawton-Brody indices. RESULTS A total of 198 nonagenarians underwent surgery, of which 38% were elective and 62% were emergency surgery. Median follow-up was 26 months. More patients in the elective group compared with the emergency group had oncology diagnoses (42.1% and 14.7%, respectively, P < .001), resided preoperatively at home (93.4% and 77.9%, respectively, P = .003), and were functionally independent (71.1% and 41.8%, respectively, P = .0005). Postoperative 30-day mortality frequency was 6.6% in the elective group and 39.3% in the emergency group (P < .001). Two-year survival frequency of non-oncology group was 72.7% in elective surgeries and 40.6% in emergency surgeries (P < .001). Two-year survival frequency of oncology group was 37% in elective surgeries and 27.8% in emergency surgeries (P = .12). CONCLUSION Elective surgery in adults aged 90 and above can be safely performed with acceptable 2-year outcomes. Emergency surgery for oncology diagnoses carries dismal outcomes, so palliative approaches should be considered.
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Affiliation(s)
- Baha Siam
- Department of Surgery, Rabin Medical Center, Petach-Tiqva, Israel; The Sackler School of Medicine, Tel-Aviv University, Israel
| | - Lisa Cooper
- Department of Geriatric Medicine, Rabin Medical Center, Petach-Tiqva, Israel; The Sackler School of Medicine, Tel-Aviv University, Israel
| | - Ran Orgad
- Department of Surgery, Rabin Medical Center, Petach-Tiqva, Israel; The Sackler School of Medicine, Tel-Aviv University, Israel
| | - Olga Esepkina
- Department of Surgery, Rabin Medical Center, Petach-Tiqva, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Petach-Tiqva, Israel; The Sackler School of Medicine, Tel-Aviv University, Israel.
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14
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Rom H, Tamir S, van Vugt J, Berger Y, Perl G, Morgenstern S, Tovar A, Brenner B, Benchimol D, Kashtan H, Sadot E. ASO Visual Abstract: Sarcopenia as a Predictor of Survival in Patients with Pancreatic Adenocarcinoma After Pancreatectomy. Ann Surg Oncol 2022. [DOI: 10.1245/s10434-021-11127-2] [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: 11/18/2022]
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15
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Tverskov V, Wiesel O, Solomon D, Orgad R, Kashtan H. The impact of cervical anastomotic leak after esophagectomy on long-term survival of patients with esophageal cancer. Surgery 2021; 171:1257-1262. [PMID: 34750016 DOI: 10.1016/j.surg.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/20/2021] [Accepted: 10/01/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Anastomotic leak is a major complication after esophagectomy. There is a paucity of data on long-term oncological outcomes of cervical anastomotic leak after esophagectomy for cancer. We evaluated the impact of such a leak on postoperative outcomes as well as on long-term oncological outcomes. METHODS A retrospective analysis of a prospectively maintained database of patients with esophageal cancer who underwent esophagectomy with a cervical esophagogastric anastomosis between 2010 and 2017. Patients were divided into 3 groups: patients with no anastomotic leak; patients with nonsevere (type 1 & 2) leak, and patients with severe (type 3) leak. A comparison of postoperative and long-term oncological outcomes was made between the groups. RESULTS Two hundred and eight patients were included in this study. Thirty-two (15%) patients had cervical anastomotic leak, of which 20 (63%) had type 1 and 2 (nonsevere) leak, and 12 (37%) had type 3 (severe) leak. Overall, 30-day mortality rate was 7%. Mortality rate was 4% in patients without leak, 15% in patients with nonsevere leak, and 25% in patients with severe anastomotic leak (P = .007). Overall median survival was 42 months. Patients with severe leak had poorer overall survival compared to patients with nonsevere and no anastomotic leak (6, 38, and 39 months, respectively, P = .011). There was no difference in disease-free survival of patients with or without anastomotic leak. CONCLUSION Leakage from cervical anastomosis after esophagectomy had no impact on disease-free survival of patients with esophageal cancer. Severe anastomotic leak was associated with lower overall survival, probably due to a high rate of postoperative mortality.
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Affiliation(s)
| | - Ory Wiesel
- Department of Surgery, Rabin Medical Center, Petach-Tiqva, Israel
| | - Daniel Solomon
- Department of Surgery, Rabin Medical Center, Petach-Tiqva, Israel; The Sackler School of Medicine, Tel Aviv University, Israel
| | - Ran Orgad
- Department of Surgery, Rabin Medical Center, Petach-Tiqva, Israel; The Sackler School of Medicine, Tel Aviv University, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Petach-Tiqva, Israel; The Sackler School of Medicine, Tel Aviv University, Israel.
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16
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Rom H, Tamir S, Van Vugt JLA, Berger Y, Perl G, Morgenstern S, Tovar A, Brenner B, Benchimol D, Kashtan H, Sadot E. Sarcopenia as a Predictor of Survival in Patients with Pancreatic Adenocarcinoma After Pancreatectomy. Ann Surg Oncol 2021; 29:1553-1563. [PMID: 34716836 DOI: 10.1245/s10434-021-10995-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/06/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine whether sarcopenia can potentially predict worse survival after resection of pancreatic ductal adenocarcinoma. BACKGROUND Sarcopenia is correlated with poor outcomes in hepatopancreatobiliary malignancies, but the relationship of both its qualitative and quantitative features with patient survival after pancreatectomy has not been investigated in a western population. PATIENTS AND METHODS Preoperative cross-sectional computed tomography scans of consecutive patients who underwent pancreatectomy in 2005-2017 were evaluated for skeletal muscle index (SMI), intramuscular adipose tissue content (IMAC), and visceral-to-subcutaneous adipose tissue area ratio (VSR). Sex-specific categorical cut-offs were determined. Findings were correlated with outcome. RESULTS The study included 111 patients, 47% of whom were female, with a median age of 67 years (range: 35-87 years), and median body mass index of 23 kg/m2 (range: 16-40 kg/m2); 77% had a Whipple procedure and 66% received adjuvant chemotherapy. Low SMI correlated with poor overall survival (OS) (P = 0.007), disease-specific survival (DSS) (P = 0.006), and recurrence-free survival (RFS) (P = 0.01). High IMAC correlated with poor OS (P = 0.04). Patients with high IMAC tended to have a shorter DSS (P = 0.09), with no correlation with RFS (P = 0.6). VSR was not associated with survival. Multivariable analysis yielded an independent association of low SMI with OS (HR = 1.7, 95%CI: 1.1-2.8, P = 0.02), DSS (HR = 1.8, 95%CI: 1.03-3.2, P = 0.04), and RFS (HR = 1.8, 95%CI: 1.1-2.8, P = 0.01), and of high IMAC with OS (HR = 1.9, 95%CI: 1.1-3.1, P = 0.01). CONCLUSION Both qualitative and quantitative measures of skeletal muscle were independently associated with impaired survival in patients with resectable PDAC. Sarcopenia might serve as an early radiographic surrogate of aggressive tumor behavior, with potential implications for clinical decision-making and future study.
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Affiliation(s)
- Hadass Rom
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Tamir
- Department of Radiology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeroen L A Van Vugt
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Yael Berger
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Perl
- Department of Oncology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Sara Morgenstern
- Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Ana Tovar
- Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Baruch Brenner
- Department of Oncology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Daniel Benchimol
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Sadot
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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17
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Schrier I, Feferman Y, Berger Y, Yahav D, Sadot E, Sulimani O, Stein M, Kashtan H. Robotic-assisted Heller Myotomy Is a Safe Operation. Isr Med Assoc J 2021; 23:631-634. [PMID: 34672444] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Surgical myotomy is the best therapeutic option for patients with achalasia. The minimally invasive technique is considered to be the preferred method for many surgeons. Robotic-assisted laparoscopic myotomy has several advantages over conventional laparoscopic surgery. These benefits include more accurate incisions that may result in a lower rate of intra-operative complications. OBJECTIVES To describe our technique of performing robotic-assisted Heller myotomy and to review the initial results of this procedure. METHODS All patients undergoing robotic-assisted Heller myotomy for achalasia between the years 2012-2018 at Rabin Medical Center were retrospectively reviewed from our institutional prospective database. RESULTS Thirty patients underwent robotic-assisted Heller myotomy for achalasia. Mean operative time was 77 minutes (range 47-109 minutes) including docking time of the robotic system. There were no cases of conversion to laparoscopic or open surgery. There were no cases of intra-operative perforation of the mucosa. None of the patients had postoperative morbidity or mortality. Good postoperative results were achieved in 25 patients. Four patients required additional intervention (3 had endoscopic dilatations and 1 with known preoperative endstage achalasia had undergone esophagectomy). One patient was lost to follow-up. CONCLUSIONS Robotic-assisted Heller myotomy is a safe technique with a low incidence of intra-operative esophageal perforation compared to the laparoscopic approach. We believe that robotic-assisted surgery should be the procedure of choice to treat achalasia.
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Affiliation(s)
- Ilan Schrier
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Feferman
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Berger
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Infectious Disease Unit, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Sadot
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omri Sulimani
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Stein
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Zlotnik O, Goshen-Lago T, Haddad R, Brenner B, Kundel Y, Ben-Aharon I, Kashtan H. Proteomic analysis to identify markers for response to neoadjuvant treatment in esophageal and gastroesophageal cancer. Cancer Rep (Hoboken) 2021; 5:e1489. [PMID: 34350714 PMCID: PMC8955071 DOI: 10.1002/cnr2.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Esophageal cancer represents a global challenge. Despite significant evolution of treatment protocols in the past decade, recurrence rates are still high and survival rates are poor. Current treatment paradigm for localized gastroesophageal junction (GEJ) carcinoma remains to be further elucidated as for the role of neoadjuvant chemoradiation versus perioperative chemotherapy. AIM To identify biomarkers for response to chemoradiation in esophageal and gastroesophageal cancer, we performed an in-depth proteomic analysis of esophageal and gastroesophageal tumors, to describe differences in pathway activation between patients with favorable and poor prognosis following neoadjuvant chemoradiation. METHODS Patients with locally advanced esophageal and gastroesophageal cancer following neoadjuvant chemoradiation were included in the cohort. The study cohort was dichotomized into two groups of patients, named "favorable prognosis" and "poor prognosis" according to the postoperative disease-free interval. We performed a mass spectrometry analysis of proteins extracted from the malignant regions of surgical specimens and analyzed data from electronic medical records. Clinical data was correlated with differences in protein expression between patient with a favorable and poor prognosis using validated gene expression pathways. RESULTS The study included 35 patients with adenocarcinoma. All patients in this cohort had esophageal adenocarcinoma. Patients median age was 62 years. Twenty-five (71.3%) patients underwent neoadjuvant chemoradiation, and 28.7% underwent neoadjuvant chemotherapy only. A proteomic analysis of our cohort identified 2885 proteins. Enrichment levels of 98 of these proteins differed significantly between favorable and poor prognosis cohorts in patients who underwent neoadjuvant chemoradiation (p < .05) but not in patients who underwent neoadjuvant chemotherapy. The favorable prognosis patients group analysis exhibited differential enrichment of 87 proteins related to cellular respiration and oxidative phosphorylation pathways as well as proteins of the RAS oncogene family. CONCLUSION In this study we identified differential enrichment of pathways related to oxidative phosphorylation and RAS oncogene pathway in esophageal cancer patients with a favorable response to chemoradiation. Following further validation, our findings may portray potential surrogate signature of biomarkers based upon these pathways.
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Affiliation(s)
- Oran Zlotnik
- Department of Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tal Goshen-Lago
- Oncology Division, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Riad Haddad
- Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Department of Surgery, Carmel Medical Center, Haifa, Israel
| | - Baruch Brenner
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Yulia Kundel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Irit Ben-Aharon
- Oncology Division, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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19
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Verter E, Berger Y, Perl G, Peretz I, Tovar A, Morgenstern S, Brenner B, Benchimol D, Kashtan H, Sadot E. ASO Visual Abstract: Neutrophil-to-Lymphocyte Ratio Predicts Recurrence Pattern in Patients with Resectable Colorectal Liver Metastases. Ann Surg Oncol 2021. [PMID: 33999345 DOI: 10.1245/s10434-021-10060-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eden Verter
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Berger
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Perl
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Idit Peretz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Ana Tovar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Sara Morgenstern
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Baruch Brenner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Daniel Benchimol
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Sadot
- Department of Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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20
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Greemland I, Raveh G, Gavrielli S, Sadot E, Kashtan H, Wasserberg N. High Rates of Incisional Hernia After Laparoscopic Right Colectomy With Midline Extraction Site. Surg Laparosc Endosc Percutan Tech 2021; 31:722-728. [PMID: 34320593 DOI: 10.1097/sle.0000000000000977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Laparoscopic surgery aims at reducing wound complications and improving cosmetics, among other advantages. High rates of postoperative ventral hernia (POVH) are observed after laparoscopic-assisted colectomies. MATERIALS AND METHODS In a 2011 to 2016 retrospective study of all patients at Rabin Medical Center, we examined POVH prevalence after right hemicolectomy for neoplasia and correlation to specimen extraction site. We also compared laparoscopic-assisted colectomy to hand-assisted laparoscopic colectomy. Included were patients who had postoperative abdominal computed tomography or magnetic resonance imaging scan as part of their routine oncological follow-up to 6 months postsurgery. Patients were excluded for conversion to laparotomy, and prior abdominal surgeries after right colectomy and before follow-up computed tomography/magnetic resonance imaging scan. Demographic and surgical data were collected from patient electronic records, and scans reviewed for POVH by a designated radiologist. RESULTS Of 370 patients, 138 (mean age 70.09 y, 58 males) were included: 54 (39.1%) were diagnosed with POVH, 42/72 (58.3%) at midline extraction site, and 12/66 (18.8%) at off-midline extraction sites (P<0.0001). Surgical site infections and patients positive for tumor metastasis were associated with higher POVH rates. Most (74%) POVHs were identified within 18 months postsurgery (P<0.0001). Body mass index, age, sex, diabetes mellitus, smoking, tumor size, lymph nodes positive for metastasis, and hand-assisted laparoscopic colectomy were not associated with POVH prevalence. CONCLUSION High rates of radiologically diagnosed POVH were found after laparoscopic-assisted colectomy, with association to midline extraction site, surgical site infections, and positive tumor distant metastasis.
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Affiliation(s)
- Itzhak Greemland
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Raveh
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Gavrielli
- Department of Imaging, Rabin Medical Center, Beilinson Hospital, Petach Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Sadot
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- Department of Surgery
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Abstract
The need for an antireflux procedure during repair of a paraesophageal hernia (PEH) has been the subject of a long-standing controversy. With most centers now performing routine fundoplication during PEH repair, high-quality data on whether crural repair alone or using a mesh may provide adequate anti-reflux effect is still scarce. We sought to answer to the question: "Is fundoplication routinely needed during PEH repair?". Our endpoints were (I) rates of postoperative gastroesophageal reflux disease (GERD) (either symptomatic or objectively assessed), (II) rates of recurrence, and (III) rates of postoperative dysphagia. We searched the MEDLINE, Cochrane, PubMed, and Embase databases for papers published between 1995 and 2019, selecting comparative cohort studies and only including papers reporting the rationale for performing or not performing fundoplication. Overall, nine papers were included for review. While four of the included studies recommended selective or no fundoplication, most of these data come from earlier retrospective studies. Higher-quality data from recent prospective studies including two randomized controlled trials recommended routine fundoplication, mostly due to a significantly lower incidence of postoperative GERD. However, only a relatively short follow-up of 12 months was presented, which we recognize as an important limitation. Fundoplication did not seem to result in reduced recurrence rates when compared to primary repair alone.
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Affiliation(s)
- Daniel Solomon
- Department of General Surgery, Rabin Medical Center, Campus Beilinson, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Petach-Tikva, Israel
| | - Eliahu Bekhor
- Department of General Surgery, Rabin Medical Center, Campus Beilinson, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Petach-Tikva, Israel
| | - Hanoch Kashtan
- Department of General Surgery, Rabin Medical Center, Campus Beilinson, Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Petach-Tikva, Israel
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22
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Verter E, Berger Y, Perl G, Peretz I, Tovar A, Morgenstern S, Brenner B, Benchimol D, Kashtan H, Sadot E. Neutrophil-to-Lymphocyte Ratio Predicts Recurrence Pattern in Patients with Resectable Colorectal Liver Metastases. Ann Surg Oncol 2021; 28:4320-4329. [PMID: 33886020 DOI: 10.1245/s10434-021-10000-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/19/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies have suggested that neutrophil-to-lymphocyte ratio (NLR) has value as a predictor of long-term outcomes in various cancer types. Its prognostic potential in patients with CRLM has not been thoroughly investigated. This original, retrospective study assessed the relationship between the preoperative NLR, survival outcomes, and recurrence patterns in patients after colorectal liver metastasis resection (CRLM). METHODS The prospectively maintained database of a tertiary medical center was queried for all patients who underwent CRLM resection between 2005 and 2017. Patients were divided into two groups: NLR <3 (normal) or >3 (high). Recurrence risk was analysed using Fine and Gray correction for competing risk method and cause specific analyses. RESULTS The cohort included 231 patients of whom 53 (23%) had a high neutrophil-to-lymphocyte ratio. At presentation, 35% had synchronous disease and 48% had a solitary metastasis; median tumor size was 2 cm. Patients with a high NLR had a significantly higher rate of simultaneous colorectal resection (P = 0.01). A high NLR was independently associated with worse OS (P = 0.02), worse DFS (P = 0.03), and higher risk of recurrence (P = 0.048), specifically recurrence with an extrahepatic pattern (P = 0.03). CONCLUSIONS A high preoperative NLR was independently associated with poorer survival outcomes and extrahepatic recurrence pattern. The NLR appears to have prognostic importance in CRLM and may serve as a surrogate marker of aggressive systemic disease after resection. These findings warrant external validation, preferably in a prospective design.
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Affiliation(s)
- Eden Verter
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Berger
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Perl
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Idit Peretz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Ana Tovar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Sara Morgenstern
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Pathology, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Baruch Brenner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel
| | - Daniel Benchimol
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Sadot
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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23
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Solomon D, Abbas M, Feferman Y, Haddad R, Perl G, Kundel Y, Morgenstern S, Menasherov N, Kashtan H. Signet Ring Cell Features are Associated with Poor Response to Neoadjuvant Treatment and Dismal Survival in Patients with High-Grade Esophageal Adenocarcinoma. Ann Surg Oncol 2021; 28:4929-4940. [PMID: 33709175 DOI: 10.1245/s10434-021-09644-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND While the prognosis of patients with locoregional esophageal adenocarcinoma (EAC) has improved in the neoadjuvant treatment (NAT) era, high-grade histology (G3) is still associated with a limited treatment response. We sought to investigate oncologic outcomes in patients after esophagectomy for G3 EAC and to identify predictors of poor survival among these patients. METHODS Patients with EAC who underwent resection with curative intent in 2011-2018 were divided by histologic grade (G3, G1/2) and compared for overall survival (OS). Cox regression was performed to analyze the response to NAT and the predictive role of signet ring cell (SRC) features. RESULTS The cohort included 163 patients, 94 (57.7%) with G3 histology. NAT was administered to 69 (73.4%) patients. Following resection, OS in the G3 EAC group was 30 months (95% confidence interval [CI] 23.9-36.1). On univariate analysis, G3 disease (p = 0.050) and SRC features (p = 0.019) predicted low OS. Median survival in the G3 EAC group was worse in patients with SRC histology (18 months, 95% CI 8.6-27.4) than those without (30 months, 95% CI 23.8-36.1; p = 0.041). No patients with SRC histology were alive at 5 years of follow-up. Among all patients administered NAT, 88.2% of those with SRC showed minimal or no pathologic response and only 27.8% were downstaged. CONCLUSIONS High-grade histology was found in most patients with EAC and predicted poor survival and treatment response. SRC features in patients with G3 disease were associated with lower OS. The benefit of NAT for G3 EAC in patients with SRC histology appears limited.
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Affiliation(s)
- Daniel Solomon
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Muhammad Abbas
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Feferman
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riad Haddad
- Department of Surgery, Carmel Carmel Medical Center, Affiliated with the Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Gali Perl
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Kundel
- Davidoff Cancer Center, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Morgenstern
- Department of Pathology, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nikolai Menasherov
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center - Beilinson Hospital, Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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24
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Solomon D, Kashtan H. ASO Author Reflections: High-Grade Status and Signet Ring Cell Features in Esophageal Adenocarcinoma. Ann Surg Oncol 2021; 28:4941-4942. [PMID: 33634389 DOI: 10.1245/s10434-020-09579-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Daniel Solomon
- Department of General Surgery, Rabin Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hanoch Kashtan
- Department of General Surgery, Rabin Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Fishbain D, Kashtan H, Eliashar R, Paret G. [POSTGRADUATE MEDICAL EDUCATION DURING COVID-19 PANDEMIC IN ISRAEL]. Harefuah 2020; 159:856-860. [PMID: 33369297] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The Covid-19 pandemic has posed significant challenges to many aspects of life, including work processes to which we have become accustomed. Health systems world-wide have been affected in numerous ways and face epic and unprecedented challenges. Medical education, both in Israel and around the world, has been deeply impacted. It is no surprise that the institutions responsible for medical education, as well as many other institutions, have had to deal with uncertainty and unrest. In this article, we review the processes adopted by the Scientific Council of the Israel Medical Association, the body responsible for postgraduate medical training in the various medical specialties. The article reviews the actions taken by the Council during the first few months of the pandemic, March-July 2020, in order to maintain the quality of training.
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Affiliation(s)
- Dana Fishbain
- The Scientific Council of IMA
- Ariel University, Department of Health Systems Management, School of Health Sciences
| | - Hanoch Kashtan
- The Scientific Council of IMA
- Division of Surgery, Rabin Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
| | - Ron Eliashar
- The Scientific Council of IMA
- Department of Otolaryngology/H and N Surgery, Division of Head-Face-Neck and Reconstructive Surgery, Hadassah Medical Center
- Hebrew University School of Medicine
| | - Gidi Paret
- The Scientific Council of IMA
- Sackler Faculty of Medicine, Tel Aviv University
- Pediatric Intensive Care, Sheba Medical Center
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26
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Eliashar R, Fishbain D, Paret G, Kashtan H. [RESIDENCY EXAMINATIONS IN THE COURSE OF THE COVID-19 CRISIS: THE EFFORTS OF THE ISRAELI SCIENTIFIC COUNCIL TO EXECUTE THE FINAL BOARD ORAL EXAMINATIONS DURING A LOCAL AND A WORLDWIDE PANDEMIC]. Harefuah 2020; 159:851-855. [PMID: 33369296] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The Israeli Scientific Council is responsible for the physician's training process and the residency exams. These are performed in two phases: Stage A (written examination) and Stage B (the final Board oral examination). The COVID-19 pandemic started in Israel a few weeks before the scheduled spring 2020 Stage B exams and had a major impact, not only on the health and economic systems in Israel, but also on the residency exams. AIMS To describe the efforts of the Israeli Scientific Council to execute the spring 2020 Stage B exams during the COVID-19 pandemic in comparison to the worldwide data, and to deduce the appropriate management during potential future crises. METHODS We present a description of the activity of the Israeli Scientific Council since the start of the COVID-19 pandemic according to documents and other sources, An internet search was conducted on the destiny of residency examinations throughout the world, and a comparison between them. RESULTS Due to rapid worsening in the restrictions enforced in Israel, the spring 2020 oral board exams were cancelled. However, a decision was made to execute them in the summer. This new schedule dictated a delay in the schedule of other residency examinations and forced condensation of 5 periods into 10 months instead of 14. The examination team prepared the new summer exams period under the assumption that heavy restrictions will still be implemented. Indeed, COVID-19 was still around and the restrictions were still enforced. Despite that, all oral Board examinations were perfectly executed. This contrasts with the rest of the world, in which most residency exams were cancelled, even without a solution or an alternative date. CONCLUSIONS Recruitment of all involved and preparation for the worst-case scenario enabled the perfect execution of the previously cancelled exams, and will enable the execution of future residency exams under conditions of potential health or war crises. DISCUSSION To the best of our knowledge, the Israeli Scientific Council is the only communal body in the world which organized an alternative period for the cancelled oral exams, only 4 months after the cancelled dates. Due to an enormous effort and rigorous preparations, Israel is also the only place in which oral exams were successfully executed, physically, under an active disease and very heavy restrictions.
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Affiliation(s)
- Ron Eliashar
- The Scientific Council of IMA
- Department of Otolaryngology/H and N Surgery, Division of Head-Face-Neck and Reconstructive Surgery, Hadassah Medical Center
- Hebrew University School of Medicine
| | - Dana Fishbain
- The Scientific Council of IMA
- Ariel University, Department of Health Systems Management, School of Health Sciences
| | - Gidi Paret
- The Scientific Council of IMA
- Sackler Faculty of Medicine, Tel Aviv University
- Pediatric Intensive Care, Sheba Medical Center
| | - Hanoch Kashtan
- The Scientific Council of IMA
- Division of Surgery, Rabin Medical Center
- Sackler Faculty of Medicine, Tel Aviv University
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27
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Cooper L, Siam B, Sagee A, Orgad R, Levi Y, Wasserberg N, Beloosesky Y, Kashtan H. Some Nursing Screening Tools Can Be Used to Assess High-Risk Older Adults Who Undergo Colorectal Surgery for Cancer. Clin Interv Aging 2020; 15:1505-1511. [PMID: 32921996 PMCID: PMC7458272 DOI: 10.2147/cia.s258992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/03/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Life expectancy and incidence of cancer among older adults are increasing. The aim of this study was to assess whether routinely used nursing screening tools can predict surgical outcomes in older adults with colorectal cancer. Methods Data of patients who underwent elective colorectal cancer surgery at Rabin Medical Center during the years 2014-2016 were collected retrospectively. Patients were divided into study group (age 80-89 y), and control group (age 60-69 y) for comparing surgical outcomes and six-month mortality. In the study group, screening tool scores were evaluated as potential predictors of surgical outcomes. These included Malnutrition Universal Screening Tool (MUST), Admission Norton Scale Scores (ANSS), Morse Fall Scale (MFS), and Charlson Co-morbidity Index (CCI). Results The study group consisted of 77 patients, and the control group consisted of 129 patients. Postoperative mortality and morbidity were similar in both groups. Nursing screening tools did not predict immediate postoperative outcomes in the study group. MUST and CCI were predictors for six-month mortality. CCI score was 9.43±2.44 in those who died within six months from surgery compared to 7.07 ±1.61 in those who were alive after six months (p<0.05). Post-operative complications were not associated with increased 30-day mortality. Advanced grade complications were associated with an increased six-month mortality (RR=1.37, 95% CI 0.95-1.98, p=0.013). Conclusion Different screening tools for high-risk older adults who are candidates for surgery have been developed, with the caveat of necessitating skilled physicians and resources such as time. Routinely used nursing screening tools may be helpful in better patient selection and informed decision making. These tools, specifically MUST and CCI who were found to predict six-month survival, can be used to additionally identify high-risk patients by the nursing staff and promote further evaluation. This can be a valuable tool in multidisciplinary and patient-centered care.
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Affiliation(s)
- Lisa Cooper
- Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Baha Siam
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Aviv Sagee
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Internal Medicine C, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Ran Orgad
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Yochai Levi
- Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
| | - Yichayaou Beloosesky
- Department of Geriatric Medicine, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel.,The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- The Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.,Department of Surgery, Rabin Medical Center, Campus Beilinson, Petah Tiqva, Israel
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28
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Cooper L, Levy Y, Nissenholtz A, Bugaevsky Y, Kashtan H, Beloosesky Y. [EVALUATION OF THE ELDERLY PATIENT WITH CANCER]. Harefuah 2020; 159:678-682. [PMID: 32955811] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
In recent years, there has been a significant increase in the number of adult patients with malignant diseases. These patients are a major therapeutic challenge due to a high incidence of comorbidities, lower functional status and often a diagnosis of the disease at a relatively advanced stage. The preferred approach to the treatment of cancer is a multidisciplinary approach. In the last decade, we have witnessed the integration of geriatricians as part of the multidisciplinary team in order to better assess patients' ability to withstand oncological or surgical treatment and, if necessary, to prepare them better for these treatments. In this article we review the use of various geriatric tools, such as generalized geriatric assessment, fragility and sarcopenia, and their effect on the decision-making process of the treating physicians and on the outcomes of the various treatments, including the outcomes of the operations. We show that comprehensive geriatric assessment is the basis for the evaluation of the adult oncology patients, and proper preparation for treatment in order to improve the outcomes of the treatment and reduce its complications. The rapid growth rate of the elderly population in Israel, together with the continuous development of oncology and cancer treatments, indicate the need to allocate resources and efforts to treat this unique population. We recommend an integration of geriatricians in the multidisciplinary team that treats this population.
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Affiliation(s)
- Lisa Cooper
- Department of Geriatrics, Rabin Medical Center, campus Beilinson, Sackler Faculty of Medicine, Tel Aviv University
| | - Yochai Levy
- Department of Geriatrics, Rabin Medical Center, campus Beilinson, Sackler Faculty of Medicine, Tel Aviv University
| | - Adaya Nissenholtz
- Department of Geriatrics, Rabin Medical Center, campus Beilinson, Sackler Faculty of Medicine, Tel Aviv University
| | - Yulia Bugaevsky
- Department of Geriatrics, Rabin Medical Center, campus Beilinson, Sackler Faculty of Medicine, Tel Aviv University
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, campus Beilinson
| | - Yichayaou Beloosesky
- Department of Geriatrics, Rabin Medical Center, campus Beilinson, Sackler Faculty of Medicine, Tel Aviv University
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29
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Zilbermints V, Israeli O, Ben Abraham B, Ben-Gal T, Rubchevsky V, Aravot D, Kashtan H, Menasherov N, Aranovich D. Abdominal Surgery in Patients with a Ventricular Assist Device: A Single Center Experience in Israel. Isr Med Assoc J 2020; 22:369-373. [PMID: 32558443] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Left ventricular assist devices (LVADs) are used more commonly in patients with advanced-stage heart failure. Some of these patients may require elective or urgent abdominal surgical procedures. OBJECTIVES To determine the outcomes of the management of LVAD-supported patients who underwent elective and urgent abdominal surgical procedures in our institution. METHODS A retrospective review was conducted on 93 patients who underwent LVAD implantation between August 2008 and January 2017. All abdominal surgeries in these patients were studied, and their impact on postoperative morbidity and mortality Ten patients underwent abdominal surgical procedures. Of these procedures, five were emergent and five were elective. The elective cases included one bariatric surgery for morbid obesity, one hiatal hernia repair, two cholecystectomies, and one small bowel resection for a carcinoid tumor. The emergency cases included suspected ischemic colitis, right colectomy for bleeding adenocarcinoma, laparotomy due to intraabdominal bleeding, open cholecystectomy for gangrenous cholecystitis, and laparotomy for sternal and abdominal wall infection. All patients undergoing elective procedures survived. Of the five patients who underwent emergency surgery, three died (60%, P = 0.16) and one presented with major morbidity. One of the two survivors required reintervention. In total, 12 interventions were performed on this group of patientswas evaluated. RESULTS Ten patients underwent abdominal surgical procedures. Of these procedures, five were emergent and five were elective. The elective cases included one bariatric surgery for morbid obesity, one hiatal hernia repair, two cholecystectomies, and one small bowel resection for a carcinoid tumor. The emergency cases included suspected ischemic colitis, right colectomy for bleeding adenocarcinoma, laparotomy due to intraabdominal bleeding, open cholecystectomy for gangrenous cholecystitis, and laparotomy for sternal and abdominal wall infection. All patients undergoing elective procedures survived. Of the five patients who underwent emergency surgery, three died (60%, P = 0.16) and one presented with major morbidity. One of the two survivors required reintervention. In total, 12 interventions were performed on this group of patients. CONCLUSIONS It is safe to perform elective abdominal procedures for LVAD-supported patients. The prognosis of these patients undergoing emergency surgery is poor and has high mortality and morbidity rates.
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Affiliation(s)
- Veacheslav Zilbermints
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oren Israeli
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Binyamin Ben Abraham
- Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tuvia Ben-Gal
- Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Rubchevsky
- Department of Cardiothoracic Surgery Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Aravot
- Department of Cardiothoracic Surgery Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nikolai Menasherov
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Aranovich
- Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel
- Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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30
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Horesh N, Lessing Y, Rudnicki Y, Kent I, Kammar H, Ben-Yaacov A, Dreznik Y, Zbar AP, Tulchinsky H, Avital S, Mavor E, Kashtan H, Klausner JM, Gutman M, Zmora O, Wasserberg N. Timing of colostomy reversal following Hartmann's procedure for perforated diverticulitis. J Visc Surg 2020; 157:395-400. [PMID: 31954631 DOI: 10.1016/j.jviscsurg.2020.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIM Hartmann's procedure is the surgical treatment of choice for perforated acute diverticulitis. Hartmann's reversal (HR) that is performed at a later stage may be challenging. The optimal timing for HR is still a subject for controversy. The aim of this study is to assess whether the timing of HR affects surgical outcome. PATIENTS AND METHODS A retrospective-cohort multi-center study was conducted, including all patients who underwent HR for acute diverticulitis from January 2004 to June 2015 in 5 medical centers. Patient data included demographics, surgical data and post-operative outcome. RESULTS One hundred and twenty-two patients were included in the database. Median time from Hartmann's procedure to reversal was 182.7 days, with the majority of patients (76 patients, 62.2%) operated 60 to 180 days from the Hartmann's procedure. Fifty-seven patients (46.7%) had post-operative complications, most commonly wound infections (27 patients, 22.1%). Receiver operating characteristic (ROC) curve and a propensity score match analysis (P=0.43) correlating between days to HR from the index procedure showed no specific cut-off point regarding post-operative complications (P=0.16), Major (Clavien-Dindo score of 3 or more) complications (P=0.19), Minor (Clavien Dindo 1-2) and no complications (P=0.14). Median length of stay was 10.9 days (range 3-90) and Pearson correlation failed to demonstrate a correlation between timing of surgical intervention and length of stay (P=0.4). CONCLUSION Hartmann's Reversal is a complex surgical procedure associated with high rates of complications. In our series, timing of surgery did not affect surgical complications rate or severity or the length of hospital stay.
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Affiliation(s)
- N Horesh
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel.
| | - Y Lessing
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - Y Rudnicki
- Department of Surgery B, Meir Medical Center, Kfar Saba, 4428164 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - I Kent
- Department of Surgery B, Meir Medical Center, Kfar Saba, 4428164 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - H Kammar
- Department of Surgery, Kaplan Medical Center, Rehovot, 7661041 Israel; The Hebrew University-Hadassah Medical School, Jerusalem 9112001 Israel
| | - A Ben-Yaacov
- Department of Surgery B, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - Y Dreznik
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - A P Zbar
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - H Tulchinsky
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - S Avital
- Department of Surgery B, Meir Medical Center, Kfar Saba, 4428164 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - E Mavor
- Department of Surgery, Kaplan Medical Center, Rehovot, 7661041 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - H Kashtan
- Department of Surgery B, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - J M Klausner
- Department of Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, 6423906 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - M Gutman
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - O Zmora
- Department of General Surgery B and Organ Transplantation, Sheba Medical Center, Tel Hashomer, 5262601 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
| | - N Wasserberg
- Department of Surgery B, Rabin Medical Center-Beilinson Hospital, Petach Tikva 4941492 Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801 Israel
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Moore A, Hikri E, Goshen-Lago T, Barkan T, Morgenstern S, Brook E, Maderer A, Roth W, Gordon N, Kashtan H, Brenner B, Moehler M, Aharon IB. Young-onset gastric cancer and Epstein-Barr Virus (EBV) - a major player in the pathogenesis? BMC Cancer 2020; 20:34. [PMID: 31937281 PMCID: PMC6961297 DOI: 10.1186/s12885-020-6517-0] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 01/06/2020] [Indexed: 12/30/2022] Open
Abstract
Objective Gastric cancer (GC) is a leading cause of cancer death, occurs predominantly in older age, with increasing incidence in young patients. The Cancer Genome Atlas indicates four subtypes for GC among which Epstein-Barr virus (EBV) subtype is estimated at 8.7%. We aim to determine the prevalence of EBV subtype in young GC patients (≤45 years) compared with an average-onset cohort (≥55 years) and characterize the clinicopathologic pattern of young-onset GC. Methods Gastric cancer samples of patients of both cohorts were screened for EBV by qPCR. Additional staining was done for Human epidermal growth factor receptor 2 (HER2), microsatellite instability (MSI) status and Programmed death-ligand 1 (PD-L1). Demographics and clinical data were retrieved from the medical records. Results Thirty-nine young-onset and 35 average-onset GC patients were reviewed. There was no apparent difference in tumor location, family history, histology and HER2 status between the cohorts. More young-onset patients were diagnosed with metastatic disease (27% vs 9%, p = 0.0498). EBV was significantly more prevalent in the young-onset cohort (33% vs 11%, p = 0.025). 15/17 EBV positive patients were under the median age of diagnosis for GC in the US (68 years). MSI-H was found only in the average-onset cohort [0% vs 27%, p = 0.001). PD-L1 positivity was higher in the young-onset cohort (31% vs 3%, p = 0.002). Conclusion Our study indicates that EBV subtype is more prevalent in young-onset GC and may play a key role in the pathogenesis. Higher rate of PD-L1 positivity in young-onset GC could change treatment strategies. We are currently evaluating these findings in a prospective trial.
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Affiliation(s)
- Assaf Moore
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Ze'ev Jabotinsky Rd 39, 4941492, Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel.
| | - Elad Hikri
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel
| | - Tal Goshen-Lago
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Ze'ev Jabotinsky Rd 39, 4941492, Petah Tikva, Israel
| | - Tamar Barkan
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel
| | - Sara Morgenstern
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel.,Department of Pathology, Rabin Medical Center, Ze'ev Jabotinsky Rd 39, 4941492, Petah Tikva, Israel
| | - Elena Brook
- Department of Pathology, Rabin Medical Center, Ze'ev Jabotinsky Rd 39, 4941492, Petah Tikva, Israel
| | - Annett Maderer
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Wilfried Roth
- Tissue Bank and Institute of Pathology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Noa Gordon
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Ze'ev Jabotinsky Rd 39, 4941492, Petah Tikva, Israel
| | - Hanoch Kashtan
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel.,Department of surgery B, Beilinson campus, Rabin Medical Center, Ze'ev Jabotinsky Rd 39, 4941492, Petah Tikva, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Ze'ev Jabotinsky Rd 39, 4941492, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel
| | - Markus Moehler
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Irit Ben Aharon
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Ze'ev Jabotinsky Rd 39, 4941492, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, 6997801, Tel Aviv, Israel
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32
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Solomon D, Kaminski O, Schrier I, Kashtan H, Stein M. Isolated Traumatic Brain Injury in the Very Old. Isr Med Assoc J 2019; 21:779-784. [PMID: 31814339] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Older age is an independent predictor of worse outcome from traumatic brain injury (TBI). No clear guidelines exist for the management of TBI in elderly patients. OBJECTIVES To describe the outcomes of elderly patients presenting with TBI and intracranial bleeding (ICB), comparing a very elderly population (≥ 80 years of age) to a younger one (70-79). METHODS Retrospective analysis of the outcomes of elderly patients presenting with TBI with ICB admitted to a level I trauma center. RESULTS The authors analyzed 100 consecutive patients aged 70-79 and 100 patients aged 80 and older. In-hospital mortality rates were 9% and 21% for groups 70-79 and ≥ 80 years old, respectively (P = 0.017). Patients 70-79 years old showed a 12-month survival rate of 73% and a median survival of 47 months. In patients ≥ 80 years old, 12-month survival was 63% and median survival was 27 months (P = NS). In patients presenting with a Glasgow Coma Scale score of ≥ 8, the in-hospital mortality rates were 41% (n=5/12) and 100% (n=8/8). Among patients ≥ 80 years old undergoing emergent surgical decompression, in-hospital mortality was 66% (n=12/18). Survivors presented with a severe drop in their functional score. Survival was dismal in patients ≥ 80 years old who were treated conservatively despite recommended operative guidelines. CONCLUSIONS There is a lack of reliable means to evaluate the outcome in patients with poor functional status at baseline. The negative prognostic impact of severe TBI is profound, regardless of treatment choices.
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Affiliation(s)
- Daniel Solomon
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oleg Kaminski
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Schrier
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michael Stein
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Fishbain D, Aviram L, Paret G, Kashtan H. [POSTGRADUATE MEDICAL EDUCATION ACCREDITATION IN ISRAEL]. Harefuah 2019; 158:659-663. [PMID: 31576713] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Accreditation of Post-Graduate Medical Education permits medical institutions to train residents, allowing them to achieve specialist certification. An accreditation system usually employs several tools such as site-visits, information gathering and occasionally self-evaluation, to determine adherence to pre-defined standards. The Scientific Council of the Israeli Medical Association is entrusted by law on this accreditation system in Israel. In our article, we briefly review the Post-Graduate Medical Education accreditation system in Israel and a number of pivotal challenges faced by the Scientific Council in this field in the 21st century. These challenges include the adaptation to different medical settings such as community based clinics and medical arrays, the adaptation of tools used for accreditation, new methods for up to date information gathering and updated structure of site-visit teams. A significant future challenge will be adapting the accreditation system to the new Competency Based Medical Education model of residency promoted in Israel by the Scientific Council.
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Affiliation(s)
- Dana Fishbain
- The Scientific Council of the Israeli Medical Association
| | - Lilach Aviram
- The Scientific Council of the Israeli Medical Association
| | - Gideon Paret
- The Scientific Council of the Israeli Medical Association
- Pediatric Intensive Care Unit, Sheba Medical Center
| | - Hanoch Kashtan
- The Scientific Council of the Israeli Medical Association
- Department of Surgery, Rabin Medical Center
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34
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Refaeli R, Cooper L, Mendel S, Slonim-Drech S, Frishman S, Kashtan H. MON-LB701: Nutritional and Functional Characteristics of Elderly Oncology Patients Undergoing Major Abdominal Surgery. Clin Nutr 2019. [DOI: 10.1016/s0261-5614(19)32156-9] [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: 10/26/2022]
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35
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Zlotnik O, Goshen-Lago T, Brenner B, Kundel Y, Menasherov N, Kashtan H, Ben-Aharon I. Proteomic analysis to identify markers for response to treatment in esophageal cancer. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.4_suppl.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
61 Background: Neoadjuvant chemoradiotherapy (NCRT) followed by surgery represents a key therapeutic strategy for locally advanced esophageal cancer (LAEC). Former studies addressed the clinicopathological patterns of patients who demonstrated good response to NCRT compared with inferior response. Nevertheless, there is paucity of data regarding potentially involved cellular pathways that account for tumor response to NCRT. We performed a comprehensive proteomic analysis to identify the key differences in protein function and pathway activation between patients with a poor response and those with a favourable response to treatment. Methods: Patients diagnosed with LAEC who were treated with NCRT and operated at our institution were included in the study. Patients were defined as good responders (GR) upon the tumor regression grade (TRG) in the pathological specimen: GR defined as TRG 0/1 and no evidence of recurrence at 1-year post surgery. Bad responders (BR) were defined as TRG 2/3 and recurrence < 1year. Tumor was isolated from the surgical specimen and proteins were extracted and processed for mass spectrometry-based analysis. Clinical data of demographics, response to treatment, and survival was retrieved from electronic medical records. Difference in protein expression between GR and BR were analysed using validated gene expression pathways tools and correlated to clinical data. Results: Forty-four patients were included in the cohort. Mean age was 66.7 years, male predominance (33/44). Thirty-five patients had adenocarcinoma – 17 GR and 18 BR. Nine patients had squamous cell carcinoma – 6 GR and 3 BR. Protein expression patterns significantly differed between GR and BR regardless of histology, mainly in cellular pathways account for nucleic acid metabolism (p < 10-9), whereas BR had overexpression of these genes. Conclusions: Our study indicate that lack of response to NCRT may derive from overexpression of unique cellular pathways. Former studies imply these cellular pathways may play a role in resistance to cisplatin. Larger transcriptomic studies are warranted for future analysis to extend these observations.
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Affiliation(s)
| | | | | | | | | | | | - Irit Ben-Aharon
- Davidoff Center Rabin Medical Center Oncology, Hod-Hasharon, Israel
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36
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Domachevsky L, Kashtan H, Brenner B, Nidam M, Morgenstern S, Kundel Y, Groshar D, Bernstine H. Baseline 18F-FDG PET/CT as predictor of the pathological response to neoadjuvant therapy in esophageal cancer: A retrospective study. Medicine (Baltimore) 2018; 97:e13412. [PMID: 30544419 PMCID: PMC6310504 DOI: 10.1097/md.0000000000013412] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The type of pathological response to neoadjuvant chemoradiation in patients with locally advanced esophageal cancer predicts overall survival (OS).We aimed to assess early 18F-FDG positron emission tomography/computed tomography parameters in predicting the pathological response to neoadjuvant treatment.The cohort included consecutive patients with locally advanced esophageal cancer who underwent baseline 18F-FDG positron emission tomography/computed tomography between September 2006 and February 2015. Positron emission tomography variables of maximum and average standardized uptake values (SUVmax, SUVaverage), metabolic tumor volume (MTV), and total lesion glycolysis were recorded in addition to computed tomography volume. MTV was calculated using cut-off values of 42%, 50% and 60% (MTV 0.42, 0.5, and 0.6) of the tumoral SUVmax. Receiver operating characteristic (ROC) analysis was used to determine sensitivity and specificity.Sixty-one patients (44 male, 17 female) fulfilled the inclusion criteria. Only MTV values of 13.6 mL (MTV 0.42) and 7.4 mL (MTV 0.5) remained significant on ROC analysis, with an area under the curve of 0.690 (confidence interval 0.557-0.823, p = .02] and 0.664 (confidence interval 0.527-0.802, P = .048), respectively in differentiating patients with a complete (n = 44) or incomplete (n = 17) pathological response.MTV at presentation is associated with the pathological response to neoadjuvant chemoradiation in patients with locally advanced esophageal cancer.
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Affiliation(s)
- Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Beilinson Hospital
- Sackler Faculty of Medicine, Tel Aviv University
| | - Baruch Brenner
- Sackler Faculty of Medicine, Tel Aviv University
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital
| | - Meital Nidam
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
| | - Sara Morgenstern
- Institute of Pathology, Rabin Medical Center, Beilinson Hospital, Petach Tikva
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital
| | - David Groshar
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
- Sackler Faculty of Medicine, Tel Aviv University
- Assuta Medical Center, Tel Aviv, Israel
| | - Hanna Bernstine
- Department of Nuclear Medicine, Rabin Medical Center, Beilinson Hospital
- Sackler Faculty of Medicine, Tel Aviv University
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37
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Moore A, Ulitsky O, Ben-Aharon I, Perl G, Kundel Y, Sarfaty M, Lewin R, Domachevsky L, Bernstine H, Groshar D, Wasserberg N, Kashtan H, Gordon N, Sulkes A, Brenner B. Early PET-CT in patients with pathological stage III colon cancer may improve their outcome: Results from a large retrospective study. Cancer Med 2018; 7:5470-5477. [PMID: 30350468 PMCID: PMC6246942 DOI: 10.1002/cam4.1818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 12/11/2022] Open
Abstract
Background Current staging of pathological stage III colon cancer (CC) is suboptimal; many patients recur despite unremarkable preoperative staging. We previously reported that early postoperative PET‐CT can alter the stage and management of up to 15% of patients with high‐risk stage III CC. This study aimed to determine the role of the test in the general stage III CC population. Methods A retrospective study of all consecutive patients with stage III CC who underwent early postoperative PET‐CT between 2005 and 2017. Results A total of 342 patients, 166 (48.5%) males, median age 66 years (range, 29‐90), were included. Pathological stage was IIIA, IIIB, and IIIC in 18 (5.3%), 257 (75.1%), and 67 (19.6%) patients, respectively. Median number of positive lymph nodes was 2 (range, 0‐32). PET‐CT results modified the management of 46 patients (13.4%): 37 (10.8%) with overt metastatic disease and 9 (2.6%) with a second primary. The 5‐year disease‐free survival for true stage III patients was 81%. The median overall survival for the entire cohort and for true stage III patients was not reached and was 57.2 months for true stage IV. Of the 37 patients found to be metastatic, 14 (37.8%) underwent curative treatments and 9/14 (64.3%) remain disease‐free, with a median follow‐up of 83.8 months. Predictive factors for upstaging following PET‐CT were identified. Conclusion Early postoperative PET‐CT changed the staging and treatment of 13.4% of stage III CC patients and has the potential for early detection of curable metastatic disease. Outcome results are encouraging. Prospective validation is ongoing.
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Affiliation(s)
- Assaf Moore
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Olga Ulitsky
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Irit Ben-Aharon
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Sarfaty
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Lewin
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Liran Domachevsky
- Department of Nuclear Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - Hanna Bernstine
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - David Groshar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Rabin Medical Center, Petach Tiqva, Israel
| | - Nir Wasserberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petach Tiqva, Israel
| | - Hanoch Kashtan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petach Tiqva, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petach Tiqva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gendler S, Shmilovich H, Aranovich D, Nadler R, Kashtan H, Stein M. Urgent Laparotomy in Patients with Metastatic Colorectal Cancer Presenting as an Acute Abdomen: A Retrospective Analysis. Isr Med Assoc J 2018; 20:619-622. [PMID: 30324778] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Unlike the elective treatment of metastatic colorectal cancer (MCRC), sufficient data and consensual guidelines on acute care are lacking. OBJECTIVES To analyze a cohort of MCRC patients who required urgent surgery due to acute abdomen and to identify risk factors contributing to the patient's perioperative mortality and morbidity. METHODS A retrospective analysis was conducted of patients diagnosed with stage IV colorectal cancer who required urgent laparotomy at the Rabin Medical Center. Comparative analysis was performed using Pearson's chi-square and Student`s t-test. RESULTS Between 2010 and 2015, 113 patients underwent urgent laparotomy due to colorectal cancer complications, of which 62 patients were found to have a metastatic, stage IV, disease. Large bowel obstruction was the most common indication for urgent laparotomy. In-hospital mortality was 30% (n=19), and overall 30 day mortality was 43%. Fifteen patients (24%) required more than one surgery. The average length of hospital stay was 21 days. Age and lactate levels at presentation were the only prognostic factor found for mortality (P < 0.05). CONCLUSIONS MCRC laparotomy patients incur a significant burden of care and have a relatively high incidence of early mortality. Our data suggest high, verging on unacceptable, mortality and complication rates in this subgroup of patients. This finding is further accentuated in the subgroup of older patients presenting with lactatemia. These data should be considered by surgeons when discussing treatment options with patients and families.
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Affiliation(s)
- Sami Gendler
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel. Tel Aviv, Israel
| | - Hila Shmilovich
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel. Tel Aviv, Israel
| | - David Aranovich
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel. Tel Aviv, Israel
| | - Roy Nadler
- Department of Surgery and Transplantations, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel. Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel. Tel Aviv, Israel
| | - Michael Stein
- Department of Surgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Israel. Tel Aviv, Israel
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Sadot E, Goldberg N, Damoni E, Aranovich D, Kashtan H, Bitterman A, Haddad R. Laparoscopic hand-assisted liver resection for tumours in the left lateral section. J Minim Access Surg 2018; 16:35-40. [PMID: 30106024 PMCID: PMC6945333 DOI: 10.4103/jmas.jmas_148_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Context: The role of the laparoscopic left lateral sectionectomy (LLLS) is debatable, and Level-1 data are lacking. Aims: The aim of the study is to evaluate the feasibility and safety of this approach. Settings and Design: This was a retrospective study. Subjects and Methods: From 2007 to 2014, patients undergoing LLLS were identified from two institutions. Statistical Analysis Used: Continuous variables were compared between groups with Student's t-test or Mann–Whitney test, as appropriate by type of distribution. Categorical variables were compared with Chi-square or Fisher's exact test, depending on the number of observations. Results: Thirty-eight patients were included in the study. The mean age was 63.5 + 13 years (range, 31–89), and the mean number of tumours was 1.7 + 1.5. Eleven (29%) patients underwent LLS combined with an additional liver resection (combined resections group). The mean duration of the operation and the mean estimated blood loss were significantly decreased in the LLS group compared to the combined resection group (101 + 71 min vs. 208 + 98 min and 216 + 217 ml vs. 450 + 223 ml; P < 0.05 for both, respectively). The major complications rate was 8% and no mortality occurred. Conclusions: In a subset of carefully selected cases, LLLS may provide the benefits of laparoscopy. This does not appear to compromise perioperative morbidity rates. We believe that this approach may serve as a training platform for surgical trainees.
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Affiliation(s)
- Eran Sadot
- Department of Surgery, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalia Goldberg
- Department of Radiology, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emil Damoni
- Department of Surgery 'A', Carmel Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - David Aranovich
- Department of Surgery, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Bitterman
- Department of Surgery 'A', Carmel Medical Center, Tel Aviv University, Tel Aviv; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Riad Haddad
- Departments of Surgery, Rabin Medical Center, Petah-Tikva; Department of Surgery 'A', Carmel Medical Center, Tel Aviv University, Tel Aviv; The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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40
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Horesh N, Lessing Y, Rudnicki Y, Kent I, Kammar H, Ben-Yaacov A, Dreznik Y, Avital S, Mavor E, Wasserberg N, Kashtan H, Klausner J, Gutman M, Zmora O, Tulchinsky H. Comparison between laparoscopic and open Hartmann's reversal: results of a decade-long multicenter retrospective study. Surg Endosc 2018; 32:4780-4787. [PMID: 29766303 DOI: 10.1007/s00464-018-6227-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hartmann's reversal is a challenging surgical procedure with significant postoperative morbidity rates. Various surgical methods have been suggested to lower the risk of postoperative complications. In this study, we aimed to compare the postoperative results between open and laparoscopic techniques for Hartmann's reversal. METHODS A retrospective study of all patients who underwent Hartmann's reversal in five centers in central Israel between January 2004 and June 2015 was conducted. Medical charts were reviewed, analyzing preoperative and operative parameters and short-term postoperative outcomes. RESULTS 260 patients were included in the study. 76 patients were operated laparoscopically with a conversion rate of 26.3% (20 patients). No differences were found between patients operated laparoscopically and those operated in an open technique regarding gender (p = 0.785), age (61.34 vs. 62.64, p = 0.521), body mass index (26.6 vs. 26.2, p = 0.948), Charlson index score (1.79 vs. 1.95, p = 0.667), and cause for Hartmann's procedure (neoplastic vs. non-neoplastic, p = 0.644). No differences were seen in average time from the Hartmann's procedure to reversal (204.89 vs. 213.60 days, p = 0.688) and in overall complication rate (46.4 vs. 46.5%, p = 1). The Clavien-Dindo score for distinguishing between minor (0-2 score, p = 1) and major complications (3-5 score, p = 0.675) failed to demonstrate an advantage to laparoscopy, as well as to average length of stay (10.91 days in the laparoscopic group vs. 11.72 days in the open group, p = 0.529). An analysis based on the intention-to-treat with laparoscopy, including converted cases in the laparoscopic group, showed similar results, including overall complication rate (48.6 vs. 45.6%, p = 0.68) and Clavien-Dindo score in both minor (p = 0.24) and major complications (p = 0.44). Length of stay (10.92 vs. 11.81 days, p = 0.45) was also similar between the two groups. CONCLUSION In this series, a laparoscopic approach to Hartmann's reversal did not offer any short-term advantage when compared to an open surgical approach.
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Affiliation(s)
- Nir Horesh
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yonatan Lessing
- Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Rudnicki
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilan Kent
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haguy Kammar
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel.,School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Almog Ben-Yaacov
- Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Dreznik
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Avital
- Department of Surgery B, Meir Medical Center, Kfar Saba, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Mavor
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Klausner
- Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of General Surgery and Transplantations B, Sheba Medical Center, Tel Hashomer, 52621, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Tulchinsky
- Division of Surgery, Tel-Aviv Medical Center, Tel Aviv, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Horesh N, Lessing Y, Rudnicki Y, Kent I, Kammar H, Ben-Yaacov A, Dreznik Y, Tulchinsky H, Avital S, Mavor E, Wasserberg N, Kashtan H, Klausner JM, Gutman M, Zmora O. Considerations for Hartmann's reversal and Hartmann's reversal outcomes-a multicenter study. Int J Colorectal Dis 2017; 32:1577-1582. [PMID: 28879552 DOI: 10.1007/s00384-017-2897-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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] [Accepted: 08/30/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Hartmann's procedure is commonly practiced in emergent cases with the restoration of bowel continuity planned at a second stage. This study assessed the rate of restorations following Hartmann's procedure and evaluated factors affecting decision-making. METHODS Data on patient demographics, comorbidities, causes for Hartmann's procedure, reversal rate, and complications were collected in a multicenter retrospective cohort study of patients who underwent Hartmann's procedure in five medical centers. RESULTS Six hundred forty patients underwent Hartmann's procedure for diverticular disease (36.1%), obstructing malignancy (31.8%), benign obstruction (5%), and other reasons (23.1%). Overall, 260 (40.6%) patients underwent subsequent restoration of bowel continuity. One hundred twenty-one (46.5%) patients had post-reversal complications, with an average Clavien-Dindo score of 1.4 and a mortality rate of 0.77%. Decision to avoid reversal was mostly related to comorbidities (49.7%) and metastatic disease (21.6%). Factors associated with the decision to restore bowel continuity included male gender (P = 0.02), patient age (62.3 years in Hartmann's reversal patients vs 73.5 years in non-reversal patients; P < 0.0001), number of comorbidities (1.1 vs 1.58; P < 0.001), average Charlson score (1.93 vs 3.44; P < 0.001), and a neoplastic etiology (P < 0.0001). A sub-analysis excluding all patients who died in the 30 days following Hartmann's procedure showed similar factors associated with ostomy closure. CONCLUSION Many patients do not have restoration of bowel continuity after undergoing Hartmann's procedure. Hartmann's reversal is associated with a significant postoperative morbidity. Surgeons and patients should be aware of the possibility that the colostomy might become permanent.
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Affiliation(s)
- Nir Horesh
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Surgery and Transplantations B, Sheba Medical Center, 52621, Tel-Hashomer, Israel.
| | - Yonatan Lessing
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Yaron Rudnicki
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Meir Medical Center, Kfar Saba, Israel
| | - Ilan Kent
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Meir Medical Center, Kfar Saba, Israel
| | - Haguy Kammar
- Department of Surgery, Kaplan Medical Center, Rehovot, Israel.,School of Medicine, Hadassah-Hebrew University, Jerusalem, Israel
| | - Almog Ben-Yaacov
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel
| | - Yael Dreznik
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Tulchinsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Shmuel Avital
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Meir Medical Center, Kfar Saba, Israel
| | - Eli Mavor
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Nir Wasserberg
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel
| | - Hanoch Kashtan
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery B, Rabin Medical Center, Petah Tikva, Israel
| | - Joseph M Klausner
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Surgery, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Mordechai Gutman
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Zmora
- Department of General Surgery and Transplantations B, Sheba Medical Center, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sarfaty M, Lankry E, Moore A, Kurman N, Purim O, Kundel Y, Ben-Aharon I, Perl G, Ulitsky O, Gordon N, Sulkes A, Menasherov N, Kashtan H, Brenner B. Esophageal Cancer in Israel has Unique Clinico-Pathological Features: A Retrospective Study. J Cancer 2017; 8:2417-2423. [PMID: 28900478 PMCID: PMC5595070 DOI: 10.7150/jca.19210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/26/2017] [Indexed: 11/09/2022] Open
Abstract
Introduction: Data regarding esophageal cancer (EC) in Israel are limited. The aim of this study was hence to characterize this entity in the Israeli population and to compare it to the literature. Patients/Methods: This is a retrospective study of all consecutive EC patients treated at our institution between 1997-2013. Data were retrieved from patients' medical files. Results: Two hundred patients were included. The median age at diagnosis was 70.5 years; 63.5% were males; 63% were Ashkenazi Jews, 29% were Sephardic Jews, and 0.5% were Arabs. Squamous cell carcinoma (SCC) was predominant: 52% versus 45.5% with adenocarcinoma (ADC). SCC was common even in the distal esophagus (45%). The overall 5-year survival rate was 25.5%. A temporal trend (2006-2013 vs 1997-2005) shows a decline in the proportion of SCC (47% vs 63%, p=0.061) and a rise in ADC (50% vs 33%, p=0.041), with a parallel decrease in patients' age (median: 68.5 vs 73 years, p=0.014). In the later period, patients received more treatment for localized and metastatic disease, with a trend for improved median survival (20.1 vs 14.9 months, p=0.658). Ashkenazi Jews were diagnosed at an older age than Sephardic Jews (median: 73 vs. 65 years, p=0.001), had a higher rate of family history of GI cancer (34% vs. 17%, p=0.026) and a higher rate of cardiovascular co-morbidity (41% vs. 24%, p=0.041). Conclusion: EC in Israel represents an intermediate entity between the Western and the endemic subtypes, showing some unique features. These included delayed reversal of the SCC/ADC ratio, commonness of SCC in the distal esophagus, prevalence of other malignancies and predominance of Ashkenazi ethnicity. The reason for these findings is unclear and its further evaluation is warranted.
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Affiliation(s)
- Michal Sarfaty
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Esty Lankry
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Assaf Moore
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Noga Kurman
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Ofer Purim
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Yulia Kundel
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Irit Ben-Aharon
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Olga Ulitsky
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Noa Gordon
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel
| | - Aaron Sulkes
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Nikolai Menasherov
- Department of Surgery A, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Hanoch Kashtan
- Department of Surgery B, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Baruch Brenner
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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Ben-Aharon I, Moore A, Hikri E, Goshen-Lago T, Lazar T, Kashtan H, Brenner B. Young-onset gastric cancer: The role of microbial factors. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.029] [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: 11/14/2022] Open
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44
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Moore A, Ben-Aharon I, Purim O, Perl G, Ulitsky O, Amit L, Kundel Y, Lewin R, Wasserberg N, Kashtan H, Brenner B. Early postoperative PET-CT in patients with pathological stage III colon cancer may change their outcome: Results from a large single institution study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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45
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Brenner B, Purim O, Gordon N, Goshen Lago T, Idelevich E, Kashtan H, Menasherov N, Fenig E, Sulkes A, Kundel Y. Association of the addition of cetuximab to preoperative chemoradiotherapy (CRT) for locally advanced esophageal squamous cell carcinoma (SqCC) with rate of long term survival: Mature results of a prospective phase Ib/II trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4057 Background: Current treatment results in locally advanced esophageal cancer (LAEC) are far from being satisfying. This prospective phase IB/II study evaluated the safety and efficacy of the addition of cetuximab to standard preoperative CRT in this disease. Methods: Patients (pts) with potentially resectable LAEC (T2-4N0-1M0, T1-4N1M0 or T1-4N0-1M1A) received an induction cycle of cisplatin 100 mg/m2, day 1, and 5-FU 1000 mg/m2/day as a continuous infusion (CI), days 1–5, followed 4 weeks later by 50.4 Gy radiotherapy given concurrently with 2 cycles of cisplatin 75 mg/m2 and escalating doses of CI 5-FU, days 1–4 and 29-32. Pts received also 10 weekly infusions of cetuximab, 250 mg/m2, with a loading dose of 400 mg/m2, starting from the induction. The phase II part of the study started when the 5-FU dose during CRT was defined. Surgery was planned 6-8 weeks after CRT. Results: 64 pts were enrolled and 60 completed CRT. Median age was 65 years (range: 38-84 years) and 66% were males. The SqCC/adenocarcinoma ratio was 39%/61% (25/39). Pts had very advanced tumors: 95% T3-T4, 67% N1 and 19% M1A. The most common grade > 3 toxicities were leucopenia (45% of pts) and neutropenia (41%). There were two cases (3%) of fatal toxicities (neutropenic sepsis and sudden death). Among the 55 operated pts, R0 resection was achieved in 51 (93%). There were 8 cases (14.5%) of postoperative mortality, due to infection (3 pts), esophageal leak (2), bleeding (2) and pulmonary insufficiency (1). Pathological down-staging was noted in 72% of pts and pathological complete response (pCR) in 33%. 5y-local control, progression-free survival (PFS) and overall survival (OS) rates for all pts were 94%, 40%, 39%, respectively. Pts with SqCC had a significantly higher pCR rate (52% vs 15%, p = 0.007), 5y-PFS (67% vs. 21%, p = 0.008) and 5y-OS (64% vs. 20%, p = 0.019). Conclusions: This study suggests that the addition of cetuximab to standard preoperative CRT is safe. R0, pCR, local control and long term PFS and OS rates in pts with SqCC tumors are encouraging. Further evaluation of this approach in this population seems warranted.
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Affiliation(s)
| | - Ofer Purim
- Rabin Medical Center, Petah Tikva, Israel
| | - Noa Gordon
- Davidoff Cancer Center, Petah Tikva, Israel
| | | | | | | | | | - Eyal Fenig
- Rabin Medical Center, Petah Tikva, Israel
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Moore A, Ben-Aharon I, Purim O, Perl G, Ulitsky O, Amit L, Kundel Y, Lewin R, Wasserberg N, Kashtan H, Brenner B. Early postoperative PET-CT in patients with pathological stage III colon cancer may change their outcome: Results from a large single-institution study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15163 Background: Staging of patients (pts) with pathological stage III colon cancer (CC) is currently suboptimal; many pts still recur despite an unremarkable preoperative staging. We previously reported that early postoperative PET-CT can alter the stage and management of up to 15% of pts with high risk stage III CC and later reported also encouraging preliminary results in a larger cohort of consecutive pts with stage III CC, in which staging and management were altered in 14.5%. The aim of the current study was to expand the previous one to a larger cohort and to evaluate the actual impact of early postoperative PET-CT on pts outcome. Methods: A Retrospective study of all consecutive pts with stage III CC who were treated at our institution and underwent early postoperative PET-CT between 2007-2016. Demographic and clinicopathological data were retrieved. Statistical analyses were done using standard methods. Results: 348 pts, 166 (47.7%) males, with a median age of 66 years (range, 29-92), were included. Pathological stage was IIIA, IIIB and IIIC in 21(6%), 254 (73%) and 73 (21%) pts, respectively. The median number of lymph nodes examined and of positive ones were 14 (range, 3-54) and 2 (range, 0-32), respectively. High FDG-uptake was noted in 95 (27.3%) pts, including 23 (6.6%) with clear postoperative changes and 18 (5.2%) with a false positive uptake, of whom 6 underwent invasive diagnostic procedures. PET-CT results modified the management of 52 pts (14.9%) who were found to have true positive findings: 44 (12.6%) with overt metastatic disease and 8 (2.3%) with a second primary tumor. At a median follow-up of 45.6 months, the estimated 5y disease-free survival for true stage III pts was 81.9% and the 6y overall survival of the entire cohort was 76.4%. Interestingly, of the 44 pts found to be metastatic, 12 (27.3%) underwent curative treatments and 8 (66.7%) of those remain free of disease, with a median follow-up of 64.7 months. Conclusions: In this large cohort, early postoperative PET-CT changed the staging and management of 14.9% of pts with resected stage III CC, with encouraging outcome results. We are conducting a prospective trial to further evaluate this strategy.
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Affiliation(s)
| | | | - Ofer Purim
- Rabin Medical Center, Petah Tikva, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel-Aviv University, Petach-Tikva, Israel
| | - Olga Ulitsky
- Beilinson Hospital, Davidoff Center, Petah Tikva, Israel
| | - Limor Amit
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel-Aviv University, Petach-Tikva, Israel
| | | | - Ron Lewin
- Davidoff Cancer Center, Petah Tikva, Israel
| | - Nir Wasserberg
- Rabin Medical Center, Department of Surgery B, Petah Tikva, Israel
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Moore A, Ben-Aharon I, Purim O, Perl G, Ulitsky O, Amit L, Kundel Y, Lewin R, Wasserberg N, Asman Y, Kashtan H, Brenner B. The role of early postoperative PET-CT in patients with pathological stage III colon cancer: Results from a large single institution study. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.4_suppl.562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
562 Background: Current staging of patients (pts) with pathological stage III colon cancer is suboptimal; many pts still recur despite unremarkable preoperative staging work-up. We previously reported that early postoperative PET-CT can alter the stage and management of pts with high risk stage III colon cancer in up to 19% of patients. The aim of the current study was to expand the previous one to a larger cohort and to determine the role of early postoperative PET-CT in the general population of stage III colon cancer pts, regardless of their individual risk. Methods: A retrospective chart review of all consecutive pts with stage III colon cancer who underwent early postoperative PET-CT between 2007 and 2016. Demographic and clinicopathological data were collected. Results: 247 pts, 124 (50%) males, with a median age of 66 years (range, 30-92), were included. Pathological stage was IIIA, IIIB and IIIC in 18 (7.3%), 161 (65.1%) and 72 (29.1%) pts, respectively. The median number of lymph nodes retrieved was 15 (range, 6-64) and that of positive lymph nodes was 2 (range, 0-21). High FDG-uptake was observed in 52 (21.0%) pts, including 6 (2.4%) who had clear postoperative changes, 10 (4.0%) who had a false positive abnormal uptake of whom 6 underwent invasive diagnostic procedures. The PET-CT results modified the management of 36 pts (14.5%) who were found to have true positive findings: 30 (12.1%) were proven to have overt metastatic disease and in 6 (2.4%) a second primary was discovered. With the median follow-up of 39.0 months (range 7.2-98.4 months), of the 30 pts found to be metastatic, 10 (33.3%) underwent curative treatments and are currently with no evidence of disease (NED). Updated data, on more patients and a longer follow-up, will be presented at the meeting. Conclusions: Early postoperative PET-CT changed the staging and treatment of 14.5% of resected stage III pts, and has the potential for early detection of curable metastatic disease. We currently evaluate this strategy and its actual impact in a prospective trial.
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Affiliation(s)
- Assaf Moore
- Department of Oncology, Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel, Kfar Saba, Israel
| | - Irit Ben-Aharon
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | - Ofer Purim
- Rabin Medical Center, Petach Tikva, Israel
| | - Gali Perl
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Petach-Tikva, Israel
| | - Olga Ulitsky
- Beilinson hospital, Davidoff center, Petah Tikva, Israel
| | - Limor Amit
- Institute of Oncology, Davidoff Center, Rabin Medical Center, Tel Aviv University, Petach Tikva, Israel
| | | | - Ron Lewin
- Davidoff Cancer Center, Rabin Medical Center, Petach-Tikva, Israel
| | - Nir Wasserberg
- Rabin Medical Center, Department of Surgery B, Petach Tikva, Israel
| | - Yael Asman
- Rabin Medical Center, Petah Tikva, Israel
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48
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Mahler I, Ben Gal T, Kashtan H, Keidar A. [LAPAROSCOPIC "SLEEVE" GASTRECTOMY POST HEART TRANSPLANTION]. Harefuah 2016; 155:155-196. [PMID: 27305748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Morbid obesity affects the function of the transplanted heart either directly, by damaging many elements that affect cardiac function or indirectly, by the initial appearance or worsening of co-morbidities that affect the heart. Bariatric surgery is the most effective treatment for a significant and sustained decrease in weight and it leads to the disappearance of co-morbidities such as diabetes, hypertension and dyslipidemia in high rates. These diseases can damage the blood vessels of the graft and impair its function. We report a case study of a 47-year-old morbidly obese male (BMI 36 kg/m2] who underwent heart transplantation three years previously, developed gradual weight gain and symptoms of aggravating heart failure. Coronary artery disease in the implanted heart was diagnosed. Clinically, he started suffering from shortness of breath and chest pain during minimal effort. In addition, he also suffered from high blood pressure and kidney failure. Laparoscopic sleeve gastrectomy was successfully performed and he was discharged four days later. On follow-up the patient has lost 35 kg. His present weight is 74 kg (BMI 25.7). All symptoms of heart failure improved and oral medications for hypertension and heart failure were withdrawn. Our conclusion is that it is justified to consider bariatric surgery in heart transplant recipients suffering from morbid obesity, as long as the long-term benefit outweighs the surgical risk. The decision to perform bariatric surgery should be made by a multidisciplinary team and the operation should take place at a center with extensive experience in bariatric surgery.
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49
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Barlev E, Zelig U, Bar O, Segev C, Mordechai S, Kapelushnik J, Nathan I, Flomen F, Kashtan H, Dickman R, Madhala-Givon O, Wasserberg N. A novel method for screening colorectal cancer by infrared spectroscopy of peripheral blood mononuclear cells and plasma. J Gastroenterol 2016; 51:214-21. [PMID: 26112122 DOI: 10.1007/s00535-015-1095-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/04/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early detection of colorectal cancer (CRC) can reduce mortality and morbidity. Current screening methods include colonoscopy and stool tests, but a simple low-cost blood test would increase compliance. This preliminary study assessed the utility of analyzing the entire bio-molecular profile of peripheral blood mononuclear cells (PBMCs) and plasma using Fourier transform infrared (FTIR) spectroscopy for early detection of CRC. METHODS Blood samples were prospectively collected from 62 candidates for CRC screening/diagnostic colonoscopy or surgery for colonic neoplasia. PBMCs and plasma were separated by Ficoll gradient, dried on zinc selenide slides, and placed under a FTIR microscope. FTIR spectra were analyzed for biomarkers and classified by principal component and discriminant analyses. Findings were compared among diagnostic groups. RESULTS Significant changes in multiple bands that can serve as CRC biomarkers were observed in PBMCs (p = ~0.01) and plasma (p = ~0.0001) spectra. There were minor but statistically significant differences in both blood components between healthy individuals and patients with benign polyps. Following multivariate analysis, the healthy individuals could be well distinguished from patients with CRC, and the patients with benign polyps were mostly distributed as a distinct subgroup within the overlap region. Leave-one-out cross-validation for evaluating method performance yielded an area under the receiver operating characteristics curve of 0.77, with sensitivity 81.5% and specificity 71.4%. CONCLUSIONS Joint analysis of the biochemical profile of two blood components rather than a single biomarker is a promising strategy for early detection of CRC. Additional studies are required to validate our preliminary clinical results.
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Affiliation(s)
- Eyal Barlev
- Department of Surgery B, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Udi Zelig
- Todos Medical Ltd, 1 HaMada St, 76703, Rehovot, Israel.
| | - Omri Bar
- Todos Medical Ltd, 1 HaMada St, 76703, Rehovot, Israel
| | - Cheli Segev
- Todos Medical Ltd, 1 HaMada St, 76703, Rehovot, Israel
| | - Shaul Mordechai
- Department of Physics, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Joseph Kapelushnik
- Pediatric Hemato-Oncology Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilana Nathan
- Department of Clinical Biochemistry, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Institute of Hematology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Felix Flomen
- Todos Medical Ltd, 1 HaMada St, 76703, Rehovot, Israel
| | - Hanoch Kashtan
- Division of General Surgery, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Ram Dickman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Gastroenterology, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
| | - Osnat Madhala-Givon
- Department of Surgery B, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Wasserberg
- Department of Surgery B, Rabin Medical Center, Beilinson Campus, Petach Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sarfaty M, Purim O, Kundel Y, Ulitsky O, Menasherov N, Kashtan H, Sulkes A, Brenner B. Esophageal cancer in Israel: A unique clinicopathological entity? J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michal Sarfaty
- Davidoff Cancer Center, Rabin Medical Center, Petah Tiqva, Israel
| | - Ofer Purim
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel
| | | | - Olga Ulitsky
- Beilinson hospital, Davidoff center, Petah Tikva, Israel
| | | | | | - Aaron Sulkes
- Davidoff Cancer Center, Rabin Medical Center, Petach-Tikva, Israel
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