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Winer LK, Kader S, Abelson JS, Hammaker AC, Eruchalu CN, Etheridge JC, Cho NL, Foote DC, Ivascu FA, Smith S, Postlewait LM, Greenwell K, Meister KM, Montgomery KB, Zmijewski P, Byrd SE, Kimbrough MK, Stopenski SJ, Nahmias JT, Harvey J, Farr D, Callahan ZM, Marks JA, Stahl CC, Al Yafi M, Sutton JM, Elsaadi A, Campbell SJ, Dodwad SJM, Adams SD, Woeste MR, Martin RC, Patel P, Anstadt MJ, Nasim BW, Willis RE, Patel JA, Newcomb MR, George BC, Quillin RC, Cortez AR. Disparities in the Operative Experience Between Female and Male General Surgery Residents: A Multi-institutional Study From the US ROPE Consortium. Ann Surg 2023; 278:1-7. [PMID: 36994704 PMCID: PMC10896185 DOI: 10.1097/sla.0000000000005847] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To examine differences in resident operative experience between male and female general surgery residents. BACKGROUND Despite increasing female representation in surgery, sex and gender disparities in residency experience continue to exist. The operative volume of male and female general surgery residents has not been compared on a multi-institutional level. METHODS Demographic characteristics and case logs were obtained for categorical general surgery graduates between 2010 and 2020 from the US Resident OPerative Experience Consortium database. Univariable, multivariable, and linear regression analyses were performed to compare differences in operative experience between male and female residents. RESULTS There were 1343 graduates from 20 Accreditation Council for Graduate Medical Education-accredited programs, and 476 (35%) were females. There were no differences in age, race/ethnicity, or proportion pursuing fellowship between groups. Female graduates were less likely to be high-volume residents (27% vs 36%, P < 0.01). On univariable analysis, female graduates performed fewer total cases than male graduates (1140 vs 1177, P < 0.01), largely due to a diminished surgeon junior experience (829 vs 863, P < 0.01). On adjusted multivariable analysis, female sex was negatively associated with being a high-volume resident (OR = 0.74, 95% CI: 0.56 to 0.98, P = 0.03). Over the 11-year study period, the annual total number of cases increased significantly for both groups, but female graduates (+16 cases/year) outpaced male graduates (+13 cases/year, P = 0.02). CONCLUSIONS Female general surgery graduates performed significantly fewer cases than male graduates. Reassuringly, this gap in operative experience may be narrowing. Further interventions are warranted to promote equitable training opportunities that support and engage female residents.
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Affiliation(s)
- Leah K. Winer
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Sarah Kader
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | | | - Austin C. Hammaker
- Department of Surgery, Lahey Hospital and Medical Center, Burlington, MA
| | | | | | - Nancy L. Cho
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | - Darci C. Foote
- Department of Surgery, Beaumont Health, Royal Oak, MI
- Department of Surgery, Center for Surgical Training and Research (CSTAR), University of Michigan, Ann Arbor, MI
| | | | | | | | | | | | | | - Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL
| | - Samuel E. Byrd
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mary K. Kimbrough
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | | | - Jalen Harvey
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas TX
| | - Deborah Farr
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas TX
| | | | - Joshua A. Marks
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
| | | | - Motaz Al Yafi
- Department of Surgery, University of Toledo, Toledo, OH
| | - Jeffrey M. Sutton
- Division of Oncologic and Endocrine Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Ali Elsaadi
- Texas Tech University Health Sciences Center School of Medicine Lubbock, TX
| | - Samuel J. Campbell
- Texas Tech University Health Sciences Center School of Medicine Lubbock, TX
| | | | - Sasha D. Adams
- Department of Surgery, McGovern Medical School at UTHealth, Houston, TX
| | | | | | - Purvi Patel
- Department of Surgery, Loyola University, Maywood, IL
| | | | - Bilal Waqar Nasim
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Ross E. Willis
- Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jitesh A. Patel
- Department of Surgery, University of Kentucky, Lexington, KY
| | | | - Brian C. George
- Department of Surgery, Center for Surgical Training and Research (CSTAR), University of Michigan, Ann Arbor, MI
| | - Ralph C. Quillin
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
| | - Alexander R. Cortez
- Department of Surgery, Cincinnati Research on Education in Surgical Training (CREST), University of Cincinnati, Cincinnati, OH
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Yaddanapudi K, Stamp BF, Subrahmanyam PB, Smolenkov A, Waigel SJ, Gosain R, Egger ME, Martin RC, Buscaglia R, Maecker HT, McMasters KM, Chesney JA. Single-Cell Immune Mapping of Melanoma Sentinel Lymph Nodes Reveals an Actionable Immunotolerant Microenvironment. Clin Cancer Res 2022; 28:2069-2081. [PMID: 35046061 PMCID: PMC9840851 DOI: 10.1158/1078-0432.ccr-21-0664] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/16/2021] [Accepted: 01/14/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Improving our understanding of the immunologic response to cancer cells within the sentinel lymph nodes (SLN) of primary tumors is expected to identify new approaches to stimulate clinically meaningful cancer immunity. EXPERIMENTAL DESIGN We used mass cytometry by time-of-flight (CyTOF), flow cytometry, and T-cell receptor immunosequencing to conduct simultaneous single-cell analyses of immune cells in the SLNs of patients with melanoma. RESULTS We found increased effector-memory αβ T cells, TCR clonality, and γδ T cells selectively in the melanoma-bearing SLNs relative to non-melanoma-bearing SLNs, consistent with possible activation of an antitumor immune response. However, we also observed a markedly immunotolerant environment in the melanoma-bearing SLNs indicated by reduced and impaired NK cells and increased levels of CD8+CD57+PD-1+ cells, which are known to display low melanoma killing capabilities. Other changes observed in melanoma-bearing SLNs when compared with non-melanoma-bearing SLNs include (i) reduced CD8+CD69+ T cell/T regulatory cell ratio, (ii) high PD-1 expression on CD4+ and CD8+ T cells, and (iii) high CTLA-4 expression on γδ T cells. CONCLUSIONS Our data suggest that these immunologic changes compromise antimelanoma immunity and contribute to a high relapse rate. We propose the development of clinical trials to test the neo-adjuvant administration of anti-PD-1 antibodies prior to SLN resection in patients with stage III melanoma. See related commentary by Lund, p. 1996.
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Affiliation(s)
- Kavitha Yaddanapudi
- Immuno-Oncology Group, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA,Department of Surgery, Division of Immunotherapy, University of Louisville, Louisville, KY, USA,Department of Microbiology/Immunology, University of Louisville, Louisville, KY, USA
| | - Bryce F. Stamp
- Immuno-Oncology Group, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA,Department of Surgery, Division of Immunotherapy, University of Louisville, Louisville, KY, USA
| | - Priyanka B. Subrahmanyam
- Institute for Immunity, Transplantation and Infection, Stanford School of Medicine, Stanford, CA, USA
| | - Andrei Smolenkov
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Sabine J. Waigel
- Department of Medicine, University of Louisville, Louisville, KY, USA
| | - Rahul Gosain
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA
| | - Michael E. Egger
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA,Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA
| | - Robert C.G. Martin
- Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA,Department of Pharmacology and Toxicology, University of Louisville, Louisville, KY, USA
| | - Robert Buscaglia
- Department of Mathematics and Statistics, Northern Arizona University, Arizona, USA
| | - Holden T. Maecker
- Institute for Immunity, Transplantation and Infection, Stanford School of Medicine, Stanford, CA, USA
| | - Kelly M. McMasters
- Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, USA,Correspondence to: Jason A. Chesney, MD, PhD, Kelly M. McMasters, MD, PhD, University of Louisville, Clinical and Translational Research Building, Louisville, KY 40202, ,
| | - Jason A. Chesney
- Immuno-Oncology Group, James Graham Brown Cancer Center, University of Louisville, Louisville, KY, USA,Department of Medicine, University of Louisville, Louisville, KY, USA,Department of Surgery, Division of Immunotherapy, University of Louisville, Louisville, KY, USA,Correspondence to: Jason A. Chesney, MD, PhD, Kelly M. McMasters, MD, PhD, University of Louisville, Clinical and Translational Research Building, Louisville, KY 40202, ,
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Burnett NP, Dunki-Jacobs EM, Callender GG, Anderson RJ, Scoggins CR, McMasters KM, Martin RC. Evaluation of Alpha-fetoprotein Staging System for Hepatocellular Carcinoma in Noncirrhotic Patients. Am Surg 2020. [DOI: 10.1177/000313481307900717] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Barcelona Clinic Liver Cancer (BCLC) staging classification is commonly used for staging hepatocellular carcinoma (HCC). This system assumes the coexistence of cirrhosis; however, a significant proportion of patients with HCC present without cirrhosis. Recently, an alternative system was proposed that stratifies patients according to alpha-fetoprotein (AFP) level. The aim of this study was to apply the AFP staging system to noncirrhotic patients with HCC and evaluate its ability to predict overall survival (OS). A prospective hepatopancreatobiliary database was reviewed for all patients with a diagnosis of HCC. Patients were staged based on BCLC classification as well as by AFP stage according to four levels: less than 10 ng/mL, 10 to 150 ng/mL, 150 to 500 ng/mL, and greater than 500 ng/mL. Cirrhotic patients were compared with noncirrhotic patients in terms of patient demographics and HCC stage. Kaplan-Meier (KM) analysis of OS was performed for noncirrhotic patients according to BCLC and AFP staging systems. Cirrhotic and noncirrhotic patients differed significantly in terms of median age at presentation (64 vs 70 years, P < 0.001) and gender (76 vs 65% male, P = 0.006). BCLS staging classification did not distinguish between cirrhotics and noncirrhotics ( P = 0.733), whereas AFP staging demonstrated a significant difference between the two groups ( P < 0.0001). KM analysis of OS for noncirrhotic patients with HCC was significant for both the BCLC and the AFP staging systems ( P = 0.003 vs P < 0.0001, respectively). Patients presenting with HCC in the absence of cirrhosis appear to have different characteristics than patients with cirrhosis. Staging according to AFP level is an appropriate predictor of prognosis in noncirrhotic patients with HCC.
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Affiliation(s)
- Nicolas P. Burnett
- Division of Surgical Oncology, University of Louisville, Louisville, Kentucky
| | | | - Glenda G. Callender
- Division of Surgical Oncology, University of Louisville, Louisville, Kentucky
| | - Ryan J. Anderson
- Division of Surgical Oncology, University of Louisville, Louisville, Kentucky
| | - Charles R. Scoggins
- Division of Surgical Oncology, University of Louisville, Louisville, Kentucky
| | - Kelly M. McMasters
- Division of Surgical Oncology, University of Louisville, Louisville, Kentucky
| | - Robert C.G. Martin
- Division of Surgical Oncology, University of Louisville, Louisville, Kentucky
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Bailer R, Martin RC. The effectiveness of using 3D reconstruction software for surgery to augment surgical education. Am J Surg 2019; 218:1016-1021. [DOI: 10.1016/j.amjsurg.2019.07.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/24/2019] [Accepted: 07/30/2019] [Indexed: 12/11/2022]
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Martin RC, Martin RR, Putnam ML. First Report of Cocksfoot Mottle Virus Infecting Dactylis glomerata in Forage Production Fields in California. Plant Dis 2018; 102:PDIS02180277PDN. [PMID: 30095321 DOI: 10.1094/pdis-02-18-0277-pdn] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
| | | | - M L Putnam
- Department of Botany and Plant Pathology, Oregon State University, Corvallis 97331
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Warren SL, Bhutiani N, Agle SC, Martin RC, McMasters KM, Ajkay N. Differences between palpable and nonpalpable tumors in early-stage, hormone receptor-positive breast cancer. Am J Surg 2018; 216:326-330. [DOI: 10.1016/j.amjsurg.2018.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/04/2018] [Accepted: 02/06/2018] [Indexed: 10/18/2022]
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7
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Bhutiani N, Brown AN, Davis EG, Jones CM, Vitale GC, Scoggins CR, Martin RC, Bozeman MC. Correlation of Biliary Colic in the Absence of Cholelithiasis with Pancreaticobiliary Obstruction. Am Surg 2018. [DOI: 10.1177/000313481808400634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A small fraction of patients undergoing cholecystectomy for biliary colic are subsequently diagnosed with an obstructive pancreatic head mass. We review our experience with such patients to provide insight into improving evaluation before cholecystectomy. Retrospective chart review of patients undergoing cholecystectomy from 2004 to 2015 identified six patients who underwent laparoscopic cholecystectomy for biliary colic before being diagnosed with a pancreatic head neoplasm within six months after cholecystectomy. Charts were analyzed for presenting symptoms, evaluation before and after cholecystectomy, and operative findings. Patients ranged from 50 to 72 years of age and included five males and one female. None had evidence of cholelithiasis or acute cholecystitis on initial evaluation. Median time from cholecystectomy to diagnosis of pancreatic head mass was two months (range 1–5 months). Two patients eventually underwent pancreaticoduodenectomy. Patients with symptoms of biliary colic in the absence of evidence of cholecystitis or choledochal abnormality should undergo intraoperative cholangiogram at the time of cholecystectomy as well as close clinical follow-up to ensure resolution of symptoms. Abnormalities of either should prompt radiographic evaluation focused on identification of a pancreatic mass causing extrinsic compression of the bile duct.
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Affiliation(s)
- Neal Bhutiani
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Amber N. Brown
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Eric G. Davis
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | | | - Gary C. Vitale
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Charles R. Scoggins
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Robert C.G. Martin
- From the University of Louisville Department of Surgery, Louisville, Kentucky
| | - Matthew C. Bozeman
- From the University of Louisville Department of Surgery, Louisville, Kentucky
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8
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Bhutiani N, Graffree B, Martin RC, Quillo AR. Factors Influencing Time to Decrease in Intraoperative Parathyroid Hormone (ioPTH) Levels in Patients Undergoing Focused Parathyroidectomy (FP). Am Surg 2018. [DOI: 10.1177/000313481808400617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate potential factors affecting the time period in which a 50 per cent parathyroid hormone (PTH) drop is observed. Eight-seven patients undergoing focused parathyroidectomy between 2011 and 2015, whose PTH values dropped to within normal range, were grouped according to whether they required > or ≤15 minutes after gland excision to achieve a 50 per cent PTH. Groups were compared according to preoperative PTH, calcium, age, glomer-ular filtration rate, and adenoma weight. Lower preoperative and preincision PTH levels were associated with requiring >15 minutes to achieve a >50 per cent drop in ioPTH. Time to >50 per cent ioPTH drop did not affect cure rates at one year, though a >15 minutes requirement was associated with higher serum calcium levels (P = 0.015). Lower baseline PTH and preincision PTH levels are significantly associated with a >15 minutes postexcision time to achieve a >50 per cent drop in ioPTH. Future analyses are warranted to determine whether a longer postexcision time threshold before proceeding with four-gland exploration is warranted in patients with primary hyperparathyroidism and mildly elevated preoperative PTH.
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Affiliation(s)
- Neal Bhutiani
- From the Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Beunca Graffree
- From the Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Robert C.G. Martin
- From the Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Amy R. Quillo
- From the Department of Surgery, Division of Surgical Oncology, University of Louisville School of Medicine, Louisville, Kentucky
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9
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Rostas JW, Bhutiani N, Crigger M, Crawford SM, Hollenbach RB, Heidrich SR, Martin RC, McMasters KM, Ajkay N. Calculation of breast volumes from mammogram: Comparison of four separate equations relative to mastectomy specimen volumes. J Surg Oncol 2018; 117:1848-1853. [DOI: 10.1002/jso.25076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 03/27/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Jack W. Rostas
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Neal Bhutiani
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Morgan Crigger
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Stacey M.W. Crawford
- School of Medicine; Department of Radiology; University of Louisville; Louisville Kentucky
| | - Reiss B. Hollenbach
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Samantha R. Heidrich
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Robert C.G. Martin
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Kelly M. McMasters
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Nicolás Ajkay
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
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Krasnick BA, Jin LX, Davidson JT, Sanford DE, Ethun CG, Pawlik TM, Poultsides GA, Tran T, Idrees K, Hawkins WG, Chapman WC, Majella Doyle MB, Weber SM, Strasberg SM, Salem A, Martin RC, Isom CA, Scoggins C, Schmidt CR, Shen P, Beal E, Hatzaras I, Shenoy R, Maithel SK, Fields RC. Adjuvant therapy is associated with improved survival after curative resection for hilar cholangiocarcinoma: A multi-institution analysis from the U.S. extrahepatic biliary malignancy consortium. J Surg Oncol 2018; 117:363-371. [PMID: 29284072 PMCID: PMC5924689 DOI: 10.1002/jso.24836] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 04/19/2017] [Accepted: 08/23/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Curative-intent treatment for localized hilar cholangiocarcinoma (HC) requires surgical resection. However, the effect of adjuvant therapy (AT) on survival is unclear. We analyzed the impact of AT on overall (OS) and recurrence free survival (RFS) in patients undergoing curative resection. METHODS We reviewed patients with resected HC between 2000 and 2015 from the ten institutions participating in the U.S. Extrahepatic Biliary Malignancy Consortium. We analyzed the impact of AT on RFS and OS. The probability of RFS and OS were calculated in the method of Kaplan and Meier and analyzed using multivariate Cox regression analysis. RESULTS A total of 249 patients underwent curative resection for HC. Patients who received AT and those who did not had similar demographic and preoperative features. In a multivariate Cox regression analysis, AT conferred a significant protective effect on OS (HR 0.58, P = 0.013), and this was maintained in a propensity matched analysis (HR 0.66, P = 0.033). The protective effect of AT remained significant when node negative patients were excluded (HR 0.28, P = 0.001), while it disappeared (HR 0.76, P = 0.260) when node positive patients were excluded. CONCLUSIONS AT should be strongly considered after curative-intent resection for HC, particularly in patients with node positive disease.
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Affiliation(s)
- Bradley A. Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Linda X. Jin
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Jesse T. Davidson
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Dominic E. Sanford
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | | | | | | | - Thuy Tran
- Stanford University Medical Center, Stanford, CA
| | | | - William G. Hawkins
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - William C. Chapman
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | | | - Sharon M. Weber
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Steven M. Strasberg
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Ahmed Salem
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | | | - Carl R. Schmidt
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Perry Shen
- Wake Forest University, Winston-Salem, NC
| | - Eliza Beal
- The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO
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11
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Postlewait LM, Ethun CG, Mcinnis MR, Merchant N, Parikh A, Idrees K, Isom CA, Hawkins W, Fields RC, Strand M, Weber SM, Cho CS, Salem A, Martin RC, Scoggins C, Bentrem D, Kim HJ, Carr J, Ahmad S, Abbott D, Wilson GC, Kooby DA, Maithel SK. The Hand-Assisted Laparoscopic Approach to Resection of Pancreatic Mucinous Cystic Neoplasms: An Underused Technique?. Am Surg 2018. [DOI: 10.1177/000313481808400123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pancreatic mucinous cystic neoplasms (MCNs) are rare tumors typically of the distal pancreas that harbor malignant potential. Although resection is recommended, data are limited on optimal operative approaches to distal pancreatectomy for MCN. MCN resections (2000–2014; eight institutions) were included. Outcomes of minimally invasive and open MCN resections were compared. A total of 289 patients underwent distal pancreatectomy for MCN: 136(47%) minimally invasive and 153(53%) open. Minimally invasive procedures were associated with smaller MCN size (3.9 vs 6.8 cm; P = 0.001), lower operative blood loss (192 vs 392 mL; P = 0.001), and shorter hospital stay(5 vs 7 days; P = 0.001) compared with open. Despite higher American Society of Anesthesiologists class, hand-assisted (n = 46) had similar advantages as laparoscopic/robotic (n = 76). When comparing hand-assisted to open, although MCN size was slightly smaller (4.1 vs 6.8 cm; P = 0.001), specimen length, operative time, and nodal yield were identical. Similar to laparoscopic/robotic, hand-assisted had lower operative blood loss (161 vs 392 mL; P = 0.001) and shorter hospital stay (5 vs 7 days; P = 0.03) compared with open, without increased complications. Hand-assisted laparoscopic technique is a useful approach for MCN resection because specimen length, lymph node yield, operative time, and complication profiles are similar to open procedures, but it still offers the advantages of a minimally invasive approach. Hand-assisted laparoscopy should be considered as an alternative to open technique or as a successive step before converting from total laparoscopic to open distal pancreatectomy for MCN.
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Affiliation(s)
- Lauren M. Postlewait
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Cecilia G. Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Mia R. Mcinnis
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Nipun Merchant
- Division of Surgical Oncology, Department of Surgery, University of Miami, Miami, Florida
| | - Alexander Parikh
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chelsea A. Isom
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - William Hawkins
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Matthew Strand
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Clifford S. Cho
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Robert C.G. Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Charles Scoggins
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky
| | - David Bentrem
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Hong J. Kim
- Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Jacquelyn Carr
- Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, North Carolina
| | - Syed Ahmad
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati Cancer Institute, Cincinnati, Ohio
| | - Daniel Abbott
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory C. Wilson
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati Cancer Institute, Cincinnati, Ohio
| | - David A. Kooby
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - Shishir K. Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Zhang XF, Beal EW, Merath K, Ethun CG, Salem A, Weber SM, Tran T, Poultsides G, Son AY, Hatzaras I, Jin L, Fields RC, Weiss M, Scoggins C, Martin RC, Isom CA, Idrees K, Mogal HD, Shen P, Maithel SK, Schmidt CR, Pawlik TM. Oncologic effects of preoperative biliary drainage in resectable hilar cholangiocarcinoma: Percutaneous biliary drainage has no adverse effects on survival. J Surg Oncol 2017; 117:1267-1277. [DOI: 10.1002/jso.24945] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/06/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Xu-Feng Zhang
- Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering; The First Affiliated Hospital of Xi'an Jiaotong University; Xi'an China
- Department of Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Eliza W. Beal
- Department of Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Katiuscha Merath
- Department of Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Cecilia G. Ethun
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Ahmed Salem
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - Sharon M. Weber
- Department of Surgery; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin
| | - Thuy Tran
- Department of Surgery; Stanford University Medical Center; Stanford California
| | - George Poultsides
- Department of Surgery; Stanford University Medical Center; Stanford California
| | - Andre Y. Son
- Department of Surgery; New York University; New York New York
| | | | - Linda Jin
- Department of Surgery; Washington University School of Medicine; St Louis Missouri
| | - Ryan C. Fields
- Department of Surgery; Washington University School of Medicine; St Louis Missouri
| | - Matthew Weiss
- Division of Surgical Oncology; Department of Surgery; The Johns Hopkins Hospital; Baltimore Maryland
| | - Charles Scoggins
- Division of Surgical Oncology; Department of Surgery; University of Louisville; Louisville Kentucky
| | - Robert C.G. Martin
- Division of Surgical Oncology; Department of Surgery; University of Louisville; Louisville Kentucky
| | - Chelsea A. Isom
- Division of Surgical Oncology; Department of Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Kamron Idrees
- Division of Surgical Oncology; Department of Surgery; Vanderbilt University Medical Center; Nashville Tennessee
| | - Harveshp D. Mogal
- Department of Surgery; Wake Forest University; Winston-Salem North Carolina
| | - Perry Shen
- Department of Surgery; Wake Forest University; Winston-Salem North Carolina
| | - Shishir K. Maithel
- Division of Surgical Oncology; Department of Surgery; Winship Cancer Institute; Emory University; Atlanta Georgia
| | - Carl R. Schmidt
- Department of Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
| | - Timothy M. Pawlik
- Department of Surgery; The Ohio State University Wexner Medical Center; Columbus Ohio
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Beal EW, Lyon E, Kearney J, Wei L, Ethun CG, Black SM, Dillhoff M, Salem A, Weber SM, Tran TB, Poultsides G, Shenoy R, Hatzaras I, Krasnick B, Fields RC, Buttner S, Scoggins CR, Martin RC, Isom CA, Idrees K, Mogal HD, Shen P, Maithel SK, Pawlik TM, Schmidt CR. Evaluating the American College of Surgeons National Surgical Quality Improvement project risk calculator: results from the U.S. Extrahepatic Biliary Malignancy Consortium. HPB (Oxford) 2017; 19:1104-1111. [PMID: 28890310 PMCID: PMC5915623 DOI: 10.1016/j.hpb.2017.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/01/2017] [Accepted: 08/12/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The objective of this study is to evaluate use of the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) online risk calculator for estimating common outcomes after operations for gallbladder cancer and extrahepatic cholangiocarcinoma. METHODS Subjects from the United States Extrahepatic Biliary Malignancy Consortium (USE-BMC) who underwent operation between January 1, 2000 and December 31, 2014 at 10 academic medical centers were included in this study. Calculator estimates of risk were compared to actual outcomes. RESULTS The majority of patients underwent partial or major hepatectomy, Whipple procedures or extrahepatic bile duct resection. For the entire cohort, c-statistics for surgical site infection (0.635), reoperation (0.680) and readmission (0.565) were less than 0.7. The c-statistic for death was 0.740. For all outcomes the actual proportion of patients experiencing an event was much higher than the median predicted risk of that event. Similarly, the group of patients who experienced an outcome did have higher median predicted risk than those who did not. CONCLUSIONS The ACS NSQIP risk calculator is easy to use but requires further modifications to more accurately estimate outcomes for some patient populations and operations for which validation studies show suboptimal performance.
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Affiliation(s)
- Eliza W. Beal
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Ezra Lyon
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Joe Kearney
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Lai Wei
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Cecilia G. Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Sylvester M. Black
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Mary Dillhoff
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Thuy B. Tran
- Department of Surgery, Stanford University Medical Center, Stanford
| | | | - Rivfka Shenoy
- Department of Surgery, New York University, New York, NY
| | | | | | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Stefan Buttner
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - Charles R. Scoggins
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
| | - Robert C.G. Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
| | - Chelsea A. Isom
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kamron Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | - Shishir K. Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Timothy M. Pawlik
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH
| | - Carl R. Schmidt
- Division of Surgical Oncology, The Ohio State University Wexner Medical Center and the James Cancer Hospital and Solove Research Institute, Columbus, OH
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14
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Buettner S, Ethun CG, Poultsides G, Tran T, Idrees K, Isom CA, Weiss M, Fields RC, Krasnick B, Weber SM, Salem A, Martin RC, Scoggins CR, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Koerkamp BG, Maithel SK, Pawlik TM. Surgical Site Infection Is Associated with Tumor Recurrence in Patients with Extrahepatic Biliary Malignancies. J Gastrointest Surg 2017; 21:1813-1820. [PMID: 28913712 PMCID: PMC5905431 DOI: 10.1007/s11605-017-3571-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 08/29/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical site infections (SSI) are one of the most common complications after hepato-pancreato-biliary surgery. Infectious complications may lead to an associated immune-modulatory effect that inhibits the body's response to cancer surveillance. We sought to define the impact of SSI on long-term prognosis of patients undergoing surgical resection of extrahepatic biliary malignancies (EHBM). METHODS Patients undergoing surgery for EHBM between 2000 and 2014 were identified using a large, multi-center, national cohort dataset. Recurrence free survival (RFS) was calculated and a multivariable Cox proportional hazards model was utilized to identify potential risk factors for RFS including SSI. RESULTS Seven hundred twenty-eight patients included in the analytic cohort; 236 (32.4%) patients had perihilar cholangiocarcinoma, 241 (33.1%) gallbladder cancer, and 251 (34.5%) distal cholangiocarcinoma. A major resection, liver resection, was performed in 205 (28.3%) patients, while 110 (15.2%) patients had a pancreaticoduodenectomy. The overall incidence of morbidity was 55.8%; among the 397 patients who experienced a complication, 161 patients specifically had an SSI. The SSI occurred as an infection of the surgical site (n = 70, 9.6%) or formation of an abscess in the operative bed (n = 91, 12.5%). SSI was associated with long-term survival as patients who experienced an SSI had a median RFS of 19.5 months compared with 30.5 months for those patients who did not have an SSI (HR 1.40, 95% CI 1.08-1.80; p = 0.01). Among 279 patients who had EHBM that had no associated lymph node metastases, well-to-moderate tumor differentiation, as well as an R0 resection margin, SSI remained associated with worse RFS (HR 1.84, 95% CI 1.03-3.29; p = 0.038), as well as overall survival (HR 1.87, 95% CI 1.18-2.97; p = 0.008). CONCLUSION SSI was a relatively common occurrence following surgery for EHBM as 1 in 10 patients experienced an SSI. In addition to standard tumor-specific factors, the occurrence of postoperative SSI was adversely associated with long-term survival.
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Affiliation(s)
- Stefan Buettner
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Cecilia G. Ethun
- Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, CA
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Chelsea A. Isom
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew Weiss
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD
| | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Bradley Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | | | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC
| | | | - Carl Schmidt
- Department of Surgery, Ohio State University, Columbus, OH
| | - Eliza Beal
- Department of Surgery, Ohio State University, Columbus, OH
| | | | - Rivfka Shenoy
- Department of Surgery, New York University, New York, NY
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
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15
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Hong YK, Pandit H, Pulliam Z, Galbraith N, Li SP, Li Y, Martin RC. Epigenetic Modulation Enhances Immunotherapy for Hepatocellular Carcinoma. J Am Coll Surg 2017. [DOI: 10.1016/j.jamcollsurg.2017.07.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Ethun CG, Postlewait LM, McInnis MR, Merchant N, Parikh A, Idrees K, Isom CA, Hawkins W, Fields RC, Strand M, Weber SM, Cho CS, Salem A, Martin RC, Scoggins CR, Bentrem D, Kim HJ, Carr J, Ahmad SA, Abbott DE, Wilson G, Kooby DA, Maithel SK. The diagnosis of pancreatic mucinous cystic neoplasm and associated adenocarcinoma in males: An eight-institution study of 349 patients over 15 years. J Surg Oncol 2017; 115:784-787. [PMID: 28211072 PMCID: PMC5560255 DOI: 10.1002/jso.24582] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/14/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Per WHO, 2000 classification, pancreatic mucinous cystic neoplasms (MCN) are defined by presence of ovarian stroma, and are primarily located in the pancreatic body/tail of females. The incidence of MCN and associated malignancy in males, since, standardization of MCN diagnostic-criteria is unknown. METHODS MCN resections from 2000 to 2014 at eight institutions of the Central-Pancreas-Consortium were included, and divided into early (2000-2007) and late (2008-2014) time-periods. Primary aim was to characterize MCN and associated adenocarcinoma/high-grade-dysplasia (AC/HGD) in males versus females over time. RESULTS Of 1667 resections for pancreatic cystic lesions, 349 pts (21%) had MCNs: 310 (89%) female, 39 (11%) male. Patients were equally divided between early (n = 173) and late (n = 176) time-periods. MCN in male-patients decreased over time (early: 15%, late: 7%; P = 0.036), as did pancreatic head/neck location (early: 22%, late: 11%; P = 0.01). MCN-associated AC/HGD was more frequent in males versus females (39 vs. 12%; P < 0.001). The overall rate of MCN-associated AC/HGD remained stable (early: 17%, late: 13%; P = 0.4), and was identical in males (39%) over both time-periods. Males with AC/HGD had more LN-positive disease versus females (57 vs. 22%; P = 0.039). CONCLUSIONS As the diagnostic-criteria of MCN have standardized over time, MCN diagnosis has decreased in males and head/neck location. Despite this, MCN-associated adenocarcinoma/high-grade dysplasia has been stable and remains high in males. Any male with suspected MCN, regardless of location, should undergo resection.
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Affiliation(s)
- Cecilia G. Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Lauren M. Postlewait
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Mia R. McInnis
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Nipun Merchant
- Division of Surgical Oncology, Department of Surgery, University of Miami, Miami, FL,Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Alexander Parikh
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Chelsea A. Isom
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - William Hawkins
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Matthew Strand
- Department of Surgery, Washington University School of Medicine, St Louis, MO
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Clifford S. Cho
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI,Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Robert C.G. Martin
- . Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
| | - Charles R. Scoggins
- . Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY
| | - David Bentrem
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Hong J. Kim
- Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Jacquelyn Carr
- Division of Surgical Oncology, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Syed A. Ahmad
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati Cancer Institute, Cincinnati, OH
| | - Daniel E. Abbott
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI,Division of Surgical Oncology, Department of Surgery, University of Cincinnati Cancer Institute, Cincinnati, OH
| | - Gregory Wilson
- Division of Surgical Oncology, Department of Surgery, University of Cincinnati Cancer Institute, Cincinnati, OH
| | - David A. Kooby
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
| | - Shishir K. Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA
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Martin RC, Bruenderman E, Cohn A, Piperdi B, Miksad R, Geschwind JF, Goldenberg A, Sanyal A, Zigmont E, Babajanyan S, Foreman P, Mantry P, McGuire B, Gholam P. Sorafenib use for recurrent hepatocellular cancer after resection or transplantation: Observations from a US regional analysis of the GIDEON registry. Am J Surg 2017; 213:688-695. [DOI: 10.1016/j.amjsurg.2016.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/18/2016] [Accepted: 10/24/2016] [Indexed: 12/26/2022]
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Philips P, Scoggins CR, Rostas JK, McMasters KM, Martin RC. Safety and advantages of combined resection and microwave ablation in patients with bilobar hepatic malignancies. Int J Hyperthermia 2016; 33:43-50. [PMID: 27405728 DOI: 10.1080/02656736.2016.1211751] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The multimodality approach has significantly improved outcomes for hepatic malignancies. Microwave ablation is often used in isolation or succession, and seldom in combination with resection. Potential benefits and pitfalls from combined resection and ablation therapy in patients with complex and extensive bilobar hepatic disease have not been well defined. METHODS A review of the University of Louisville prospective Hepato-Pancreatico-Biliary Patients database was performed with multi-focal bilobar disease that underwent microwave ablation with resection or microwave only included. RESULTS One hundred and eight were treated with microwave only (MWA, n = 108) or combined resection and ablation (CRA, n = 84) and were compared with similar disease-burden patients undergoing resection only (n = 84). The groups were comparable except that the MWA group was older (p = .02) and with higher co-morbidities (diabetes, hepatitis). The resection group had larger tumours (4 vs. 3.2 and 3 cm) but the CRA group had more numerous lesions (4 vs. 3 and 2, p = .002). Short-term outcomes including morbidity (47.6% vs. 43%, p = .0715) were similar between the CRA and resection only groups. Longer operative time (164 vs. 126 min, p = .003) and need for blood transfusion (p = .001) were independent predictors of complications. Survival analyses for colorectal metastasis patients (n = 158) demonstrated better overall survival (OS) (43.9 vs. 37.6 and 30.5 months, p = .035), disease-free survival (DFS) (38 vs. 26.6 and 16.9 months, p = .028) and local recurrence-free survival (LRFS) (55.4 vs. 17 and 22.9 months, p < .001) with resection only. CONCLUSION The use of microwave ablation in addition to surgical resection did not significantly increase the morbidities or short-term outcomes. In combination with systemic and other local forms of therapy, combined resection and ablation is a safe and effective procedure.
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Affiliation(s)
- Prejesh Philips
- a Department of Surgical Oncology , University of Louisville , Louisville , KY , USA
| | - C R Scoggins
- a Department of Surgical Oncology , University of Louisville , Louisville , KY , USA
| | - J K Rostas
- a Department of Surgical Oncology , University of Louisville , Louisville , KY , USA
| | - K M McMasters
- a Department of Surgical Oncology , University of Louisville , Louisville , KY , USA
| | - R C Martin
- a Department of Surgical Oncology , University of Louisville , Louisville , KY , USA
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20
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Margonis GA, Gani F, Buettner S, Amini N, Sasaki K, Andreatos N, Ethun CG, Poultsides G, Tran T, Idrees K, Isom CA, Fields RC, Krasnick B, Weber SM, Salem A, Martin RC, Scoggins C, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Maithel SK, Pawlik TM. Rates and patterns of recurrence after curative intent resection for gallbladder cancer: a multi-institution analysis from the US Extra-hepatic Biliary Malignancy Consortium. HPB (Oxford) 2016; 18:872-878. [PMID: 27527802 PMCID: PMC5094487 DOI: 10.1016/j.hpb.2016.05.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/18/2016] [Accepted: 05/30/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer is a relatively rare malignancy. The current study aimed to define the incidence and patterns of recurrence following gallbladder cancer resection. METHODS Using a multi-institutional cohort we identified 217 patient undergoing curative intent surgery for gallbladder cancer. Patterns of recurrence were classified as locoregional and distant recurrence. RESULTS At last follow-up, 76 patients (35.0%) had experienced a recurrence (locoregional only, n = 12, 15.8%; distant only, n = 50, 65.8%; locoregional and distant, n = 14, 18.4%). Median time to recurrence was 9.5 months (IQR 4.7-17.6) and was not associated with recurrence site (all p > 0.05). On multivariable analysis, T3 disease (HR = 8.44, p = 0.014), lymphovascular invasion (HR = 4.24, p < 0.001) and residual disease (HR = 2.04, p = 0.042) were associated with an increased risk of recurrence. Patients who recurred demonstrated a worse 1-, 3- and 5-year OS (1-year OS: 91.3% vs. 68.6%, p = 0.001, 3-year OS: 79.3% vs. 28.7%, p < 0.001, and 5-year OS: 75.9% vs. 16.0%, p < 0.001). After adjusting for other risk factors, recurrence was independently associated with a decreased OS (HR = 3.71, p = 0.006). Of note, receipt of adjuvant therapy was associated with improved OS (HR = 0.56, p = 0.027) among those patients who developed a tumor recurrence. DISCUSSION Over one-third of patients experienced a recurrence after gallbladder cancer surgery. While chemotherapy did not decrease the rate of recurrence, patients who experienced recurrence after administration of adjuvant treatment faired better than patients who did not receive adjuvant therapy.
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Affiliation(s)
| | - Faiz Gani
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stefan Buettner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Neda Amini
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Kazunari Sasaki
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Cecilia G. Ethun
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea A. Isom
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Bradley Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Charles Scoggins
- Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Harveshp D. Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Carl Schmidt
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | - Eliza Beal
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | | | - Rivfka Shenoy
- Department of Surgery, New York University, New York, NY, USA
| | - Shishir K. Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy M. Pawlik
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA,Department of Surgery, Ohio State University, Columbus, OH, USA,Correspondence Timothy M. Pawlik, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, Wexner Medical Center at the Ohio State University, 395 W. 12th Avenue, Suite 670, Columbus, OH 43210, USA. Tel: +1 (614) 293 8701. Fax: +1 (614) 293 4063.Department of SurgeryDepartment of SurgeryThe Urban Meyer III and Shelley Meyer Chair for Cancer ResearchWexner Medical Center at the Ohio State University600 N. Wolfe Street395 W. 12th Avenue, Suite 670ColumbusOH43210USA
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21
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Postlewait LM, Ethun CG, Le N, Pawlik TM, Buettner S, Poultsides G, Tran T, Idrees K, Isom CA, Fields RC, Krasnick B, Weber SM, Salem A, Martin RC, Scoggins C, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Vitiello G, Cardona K, Maithel SK. Proposal for a new T-stage classification system for distal cholangiocarcinoma: a 10-institution study from the U.S. Extrahepatic Biliary Malignancy Consortium. HPB (Oxford) 2016; 18:793-799. [PMID: 27506989 PMCID: PMC5061021 DOI: 10.1016/j.hpb.2016.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Seventh AJCC distal cholangiocarcinoma T-stage classification inadequately separates patients by survival. This retrospective study aimed to define a novel T-stage system to better stratify patients after resection. METHODS Curative-intent pancreaticoduodenectomies for distal cholangiocarcinoma (1/2000-5/2015) at 10 US institutions were included. Relationships between tumor characteristics and overall survival (OS) were assessed and incorporated into a novel T-stage classification. RESULTS 176 patients (median follow-up: 24mo) were included. Current AJCC T-stage was not associated with OS (T1: 23mo, T2: 20mo, T3: 25mo, T4: 12mo; p = 0.355). Tumor size ≥3 cm and presence of lymphovascular invasion (LVI) were associated with decreased OS on univariate and multivariable analyses. Patients were stratified into 3 groups [T1: size <3 cm and (-)LVI (n = 69; 39.2%); T2: size ≥3 cm and (-)LVI or size <3 cm and (+)LVI (n = 82; 46.6%); and T3: size ≥3 cm and (+)LVI (n = 25; 14.2%)]. Each progressive proposed T-stage was associated with decreased median OS (T1: 35mo; T2: 20mo; T3: 8mo; p = 0.002). CONCLUSION Current AJCC distal cholangiocarcinoma T-stage does not adequately stratify patients by survival. This proposed T-stage classification, based on tumor size and LVI, better differentiates patient outcomes after resection and could be considered for incorporation into the next AJCC distal cholangiocarcinoma staging system.
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Affiliation(s)
- Lauren M. Postlewait
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Cecilia G. Ethun
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Nina Le
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Timothy M. Pawlik
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stefan Buettner
- Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Kamran Idrees
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea A. Isom
- Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Bradley Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert C.G. Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Charles Scoggins
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Harveshp D. Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Carl Schmidt
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Eliza Beal
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Shishir K. Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA,Correspondence Shishir K. Maithel, Winship Cancer Institute, Division of Surgical Oncology, 1365C Clifton Road NE, 2nd Floor, Atlanta, GA 30322, USA. Tel: +1 404 778 5777 (office). Fax: +1 404 778 4255.Winship Cancer InstituteDivision of Surgical Oncology1365C Clifton Road NE2nd FloorAtlantaGA30322USA
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Buettner S, Margonis GA, Kim Y, Gani F, Ethun CG, Poultsides G, Tran T, Idrees K, Isom CA, Fields RC, Krasnick B, Weber SM, Salem A, Martin RC, Scoggins CR, Shen P, Mogal HD, Schmidt C, Beal E, Hatzaras I, Shenoy R, Maithel SK, Pawlik TM. Conditional probability of long-term survival after resection of hilar cholangiocarcinoma. HPB (Oxford) 2016; 18:510-7. [PMID: 27317955 PMCID: PMC4913135 DOI: 10.1016/j.hpb.2016.04.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/24/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND While traditional survival analyses focus on factors determined at the time of surgery, conditional survival (CS) estimates prognosis relative to time following treatment. We sought to compare actuarial and CS among patients undergoing curative intent surgery for hilar cholangiocarcinoma. METHODS 242 patients undergoing surgery between 2000 and 2014 were identified using a multi-institutional database. CS was calculated as the probability of surviving an additional 3 years, given that the patient had already survived "x" years from surgery. RESULTS Median patient age was 67 years (IQR: 57-73) and most patients were male (n = 140, 57.9%). Lymph node metastases were noted in 79 (32.6%) patients while an R0 margin was obtained in 66.1% (n = 160). Median OS was 22.3 months. Actuarial survival decreased over time from 46.3% at 2 years following surgery to 18.2% at 5 years; in contrast, the 3-year CS (CS3) increased with time (CS3 at 2 years was 39.3% versus 54.4% at 5 years). CS3 exceeded actuarial survival for high-risk patients with patients with perineural invasion demonstrating an actuarial survival of 15.4% at 5 years versus CS3 of 37.6% at 2 years following surgery (Δ = 22.2%). CONCLUSIONS CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients.
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Affiliation(s)
- Stefan Buettner
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Yuhree Kim
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Faiz Gani
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Cecilia G. Ethun
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - George Poultsides
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Thuy Tran
- Department of Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Kamran Idrees
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chelsea A. Isom
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan C. Fields
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Bradley Krasnick
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Ahmed Salem
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | | | - Perry Shen
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Harveshp D. Mogal
- Department of Surgery, Wake Forest University, Winston-Salem, NC, USA
| | - Carl Schmidt
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | - Eliza Beal
- Department of Surgery, Ohio State University, Columbus, OH, USA
| | | | - Rivfka Shenoy
- Department of Surgery, New York University, New York, NY, USA
| | - Shishir K. Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Timothy M. Pawlik
- Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA,Correspondence: Timothy M. Pawlik, Division of Surgical Oncology, John L. Cameron Professor of Alimentary Surgery, Department of Surgery, Johns Hopkins Hospital, 600 N. Wolfe Street, Blalock 688, Baltimore, MD 21287, USA. Tel: +1 (410) 502 2387. Fax: +1 (410) 502 2388.
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23
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Postlewait LM, Squires MH, Kooby DA, Weber SM, Scoggins CR, Cardona K, Cho CS, Martin RC, Winslow ER, Maithel SK. The relationship of blood transfusion with peri-operative and long-term outcomes after major hepatectomy for metastatic colorectal cancer: a multi-institutional study of 456 patients. HPB (Oxford) 2016; 18:192-199. [PMID: 26902139 PMCID: PMC4814612 DOI: 10.1016/j.hpb.2015.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 08/31/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data on prognostic implications of peri-operative blood transfusion around resection of colorectal cancer liver metastases (CRLM) are conflicting. This retrospective study assesses the association of transfusion with complications and disease-specific survival (DSS). METHODS Major hepatectomies for CRLM from 2000 to 2010 at three institutions were included. Transfusion was analyzed based on timing and volume. RESULTS Of 456 patients, 140 (30.7%) received transfusions. Transfusion was associated with extended hepatectomy (28.6 vs 18.4%; p = 0.020), tumor size (5.7 vs 4.2 cm; p < 0.001), and operative blood loss (917 vs 390 mL; p < 0.001). Transfusion was independently associated with major complications (OR 2.61; 95% CI: 1.53-4.44; p < 0.001). Transfusion at any time was not associated with DSS; however, patients who specifically received blood post-operatively had reduced DSS (37.4 vs 42.7 months; p = 0.044). Increased volume of transfusion (≥3 units) was also associated with shortened DSS (Total: 37.4 vs 41.5 months, p = 0.018; Post-operative: 27.2 vs 40.3 months, p = 0.015). On multivariate analysis, however, transfusion was not independently associated with worsened DSS, regardless of timing and volume. CONCLUSION Transfusion with major hepatectomy for colorectal cancer metastases is independently associated with increased complications but not disease-specific survival. Judicious use of transfusion per a blood utilization protocol in the peri-operative period is warranted.
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Affiliation(s)
- Lauren M. Postlewait
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Malcolm H. Squires
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - David A. Kooby
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Sharon M. Weber
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Charles R. Scoggins
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Kenneth Cardona
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Clifford S. Cho
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Robert C.G. Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA
| | - Emily R. Winslow
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shishir K. Maithel
- Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA,Correspondence Shishir K. Maithel, Emory University, Winship Cancer Institute, Division of Surgical Oncology, 1365C Clifton Road NE, 2nd Floor, Atlanta, GA 30322, USA. Tel: +1 404 778 5777. Fax: +1 404 778 4255.
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Martin RC, North DA. Enhanced ultrasound with navigation leads to improved liver lesion identification and needle placement. J Surg Res 2016; 200:420-6. [DOI: 10.1016/j.jss.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/22/2015] [Accepted: 09/03/2015] [Indexed: 12/30/2022]
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Doughtie CA, Edwards JD, Philips P, Agle SC, Scoggins CR, McMasters KM, Martin RC. Infectious complications in combined colon resection and ablation of colorectal liver metastases. Am J Surg 2015; 210:1185-90; discussion 1190-1. [DOI: 10.1016/j.amjsurg.2015.07.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 12/15/2022]
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Philips P, North DA, Scoggins C, Schlegel M, Martin RC. Gastric-Esophageal Stenting for Malignant Dysphagia: Results of Prospective Clinical Trial Evaluation of Long-Term Gastroesophageal Reflux and Quality of Life-Related Symptoms. J Am Coll Surg 2015; 221:165-73. [DOI: 10.1016/j.jamcollsurg.2015.01.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 01/17/2015] [Indexed: 12/31/2022]
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27
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Martin RC, Farmer RW, Hill RCS, McMasters KM, Scoggins CR. Esophageal anastomotic leak does not affect ability to receive adjuvant treatment. J Surg Oncol 2015; 111:855-61. [DOI: 10.1002/jso.23902] [Citation(s) in RCA: 3] [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] [Received: 11/15/2014] [Accepted: 01/07/2015] [Indexed: 01/23/2023]
Affiliation(s)
- Robert C.G. Martin
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Russell W. Farmer
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - R. Charles St. Hill
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Kelly M. McMasters
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
| | - Charles R. Scoggins
- Department of Surgery; Division of Surgical Oncology; University of Louisville; Louisville Kentucky
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Squires MH, Lad NL, Fisher SB, Kooby DA, Weber SM, Brinkman A, Sarmiento JM, Scoggins CR, Egger ME, Cardona K, Cho CS, Martin RC, Russell MC, Winslow E, Staley CA, Maithel SK. Value of Primary Operative Drain Placement after Major Hepatectomy: A Multi-Institutional Analysis of 1,041 Patients. J Am Coll Surg 2015; 220:396-402. [DOI: 10.1016/j.jamcollsurg.2014.12.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 02/08/2023]
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29
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Kimbrough CW, Agle SC, Scoggins CR, Martin RC, Marvin MR, Davis EG, McMasters KM, Jones CM. Factors predictive of readmission after hepatic resection for hepatocellular carcinoma. Surgery 2014; 156:1039-46. [DOI: 10.1016/j.surg.2014.06.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/24/2014] [Indexed: 12/12/2022]
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Kwon D, McFarland K, Velanovich V, Martin RC. Borderline and locally advanced pancreatic adenocarcinoma margin accentuation with intraoperative irreversible electroporation. Surgery 2014; 156:910-20. [DOI: 10.1016/j.surg.2014.06.058] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/24/2014] [Indexed: 02/08/2023]
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Lencioni R, Aliberti C, de Baere T, Garcia-Monaco R, Narayanan G, O’Grady E, Rilling WS, Walker D, Martin RC. Transarterial Treatment of Colorectal Cancer Liver Metastases with Irinotecan-Loaded Drug-Eluting Beads: Technical Recommendations. J Vasc Interv Radiol 2014; 25:365-9. [DOI: 10.1016/j.jvir.2013.11.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/18/2013] [Accepted: 11/24/2013] [Indexed: 12/21/2022] Open
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Burton AL, Egger ME, Quillo AR, Stromberg AJ, Hagendoorn L, Scoggins CR, Martin RC, McMasters KM, Callender GG. Prognostic factors in young women with cutaneous melanoma. Am J Surg 2014; 207:102-8. [DOI: 10.1016/j.amjsurg.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 09/30/2013] [Accepted: 10/03/2013] [Indexed: 11/28/2022]
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Schiffman SC, Nowacki MR, Spencer L, McMasters KM, Scoggins CR, Martin RC. Molecular factors associated with recurrence and survival following hepatectomy in patients with intrahepatic cholangiocarcinoma: A guide to adjuvant clinical trials. J Surg Oncol 2013; 109:98-103. [DOI: 10.1002/jso.23459] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 09/03/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Suzanne C. Schiffman
- From the Division of Surgical Oncology, Department of Surgery; University of Louisville and The James Graham Brown Cancer Center; Louisville Kentucky
| | | | - Lena Spencer
- Norton Hospital Department of Pathology; Louisville Kentucky
| | - Kelly M. McMasters
- From the Division of Surgical Oncology, Department of Surgery; University of Louisville and The James Graham Brown Cancer Center; Louisville Kentucky
| | - Charles R. Scoggins
- From the Division of Surgical Oncology, Department of Surgery; University of Louisville and The James Graham Brown Cancer Center; Louisville Kentucky
| | - Robert C.G. Martin
- From the Division of Surgical Oncology, Department of Surgery; University of Louisville and The James Graham Brown Cancer Center; Louisville Kentucky
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Bower M, Wunderlich C, Brown R, Scoggins CR, McMasters KM, Martin RC. Obesity rather than neoadjuvant chemotherapy predicts steatohepatitis in patients with colorectal metastasis. Am J Surg 2013; 205:685-90. [DOI: 10.1016/j.amjsurg.2012.07.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 06/19/2012] [Accepted: 07/17/2012] [Indexed: 01/13/2023]
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Fox M, Van Berkel V, Bousamra M, Sloan S, Martin RC. Surgical management of pulmonary carcinoid tumors: sublobar resection versus lobectomy. Am J Surg 2013; 205:200-8. [DOI: 10.1016/j.amjsurg.2012.05.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 05/11/2012] [Accepted: 05/11/2012] [Indexed: 10/27/2022]
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Burton AL, Egger ME, Gilbert JE, Stromberg AJ, Hagendoorn L, Martin RC, Scoggins CR, McMasters KM, Callender GG. Assessment of mitotic rate reporting in melanoma. Am J Surg 2012; 204:969-74; discussion 974-5. [DOI: 10.1016/j.amjsurg.2012.05.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 05/22/2012] [Accepted: 05/22/2012] [Indexed: 10/27/2022]
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Li Y, Dunki-Jacobs E, Li S, Martin RC. Abstract 1982: Turmeric oil inhibits hepatocellular carcinoma through abolishing EpCAM expression. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-1982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In previous study, we found that turmeric oil, a volatile oil from turmeric, can prevent hepatocellular carcinoma (HCC) in an orthotopic HCC mouse model. Epithelial cell adhesion molecule (EpCAM), a marker of cancer stem cells (CSC), is correlated with HCC initiation, progression, and prognosis. Our resent data showed that turmeric oil can decrease EpCAM expression in esophageal cancer and HCC cell lines. Since the role of EpCAM in HCC carcinogenesis is becoming clarified, it is likely that turmeric oil prevents HCC through EpCAM signaling. Aim: To investigate the mechanism of turmeric oil for HCC prevention. Method: EpCAM expression in the specimens from HCC patients (n=25) was evaluated by immunohistochemical staining. Red fluorescent protein (RFP)-labeled H4IIE cells were inoculated into liver lobe of ACI rats. The rat HCC tumor tissues from RFP-H4IIE cell inoculation were evaluated for the subpopulation cells, which co-expressed RFP and EpCAM. The HCC rats by H4IIE cell inoculation were treated with turmeric oil (100mg/kg, i.p, every 2 days) for 2 weeks. The H4IIE cells treated with turmeric oil as well as with EpCAM siRNA, and then inoculated at 106 into the right flank of nude BALB/c mice for 1 week. Three HCC cell lines from human (HepG-2), mouse (hepal-6), and rat (H4IIE) cells, were treated with turmeric oil to evaluate the cell viability EpCAM expression, and β-catenin in vitro. Results: In human samples, a strong EpCAM expression was found HCC tissues, while EpCAM was barely detected in the healthy controls. In HCC animal models, RFP+ EpCAM+ cells were detected in the formed tumor tissue and in circulation. The incidence of HCC by H4IIE cells inoculation was significantly decreased in rats treated with turmeric oil. Abolishing of EpCAM by turmeric oil caused the H4IIE cells unable to form tumor in nude mice. In cell culture study, turmeric oil significantly decreased EpCAM expression in all three HCC cell lines. Turmeric oil caused relocalization of β-catenin, a component in Wnt/β-catenin pathway, in nuclear and cytosol (Figure 1). Conclusion: 1) EpCAM-positive HCC cells contribute to HCC initiation in animal models; 2) The inhibition of HCC by turmeric oil is through decreasing EpCAM expression; 3). The regulation of EpCAM expression by turmeric oil is associated with Wnt/β-catenin pathway.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 1982. doi:1538-7445.AM2012-1982
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Affiliation(s)
- Yan Li
- 1Univ. of Louisville, Louisville, KY
| | | | - Suping Li
- 1Univ. of Louisville, Louisville, KY
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Triebel KL, Martin RC, Novack TA, Dreer L, Turner C, Pritchard PR, Raman R, Marson DC. Treatment consent capacity in patients with traumatic brain injury across a range of injury severity. Neurology 2012; 78:1472-8. [PMID: 22496195 DOI: 10.1212/wnl.0b013e3182553c38] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate medical decision-making capacity (MDC) in patients with acute traumatic brain injury (TBI) across a range of injury severity. METHODS We evaluated MDC cross-sectionally 1 month after injury in 40 healthy controls and 86 patients with TBI stratified by injury severity (28 mild [mTBI], 15 complicated mild [cmTBI], 43 moderate/severe [msevTBI]). We compared group performance on the Capacity to Consent to Treatment Instrument and its 5 consent standards (expressing choice, reasonable choice, appreciation, reasoning, understanding). Capacity impairment ratings (no impairment, mild/moderate impairment, severe impairment) on the consent standards were also assigned to each participant with TBI using cut scores referenced to control performance. RESULTS One month after injury, the mTBI group performed equivalently to controls on all consent standards. In contrast, the cmTBI group was impaired relative to controls on the understanding standard. No differences emerged between the mTBI and cmTBI groups. The msevTBI group was impaired on almost all standards relative to both control and mTBI groups, and on the understanding standard relative to the cmTBI group. Capacity compromise (mild/moderate or severe impairment ratings) on the 3 clinically complex standards (understanding, reasoning, appreciation) occurred in 10%-30% of patients with mTBI, 50% of patients with cmTBI, and 50%-80% of patients with msevTBI. CONCLUSIONS One month following injury, MDC is largely intact in patients with mTBI, but is impaired in patients with cmTBI and msevTBI. Impaired MDC is prevalent in acute TBI and is strongly related to injury severity.
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Affiliation(s)
- K L Triebel
- Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, Birmingham, USA
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Callender GG, Gershenwald JE, Egger ME, Scoggins CR, Martin RC, Schacherer CW, Edwards MJ, Urist MM, Ross MI, Stromberg AJ, McMasters KM. A Novel and Accurate Computer Model of Melanoma Prognosis for Patients Staged by Sentinel Lymph Node Biopsy: Comparison with the American Joint Committee on Cancer Model. J Am Coll Surg 2012; 214:608-17; discussion 617-9. [DOI: 10.1016/j.jamcollsurg.2011.12.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 12/20/2011] [Indexed: 12/29/2022]
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40
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Brown RE, St. Hill CR, Greene QJ, Farmer RW, Reuter NP, Callendar GG, Martin RC, McMasters KM, Scoggins CR. Impact of histology on survival in retroperitoneal sarcomas. Am J Surg 2011; 202:748-52; discussion 752-3. [DOI: 10.1016/j.amjsurg.2011.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 08/29/2011] [Accepted: 09/06/2011] [Indexed: 10/16/2022]
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41
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Schiffman SC, Chu CK, Park J, Russell M, Keilin S, Kooby DA, Scoggins CR, McMasters KM, Martin RC. Is prior cholecystectomy associated with decreased survival in patients with resectable pancreatic adenocarcinoma following pancreaticoduodenectomy? Am J Surg 2011; 201:519-24. [DOI: 10.1016/j.amjsurg.2010.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 02/04/2010] [Indexed: 01/23/2023]
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Brown RE, Abbas AE, Ellis S, Williams S, Scoggins CR, McMasters KM, Martin RC. A Prospective Phase II Evaluation of Esophageal Stenting for Neoadjuvant Therapy for Esophageal Cancer: Optimal Performance and Surgical Safety. J Am Coll Surg 2011; 212:582-8; discussion 588-9. [DOI: 10.1016/j.jamcollsurg.2010.12.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 01/24/2023]
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Burton AL, Roach BA, Mays MP, Chen AF, Ginter BA, Vierling AM, Scoggins CR, Martin RC, Stromberg AJ, Hagendoorn L, Mcmasters KM. Prognostic Significance of Tumor Infiltrating Lymphocytes in Melanoma. Am Surg 2011. [DOI: 10.1177/000313481107700219] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prognostic significance of tumor infiltrating lymphocyte (TIL) response in cutaneous melanoma is controversial. This analysis of data from a prospective, randomized trial included patients with cutaneous melanoma ≥ 1.0 mm Breslow thickness who underwent wide local excision and sentinel lymph node (SLN) biopsy. Univariate and multivariate analyses were performed to determine factors associated with TIL response, disease-free survival (DFS), and overall survival (OS). A total of 515 patients were included; TIL response was classified as “brisk” (n = 100; 19.4%) or “non-brisk” (n = 415; 80.6%). Patients in the nonbrisk TIL group were more likely to have tumor-positive SLN (17.6% vs 7%; P = 0.0087). On multivariate analysis, nonbrisk TIL response, increased tumor thickness, and ulceration were significant independent predictors of tumor-positive SLN. By Kaplan-Meier analysis, 5-year DFS rate was 91 per cent for those with a brisk TIL response compared with 86 per cent in the nonbrisk group ( P = 0.41). The 5-year OS rates were 95 per cent versus 84 per cent in the brisk versus nonbrisk TIL groups, respectively ( P = 0.0083). However, on multivariate analysis, TIL response was not a significant independent factor predicting DFS or OS. TIL response is a significant predictor of SLN metastasis but is not a major predictor of DFS or OS.
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Affiliation(s)
- Alison L. Burton
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Brent A. Roach
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Michael P. Mays
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Andrea F. Chen
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | | | - Abbey M. Vierling
- Department of Surgery, University of Louisville, Louisville, Kentucky
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Reuter NP, Bower M, Scoggins CR, Martin RC, McMasters KM, Chagpar AB. The lower incidence of melanoma in women may be related to increased preventative behaviors. Am J Surg 2010; 200:765-8, discussion 768-9. [DOI: 10.1016/j.amjsurg.2010.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 06/15/2010] [Accepted: 06/15/2010] [Indexed: 10/18/2022]
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Brown RE, Stromberg AJ, Hagendoorn LJ, Hulsewede DY, Ross MI, Noyes RD, Goydos JS, Urist MM, Edwards MJ, Scoggins CR, McMasters KM, Martin RC. Surveillance after surgical treatment of melanoma: Futility of routine chest radiography. Surgery 2010; 148:711-6; discussion 716-7. [DOI: 10.1016/j.surg.2010.07.042] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 07/15/2010] [Indexed: 11/25/2022]
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Picozzi VJ, Abrams RA, Decker PA, Traverso W, O'Reilly EM, Greeno E, Martin RC, Wilfong LS, Rothenberg ML, Posner MC, Pisters PWT. Multicenter phase II trial of adjuvant therapy for resected pancreatic cancer using cisplatin, 5-fluorouracil, and interferon-alfa-2b-based chemoradiation: ACOSOG Trial Z05031. Ann Oncol 2010; 22:348-54. [PMID: 20670978 DOI: 10.1093/annonc/mdq384] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The American College of Surgeons Oncology Group sought to confirm the efficacy of a novel interferon-based chemoradiation regimen in a multicenter phase II trial. PATIENTS AND METHODS Patients with resected (R0/R1) adenocarcinoma of the pancreatic head were treated with adjuvant interferon-alfa-2b (3 million units s.c. on days 1, 3, and 5 of each week for 5.5 weeks), cisplatin (30 mg/m(2) i.v. weekly for 6 weeks), and continuous infusion 5-fluorouracil (5-FU; 175 mg·m(2)/day for 38 days) concurrently with external-beam radiation (50.4 Gy). Chemoradiation was followed by two 6-week courses of continuous infusion 5-FU (200 mg·m(2)/day). The primary study end point was 18-month overall survival from protocol enrollment (OS18); an OS18 ≥65% was considered a positive study outcome. RESULTS Eighty-nine patients were enrolled. Eighty-four patients were assessable for toxicity. The all-cause grade ≥3 toxicity rate was 95% (80 patients) during therapy. No long-term toxicity or toxicity-related deaths were noted. At 36-month median follow-up, the OS18 was 69% [95% confidence interval (CI) 60% to 80%]; the median disease-free survival and overall survival were 14.1 months (95% CI 11.0-20.1 months) and 25.4 months (95% CI 23.4-34.1 months), respectively. CONCLUSIONS Notwithstanding promising multi-institutional efficacy results, further development of this regimen will require additional modifications to mitigate toxic effects.
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Affiliation(s)
- V J Picozzi
- Department of Medical Oncology, Virginia Mason Medical Center, Seattle, WA 98111, USA.
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Bowling JT, Reuter NP, Martin RC, Mcmasters KM, Tatum C, Scoggins CR. Prior Biliary Tree Instrumentation Does Not Preclude Hepatic Arterial Therapy for Malignancy. Am Surg 2010. [DOI: 10.1177/000313481007600626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Hepatic arterial therapy (HAT) has become an accepted alternative for patients with unresectable hepatic malignancies. HAT has an acceptable toxicity profile, yet its safety for use in patients who have undergone significant biliary manipulation is undocumented. A retrospective review identified 18 consecutive patients with unresectable hepatic malignancies who had undergone significant prior biliary tree manipulation. All patients received peri-HAT antibiotics. Clinicopathologic, treatment-related, and outcomes data were collected and analyzed. Eighteen patients who had HAT were analyzed; 72 per cent were men, the median age was 61 years, and 61 per cent had greater than 25 per cent hepatic parenchymal replacement by tumor. Seventy-eight per cent of patients had an indwelling biliary stent and 22 per cent had undergone a hepaticojejunostomy Twenty-two per cent of patients developed a complication, none of which were infectious, and there were no peri-HAT deaths. The majority of patients had evidence of either a partial response (55%) or stable disease (22%) upon follow-up. One patient had a complete response to HAT. The median survival was 27 months. Hepatic arterial therapy seems to be safe for patients with unresectable hepatic malignancies and a history of significant biliary instrumentation. There is no increased risk of infectious complications in this population after HAT
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Affiliation(s)
- Jason T. Bowling
- Division of Surgical Oncology, Department of Surgery and the James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
| | - Nathan P. Reuter
- Division of Surgical Oncology, Department of Surgery and the James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
| | - Robert C.G. Martin
- Division of Surgical Oncology, Department of Surgery and the James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
| | - Kelly M. Mcmasters
- Division of Surgical Oncology, Department of Surgery and the James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
| | - Cliff Tatum
- Division of Surgical Oncology, Department of Surgery and the James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
| | - Charles R. Scoggins
- Division of Surgical Oncology, Department of Surgery and the James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky
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Augenstein VA, Reuter NP, Bower MR, McMasters KM, Scoggins CR, Martin RC. Bile cultures: A guide to infectious complications after pancreaticoduodenectomy. J Surg Oncol 2010; 102:478-81. [DOI: 10.1002/jso.21612] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Martin RC, Scoggins CR, McMasters KM. Laparoscopic Hepatic Lobectomy: Advantages of a Minimally Invasive Approach. J Am Coll Surg 2010; 210:627-34, 634-6. [DOI: 10.1016/j.jamcollsurg.2009.12.022] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 02/06/2023]
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