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  • 1
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    Online Resource
    The Association of Race With Adequate Lymph Node Evaluation for Gastric Cancer
    SAGE Publications ; 2022
    In:  The American Surgeon Vol. 88, No. 9 ( 2022-09), p. 2280-2288
    Details
    In: The American Surgeon, SAGE Publications, Vol. 88, No. 9 ( 2022-09), p. 2280-2288
    Abstract: National studies have reported racial and socioeconomic disparities in gastric cancer (GC) care. The current study evaluated adequate lymph node (LN) assessment (≥16 LNs) during resection for GC within a healthcare system servicing a socioeconomically disparate, mostly non-White population in the Southeast United States. Methods A retrospective cohort study of patients undergoing resection for GC between 2003-2019 was performed. Factors associated with adequate LN assessment including patient and tumor characteristics were analyzed. Results Among 202 patients, adequate LN assessment was performed in 97 (48%) patients. On univariable analysis, younger age, non-White race, lower Charlson Comorbidity Index (CCI), Medicaid or no insurance, D1+/D2 lymphadenectomy, clinical evidence of regional LN metastases, total gastrectomy, and receipt of neoadjuvant therapy were associated with adequate LN assessment. On multivariable analysis, non-White race (OR 2.79, 95% CI 1.38-5.65), CCI 〈 4 (OR 2.14, 95% CI 1.15-3.96), and D1+/D2 lymphadenectomy (OR 3.63, 95% CI 1.96-6.74) were the only factors independently associated with adequate LN evaluation. Conclusions In the current study, non-White race, independent of socioeconomics, was significantly associated with adequate LN assessment. Future work is necessary to improve standardization and achieve higher rates of adequate LN assessment for all patients during resection for GC.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/00031348221101601
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 2
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    Traveling for Pancreatic Cancer Care Is Worth the Trip
    SAGE Publications ; 2021
    In:  The American Surgeon Vol. 87, No. 4 ( 2021-04), p. 549-556
    Details
    In: The American Surgeon, SAGE Publications, Vol. 87, No. 4 ( 2021-04), p. 549-556
    Abstract: Centralized care for patients with pancreatic cancer is associated with longer survival. We hypothesized that increased travel distance from home is associated with increased survival for pancreatic cancer patients. Methods The National Cancer Database user file for all pancreatic cancer patients was investigated from 2004 through 2015. Distance from the patients’ zip code to the treating facility was determined. Survival was investigated using the Kaplan-Meier method. Cox hazard ratios (CoxHRs) were determined based on stage of disease, distance traveled for care, and clinical factors. Results 340 780 patients were identified. In the average age of 68 ± 12 years, 51% were male and 83% were Caucasian. For all stages of cancer, longer survival was associated with traveling farther ( P 〈 .001). The survival advantage was longer for Caucasians than African Americans (3.7 months vs. 2.6 months, P 〈 .001) Travel was associated with a 13% decrease in risk of death ( P 〈 .001). Even controlling for the pathologic stage, traveling farther was associated with decreased risk of death (CoxHR = .91, P 〈 .001). Discussion Traveling for care is associated with improved survival for pancreatic cancer patients. While a selection bias may exist, the fact that all stages of patients investigated benefited suggests that this is a real phenomenon.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/0003134820951484
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 3
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    Early Postoperative Extubation is Associated with Shorter Hospitalization and Improved Short-Term Survival in Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy
    SAGE Publications ; 2022
    In:  The American Surgeon Vol. 88, No. 5 ( 2022-05), p. 887-893
    Details
    In: The American Surgeon, SAGE Publications, Vol. 88, No. 5 ( 2022-05), p. 887-893
    Abstract: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is associated with significant operative time, hospital resources, and morbidity. We examine factors associated with hospital length of stay (LOS) and early overall survival (OS) after CRS/HIPEC. Materials and Methods Patients who underwent CRS/HIPEC were evaluated for factors associated with LOS. Institutional learning curve influence was addressed by comparing early vs late cohorts. Variables with P 〈 .200 after univariate analysis were considered for inclusion in multivariate linear regression modeling. Independent factors associated with OS were evaluated using the Kaplan-Meier method. Results Seventy patients underwent CRS/HIPEC (mean age 52.3 years, 64.3% female, and 68.6% Caucasian). Presence of any surgical complication was found in 26 (37.1%), 28 (40%) remained intubated postoperatively, and the mean Peritoneal Carcinomatosis Index (PCI) score was 14.4 ([Formula: see text]10.4). Mean intensive care unit and hospital LOS were 2.9 days ([Formula: see text] 2.3) and 9.6 days ([Formula: see text]3.6), respectively. After adjusting for covariates, only shorter time to postoperative ambulation (regression coefficient .92, P = .001) and early extubation (regression coefficient −1.90, P = .018) were associated with decreased hospital LOS on multivariate analysis. Immediate postoperative extubation conferred an independent early survival benefit on Kaplan-Meier analysis (mean OS 714.8 vs 473.4 days, P = .010). There was no difference in hospital LOS or OS between early and late cohorts. Conclusion Early postoperative extubation and shorter time to ambulation are associated with decreased hospital LOS. Moreover, CRS/HIPEC patients extubated immediately postoperatively have an early survival benefit. Every effort should be made to achieve early postoperative extubation and mobilization in CRS/HIPEC patients.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/00031348211050588
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 4
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    The Evolving Role of Surgery for Gastric Lymphoma: From Curative Resection to Surgical Management of Complications
    SAGE Publications ; 2014
    In:  The American Surgeon Vol. 80, No. 11 ( 2014-11), p. 322-324
    Details
    In: The American Surgeon, SAGE Publications, Vol. 80, No. 11 ( 2014-11), p. 322-324
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/000313481408001118
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2014
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  • 5
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    The Impact of Ostomy Creation after Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy in a Newly Established Peritoneal Malignancy Program
    SAGE Publications ; 2018
    In:  The American Surgeon Vol. 84, No. 6 ( 2018-06), p. 776-782
    Details
    In: The American Surgeon, SAGE Publications, Vol. 84, No. 6 ( 2018-06), p. 776-782
    Abstract: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has improved outcomes for selected patients with peritoneal carcinomatosis and often requires ostomy creation. We examined the impact of ostomy creation in a newly established peritoneal malignancy program. A retrospective review was performed of CRS-HIPEC procedures from 2011 to 2016. Those who did and did not receive an ostomy were compared. Fifty-eight patients underwent CRS-HIPEC and an ostomy was created in 25.9 per cent. Median peritoneal cancer index (14 vs 16, P = 0.63) and multivisceral resection rates (87.9 vs 100.0%, P = 0.17) were similar between groups. Multivariable analysis revealed that bowel resection (OR 210.65, P = 0.02) was significantly associated with ostomy creation. Advanced age was noted to be inversely associated with stoma formation (OR 0.04, P = 0.04). Progression-free survival was significantly lower in the ostomy group (18 vs 23 months, P = 0.03). Those with an ostomy experienced prolonged length of stay (13.3 ± 7.4 vs 9.5 ± 3.7, P = 0.01). At follow-up, 6/10 temporary ostomies had undergone reversal and three patients experienced morbidity after reversal. Ostomy creation may occur during CRS-HIPEC and carries potential for morbidity. Ostomy creation may contribute to postoperative length of stay. Patients should be counseled preoperatively on the potential impact of ostomy placement during CRS-HIPEC.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/000313481808400618
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
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  • 6
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    Robotic-Assisted Retroperitoneoscopic Adrenalectomy: Making a Good Procedure Even Better
    SAGE Publications ; 2013
    In:  The American Surgeon Vol. 79, No. 1 ( 2013-01), p. 84-89
    Details
    In: The American Surgeon, SAGE Publications, Vol. 79, No. 1 ( 2013-01), p. 84-89
    Abstract: Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive procedure offering several advantages over a transabdominal laparoscopic operation. The three-dimensional optics and articulating instrumentation offered by current robotic surgical technology potentially improve this procedure. Robotic-assisted PRA (RA-PRA) was performed in patients meeting standard criteria for minimally invasive adrenalectomy. We prospectively collected demographic, clinical, perioperative, and pathologic data on patients undergoing RA-PRA. Thirty consecutive RA-PRAs were performed in 28 patients (26 unilateral and 2 bilateral). Indications for adrenalectomy included pheochromocytoma (8), hyperaldosteronism (3), hypercortisolism (8), oligometastases (5), and nonfunctional tumors (6). Mean tumor size was 3.8 ± 1.6 cm. Mean body mass index was 30.7 ± 6.5 kg/m 2 . Mean operative time was 154 ± 43 minutes for unilateral total adrenalectomy. Four patients with multiple endocrine neoplasia Type 2A-associated pheochromocytomas underwent cortical-preserving procedures. Three patients experienced perioperative complications (one pneumothorax, one urinary retention, one required postoperative blood transfusion). No patient required conversion to an open procedure. Robotic surgical technology is an excellent complement to retroperitoneoscopic adrenalectomy. The three-dimensional view and ergonomic advantages of a robotic procedure promote better visualization and a more flexible approach to dissection. We believe these features may optimize the ability to maintain a vascularized remnant during minimally invasive cortical-sparing adrenalectomy.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/000313481307900135
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2013
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  • 7
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    What Is the Utility of Restaging Imaging for Patients With Clinical Stage II/III Rectal Cancer After Completion of Neoadjuvant Chemoradiation and Prior to Proctectomy?
    SAGE Publications ; 2021
    In:  The American Surgeon Vol. 87, No. 2 ( 2021-02), p. 242-247
    Details
    In: The American Surgeon, SAGE Publications, Vol. 87, No. 2 ( 2021-02), p. 242-247
    Abstract: In the United States, patients with clinical stage II or III rectal cancer typically receive neoadjuvant chemoradiation therapy (chemo/XRT) over a 5-6 week period followed by a 6-10 week break prior to proctectomy. In the current study, we evaluate the utilization of restaging studies performed and detection of disease progression during this window. Methods A retrospective review of patients with clinical stage II/III rectal cancer was performed. Medical records were analyzed to collect clinicopathologic data and the performance and results of preoperative, early postoperative, and first surveillance CT and/or PET/CT in patients completing long course neoadjuvant chemo/XRT and undergoing proctectomy. Results Between 2005 and 2017, 176 patients with clinical stage II or III rectal adenocarcinoma completed neoadjuvant chemo/XRT and underwent proctectomy. Preoperative restaging with CT CAP and/or CT/PET was performed in 72 (40.9%) patients with no detection of disease progression. Of the 104 patients without preoperative restaging, 1 had intraoperative detection of liver metastases and 31 had early postoperative reimaging (within 30 days of proctectomy) of which 2 had detection of new pulmonary metastases. Among 72 patients with no preoperative or early postoperative reimaging, first surveillance imaging was available in 47 and detected new metastases in 8 (17%). Discussion In patients with clinical stage II/III rectal cancer who undergo long course neoadjuvant chemo/XRT, perioperative reimaging with CT CAP and/or PET/CT detects new metastases in a small percentage of patients. A multi-institutional, prospective analysis using standardized staging protocols is warranted to better determine the value of preoperative restaging in these patients.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/0003134820950298
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
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  • 8
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    Gracilis Flap Reconstruction After Proctocolectomy for Malignancy and Inflammatory Bowel Disease
    SAGE Publications ; 2023
    In:  The American Surgeon Vol. 89, No. 2 ( 2023-02), p. 247-254
    Details
    In: The American Surgeon, SAGE Publications, Vol. 89, No. 2 ( 2023-02), p. 247-254
    Abstract: Gracilis flap reconstruction (GFR) following abdominoperineal resection (APR) or proctocolectomy (PC) can reduce pelvic wound complications but has not been adequately assessed in the setting of immunosuppression, fistulous disease, and neoadjuvant chemoradiation. Methods Patients undergoing APR/PC with GFR were retrospectively analyzed with regard to perioperative characteristics, and morbidity was assessed. Results Patients underwent GFR for rectal cancer ( n = 28), anal cancer ( n = 3), inflammatory bowel disease ( n = 13), or benign fistulizing disease ( n = 1). 22.2% were chronically immunosuppressed, and 66.7% underwent preoperative chemoradiation. Twenty (44.4%) patients had minor wound complications, all treated nonoperatively. Nine patients had major complications with 4 patients requiring reoperation. The 4 threatened flaps were unilateral, and all were salvaged. Donor site morbidity was minimal. Patients with major complications were older (56 vs. 71 years, P = .030), and less likely to have pelvic drains ( P = .018). Conclusion In high-risk perineal wounds, GFR offers durable reconstruction with acceptably low morbidity.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/00031348211011146
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 9
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    Rising BMI is Associated with Increased Rate of Clinically Relevant Pancreatic Fistula after Distal Pancreatectomy for Pancreatic Adenocarcinoma
    SAGE Publications ; 2019
    In:  The American Surgeon Vol. 85, No. 12 ( 2019-12), p. 1376-1380
    Details
    In: The American Surgeon, SAGE Publications, Vol. 85, No. 12 ( 2019-12), p. 1376-1380
    Abstract: Clinically relevant pancreatic fistula (CR-POPF), after distal pancreatectomy (DP), remains a clinical challenge. Prior studies investigating the relationship between BMI and CR-POPF have yielded conflicting results. We hypothesized that BMI is associated with CR-POPF in patients having DP for pancreatic ductal adenocarcinoma (PDAC). Patients who underwent DP for PDAC at a single institution from 2006 to 2018 were retrospectively reviewed. A CR-POPF was defined as International Study Group of Pancreatic Surgery (ISGPS) grade B or C fistula. Uni- and multivariable logistic regression analysis assessed factors associated with CR-POPF after DP. Seventy-eight patients met the inclusion criteria, 51 per cent were female, 51 per cent were white, and the average age was 59 ± 15 years. The median BMI was 26 (IQR 24–29). Of all, 19 per cent (n = 15) of patients had a CR-POPF. With a mean follow-up of 2.8 ± 2.5 years, the presence of a CR-POPF was not associated with survival ( P = 0.17). On univariable logistic regression, older age was associated with a decreased risk of CR-POPF (odds ratio (OR) = 0.95, P = 0.015). Increasing BMI was associated with an increased risk of CR-POPF (OR = 1.1, P = 0.044). On multivariate analysis, after controlling for multiple factors, BMI (OR = 1.12, P = 0.035) was the only factor associated with the development of a CR-POPF, whereas older age (OR = 0.94, P 〈 0.001) was slightly protective. Increasing BMI is associated with an increased risk of CR-POPF after DP for PDAC. These findings should be considered during preoperative counseling. Efforts to diminish the risk of CR-POPF should be focused on patients with higher BMI.
    Type of Medium: Online Resource
    ISSN: 0003-1348 , 1555-9823
    URL: Article
    DOI: 10.1177/000313481908501232
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 10
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    Delivery of Antiangiogenic Agents for Cancer Gene Therapy
    SAGE Publications ; 2005
    In:  Technology in Cancer Research & Treatment Vol. 4, No. 4 ( 2005-08), p. 331-341
    Details
    In: Technology in Cancer Research & Treatment, SAGE Publications, Vol. 4, No. 4 ( 2005-08), p. 331-341
    Abstract: The understanding that tumor growth and metastasis are angiogenesis dependent processes has led to interest in targeting tumor vasculature in anticancer therapy. Furthermore, recent insights into the molecular interactions that orchestrate physiologic and pathologic angiogenesis have resulted in a variety of antiangiogenic strategies. A gene therapy-mediated approach for the delivery of antiangiogenic agents has several advantages, including the potential for sustained expression. However, the choice of angiogenesis inhibitor, method of gene delivery, and target/site for transgene expression are important variables to be considered when designing this approach. Here we review the major alternatives within each of these categories and provide illustrative examples of their use in preclinical models.
    Type of Medium: Online Resource
    ISSN: 1533-0346 , 1533-0338
    URL: Article
    DOI: 10.1177/153303460500400403
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2005
    detail.hit.zdb_id: 2146365-7
    detail.hit.zdb_id: 2220436-2
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