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Lizalek JM, Eske J, Thomas KK, Reames BN, Smith L, Schmid K, Krell RW. Hospital Service Volume as an Indicator of Treatment Patterns for Colorectal Cancer. J Surg Res 2024; 302:685-696. [PMID: 39208494 DOI: 10.1016/j.jss.2024.07.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/17/2024] [Accepted: 07/28/2024] [Indexed: 09/04/2024]
Abstract
INTRODUCTION A hospital's approach (volume of cancer treatment services provided) to treating metastatic colorectal cancer influences a patient's treatment as strongly as patient disease status. The implications of hospital-level treatment approaches across disease stages remain understudied. We sought to determine if hospital service volume (SV) for metastatic colorectal cancer could be predictive of nonstandard treatment patterns in stages I-III colon cancer. MATERIALS AND METHODS Using the National Cancer Database, we examined rates of nonstandard treatment patterns among patients with colon cancer between 2010 and 2017. After adjusting for clinicopathological characteristics using multivariable logistic regression, we evaluated the relationship between hospital-level SV for metastatic colorectal cancer and nonstandard treatment approaches for patients with stages I-III colon cancer. RESULTS There were significant associations between hospital-level SV for metastatic colorectal cancer and the odds of chemotherapy overtreatment among patients with stage I-III colon cancer, as well as undertreatment among patients with stages II-III disease after adjusting for hospital-, patient-, and tumor-level covariates. Patients at the highest-level SV hospitals for metastatic disease had 1.29 higher odds (95% CI = 1.18-1.41; P < 0.0001) of receiving overtreatment compared to patients from lowest SV hospitals. The odds ratio of undertreatment in highest SV compared to lowest SV was 0.64 (95% CI 0.56-0.72; P< 0.0001). CONCLUSIONS Hospital-level SV of patients with metastatic colon cancer is a significant indicator of nonstandard treatment patterns among patients with stage I-III colon cancer. Hospitals with the highest volume of cancer treatments have higher odds of providing overtreatment, while low SVs are associated with higher odds of undertreatment.
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Affiliation(s)
- Jason M Lizalek
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Jamie Eske
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Katryna K Thomas
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas
| | - Bradley N Reames
- Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska
| | - Lynette Smith
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Kendra Schmid
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Robert W Krell
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas.
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2
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Abedizadeh R, Majidi F, Khorasani HR, Abedi H, Sabour D. Colorectal cancer: a comprehensive review of carcinogenesis, diagnosis, and novel strategies for classified treatments. Cancer Metastasis Rev 2024; 43:729-753. [PMID: 38112903 DOI: 10.1007/s10555-023-10158-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
Colorectal cancer is the third most common and the second deadliest cancer worldwide. To date, colorectal cancer becomes one of the most important challenges of the health system in many countries. Since the clinical symptoms of this cancer appear in the final stages of the disease and there is a significant golden time between the formation of polyps and the onset of cancer, early diagnosis can play a significant role in reducing mortality. Today, in addition to colonoscopy, minimally invasive methods such as liquid biopsy have received much attention. The treatment of this complex disease has been mostly based on traditional treatments including surgery, radiotherapy, and chemotherapy; the high mortality rate indicates a lack of success for current treatment methods. Moreover, disease recurrence is another problem of traditional treatments. Recently, new approaches such as targeted therapy, immunotherapy, and nanomedicine have opened new doors for cancer treatment, some of which have already entered the market, and many methods have shown promising results in clinical trials. The success of immunotherapy in the treatment of refractory disease, the introduction of these methods into neoadjuvant therapy, and the successful results in tumor shrinkage without surgery have made immunotherapy a tough competitor for conventional treatments. It seems that the combination of those methods with such targeted therapies will go through promising changes in the future of colorectal cancer treatment.
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Affiliation(s)
- Roya Abedizadeh
- Department of Cancer Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Isar 11, Babol, 47138-18983, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Bani-Hashem Square, Tehran, 16635-148, Iran
| | - Fateme Majidi
- Department of Cancer Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Isar 11, Babol, 47138-18983, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Bani-Hashem Square, Tehran, 16635-148, Iran
| | - Hamid Reza Khorasani
- Department of Cancer Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Isar 11, Babol, 47138-18983, Iran
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Bani-Hashem Square, Tehran, 16635-148, Iran
| | - Hassan Abedi
- Department of Internal Medicine, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran.
| | - Davood Sabour
- Department of Cancer Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Isar 11, Babol, 47138-18983, Iran.
- Department of Stem Cells and Developmental Biology, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Bani-Hashem Square, Tehran, 16635-148, Iran.
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Coleman K, Fellner AN, Guend H. Learning curve for robotic rectal cancer resection at a community-based teaching institution. J Robot Surg 2023; 17:3005-3012. [PMID: 37922066 PMCID: PMC10678792 DOI: 10.1007/s11701-023-01671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/04/2023] [Indexed: 11/05/2023]
Abstract
The surgical management of rectal cancer is shifting toward more widespread use of robotics across a spectrum of medical centers. There is evidence that the oncologic outcomes are equivalent to laparoscopic resections, and the post-operative outcomes may be improved. This study aims to evaluate the learning curve of robotic rectal cancer resections at a community-based teaching institution and evaluate clinical and oncologic outcomes. A retrospective review of consecutive robotic rectal cancer resections by a single surgeon was performed for a five-year period. The cumulative sum (CUSUM) for total operative time was calculated and plotted to establish a learning curve. The oncologic and post-operative outcomes for each phase were analyzed and compared. The CUSUM learning curve yielded two phases, the learning phase (cases 1-79) and the proficiency phase (cases 80-130). The median operative time was significantly lower in the proficiency phase. The type of neoadjuvant therapy used between the two groups was statistically different, with chemoradiation being the primary regimen in the learning phase and total neoadjuvant therapy being more common in the proficiency phase. Otherwise, oncologic and overall post-operative outcomes were not significantly different between the groups. Robotic rectal resections can be done in a community-based hospital system by trained surgeons with outcomes that are favorable and similar to larger institutions.
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Affiliation(s)
- Kristen Coleman
- Department of Surgery, TriHealth, 375 Dixmyth Ave, Cincinnati, OH, 45220, USA.
| | | | - Hamza Guend
- TriHealth Surgical Institute, Cincinnati, OH, USA
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Zeting Y, Shuli M, Yue L, Haowei F, Jing S, Yueping Z, Jie W, Teng C, Wanli D, Zhang K, Peihao Y. Tissue adhesive indocyanine green-locking granular gel-mediated photothermal therapy combined with checkpoint inhibitor for preventing postsurgical recurrence and metastasis of colorectal cancer. Bioeng Transl Med 2023; 8:e10576. [PMID: 38023716 PMCID: PMC10658503 DOI: 10.1002/btm2.10576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 12/01/2023] Open
Abstract
Developing effective therapy to inhibit postoperative recurrence and metastasis of colorectal cancer (CRC) is challenging and significant to reduce mortality and morbidity. Here, a granular hydrogel, assembled from gelatin microgels by dialdehyde starch and interpenetrated with in situ polymerized poly(sulfobetaine methacrylate-co-N-isopropylacrylamide) (P(SBMA-co-NIPAM)), is prepared to load and lock Food and Drug Administration (FDA)-approved indocyanine green (ICG) with definite photothermal function and biosafety for photothermal therapy (PTT) combining with checkpoint inhibitor. The presence of P(SBMA-co-NIPAM) endows granular hydrogel with high retention to water-soluble ICG, preventing easy diffusion and rapid scavenging of ICG. The ICG-locking granular hydrogel can be spread and adhered onto the surgery site at wet state in vivo, exerting a persistent and stable PTT effect. Combined with αPD-L1 treatment, ICG-locking granular hydrogel-mediated PTT can eradicate postsurgery residual and metastatic tumors, and prevent long-term tumor recurrence. Further mechanistic studies indicate that combination treatment effectively promotes dendritic cells maturation in lymph nodes, enhances the number and infiltration of CD8+ T and CD4+ T cells in tumor tissue, and improves memory T cell number in spleen, thus activating the antitumor immune response. Overall, ICG-locking gel-mediated PTT is expected to exhibit broad clinical applications in postoperative treatment of cancers, like CRC.
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Affiliation(s)
- Yuan Zeting
- Interventional Cancer Institute of Chinese Integrative Medicine & Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Central Laboratory, Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Department of Pharmaceutics, School of PharmacyEast China University of Science and TechnologyShanghaiChina
- Shanghai Putuo Central School of Clinical MedicineAnhui Medical UniversityHefeiP. R. China
| | - Ma Shuli
- Interventional Cancer Institute of Chinese Integrative Medicine & Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Central Laboratory, Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Department of Pharmaceutics, School of PharmacyEast China University of Science and TechnologyShanghaiChina
| | - Li Yue
- Interventional Cancer Institute of Chinese Integrative Medicine & Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Central Laboratory, Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
| | - Fang Haowei
- Department of Polymer Materials, School of Materials Science and EngineeringShanghai UniversityShanghaiP. R. China
| | - Shang Jing
- Interventional Cancer Institute of Chinese Integrative Medicine & Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Central Laboratory, Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Shanghai Putuo Central School of Clinical MedicineAnhui Medical UniversityHefeiP. R. China
| | - Zhan Yueping
- Interventional Cancer Institute of Chinese Integrative Medicine & Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Central Laboratory, Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
| | - Wang Jie
- Department of General Surgery, Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
| | - Chen Teng
- Department of General Surgery, Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
| | - Deng Wanli
- Department of Oncology, Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
| | - Kunxi Zhang
- Interventional Cancer Institute of Chinese Integrative Medicine & Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Department of Polymer Materials, School of Materials Science and EngineeringShanghai UniversityShanghaiP. R. China
| | - Yin Peihao
- Interventional Cancer Institute of Chinese Integrative Medicine & Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
- Department of Pharmaceutics, School of PharmacyEast China University of Science and TechnologyShanghaiChina
- Department of General Surgery, Putuo HospitalShanghai University of Traditional Chinese MedicineShanghaiP. R. China
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Formisano G, Ferraro L, Salaj A, Giuratrabocchetta S, Piccolo G, Di Raimondo G, Bianchi PP. Robotic Total Mesorectal Excision for Low Rectal Cancer: A Narrative Review and Description of the Technique. J Clin Med 2023; 12:4859. [PMID: 37510973 PMCID: PMC10381747 DOI: 10.3390/jcm12144859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
Robotic surgery may offer significant advantages for treating extraperitoneal rectal cancer. Although laparoscopy has been shown to be safe and effective, laparoscopic total mesorectal excision (TME) remains technically challenging and is still performed in selected centers. Robotic anterior resection (RAR) may overcome the drawback of conventional laparoscopy, providing high-quality surgery with favorable oncological outcomes. Moreover, recent data show how RAR offers clinical and oncological benefits when affording difficult TMEs, such as low and advanced rectal tumors, in terms of complication rate, specimen quality, recurrence rate, and survival. This series aims to review the most recent and relevant literature, reporting mid- and long-term oncological outcomes and focusing on minimally invasive RAR for low rectal cancer.
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Affiliation(s)
- Giampaolo Formisano
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Luca Ferraro
- Department of General Surgery, Asst Santi Paolo e Carlo, 20142 Milan, Italy
| | - Adelona Salaj
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Simona Giuratrabocchetta
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Gaetano Piccolo
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Giulia Di Raimondo
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
| | - Paolo Pietro Bianchi
- Department of Surgery, Asst Santi Paolo e Carlo, Dipartimento di Scienze della Salute, University of Milan, 20122 Milan, Italy
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Hayden DM, Korous KM, Brooks E, Tuuhetaufa F, King-Mullins EM, Martin AM, Grimes C, Rogers CR. Factors contributing to the utilization of robotic colorectal surgery: a systematic review and meta-analysis. Surg Endosc 2023; 37:3306-3320. [PMID: 36520224 PMCID: PMC10947550 DOI: 10.1007/s00464-022-09793-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 11/27/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Some studies have suggested disparities in access to robotic colorectal surgery, however, it is unclear which factors are most meaningful in the determination of approach relative to laparoscopic or open surgery. This study aimed to identify the most influential factors contributing to robotic colorectal surgery utilization. METHODS We conducted a systematic review and random-effects meta-analysis of published studies that compared the utilization of robotic colorectal surgery versus laparoscopic or open surgery. Eligible studies were identified through PubMed, EMBASE, CINAHL, Cochrane CENTRAL, PsycINFO, and ProQuest Dissertations in September 2021. RESULTS Twenty-nine studies were included in the analysis. Patients were less likely to undergo robotic versus laparoscopic surgery if they were female (OR = 0.91, 0.84-0.98), older (OR = 1.61, 1.38-1.88), had Medicare (OR = 0.84, 0.71-0.99), or had comorbidities (OR = 0.83, 0.77-0.91). Non-academic hospitals had lower odds of conducting robotic versus laparoscopic surgery (OR = 0.73, 0.62-0.86). Additional disparities were observed when comparing robotic with open surgery for patients who were Black (OR = 0.78, 0.71-0.86), had lower income (OR = 0.67, 0.62-0.74), had Medicaid (OR = 0.58, 0.43-0.80), or were uninsured (OR = 0.29, 0.21-0.39). CONCLUSION When determining who undergoes robotic surgery, consideration of factors such as age and comorbid conditions may be clinically justified, while other factors seem less justifiable. Black patients and the underinsured were less likely to undergo robotic surgery. This study identifies nonclinical disparities in access to robotics that should be addressed to provide more equitable access to innovations in colorectal surgery.
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Affiliation(s)
- Dana M Hayden
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Kevin M Korous
- Institute for Health and Equity, Medical College of Wisconsin, 1000 N. 92nd St, Milwaukee, WI, 53226, USA
| | - Ellen Brooks
- University of Utah School of Medicine, Department of Family and Preventive Medicine, Salt Lake, UT, USA
| | - Fa Tuuhetaufa
- University of Utah School of Medicine, Department of Family and Preventive Medicine, Salt Lake, UT, USA
| | | | - Abigail M Martin
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Chassidy Grimes
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Charles R Rogers
- Institute for Health and Equity, Medical College of Wisconsin, 1000 N. 92nd St, Milwaukee, WI, 53226, USA.
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7
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Leslie TF, Frankenfeld CL, Menon N. Disparities in colorectal cancer time-to-treatment and survival time associated with racial and economic residential segregation surrounding the diagnostic hospital, Georgia 2010-2015. Cancer Epidemiol 2022; 81:102267. [PMID: 36166941 DOI: 10.1016/j.canep.2022.102267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate patient-level colorectal cancer outcomes in relation to residential income and racial segregation and composition of the neighborhood surrounding the diagnosing hospitals, and characterize presence of cancer-relevant diagnosis and treatment modalities that might contribute to these associations. METHODS We utilized Georgia state cancer registry data (2010-2015), matching diagnosis information to hospital technology provided by the American Hospital Association and spatial information to the US Census. We modeled time-to-treatment and survival time, using Cox proportional hazards models, stratified by segregation. Segregation was examined as residential economic and racial evenness (Atkinson index) and isolation (isolation index) and mean income at the Census tract level. To assess possible contributing factors, analysis of hospital diagnosis and treatment technologies in relation to segregation was conducted. RESULTS Average income of the Census tract and racial residential segregation of the diagnosing hospital's neighborhood was generally unassociated with time-to-treatment or survival time. Higher income evenness around the diagnosing hospital was associated with shorter time-to-treatment, with no association with time-to-death. Higher income isolation for the diagnosing hospital, conversely, was associated with longer times to treatment, but also longer survival times. Hospitals in regions with higher level of residential income segregation were less likely to have a particular diagnosing or treatment technologies, such as virtual colonoscopy and chemotherapy. CONCLUSION Hospital resources may be a function of their immediate economic environment, and this may have influence on cancer outcomes. Future work should evaluate patient outcomes in light of technologies or therapies utilized within particular economic environments.
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Affiliation(s)
- Timothy F Leslie
- Department of Geography and Geoinformation Science, George Mason University, Fairfax, VA, USA.
| | | | - Nirup Menon
- School of Business, George Mason University, Fairfax, VA, USA
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Nwaelugo NS, Goldblatt MI, Gould JC, Higgins RM. The evolution of the general surgery resident operative case experience in the era of robotic surgery. Surg Endosc 2022; 36:6679-6687. [PMID: 34981239 DOI: 10.1007/s00464-021-08940-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Robotic-assisted general surgery procedures are becoming commonplace, requiring more residency programs to establish training curricula for residents. Concerns exist regarding the impact this will have on surgical residents' operative case distribution in laparoscopic and open surgery. This study aimed to analyze the impact of a growing robotic operative case volume and established robotic surgery training curriculum on the general surgery resident operative experience. METHODS The robotic surgery training curriculum at the Medical College of Wisconsin was established in 2017. ACGME operative case logs of residents from 2014 to 2020 were analyzed to determine resident participation in open, laparoscopic, and robotic cases. Case categories included alimentary tract, abdomen, endocrine, thoracic, pediatric, and trauma. A one-way analysis of variance (ANOVA) was used to analyze overall cases, as well as participation by case type, post-graduate year (PGY) level, resident role, and institution type. Statistical significance was defined as a p value < 0.05. RESULTS Operative case logs from 77 residents were analyzed with a total of 34,757 cases: 59.3% open, 39.6% laparoscopic, and 1.1% robotic. There was no significant change in open or laparoscopic case volumes. However, there was a 3.4% increase in robotic cases, from 2014 to 2020 (p = 0.01), specifically in foregut (4.0%, p = 0.01), intestinal (1.6%, p = 0.03), and hernia (8.3%, p = 0.003) procedures. Academic (2.8%, p = 0.01) and veterans' hospital (2.0%, p = 0.01) institutions saw a significant increase in their residents' robotic cases. The only resident role with a significant increase in robotic cases was first assistant (8.0%, p = 0.004). There was no significant difference across PGY levels by surgical approach. CONCLUSIONS This study highlights that the growth of robotic cases has not had a detrimental effect on the resident experience with open and laparoscopic cases. As robotic cases continually increase, the impact on laparoscopic and open case volumes must be monitored to ensure a well-balanced training experience.
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Affiliation(s)
- Nnenna S Nwaelugo
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Matthew I Goldblatt
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Jon C Gould
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Rana M Higgins
- Division of Minimally Invasive and Gastrointestinal Surgery, Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
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He LH, Yang B, Su XQ, Zhou Y, Zhang Z. Comparison of clinical efficacy and postoperative inflammatory response between laparoscopic and open radical resection of colorectal cancer. World J Clin Cases 2022; 10:4042-4049. [PMID: 35665125 PMCID: PMC9131216 DOI: 10.12998/wjcc.v10.i13.4042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/18/2022] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In recent years, the incidence of colorectal cancer (CRC) has increased annually, which has seriously threatened the health and quality of life of patients. In the treatment of CRC, both laparoscopic and radical resection are widely used.
AIM To explore and discuss clinical efficacy and postoperative inflammatory response of laparoscopic and open radical resection of CRC.
METHODS A total of 96 patients with CRC diagnosed in our hospital from March 2016 to April 2021 were selected, and were divided into the study group (n = 48) and control group (n = 48) using a simple random method. The control group was treated with open radical resection of CRC, and the study group was treated with laparoscopic radical resection of CRC. The perioperative conditions (operation time, intraoperative blood loss, the recovery time of gastrointestinal function, number of lymph node dissections and length of hospital stay), inflammatory response index levels [interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP)] before and after operation, pain stress response indices [levels of neuropeptide (NPY), prostaglandin E2 (PGE2), 5-hydroxytryptamine (5-HT)], and the incidence of the complications between the two groups were counted.
RESULTS The operation time in the study group was (186.18 ± 33.54 min), which was longer than that of the control group (129.38 ± 26.83 min), but the intraoperative blood loss (111.34 ± 21.45 mL), recovery time of gastrointestinal function (25.35 ± 4.55 h), and hospital stay (10.09 ± 2.38 d) were better than those in the control group (163.77 ± 32.41 mL, 36.06 ± 7.13 h, 13.51 ± 3.66 d) (P < 0.05). There was no significant difference in the number of lymph node dissections between the study group (15.19 ± 3.04) and the control group (16.20 ± 2.98) (P > 0.05). There was no significant difference between the levels of serum IL-6 (9.79 ± 4.11 ng/mL), IL-8 (3.79 ± 1.71 ng/L), IL-10 (48.96 ± 12.51 ng/L) and CRP (7.98 ± 2.33 mg/L) in the study group and the control group (10.56 ± 3.78 ng/mL, 4.08 ± 1.45 ng/L, 50.13 ± 11.67 ng/L, 8.29 ± 2.60 mg/L) before the operation (P > 0.05). After the operation, there was no significant difference between the levels of serum IL-6 (19.11 ± 6.68 ng/mL). There was no significant difference in serum NPY (109.79 ± 13.46 UG/L), PGE2 (269.54 ± 37.34 ng/L), 5-HT (151.70 ± 18.86 ng/L) between the study group and the control group (113.29 ± 15.01 UG/L, 273.91 ± 40.04 ng/L, 148.85 ± 20.45 ng/L) before the operation (P > 0.05). The incidence of the complications in the study group (4.17%) was lower than that of the control group (18.75%) (P < 0.05).
CONCLUSION Laparoscopic radical resection of CRC can reduce surgical trauma, inflammatory response and pain stress caused by surgery, which shortens rehabilitation of patients, with a low incidence of complications.
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Affiliation(s)
- Long-Hai He
- Department of General Surgery, The First People’s Hospital of Wanzhou District, Chongqing 404040, China
| | - Bo Yang
- Department of General Surgery, The First People’s Hospital of Wanzhou District, Chongqing 404040, China
| | - Xiao-Qin Su
- Department of Clinical Nutrition, The First People’s Hospital of Wanzhou District, Chongqing 404040, China
| | - Yue Zhou
- Department of Clinical Nutrition, The First People’s Hospital of Wanzhou District, Chongqing 404040, China
| | - Zhen Zhang
- Department of General Surgery, The First People’s Hospital of Wanzhou District, Chongqing 404040, China
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10
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Sato S, Kagoshima H, Shiozawa M, Nukada S, Iguchi K, Mikayama Y, Oshima T, Numata M, Tamagawa H, Rino Y, Masuda M, Tanaka K. Automated non-invasive identification of pelvic autonomic nerves with a handheld Raman spectrometer and potential application to nerve-sparing colorectal surgery: a preliminary study in surgical specimens. Transl Cancer Res 2022; 10:3921-3929. [PMID: 35116691 PMCID: PMC8798359 DOI: 10.21037/tcr-21-587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 07/14/2021] [Indexed: 11/06/2022]
Abstract
Background Although minimally invasive surgery for colorectal cancer, whether performed as standard laparoscopic or robotic surgery, has been established as an oncologically safe procedure, postoperative urinary dysfunction and sexual dysfunction remain matters of concern, even when so-called nerve-sparing surgery is performed. We have hypothesized that Raman spectroscopy can be used intraoperatively as a non-invasive label-free means of objective identification of the pelvic nerves, and we conducted a preliminary study by applying a newly developed handheld Raman spectrometer to surgical specimens. Methods Samples of nervous tissue, colon cancer tissue, and tissues from surrounding pelvic organs were obtained from 25 patients undergoing colectomy. Raman spectra were obtained by irradiation with the Progeny™ Raman spectrometer. We looked for characteristic Raman shifts to distinguish nervous tissue from cancer tissue. To improve discrimination between nervous tissue and other tissues, the spectral data were subjected to principal component analysis. Results We detected characteristic differences in the spectra at 1,309 cm-1, 1,442 cm-1, and 1,658 cm-1. A significant difference was detected at 1,442 cm-1, and accuracy of the modality for identification of nervous tissue was 75%. The addition of principle component analysis (4 components) yielded 100% sensitivity, 85% specificity, and 90%, notably increasing accuracy from 75% to 90% in discriminating between nervous tissue and cancer tissue. Conclusions Raman spectroscopy holds promise for non-invasive intraoperative recognition of nervous tissue. We expect the modality to become a powerful clinical tool, compensating for the lack of tactile feedback intrinsic to minimally invasive colectomy and thus thwarting the risk of postoperative urinary and/or sexual dysfunction.
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Affiliation(s)
- Sumito Sato
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | | | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Suguru Nukada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kenta Iguchi
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Yo Mikayama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kuniya Tanaka
- Department of Gastroenterological and General Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
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11
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Kao HY, Yang YC, Hung YH, Wu YJ. When Does Da Vanci Robotic Surgical Systems Come Into Play? Front Public Health 2022; 10:828542. [PMID: 35174126 PMCID: PMC8841676 DOI: 10.3389/fpubh.2022.828542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/06/2022] [Indexed: 12/04/2022] Open
Abstract
The emergent of medical science and technology has risen the minimally invasive surgery. Da Vinci Robotic Surgical Systems (RSS) is the trend at present. Compared with the past surgical methods, many studies related to RSS tend to explore postoperative outcomes and quality of life or compare the advantages and disadvantages than the other surgery. Few studies to understand the patients' willing who use RSS. This study mainly explores the patients' willingness and adopts the Technology Acceptance Model (TAM) as the theoretical foundation, and appended the trust concept to discuss. The study was a retrospective study and used a structured questionnaire to conduct a survey. The subjects included the patients with single-disease who had used RSS in a Medical Center of Southern Taiwan but excluded the patients with multiple disorder. This study conducted SPSS 22.0 and Smart PLS 2.0 software for statistical analysis, which included descriptive statistical analysis and applied Partial Least Squares (PLS) analysis to test the research model and to examine the established hypotheses. A total of 136 cases were collected in this study. Study validation was tested. Trust positively affects Perceived Usefulness (β = 0.550) and Perceived Ease of Use (β = 0.300). Perceived Ease of Use positively affects Perceived Usefulness (β = 0.188). Perceived Usefulness positively affects Attitude Toward Using (β = 0.589. Attitude Toward Using positively affects Behavioral Intention (β = 0.446. The relationship between perceived Ease of Use and Attitude toward Using was insignificant. Additionally, the relationship between Perceived Usefulness and Behavioral Intention was insignificant. In the research results, we found that patients are mostly in the middle and high age groups, and if the patient himself feels that RSS is extremely helpful to his illness, the intensity of his choice of intention will be high. In comparison, the information related to RSS has been clearly known, it does not directly affect the selection intention. According to age, most of the choices of RSS is based on safety and risk considerations, and it is beneficial to the patient himself, but RSS is also more expensive. We recommended that the government consider ββ reimbursing the RSS process in health insurance programs to meet the needs and expectations of patients.
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Affiliation(s)
- Hao-Yun Kao
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Chen Yang
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Han Hung
- Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Nursing, Yuan's General Hospital, Kaohsiung, Taiwan
- Yu-Han Hung
| | - Yenchun Jim Wu
- College of Humanities and Arts, National Taipei University of Education, Taipei, Taiwan
- Graduate Institute of Global Business and Strategy, National Taiwan Normal University, Taipei, Taiwan
- *Correspondence: Yenchun Jim Wu
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12
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Simon HL, Reif de Paula T, Spigel ZA, Keller DS. National disparities in use of minimally invasive surgery for rectal cancer in older adults. J Am Geriatr Soc 2021; 70:126-135. [PMID: 34559891 DOI: 10.1111/jgs.17467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/30/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) is safe and improves outcomes in older persons with rectal cancer but may be underutilized. As older persons are the largest surgical population, investigation of the current use and factors impacting MIS use is warranted. Our goal is to investigate the trends and disparities that affect utilization of MIS in older persons with rectal cancer. METHODS The National Cancer Database was reviewed for persons 65 years and older who underwent curative resection for rectal adenocarcinoma from 2010 to 2017. Cases were stratified by surgical approach (open or MIS [laparoscopic or robotic]). Univariate analysis compared patient and provider demographics across approaches. Multivariate analysis investigated variables associated with MIS use. Main outcome measures were trends and factors associated with MIS use in older persons. RESULTS Of 31,910 patients analyzed, 51.9% (n = 16,555) were open and 48.1% (n = 15,355) MIS. The MIS cohort was 66.7% (n = 10,236) laparoscopic and 33.3% (n = 5119) robotic. MIS increased from 29% in 2010 (n = 1197; 25% laparoscopic, 4% robotic) to 65% in 2017 (n = 2382; 35% laparoscopic, 30% robotic), likely from annual increases in robotics (OR 1.24/year, p < 0.0001). In the unadjusted analysis, there were significant differences in MIS use by age, race, comorbidity, socioeconomic status, and facility type. In multivariate analysis, patients with advancing age (OR 0.93, p < 0.001), major comorbidity (OR 0.75, p < 0.001), total proctectomy (OR0.78, p < 0.001), and advanced pathologic stage (OR 0.51, p < 0.001) were less likely to undergo MIS. CONCLUSION Nationwide, less than half of rectal cancer cases in older persons were performed with MIS, despite steady robotic growth. Patient and facility factors impacted MIS use. Further work on regionalizing rectal cancer care and ensuring equitable MIS access and training could improve utilization.
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Affiliation(s)
- Hillary L Simon
- Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Thais Reif de Paula
- Division of Colorectal Surgery, Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - Zachary A Spigel
- Department of Surgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Deborah S Keller
- Division of Colorectal Surgery, Department of Surgery, The University of California at Davis Medical Center, Sacramento, California, USA
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13
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Horsey ML, Sparks AD, Simkins A, Kim G, Ng M, Obias VJ. Comparing outcomes for non-metastatic rectal cancer in academic vs. community centers: A propensity-matched analysis of the National Cancer Database. Am J Surg 2021; 222:989-997. [PMID: 34024628 DOI: 10.1016/j.amjsurg.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known regarding the impact of hospital academic status on outcomes following rectal cancer surgery. We compare these outcomes for nonmetastatic rectal adenocarcinoma at academic versus community institutions. METHODS The National Cancer Database (2010-2016) was queried for patients with nonmetastatic rectal adenocarcinoma who underwent resection. Propensity score matching was performed across facility cohorts to balance confounding covariates. Kaplan-Meier estimation and Cox-proportional hazards regression were used to analyze survival, other short and long-term outcomes were analyzed by way of logistic regression. RESULTS After matching, 15,096 patients were included per cohort. Academic centers were associated with significantly decreased odds of conversion and positive margins with significantly increased odds of ≥12 regional nodes examined. Academic programs also had decreased odds of 30 and 90-day mortality and decreased 5-year mortality hazard. After matching for facility volume, no significant differences in outcomes between centers was seen. CONCLUSIONS No difference between academic and community centers in outcomes following surgery for non-metastatic rectal cancer was seen after matching for facility procedural volume.
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Affiliation(s)
- Michael L Horsey
- Walter Reed National Military Medical Center, Bethesda, MD, USA.
| | - Andrew D Sparks
- Department of Surgery, George Washington University Medical Faculty Associates, Washington, DC, USA
| | - Aron Simkins
- Department of Hematology & Oncology, George Washington University Hospital, Washington, DC, USA
| | - George Kim
- Department of Hematology & Oncology, George Washington University Hospital, Washington, DC, USA
| | - Matthew Ng
- Department of Colon and Rectal Surgery at the George Washington University Hospital, Washington, DC, USA
| | - Vincent J Obias
- Department of Colon and Rectal Surgery at the George Washington University Hospital, Washington, DC, USA
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14
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Williams AD, Sun T, Kakade S, Wong SL, Shulman LN, Carp NZ. Comparison of open and minimally invasive approaches to colon cancer resection in compliance with 12 regional lymph node harvest quality measure. J Surg Oncol 2021; 123:986-996. [PMID: 33577718 DOI: 10.1002/jso.26298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 11/01/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND There has been a growing trend toward minimally invasive surgery (MIS) for colon cancer. Pathological analysis of a minimum of 12 lymph nodes (LNs) is a benchmark for adequate resection. Here, we present a comparison of surgical techniques in achieving a full oncologic resection. METHODS Patients undergoing surgery for Stage I-III colon cancer (2010-2016) were identified from the National Cancer Database. Cases were stratified by surgical approach. Trends in approach were assessed, including whether the 12-LN benchmark was met. Uni- and multivariate regression was used to assess overall survival (OS). RESULTS A total of 290,776 colectomies were analyzed. MIS increased from 32.8% to 57.2% from 2010 to 2016 (p < .001). An overall median of 18 LNs were harvested and compliance with the 12-LN benchmark increased (84.6%-91.6%, p < .001); there were no difference between open and MIS. A subset analysis comparing hospital type revealed that regardless of approach, compliance was lower at community hospitals (p < .001). OS was better for patients treated at academic or National Cancer Institute centers, underwent MIS, and in those meeting the 12-LN benchmark (all p ≤ .002). CONCLUSION As MIS colon resections continue to increase, we demonstrate that there is no difference in the ability to achieve the 12-LN benchmark with open and MIS approaches.
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Affiliation(s)
- Austin D Williams
- Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Tian Sun
- Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Sumedh Kakade
- Department of Surgery, Riddle Hospital, Media, Pennsylvania, USA
| | - Sandra L Wong
- Department of Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Commission on Cancer, American College of Surgeons, Chicago, Illinois, USA
| | - Lawrence N Shulman
- Commission on Cancer, American College of Surgeons, Chicago, Illinois, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ned Z Carp
- Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA.,Commission on Cancer, American College of Surgeons, Chicago, Illinois, USA
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15
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Garfinkle R, Abou-Khalil M, Salama E, Marinescu D, Pang A, Morin N, Demyttenaere S, Liberman AS, Vasilevsky CA, Boutros M. Development and Validation of a Clinical Risk Score for Intensive Care Resource Utilization After Colon Cancer Surgery: a Practical Guide to the Selection of Patients During COVID-19. J Gastrointest Surg 2021; 25:252-259. [PMID: 32495141 PMCID: PMC7269615 DOI: 10.1007/s11605-020-04665-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND The purpose of this study was to develop and validate a prediction model and clinical risk score for Intensive Care Resource Utilization after colon cancer surgery. METHODS Adult (≥ 18 years old) patients from the 2012 to 2018 ACS-NSQIP colectomy-targeted database who underwent elective colon cancer surgery were identified. A prediction model for 30-day postoperative Intensive Care Resource Utilization was developed and transformed into a clinical risk score based on the regression coefficients. Model performance was assessed using the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. The model was validated in a separate test set of similar patients. RESULTS In total, 54,893 patients underwent an elective colon cancer resection, of which 1224 (2.2%) required postoperative Intensive Care Resource Utilization. The final prediction model retained six variables: age (≥ 70; OR 1.90, 95% CI 1.68-2.14), sex (male; OR 1.73, 95% CI 1.54-1.95), American Society of Anesthesiologists score (III/IV; OR 2.52, 95% CI 2.15-2.95), cardiorespiratory disease (yes; OR 2.22, 95% CI 1.94-2.53), functional status (dependent; OR 2.81, 95% CI 2.22-3.56), and operative approach (open surgery; OR 1.70, 95% CI 1.51-1.93). The model demonstrated good discrimination (AUC = 0.73). A clinical risk score was developed, and the risk of requiring postoperative Intensive Care Resource Utilization ranged from 0.03 (0 points) to 19.0% (8 points). The model performed well on test set validation (AUC = 0.73). CONCLUSION A prediction model and clinical risk score for postoperative Intensive Care Resource Utilization after colon cancer surgery was developed and validated.
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Affiliation(s)
- Richard Garfinkle
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC Canada
| | - Maria Abou-Khalil
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC Canada
| | - Ebram Salama
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC Canada
| | - Daniel Marinescu
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC Canada
| | - Allison Pang
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC Canada
| | - Nancy Morin
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC Canada
| | | | - A. Sender Liberman
- Department of Surgery, McGill University Health Center, Montreal, QC Canada
| | - Carol-Ann Vasilevsky
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC Canada
| | - Marylise Boutros
- Division of Colon and Rectal Surgery, Jewish General Hospital, Montreal, QC Canada ,McGill University, Jewish General Hospital, 3755 Cote Ste Catherine, G-317, Montreal, Quebec H3T 1E2 Canada
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16
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Lo BD, Zhang GQ, Stem M, Sahyoun R, Efron JE, Safar B, Atallah C. Do specific operative approaches and insurance status impact timely access to colorectal cancer care? Surg Endosc 2020; 35:3774-3786. [PMID: 32813058 DOI: 10.1007/s00464-020-07870-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/05/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The increased use of minimally invasive surgery in the management of colorectal cancer has led to a renewed focus on how certain factors, such as insurance status, impact the equitable distribution of both laparoscopic and robotic surgery. Our goal was to analyze surgical wait times between robotic, laparoscopic, and open approaches, and to determine whether insurance status impacts timely access to treatment. METHODS After IRB approval, adult patients from the National Cancer Database with a diagnosis of colorectal cancer were identified (2010-2016). Patients who underwent radiation therapy, neoadjuvant chemotherapy, had wait times of 0 days from diagnosis to surgery, or had metastatic disease were excluded. Primary outcomes were days from cancer diagnosis to surgery and days from surgery to adjuvant chemotherapy. Multivariable Poisson regression analysis was performed. RESULTS Among 324,784 patients, 5.9% underwent robotic, 47.5% laparoscopic, and 46.7% open surgery. Patients undergoing robotic surgery incurred the longest wait times from diagnosis to surgery (29.5 days [robotic] vs. 21.7 [laparoscopic] vs. 17.2 [open], p < 0.001), but the shortest wait times from surgery to adjuvant chemotherapy (48.9 days [robotic] vs. 49.9 [laparoscopic] vs. 54.8 [open], p < 0.001). On adjusted analysis, robotic surgery was associated with a 1.46 × longer wait time to surgery (IRR 1.462, 95% CI 1.458-1.467, p < 0.001), but decreased wait time to adjuvant chemotherapy (IRR 0.909, 95% CI 0.905-0.913, p < 0.001) compared to an open approach. Private insurance was associated with decreased wait times to surgery (IRR 0.966, 95% CI 0.962-0.969, p < 0.001) and adjuvant chemotherapy (IRR 0.862, 95% CI 0.858-0.865, p < 0.001) compared to Medicaid. CONCLUSION Though patients undergoing robotic surgery experienced delays from diagnosis to surgery, they tended to initiate adjuvant chemotherapy sooner compared to those undergoing open or laparoscopic approaches. Private insurance was independently associated not only with access to robotic surgery, but also shorter wait times during all stages of treatment.
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Affiliation(s)
- Brian D Lo
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - George Q Zhang
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Miloslawa Stem
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Rebecca Sahyoun
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Jonathan E Efron
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Bashar Safar
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA
| | - Chady Atallah
- Colorectal Research Unit, Ravitch Division of Colon and Rectal Surgery, Department of Surgery, The Johns Hopkins University School of Medicine, 600 N. Wolfe St., Blalock 618, Baltimore, MD, 21205, USA.
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17
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Differential short-term outcomes of laparoscopic resection in colon and rectal cancer patients aged 80 and older: an analysis of Nationwide Inpatient Sample. Surg Endosc 2020; 35:872-883. [DOI: 10.1007/s00464-020-07459-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 02/11/2020] [Indexed: 12/29/2022]
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