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Shapera E, Sucandy I, Syblis C, Crespo K, Ja'Karri T, Ross S, Rosemurgy A. Cost analysis of robotic versus open hepatectomy: Is the robotic platform more expensive? J Robot Surg 2022; 16:1409-1417. [PMID: 35152343 DOI: 10.1007/s11701-022-01375-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/21/2022] [Indexed: 11/27/2022]
Abstract
The robotic platform is perceived to be more expensive when compared to laparoscopic and open operations. We aimed to compare the perioperative costs of robotic vs. open hepatectomy for the treatment of liver tumors at our facility. We followed 370 patients undergoing robotic and open hepatectomy for benign and malignant liver tumors. Demographic, perioperative, cost and payment data were collected and analyzed. For illustrative purposes, the data were presented as median (mean ± SD). Two hundred sixty-seven robotic and 104 open hepatectomies were analyzed. There were no significant differences in perioperative variables between the two cohorts. The robotic group had a significantly lower estimated blood loss (EBL) (135 [208 ± 244.8] vs 300 [427 ± 502.5] ml, p < 0.0001), smaller lesion size (4 [5 ± 3.6] vs 5[6 ± 4.9] cm, p = 0.0052), shorter length of stay (LOS) (4 [4 ± 3.4] vs 6[8 ± 5.7] days, p < 0.0001) and decreased 90-day mortality (3 vs 7 p = 0.0028). There were no significant differences between the two groups any cost variable. The open group received significantly higher reimbursement ($29,297 [62,962 ± 75,377.96] vs $19,102 [38,975 ± 39,362.11], p < 0.001) and profit ($5005 [30,981 ± 79,541.09] vs $- 6682 [6146 ± 40,949.65], p < 0.001). Robotic hepatectomy is associated with lower EBL, shorter LOS and less mortality. There was no greater cost associated with the robotic platform despite a reduced reimbursement and profit.
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Affiliation(s)
- Emanuel Shapera
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA.
| | - Cameron Syblis
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Kaitlyn Crespo
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Thomas Ja'Karri
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Sharona Ross
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
| | - Alexander Rosemurgy
- Digestive Health Institute, AdventHealth Tampa, 3000 Medical Park Drive, Suite 500, Tampa, FL, 33613, USA
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Xu K, Wu CL, Wang ZX, Wang HJ, Yin FJ, Li WD, Liu CC, Fan HN. VEGF Family Gene Expression as Prognostic Biomarkers for Alzheimer's Disease and Primary Liver Cancer. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:3422393. [PMID: 34845413 PMCID: PMC8627334 DOI: 10.1155/2021/3422393] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/09/2021] [Accepted: 10/26/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND To analyze the expression of vascular endothelial growth factor (VEGF) in hepatocellular carcinoma (HCC) and cognitive impairment, explore the relationship between the expression of VEGF family genes and prognosis of patients with HCC, and evaluate the predictive ability of VEGF in cognitive impairment using computerized methods. METHODS VEGF expression in liver cancer tissues and normal tissues was analyzed using bioinformatics methods. The Kaplan-Meier survival analysis method was also used to analyze the relationship between VEGF expression and the prognosis of patients with HCC. Furthermore, immune infiltration assessment and gene set enrichment analysis were performed. Meanwhile, the differential expression of VEGF family genes between patients with Alzheimer's disease (AD) and healthy controls was also checked. RESULTS Based on The Cancer Genome Atlas (TCGA) database, the VEGF family genes (VEFGA, VEGFB, VEGFC, and VEGFD) were highly expressed in cancer tissues and were significantly associated with poor prognosis in HCC. In HCC, the VEGF family genes showed significant heterogeneity in their functional and immune infiltration characteristics. Finally, VEGF family genes were identified as prognostic biomarkers in AD and risk prediction markers in HCC. CONCLUSIONS VEGF is highly expressed in patients with HCC and lowly expressed in patients with AD. VEGF has opposite opposing roles in the treatment of tumors and cognitive impairment.
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Affiliation(s)
- Kai Xu
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, China
| | - Chuan-ling Wu
- Jianhu College, Zhejiang Industry Polytechnic College, China
| | - Zhi-xin Wang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, China
- Qinghai Province Key Laboratory of Hydatid Disease Research, China
| | - Hai-jiu Wang
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, China
- Qinghai Province Key Laboratory of Hydatid Disease Research, China
| | - Feng-jiao Yin
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, China
| | - Wen-deng Li
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, China
| | - Chu-chu Liu
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, China
| | - Hai-ning Fan
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, China
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Motoyama S, Maeda E, Iijima K, Sato Y, Koizumi S, Wakita A, Nagaki Y, Fujita H, Yoneya T, Imai K, Terata K, Minamiya Y, Higashi T. Does Esophagectomy Provide a Survival Advantage to Patients Aged 80 Years or Older? Analyzing 5,066 Patients in the National Database of Hospital-Based Cancer Registries in Japan. Ann Surg 2020; 276:e16-e23. [DOI: 10.1097/sla.0000000000004437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Giannotti C, Sambuceti S, Signori A, Ballestrero A, Murialdo R, Romairone E, Scabini S, Caffa I, Odetti P, Nencioni A, Monacelli F. Frailty assessment in elective gastrointestinal oncogeriatric surgery: Predictors of one-year mortality and functional status. J Geriatr Oncol 2019; 10:716-723. [DOI: 10.1016/j.jgo.2019.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 04/03/2019] [Accepted: 04/21/2019] [Indexed: 12/11/2022]
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Salyer C, Kobelka C, Barrie A, Weintraub MR, Powell CB. Clinical characteristics and outcomes in elderly women with BRCA1 and BRCA2 mutations. Gynecol Oncol 2019; 154:374-378. [PMID: 31160070 DOI: 10.1016/j.ygyno.2019.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Describe clinical characteristics and risk reducing strategies utilized among women with a BRCA mutation who lived to age 75 and above. METHODS A retrospective study of women with BRCA mutations identified from 1995 to 2015 in a California health care system. From a database of 1189 women, 69 participants were identified who lived to age 75 or older. Demographic and clinical characteristics were recorded, as well as cancer history and risk-reducing strategies utilized. Descriptive and bivariate analyses were used to analyze the cohort. RESULTS The median age of the cohort at study entry was 78 (IQR: 76-84) and the median age at time of genetic testing was 73 (IQR 68-79). Fifty (72%) women had a prior history of breast cancer and 27 (39%) had a history of ovarian cancer. Three of 19 (16%) women with no history of breast cancer elected to undergo a risk-reducing mastectomy (RRM) after their positive genetic test. Among 30 women with ovaries still in place, 14 (47%) underwent a risk-reducing salpingo-oophorectomy (RRSO); six were age 70 or older at the time of surgery. Four (6%) women in the cohort developed BRCA-related cancer after testing, one developed breast cancer and three developed pancreatic cancer. CONCLUSIONS Most women with BRCA mutations surviving beyond age 75 received their genetic test result at an older age and had a history of BRCA-related cancer. Women continued surveillance and risk reducing surgeries at an older age. Pancreatic cancer was the most common new cancer diagnosed in older BRCA mutation carriers.
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Affiliation(s)
- Chelsea Salyer
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
| | - Christine Kobelka
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
| | - Allison Barrie
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
| | - Miranda Ritterman Weintraub
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America
| | - C Bethan Powell
- Kaiser Permanente Obstetrics and Gynecology Residency Program, Oakland, CA, United States of America; Kaiser Permanente Genetics Department, San Francisco, CA, United States of America; Rebecca and John Moores Cancer Center, Department of Reproductive Medicine, Division of Gynecologic Oncology, University of California, San Diego, La Jolla, CA, United States of America; Kaiser Permanente Oakland Department of Graduate Medical Education, Oakland, CA, United States of America; Kaiser Permanente Northern California Gynecologic Oncology Program, San Francisco, CA, United States of America; Division of Research, Kaiser Permanente Northern California, Oakland CA, United States of America.
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Bracken-Clarke D, Farooq AR, Horgan AM. Management of Locally Advanced and Metastatic Esophageal Cancer in the Older Population. Curr Oncol Rep 2018; 20:99. [PMID: 30426245 DOI: 10.1007/s11912-018-0745-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This review aims to synthesise the current literature on the management of early-stage and metastatic esophageal cancers, focusing on the older population. In particular, we aim to dissect out the elderly-specific data from the relevant trials and to discuss the issues unique to this population. RECENT FINDINGS While surgery is the curative modality in esophageal malignancies, the CROSS, MAGIC and FLOT trials demonstrate a clear advantage to neoadjuvant therapy (chemotherapy and chemoradiotherapy). These trials, however, included few elderly patients. There is a similar lack of elderly-specific data in the metastatic setting. Esophageal malignancies remain highly lethal with increasing incidence with age. Despite the relative lack of elderly-specific data, the fit older population appear to similarly benefit from multimodal therapy in early-stage and palliative therapy in metastatic disease.
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Affiliation(s)
- Dara Bracken-Clarke
- Medical Oncology Department, University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Abdul Rehman Farooq
- Medical Oncology Department, University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland
| | - Anne M Horgan
- Medical Oncology Department, University Hospital Waterford, Dunmore Road, Waterford, X91 ER8E, Ireland.
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Corrigan LR, Bracken-Clarke DM, Horgan AM. The challenge of treating older patients with pancreaticobiliary malignancies. Curr Probl Cancer 2018; 42:59-72. [PMID: 29459178 DOI: 10.1016/j.currproblcancer.2018.01.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 01/15/2018] [Accepted: 01/16/2018] [Indexed: 02/06/2023]
Abstract
Pancreatic and biliary tract cancers are aggressive malignancies. They commonly present with metastatic or unresectable disease. Those that do present with resectable cancer have high rates of recurrence. Despite recent advances in surgical technique, chemotherapy, and radiotherapy regimens, they are associated with poor survival outcomes. These cancers represent an exception to the trend of improved overall survival evident in most malignancies in recent decades. Depending on the goal of treatment, active management of pancreatic and biliary cancers involves surgery, chemotherapy, and radiation therapy, either alone or in combination. Both pancreatic and biliary tract cancers have a preponderance in the older population. Older patients are a heterogeneous group; although tolerability of multimodality treatment may be a challenge for some, many fit older patients may be undertreated based on their age alone. The growing field of geriatric oncology has highlighted the importance of a comprehensive assessment of these patients, and not relying on age alone as a discriminating factor for treatment. Management of older patients with pancreaticobiliary cancers is particularly challenging owing to limited prospective data in this population. As such, there is uncertainty with regard to optimal treatment approaches for these patients. In this article, we outline the therapeutic options available to patients with localized or advanced pancreatic and biliary tract cancers, and the evidence for specified treatment options in the elderly. We examine the inclusion and outcomes of elderly patients in relevant clinical trials; the morbidity that may be encountered by elderly patients receiving specified treatments and the tools that may assist the physician in selecting elderly patients for particular treatments.
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Affiliation(s)
- Lynda R Corrigan
- Department of Medical Oncology, University Hospital Waterford, Ardkeen, Co Waterford, Ireland.
| | - Dara M Bracken-Clarke
- Department of Medical Oncology, University Hospital Waterford, Ardkeen, Co Waterford, Ireland
| | - Anne M Horgan
- Department of Medical Oncology, University Hospital Waterford, Ardkeen, Co Waterford, Ireland
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