1
|
Franko J, Raman S, Patel S, Petree B, Lin M, Tee MC, Le VH, Frankova D. Survival and cancer recurrence after short-course perioperative probiotics in a randomized trial. Clin Nutr ESPEN 2024; 60:59-64. [PMID: 38479940 DOI: 10.1016/j.clnesp.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 11/04/2023] [Accepted: 01/07/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND & AIMS The long-term impact of perioperative probiotics remains understudied while mounting evidence links microbiome and oncogenesis. Therefore, we analyzed overall survival and cancer recurrence among patients enrolled in a randomized trial of perioperative probiotics. METHODS 6-year follow-up of surgical patients participating in a randomized trial evaluating short-course perioperative oral probiotic VSL#3 (n = 57) or placebo (n = 63). RESULTS Study groups did not differ in age, preoperative hemoglobin, ASA status, and Charlson comorbidity index. There was a significant difference in preoperative serum albumin (placebo group 4.0 ± 0.1 vs. 3.7 ± 0.1 g/dL in the probiotic group, p = 0.030). Thirty-seven deaths (30.8 %) have occurred during a median follow-up of 6.2 years. Overall survival stratified on preoperative serum albumin and surgical specialty was similar between groups (p = 0.691). Age (aHR = 1.081, p = 0.001), serum albumin (aHR = 0.162, p = 0.001), and surgical specialty (aHR = 0.304, p < 0.001) were the only predictors of overall survival in the multivariate model, while the placebo/probiotic group (aHR = 0.808, p = 0.726) was not predictive. The progression rate among cancer patients was similar in the probiotic group (30.3 %, 10/33) compared to the placebo group (21.2 %, 7/33; p = 0.398). The progression-free survival was not significantly different (unstratified p = 0.270, stratified p = 0.317). CONCLUSIONS Perioperative short-course use of VSL#3 probiotics does not influence overall or progression-free survival after complex surgery for visceral malignancy.
Collapse
Affiliation(s)
- Jan Franko
- Department of Surgery, MercyOne Medical Center, Des Moines, IA, USA.
| | - Shankar Raman
- Department of Surgery, MercyOne Medical Center, Des Moines, IA, USA
| | - Shiv Patel
- Department of Surgery, MercyOne Medical Center, Des Moines, IA, USA
| | - Brandon Petree
- Department of Surgery, MercyOne Medical Center, Des Moines, IA, USA
| | - Mayin Lin
- Department of Surgery, MercyOne Medical Center, Des Moines, IA, USA
| | - May C Tee
- Department of Surgery, MercyOne Medical Center, Des Moines, IA, USA; Howard University Hospital, Washington, DC, USA
| | - Viet H Le
- Department of Surgery, MercyOne Medical Center, Des Moines, IA, USA
| | - Daniela Frankova
- Department of Internal Medicine, Des Moines University, Des Moines, IA, USA
| |
Collapse
|
2
|
Lloy S, Lin M, Franko J, Raman S. The Future of Interventions for Stage IV Colorectal Cancers. Clin Colon Rectal Surg 2024; 37:114-121. [PMID: 38327731 PMCID: PMC10843879 DOI: 10.1055/s-0043-1761624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Future options for the management of stage IV colorectal cancer are primarily focused on personalized and directed therapies. Interventions include precision cancer medicine, utilizing nanocarrier platforms for directed chemotherapy, palliative pressurized intraperitoneal aerosol chemotherapy (PIPAC), adjunctive oncolytic virotherapy, and radioembolization techniques. Comprehensive genetic profiling provides specific tumor-directed therapy based on individual genetics. Biomimetic magnetic nanoparticles as chemotherapy delivery systems may reduce systemic side effects of traditional chemotherapy by targeting tumor cells and sparing healthy cells. PIPAC is a newly emerging option for patients with peritoneal metastasis from colorectal cancer and is now being used internationally, showing promising results as a palliative therapy for colorectal cancer. Oncolytic virotherapy is another emerging potential treatment option, especially when combined with standard chemotherapy and/or radiation, as well as immunotherapy. And finally, radioembolization with yttrium-90 ( 90 Y) microspheres has shown some success in treating patients with unresectable liver metastasis from colorectal cancer via selective arterial injection.
Collapse
Affiliation(s)
- Samantha Lloy
- General Surgery Residency Program, MercyOne Des Moines Medical Center, Des Moines, Iowa
| | - Mayin Lin
- General Surgery Residency Program, MercyOne Des Moines Medical Center, Des Moines, Iowa
| | - Jan Franko
- General Surgery Residency Program, MercyOne Des Moines Medical Center, Des Moines, Iowa
| | - Shankar Raman
- General Surgery Residency Program, MercyOne Des Moines Medical Center, Des Moines, Iowa
| |
Collapse
|
3
|
Chew DK, Schmelter RA, Tran MT, Franko J. Reducing aneurysm sac growth and secondary interventions following endovascular abdominal aortic aneurysm repair by preemptive coil embolization of the inferior mesenteric artery and lumbar arteries. J Vasc Surg 2024; 79:532-539. [PMID: 38008267 DOI: 10.1016/j.jvs.2023.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE Type II endoleak (EL-2) is the most common complication following endovascular aneurysm repair (EVAR), leading to continued sac growth and potential rupture. In this study, we examined the association between patency of the inferior mesenteric artery (IMA) and lumbar arteries (LAs) with respect to sac growth. The effect of preemptive embolization of the IMA and/or LAs on the need for secondary interventions for sac growth post-EVAR was also evaluated. METHODS A retrospective cohort study was performed on consecutive patients who underwent EVAR for non-ruptured, infrarenal abdominal aortic aneurysms (AAAs) from January 2012 to December 2020. A select group of patients underwent preemptive embolization of the IMA and/or LA. Patients with any types I, III, or IV endoleaks were excluded. Patency of the IMA and LA on preoperative computed tomography angiogram (CTA) was evaluated on TeraRecon workstation. All secondary interventions to treat EL-2 were recorded. Sac growth was defined as centerline axial diameter increase of ≥5 mm on follow-up CTA. RESULTS A total of 300 patients (mean age, 74 ± 8.5 years; 83.7% male) underwent EVAR. Ninety-nine patients had preemptive embolization of the IMA and/or LA. Mean follow-up of the cohort was 59.3 ± 30.5 months. Thirty-six patients (12%) demonstrated sac growth on follow-up; 12 of these (33.3%) had preemptive embolization. The median time until detection of sac growth was 28.8 months (interquartile range, 15.2-46.5 months), with a mean growth of 10.1 ± 6.4 mm. Sac growth was significantly associated with presence of EL-2: 27 of 36 (75%) with EL-2 vs 9 of 36 (25%) without EL-2 (P < .001). Patients with sac growth had a higher mean total number (2.6 ± 1.5) of patent lower LAs (L3, L4) compared with those without (2.0 ± 1.4; P = .03). Patency of L1, L2, and L3 LAs were not associated with sac growth. However, patency of at least one L4 LA was significantly associated with sac growth (14.8% vs 7.7%; P = .04). The highest incidence of sac growth (17.6%) was seen when both IMA and L4 LA were patent; significantly different from the lowest incidence (5.3%) when both were occluded preoperatively (P = .018). Preemptive coiling of the IMA and/or LA significantly reduced the need for post-EVAR secondary intervention for sac growth. Freedom from post-EVAR secondary intervention was achieved in 92 of 99 (92.9%) pre-EVAR coiled patients vs 163 of 201 (81.5%) patients who did not undergo pre-EVAR coiling (P = .009). CONCLUSIONS Preemptive coil embolization of the IMA and LAs, especially L4 LA, reduces the need for secondary interventions for sac growth, potentially improving the long-term durability of EVAR.
Collapse
Affiliation(s)
- David K Chew
- MercyOne Medical Center, Des Moines, IA; Iowa Heart Center, Des Moines, IA.
| | | | | | | |
Collapse
|
4
|
Sedinkin JD, Le VH, Tee MC, Franko J, Lin M, Raman SR. Robotic Resection of a Large Pelvic Schwannoma. Dis Colon Rectum 2024; 67:e198. [PMID: 38064207 DOI: 10.1097/dcr.0000000000002938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Affiliation(s)
| | - Viet H Le
- Department of Surgery, MercyOne Des Moines Medical Center, Iowa
| | - May C Tee
- Department of Surgery, Howard University, Washington, DC
| | - Jan Franko
- Department of Surgery, MercyOne Des Moines Medical Center, Iowa
| | - Mayin Lin
- Department of Surgery, MercyOne Des Moines Medical Center, Iowa
| | - Shankar R Raman
- Department of Surgery, MercyOne Des Moines Medical Center, Iowa
| |
Collapse
|
5
|
Baragada S, Petree B, Tee M, Frankova D, Raman S, Franko J. Differences in Resident Self-Evaluation and Clinical Competency Committee Evaluation Using ACGME Milestone Versions 1.0 and 2.0. J Surg Educ 2023; 80:1378-1384. [PMID: 37573192 DOI: 10.1016/j.jsurg.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/09/2023] [Accepted: 07/05/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE Intentionally self-driven professional development of surgical resident physicians is a hallmark of surgical training and is expected to gain further traction as Entrustable Professional Activities (EPAs) become the new paradigm for surgical education. We aimed to analyze how surgical residents rate themselves as compared to the evaluation of the Clinical Competency Committee using ACGME Milestones Version 1 (M1.0) and Version 2 (M2.0). DESIGN We asked 22 general surgical trainees for self-evaluation of Milestones (both M1.0 and M2.0) from 2017 semiannually to 2022. ACGME-required Milestone evaluations by the Clinical Competency Committee (CCC) were independently performed after the time window for resident self-evaluation. Neither trainees nor CCC were aware of the other party's evaluations. There were 1552 paired data available for evaluating individual competencies by both trainees and CCC. Paired Wilcoxon signed-rank tests were then performed among the corresponding pairs. SETTING MercyOne Des Moines Medical Center, Des Moines, IA; Teaching tertiary referral center. PARTICIPANTS Twenty-two general surgical trainees at this hospital and 28 faculty surgeons participated in this study. RESULTS The average self-evaluation of surgical residents was lower in the M1.0 cohort compared to the corresponding CCC evaluation (1.96 ± 0.72 vs. 2.11 ± 0.67; p < 0.001). M1.0 self-assessments and CCC-assessments were statistically similar for ICS (p = 0.548) and PROF (p = 0.554) competencies and differed for MK (p < 0.001), PBLI (p < 0.001), PC (p < 0.001), SBP (p = 0.008). On the contrary, the M2.0 cohort demonstrated higher average self-evaluation of surgical residents compared to the corresponding CCC evaluation (2.75 ± 0.87 vs. 2.12 ± 0.97; p < 0.001). Significant differences were observed for all 6 ACGME competencies using M2.0 self-assessments and CCC-assessments (all p < 0.001). Multivariate regression modeling (p < 0.001, R2 = 0.255) predicted the degree of discordance between self-assessment and CCC-assessed achievement of competencies with a significant effect of gender (baseline male: coef = -0.232, p < 0.001), PGY level (-0.083 per year, p < 0.001) and Milestone version (0.831, p < 0.001). A significant interaction exists for all gender/Milestone combinations except for the female trainees with M1.0. CONCLUSIONS The difference between self-evaluated Milestone achievement and faculty-driven CCC evaluation of surgical resident physician performance is more evident in Milestones 2.0 than in Milestones 1.0. Residents self-evaluate higher compared to faculty using Milestones 2.0. This discrepancy is seen among both genders and is more pronounced among male residents overestimating core competencies with M2.0 self-evaluation than formal CCC assessment.
Collapse
Affiliation(s)
- Savitha Baragada
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa
| | - Brandon Petree
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa
| | - May Tee
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa; Department of Surgery, Howard University College of Medicine, Washington, DC
| | - Daniela Frankova
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa; Department of Clinical Medicine, Des Moines University College of Osteopathic Medicine, Des Moines, Iowa
| | - Shankar Raman
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa
| | - Jan Franko
- MercyOne Medical Center, General Surgery Residency, Des Moines, Iowa.
| |
Collapse
|
6
|
Franko J. Removing the Appendix: Prologue to Severe Clostridioides difficile Infection and Recurrence? Dig Dis Sci 2023; 68:3488-3489. [PMID: 37402982 DOI: 10.1007/s10620-023-07978-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Jan Franko
- MercyOne Medical Center, 411 Laurel Street, Suite 2100, Des Moines, IA, 50314, USA.
| |
Collapse
|
7
|
Franko J, Yin J, Adams RA, Zalcberg J, Fiskum J, Van Cutsem E, Goldberg RM, Hurwitz H, Bokemeyer C, Kabbinavar F, Curtis A, Meyers J, Chibaudel B, Yoshino T, de Gramont A, Shi Q. Trajectories of body weight change and survival among patients with mCRC treated with systemic therapy: Pooled analysis from the ARCAD database. Eur J Cancer 2022; 174:142-152. [PMID: 35994794 DOI: 10.1016/j.ejca.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Higher body mass index is associated with a higher incidence of colorectal cancer (CRC) but also with improved survival in metastatic CRC (mCRC). Whether weight change after mCRC diagnosis is associated with survival remains largely unknown. METHODS We analysed individual patient data for previously untreated patients enrolled in five phase 3 randomised trials conducted between 1998 and 2006. Weight measurements were prospectively collected at baseline and up to 59.4 months after diagnosis. We used stratified multivariable Cox models to assess the prognostic associations of weight loss with overall and progression-free survival, adjusting for other factors. The primary end-point was a difference in overall survival (OS) between populations with weight loss and stable or increasing weight. FINDINGS Data were available for 3504 patients. The median weight change at 3 months was -0.54% (IQR -3.9 … +1.5%). We identified a linear trend of increasing risk of death associated with progressive weight loss. Unstratified median OS was 20.5, 18.0, and 11.9 months (p < 0.001) for stable weight or gain, <5% weight loss, and ≥5% weight loss at 3 months, respectively. Weight loss was associated with a higher risk of death (<5% loss: aHR 1.18 [1.06-1.30], p < 0.002; ≥5% loss: aHR 1.87 [1.67-2.1], p < 0.001) as compared to stable or increasing weight at 3 months post-baseline (reference), while adjusting for age, sex, performance, and a number of metastatic sites. INTERPRETATION Patients losing weight during systemic therapy for metastatic colorectal cancer have significantly shorter OS. The degree of weight loss is proportional to the observed increased risk of death and remains evident among underweight, normal weight, and obese individuals. On-treatment weight change could be used as an intermediate end-point. FUNDING The creation and management of the database containing the individual patient data from the original randomised trials is supported by the Aide et Recherche en Cancérologie Digestive Foundation.
Collapse
Affiliation(s)
- Jan Franko
- MercyOne Medical Center, Des Moines, IA, USA.
| | - Jun Yin
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - John Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Jack Fiskum
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium
| | | | | | - Carsten Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Jeffery Meyers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Benoist Chibaudel
- Department of Medical Oncology, Hôpital Franco-Britannique - Fondation Cognacq-Jay, Levallois-Perret, France
| | - Takayuki Yoshino
- Department of Gastrointestinal Oncology, National Cancer Center Hospital East, Japan
| | - Aimery de Gramont
- Department of Medical Oncology, Hôpital Franco-Britannique - Fondation Cognacq-Jay, Levallois-Perret, France
| | - Qian Shi
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
8
|
Mercier F, Passot G, Bonnot PE, Cashin P, Ceelen W, Decullier E, Villeneuve L, Walter T, Levine EA, Glehen O, Baik SH, Baratti D, Bhatt A, De Hingh I, De Simone M, Dubé P, Edwards RP, Franko J, Gonzalez-Bayon L, Gushchin V, Holtzman MP, Hsieh MC, Kecmanovic D, Lee KW, Lehmann K, Liu Y, Mehta S, Morris DL, O’Dwyer S, Orsenigo E, Pande PK, Park EJ, Pingpank JF, Piso P, Rajan F, Rau B, Sardi A, Sideris L, Sommariva A, Spiliotis J, Tentes AAK, Teo M, Yarema R, Younan R, Zaveri SS, Zeh HJ, Abba J, Abboud K, Alyami M, Arvieux C, Bakrin N, Bereder JM, Bouzard D, Brigand C, Carrère S, Delroeux D, Dumont F, Eveno C, Facy O, Guyon F, Ferron G, Kianmanesh R, Dico RL, Lorimier G, Marchal F, Mariani P, Meeus P, Msika S, Ortega-Deballon P, Paquette B, Peyrat P, Pirro N, Pocard M, Porcheron J, Quenet F, Rat P, Sgarbura O, Thibaudeau E, Tuech JJ, Zinzindohoue F. An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World J Surg 2022; 46:1336-1343. [PMID: 35286418 DOI: 10.1007/s00268-022-06498-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Peritoneal carcinomatosis from appendiceal goblet cell carcinoma (A-GCC) is a rare and aggressive form of appendiceal tumor. Cytoreductive surgery (CRS) and hyperthermic intra peritoneal chemotherapy (HIPEC) was reported as an interesting alternative regarding survival compared to surgery without HIPEC and/or systemic chemotherapy. Our aim was to evaluate the impact of CRS and HIPEC for patients presenting A-GCC through an international registry. METHODS A prospective multicenter international database was retrospectively searched to identify all patients with A-GCC tumor and peritoneal metastases who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI). The post-operative complications, long-term results, and principal prognostic factors were analyzed. RESULTS The analysis included 83 patients. After a median follow-up of 47 months, the median overall survival (OS) was 34.6 months. The 3- and 5-year OS was 48.5% and 35.7%, respectively. Patients who underwent complete macroscopic CRS had a significantly better survival than those treated with incomplete CRS. The 5-year OS was 44% and 0% for patients who underwent complete, and incomplete CRS, respectively (HR 9.65, p < 0.001). Lymph node involvement and preoperative chemotherapy were also predictive of a worse prognosis. There were 3 postoperative deaths, and 30% of the patients had major complications. CONCLUSION CRS and HIPEC may increase long-term survival in selected patients with peritoneal metastases of A-GCC origin, especially when complete CRS is achieved. Ideally, randomized control trials or more retrospective data are needed to confirm CRS and HIPEC as the gold standard in this pathology.
Collapse
Affiliation(s)
- Frederic Mercier
- Department of Surgical Oncology, CHU Montreal, University of Montreal, 1000 St-Denis, Montreal, QC, H2X 0C1, Canada. .,The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.
| | - Guillaume Passot
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | | | - Peter Cashin
- Department of Surgery, Akademiska Sjukhuset, Uppsala University Hospital, Uppasala, Sweden
| | - Wim Ceelen
- Department of Gastrointestinal Surgery, Gent University Hospital, Ghent, Belgium
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Laurent Villeneuve
- EMR 37-38, Lyon 1 University, Lyon, France.,Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Thomas Walter
- Department of Gastroenterology and Oncology, Hospices Civils de Lyon, Edouard Herriot Hospital University of Lyon, Lyon, France
| | - Edward A Levine
- Section of Surgical Oncology, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Olivier Glehen
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Franko J, Yin J, Adams R, Zalcberg JR, Fiskum J, VanCutsem E, Goldberg RM, Hurwitz HI, Bokemeyer C, Kabbinavar FF, Curtis A, Chibaudel B, Yoshino T, De Gramont A, Shi Q. Trajectories of body weight change and survival among mCRC patients treated with systemic therapy: Pooled analysis from the ARCAD database. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.4_suppl.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
80 Background: Higher baseline body mass index is associated with improved survival in metastatic CRC (mCRC). Whether weight gain or loss after mCRC diagnosis is associated with survival remains largely unknown. Methods: We analyzed individual patient data from 3504 patients with previously untreated mCRC enrolled in five phase III randomized trials (AVF2017g, AVF2192g, CRYSTAL, N9741, OPUS) conducted between 2000 and 2006. Weight measurements were prospectively collected at 3 months after diagnosis and then up to 5 years. Patients were categorized into three groups based on the percent weight change at 3 months: stable weight or gain, weight loss up to 5% of baseline weight, and ≥5% weight loss of baseline weight. Cox models were used to assess the prognostic associations of weight change at 3 months with overall survival (OS) and progression-free survival (PFS), adjusting for baseline BMI, age, sex, performance score, chemotherapy backbone (oxaliplatin vs. irinotecan), and biologics type (cetuximab vs. bevacizumab). Sub-analyses included Cox models adjusted for additional clinical-pathological factors (primary tumor sidedness [right colon vs. left colon-rectum], and BRAF status; N=1,511). Results: Median percent weight change at 3 months was -0.5% (IQR -4.0 to+1.6%). OS was better in patients with weight stability or gain than in those with weight loss (up to 5% or ≥5%; (Table). Results were consistent for PFS for patients with ≥5% weight loss of baseline weight, as well as for sub-analyses. Conclusions: Patients losing weight during the first 3 months of systemic therapy for metastatic colorectal cancer have significantly shorter overall survival than those with stable or increasing weight. Degree of weight loss is proportional to the observed increased risk of death and remains evident among underweight, normal weight and obese individuals. Further studies examining possible usefulness of on-treatment early weight loss as a novel intermediary end-point are needed.[Table: see text]
Collapse
Affiliation(s)
| | | | - Richard Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
| | | | - Jack Fiskum
- Department of Health Science Research, Mayo Clinic, Rochester, MN
| | | | | | | | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | | |
Collapse
|
10
|
Franko J, Tee MC, Lin M, Ismail O, Losh J, Neitzel J, Patterson A, Raman S, Goldman CD. Inter-Faculty Variability in Holistic Assessment of Residency Candidates. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
11
|
Franko J, Raman S, Tee MC, Le VH, Sedinkin JD, Silva M, Ferrel B, Frankova D. Postoperative Delirium Among Patients Undergoing Major Abdominal Surgery Randomized to In-hospital Probiotics or Placebo. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
12
|
Franko J, Le VH, Tee MC, Lin M, Sedinkin J, Raman S, Frankova D. Signet ring cell carcinoma of the gastrointestinal tract: National trends on treatment effects and prognostic outcomes. Cancer Treat Res Commun 2021; 29:100475. [PMID: 34655861 DOI: 10.1016/j.ctarc.2021.100475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Signet ring cell carcinoma (SRCC) is a distinct malignancy occurring across the tubular gastrointestinal tract (tGIT). We comprehensively examined the outcomes of patients diagnosed with SRCC across tGIT. METHODS SRCC and not-otherwise-specified adenocarcinoma (NOS) patients reported to the National Cancer Database from 2004 to 2015 were included. Baseline characteristics, outcomes and site-specific adjusted hazard ratios (aHR) derived from Cox models of SRCC patients were compared to those of NOS patients. Overall survival (OS) was primary endpoint. RESULTS A total of 41,686 SRCC (4.6%) and 871,373 NOS patients (95.4%) were included. SRCC patients were younger (63.1 ± 14.7 vs. 67.0 ± 13.4 y, p < 0.001) and more likely to present with Stage IV disease than NOS patients (42.5% vs. 24.5%, p < 0.001). Stomach (n = 24,433) and colon (n = 9,914) contributed highest frequency of SRCC. SRCC histology was associated with shorter OS (aHR = 1.377, p < 0.001) in multivariate model. There was an interaction between SRCC and chemotherapy effects on risk of death (interaction aHR = 1.072, pinteraction< 0.001) and between SRCC histology and disease site, suggesting that the effect of SRCC on OS is site-dependent, with a higher increased risk of death in patients with rectal SRCC (aHR = 2.378, pinteraction< 0.001). CONCLUSION Significant negative prognostic effect associated with SRCC is site-dependent across the GIT. Surgical and or systemic therapy was associated with improved OS among SRCC patients, but remained lower than NOS patients. Further understanding of gastrointestinal SRCC molecular profile is needed to better inform future treatment strategies.
Collapse
Affiliation(s)
- Jan Franko
- MercyOne Medical Center, Des Moines, IA, USA.
| | - Viet H Le
- MercyOne Medical Center, Des Moines, IA, USA
| | - May C Tee
- MercyOne Medical Center, Des Moines, IA, USA
| | - Mayin Lin
- MercyOne Medical Center, Des Moines, IA, USA
| | | | | | - Daniela Frankova
- MercyOne Medical Center, Des Moines, IA, USA; Des Moines University, Des Moines, IA, USA
| |
Collapse
|
13
|
Franko J, Chamberlain DM, James AB, Collins A, Tee MC, Le VH, Frankova D. Rising Incidence of Peri-Operative Bactibilia among Patients Undergoing Complex Biliopancreatic Surgery. Surg Infect (Larchmt) 2021; 23:47-52. [PMID: 34619058 DOI: 10.1089/sur.2021.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Biliary instrumentation is associated with bactibilia and post-operative infection. Bactibilia incidence over time remains unknown. Patients and Methods: Consecutive patients with bilioenteric anastomosis surgery and available surveillance intra-operative bile duct cultures were evaluated for post-operative infection. The study period (2008-2019) was divided into quartiles to examine time-based trends. Results: Among 101 cases, 60 intra-operative bile duct cultures had no growth and 41 patients had documented at least one culture-positive isolate in their bile. Frequency of patients with culture-positive intra-operative bile increased over the study period (period 1, 1/28, 3.6% vs. period 2, 7/21, 33.3% vs. period 3, 15/26, 57.7% vs. period 4, 18/26, 69.2%; p < 0.001). Culture-positive post-operative infection (17/101; 16.8%) was not associated with intra-operative bile duct culture (p = 0.552), however, the same micro-organism isolate was identified on post-operative infection and intra-operative culture of bile duct bile among six of 17 patients (35.3%). Conclusions: We found an increasing incidence of bactibilia and post-operative culture-positive infections over the last decade. One-third of patients with a positive intra-operative bile duct culture experienced post-operative infection with the same organism, yet a clear link between bile colonization and post-operative infection was not established.
Collapse
Affiliation(s)
- Jan Franko
- MercyOne Medical Center, Des Moines, Iowa, USA
| | | | | | | | - May C Tee
- MercyOne Medical Center, Des Moines, Iowa, USA
| | - Viet H Le
- MercyOne Medical Center, Des Moines, Iowa, USA
| | - Daniela Frankova
- MercyOne Medical Center, Des Moines, Iowa, USA.,Des Moines University, Des Moines, Iowa, USA
| |
Collapse
|
14
|
Tee MC, Brahmbhatt RD, Franko J. Robotic Resection of Type I Hilar Cholangiocarcinoma with Intrapancreatic Bile Duct Dissection. Ann Surg Oncol 2021; 29:964-969. [PMID: 34613533 DOI: 10.1245/s10434-021-10811-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/04/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Type I hilar cholangiocarcinoma is a malignancy of the extrahepatic bile duct for which margin-negative resection with sufficient lymphadenectomy may provide curative treatment. The aim of this video is to highlight the advantages of optical magnification, articulating instruments, and indocyanine green fluorescent cholangiography to demonstrate extrahepatic bile duct resection from the biliary confluence to the intrapancreatic bile duct with comprehensive hilar lymphadenectomy for pathologic staging. METHODS A 58-year-old male presented with obstructive jaundice and was found to have a biliary stricture arising from the cystic duct and bile duct junction. Endoscopic biopsy of the bile duct confirmed adenocarcinoma. His case was presented at a multidisciplinary tumor conference where consensus was to proceed with upfront robotic en bloc extrahepatic bile duct resection with hilar lymphadenectomy and Roux-en-Y hepaticojejunostomy. RESULTS Final pathology demonstrated margin-negative resection of moderately differentiated adenocarcinoma, 1 out of 12 lymph nodes involved with disease, and pathologic stage T2N1M0 (stage IIIC). The patient had no postoperative complications and was discharged home on postoperative day 5. At 6 weeks from his operative date, he was initiated on four cycles of adjuvant gemcitabine/capecitabine, followed by 50 Gray external beam radiation therapy with capecitabine, then four cycles of gemcitabine/capecitabine, completed after 6 months of therapy. CONCLUSIONS Robotic extrahepatic bile duct resection, hilar lymphadenectomy, and biliary enteric reconstruction is feasible and should be considered for selected cases of bile duct resection.
Collapse
Affiliation(s)
- May C Tee
- MercyOne Medical Center, Department of Surgery, Division of Surgical Oncology, Des Moines, IA, USA. .,Creighton University School of Medicine, Omaha, NE, USA. .,Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA.
| | - Rushin D Brahmbhatt
- MercyOne Medical Center, Department of Surgery, Division of Surgical Oncology, Des Moines, IA, USA
| | - Jan Franko
- MercyOne Medical Center, Department of Surgery, Division of Surgical Oncology, Des Moines, IA, USA.,Creighton University School of Medicine, Omaha, NE, USA.,Des Moines University College of Osteopathic Medicine, Des Moines, IA, USA
| |
Collapse
|
15
|
Tee MC, Chen L, Franko J, Edwards JP, Raman S, Ball CG. Effect of wound protectors on surgical site infection in patients undergoing whipple procedure. HPB (Oxford) 2021; 23:1185-1195. [PMID: 33334675 DOI: 10.1016/j.hpb.2020.11.1146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/10/2020] [Accepted: 11/29/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Conflicting data persists for use of wound protectors in pancreatoduodenectomy (PD) to prevent surgical site infection (SSI). We aimed to examine, at a multi-institutional level, the effect of wound protectors on superficial or deep SSI following elective open PD. METHODS The American College of Surgeons National Surgical Quality Improvement Program pancreatectomy procedure targeted participant use file was queried from 2016 to 2018. Planned open PD procedures were extracted. Univariable, multivariable, and propensity score matched analyses were conducted. RESULTS 11,562 patients undergoing PD were evaluated, 27% of which used wound protectors. Wound protectors decreased superficial or deep SSI risk in all patients (5.7% vs. 9.5%, P < 0.001), patients who have (6.6% vs. 12.2%, P < 0.001) and who did not have (4.6% vs. 6.5%, P = 0.011) a biliary stent. Propensity score matched analysis confirms such results (OR = 0.56, 95% CI: 0.46-0.69, P < 0.001 overall, OR = 0.66, 95% CI: 0.46-0.95, P = 0.03 without biliary stent, OR = 0.57, 95% CI: 0.44-0.73, P < 0.001 with biliary stent). CONCLUSIONS Wound protectors reduce risk of superficial or deep SSI in patients undergoing PD, yet only a quarter of PD were associated with their use. This protective effect is seen whether patients have or have not had preoperative biliary stenting.
Collapse
Affiliation(s)
- May C Tee
- Mercy Medical Center, Department of Surgery, Division of Subspecialty General Surgery, #2100 - 411 Laurel Street, Des Moines, IA, 50314, USA.
| | - Leo Chen
- University of British Columbia, Department of Surgery, Vancouver, BC, Canada
| | - Jan Franko
- Mercy Medical Center, Department of Surgery, Division of Subspecialty General Surgery, #2100 - 411 Laurel Street, Des Moines, IA, 50314, USA
| | - Janet P Edwards
- University of Calgary, Department of Surgery, Calgary, AB, Canada
| | - Shankar Raman
- Mercy Medical Center, Department of Surgery, Division of Subspecialty General Surgery, #2100 - 411 Laurel Street, Des Moines, IA, 50314, USA
| | - Chad G Ball
- University of Calgary, Department of Surgery, Calgary, AB, Canada
| |
Collapse
|
16
|
Brahmbhatt RD, Tee MC, Franko J. Robotic Isolated Caudate Lobectomy for Solitary Colorectal Liver Metastasis. Ann Surg Oncol 2021; 28:8236-8237. [PMID: 34195901 DOI: 10.1245/s10434-021-10321-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/30/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Safety of liver resection for colorectal adenocarcinoma continues to improve due to decreased morbidity of resection. Minimally invasive techniques contribute greatly to this morbidity reduction. Isolated caudate lobectomy presents a unique technical challenge because of proximity to major vasculature. The video aims to review nuances of robotic isolated caudate lobectomy for metastatic colon adenocarcinoma.
Collapse
Affiliation(s)
- Rushin D Brahmbhatt
- Department of Surgery, Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA.
| | - May C Tee
- Department of Surgery, Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA
| | - Jan Franko
- Department of Surgery, Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA
| |
Collapse
|
17
|
Le VH, Franko J, Paz BI, Singh G, Fakih M, Chung V. Chemotherapy-induced early transient increase and surge of CA 19-9 level in patients with pancreatic Adenocarcinoma ✰. Cancer Treat Res Commun 2021; 28:100397. [PMID: 34023768 DOI: 10.1016/j.ctarc.2021.100397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
This study aimed to characterize chemotherapy-induced transient increase and surge of CA 19-9 level to treatment response in patients with advanced pancreatic ductal adenocarcinoma (PDAC). A retrospective case series was performed of advanced PDAC patients treated with first-line chemotherapy at City of Hope Comprehensive Cancer Center from Jan 2017 to May 2020. CA 19-9 surge was defined as an increase of >20% from baseline followed by a >20% drop in one or more subsequent CA 19-9 levels compared to baseline. Out of 106 advanced PDAC patients, 38 were evaluable for CA 19-9 surge. Fourteen (51.9%) patients treated with FOLFIRINOX and 3 (27.3%) patients treated with nab-P + Gem chemotherapy demonstrated an early transient rise in CA 19-9 level. A CA 19-9 surge was documented in 9 (23.7%) patients, all with duration of surge lasting < 16 weeks. Five out of 9 (55.6%) patients (4: FOLFIRINOX, 1: nab-P + Gem) with CA 19-9 surge demonstrated partial objective response rate on surveillance cross-sectional imaging. One patient (FOLFIRINOX) had stable disease, and 2 patients (1: FOLFIRINOX, 1: nab-P + Gem) were found to have disease progression after treatment interruption. The initial early rise of CA 19-9 levels during chemotherapy in patients with advanced PDAC may not indicate tumor progression. Rather, it may represent a chemotherapy-induced transient increase or surge phenomenon of the tumor marker in patients responding to treatment.
Collapse
Affiliation(s)
- Viet H Le
- Department of Surgery, MercyOne Medical Center, Des Moines IA United States.
| | - Jan Franko
- Department of Surgery, MercyOne Medical Center, Des Moines IA United States.
| | - Benjamin I Paz
- Department of Surgery, City of Hope National Medical Center, Duarte CA United States.
| | - Gagandeep Singh
- Department of Surgery, City of Hope National Medical Center, Duarte CA United States.
| | - Marwan Fakih
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte CA United States.
| | - Vincent Chung
- Department of Medical Oncology and Therapeutic Research, City of Hope National Medical Center, Duarte CA United States.
| |
Collapse
|
18
|
Ferrel B, Franko J, Tee MC. Rare case of pancreatic neuroendocrine tumour presenting as paraneoplastic hypercalcaemia. BMJ Case Rep 2021; 14:14/4/e240786. [PMID: 33858893 PMCID: PMC8054046 DOI: 10.1136/bcr-2020-240786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An asymptomatic 68-year-old woman who presented with an isolated hypercalcaemia was diagnosed with a rare, previously unsuspected parathyroid hormone-related peptide (PTHrP)-producing pancreatic neuroendocrine tumour. She underwent an extensive operation including vascular resection and reconstruction, resulting in successful removal of the tumour with negative margins. Medical and surgical management of pancreatic neuroendocrine tumours and PTHrP-mediated paraneoplastic hypercalcaemia is discussed.
Collapse
Affiliation(s)
- Benjamin Ferrel
- Department of Surgical Oncology, MercyOne Medical Center, Des Moines, Iowa, USA
| | - Jan Franko
- Department of Surgical Oncology, MercyOne Medical Center, Des Moines, Iowa, USA
| | - May C Tee
- Department of Surgical Oncology, MercyOne Medical Center, Des Moines, Iowa, USA
| |
Collapse
|
19
|
Ferrel B, Patel S, Castillo A, Gryn O, Franko J, Chew D. The Effect of Abdominal Aortic Aneurysm Size on Endoleak, Secondary Intervention and Overall Survival Following Endovascular Aortic Aneurysm Repair. Vasc Endovascular Surg 2021; 55:467-474. [PMID: 33722111 DOI: 10.1177/15385744211000572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the effect of abdominal aortic aneurysm (AAA) size on endoleak development and secondary intervention after endovascular repair (EVAR), as well as to examine the effect on overall survival and cause of mortality. METHODS Retrospective analysis was performed on all non-ruptured AAA treated by elective EVAR using FDA-approved endografts in our facility from July 2004 to December 2017. Patients were grouped into 3 cohorts based on preoperative aneurysm size: Group I (<5.5 cm), Group II (5.5-6.4 cm), and Group III (≥ 6.5 cm). Occurrences of endoleak, secondary intervention and overall survival underwent univariate and multivariate analysis. Cause of death data on deceased patients was similarly examined. RESULTS A total of 517 patients were analyzed. There was no difference between size groups in the rate of endoleak (Group I 48/277, 17.3%; Group II 33/160, 20.6%; Group III 18/80, 22.5%; p = 0.46) or time until endoleak development. Univariate analysis showed no difference in the rate of secondary intervention (Group I 36/277, 13.0%; Group II 24/160, 15.0%; Group III 18/80, 22.5%; p = 0.11), time until intervention or number of interventions performed. Multivariate analysis showed an association with shorter time to secondary intervention for both Group III aneurysms (HR 2.03, 95% CI 1.11-3.73; p = 0.02) and female patients (HR 1.79, 95% CI 1.02-3.13; p = 0.04). There was no difference in overall survival, aneurysm-related mortality or overall cause of mortality. CONCLUSION AAA diameter prior to EVAR was not associated with any differences in rates of endoleak or secondary intervention, and was not associated with poorer overall survival or greater aneurysm-related mortality. Patients with suitable anatomy for EVAR can be considered for this intervention without concern for increased complications or poorer outcomes related to large aneurysm diameter alone.
Collapse
Affiliation(s)
| | - Shiv Patel
- 22606MercyOne Medical Center, Des Moines, IA, USA
| | | | | | - Jan Franko
- 22606MercyOne Medical Center, Des Moines, IA, USA
| | - David Chew
- 22606MercyOne Medical Center, Des Moines, IA, USA
| |
Collapse
|
20
|
Franko J, Ferrel B, Gorvet M. ASO Author Reflections: Characterizing the Peritoneal Immune Response to the Surgical and Thermal Trauma of Peritoneal Cytoreduction and HIPEC. Ann Surg Oncol 2020; 27:5014-5015. [PMID: 32720041 DOI: 10.1245/s10434-020-08943-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Jan Franko
- MercyOne Medical Center, Des Moines, IA, USA.
| | | | - Marc Gorvet
- MercyOne Medical Center, Des Moines, IA, USA
| |
Collapse
|
21
|
Franko J, Brahmbhatt R, Tee M, Raman S, Ferrel B, Gorvet M, Andres M. Cellular Immunoprofile of Peritoneal Environment During a HIPEC Procedure. Ann Surg Oncol 2020; 27:5005-5013. [PMID: 32696309 DOI: 10.1245/s10434-020-08870-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 06/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND We characterized the peritoneal immune cellular profile during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) in this pilot study. METHODS We prospectively performed flow cytometric analysis of peritoneal fluid collected at laparotomy and during HIPEC at 0, 30, 60, and 90 min. Analysis consisted of standard flow cytometric leukocyte gating and the use of antibodies for stem cells, B lymphocytes, T-helper, T-suppressor, and natural killer (NK) cells. RESULTS The mean peritoneal carcinomatosis index (PCI) score was 19.8 ± 11.5 (median 19). Twelve patients had a completeness of cytoreduction (CCR) score of 0-1, and three patients had a CCR score of ≥ 2 (20%). The proportion of peritoneal NK cells remained stable (p = 0.655) throughout perfusion. The CD4/CD8 ratio (p = 0.019) and granulocyte/lymphocyte ratio (p = 0.018) evolved during cytoreduction, with no further change during HIPEC. Two distinct temporal patterns of peritoneal T lymphocytes became evident (the 'high' and 'low' CD4/CD8 ratio groups) and patients maintained their high versus low peritoneal CD4/CD8 ratio status throughout the duration of HIPEC. High CD4/CD8 was associated with longer cytoreduction (p = 0.019) and borderline higher PCI score (p = 0.058). No association was identified with age (p = 0.131), sex (p = 1.000), CCR status (p = 0.580), occurrence of complication (p = 0.282), or ascites volume (p = 0.713). CONCLUSION The cellular immunoprofile of peritoneal fluid during HIPEC is stable but changes during cytoreduction. Two distinct immune groups emerged, based on CD4/CD8 ratios in the peritoneal perfusate. Further studies are warranted to evaluate peritoneal immunity and the clinical significance of novel peritoneal immune phenotype.
Collapse
Affiliation(s)
- Jan Franko
- Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA.
| | - Rushin Brahmbhatt
- Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA
| | - May Tee
- Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA
| | - Shankar Raman
- Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA
| | - Benjamin Ferrel
- Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA
| | - Marc Gorvet
- Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA
| | - Matthew Andres
- Division of Surgical Oncology, MercyOne Medical Center, Des Moines, IA, USA.,Department of Pathology, MercyOne Medical Center, Des Moines, IA, USA
| |
Collapse
|
22
|
Franko J, Ferrel B, Pierson P, Raman S, Frankova D, Rearigh LM, Afroze A, Guevara Hernandez MA, Terrero-Salcedo D, Kermode D, Gorvet M. Influence of prior appendectomy and cholecystectomy on Clostridioides difficile infection recurrence and mortality. Am J Surg 2020; 220:203-207. [DOI: 10.1016/j.amjsurg.2019.10.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/13/2019] [Accepted: 10/18/2019] [Indexed: 11/15/2022]
|
23
|
Franko J, Frankova D. Effect of Surgical Oncologist Turnover on Hospital Volume and Treatment Outcomes Among Patients With Upper GI Malignancies. JCO Oncol Pract 2020; 16:e1161-e1168. [PMID: 32539648 DOI: 10.1200/jop.19.00761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Lack of surgical expertise may affect cancer care delivery. Here, we examined the impact of surgical oncologist vacancy and turnover in a community cancer center serving a mixed urban and rural population. METHODS Survival outcomes of patients with potentially resectable esophageal, gastric, and pancreatic carcinomas treated in the index hospital (n = 519) were compared with those of a then-contemporary control group derived from the state-specific SEER registry (n = 3,340). The onboarding period (ie, the period without a surgical oncologist) and early and late periods with a surgical oncologist were defined. RESULTS At the state level, there was a steady trend of patients who were annually referred (290.4 ± 34.3 patients per year; P < .001) and underwent operation (158.7 ± 18.7 patients per year; P < .001). We observed the absence of an analogous trend in the index hospital (P = .141). The index hospital diagnosed 12.2% of state cancers of interest during the years with surgical oncologists but only 6.7% of cancers when surgical oncologists were absent (P = .031). The survival model adjusted for age, stage, and primary disease site comparing the early and late periods demonstrated that being treated in the index hospital did not result in inferior survival (hazard ratio, 1.067; P = .265). CONCLUSION Loss of surgical oncologists was associated with referral decline and likely out-migration of patients, whereas prompt restoration of surgical oncology services reinstated volumes and preserved survival outcomes.
Collapse
|
24
|
Franko J, Raman S, Krishnan N, Frankova D, Tee MC, Brahmbhatt R, Goldman CD, Weigel RJ. Randomized Trial of Perioperative Probiotics Among Patients Undergoing Major Abdominal Operation. J Am Coll Surg 2019; 229:533-540.e1. [DOI: 10.1016/j.jamcollsurg.2019.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 09/11/2019] [Indexed: 12/12/2022]
|
25
|
Ferrel B, Patel S, Castillo A, Franko J, Chew D. The Effect of Abdominal Aortic Aneurysm Size on Endoleak, Secondary Intervention, and Overall Survival After Endovascular Aortic Aneurysm Repair. J Vasc Surg 2019. [DOI: 10.1016/j.jvs.2019.06.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
26
|
Jayanathan M, Erwin RP, Molacek N, Fluck M, Hunsinger M, Wild J, Arora TK, Shabahang MM, Franko J, Blansfield JA. MAGIC versus MacDonald treatment regimens for gastric cancer: Trends and predictors of multimodal therapy for gastric cancer using the National Cancer Database. Am J Surg 2019; 219:129-135. [PMID: 31262435 DOI: 10.1016/j.amjsurg.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/24/2019] [Accepted: 06/05/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Multimodal therapy is beneficial in gastric cancer, however this practice is not universal. This study examines trends, identifies associative factors, and examines overall survival (OS) benefit from multimodal therapy in gastric cancer. METHODS Gastric cancer patients staged IB-III from 2005 to 2014, identified using the National Cancer Database, were categorized by treatment: surgery alone, perioperative chemotherapy, and adjuvant chemoradiation. Groups were analyzed to identify associative factors of perioperative therapy. RESULTS We examined 9243 patients, with the majority receiving multimodal therapy (57%). The proportion of those receiving perioperative chemotherapy rose dramatically from 7.5% in 2006 to 46% in 2013. Academic center treatment was strongly associated with perioperative over adjuvant therapy (p < 0.0001). An OS advantage was clearly seen in those receiving multimodal therapy versus surgery alone (p < 0.0001), with no difference between perioperative and adjuvant therapies. CONCLUSIONS Treatment of gastric cancer with multimodal therapy has risen significantly since 2005, largely due to increasing use of perioperative chemotherapy. As perioperative therapy becomes more prevalent, more patients will have the opportunity for the improved survival benefit of multimodal therapy.
Collapse
Affiliation(s)
- Mark Jayanathan
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States.
| | - Ryan P Erwin
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Nicholas Molacek
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Marcus Fluck
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Marie Hunsinger
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Jeffrey Wild
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Tania K Arora
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Mohsen M Shabahang
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| | - Jan Franko
- Mercy Medical Center, Section of Surgical Oncology, Des Moines, IA, 50314, United States
| | - Joseph A Blansfield
- Geisinger Medical Center, Department of General Surgery, 100 N. Academy Avenue, Danville, PA, 17822, United States
| |
Collapse
|
27
|
Franko J, McAvoy S. Reply to: Insufficient number of examined lymph nodes may offset the survival benefit from neoadjuvant therapy in esophageal squamous cell carcinoma. Surgery 2018; 165:664-667. [PMID: 30467040 DOI: 10.1016/j.surg.2018.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/12/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Jan Franko
- Department of Surgery. Mercy Medical Center, Des Moines, IA, USA
| | - Sarah McAvoy
- Department of Radiation Oncology. Mercy Medical Center, Des Moines, IA, USA
| |
Collapse
|
28
|
Amblard I, Mercier F, Bartlett D, Ahrendt S, Lee K, Zeh H, Levine E, Baratti D, Deraco M, Piso P, Morris D, Rau B, Tentes A, Tuech JJ, Quenet F, Akaishi E, Pocard M, Yonemura Y, Lorimier G, Delroeux D, Villeneuve L, Glehen O, Passot G, Abba J, Abboud K, Alyami M, Arvieux C, Bakrin N, Bereder JM, Bouzard D, Brigand C, Carrère S, Delroeux D, Dumont F, Eveno C, Facy O, Guyon F, Kianmanesh R, Lo Dico R, Lorimier G, Marchal F, Mariani P, Meeus P, Msika S, Ortega-Deballon P, Paquette B, Peyrat P, Pirro N, Pocard M, Porcheron J, Quenet F, Rat P, Sgarbura O, Thibaudeau E, Tuech JJ, Zinzindohoue F, Ahrendt S, Akaishi E, Baik S, Baratti D, Bhatt A, Cachin P, Ceelen W, De Hingh I, De Simone M, Dubé P, Edwards R, Franko J, Gonzalez-Bayon L, Gushchin V, Holtzman M, Hsieh MC, Kecmanovic D, Lee K, Lehmann K, Liu Y, Mehta S, Morris D, O'Dwyer S, Orsevigo E, Pande P, Park E, Pingpank J, Piso P, Rajan F, Rau B, Sardi A, Sideris L, Sommariva A, Spiliotis J, Sugarbaker P, Tentes A, Teo M, Yarema R, Younan R, Zaveri S, Zeh H. Cytoreductive surgery and HIPEC improve survival compared to palliative chemotherapy for biliary carcinoma with peritoneal metastasis: A multi-institutional cohort from PSOGI and BIG RENAPE groups. Eur J Surg Oncol 2018; 44:1378-1383. [PMID: 30131104 DOI: 10.1016/j.ejso.2018.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/12/2022] Open
|
29
|
Franko J, McAvoy S. Timing of esophagectomy after neoadjuvant chemoradiation treatment in squamous cell carcinoma. Surgery 2018; 164:455-459. [PMID: 29903507 DOI: 10.1016/j.surg.2018.04.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/08/2018] [Accepted: 04/23/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Time interval between neoadjuvant (combined) chemotherapy and radiation (nCRT) and surgery has been linked to pathologic response rates and outcomes in patients with various solid cancers. The optimal timing between nCRT and esophagectomy in patients with esophageal squamous cell carcinoma (SCC), however, is not known. Our aim was to analyze the relation between elapsed time from completion of nCRT to esophagectomy and postsurgical mortality and overall survival. METHODS We reviewed the National Cancer Database for patients with SCC (n = 1,244) of the esophagus diagnosed between 2003 and 2011 who were treated with nCRT followed by esophagectomy within 26 weeks after completion of nCRT. RESULTS Thirty-day mortality was 5.6% and 90-day mortality was 11.1%. The duration of post-nCRT interval was not a predictor of 30-day and 90-day postoperative mortality in multivariate models, but 30-day postoperative mortality was predictable based on increasing Charlson-Deyo comorbidities (adjusted odds ratio [aOR] 1.77, P = .054) and improved in academic institutions (aOR 0.66, P = .005). Similar findings were found for 90-day mortality (comorbidity index aOR 1.58, P = .046) and for treatment at an academic facility (0.82, P = .062). In a multivariate survival analysis, the duration of the post-nCRT interval was not found to be a predictor of overall survival (P = .769), whereas increasing age (hazard ratio [HR] 1.02, P = .005), increasing comorbidity score (HR 1.38, P = .005), treatment at an academic hospital (HR 0.84, P = .001), and post-treatment nodal status (HR 1.73, P < .001) were predictors. CONCLUSION Perioperative mortality and overall survival are not affected by the time interval between completion of nCRT and esophagectomy among patients with SCC histology.
Collapse
Affiliation(s)
- Jan Franko
- Department of Surgery, Mercy Medical Center, Des Moines, IA.
| | - Sarah McAvoy
- Department of Radiation Oncology, Mercy Medical Center, Des Moines, IA
| |
Collapse
|
30
|
Frankova D, Olson KM, Whyms BJ, Guevara Hernandez MA, Franko J. The effect of intravenous insulin, apheresis and oral lipid-lowering agents on non-fasting hypertriglyceridemia and associated pancreatitis. Postgrad Med 2018; 130:494-500. [PMID: 29702000 DOI: 10.1080/00325481.2018.1470439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES There is evidence that increasing severity of hypertriglyceridemia increases the risk of acute pancreatitis. There is a debate about superiority of treatment methods and previous works have specifically called for direct comparison between IV insulin and apheresis techniques. Identify patient characteristics predictive of lipid-lowering therapy selection in a large community hospital for treatment of hypertriglyceridemia; evaluate for a concentration-dependent relationship between hypertriglyceridemia severity and risk of acute pancreatitis; assess for differences in clinical outcomes between patients treated with IV insulin versus apheresis. METHODS Single center, retrospective cohort study including patients with hypertriglyceridemia between January 2007 and December 2016. Main measures included frequency of pancreatitis, choice of lipid-lowering therapy, and clinical comparisons of diet, oral lipid-lowering agents, IV insulin, and apheresis. RESULTS Initial serum triglyceride level and disease acuity was higher among patients in insulin and apheresis groups. Neither triglyceride level, Charlson comorbidity index, age, BISAP score, nor initial CRP predicted use of IV insulin versus apheresis. Prevalence of pancreatitis increased with higher triglyceride level, reaching 48% with triglycerides >2000 md/dL (p < 0.001). There was a significant decrease in serum triglycerides at each time interval (p < 0.05) in patients treated with IV insulin and apheresis, but no difference in clearance rate between the two. Length of stay did not differ between IV insulin and apheresis. CONCLUSION The presence of pancreatitis, hyperglycemia, and hypertriglyceridemia severity influenced selection of therapies like IV insulin and apheresis. We found no superiority of either IV insulin or apheresis in the treatment of severe hypertriglyceridemia among patients hospitalized for pancreatitis.
Collapse
Affiliation(s)
- Daniela Frankova
- a Internal Medicine Residency Program , Mercy Medical Center , Des Moines , IA , USA
| | - Kristin Melissa Olson
- a Internal Medicine Residency Program , Mercy Medical Center , Des Moines , IA , USA
| | - Brian Joseph Whyms
- a Internal Medicine Residency Program , Mercy Medical Center , Des Moines , IA , USA
| | | | - Jan Franko
- a Internal Medicine Residency Program , Mercy Medical Center , Des Moines , IA , USA
| |
Collapse
|
31
|
Franko J. Therapeutic efficacy of systemic therapy for colorectal peritoneal carcinomatosis: Surgeon's perspective. Pleura Peritoneum 2018; 3:20180102. [PMID: 30911652 PMCID: PMC6405010 DOI: 10.1515/pp-2018-0102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 02/11/2018] [Indexed: 12/18/2022] Open
Abstract
Treatment choices for colorectal peritoneal carcinomatosis/metastases include systemic therapy and increasingly cytoreductive surgery with intraperitoneal chemotherapy delivery. These options are best considered as complementary and not exclusive alternatives. Two prospective randomized trials support use of peritonectomy procedures and intraperitoneal chemotherapy for colorectal peritoneal carcinomatosis. This overview examines efficacy, limitations and landscape of systemic therapy focusing on colorectal peritoneal carcinomatosis. Observations from literature support notions that (1) systemic therapy provides survival benefit for all prototypical patients with mCRC irrespective of metastatic disease site; (2) the magnitude of this benefit is considerably reduced among patients with peritoneal metastases who consequently experience significantly shorter overall survival; (3) efficacy of systemic therapy improved over time but at a slower pace for those with carcinomatosis; (4) this therapeutic difference has not diminished with introduction of targeted therapy, but perhaps widened; (5) further research of cytoreductive surgery and/or intraperitoneal regional therapies is thus a multidisciplinary responsibility of the entire oncology community; (6) peritonectomy procedures with intraperitoneal regional therapy are not scientifically supported in absence of systemic therapies.
Collapse
Affiliation(s)
- Jan Franko
- Chair of Surgical Oncology, Mercy Medical Center, 411 Laurel Street, Suite 2100, Des Moines, IA 50314, USA
| |
Collapse
|
32
|
Franko J, Graff TM, McClairen C. Body weight and composition changes, primary tumor side, and resection as survival predictors in metastatic colorectal cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
850 Background: Common symptoms of metastatic colorectal cancer (mCRC) are sarcopenia and weight loss. We investigated whether weight loss, sarcopenia and primary tumor resection can predict overall survival among patients (pts) with mCRC Methods: Consecutive pts newly diagnosed with mCRC in a community hospital between 2012-2014 we reviewed. We gathered initial and 6-month follow up data on weight, standardized muscle mass measure (estimated psoas muscle area/m2 height, sEPA) and subcutaneous fat (SQ). Results: There were 109 pts (age 66.9±14.5, range 37-93 years). Chemotherapy recipients were younger (n = 59, 61.2±13.3 years) and survived longer (22.3 versus 5.3 months, p < 0.001) as compared to best supportive care patients (n = 50, 73.6±13.0 years, p < 0.001). There were no baseline and 6-month differences between pts with resected versus in situ primary tumor in age (p = 0.074), baseline weight (p = 0.728) or percent weight loss (p = 0.404), albumin (p = 0.322), hemoglobin (p = 0.301), creatinine (p = 0.791), initial standardized EPA (p = 0.866), percent of sEPA loss (p = 0.952), and percent subcutaneous thickness loss (p = 0.477). Cohort was further dichotomized by median anthropometric changes at 6 months: -7.1% for weight loss, -6.2% sEPA, -3.3% SQ fat. Cox proportional hazard models demonstrated that anthropometric measures and receipt of systemic chemotherapy were the strongest predictors of survival with their predictive strength surpassing traditional predictors as age, tumor sidedness, primary tumor resection, initial BMI and serum albumin level. Conclusions: Weight loss and anthropometric changes are strongly associated with shorter survival. Prognostic characteristics of loss of weight, muscle and fat should be investigated further using more robust datasets. [Table: see text]
Collapse
|
33
|
Franko J, Kraemer S, Goldman CD, Frankova D, Raman S. Staffing turnover effect of fellowship-trained surgical specialists on oncologic outcomes in community cancer center. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
187 Background: Contemporary health care is delivered in highly interdependent team-based environment. Transitions in surgeon complement may be associated with a disturbance of workflow, especially in smaller-sized community cancer centers. Herein we examined the impact of two surgical oncologists turnover in our cancer center. Methods: Survival outcomes of all cases of esophageal, gastric, rectal and pancreatic adenocarcinoma treated in the index cancer center (n = 1,445) were compared to then-contemporary standard derived from Iowa-SEER registry, 2001-2015 (n = 12,617). Period before and after changeover of surgeons was compared using descriptive statistics and regression model. Results: Substantial reduction of annually referred (101.8±9.2 versus 60.5±0.7 case per year, p = 0.026) and operative cases (37.0±4.5 versus 17.5±3.5 cases per year, p = 0.027) was seen during fully-staffed versus on-boarding periods at the index hospital. At the state level, there was no fluctuation of annually referred cases (898.0±19.8 versus 910.5±35.6 cases per year, p = 0.384) and minimal decrease in operated cases (366.2±18.0 versus 335.0±24.1 cases per year, p = 0.020) in early versus late period. New surgical team was able to improve upon survival of resectable esophageal cancer patients in the index hospital and maintain survival of other complex GI malignancies as compared to geographically relevant standard of Iowa-SEER registry. Survival regression model on all 5,795 non-metastatic cases with available data, adjusted for age, stage and primary disease site, demonstrated that being treated in the index hospital did not result is inferior survival comparing early and late period (HR = 1.060, p = 0.237). Conclusions: Loss of surgical cancer specialists was associated with profound & significant loss of referrals to the index cancer center, and likely outmigration of patients from the community seeking advanced care. Quick restoration of surgical services may reinstate overall efficacy of care for resectable cancer cases without negative survival effect.
Collapse
|
34
|
Lange KN, McKay D, Gentry BG, Franko J. Antimicrobial Properties of Perfusate Fluid After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CS-HIPEC) with Mitomycin C. Ann Surg Oncol 2017; 24:3837-3841. [DOI: 10.1245/s10434-017-6113-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
35
|
Abstract
Background and Objectives: The safety of minimally invasive esophagectomy (MIE) outside of high-volume centers has not been studied. Therefore, we evaluated our experience with the introduction of MIE in the setting of a community teaching hospital. Methods: A retrospective cohort of all elective esophagectomy patients treated in a community hospital from 2008 through 2015 was evaluated (n = 57; open = 31 vs MIE = 26). Clavien-Dindo complication grades were recorded prospectively. Results: Mean age was 63 ± 11 years (range, 30–83), mean Charlson comorbidity index was 4.5 ± 1.7 and proportion of ASA score ≥3 was 87%. The groups did not differ in age, gender distribution, or comorbidity indices. There were 108 complications observed, including 2 deaths (3.5%, both coronary events). Postoperative complication rate was 77.1% and serious complication rate (grades 3 and 4) was 50.8% in the entire cohort. The rate of serious complications was similar (58% for open vs 42% for MIE group; 2-sided P = .089). MIE operations were longer (342 ± 109 vs 425 ± 74 minutes; P = .001). Length of stay trended toward not being significantly shorter among MIE cases (15 ± 13 vs 12 ± 12 days; P = .071). Logistic regression models including MIE status were not predictive of complications. Conclusions: Introduction of MIE esophagectomy in our community hospital was associated with prolonged operative time, but no detectable adverse outcomes. Length of stay was nonsignificantly shortened by the use of MIS esophagectomy.
Collapse
Affiliation(s)
- Dante Dali
- Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA
| | - Trent Howard
- Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA
| | - Hanif Mian Hashim
- Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA
| | - Charles D Goldman
- Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA
| | - Jan Franko
- Division of Surgical Oncology, Mercy Medical Center, Des Moines, Iowa, USA
| |
Collapse
|
36
|
Wolf CL, Frankova D, Franko J. Abstract P3-10-11: Influence of winter season, driving distance, and time on receipt of breast conserving therapy among Iowa urban and rural patients. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-10-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: The distance to treatment centers has been reported as a factor influencing the choice of mastectomy over breast conservation therapy (BCT) among breast cancer patients, potentially enhancing disparities for rural patients. We analyzed the impact of crowfly and driving distance to the radiation center and winter season on patient choice of BCT versus mastectomy among breast cancer patients.
METHODS & SETTINGS: Our patient base included 3223 stage 0-3 breast cancer patients treated between 2002 and 2015. Treatment was provided at an established breast center serving urban, suburban, and rural patients in central Iowa.
RESULTS: Crowfly distance (19±22 miles, range 0-160, median 8.7) was consistently shorter as compared to true driving distance (25±27 miles, 0-205, 12.8). One-quarter patients drove over 33 miles (equivalent of 38 minutes). There was tight correlation between crowfly and driving distance (Spearman's rho=0.989, p<0.001) and time (0.985, p<0.001).
In univariate analysis, there was no significant difference in crowfly, driving distance, and driving time in minutes to the radiation center between BCT and mastectomy patients (19.3±22.5 vs 18.4±21.6 miles, p = 0.317; 25.1±27.5 vs 24.4±27.0 miles, p = 0.585; 29.9±25.3 vs 29.5±24.9 minutes, p = 0.664).
Receipt of BCT was not predicted by crowfly or true driving distance, driving time, or season. There was no interaction between distance, winter season, and drive time. Receipt of BCT was more likely with older age (OR=1.02 per year of age, p<0.001) and later year of treatment (OR=1.05, p<0.001).
CONCLUSION: Driving distance, time, and crowfly distance correlated tightly and do not influence patient choice of surgery type for breast cancer in our population. Despite a substantial rural population, driving distance, driving duration, and climate did not significantly influence patients' decisions for mastectomy versus BCT.BACKGROUND: The distance to treatment centers has been reported as a factor influencing the choice of mastectomy over breast conservation therapy (BCT) among breast cancer patients, potentially enhancing disparities for rural patients. We analyzed the impact of crowfly and driving distance to the radiation center and winter season on patient choice of BCT versus mastectomy among breast cancer patients.
METHODS & SETTINGS: Our patient base included 3223 stage 0-3 breast cancer patients treated between 2002 and 2015. Treatment was provided at an established breast center serving urban, suburban, and rural patients in central Iowa.
RESULTS: Crowfly distance (19±22 miles, range 0-160, median 8.7) was consistently shorter as compared to true driving distance (25±27 miles, 0-205, 12.8). One-quarter patients drove over 33 miles (equivalent of 38 minutes). There was tight correlation between crowfly and driving distance (Spearman's rho=0.989, p<0.001) and time (0.985, p<0.001).
In univariate analysis, there was no significant difference in crowfly, driving distance, and driving time in minutes to the radiation center between BCT and mastectomy patients (19.3±22.5 vs 18.4±21.6 miles, p = 0.317; 25.1±27.5 vs 24.4±27.0 miles, p = 0.585; 29.9±25.3 vs 29.5±24.9 minutes, p = 0.664).
Receipt of BCT was not predicted by crowfly or true driving distance, driving time, or season. There was no interaction between distance, winter season, and drive time. Receipt of BCT was more likely with older age (OR=1.02 per year of age, p<0.001) and later year of treatment (OR=1.05, p<0.001).
CONCLUSION: Driving distance, time, and crowfly distance correlated tightly and do not influence patient choice of surgery type for breast cancer in our population. Despite a substantial rural population, driving distance, driving duration, and climate did not significantly influence patients' decisions for mastectomy versus BCT.
Citation Format: Wolf CL, Frankova D, Franko J. Influence of winter season, driving distance, and time on receipt of breast conserving therapy among Iowa urban and rural patients [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P3-10-11.
Collapse
Affiliation(s)
- CL Wolf
- Mercy Internal Medicine Residency, Des Moines, IA; Mercy Medical Center, Des Moines, IA
| | - D Frankova
- Mercy Internal Medicine Residency, Des Moines, IA; Mercy Medical Center, Des Moines, IA
| | - J Franko
- Mercy Internal Medicine Residency, Des Moines, IA; Mercy Medical Center, Des Moines, IA
| |
Collapse
|
37
|
Franko J, Hsu H, Thirunavukarasu P, Frankova D, Goldman C. Chemotherapy and radiation components of neoadjuvant treatment of pancreatic head adenocarcinoma: Impact on perioperative mortality and long-term survival. Eur J Surg Oncol 2017; 43:351-357. [DOI: 10.1016/j.ejso.2016.10.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 08/29/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022] Open
|
38
|
Franko J, Shi Q, Meyers JP, Maughan TS, Adams RA, Seymour MT, Saltz L, Punt CJA, Koopman M, Tournigand C, Tebbutt NC, Diaz-Rubio E, Souglakos J, Falcone A, Chibaudel B, Heinemann V, Moen J, De Gramont A, Sargent DJ, Grothey A. Prognosis of patients with peritoneal metastatic colorectal cancer given systemic therapy: an analysis of individual patient data from prospective randomised trials from the Analysis and Research in Cancers of the Digestive System (ARCAD) database. Lancet Oncol 2016; 17:1709-1719. [PMID: 27743922 DOI: 10.1016/s1470-2045(16)30500-9] [Citation(s) in RCA: 387] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/25/2016] [Accepted: 08/25/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Patients with peritoneal metastatic colorectal cancer have reduced overall survival compared with patients with metastatic colorectal cancer without peritoneal involvement. Here we further investigated the effect of the number and location of metastases in patients receiving first-line systemic chemotherapy. METHODS We analysed individual patient data for previously untreated patients enrolled in 14 phase 3 randomised trials done between 1997 and 2008. Trials were included if protocols explicitly pre-specified and solicited for patients with peritoneal involvement in the trial data collection process or had done a formal peritoneum-focused review of individual pre-treatment scans. We used stratified multivariable Cox models to assess the prognostic associations of peritoneal metastatic colorectal cancer with overall survival and progression-free survival, adjusting for other key clinical-pathological factors (age, sex, Eastern Cooperative Oncology Group (ECOG) performance score, primary tumour location [colon vs rectum], previous treatment, and baseline BMI). The primary endpoint was difference in overall survival between populations with and without peritoneal metastases. FINDINGS Individual patient data were available for 10 553 patients. 9178 (87%) of 10 553 patients had non-peritoneal metastatic colorectal cancer (4385 with one site of metastasis, 4793 with two or more sites of metastasis), 194 (2%) patients had isolated peritoneal metastatic colorectal cancer, and 1181 (11%) had peritoneal metastatic colorectal cancer and other organ involvement. These groups were similar in age, ethnic origin, and use of targeted treatment. Patients with peritoneal metastatic colorectal cancer were more likely than those with non-peritoneal metastatic colorectal cancer to be women (565 [41%] of 1371 vs 3312 [36%] of 9169 patients; p=0·0003), have colon primary tumours (1116 [84%] of 1334 patients vs 5603 [66%]; p<0·0001), and have performance status of 2 (136 [10%] vs 521 [6%]; p<0·0001). We recorded a higher proportion of patients with mutated BRAF in patients with peritoneal-only (eight [18%] of 44 patients with available data) and peritoneal metastatic colorectal cancer with other sites of metastasis (34 [12%] of 289), compared with patients with non-peritoneal metastatic colorectal cancer (194 [9%] of 2230; p=0·028 comparing the three groups). Overall survival (adjusted HR 0·75, 95% CI 0·63-0·91; p=0·003) was better in patients with isolated non-peritoneal sites than in those with isolated peritoneal metastatic colorectal cancer. Overall survival of patients with two of more non-peritoneal sites of metastasis (adjusted HR 1·04, 95% CI 0·86-1·25, p=0.69) and those with peritoneal metastatic colorectal cancer plus one other site of metastasis (adjusted HR 1·10, 95% CI 0·89-1·37, p=0·37) was similar to those with isolated peritoneal metastases. Compared with patients with isolated peritoneal metastases, those with peritoneal metastases and two or more additional sites of metastasis had the shortest survival (adjusted HR 1·40; CI 1·14-1·71; p=0·0011). INTERPRETATION Patients with peritoneal metastatic colorectal cancer have significantly shorter overall survival than those with other isolated sites of metastases. In patients with several sites of metastasis, poor survival is a function of both increased number of metastatic sites and peritoneal involvement. The pattern of metastasis and in particular, peritoneal involvement, results in prognostic heterogeneity of metastatic colorectal cancer. FUNDING None.
Collapse
Affiliation(s)
- Jan Franko
- Division of Surgical Oncology, Mercy Medical Center, Des Moines, IA, USA.
| | - Qian Shi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey P Meyers
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | - Matthew T Seymour
- Gastrointestinal Cancer Research Unit, Cookridge Hospital, Leeds, UK
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cornelis J A Punt
- Department of Medical Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | | | | | - Niall C Tebbutt
- Sydney Medical School, the University of Sydney, NSW, Australia
| | | | - John Souglakos
- University of Crete, School of Medicine, Heraklion, Greece
| | | | - Benoist Chibaudel
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Volker Heinemann
- University of Munich, Department of Medical Oncology and Comprehensive Cancer Center, Munich, Germany
| | - Joseph Moen
- Department of Biostatistics, University of Iowa, Iowa City, IA, USA
| | - Aimery De Gramont
- Department of Medical Oncology, Franco-British Institute, Levallois-Perret, France
| | - Daniel J Sargent
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Axel Grothey
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
39
|
Hanif MH, Raman SR, Goldman CD, Franko J. Utility of Neutrophil, Lymphocyte, Monocyte, and Platelet Ratio in Predicting Complications Among Patients Undergoing Major Abdominal Operation Enrolled Into PROGRESS Trial. J Am Coll Surg 2016. [DOI: 10.1016/j.jamcollsurg.2016.08.290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
40
|
Jacob JD, Hodge C, Franko J, Pezzi CM, Goldman CD, Klimberg VS. Rare breast cancer: 246 invasive secretory carcinomas from the National Cancer Data Base. J Surg Oncol 2016; 113:721-5. [PMID: 27040042 DOI: 10.1002/jso.24241] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 03/16/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Invasive secretory breast carcinoma (SBC) is a rare subtype of breast malignancy. METHODS Cases of SBC and infiltrating ductal carcinoma (IDC) from the National Cancer Database (1998-2011) were queried. RESULTS Patients with SBC (n = 246) and IDC were identified (n = 1,564,068). The group with SBC was younger (age 56.4 ± 16.0 vs. 60.4 ± 13.9 years, P < 0.001), had similar tumor size (19.9 ± 17.8 vs. 21.6 ± 25.5 mm, P = 0.297), more frequently African-Americans (24.1 vs. 14.8 vs. 13.7; P = 0.004), more well-differentiated (32 vs. 18%, P < 0.001) and less likely to be hormone receptor positive (ER: 64 vs. 76%, P = 0.001; PR: 43 vs. 65%, P < 0.001). No differences were found for incidence of node-positivity (32 vs. 34%, P = 0.520) and stage IV presentation (2.4 vs. 3.6%, P = 0.372). Breast conserving surgery (60 vs. 58%, P = 0.405) and hormonal therapy (67 vs. 71%, P = 0.489) rates were similar. Systemic chemotherapy was used less often for SBC (38 vs. 45%, P = 0.035). The overall survival of all patients with SBC was better than all patients with IDC (median not reached vs. 14.8 years, P = 0.025). CONCLUSION SBC is an uncommon tumor that is often well-differentiated and seen in younger women. Contrary to prior reports, they are frequently hormone receptor-positive. Compared to IDC, overall survival is improved. J. Surg. Oncol. 2016;113:721-725. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- John Doromal Jacob
- Department of Surgery, Abington Hospital-Jefferson Health, Abington, Pennsylvania
| | - Caitlin Hodge
- Department of Surgery, Abington Hospital-Jefferson Health, Abington, Pennsylvania
| | - Jan Franko
- Surgical Affiliates, Mercy Medical Center, Des Moines, Iowa
| | - Christopher M Pezzi
- Department of Surgery, Abington Hospital-Jefferson Health, Abington, Pennsylvania
| | | | - Vicki Suzanne Klimberg
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| |
Collapse
|
41
|
Franko J, Shi Q, Meyers JP, Heinemann V, Falcone A, Tebbutt NC, Maughan T, Seymour M, Saltz L, Tournigand C, Diaz-Rubio E, Sougklakos I, Chibaudel B, Moen J, De Gramont A, Adams RA, Sargent DJ, Grothey A. Prognostic value of isolated peritoneal versus other metastatic sites in colorectal cancer (CRC) patients treated by systemic chemotherapy: Findings from 9,265 pts in the ARCAD database. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
656 Background: Patients (pts) with peritoneal metastases from CRC (pmCRC) have reduced OS compared to mCRC pts without peritoneal involvement. Here we further investigated the impact of number and location of metastases among pts receiving first-line systemic chemotherapy. Methods: Individual patient data were available on 9,265 pts (median age 64; 63% male; 93% ECOG PS 0-1; 68% colon primary tumor; brain metastases excluded) enrolled onto 12 first-line randomized trials (4 tested targeted regimens). Stratified multivariable Cox models were used to assess the associations with overall survival (OS); adjusted hazard ratios (HRadj) and 95% confidence intervals are reported (CI). Results: There were 7,963 (86%) pts with non-pmCRC (3,904 with one disease site; 4,059 with ≥2 disease sites), 191 (2%) pts with isolated pmCRC, and 1,111 (12%) non-isolated pmCRC. These groups were similar in age, race, and use of targeted chemotherapy. Compared to non-pmCRC, pts with pmCRC were more likely to be female (41% vs. 36%, p<.001), have colon primary tumors (85% vs. 67%, p<.0001), and have PS2 (10% vs. 6%, p<.0001). Compared to isolated pmCRC, pts with solitary non-peritoneal sites (both M1a) had significantly better OS (HRadj=0.78; CI, 0.64-0.94, p=.009) while pts with ≥2 non-peritoneal sites had similar OS (HRadj=1.06; CI 0.88-1.28, p=.535). OS of pts with pmCRC with a single other disease site (n=446) was similar to isolated pmCRC (HRadj=1.13; CI 0.91-1.40, p=.28), but those with pmCRC + ≥2 additional disease sites (n=665) had shortest survival (HRadj=1.44; CI 1.17-1.77, p<.001). A combination of peritoneal and liver metastases (n=821; HRadj=1.37, CI 1.12-1.67, p=.002) was associated with poorer survival compared with isolated pmCRC; but combination with extrahepatic sites (n=290; HRadj=1.15, CI 0.91-1.45, p=.25) was not. Conclusions: pmCRC pts have significantly worse survival than those with other solitary site mCRC. Among those with multiple disease sites, poorer survival is a function of increased number of metastatic sites and peritoneal involvement, which indicates prognostic heterogeneities among M1b pts.
Collapse
Affiliation(s)
| | | | | | - Volker Heinemann
- Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | | | - Tim Maughan
- University of Oxford, Oxford, United Kingdom
| | - Matthew Seymour
- Gastrointestinal Cancer Research Unit, Cookridge Hospital, Leeds, United Kingdom
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Franko J, Hsu HW, Thirunavukarasu P, Frankova D, Goldman CD. Outcomes of neoadjuvant chemotherapy versus chemoradiation among patients with resected pancreatic head adenocarcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
398 Background: Increasing use of neoadjuvant therapy in pancreatic cancer has been reported. We compared patterns of practice and outcomes of neoadjuvant chemotherapy (nCHT) versus chemoradiation (nCRT) among pancreatic cancer pts receiving pancreaticoduodenectomy. Methods: National Cancer Data Base pancreatic head adenocarcinoma patients (pts) diagnosed between 2003 and 2011 treated by nCHT or nCRT followed by pancreaticoduodenectomy. Backward elimination logistic and Cox regression models were used. Primary outcome measures were 30-day and 90-day postsurgical mortality and overall survival; adjusted odds (aOR) & hazard ratios (aHR) and 95% confidence intervals (CI) are reported. Results: In all 1,432 pts received neoadjuvant treatment with nCHT (n = 523) or nCRT (n = 909). Odds of 30-day mortality were influenced by age (aOR 1.03, CI 0.99-1.06,p = 0.077), average annual resection volume of facility (aOR 0.98, CI 0.97-1.00, p = 0.135), and household income quartile (aOR 1.94, CI 0.97-3.90, p = 0.060), but not by delivery of RT, comorbidities, gender, insurance status or facility type. Odds of 90-day mortality were influenced by age (aOR 1.03, 1.01-1.05,p = 0.004), household income quartile (aOR 1.37, CI 0.87-2.16, p = 0.171), and delivery of nCRT (aOR 1.69, CI 1.04-2.74, p = 0.032), but not by average annual resection volume of facility, comorbidity, gender, insurance status or facility type. Survival odds were influenced by age (aHR 1.01, CI 1.00-1.02, p = 0.001), margin status (aOR 1.50, CI 1.27-1.77, p < 0.001), ypN status (aHR 1.45, CI 1.26-1.68), p < 0.001), adjuvant CHT (aHR 0.81, CI 0.69-0.94, p = 0.006), and nCRT (aHR 1.21, CI 1.04-1.40, p = 0.012). On average pts with nCHT as compared to nCRT lived longer (median OS 26.4 vs. 24.2 months, p = 0.001; actuarial 3 yr 58% vs 49%, and 5 year survival 30% vs 14%). Conclusions: There is no detectable difference in early outcome (30-day postsurgical mortality) among pancreaticoduodenectomy pts treated with nCHT or nCRT. Trend toward a more favorable long-term outcome (30-day postsurgical mortality and overall survival) among those with nCHT without radiation is noted. Further studies with more detailed data sources are needed.
Collapse
|
43
|
Franko J, Voynov G, Goldman CD. Esophagectomy Timing After Neoadjuvant Therapy for Distal Esophageal Adenocarcinoma. Ann Thorac Surg 2015; 101:1123-30. [PMID: 26652139 DOI: 10.1016/j.athoracsur.2015.09.044] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 09/12/2015] [Accepted: 09/15/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND The time elapsed between completion of neoadjuvant therapy and esophagectomy may influence response rate and possibly allow for avoidance of surgical intervention in selected cases ("wait and see" approach). However, a very long postradiation interval has been associated with worsened surgical outcomes in esophageal carcinoma. Therefore we analyzed outcomes of patients with invasive distal esophageal adenocarcinoma treated with neoadjuvant chemoradiation and esophagectomy based on the time elapsed between completion of neoadjuvant chemoradiation and resection. METHODS Patients with invasive distal esophageal carcinoma diagnosed between 2003 and 2011 and treated by neoadjuvant chemoradiation followed by esophagectomy within 26 weeks were identified in the National Cancer Data Base (NCDB). Primary outcome measures were 30- and 90-day postsurgical mortality and overall survival. RESULTS In all, 4,284 patients aged 60.3 ± 9.4 years were analyzed (mean ± standard deviation). The interval after radiation therapy until esophagectomy was 7.8 ± 3.4 weeks (median, 7.1 weeks). The postradiation interval was 8 weeks or more in 35% of patients. Thirty-day mortality was 2.9% (n = 127), and 90-day mortality was 7.8% (n = 336). A postradiation interval of 9 weeks or more was associated with increased perioperative mortality odds both at the 30-day (adjusted odds ratio [OR], 2.160; 95% confidence interval, 1.099-4.242; p = 0.025) and 90-day follow-up (adjusted OR, 1.912; 95% confidence interval, 1.290-2.835; p < 0.001). Similarly, a postradiation interval of 9 weeks or more was associated with an increased mortality risk (adjusted hazard ratio [HR], 1.194; 95% confidence interval, 1.032-1.380; p = 0.017). CONCLUSIONS Perioperative mortality and overall survival are significantly associated with the time interval between neoadjuvant chemoradiation and esophagectomy. A "wait and see" approach after neoadjuvant therapy for esophageal adenocarcinoma may not be safe. Further studies based on more detailed data are needed.
Collapse
Affiliation(s)
- Jan Franko
- Department of Surgery, Mercy Medical Center, Des Moines, Iowa.
| | - George Voynov
- Department of Radiation Oncology, Mercy Medical Center, Des Moines, Iowa
| | | |
Collapse
|
44
|
|
45
|
Hsu HW, Dunlavy P, Franko J, Chew DK. The Effect of Abdominal Aortic Aneurysm Size on Type II Endoleak and Sac Regression Following Endovascular Stent Graft Repair. J Vasc Surg 2015. [DOI: 10.1016/j.jvs.2015.06.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
46
|
Kray J, Kirk S, Franko J, Chew DK. Role of type II endoleak in sac regression after endovascular repair of infrarenal abdominal aortic aneurysms. J Vasc Surg 2015; 61:869-74. [DOI: 10.1016/j.jvs.2014.11.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
|
47
|
Kray J, Kirk S, Chew D, Franko J. Role of Type II Endoleak in Abdominal Aortic Aneurysm Sac Regression After Endovascular Repair. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
48
|
Hammond JS, Franko J, Holloway SE, Heckman JT, Orons PD, Gamblin TC. Gemcitabine transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma. Hepatogastroenterology 2014; 61:1339-1343. [PMID: 25436307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIMS Transcatheter arterial chemoembolization (TACE) has been shown to increase survival in patients with unresectable hepatocellular carcinoma (HCC), however toxicity from commonly used agents limits its use in unresectable disease. Gemcitabine is a well tolerated chemotherapeutic agent with a high first pass clearance. In this study we evaluated a cohort of patients with unresectable HCC treated with gemcitabine-TACE alone. METHODOLOGY A review of all patients that underwent gemcitabine-TACE for unresectable HCC from 2002 to 2006 was performed. No patients were eligible for resection, liver transplantation or ablation. All patients received gemcitabine-TACE alone. The primary outcome measure was survival from first treatment. Secondary outcome measures included radiological response and toxicity. RESULTS 55 patients underwent a total of 172 gemcitabine-TACE treatments for unresectable HCC. Median age was 64.7 years. All patients had Barcelona-Clinic Liver Cancer (BCLC) stage B (44%) or C (56%) disease. Median survival following gemcitabine-TACE was 8.8 months. 22% demonstrated a partial response and 61% had stable disease. 6% experienced grade 3/4 adverse events. There was 1 treatment related death. CONCLUSIONS Gemcitabine-TACE is well tolerated and appears to provide an alternative agent for patients with unresectable HCC undergoing chemoembolization.
Collapse
|
49
|
Dali D, Trent H, Grimm S, Goldman CD, Franko J. Postoperative neutrophil-to-lymphocyte ratio as a predictor of surgical complications, recurrence-free (RFS), and overall survival (OS) among esophageal adenocarcinoma patients after induction chemoradiation followed by esophagectomy. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
50
|
Franko J, Goldman CD, Turaga KK. Role of Chemotherapy in Peritoneal Carcinomatosis in Metastatic Colorectal Cancer. Curr Colorectal Cancer Rep 2013. [DOI: 10.1007/s11888-013-0173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|