1
|
Vaish R, Hawaldar R, Gupta S, Dandekar M, Shah S, Chaukar D, Pantvaidya G, Deshmukh A, Chaturvedi P, Pai P, Nair D, Nair S, Thakur M, Ghosh-Laskar S, Agarwal JP, D'Cruz AK. N0 neck trial: Does intensification of follow-up (Ultrasound + Physical Examination) influence outcomes in early-stage oral cancer? Eur J Cancer 2024; 204:114064. [PMID: 38705028 DOI: 10.1016/j.ejca.2024.114064] [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] [Received: 02/03/2024] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 05/07/2024]
Abstract
AIM OF THE STUDY We previously reported a survival benefit of elective neck dissection (END) over therapeutic neck dissection (TND) in patients with clinically node-negative early-stage oral cancer. We now report the results of the second question in the same study addressing the impact of adding neck ultrasound to physical examination during follow-up on outcomes. METHODS Patients with lateralized T1/T2 oral squamous cell carcinoma (SCC) were randomized to END or TND and to follow-up with physical-examination plus neck ultrasound (PE+US) versus physical-examination (PE). The primary endpoint was overall survival (OS). RESULTS Between January 2004 and June 2014, 596 patients were enrolled. This is an intention to treat analysis of 592 analysable patients, of whom 295 were allocated to PE+US and 297 to PE with a median follow-up of 77.47 months (interquartile range (IQR) 54.51-126.48). There was no significant difference (unadjusted hazard ratio [HR], 0.92, 95% CI, 0.71-1.20, p = 0.54) in 5-year OS between PE+US (70.8%, 95% CI, 65.51-76.09) and PE (67.3%, 95% CI, 61.81-72.79). Among 131 patients with neck node relapse as the first event, the median time to relapse detection was 4.85 (IQR 2.33-9.60) and 7.62 (IQR 3.22-9.86) months in PE+US and PE arms, respectively. The N stage in the PE+US arm was N1 33.8%, N2a 7.4%, N2b/c 44.1% and N3 14.7% while in PE was N1 28.6%, N2a 9.5%, N2b/c 39.7%, N3 20.6% and unknown 1.6%. CONCLUSION Adding neck ultrasound to physical examination during follow-up detects nodal relapses earlier but does not improve overall survival.
Collapse
Affiliation(s)
- Richa Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | - Sudeep Gupta
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | - Snehal Shah
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Devendra Chaukar
- Department of Head and Neck Oncology, Max Nanavati Hospital, Mumbai, India
| | | | - Anuja Deshmukh
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | - Prathamesh Pai
- Punyashlok Ahilyadevi Holkar, Head Neck Cancer Institute of India (HNCII), India
| | - Deepa Nair
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Sudhir Nair
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | | | | | - J P Agarwal
- Tata Memorial Centre, Homi Bhabha National Institute, India
| | - Anil K D'Cruz
- Director Oncology-Apollo Group of Hospitals, Department of Oncology, Apollo Hospital, Navi Mumbai, India.
| |
Collapse
|
2
|
Marquez JL, Chow J, Moss W, Luo J, Eddington D, Agarwal JP, Kwok AC. Outpatient Prescription Opioid Use following Discharge after Deep Inferior Epigastric Perforator Breast Reconstruction with and without an Educational Intervention. J Reconstr Microsurg 2024. [PMID: 38452802 DOI: 10.1055/a-2283-4775] [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: 03/09/2024]
Abstract
BACKGROUND There is limited evidence for appropriate postoperative opioid prescribing in autologous breast reconstruction. We sought to describe postoperative outpatient prescription opioid use following discharge after deep inferior epigastric perforator (DIEP) breast reconstruction with and without an educational video. METHODS Patients undergoing DIEP reconstruction were given a 28-day postoperative pain and medication logbook from August 2022 to June 2023. Our practice implemented an educational video upon discharge on proper opioid consumption. Descriptive statistics on patient characteristics, intraoperative and postoperative opioid consumption, and outpatient prescription opioid use after discharge were compared between the two cohorts. RESULTS A total of 53 logbooks were completed with 20 patients in the no video cohort and 33 in the video cohort. On average, the days to cessation of opiates was longer in the no video cohort (8.2 vs. 5.1 days, p = 0.003). The average number of oxycodone 5 mg equivalents consumed following discharge was 13.8 in the no video cohort and 7.8 in the video cohort, which was statistically significant (p = 0.01). Overall, the percentage of opioids prescribed that were consumed in the video cohort was 28.3% versus 67.1% in the no video cohort. CONCLUSION For patients discharging home after DIEP reconstruction, we recommend a prescription for 12 oxycodone 5 mg tablets. With the use of an educational video regarding proper opioid consumption, we were able to reduce the total outpatient opioid use to 5 oxycodone 5 mg tablets following hospital discharge.
Collapse
Affiliation(s)
- Jessica L Marquez
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Josh Chow
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Whitney Moss
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jessica Luo
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Devin Eddington
- Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jayant P Agarwal
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Alvin C Kwok
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
3
|
Miller A, Jeyapalina S, Agarwal JP, Beck JP. Association between blood markers and the progression of osseointegration in percutaneous prostheses patients-A pilot study. J Biomed Mater Res B Appl Biomater 2024; 112:e35398. [PMID: 38456331 DOI: 10.1002/jbm.b.35398] [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: 12/28/2023] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 03/09/2024]
Abstract
Patients implanted with osseointegrated (OI) prosthetic systems have reported vastly improved upper and lower extremity prosthetic function compared with their previous experience with socket-suspension systems. However, OI systems have been associated with superficial and deep-bone infections and implant loosening due, in part, to a failure of the osseointegration process. Although monitoring the osseointegration using circulating biomarkers has clinical relevance for understanding the progression of osseointegration with these devices, it has yet to be established. Ten patients were enrolled in this study. Blood samples were collected at pre-selected times, starting before implantation surgery, and continuing to 12 months after the second surgery. Bone formation markers, bone resorption markers, and circulating amino acids were measured from blood samples. A linear mixed model was generated for each marker, incorporating patient ID and age with the normalized marker value as the response variable. Post hoc comparisons were made between 1 week before Stage 1 Surgery and all subsequent time points for each marker, followed by multiple testing corrections. Serial radiographic imaging of the residual limb containing the implant was obtained during follow-up, and the cortical index (CI) was calculated for the bone at the porous region of the device. Two markers of bone formation, specifically bone-specific alkaline phosphatase (Bone-ALP) and amino-terminal propeptide of type I procollagen (PINP), exhibited significant increases when compared with the baseline levels of unloaded residual bone prior to the initial surgery, and they subsequently returned to their baseline levels by the 12-month mark. Patients who experienced clinically robust osseointegration experienced increased cortical bone thickness at the porous coated region of the device. A medium correlation was observed between Bone-ALP and the porous CI values up to PoS2-M1 (p = .056), while no correlation was observed for PINP. An increase in bone formation markers and the lack of change observed in bone resorption markers likely reflect increased cortical bone formation induced by the end-loading design of the Utah OI device used in this study. A more extensive study is required to validate the correlation observed between Bone-ALP and porous CI values.
Collapse
Affiliation(s)
- Andrew Miller
- Research, George E. Wahlen Department of Veteran Affairs Medical Center, Salt Lake City, Utah, USA
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah School of Engineering, Salt Lake City, Utah, USA
| | - Sujee Jeyapalina
- Research, George E. Wahlen Department of Veteran Affairs Medical Center, Salt Lake City, Utah, USA
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, Salt Lake City, Utah, USA
- Department of Biomedical Engineering, University of Utah School of Engineering, Salt Lake City, Utah, USA
| | - Jayant P Agarwal
- Research, George E. Wahlen Department of Veteran Affairs Medical Center, Salt Lake City, Utah, USA
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, Salt Lake City, Utah, USA
| | - James Peter Beck
- Research, George E. Wahlen Department of Veteran Affairs Medical Center, Salt Lake City, Utah, USA
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, Salt Lake City, Utah, USA
- Department of Orthopaedics, University of Utah, School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
4
|
Donato DP, Simpson AM, Willcockson J, Veith J, King BW, Agarwal JP. Associations with Discharge to Post-Acute Care Facilities Among Patients Undergoing Open Reduction Internal Fixation of Distal Radius Fractures. Plast Surg (Oakv) 2024; 32:40-46. [PMID: 38433790 PMCID: PMC10902480 DOI: 10.1177/22925503221085082] [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: 03/05/2024] Open
Abstract
Introduction: Distal radius fractures are a common injury of the hand and wrist that often require intensive rehabilitation. We sought to identify risk factors associated with discharge to a post-acute care facility following distal radius fracture repair. Methods: The 2011 to 2016 National Surgical Quality Improvement Program® (NSQIP) database was queried for all Current Procedural Terminology (CPT) codes that corresponded with open distal radius fracture repair. Patients with concomitant traumatic injuries were excluded. Patient demographics, comorbidities, perioperative factors, laboratory data, and surgical details were collected. Our primary outcome was to determine postoperative discharge destination: home versus a post-acute care facility, and to identify factors that predict discharge to post-acute care facility. Secondary outcomes included unplanned readmission, reoperation, and complications. Results: Between 2011 and 2016, a total of 12,001 patients underwent open distal radius fracture repair and had complete information for their discharge. Of these analyzed patients, 3.24% (n = 389) were discharged to rehabilitation facilities. The following factors were identified on multivariate analysis to have an association with discharge to a post-acute care facility: 65 years or older, White race, underweight, using steroids preoperatively, American Society of Anesthesiologists (ASA) classification > 2, admitted from a nursing home or already hospitalized, anemic, undergoing bilateral surgery, wound classification other than clean, and complications prior to discharge. Conclusion: Factors identified by our study to have associations with discharge to post-acute care facilities following distal radius fracture repair can help in appropriate patient counseling and triage from the hospital to home versus a post-acute care facility.
Collapse
Affiliation(s)
- Daniel P Donato
- Division of Plastic and Reconstructive Surgery, University of Texas Medical Branch, Galveston, TX, USA
| | - Andrew M Simpson
- Division of Plastic Surgery, Western University, London, ON, Canada
| | - James Willcockson
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jacob Veith
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brody W King
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
5
|
Sudduth JD, Marquez JL, Samlowski EE, Bautista C, Eddington D, Agarwal JP, Kwok AC. The Effect of Body Mass Index on Free Flap Breast Reconstruction. J Reconstr Microsurg 2024; 40:132-138. [PMID: 37308097 DOI: 10.1055/s-0043-1769746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Literature addressing the risks associated with increasing body mass index (BMI) for patients undergoing free flap breast reconstruction is limited. Often, an arbitrary BMI cutoff (i.e., BMI of 30 kg/m2) is used to determine candidacy for a free flap without substantial backing evidence. This study utilized a national multi-institutional database to analyze outcomes of free flap breast reconstruction and stratified complications by BMI class. METHODS Using the 2010 to 2020 National Surgical Quality Improvement Program database, patients who underwent free flap breast reconstruction were identified. Patients were divided into six cohorts based on the World Health Organization BMI classes. Cohorts were compared by basic demographics and complications. A multivariate regression model was created to control for age, diabetes, bilateral reconstruction, American Society of Anesthesiologists class, and operative time. RESULTS Surgical complications increased with each BMI class, with the highest rates occurring in class I, II, and III obesity, respectively. In a multivariable regression model, the risk for any complication was significant for class II and III obesity (odds ratio [OR]: 1.23, p < 0.004; OR: 1.45, p < 0.001, respectively). Diabetes, bilateral reconstruction, and operative time were independently associated with an increased risk of any complication (OR: 1.44, 1.14, 1.14, respectively, p < 0.001). CONCLUSION This study suggests that the risks of postoperative complications following free flap breast reconstruction are highest for patients with a BMI greater than or equal to 35 kg/m2, having nearly 1.5 times higher likelihood of postoperative complications. Stratifying these risks by weight class can help guide preoperative counseling with patients and help physicians determine candidacy for free flap breast reconstruction.
Collapse
Affiliation(s)
- Jack D Sudduth
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Jessica L Marquez
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Erika E Samlowski
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Catie Bautista
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Devin Eddington
- Division of Epidemiology, Department of Internal Medicine, The University of Utah Hospital, Salt Lake City, Utah
| | - Jayant P Agarwal
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| | - Alvin C Kwok
- Division of Plastic Surgery, Department of Surgery, The University of Utah Hospital, Salt Lake City, Utah
| |
Collapse
|
6
|
Marquez JL, French M, Ormiston L, Pires G, Martheswaran T, Eddington D, Tuncer F, Agarwal JP, Kwok AC. Outcomes after tissue expander exchange to implant in two-stage prepectoral breast reconstruction with and without acellular dermal matrix: A retrospective cohort study. J Plast Reconstr Aesthet Surg 2024; 89:97-104. [PMID: 38160591 DOI: 10.1016/j.bjps.2023.12.008] [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: 09/07/2023] [Revised: 11/20/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
As prepectoral implant placement becomes widely adopted, recent studies investigating the use of acellular dermal matrix (ADM) during tissue expander placement have demonstrated no major benefit with regard to postoperative outcomes. We sought to evaluate second-stage outcomes 1 year after tissue expander exchange to implant with and without ADM. Consecutive patients who underwent prepectoral tissue expander-based breast reconstruction with and without ADM were identified. Patients were followed up for 1 year after tissue expander exchange to implant. Second-stage outcomes of interest including implant rippling, capsular contracture, implant explantation, additional revision surgeries, and patient-reported outcomes were collected and compared. Sixty-eight breasts in the ADM cohort and sixty-one breasts in the no ADM cohort underwent tissue expander exchange to implant. Second-stage outcomes of interest were similar between the ADM and no ADM cohorts with no statistically significant differences identified regarding incidences of implant rippling (24.6% vs. 12.1%, p = 0.08), capsular contracture (4.5% vs. 3.3%, p = 1.00), and explantation (6.6% vs. 1.7%, p = 0.67) between the two cohorts. BREAST-Q scores were similar between the two cohorts with the exception of physical wellbeing and satisfaction in terms of implant rippling, as can be seen, which improved in the no ADM cohort (p = 0.04). Our study reports no major benefit for the inclusion of ADM with respect to implant rippling, capsular contracture, explantation, need for additional revision surgeries, and patient-reported satisfaction in prepectoral second-stage implant-based breast reconstruction.
Collapse
Affiliation(s)
- Jessica L Marquez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Mackenzie French
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Laurel Ormiston
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Giovanna Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Tanisha Martheswaran
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Devin Eddington
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Fatma Tuncer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA.
| |
Collapse
|
7
|
Tibdewal A, Agrawal A, Bhogadi A, Mummudi N, Khatavkar G, Agarwal JP. Long Term Outcomes of Conventional Palliative Radiotherapy in Bone Metastases of Lung Cancer: A Prospective Study. Int J Radiat Oncol Biol Phys 2023; 117:e66-e67. [PMID: 37785955 DOI: 10.1016/j.ijrobp.2023.06.793] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Bone metastases (BM) are highly prevalent in metastatic lung cancer (LC) leading to consequential morbidity and a decline in quality of life. The identification of oncogenes mutation and introduction of targeted therapy has prolonged the survival and therefore evaluation of long-term pain response rates, durability and re-irradiation (Re-RT) with conventional radiotherapy (RT) is crucial, especially in LMIC where penetration of stereotactic body radiotherapy for BM is poor. MATERIALS/METHODS This prospective observational study included consecutive patients with histologically proven LC with radiologically confirmed BM. The primary objective was to evaluate the pain response rates in lung cancer patients with bone metastases treated with palliative RT. Palliative RT to BM was delivered using a conventional/conformal technique. The International Bone Metastases Consensus response criteria using Numeric Pain Rating Scale (NPRS) and Oral Morphine Equivalent Dose (OMED) was used to evaluate the pain response at 12, 24, and 52 weeks. Assuming the worst-case scenario, pain progression-free survival (PPFS) was calculated from the date of baseline assessment to the date of pain progression (PP) or death using Kaplan-Meier survival analysis. Known prognostic factors were evaluated using Cox regression analysis. RESULTS From June 2020 to August 2022, 250 patients of NSCLC (94%) were accrued. The majority were male (66%), smokers (35%), lytic lesions (75%) and in the axial skeleton (82%). The oncogenic mutation was seen in 123 (49%) patients. At baseline, the mean OMED was 20mg/day (SD-21), and the mean pain score was 6 (SD-2.3). The majority (66%) received an 8 Gy single fraction with only 3% treated with SBRT. In evaluable patients, the CR and PR rates at 12 (n-161) and 24 weeks (n-121) were 34%, 40%, and 44%, 35% respectively. The indeterminate response rate (IRR) at 3 and 6 months were 18% while the rate of PP was 6%. On multivariate analysis, negative oncogene mutation {HR-0.34 (CI 0.22- 0.50), p<0.0001} and soft tissue mass {HR-0.46 (CI 0.31- 0.68) p<0.0001} were significant prognostic factors for pain progression. Of 71 evaluable patients at 1 year, 56% had a complete response with an ORR of 87%. In patients with oncogene mutation, the CR rates at 12 (n-101), 24 (n-77), and 52 weeks were 40%, 47%, and 60% with an ORR of 86%. PP is observed in less than 4%. Pain response was significantly more durable than mutation negative (8 vs 3 months, p-0.003). Re-RT rate was overall 11% (n = 27) and 8.2% in oncogene mutation patients. Re-RT rate with single-fraction was 8% and 3% with fractionated RT. The median time to Re-RT was 9.7 weeks. The PPFS was 70% and 60% at 12 and 24 weeks, respectively. CONCLUSION This prospective study in an LC-specific population demonstrated excellent CR and PR rates with conventional RT. Durable pain relief with modest Re-RT rates with single fraction, particularly in oncogene mutation compels us to evaluate the role of SBRT for BM, especially in LMIC in a randomized setting.
Collapse
Affiliation(s)
- A Tibdewal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - A Agrawal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - A Bhogadi
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - G Khatavkar
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
8
|
Marquez JL, Sudduth JD, Kuo K, Patel AA, Eddington D, Agarwal JP, Kwok AC. A Comparison of Postoperative Outcomes Between Immediate, Delayed Immediate, and Delayed Autologous Free Flap Breast Reconstruction: Analysis of 2010-2020 NSQIP Data. J Reconstr Microsurg 2023; 39:664-670. [PMID: 36928907 DOI: 10.1055/a-2056-0909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND While many factors influence decisions related to the timing between mastectomy and flap-based breast reconstruction, there is limited literature comparing postoperative complications between immediate (IBR), delayed immediate (DIBR), and delayed (DBR) reconstruction modalities. Using the National Surgical Quality Improvement Program (NSQIP), we sought to compare postoperative complication rates of each timing modality. METHODS The NSQIP 2010-2020 database was queried for patients who underwent free flap breast reconstruction. Cases were categorized to include mastectomy performed concurrently with a free flap reconstruction, removal of a tissue expander with free flap reconstruction, and free flap reconstruction alone which are defined as IBR, DIBR, and DBR, respectively. The frequency of postoperative outcomes including surgical site infection (SSI), wound dehiscence, intraoperative transfusion, deep venous thrombosis (DVT), and return to operating room (OR) was assessed. Overall complication rates, hospital length of stay (LOS), and operative time were analyzed. Multivariable regression analysis controlling for age, race, BMI, diabetes, hypertension, ASA class, and laterality was performed. RESULTS A total of 7,907 cases that underwent IBR, DIBR (n = 976), and DBR reconstruction (n = 6,713) were identified. No statistical difference in occurrence of SSIs, wound dehiscence, or DVT was identified. DIBR (9%) and DBR (11.9%) were associated with less occurrences of reoperation than IBR (13.2%, p < 0.001). Univariate and multivariate regression analysis demonstrated that DIBR and DBR were associated with a lower odds of complications and shorter operation time versus IBR. No statistically significant differences between DIBR and DBR in surgical complications, LOS, and operative time were identified. CONCLUSION Awareness of overall complication rates associated with each reconstructive timing modality can be used to help guide physicians when discussing reconstructive options. Our data suggests that DIBR and DBR are associated with less overall complications than IBR. Physicians should continue to consider patients' unique circumstances when deciding upon which timing modality is appropriate.
Collapse
Affiliation(s)
- Jessica L Marquez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jack D Sudduth
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Keith Kuo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ashraf A Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Devin Eddington
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
9
|
Mahajan A, B G, Wadhwa S, Agarwal U, Baid U, Talbar S, Janu AK, Patil V, Noronha V, Mummudi N, Tibdewal A, Agarwal JP, Yadav S, Kumar Kaushal R, Puranik A, Purandare N, Prabhash K. Deep learning based automated epidermal growth factor receptor and anaplastic lymphoma kinase status prediction of brain metastasis in non-small cell lung cancer. Explor Target Antitumor Ther 2023; 4:657-668. [PMID: 37745691 PMCID: PMC10511818 DOI: 10.37349/etat.2023.00158] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/13/2023] [Indexed: 09/26/2023] Open
Abstract
Aim The aim of this study was to investigate the feasibility of developing a deep learning (DL) algorithm for classifying brain metastases from non-small cell lung cancer (NSCLC) into epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement groups and to compare the accuracy with classification based on semantic features on imaging. Methods Data set of 117 patients was analysed from 2014 to 2018 out of which 33 patients were EGFR positive, 43 patients were ALK positive and 41 patients were negative for either mutation. Convolutional neural network (CNN) architecture efficient net was used to study the accuracy of classification using T1 weighted (T1W) magnetic resonance imaging (MRI) sequence, T2 weighted (T2W) MRI sequence, T1W post contrast (T1post) MRI sequence, fluid attenuated inversion recovery (FLAIR) MRI sequences. The dataset was divided into 80% training and 20% testing. The associations between mutation status and semantic features, specifically sex, smoking history, EGFR mutation and ALK rearrangement status, extracranial metastasis, performance status and imaging variables of brain metastasis were analysed using descriptive analysis [chi-square test (χ2)], univariate and multivariate logistic regression analysis assuming 95% confidence interval (CI). Results In this study of 117 patients, the analysis by semantic method showed 79.2% of the patients belonged to ALK positive were non-smokers as compared to double negative groups (P = 0.03). There was a 10-fold increase in ALK positivity as compared to EGFR positivity in ring enhancing lesions patients (P = 0.015) and there was also a 6.4-fold increase in ALK positivity as compared to double negative groups in meningeal involvement patients (P = 0.004). Using CNN Efficient Net DL model, the study achieved 76% accuracy in classifying ALK rearrangement and EGFR mutations without manual segmentation of metastatic lesions. Analysis of the manually segmented dataset resulted in improved accuracy of 89% through this model. Conclusions Both semantic features and DL model showed comparable accuracy in classifying EGFR mutation and ALK rearrangement. Both methods can be clinically used to predict mutation status while biopsy or genetic testing is undertaken.
Collapse
Affiliation(s)
- Abhishek Mahajan
- Clatterbridge Centre for Oncology NHS Foundation Trust, L7 8YA Liverpool, UK
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Gurukrishna B
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Shweta Wadhwa
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Agarwal
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ujjwal Baid
- Department of Electronics and Telecommunication Engineering, SGGS Institute of Engineering and Technology, Nanded 431606, Maharashtra, India
| | - Sanjay Talbar
- Department of Electronics and Telecommunication Engineering, SGGS Institute of Engineering and Technology, Nanded 431606, Maharashtra, India
| | - Amit Kumar Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vijay Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - JP Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Subash Yadav
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Rajiv Kumar Kaushal
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400012, Maharashtra, India
| |
Collapse
|
10
|
Marquez JL, Patel AA, Scott KB, Sudduth JD, Eddington D, Kim E, Johns D, Kwok AC, Agarwal JP. A Comparison of Postoperative Outcomes between Unilateral and Bilateral Palatoplasty: Analysis of 2015-2020 Pediatric NSQIP Data. Cleft Palate Craniofac J 2023:10556656231190517. [PMID: 37501523 DOI: 10.1177/10556656231190517] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
OBJECTIVE We sought to identify differences in 30-day medical and surgical complications in unilateral versus bilateral palatoplasty. DESIGN The NSQIP-P 2015-2020 database was queried to identify cleft palate repairs using CPT codes. Cases were stratified as unilateral (Veau III) and bilateral (Veau IV) using ICD-9 and -10 codes. SETTING A nationally representative random sample. PATIENTS/PARTICIPANTS A total of 3791 cases were identified with 2608 undergoing unilateral repair and 1183 undergoing bilateral repair. MAIN OUTCOMES/MEASURES The postoperative outcomes of interest included surgical complications (surgical site infections, wound dehiscence), medical complications (pneumonia, urinary tract infection, seizure, cardiac arrest, bleeding/transfusions, systemic sepsis, unplanned intubation), readmission, and reoperation. RESULTS The bilateral cohort was older (696 days versus 619 days, P < .001) and had longer operative times (157.3 min versus 144.5 min, P < .001). The unilateral cohort had more comorbidities including developmental delay, structural CNS abnormalities, need for nutritional support, and bleeding disorders. The bilateral cohort had statistically significant higher occurrences of wound dehiscence (2.1% versus. 1.2%, P = .03) and readmission (3.2% versus 1.7%, P = .01). On multivariate analysis, bilateral cleft repair (OR: 1.83, CI: 1.176-2.840, P = .007) and ASA class 4 (OR: 13.1, CI 2.288- 62.586, P = .002) were associated with greater odds of readmission. CONCLUSION Patients who underwent bilateral cleft repair had a higher proportion of 30-day postoperative complications and a two-fold increased odds of readmission. While palatoplasty is generally regarded as a safe procedure in the pediatric population, identifying factors related to an increased risk of early postoperative complications can help surgical teams better manage high-risk individuals.
Collapse
Affiliation(s)
- Jessica L Marquez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ashraf A Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kaylee B Scott
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jack D Sudduth
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Devin Eddington
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erinn Kim
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Dana Johns
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
11
|
Pires G, Marquez JL, Memmott S, Sudduth JD, Moss W, Eddington D, Hobson G, Tuncer F, Agarwal JP, Kwok AC. An Evaluation of Early Complications after Prepectoral Tissue Expander Placement in First-Stage Breast Reconstruction with and without Acellular Dermal Matrix. Plast Reconstr Surg 2023:00006534-990000000-01967. [PMID: 37285211 DOI: 10.1097/prs.0000000000010801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Prepectoral breast reconstruction has become popularized with the concurrent use of acellular dermal matrix (ADM). We sought to compare three-month postoperative complication rates and explantation rates for first stage, tissue expander based prepectoral breast reconstruction with and without the use of ADM. METHODS A single institution retrospective chart review was performed to identify consecutive patients undergoing prepectoral tissue-expander based breast reconstruction from August 2020 to January 2022. Chi-squared tests were used to compare demographic categorical variables and multiple variable regression models were used to identify variables associated with three-month postoperative outcomes. RESULTS We enrolled 124 consecutive patients. Fifty-five patients (98 breasts) were included in the no-ADM cohort and 69 patients (98 breasts) were included in the ADM cohort. There were no statistically significant differences between ADM and no-ADM cohort in regard to 90-day postoperative outcomes. On multivariable analysis, there were no independent associations between seroma, hematoma, wound dehiscence, mastectomy skin flap necrosis, infection, unplanned return to the OR, or explanation in the ADM or no ADM groups after controlling for age, BMI, history of diabetes, tobacco use, neoadjuvant chemotherapy, and postoperative radiotherapy. CONCLUSION Our results reveal no significant differences in odds of postoperative complications, unplanned return to the OR, or explantation between ADM and no-ADM cohorts. More studies are needed to evaluate the safety of prepectoral, tissue expander placement without ADM.
Collapse
Affiliation(s)
- Giovanna Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jessica L Marquez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stanley Memmott
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jack D Sudduth
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Whitney Moss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Devin Eddington
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gregory Hobson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Fatma Tuncer
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
12
|
Swain M, Budrukkar A, Rembielak A, Kron T, Agarwal JP. Challenges in the Sustainability of Brachytherapy Service in Contemporary Radiotherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00205-4. [PMID: 37302881 DOI: 10.1016/j.clon.2023.05.013] [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] [Received: 03/14/2023] [Revised: 05/10/2023] [Accepted: 05/22/2023] [Indexed: 06/13/2023]
Abstract
Brachytherapy has a long history of delivering a highly conformal radiation dose to the target volume with sparing of adjacent normal tissue and has an irreplaceable role in certain cancers, such as cervical and prostate cancers. There have been futile attempts to replace brachytherapy with other radiation techniques. Despite that there are multifaceted challenges in preserving this dying art, from establishment, to a trained workforce, to maintenance of the equipment and source replacement costs. Here we focus on the challenges to access brachytherapy, the availability and distribution of care across the globe and appropriate training leading to proper implementation of the procedure. Brachytherapy holds a significant place in the treatment armamentarium of most common cancers, such as cervical, prostate, head and neck and skin cancers. However, there is an uneven distribution of brachytherapy facilities, not only across the globe, but also at a national level, with a larger proportion of facilities concentrated in certain regions, more so in low and low-middle income countries. The regions with the highest incidence of cervical cancer have the least access to brachytherapy facilities. Attempts to bridge the gap are essential and should be focused on uniform distribution and access to care, improving training of the workforce through specialised training programmes, reducing the cost of care, planning to reduce the recurring cost, generating evidence and research guidelines, renewing interest in brachytherapy through rebranding, use of social media and building an attainable long-term roadmap.
Collapse
Affiliation(s)
- M Swain
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India
| | - A Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - T Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, HomiBhabha National Institute (HBNI), Parel, Mumbai, India.
| |
Collapse
|
13
|
Steyl SK, Beck JP, Agarwal JP, Bachus KN, Rou DL, Jeyapalina S. Fluorapatite-Coated Percutaneous Devices Promote Wound Healing and Limit Epithelial Downgrowth at the Skin-Device Interface. J Tissue Eng Regen Med 2023. [DOI: 10.1155/2023/2212035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
A percutaneous osseointegrated device becomes deeply ingrown by endosteal bone and traverses the overlying soft tissues of the residual limb, providing a direct link to the bone-anchored artificial limb. Continuous wound healing around these devices can result in the formation of sinus tracts as “down-growing” epithelial cells are unable to recognize and adhere to the “nonbiological” implant surface. Such sinus tracts provide paths for bacterial colonization and deep infection. In order to limit adverse outcomes and provide a robust seal, it was hypothesized that by coating the titanium surface of the percutaneous post with the mineral component of dental enamel, down-growing epidermal cells might recognize the coating as “biological” and adhere to this nonliving surface. To test this hypothesis, sintered partially and fully fluoridated hydroxyapatite (HA) was chosen as coatings. Using an established surgical protocol, fluorapatite (FA), hydroxyfluorapatite (FHA), HA-coated percutaneous posts, and titanium controls were surgically placed under the dorsal skin in 20 CD hairless rats. The animals were sacrificed at four weeks, and implants and surrounding tissues were harvested and subjected to further analyses. Downgrowth and granulation tissue area data showed statistically significant reductions around the FA-coated devices. Moreover, compared to the control group, the FA- and HA-coated groups showed downregulation of mRNA for EGFr, EGF, and FGF-10. Interestingly, the FA-coated group had upregulation of TGF-α. These data suggest that FA could become an ideal coating material for preventing downgrowth, assuming the long-term stability of these coated surfaces can be verified in a clinically relevant animal model.
Collapse
|
14
|
Jeyapalina S, Wei G, Stoddard GJ, Sudduth JD, Lundquist M, Huntsman M, Marquez JL, Agarwal JP. Serum procalcitonin level is independently associated with mechanical ventilation and case-fatality in hospitalized COVID-19-positive US veterans-A potential marker for disease severity. PLoS One 2023; 18:e0284520. [PMID: 37068086 PMCID: PMC10109491 DOI: 10.1371/journal.pone.0284520] [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: 10/31/2022] [Accepted: 04/02/2023] [Indexed: 04/18/2023] Open
Abstract
The Coronavirus-19 disease (COVID-19) has claimed over 6.8 million lives since first being reported in late 2019. The virus that causes COVID-19 disease is highly contagious and spreads rapidly. To date, there are no approved prognostic tools that could predict why some patients develop severe or fatal disease outcomes. Early COVID-19 studies found an association between procalcitonin (PCT) and hospitalization or duration of mechanical ventilation and death but were limited by the cohort sizes. Therefore, this study was designed to confirm the associations of PCT with COVID-19 disease severity outcomes in a large cohort. For this retrospective data analysis study, 27,154 COVID-19-positive US veterans with post-infection PCT laboratory test data and their disease severity outcomes were accessed using the VA electronic healthcare data. Cox regression models were used to test the association between serum PCT levels and disease outcomes while controlling for demographics and relevant confounding variables. The models demonstrated increasing disease severity (ventilation and death) with increasing PCT levels. For PCT serum levels above 0.20 ng/ml, the unadjusted risk increased nearly 2.3-fold for mechanical ventilation (hazard ratio, HR, 2.26, 95%CI: 2.11-2.42) and in-hospital death (HR, 2.28, 95%CI: 2.16-2.41). Even when adjusted for demographics, diabetes, pneumonia, antibiotic use, white blood cell count, and serum C-reactive protein levels, the risks remained relatively high for mechanical ventilation (HR, 1.80, 95%CI: 1.67-1.94) and death (HR, 1.76, 95%CI: 1.66-1.87). These data suggest that higher PCT levels have independent associations with ventilation and in-hospital death in veterans with COVID-19 disease, validating previous findings. The data suggested that serum PCT level may be a promising prognostic tool for COVID-19 severity assessment and should be further evaluated in a prospective clinical trial.
Collapse
Affiliation(s)
- Sujee Jeyapalina
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Guo Wei
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Gregory J Stoddard
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Jack D Sudduth
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Margaret Lundquist
- Research, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States of America
| | - Merodean Huntsman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Jessica L Marquez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, United States of America
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States of America
| |
Collapse
|
15
|
Abou-Al-Shaar H, Karsy M, Eli IM, Agarwal JP, Gociman B, Mahan MA. Masseter-to-facial nerve transfer for facial nerve reanimation. Neurosurg Focus Video 2023; 8:V6. [PMID: 36628088 PMCID: PMC9815213 DOI: 10.3171/2022.9.focvid22107] [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] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/27/2022] [Indexed: 01/02/2023]
Abstract
Smooth symmetric facial muscle function is important for social interactions. When lesions of the facial nerve occur, achieving complete restoration of balanced and spontaneous facial function can be challenging. In this video, the authors demonstrate the surgical details and long-term follow-up of a masseter-to-facial nerve transfer in a 3-year-old girl who had insidious onset of a left facial palsy due to a facial nerve schwannoma. After resection, she underwent distal nerve repair with a masseter-to-zygomatic branch transfer. She demonstrated decreased lagophthalmos and good activation and excursion on the left side with near symmetry to the right side, but lacked left frontalis function. The video can be found here: https://stream.cadmore.media/r10.3171/2022.9.FOCVID22107.
Collapse
Affiliation(s)
- Hussam Abou-Al-Shaar
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania;
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah;
| | - Ilyas M. Eli
- Department of Neurosurgery, Ascension St. Thomas Rutherford Hospital, Murfreesboro, Tennessee; and
| | - Jayant P. Agarwal
- Division of Plastic Surgery, University of Utah, Salt Lake City, Utah
| | - Barbu Gociman
- Division of Plastic Surgery, University of Utah, Salt Lake City, Utah
| | - Mark A. Mahan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah;
| |
Collapse
|
16
|
Luo J, Moss WD, Pires GR, Rhemtulla IA, Rosales M, Stoddard GJ, Agarwal JP, Kwok AC. A Nationwide Analysis Evaluating the Safety of Using Acellular Dermal Matrix with Tissue Expander-Based Breast Reconstruction. Arch Plast Surg 2022; 49:716-723. [PMID: 36523919 PMCID: PMC9747277 DOI: 10.1055/s-0042-1758638] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/08/2022] [Indexed: 12/23/2022] Open
Abstract
Background In March 2021, the United States Food and Drug Administration (FDA) safety communication cautioned against the use of acellular dermal matrix (ADM) products in breast reconstruction and reiterated that the FDA does not approve ADM use in breast surgery. This study aims to assess the safety of ADM use in breast reconstruction. Methods Women who underwent ADM and non-ADM assisted tissue expander (TE)-based breast reconstruction were identified using the National Surgical Quality Improvement Program database (2012-2019). Trends of ADM use over time, and 30-day outcomes of surgical site infection (SSI), dehiscence, and unplanned reoperation were assessed. Results Of the 49,049 TE-based breast reconstructive cases, 42.4% were ADM assisted and 57.6% non-ADM assisted. From 2012 to 2019, the use of ADM increased from 26.1 to 55.6% (relative risk [RR] =1.10; p < 0.01). Higher rates of SSI (3.9 vs. 3.4%; p = 0.003) and reoperation (7.4 vs. 6.0%; p < 0.001) were seen in the ADM cohort. There was no significant difference seen in dehiscence rates (0.7 vs. 0.7%; p = 0.73). The most common reoperation within 30 days for the ADM group (17.6%) was removal of TE without insertion of implant (current procedural terminology: 11,971). ADM-assisted breast reconstruction was associated with increased relative risk of SSI by 10% (RR = 1.10, confidence interval [CI]: 1.01-1.21; p = 0.03) and reoperation by 15% (RR = 1.15, CI: 1.08-1.23; p < 0.001). Conclusions ADM-assisted breast reconstruction more than doubled from 2012 to 2019. There are statistically higher complication rates of SSI (0.5%) and reoperation (1.4%) with ADM use in TE-based breast reconstruction, suggesting that reconstruction without ADM is safe when comparing immediate postoperative outcomes.
Collapse
Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Whitney D. Moss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Giovanna R. Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Irfan A. Rhemtulla
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Gregory J. Stoddard
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jayant P. Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Alvin C. Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
17
|
Pires GR, Moss WD, Memmott S, Wright T, Eddington D, Brintz BJ, Agarwal JP, Kwok AC. Analysis of Readmissions and Reoperations in Pediatric Microvascular Reconstruction. J Reconstr Microsurg 2022; 39:343-349. [PMID: 35952678 DOI: 10.1055/s-0042-1755265] [Citation(s) in RCA: 1] [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: 10/15/2022]
Abstract
BACKGROUND Free tissue transfer is utilized as a reconstructive option for various anatomic defects. While it has long been performed in adults, reconstructive surgeons have used free tissue transfer to a lesser degree in children. As such, there are few analyses of factors associated with complications in free tissue transfer within this population. The aim of this study is to assess factors associated with readmission and reoperation in pediatric free flap patients utilizing the pediatric National Surgical Quality Improvement Program database. METHODS Pediatric patients who underwent microvascular reconstruction between 2015 and 2020 were included. Patients were identified by five microvascular reconstruction Current Procedural Terminology codes and were then stratified by flap site (head and neck, extremities, trunk) and defect etiology (congenital, trauma, infection, neoplasm). Multivariate logistic regression was performed to identify factors associated with readmissions and reoperations. RESULTS The study cohort consisted of 258 patients. The average age was 10.0 ± 4.7 years and the majority of patients were male (n = 149, 57.8%), were of white race (n = 164, 63.6%), and had a normal body mass index. Twenty-two patients (8.5%) experienced an unplanned readmission within 30 days of the initial operation, most commonly for wound disruption (31.8% of readmissions). The overall rate of unplanned reoperation within 30 days was 11.6% (n = 30) for all patients, with an average of 8.9 ± 7.5 days to reoperation. On multivariate regression analysis, each hour increase in operative time was associated with an increased odds of reoperation (odds ratio [OR]: 1.27; 95% confidence interval [CI]: 1.12, 1.45) and readmission (OR: 1.16; 95% CI: 1.02, 1.34). CONCLUSION In pediatric patients undergoing free tissue transfer, higher readmission and reoperation risk was associated with longer operative duration. Overall, free tissue transfer is safe in the pediatric population with relatively low rates of readmission and reoperation.
Collapse
Affiliation(s)
- Giovanna R Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Whitney D Moss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Stanley Memmott
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Thomas Wright
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Devin Eddington
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Ben J Brintz
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
18
|
Luo J, Rosales M, Wei G, Stoddard GJ, Kwok AC, Jeyapalina S, Agarwal JP. Hospitalization, mechanical ventilation, and case-fatality outcomes in US veterans with COVID-19 disease between years 2020-2021. Ann Epidemiol 2022; 70:37-44. [PMID: 35462045 PMCID: PMC9021125 DOI: 10.1016/j.annepidem.2022.04.003] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 01/28/2023]
Abstract
PURPOSE Although veterans represent a significant proportion (7%) of the USA population, the COVID-19 disease impact within this group has been underreported. To bridge this gap, this study was undertaken. METHOD A total of 419,559 veterans, who tested positive for COVID-19 disease in the Veterans Affairs hospital system from March 1st, 2020 to December 31st, 2021 with 60-days follow-up, was included in this retrospective review. Primary outcome measures included age-adjusted incidences and relative incidences of COVID-19 hospitalization, mechanical ventilation, and case-fatality outcomes. RESULTS Of this veteran cohort with COVID-19 disease, predominately 85.7% were male, 59.1% were White veterans, 27.5% were ages 50-64, and 40.5% were obese. Although Black veterans were at 63% higher relative risk (RR) for hospitalization incidences, they had a similar risk RR for in-hospital deaths compared to the White-veteran referent. Asian, American Indian/Alaska Native races, advanced age ≥65, and the underweight were at high RR for mechanical ventilator and/or in-hospital deaths compared to respective referent groups. Veterans who are ≥85 years old had a nearly 5-fold higher incidence of death compared respective referent group. The monthly outcomes for hospitalization, ventilation, and case-fatality data showed decreasing trends with time. CONCLUSION An increased incidence of death was associated with age ≥65 years and underweight veterans compared to the referent group. Age-adjusted data, however, did not show any increased incidence of death in Black veterans compared to White veterans. RATINGS OF THE QUALITY OF THE EVIDENCE 3 (Case-control studies; retrospective cohort study).
Collapse
Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Guo Wei
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Gregory J Stoddard
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT
| | - Sujee Jeyapalina
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT.
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT.
| |
Collapse
|
19
|
Luo J, Willis RN, Ohlsen SM, Piccinin M, Moores N, Kwok AC, Agarwal JP. Meshed Acellular Dermal Matrix for Two-Staged Prepectoral Breast Reconstruction: An Institutional Experience. Arch Plast Surg 2022; 49:166-173. [PMID: 35832668 PMCID: PMC9045533 DOI: 10.1055/s-0042-1744408] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The introduction of acellular dermal matrix (ADM) to breast reconstruction has allowed surgeons to reexplore the prepectoral implant placement technique in postmastectomy breast reconstruction. Our institution adopted a novel approach using meshed ADM to lessen the financial burden of increased ADM utilization with the prepectoral breast reconstruction. This is a retrospective, single-center review of two-stage prepectoral breast reconstruction using meshed human-derived ADM for anterior prosthesis coverage. Patient demographics, oncologic data, perioperative characteristics, and complications were examined and reported as means with standard deviations. Cost-saving with the meshed technique was evaluated. Forty-eight patients (72 breasts) with a mean age of 48.5 ± 15.0 years (range 26–70 years) were included in the study. The mean follow-up time was 13.2 ± 4.4 months (range 4.1–25.8 months). Nineteen breasts (24.6%) experienced complications, with seromas being the most common complication (12.5%,
n
= 9). Expander removal and reoperation occurred at a rate of 8.3 and 9.7%, respectively. The average time to drain removal was 18.8 ± 6.6 days (range 8–32 days). Meshed ADM provided an average cost savings of $6,601 for unilateral and $13,202 for bilateral reconstructions. Our study found that human-derived meshed ADM can be safely used in two-staged prepectoral tissue expander-based breast reconstruction and can result in significant cost savings.
Collapse
Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Rhett N. Willis
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Suzanna M. Ohlsen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Meghan Piccinin
- Michigan State University College of Osteopathic Medicine, East Lansing, Michigan
| | - Neal Moores
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Alvin C. Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jayant P. Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| |
Collapse
|
20
|
Luo J, Collier W, Magno-Padron D, Tieman J, Pires G, Moss W, Rosales M, Kim J, Agarwal JP, Kwok AC. Characteristics of Nonelderly Adult Health Care Persistent Super Utilizers in Utah. Popul Health Manag 2022; 25:472-479. [PMID: 35353618 DOI: 10.1089/pop.2021.0275] [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: 11/13/2022] Open
Abstract
In the United States, the top 1% and top 5% of health care spenders account for 23% and 50% of total health care spending, respectively. These high spenders have been coined the term super utilizers (SU). The aim of this study was to identify the characteristics associated with these patients to aid in developing public health interventions aimed at transitioning patients out of the SU category and thus ultimately helping to control health care costs. The authors utilized the Utah All-Payer Claims Database and Utah Population Database from 2013 to 2015 to identify demographics, comorbid conditions, health care utilization, and cost characteristics of persistent super utilizers (PSU) (≥3 hospitalizations per year for 3 years) of health care compared with persistent nonsuper utilizers (PNSU) (<3 hospitalizations per year for 3 years). Multivariable logistic regression was utilized to identify the characteristics associated with PSU versus PNSU. Higher outpatient/Emergency Department/noninpatient (eg, visits with imaging and Centers for Medicare & Medicaid Services preventive visits) health care utilization and spending, and prevalence of comorbid disease and psychosocial conditions were associated with PSU. In multivariable analysis, factors such as heart disease, chronic kidney disease (CKD), diabetes, alcohol abuse, and depression were statistically significantly associated with higher odds of PSU, with the most noteworthy being CKD (odds ratio [OR] 6.85, 95% confidence interval [95% CI] 5.84-8.02; P < 0.001), alcohol abuse (OR 5.90, 95% CI 4.49-7.69; P < 0.001), and heart diseases (OR 4.41, 95% CI 3.74-5.18; P < 0.001). The annual health care cost of a PSU is about 11.5 times greater than a PNSU ($54,776 vs. $4801; P < 0.001).
Collapse
Affiliation(s)
- Jessica Luo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Willem Collier
- Division of Biostatistics, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - David Magno-Padron
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Joshua Tieman
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Giovanna Pires
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Whitney Moss
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Megan Rosales
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jaewhan Kim
- Department of Physical Therapy and Athletic Training, and CTSI Health Economics Core, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
21
|
Mummudi N, Jiwnani S, Niyogi D, Srinivasan S, Ghosh-Laskar S, Tibdewal A, Rane P, Karimundackal G, Pramesh CS, Agarwal JP. Salvage radiotherapy for postoperative locoregional failure in esophageal cancer: a systematic review and meta-analysis. Dis Esophagus 2022; 35:6257764. [PMID: 33912933 DOI: 10.1093/dote/doab020] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/02/2020] [Indexed: 12/11/2022]
Abstract
Locoregional recurrences following surgery for esophageal cancers represent a significant clinical problem with no standard recommendations for management. We conducted this systematic review and meta-analysis with the objective of studying safety and efficacy of salvage radiotherapy in this setting. All prospective and retrospective cohort studies, which studied patients who developed locoregional recurrence following initial radical surgery for esophageal cancer and subsequently received salvage radiation therapy (RT)/chemoradiation with all relevant information regarding survival outcome and toxicity available, were included. The quality of eligible individual studies was assessed using the Newcastle-Ottawa Scale score for risk of bias. R package MetaSurv was used to obtain a summary survival curve from survival probabilities and numbers of at-risk patients collected at various time points and to test the overall heterogeneity using the I2 statistic. Thirty studies (27 retrospective, 3 prospective) published from 1995 to 2020 with 1553 patients were included. The median interval between surgery and disease recurrence was 12.5 months. The median radiation dose used was 60 Gy and 57% received concurrent chemotherapy. The overall incidence of acute grade 3/4 mucositis and dermatitis were 8 and 4%, respectively; grade 3/4 acute pneumonitis was reported in 5%. The overall median follow-up of all studies included was 27 months. The 1-, 2- and 3-year overall survival (OS) probabilities were 67.9, 35.9 and 30.6%, respectively. Factors which predicted better survival on multivariate analysis were good PS, lower group stage, node negativity at index surgery, longer disease-free interval, nodal recurrence (as compared to anastomotic site recurrence), smaller disease volume, single site of recurrence, RT dose >50 Gy, conformal RT, use of concomitant chemotherapy and good radiological response after radiotherapy. Salvage radiotherapy with or without concomitant chemotherapy for locoregional recurrences after surgery for esophageal cancer is safe and effective. Modern radiotherapy techniques may improve outcomes and reduce treatment-related morbidity.
Collapse
Affiliation(s)
- N Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Jiwnani
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - D Niyogi
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Srinivasan
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Tibdewal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - P Rane
- Department of Bio-statistics, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - G Karimundackal
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
22
|
Moores NG, Luo J, Pires G, Moss W, Short S, Bollo RJ, Randall RL, Agarwal JP. Transverse Rectus Abdominis Muscle Flow-Through to Free Fibula Flap for Lumbar Spinal Reconstruction in a Pediatric Patient: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00054. [PMID: 35202034 DOI: 10.2106/jbjs.cc.21.00122] [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: 11/14/2022]
Abstract
CASE A 7-week-old girl presented with a recurrent primitive myxoid mesenchymal tumor of infancy requiring extensive resection of lower back musculature, L3-S2 vertebral bodies, and left L5 nerve root. Reconstruction consisted of transverse rectus abdominis muscle (TRAM) flow-through to free fibular flap to reconstruct the bony defect and fill the soft-tissue void. One-year postoperative imaging revealed a well-incorporated fibula graft. At the 30-month follow-up, the patient can bear weight on the autograft while sitting upright, allowing for efficient ambulation with a wheelchair. CONCLUSION TRAM flow-through to free fibular flap is an efficacious reconstructive method for a multilevel vertebral spinal defect in a pediatric patient.
Collapse
Affiliation(s)
- Neal G Moores
- Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Jessica Luo
- Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Giovanna Pires
- Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Whitney Moss
- Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Scott Short
- Division of Pediatric Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Robert J Bollo
- Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - R Lor Randall
- Department of Orthopedic Surgery, UC Davis Health, Sacramento, California
| | - Jayant P Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah
| |
Collapse
|
23
|
Magno-Pardon DA, Luo J, Carter GC, Agarwal JP, Kwok AC. An Analysis of the Modified Five-Item Frailty Index for Predicting Complications following Free Flap Breast Reconstruction. Plast Reconstr Surg 2022; 149:41-47. [PMID: 34936600 DOI: 10.1097/prs.0000000000008634] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The modified five-item frailty index is a validated and effective tool for assessing risk in surgical candidates. The authors sought to compare the predictive ability of the modified five-item frailty index to established risk factors for complications in free flap breast reconstruction. METHODS The 2012 to 2018 American College of Surgeons National Surgical Quality Improvement Program database was queried for free flap breast reconstructive procedures. Univariate and multivariate regression analysis models were used to assess how modified five-item frailty index and factors commonly used to risk stratify (age, body mass index, American Society of Anesthesiologists classification, and history of smoking) were associated with complications. RESULTS Of the total 10,550 cases, 24.1 percent experienced complications. A high modified five-item frailty index score is associated with a higher overall rate of postoperative complications (p < 0.001). This significant trend was demonstrated in both surgical (p < 0.001) and medical (p < 0.001) complications. When controlling for other risk factors commonly used for risk stratification such as age, body mass index, American Society of Anesthesiologists classification, and history of smoking, the modified five-item frailty index was significantly associated with medical (OR, 1.75; 95 percent CI, 1.37 to 2.22; p = 0.001) and any complications (OR, 1.58; 95 percent CI, 1.29 to 1.93; p < 0.001) and had the largest effect size. Assessing for specific complications, the modified five-item frailty index is the strongest independent predictor of reoperation (OR, 1.41; 95 percent CI, 1.08 to 1.81; p = 0.009). CONCLUSION The modified five-item frailty index is a useful predictor of postoperative outcomes in patients undergoing free flap breast reconstruction when compared to other historically considered risk factors for surgical complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
Collapse
Affiliation(s)
- David A Magno-Pardon
- From the Division of Plastic Surgery, University of Utah; and Department of Population Health Sciences, University of Utah School of Medicine
| | - Jessica Luo
- From the Division of Plastic Surgery, University of Utah; and Department of Population Health Sciences, University of Utah School of Medicine
| | - Gentry C Carter
- From the Division of Plastic Surgery, University of Utah; and Department of Population Health Sciences, University of Utah School of Medicine
| | - Jayant P Agarwal
- From the Division of Plastic Surgery, University of Utah; and Department of Population Health Sciences, University of Utah School of Medicine
| | - Alvin C Kwok
- From the Division of Plastic Surgery, University of Utah; and Department of Population Health Sciences, University of Utah School of Medicine
| |
Collapse
|
24
|
Holoyda KA, Donato DP, Magno-Padron DA, Simpson AM, Agarwal JP. Hand and wrist injuries among collegiate athletes vary with athlete division. Inj Epidemiol 2021; 8:69. [PMID: 34906242 PMCID: PMC8670021 DOI: 10.1186/s40621-021-00363-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The rates, severity and consequences of hand and wrist injuries sustained by National Collegiate Athletic Association athletes are not well characterized. This study describes the epidemiology of hand and wrist injuries among collegiate athletes competing in different divisions. METHODS The National Collegiate Athletic Association Injury Surveillance Program (NCAA-ISP) was accessed from 2004 to 2015 for the following sports: baseball, basketball, football, ice hockey, lacrosse, soccer, wrestling, field hockey, gymnastics, softball and volleyball. The data were used to identify all hand and wrist injuries, the specific injury diagnosis, mean time loss of activity following injury, and need for surgery following injury. These were then stratified by gender. Descriptive statistics were performed to examine the association between sports, event type and division. Student's t test was used to calculate p-values for independent variables. Chi-Square test was used to calculate odds ratio. P < 0.05 was considered significant. RESULTS 103,098 hand and wrist injuries were reported in in the studied NCAA sports from 2004 to 2015. Male athletes sustained 72,423 injuries (6.01/10,000 athlete exposure) and female athletes sustained 30,675 injuries (4.13/10,000 athlete exposure). Division I athletes sustained significantly more injuries compared to divisions II and III. Overall, 3.78% of hand and wrist injuries required surgical intervention. A significantly higher percentage of division I athletes (both male and female) underwent surgical intervention compared to divisions II and III. The mean time lost due to hand and wrist injury was 7.14 days for all athletes. Division I athletes missed the fewest days due to injury at 6.29 days though this was not significant. CONCLUSIONS Hand and wrist injuries are common among collegiate athletes. Division I athletes sustain higher rates of injuries and higher surgical intervention rates, while tending to miss fewer days due to injury. Improved characterization of divisional differences in hand and wrist injuries can assist injury management and prevention.
Collapse
Affiliation(s)
- Kathleen A Holoyda
- Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT, 84132, USA
| | - Daniel P Donato
- Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT, 84132, USA
| | - David A Magno-Padron
- Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT, 84132, USA
| | - Andrew M Simpson
- Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT, 84132, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, 30 N 1900 E, 3B400, Salt Lake City, UT, 84132, USA.
| |
Collapse
|
25
|
Laskar SG, Sinha S, Singh M, Mummudi N, Mittal R, Gavarraju A, Budrukkar A, Swain M, Agarwal JP, Gupta T, Murthy V, Mokal S, Patil V, Noronha V, Joshi A, Menon N, Prabhash K. Post-cricoid and Upper Oesophagus Cancers Treated with Organ Preservation Using Intensity-modulated Image-guided Radiotherapy: a Phase II Prospective Study of Outcomes, Toxicity and Quality of Life. Clin Oncol (R Coll Radiol) 2021; 34:220-229. [PMID: 34872822 DOI: 10.1016/j.clon.2021.11.012] [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] [Received: 07/28/2021] [Revised: 10/12/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
AIMS To prospectively examine the outcomes, toxicity and quality of life (QoL) of patients with post-cricoid and upper oesophagus (PCUE) cancers treated with an organ-preservation approach of (chemo)-radiotherapy using intensity-modulated image-guided radiotherapy (IM-IGRT). MATERIALS AND METHODS This phase II prospective study was conducted at a tertiary cancer centre from February 2017 to January 2020. Forty patients with squamous cell carcinoma of PCUE of stage T1-3, N0-2, M0 were accrued. Gross exolaryngeal extension/dysfunctional larynx were major exclusion criteria. Patients received 63-66 Gy in once-daily fractions using volumetric modulated arc therapy with daily IGRT. Outcome measures included disease-related outcomes, patterns of failure, Radiation Therapy Oncology Group toxicities, feeding tube dependency and QoL. RESULTS The median follow-up was 22 months. Twenty-six (87.5%) patients had locoregionally advanced disease and 34 (85%) patients received (chemo)-radiotherapy. A complete response was observed in 26 (65%) patients. The 2-year locoregional control, event-free survival and cause-specific survival were 59.6%, 40.2% and 44.8%, respectively. The volume of primary tumour (GTVPvol) exceeding 28 cm3 had inferior overall survival (P = 0.005) on univariate analysis. Multivariable analysis showed GTVPvol and positron emission tomography-computed tomography maximum standardised uptake value to be independently predictive for event-free and overall survival. A feeding tube requirement at presentation was seen in 11 (27.5%) patients, whereas long-term feeding tube dependency at 6 months was seen in 10 (37%) patients. For QoL, a statistical improvement in pain, appetite loss and swallowing was observed over time. CONCLUSION Although the outcomes of PCUE cancers remain dismal, the use of state of the art diagnostic modalities, careful case selection and modern radiotherapy techniques improved outcomes as compared with before in this exclusive analysis of PCUE cancers.
Collapse
Affiliation(s)
- S G Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - S Sinha
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Singh
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - R Mittal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Gavarraju
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - M Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Mokal
- Clinical Research Secretariat, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Patil
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - N Menon
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
26
|
Magno-Padron DA, Holoyda KA, Moss W, Pires G, Carter GC, Agarwal JP, Kwok AC. Elective surgery resource utilization. Langenbecks Arch Surg 2021; 407:829-833. [PMID: 34693466 PMCID: PMC8542497 DOI: 10.1007/s00423-021-02363-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/18/2021] [Indexed: 11/26/2022]
Abstract
Purpose Cessation of elective surgery during COVID-19 was partly driven by concern for consumption of hospital resources required by critically ill patients. We aim to determine the extent of resource utilization by elective outpatient surgery to assist in ensuring future resource conservation decisions are data driven. Methods The study utilized a retrospective cohort gathered from the American College of Surgeons National Surgical Quality Improvement Program database. Participants were adult patients who underwent elective or non-elective surgery between 2017 and 2018. Outcomes included patient characteristics and post-operative outcomes for elective and non-elective surgeries. Post-operative outcomes were used as a surrogate for the consumption of hospital resources. Results A total of 1,558,938 (79.8%) elective and 393,339 (20.2%) non-elective surgeries were identified. Elective surgery patients were more likely to be outpatient status, have an ASA class < 3, and exhibited lower rates of prolonged ventilation, 30-day reoperation, and 30-day readmissions, and averaged 5 days less of inpatient stay. Elective outpatient surgery (vs. elective inpatient surgery) averaged shorter operative times and exhibited lower rates of readmissions (2.1% vs. 5.5%; p < 0.001), reoperations (1.1% vs. 2.8%; p < 0.001), prolonged ventilation (0.0% vs. 0.3%; p < 0.001), and 30-day mortality (0.1% vs. 0.5%; p < 0.001) and accounted for 30.2% of the overall relative value units ($339,815,038). Conclusion We evaluated utilization of hospital resources by patients undergoing elective outpatient surgery by identifying surgeries performed in 2017–2018 then stratifying them by outpatient status. Elective outpatient surgeries consumed negligible amounts of hospital resources and should not be considered a threat to resources in the setting of high demand by critically ill COVID-19 patients.
Collapse
Affiliation(s)
- David A Magno-Padron
- Division of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Kathleen A Holoyda
- Division of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | | | - Giovanna Pires
- Division of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Gentry C Carter
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jayant P Agarwal
- Division of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alvin C Kwok
- Department of Surgery, Division of Plastic Surgery, University of Utah School of Medicine, 30 North 1900 East, 3B400, Salt Lake City, UT, 84132, USA.
| |
Collapse
|
27
|
Thirumalairaj R, Parikh PM, Agarwal A, Singh R, Krishnamurthy A, Desai SS, Maheshwari A, Mehta P, Ghafur A, Somashekhar SP, Iqbal A, Savant DN, Hussain SMA, Bhatt A, Wangdi T, Bajpai J, Ranade AA, Babu KG, Bapna A, Biswas G, Malhotra H, Krishna MV, Baral RP, Vashishtha R, Safi AJ, Agarwal S, Agarwal JP, Rathnam KK, Mohapatra PN, Kumar RV, Rajappa S, Limaye SA, Vora A, Reddy VAP, Parekh BB, Rath GK. South Asian Declaration-Consensus Guidelines for COVID-19 Vaccination in Cancer Patients. South Asian J Cancer 2021; 10:3-8. [PMID: 34430512 PMCID: PMC8378920 DOI: 10.1055/s-0041-1731909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Indexed: 12/14/2022] Open
Abstract
We provide the South Asian Declaration, containing the consensus guidelines for coronavirus disease 2019 (COVID-19) vaccination in cancer patients.
Collapse
Affiliation(s)
- Raja Thirumalairaj
- Department of Medical Oncology, Apollo Cancer Center, Teynampet, Chennai, India
| | - Purvish M Parikh
- Department of Oncology, Integrated Academic Society of Clinical Oncology, Mumbai Oncocare Centers, Mumbai, Maharashtra, India
| | - Amit Agarwal
- Department of Medical Oncology, BLK Superspecilaity Hospital, Delhi, India
| | - Randeep Singh
- Department of Molecular Oncology Society, Narayana Health, Delhi, India
| | | | - Sharad S Desai
- Department of Surgical Oncology, Mahatma Gandhi Cancer Hospital, Miraj, Maharashtra, India
| | - Amita Maheshwari
- Divison of Gynecologic Oncology, Department of Surgical Oncology, Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Prashant Mehta
- Department of Medical Oncology/Hematoncology/BMT, Asian Institute of Medical Sciences, Faridabad, India
| | - Abdul Ghafur
- Department of Infectious Diseases, Apollo Cancer Institute, Chennai, India
| | - S P Somashekhar
- Department of Surgical Oncology, MHEPL, Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, India
| | - Ahamed Iqbal
- Oncology and Radiotherapy Department, Teaching Hospital, Batticaloa, Sri Lanka
| | | | - Syed Md Akram Hussain
- Department of Radiotherapy, Square Oncology and Radiotherapy Centre, Dhaka, Bangladesh
| | - Amit Bhatt
- Department of Medical Oncology, Avinash Cancer Clinic, Pune, India
| | - Tashi Wangdi
- Oncology Department, JDWNR Hospital and KGUMS, Thimphu, Bhutan
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - K Govind Babu
- Department of Medical and Pediatric Oncology, St. Johns Medical College and Hospital, HCG Hospitals, Bangalore, India
| | - Ajay Bapna
- Department of Medical Oncology, BMCHRC, Jaipur, Rajasthan, India
| | - Ghanshyam Biswas
- Department of Medical Oncology, Sparsh Hospital and Sum Hospital, Bhubaneswar, Odisha, India
| | - Hemant Malhotra
- Department of Medical Oncology, Sri Ram Cancer Center, Mahatma Gandhi Medical College Hospital, Jaipur, Rajasthan, India
| | - M Vamshi Krishna
- Department of Medical Oncology and Hematology, Institute of Oncology, AIG Hospitals, Gachibowli, Hyderabad, India
| | - Rajendra Prasad Baral
- Department of Medical Oncology, Norvic International Hospital and Om Hospital and Research Center, Kathmandu, Nepal
| | - Rajesh Vashishtha
- Department of Radiation Oncology, Max Super Speciality Hospital, Bathinda, Punjab, India
| | - Ahmad Javid Safi
- Afghanistan Cancer Foundation and Covid-19 Control Command Centre, Kabil, Afghanistan
| | - Sharmila Agarwal
- Department of Radiotherapy, Jaslok Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Krishna Kumar Rathnam
- Department of Medical Oncology, Meenakshi Mission Hospital and Research Centre, Madurai, India
| | - P N Mohapatra
- Department of Medical Oncology, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Rajeev Vijay Kumar
- Department of Oncology, BGS Gleneagles Global Hospital, Bangalore, India
| | - Senthil Rajappa
- Department of Medical Oncology, Basavatarakam Indo American Cancer Hospital and Research Center, Hyderabad, India
| | - Sewanti Atul Limaye
- Department of Oncology and Oncology Research, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - Amish Vora
- Department of Oncology, H.O.P.E. Oncology Cancer Clinic, PSRI Hospital, New Delhi, India
| | - Vijay A P Reddy
- Department of Radiation Oncology, Apollo Cancer Institute, Hyderabad, India
| | - Bhavesh B Parekh
- Department of Oncology, Shalby Cancer and Research Institute, Ahmedabad, Gujrat, India
| | - G K Rath
- National Cancer Center, Delhi, India
| |
Collapse
|
28
|
Kumar A, Wadasadawala T, Laskar SG, Gondhowiardjo S, Agarwal JP. Mental Health Impact of COVID-19 in Radiation Oncology Health Care Workers of Asian Countries. Clin Oncol (R Coll Radiol) 2021; 33:e243-e244. [PMID: 33676823 PMCID: PMC7904513 DOI: 10.1016/j.clon.2021.02.007] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- A Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - T Wadasadawala
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Gondhowiardjo
- Department of Radiation Oncology, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| |
Collapse
|
29
|
Simpson AM, Donato DP, Veith J, Magno-Padron D, Agarwal JP. Hand and Wrist Injuries Among Collegiate Athletes: The Role of Sex and Competition on Injury Rates and Severity. Orthop J Sports Med 2020; 8:2325967120964622. [PMID: 33403205 PMCID: PMC7745597 DOI: 10.1177/2325967120964622] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background: There is a high incidence of hand and wrist injuries in athletes participating in collegiate sports, but there is little information published characterizing them. Purpose: To characterize hand and wrist injuries in collegiate athletes using a large national database. Study Design: Descriptive epidemiology study. Methods: This retrospective cross-sectional analysis was designed using data from the National Collegiate Athletic Association (NCAA) Injury Surveillance Program database to identify hand and wrist injuries (exclusive of any radial or ulnar fractures) in male and female collegiate athletes participating in NCAA Division I, II, and III sports from 2004 to 2015. Descriptive analyses were performed on stratified data to examine the associations between these injuries and sport, event type, and sex. Results: Men’s ice hockey (8.25 per 10,000 athlete-exposures [AEs]) and women's ice hockey (8.21 per 10,000 AEs) had the highest rate of hand and wrist injuries in all exposures. In every sport except women’s gymnastics (P = .107), injuries were more commonly sustained during competition rather than during practice. Ligamentous injury to the phalynx was the most commonly sustained injury overall (1.416 per 10,000 AEs), and a metacarpal fracture was the most commonly sustained hand or wrist fracture (0.507 per 10,000 AEs). Injuries sustained during men’s wrestling (14.08 days) and women’s gymnastics (10.39 days) incurred the most time lost from sport. Surgery for hand and wrist injuries was most commonly required for men’s football (0.413 per 10,000 AEs) and women’s field hockey (0.404 per 10,000 AEs). Conclusion: Hand and wrist injuries were common among collegiate athletes. Male athletes experienced injuries with more frequency and severity. Injuries occurred more commonly during competition. While the majority of injuries were minor and did not require surgery, certain sports conferred a much higher risk of significant injuries requiring a surgical intervention.
Collapse
Affiliation(s)
- Andrew M. Simpson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Daniel P. Donato
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA
| | - Jacob Veith
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
- Jacob Veith, MD, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, 30 North 1900 East, #3B400, Salt Lake City, UT 84132, USA ()
| | - David Magno-Padron
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| | - Jayant P. Agarwal
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|
30
|
Anand AK, Agarwal JP, D'Cruz A, Dattatreya PS, Goswami C, Joshi A, Julka PK, Noronha V, Prabhash K, Rao RR, Kumar R, Toprani R, Saxena V. Evolving multidisciplinary treatment of squamous cell carcinoma of the head and neck in India ✰. Cancer Treat Res Commun 2020; 26:100269. [PMID: 33338859 DOI: 10.1016/j.ctarc.2020.100269] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 06/12/2023]
Abstract
In this article, we highlight the evolution of a multimodal approach in the overall management of squamous cell carcinoma of the head and neck (SCCHN) in India; present advances in technology (newer surgical techniques), novel medical and radiotherapy (RT) approaches; review their roles for an integrated approach for treating SCCHN and discuss the current role of immunotherapy in SCCHN. For locally advanced (LA) SCCHN, the multidisciplinary approach includes surgery followed by RT, with or without chemotherapy (CT) or concurrent chemoradiotherapy. Improved surgical techniques of reconstruction and voice-preservation are being implemented. Advanced forms of high-precision conformal techniques like intensity-modulated radiotherapy are used to deliver highly conformal doses to tumors, sparing the surrounding normal tissue. Compared with RT alone, novel CT regimens and targeted therapeutic agents have the potential to improve locoregional control and survival and reduce treatment-induced toxicities. Several clinical trials have demonstrated efficacy, safety, and quality of life benefits of adding cetuximab to RT regimens in LASCCHN. Studies have also suggested a cetuximab-related laryngeal preservation benefit. At progression, platinum-based CT combined with cetuximab (a monoclonal anti-epidermal growth factor receptor antibody) is the only validated option available as the first-line therapy. Thus, an integrated multidisciplinary approach plays a key role in maximizing patient outcomes, reduction in treatment related morbidities that consequently impact quality of life of survivors.
Collapse
Affiliation(s)
- A K Anand
- Max Super Speciality Hospital, Delhi, India.
| | | | - A D'Cruz
- Tata Memorial Hospital, Mumbai, India
| | | | - C Goswami
- Superspeciality Hospital, Kolkata, India
| | - A Joshi
- Memorial Hospital, Mumbai, India
| | - P K Julka
- Max Super Speciality Hospital, Delhi, India.
| | - V Noronha
- Tata Memorial Hospital, Mumbai, India
| | | | | | | | - R Toprani
- Healthcare Global Enterprises Cancer Centre, Ahmedabad, India
| | - V Saxena
- Medical Affairs, Merck Specialities Pvt Ltd, India.
| |
Collapse
|
31
|
Agarwal S, Pappas L, Matsen CB, Agarwal JP. Second primary breast cancer after unilateral mastectomy alone or with contralateral prophylactic mastectomy. Cancer Med 2020; 9:8043-8052. [PMID: 32918537 PMCID: PMC7643660 DOI: 10.1002/cam4.3394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/07/2020] [Revised: 07/05/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background An increasing number of patients undergo contralateral prophylactic mastectomy (CPM) for unilateral breast cancer. However, the benefit of CPM has not been quantified in the setting of contemporary breast cancer therapy. Methods We performed an analysis of 180 068 patients in the Surveillance, Epidemiology, and End Results (SEER) database, diagnosed with unilateral ductal breast carcinoma between 1998 and 2013 and treated with unilateral mastectomy (UM) or CPM. UM was performed in 146 213 patients (81.2%); CPM was performed in 33 855 patients (19.8%). Primary outcome of interest was cumulative incidence of a second primary breast cancer in the ipsilateral or contralateral breast greater than 3 months after initial diagnosis. Cumulative incidence analysis was based on a Cox proportional model to generate curves of second primary breast cancer in any breast, ipsilateral breast only, or contralateral breast only. Results Patients who underwent CPM had a significantly reduced incidence of second primary breast cancer 10 and 15 years after surgery (CPM 0.93% [0.73%, 1.12%] vs UM 4.44% [4.28%, 4.60%]). Patients who underwent CPM had significantly lower adjusted hazard of second primary breast cancer when compared with UM (HR 0.38 vs 1.0, P < .0001). Conclusions CPM offers some protection from a second primary breast cancer, attributable to a reduced incidence in the contralateral breast. These findings provide additional information to providers and patients as they make decisions regarding surgical management. They should also be interpreted in the context of the absolute incidence of second primary breast cancer after UM and previous literature demonstrating no survival benefit.
Collapse
Affiliation(s)
- Shailesh Agarwal
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Lisa Pappas
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Cindy B Matsen
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jayant P Agarwal
- Department of Surgery, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
32
|
Mummudi N, Ghosh-Laskar S, Tibdewal A, Agarwal JP. COVID-19 Pandemic and Nationwide Lockdown - Implications of the Double Trouble on Radiotherapy Practice in India. Clin Oncol (R Coll Radiol) 2020; 32:e219. [PMID: 32536557 PMCID: PMC7280101 DOI: 10.1016/j.clon.2020.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- N Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - A Tibdewal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| |
Collapse
|
33
|
Magno-Padron DA, Collier W, Kim J, Agarwal JP, Kwok AC. A Nationwide Analysis of Early and Late Readmissions following Free Tissue Transfer for Breast Reconstruction. J Reconstr Microsurg 2020; 36:450-457. [PMID: 32172527 DOI: 10.1055/s-0040-1702175] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Traditionally, surgical quality outcomes are assessed using a 30-day postoperative window. For breast cancer patients undergoing free tissue transfer for breast reconstruction, we sought to describe the distribution of and specific risk factors for early and late readmissions within a 0- to 90-day postoperative period. PATIENTS AND METHODS The Nationwide Readmissions Database was used to conduct a retrospective cohort study. Breast cancer patients undergoing free tissue transfer for breast reconstruction were identified using International Classification of Diseases -9 diagnosis and procedure codes. Ninety-day readmissions related to infection or wound complications were identified. Univariable and multivariable logistic regression models were used to identify patient risk factors for readmissions that occurred early (0-30 days) and late (31-90 days) after their index procedure. RESULTS In the weighted sample, we identified approximately 7,305 free flap breast reconstructions and a surgical wound-related readmission rate of 4.3% (n = 312): 65.4% of the readmissions occurred early while 34.6% occurred late after surgery. The mean days to readmission was 26, and 75% of all readmissions occurred within the first 36 days after surgery. Variables independently associated with readmissions during the 0- to 90-day postoperative period included: history of chronic obstructive pulmonary disease (p = 0.036), hypertension (p = 0.03), obesity (p ≤ 0.001), and history of smoking (p = 0.004). The variables independently associated with the early readmission period were the same as those identified for the 0- to 90-day postoperative period. The variables independently associated with late readmissions were different: history of depression (p = 0.001) and history of smoking (p = 0.001). CONCLUSION The conventional 30-day hospital readmission rate classically used as a quality metric is overlooking a significant portion of admissions after free flap-based breast reconstruction. Different variables were found to be associated with readmission in the early versus late cohorts. Interventions targeting these variables could decrease readmissions and their associated costs.
Collapse
Affiliation(s)
| | - Willem Collier
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jaewhan Kim
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Jayant P Agarwal
- Department of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| | - Alvin C Kwok
- Department of Plastic Surgery, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
34
|
Panda S, Swamidas J, Chopra S, Mangaj A, Fogliata A, Kupelian P, Agarwal JP, Cozzi L. Treatment planning comparison of volumetric modulated arc therapy employing a dual-layer stacked multi-leaf collimator and helical tomotherapy for cervix uteri. Radiat Oncol 2020; 15:22. [PMID: 32000832 PMCID: PMC6990476 DOI: 10.1186/s13014-020-1473-z] [Citation(s) in RCA: 8] [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: 10/29/2019] [Accepted: 01/19/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose To ascertain the dosimetric performance of a new delivery system (the Halcyon system, H) equipped with dual-layer stacked multi-leaf collimator (MLC) for risk-adapted targets in cervix uteri cancer patients compared to another ring-based system in clinical operation (Helical Tomotherapy, HT). Methods Twenty patients were retrospectively included in a treatment planning study (10 with positive lymph nodes and 10 without). The dose prescription (45Gy to the primary tumour volume and a simultaneously integrated boost up to 55Gy for the positive patients) and the clinical planning objectives were defined consistently as recommended by an ongoing multicentric clinical trial. Halcyon plans were optimised for the volumetric modulated arc therapy. The plan comparison was performed employing the quantitative analysis of the dose-volume histograms. Results The coverage of the primary and nodal target volumes was comparable for both techniques and both subsets of patients. The primary planning target volume (PTV) receiving at least 95% of the prescription isodose ranged from 97.2 ± 1.1% (node-negative) to 99.1 ± 1.2% (node-positive) for H and from 96.5 ± 1.9% (node-negative) to 98.3 ± 0.9% (node-positive) for HT. The uncertainty is expressed at one standard deviation from the cohort of patient per each group. For the nodal clinical target volumes, the dose received by 98% of the planning target volume ranged 55.5 ± 0.1 to 56.0 ± 0.8Gy for H and HT, respectively. The only significant and potentially relevant differences were observed for the bowels. In this case, V40Gy resulted 226.3 ± 35.9 and 186.9 ± 115.9 cm3 for the node-positive and node-negative patients respectively for Halcyon. The corresponding findings for HT were: 258.9 ± 60.5 and 224.9 ± 102.2 cm3. On the contrary, V15Gy resulted 1279.7 ± 296.5 and 1557.2 ± 359.9 cm3 for HT and H respectively for node-positive and 1010.8 ± 320.9 versus 1203.8 ± 332.8 cm3 for node-negative. Conclusion This retrospective treatment planning study, based on the dose constraints derived from the Embrace II study protocol, suggested the essential equivalence between Halcyon based and Helical Tomotherapy based plans for the intensity-modulated rotational treatment of cervix uteri cancer. Different levels of sparing were observed for the bowels with H better protecting in the high-dose region and HT in the mid-low dose regions. The clinical impact of these differences should be further addressed.
Collapse
Affiliation(s)
- S Panda
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - J Swamidas
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - S Chopra
- Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Centre, Homi Bhabha National Institute, Kharghar, Navi Mumbai, Maharashtra, India
| | - A Mangaj
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - A Fogliata
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy
| | - P Kupelian
- Varian Medical Systems, Palo Alto, CA, USA.,Radiation Oncology Dept., University of California, Los Angeles, USA
| | - J P Agarwal
- Department of Radiation Oncology and Medical Physics, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Parel, Mumbai, Maharashtra, India
| | - L Cozzi
- Humanitas Research Hospital, Radiotherapy and Cancer Center Radiosurgery Dept, Via Manzoni 56, 20089, Milan-Rozzano, Italy. .,Dept. of Biomedical Sciences, Humanitas University, Milan-Rozzano, Italy.
| |
Collapse
|
35
|
Mummudi N, Agarwal JP, Chatterjee S, Mallick I, Ghosh-Laskar S. Oral Cavity Cancer in the Indian Subcontinent - Challenges and Opportunities. Clin Oncol (R Coll Radiol) 2019; 31:520-528. [PMID: 31174947 DOI: 10.1016/j.clon.2019.05.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/21/2022]
Abstract
Oral cavity cancer (OCC) poses a global challenge that plagues both the Orient and the Occident, accounting for an estimated 350 000 new cases and 177 000 deaths in 2018. OCC is a major public health problem in the Indian subcontinent, where it ranks among the top three cancer types in both incidence and mortality. Major risk factors are the use of tobacco, betel quid and alcohol consumption. OCC is a heterogeneous group of multiple histologies that affects multiple subsites. The oral cavity includes the lips, buccal mucosa, teeth, gingiva, anterior two-thirds of the tongue, floor of the mouth and hard palate. OCC is defined as cancer of lips, mouth and tongue as defined by the International Classification of Diseases coding scheme. The epidemiology, aetio-pathogenesis and treatment philosophy are similar within this group. Although salivary gland malignancies, sarcomas, mucosal melanomas and lymphomas can also arise within the oral cavity, this review will focus on squamous cell cancer, which is the predominant histology in OCC. We review and contrast data from developing and developed countries. We also highlight the unique regional challenges that countries in the East face; citing India as an example, we elaborate on the opportunities and scope for improvement in the management of OCC.
Collapse
Affiliation(s)
- N Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
| | - S Ghosh-Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
| |
Collapse
|
36
|
Simpson AM, Donato DP, Kwok AC, Agarwal JP. Response to letter commenting on predictors of complications following breast reduction surgery: A national surgical quality improvement program study of 16,812 cases. J Plast Reconstr Aesthet Surg 2019; 72:1436-1447. [PMID: 31085127 DOI: 10.1016/j.bjps.2019.03.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew M Simpson
- School of Medicine, Division of Plastic and Reconstructive Surgery, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA.
| | - Daniel P Donato
- School of Medicine, Division of Plastic and Reconstructive Surgery, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Alvin C Kwok
- School of Medicine, Division of Plastic and Reconstructive Surgery, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Jayant P Agarwal
- School of Medicine, Division of Plastic and Reconstructive Surgery, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| |
Collapse
|
37
|
Simpson AM, Moores N, Swistun L, Ying J, Agarwal JP. Incidence of complications following two-stage expander/implant breast reconstruction: The impact of cancer diagnosis in prophylactic mastectomy. Breast J 2019; 25:757-759. [PMID: 31077489 DOI: 10.1111/tbj.13336] [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: 03/23/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Andrew M Simpson
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Neal Moores
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| | | | - Jian Ying
- Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, Salt Lake City, Utah
| |
Collapse
|
38
|
Jeyapalina S, Colombo JS, Beck JP, Agarwal JP, Schmidt LA, Bachus KN. Epidermal growth factor receptor genes are overexpressed within the periprosthetic soft-tissue around percutaneous devices: A pilot study. J Biomed Mater Res B Appl Biomater 2019; 108:527-537. [PMID: 31074946 DOI: 10.1002/jbm.b.34409] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 03/20/2019] [Accepted: 04/25/2019] [Indexed: 12/11/2022]
Abstract
Epidermal downgrowth around percutaneous devices produce sinus tracts, which then accumulate bacteria becoming foci of infection. This mode to failure is epidermal-centric, and is accelerated by changes in the chemokines and cytokines of the underlying periprosthetic granulation tissue (GT). In order to more fully comprehend the mechanism of downgrowth, in this 28-day study, percutaneous devices were placed in 10 Zucker diabetic fatty rats; 5 animals were induced with diabetes mellitus II (DM II) prior to the surgery and 5 animals served as a healthy, nondiabetic cohort. At necropsy, periprosthetic tissues were harvested, and underwent histological and polymerase chain reaction (PCR) studies. After isolating GTs from the surrounding tissue and extracting ribonucleic acids, PCR array and quantitative-PCR (qPCR) analyses were carried-out. The PCR array for 84 key wound-healing associated genes showed a five-fold or greater change in 31 genes in the GTs of healthy animals compared to uninjured healthy typical skin tissues. Eighteen genes were overexpressed and these included epidermal growth factor (EGF) and epidermal growth factor receptor (EGFR). Thirteen genes were underexpressed. When GTs of DM II animals were compared to healthy animals, there were 8 genes overexpressed and 25 genes underexpressed; under expressed genes included EGF and EGFR. The qPCR and immunohistochemistry data further validated these observations. Pathway analysis of genes up-regulated 15-fold or more indicated two, EGFR and interleukin-10, centric clustering effects. It was concluded that EGFR could be a key player in exacerbating the epidermal downgrowth, and might be an effective target for preventing downgrowth.
Collapse
Affiliation(s)
- Sujee Jeyapalina
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - John S Colombo
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,The School of Dentistry, University of Utah School of Medicine, Salt Lake City, Utah
| | - James P Beck
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Orthopaedic Research Laboratories, University of Utah Orthopaedic Center, Salt Lake City, Utah
| | - Jayant P Agarwal
- Division of Plastic Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.,Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Linda A Schmidt
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Kent N Bachus
- Research, Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Orthopaedic Research Laboratories, University of Utah Orthopaedic Center, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| |
Collapse
|
39
|
Holoyda KA, Simpson AM, Ye X, Agarwal JP, Kwok AC. Immediate Bilateral Breast Reconstruction Using Abdominally Based Flaps: An Analysis of the Nationwide Inpatient Sample Database. J Reconstr Microsurg 2019; 35:594-601. [PMID: 31075801 DOI: 10.1055/s-0039-1688719] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Bilateral mastectomy rates are increasing in the United States. The abdomen is the most common harvest site for autologous reconstruction. Nationwide data were examined to determine differences in hospital charges, length of stay (LOS), and early postoperative complications following immediate bilateral pedicled transverse rectus abdominis myocutaneous (pTRAM), free TRAM (fTRAM), deep inferior epigastric perforator (DIEP), and superficial inferior epigastric artery (SIEA) perforator flaps and were compared with unilateral reconstruction. METHODS Patients who underwent immediate bilateral breast reconstruction using a single method of abdominally based reconstruction were identified using the 2009 to 2014 Nationwide Inpatient Sample Database. Outcomes included total hospital charges, LOS, and immediate postoperative complications. RESULTS We identified 13,348 cases of bilateral mastectomy with a single type of immediate bilateral autologous flap reconstruction. The majority were bilateral DIEP flaps. Mean total cost for bilateral pTRAM, fTRAM, DIEP, and SIEA flaps was US $21,886.80, US $28,839.40, US $30,051.30, and US $33,784.90, respectively (p < 0.0001). Mean LOS for bilateral pTRAM, fTRAM, DIEP, and SIEA was 4.3, 4.9, 4.5, and 5.4 days, respectively (p = 0.0002), and hematoma rates were 1.93, 2.61, 3.68, and 16.59%, respectively, (p = 0.0001), whereas return to the operating room for vascular anastomosis revision was 0, 1.63, 1.99, and 19.07%, respectively (p < 0.0001). Cost is less for unilateral pTRAM, fTRAM, and DIEP flaps (p < 0.0001). LOS is shorter for unilateral fTRAM versus bilateral (p < 0.0001). No differences were appreciated between unilateral and bilateral hematoma and reoperation rates for any reconstruction (p > 0.1). CONCLUSION Immediate complication rates were higher in bilateral free flaps compared with bilateral pedicled flaps. pTRAM and fTRAM flap reconstructions are still performed frequently with acceptable immediate results without considering long-term morbidity, aesthetics, and abdominal muscle function. Bilateral SIEA free flaps were associated with significantly higher total cost, LOS, and complication rates compared with other groups. Complications were similar between unilateral and bilateral reconstruction procedures. While cost is significantly greater for bilateral procedures compared with unilateral pTRAM, fTRAM, and DIEP flaps, it is not doubled.
Collapse
Affiliation(s)
- Kathleen A Holoyda
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Andrew M Simpson
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Xiangyang Ye
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States
| |
Collapse
|
40
|
Agarwal JP, Krishnatry R, Panda G, Pathak R, Vartak C, Kinhikar RA, James S, Khobrekar SV, Shrivastava SK, D'Cruz AK, Deshpande DD. An Audit for Radiotherapy Planning and Treatment Errors From a Low-Middle-Income Country Centre. Clin Oncol (R Coll Radiol) 2018; 31:e67-e74. [PMID: 30322681 DOI: 10.1016/j.clon.2018.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 05/06/2018] [Revised: 08/21/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
AIMS To report the findings of an audit for radiotherapy errors from a low-middle-income country (LMICs) centre. This would serve as baseline data for radiotherapy error rates, their severity and causes, in such centres where modern error reporting and learning processes still do not exist. MATERIALS AND METHODS A planned cross-sectional weekly audit of electronic radiotherapy charts at the radiotherapy planning and delivery step for all patients treated with curative intent was conducted. Detailed analysis was carried out to determine the step of origin of error, time and contributing factors. They were graded as per indigenous institutional (TMC) radiotherapy error grading (TREG) system and the contributing factors identified were prioritised using the product of frequency, severity and ease of detection. RESULTS In total, 1005 consecutive radically treated patients' charts were audited, 67 radiotherapy errors affecting 60 patients, including 42 incidents and 25 near-misses were identified. Transcriptional errors (29%) were the most common type. Most errors occurred at the time of treatment planning (59.7%), with "plan information transfer to the radiation oncology information system" being the most frequently affected sub-step of the radiotherapy process (47.8%). More errors were noted at cobalt units (52/67; 77.6%) than at linear accelerators. Trend analysis showed an increased number of radiotherapy incidents on Fridays and near-misses on Mondays. Trend for increased radiotherapy errors noted in the evening over other shifts. On severity grading, most of the errors (54/60; 90%) were clinically insignificant (grade I/II). Inadequacies and non-adherence towards standard operating procedures, poor documentation and lack of continuing education were the three most prominent causes. CONCLUSION Preliminary data suggest a vulnerability of LMIC set-up to radiotherapy errors and emphasises the need for the development of longitudinal prospective processes, such as voluntary reporting and a continued education system, to ensure robust and comprehensive safe practises on par with centres in developed countries.
Collapse
Affiliation(s)
- J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - R Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India.
| | - G Panda
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - R Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - C Vartak
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - R A Kinhikar
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Department of Medical Physics, Tata Memorial Center, Parel, Mumbai, India
| | - S James
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - S V Khobrekar
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Tata Memorial Hospital, Parel, Mumbai, India
| | - S K Shrivastava
- Department of Radiation Oncology, Tata Memorial Centre, Parel, Mumbai, India; Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India
| | - A K D'Cruz
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Tata Memorial Hospital, Parel, Mumbai, India
| | - D D Deshpande
- Homi Bhabha National Institute, Training School Complex, Anushakti Nagar, Mumbai, India; Department of Medical Physics, Tata Memorial Center, Parel, Mumbai, India
| |
Collapse
|
41
|
Serpico V, Mone MC, Zhang C, Presson AP, Matsen CB, Junkins S, Killian H, Porretta J, Agarwal JP, Nelson EW. Value Driven Outcomes: Standardizing Pain Management to Reduce Postoperative Opiates for Patients Undergoing Mastectomy with Immediate Reconstruction. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.08.060] [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: 11/26/2022]
|
42
|
Simpson AM, Donato DP, Kwok AC, Agarwal JP. Predictors of complications following breast reduction surgery: A National Surgical Quality Improvement Program study of 16,812 cases. J Plast Reconstr Aesthet Surg 2018; 72:43-51. [PMID: 30291050 DOI: 10.1016/j.bjps.2018.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 11/22/2017] [Revised: 08/13/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Breast reduction is one of the most common procedures performed by plastic surgeons. Despite good outcomes and high patient satisfaction, there are little national data on the predictors that lead to complications in this patient population. We accessed a national outcomes database to examine these factors. METHODS This is a retrospective study examining the National Surgical Quality Improvement Program database from 2006 to 2015. Patients who underwent primary breast reduction were identified. Patients who underwent any cancer-related procedures were excluded. We identified patient-related and procedure-related factors for analysis. Univariate and multivariate logistic regression analyses were used to identify independent predictors of complications. RESULTS In total, 16,812 individual cases were identified. The overall complication rate for the cohort was 6.2%, and the major complication rate was 3.0%. Diabetes, bleeding disorder, hypertension, obesity, smoking, steroid use, and prolonged operative time were associated with increased risk of complications (p < 0.05). Concurrent body contouring was a predictor of increased major complications; however, liposuction was not. CONCLUSIONS Common surgical risk factors are associated with complications in breast reduction surgery. Although liposuction is not an independent risk factor, concurrent body contouring is associated with increased complications. Surgeons should be aware of these associations when discussing breast reduction with patients.
Collapse
Affiliation(s)
- Andrew M Simpson
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA.
| | - Daniel P Donato
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, School of Medicine, University of Utah, 30N 1900 E, 3B400, Salt Lake City, UT 84132, USA
| |
Collapse
|
43
|
Krishnatry R, Bhatia J, Murthy V, Agarwal JP. Survey on Adaptive Radiotherapy Practice. Clin Oncol (R Coll Radiol) 2018; 30:819. [PMID: 30213704 DOI: 10.1016/j.clon.2018.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 08/09/2018] [Accepted: 08/21/2018] [Indexed: 02/07/2023]
Affiliation(s)
- R Krishnatry
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - J Bhatia
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - V Murthy
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India
| |
Collapse
|
44
|
Kwok AC, Simpson AM, Ye X, Tatro E, Agarwal JP. Immediate Unilateral Breast Reconstruction using Abdominally Based Flaps: Analysis of 3,310 Cases. J Reconstr Microsurg 2018; 35:74-82. [PMID: 30085346 DOI: 10.1055/s-0038-1667046] [Citation(s) in RCA: 8] [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] [Indexed: 10/28/2022]
Abstract
BACKGROUND The abdomen is the most common area from which tissue is harvested for autologous breast reconstruction. We sought to examine national data to determine the differences in total hospital charges, length of stay (LOS), and early postoperative complications following pedicled transverse rectus abdominis myocutaneous flap (pTRAM), free TRAM (fTRAM), deep-inferior epigastric perforator (DIEP), and superficial inferior epigastric artery perforator (SIEA) flaps. METHODS The 2009-2013 Nationwide Inpatient Sample Database was used to identify patients who underwent a unilateral mastectomy and only one type of abdominally based autologous flap (pTRAM, fTRAM, DIEP, and SIEA) during the same hospital admission. Outcomes of interest included total charges, LOS, and complications including revision of vascular anastomosis and hematoma. RESULTS A total of 3,310 cases were identified, corresponding to 15,991 abdominally based unilateral immediate breast reconstructions after standard weighting was applied; 5,079 (31.8%) were pTRAM flaps, 4,461 (27.9%) were fTRAM flaps, 6,206 (38.8%) were DIEP flaps, and 245 (1.5%) were SIEA flaps. The mean total charges for pTRAM, fTRAM, DIEP, and SIEA flaps were $17,765.5, $22,637.6, $25,814.6, and $26,605.2, respectively (p < 0.0001). The mean LOS for pTRAM, fTRAM, DIEP, and SIEA flaps were 96.5, 106.5, 106.7, and 108.9 hours, respectively (p = 0.002). The rates for return to the OR for the revision of a vascular anastomosis for pTRAM, fTRAM, DIEP, and SIEA were 0.0%, 1.72%, 2.66%, and 5.64%, respectively (p < 0.0001). CONCLUSIONS There is variation in the total charges, LOS, and early complications between pTRAM, fTRAM, DIEP, and SIEA flap-based breast reconstruction. fTRAM, DIEP, and SIEA flaps incur higher hospital total charges, have longer lengths of stay, and experience more immediate complications compared with pTRAM. Well-designed prospective trials are required to better understand the findings from this study with the inclusion of other critical outcomes such as patient satisfaction, aesthetic results, and long-term outcomes such as abdominal wall morbidity.
Collapse
Affiliation(s)
- Alvin C Kwok
- Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, Salt Lake City, Utah
| | - Andrew M Simpson
- Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, Salt Lake City, Utah
| | - Xiangyang Ye
- Division of Epidemiology, University of Utah, School of Medicine, Salt Lake City, Utah
| | - Eric Tatro
- Texas Tech Health Science Center, Paul L. Foster School of Medicine, El Paso, Texas
| | - Jayant P Agarwal
- Division of Plastic and Reconstructive Surgery, University of Utah, School of Medicine, Salt Lake City, Utah
| |
Collapse
|
45
|
Purandare NC, Pramesh CS, Agarwal JP, Agrawal A, Shah S, Prabhash K, Karimundackal G, Jiwnani S, Tandon S, Rangarajan V. Solitary pulmonary nodule evaluation in regions endemic for infectious diseases: Do regional variations impact the effectiveness of fluorodeoxyglucose positron emission tomography/computed tomography. Indian J Cancer 2018; 54:271-275. [PMID: 29199704 DOI: 10.4103/0019-509x.219563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a preferred imaging modality for the evaluation of solitary pulmonary nodule (SPN), particularly in the developed world. Since FDG can concentrate in infective/inflammatory lesions, the diagnostic utility of FDG-PET can be questioned, particularly in regions endemic for infectious decisions. AIM To evaluate the accuracy of FDG-PET/CT in evaluation of SPNs in a population endemic for infectious disease and to assess if regional variations have an impact on its effectiveness. MATERIALS AND METHODS All patients who underwent an FDG/PET-CT with a clinico-radiological diagnosis of SPN categorized as indeterminate were included. Based on a maximum standardized uptake values (SUVmax) cut-off of 2.5, lesions were classified as benign (<2.5) or malignant (>2.5) and compared with gold standard histopathology. The diagnostic accuracy of PET-CT to detect malignancy was calculated. On the basis of final histopathology, lesions were grouped as (a) malignant nodules (b) infective/granulomatous nodules with a specific diagnosis and (c) nonspecific inflammatory nodules. The SUVmaxbetween these groups was compared using nonparametric statistical tests. RESULTS A total of 191 patients (129 males, 62 females) with a median age of 64 years (range: 36-83) were included. Totally, 144 nodules (75.3%) were malignant and 47 were benign (24.7%). Adenocarcinoma (n = 84) was the most common malignancy. Tuberculosis (n = 16) and nonspecific infections (n = 24) were the two most common benign pathologies. There was a significant overlap in the metabolic uptake of malignant (median SUVmax-11.2, range: 3.3-34.6) and tuberculous nodules (median SUVmax-10.3, range: 2.7-22.5) with no statistically difference between their SUVmaxvalues (P = 0.43). The false-positive rate was 65.2% and the false-negative rate was 5.5%. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FDG-PET/CT for detecting malignancy were 94.4%, 34.7%, 81.9%, 66.6%, and 79.5%, respectively. CONCLUSIONS Though FDG-PET scans show a very high sensitivity for malignant nodules, it has a high false-positive rate and reduced specificity when characterizing SPNs in an infectious endemic region. Physicians must be aware of this limitation in the workup of lung nodules, and regional variations must be considered before further management decisions are taken.
Collapse
Affiliation(s)
- N C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - A Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S Tandon
- Department of Chest Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Centre, Mumbai, Maharashtra, India
| |
Collapse
|
46
|
Agarwal JP, Chakraborty S, Laskar SG, Mummudi N, Patil VM, Upasani M, Prabhash K, Noronha V, Joshi A, Purandare N, Tandon S, Arora J, Badhe R. Applying the QUARTZ Trial Results in Clinical Practice: Development of a Prognostic Model Predicting Poor Outcomes for Non-small Cell Lung Cancers with Brain Metastases. Clin Oncol (R Coll Radiol) 2018; 30:382-390. [PMID: 29499878 DOI: 10.1016/j.clon.2018.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/21/2017] [Accepted: 01/05/2018] [Indexed: 01/21/2023]
Abstract
AIMS The role of whole brain radiotherapy (WBRT) in patients with brain metastases from non-small cell lung cancers (NSCLC) has been questioned. However, no reliable criteria exist to identify patients who do not benefit from WBRT. The objective of the current study was to develop a prognostic model to identify such patients whose survival matches that of the Quality of Life after Treatment for Brain Metastases (QUARTZ) study. MATERIALS AND METHODS Outcome data of patients with NSCLC with brain metastases undergoing WBRT enrolled in a prospective observational study in a tertiary cancer centre were used to develop a prognostic model. Baseline clinico-radiological factors were used for development of the model. The model was internally validated and calibration accuracy was checked for prediction of 70 day mortality. The generated prognostic model was presented as a nomogram. RESULTS The median overall survival of 140 patients enrolled in the study was 166 days (95% confidence interval 108-242 days). The prognostic model identified gender, Karnofsky performance status and epidermal growth factor receptor activating mutation status as significant factors influencing overall survival. The model showed a modest discriminative ability with an optimism-corrected C-index of 0.64. However, model calibration error did reveal a moderate degree of calibration error. The high-risk subgroup identified by the model had a median overall survival of 67 days (95% confidence interval 56-101 days), which was similar to that observed in the QUARTZ trial. CONCLUSION This prognostic model derived from traditional clinico-radiological features had a modest ability to identify patients with poor prognosis who may not benefit from WBRT. However, the high-risk subgroup identified using this prognostic model had a survival similar to that observed for patients in the QUARTZ trial.
Collapse
Affiliation(s)
- J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Chakraborty
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India.
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - N Mummudi
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - M Upasani
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - N Purandare
- Department of Radiology, Tata Memorial Hospital, Parel, Mumbai, India
| | - S Tandon
- Department of Pulmonary Medicine, Tata Memorial Hospital, Parel, Mumbai, India
| | - J Arora
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - R Badhe
- Department of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| |
Collapse
|
47
|
Noronha V, Zanwar S, Joshi A, Patil VM, Mahajan A, Janu A, Agarwal JP, Bhargava P, Kapoor A, Prabhash K. Practice Patterns and Outcomes for Pemetrexed Plus Platinum Doublet as Neoadjuvant Chemotherapy in Adenocarcinomas of Lung: Looking Beyond the Usual Paradigm. Clin Oncol (R Coll Radiol) 2018; 30:23-29. [PMID: 29239731 DOI: 10.1016/j.clon.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/08/2017] [Accepted: 10/16/2017] [Indexed: 02/05/2023]
Affiliation(s)
- V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - S Zanwar
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - V M Patil
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Mahajan
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - A Janu
- Department of Radiodiagnosis, Tata Memorial Hospital, Mumbai, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - P Bhargava
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - A Kapoor
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, India.
| |
Collapse
|
48
|
Wagle PB, Jambhekar NA, Kumar R, Prabhash K, Pramesh CS, Desai SB, Noronha V, Karimundackal G, Shah A, Joshi A, Laskar SG, Jiwnani S, Pai T, Agarwal JP. A comparative analysis of immunohistochemistry and fluorescent in situ hybridization assay to detect anaplastic lymphoma kinase status in lung adenocarcinoma cases: A search for a testing algorithm. Indian J Cancer 2017; 54:148-154. [PMID: 29199679 DOI: 10.4103/ijc.ijc_202_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Testing for echinoderm microtubule-associated protein-like 4 (EML4) anaplastic lymphoma kinase (ALK) translocation by fluorescence in situ hybridization (FISH) is well established whereas the Food and Drug Administration (FDA) ALK immunohistochemical (IHC) test is relatively new. AIMS AND OBJECTIVE The aim of this study is to compare FDA-approved ALK IHC test (D5F3 clone) with the standard ALK FISH test. MATERIALS AND METHODS A validation and a test arm with 100 and 200 cases of Formalin-Fixed, Paraffin-embedded blocks of lung adenocarcinoma, respectively, comprised the material. All cases had ALK IHC test on automated Ventana Benchmark XT IHC slide stainer using anti-ALK D5F3 rabbit monoclonal primary antibody; when positive tumor cells (any percentage) showed strong granular cytoplasmic staining. For the FISH test, Vysis ALK Dual Color Break Apart Rearrangement Probe (Abbott Molecular Inc.,) was used to detect ALK gene 2p23 rearrangements; when positive the red and green signals were split two signal diameter apart and/or isolated 3'red signal were detected in more than 15% tumor cells. The ALK FISH results were available in all 100 validation cases and 64-test arm cases which formed the basis of this analysis. RESULTS The ALK IHC test was positive in 16% cases; four discordant cases were ALK IHC positive but ALK FISH negative, but no case was ALK IHC negative and ALK FISH positive. There was 100% sensitivity, 90.5% specificity, and 93.75% accuracy. CONCLUSION A negative ALK IHC result obviates the need for a FISH test barring those with a strong clinical profile, and a positive ALK IHC result is sufficient basis for the initiation of treatment.
Collapse
Affiliation(s)
- P B Wagle
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - N A Jambhekar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - R Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S B Desai
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Shah
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - T Pai
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
49
|
Mathew AS, Agarwal JP, Munshi A, Laskar SG, Pramesh CS, Karimundackal G, Jiwnani S, Prabhash K, Noronha V, Joshi A, Rangarajan V, Purandare NC, Jambhekar N, Tandon S, Mahajan A, Kumar R, Deodhar J. A prospective study of telephonic contact and subsequent physical follow-up of radically treated lung cancer patients. Indian J Cancer 2017; 54:241-252. [PMID: 29199699 DOI: 10.4103/0019-509x.219599] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND We tested the hypothesis that telephonic follow-up (FU) may offer a convenient and equivalent alternative to physical FU of radically treated lung cancer patients. DESIGN Prospective study carried out at a tertiary referral cancer care institute, Mumbai. MATERIALS AND METHODS Two hundred consecutive lung cancer patients treated with curative intent were followed up regularly with telephonic interviews paired with their routine physical FU visits. Patient satisfaction with the telephonic call and the physical visit, the anxiety level of the patient after meeting the physician and the economic burden of the visit to the patient were noted in a descriptive manner. Kappa statistics was used to assess concurrence between the telephonic and physical impression of disease status. RESULTS With a median FU duration of 21.5 months, the median satisfaction scores for telephonic and physical FU were 8 and 9, respectively. The prevalence and bias adjusted kappa (PABAK) score of the entire cohort of patients was 0.64 (95% confidence interval [CI] =0.58-0.70). Data analyzed up to first disease progression/relapse on FU had a PABAK score of 0.71 (95% CI = 0.64-0.77) indicating substantial agreement. Patients with disease controlled at the FU had a significant PABAK score of 0.88 (95% CI = 0.80-0.94) indicating excellent concurrence. On average, each patient spent Rs. 5117.10 on travel and Rs. 3079.06 on lodging per FU visit. CONCLUSION Telephonic FU is substantially accurate in assessing disease status until the first relapse. In a resource-constrained country like India, it is worthwhile to further explore the benefits of such an alternative strategy.
Collapse
Affiliation(s)
- A S Mathew
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J P Agarwal
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Munshi
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S G Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - G Karimundackal
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Jiwnani
- Department of Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - K Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Joshi
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - V Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - N C Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - N Jambhekar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - S Tandon
- Department of Pulmonary Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - A Mahajan
- Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - R Kumar
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - J Deodhar
- Department of Clinical Psychology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
50
|
Abstract
The Oncology Grand Rounds series is designed to place original reports published in the Journal into clinical context. A case presentation is followed by a description of diagnostic and management challenges, a review of the relevant literature, and a summary of the authors' suggested management approaches. The goal of this series is to help readers better understand how to apply the results of key studies, including those published in Journal of Clinical Oncology, to patients seen in their own clinical practice. A 45-year-old premenopausal woman presented with multifocal cancer in the right breast, with lesions at 1:00 and 4:00, the largest measuring approximately 3 cm on exam, and multiple palpable right axillary lymph nodes. A core biopsy confirmed invasive ductal carcinoma, grade 2 of 3, that was estrogen receptor positive, progesterone receptor positive, and HER2 negative. Fine needle aspiration of a right axillary node confirmed metastatic carcinoma. A positron emission tomography (PET)/ computed tomography done before starting chemotherapy demonstrated an absence of metastatic disease with expected avidity in two separate breast masses and multiple conglomerated 1-2 cm level I and II axillary lymph nodes. She received neoadjuvant chemotherapy with doxorubicin plus cyclophosphamide, followed by paclitaxel, and had a complete clinical response with resolution of the breast and axillary masses on exam. A repeat PET/computed tomography demonstrated reduced size of the breast and axillary disease, and no significant residual PET avidity. Her breast surgeon recommended a right mastectomy with axillary node dissection. As part of her multidisciplinary treatment plan, she consulted with two plastic surgeons to discuss reconstruction options. Plastic Surgeon A advised placement of an implant at the time of mastectomy while Surgeon B contrasted the pros and cons of an autologous transverse rectus abdominis muscle flap reconstruction with an implant based reconstruction. Surgeon B believed that autologous reconstruction would yield the best long-term cosmetic outcome. Before making her surgery decision, the patient consulted with a radiation oncologist to discuss the effect radiation may have on her reconstruction outcome.
Collapse
Affiliation(s)
- Matthew M Poppe
- Matthew M. Poppe and Jayant P. Agarwal, University of Utah, Salt Lake City, UT
| | - Jayant P Agarwal
- Matthew M. Poppe and Jayant P. Agarwal, University of Utah, Salt Lake City, UT
| |
Collapse
|