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Raje P, Sonal S, Qwaider YZ, Sell NM, Stafford CE, Boudreau C, Schneider D, Ike A, Kunitake H, Berger DL, Ricciardi R, Bordeianou LG, Cauley CE, Lee GC, Goldstone RN. Colitis-Associated Colorectal Cancer Survival is Comparable to Sporadic Cases after Surgery: a Matched-Pair Analysis. J Gastrointest Surg 2023; 27:1423-1428. [PMID: 37165158 PMCID: PMC11007866 DOI: 10.1007/s11605-023-05692-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/22/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) confers an increased lifetime risk of colorectal cancer (CRC). The pathogenesis of colitis-associated CRC is considered distinct from sporadic CRC, but existing is mixed on long-term oncologic outcomes. This study aims to compare clinicopathological characteristics and survival between colitis-associated and sporadic CRC. METHODS Data was retrospectively extracted and analyzed from a single institutional database of patients with surgically resected CRC between 2004 and 2015. Patients with IBD were identified as having colitis-associated CRC. The remainder were classified as sporadic CRC. Propensity score matching was performed. Univariate and survival analyses were carried out to estimate the differences between the two groups. RESULTS Of 2275 patients included in this analysis, 65 carried a diagnosis of IBD (2.9%, 33 Crohn's disease, 29 ulcerative colitis, 3 indeterminate colitis). Average age at CRC diagnosis was 62 years for colitis-associated CRC and 65 for sporadic CRC. The final propensity score matched cohort consisted of 65 colitis-associated and 130 sporadic CRC cases. Patients with colitis-associated CRC were more likely to undergo total proctocolectomy (p < 0.01) and had higher incidence of locoregional recurrence (p = 0.026) compared to sporadic CRC patients. There were no significant differences in time to recurrence, tumor grade, extramural vascular invasion, perineural invasion, or rate of R0 resections. Overall survival and disease-free survival did not differ between groups. On multiple Cox regression, IBD diagnosis was not a significant predictor of survival. CONCLUSIONS Patients with colitis-associated CRC who undergo surgical resection have comparable overall and disease-free survival to patients with sporadic CRC.
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Affiliation(s)
- Praachi Raje
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Swati Sonal
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Yasmeen Z Qwaider
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Naomi M Sell
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Caitlin E Stafford
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Chloe Boudreau
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
| | - Derek Schneider
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
| | - Amarachi Ike
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
| | - Hiroko Kunitake
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Rocco Ricciardi
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Christy E Cauley
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Grace C Lee
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Robert N Goldstone
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, 15 Parkman St. WACC 460, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
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Servin-Rojas M, Shafique N, Sell NM, Gamblin TC, Qadan M. Facility type is associated with improved perioperative and oncologic outcomes after minimally invasive surgery for pancreatic cancer. HPB (Oxford) 2023:S1365-182X(23)00127-2. [PMID: 37149486 DOI: 10.1016/j.hpb.2023.04.010] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/06/2023] [Accepted: 04/18/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND This study sought to evaluate outcome differences by facility type in patients who underwent minimally invasive surgery (MIS) for pancreatic ductal adenocarcinoma (PDAC). METHODS The National Cancer Database was used to identify patients with clinical stage I-III PDAC who underwent MIS from 2010 to 2019 in academic or community facilities. RESULTS Of 6806 patients who fulfilled inclusion criteria; 1788 (26.3%) were treated at community facilities and 5018 (74.7%) at academic facilities. Patients treated at academic facilities were more likely to receive care at a high-volume facility (62% vs. 32%, p < 0.001), undergo a Whipple (64% vs. 61%, p < 0.001), and be clinical stage II (42% vs. 38%) and III (5.6% vs. 4.9%, p = 0.001). Treatment at academic facilities was predictive of receiving neoadjuvant therapy (OR 2.08, p < 0.001), negative margin resection (OR 0.80, p = 0.004), lower 90-day mortality (OR 0.72, p = 0.02), decreased length of stay (IRR 0.96, p < 0.001), and longer OS (HR 0.88, p = 0.002). CONCLUSION Patients who underwent MIS for PDAC at academic facilities experienced an association with improved perioperative and oncologic outcomes than those treated in community facilities.
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Affiliation(s)
| | - Neha Shafique
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - T Clark Gamblin
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, United States.
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Qiao G, Ilagan CH, Fernandez-Del Castillo C, Ferrone CR, Janseen QP, Balachandran VP, Sell NM, Drebin JA, Hank T, Kingham TP, D'Angelica MI, Jarnagin WR, Lillemoe KD, Wei AC, Qadan M. Development and validation of the Massachusetts General Hospital/Memorial Sloan Kettering nomogram to predict overall survival of resected patients with pancreatic ductal adenocarcinoma treated with neoadjuvant therapy. Surgery 2022; 172:1228-1235. [PMID: 35931556 DOI: 10.1016/j.surg.2022.05.024] [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] [Received: 02/07/2022] [Revised: 04/20/2022] [Accepted: 05/23/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prognostication in patients undergoing resection for pancreatic ductal adenocarcinoma following neoadjuvant therapy remains challenging. In this study, we aimed to develop and validate a nomogram for the prediction of overall survival of these patients. METHODS Patients who underwent neoadjuvant therapy followed by surgical resection at the Massachusetts General Hospital were analyzed (training cohort). Patients from Memorial Sloan Kettering were included as a validation cohort. A nomogram to predict overall survival was designed, trained, and subjected to internal (bootstrap) validation. RESULTS A total of 325 patients were identified from Massachusetts General Hospital. Multivariable Cox regression analysis demonstrated that age (hazard ratio 1.828, 95% confidence interval 1.251-2.246; P = .007), serum carbohydrate antigen 19-9 ≥ 37 U/mL (HR 1.602, 95% confidence interval 1.187-3.258; P = .015), tumor size (hazard ratio 2.278, 95% confidence interval 1.405-4.368; P = .003), nodal status (hazard ratio 1.309, 95% confidence interval 1.108-2.439; P = .032), and R1 tumor resection (hazard ratio 1.481, 95% confidence interval 1.049-2.091; P = .026) were independent factors associated with overall survival. A nomogram that incorporated these significant prognostic factors was established. The calibration plots demonstrated high concordance between predictive nomogram values and actual overall survival for 1-year, 3-year, and 5-year overall survival. The model demonstrated excellent discriminatory power in both the Massachusetts General Hospital and Memorial Sloan Kettering cohorts, with adjusted Harrel's concordance index values of 0.729 and 0.712, respectively. CONCLUSION In this report, we established and validated a novel nomogram for predicting the survival of patients who underwent neoadjuvant therapy followed by pancreatectomy. This model allows clinicians to better estimate the survival of these specific patients.
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Affiliation(s)
- Guoliang Qiao
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | | | | | | | | | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - Thomas Hank
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering, New York, NY
| | | | | | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Alice C Wei
- Department of Surgery, Memorial Sloan Kettering, New York, NY
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA.
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Cassidy DJ, Coe TM, Jogerst KM, McKinley SK, Sell NM, Sampson M, Park YS, Petrusa E, Goldstone RN, Hashimoto DA, Gee DW. Transfer of virtual reality endoscopy training to live animal colonoscopy: a randomized control trial of proficiency vs. repetition-based training. Surg Endosc 2022; 36:6767-6776. [PMID: 35146554 PMCID: PMC8831003 DOI: 10.1007/s00464-021-08958-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/03/2021] [Accepted: 12/09/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Low first-time pass rates of the Fundamentals of Endoscopic Surgery (FES) exam stimulated development of virtual reality (VR) simulation curricula for test preparation. This study evaluates the transfer of VR endoscopy training to live porcine endoscopy performance and compares the relative effectiveness of a proficiency-based vs repetition-based VR training curriculum. METHODS Novice endoscopists completed pretesting including the FES manual skills examination and Global Assessment of GI Endoscopic Skills (GAGES) assessment of porcine upper and lower endoscopy. Participants were randomly assigned one of two curricula: proficiency-based or repetition-based. Following curriculum completion, participants post-tested via repeat FES examination and GAGES porcine endoscopy assessments. The two cohorts pre-to-post-test differences were compared using ANCOVA. RESULTS Twenty-two residents completed the curricula. There were no differences in demographics or clinical endoscopy experience between the groups. The repetition group spent significantly more time on the simulator (repetition: 242.2 min, SD 48.6) compared to the proficiency group (proficiency: 170.0 min, SD 66.3; p = 0.013). There was a significant improvement in porcine endoscopy (pre: 10.6, SD 2.8, post: 16.6, SD 3.4; p < 0.001) and colonoscopy (pre: 10.4, SD 2.7, post: 16.4, SD 4.2; p < 0.001) GAGES scores as well as FES manual skills performance (pre: 270.9, SD 105.5, post: 477.4, SD 68.9; p < 0.001) for the total cohort. There was no difference in post-test GAGES performance or FES manual skills exam performance between the two groups. Both the proficiency and repetition group had a 100% pass rate on the FES skills exam following VR curriculum completion. CONCLUSION A VR endoscopy curriculum translates to improved performance in upper and lower endoscopy in a live animal model. VR curricula type did not affect FES manual skills examination or live colonoscopy outcomes; however, a proficiency curriculum is less time-consuming and can provide a structured approach to prepare for both the FES exam and clinical endoscopy.
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Affiliation(s)
- Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA.
| | - Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Kristen M Jogerst
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
- Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Michael Sampson
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Yoon Soo Park
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Robert N Goldstone
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Daniel A Hashimoto
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, 55 Fruit St. GRB-425, Boston, MA, 02114, USA.
- Department of Surgery, Massachusetts General Hospital, 15 Parkman St. WAC-460, Boston, MA, 02114, USA.
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He K, Sell NM, Chugh P, Rasic G, Collado L, Smink DS, Whang E, Kristo G. Improving the financial wellness of general surgery residents: A nationwide survey. Am J Surg 2022; 224:888-892. [DOI: 10.1016/j.amjsurg.2022.04.035] [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] [Received: 03/11/2022] [Revised: 04/15/2022] [Accepted: 04/30/2022] [Indexed: 11/26/2022]
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Qwaider YZ, Sell NM, Stafford CE, Boudreau C, Kunitake H, Goldstone RN, Ricciardi R, Bordeianou LG, Cauley CE, Berger DL. Prognosis of Different Histological Types in Patients with Stage II and III Colon Cancer. J Gastrointest Surg 2022; 26:476-478. [PMID: 34505220 DOI: 10.1007/s11605-021-05091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/22/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Yasmeen Z Qwaider
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Naomi M Sell
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Caitlin E Stafford
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chloe Boudreau
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hiroko Kunitake
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert N Goldstone
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rocco Ricciardi
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christy E Cauley
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Sell NM, Francone TD. Anastomotic Troubleshooting. Clin Colon Rectal Surg 2021; 34:385-390. [PMID: 34853559 DOI: 10.1055/s-0041-1735269] [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: 10/19/2022]
Abstract
Anastomotic leak remains a critical and feared complication in colorectal surgery. The development of a leak can be catastrophic for a patient, resulting in overall increased morbidity and mortality. To help mitigate this risk, there are several ways to assess and potentially validate the integrity of a new anastomosis to give the patient the best chance of avoiding this postoperative complication. A majority of anastomoses will appear intact with no obvious sign of anastomotic dehiscence on gross examination. However, each anastomosis should be interrogated before the conclusion of an operation. The most common method to assess for an anastomotic leak is the air leak test (ALT). The ALT is a safe intraoperative method utilized to test the integrity of left-sided colon and rectal anastomoses and most importantly allows the ability to repair a failed test before concluding the operation. Additional troubleshooting is sometimes needed due to technical difficulties with the circular stapler. Problems, such as incomplete doughnuts and stapler misfiring, do occur and each surgeon should be prepared to address them.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
| | - Todd D Francone
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Department of Surgery, Newton-Wellesley Hospital, Newton, Massachusetts
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Qwaider YZ, Sell NM, Stafford CE, Kunitake H, Ricciardi R, Bordeianou LG, Goldstone RN, Cauley CE, Berger DL. The time Interval Between the End of Radiotherapy and Surgery Does Not Affect Outcomes in Rectal Cancer. Am Surg 2021:31348211047215. [PMID: 34633256 DOI: 10.1177/00031348211047215] [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: 11/17/2022]
Abstract
INTRODUCTION The ideal time interval between the completion of chemoradiotherapy and subsequent surgical resection of advanced stage rectal tumors is highly debated. Our aim is to study the effect of the time interval between the completion of chemoradiotherapy and surgical resection on postoperative and oncologic outcomes in rectal cancer. METHODS Patients who underwent neoadjuvant chemoradiotherapy for resected locally advanced rectal tumors between 2004 and 2015 were included in this analysis. The time interval was calculated from the date of radiation completion to date of surgery. Patients were split into 2 groups based on the time interval (<8 weeks and >8 weeks). Postoperative outcomes (anastomotic leak, pathologic complete response (pCR), and readmission) and survival were assessed with multivariable logistic regression and Cox regression models while adjusting for relevant confounders. RESULTS 200 patients (62% male) underwent resection with a median time interval of 8 weeks from completion of radiotherapy. On multivariable logistic regression, there was no significant increase in odds between time interval to surgery and anastomotic leak (aOR = .8 [.27-2.7], P = .8), pCR (aOR = 1.2[.58-2.6] P = .6), or readmission (aOR = 1.02, 95% CI:0.49-2.24, P = .9). Time interval to surgery was not an independent prognostic factor for overall (HR = 1.04 CI = .4-2.65, P = .9) and disease-free survival (HR = 1.2 CI = .5-2.9, P = .6). CONCLUSION The time interval between neoadjuvant radiotherapy completion and surgical resection does not affect anastomotic leak rate, achievement of pCR, or overall and disease-free survival in patients with rectal cancer. Extended periods of time to surgical resection are relatively safe.
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Affiliation(s)
- Yasmeen Z Qwaider
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Naomi M Sell
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Caitlin E Stafford
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Hiroko Kunitake
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Rocco Ricciardi
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Liliana G Bordeianou
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Robert N Goldstone
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Christy E Cauley
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - David L Berger
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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Machairas N, Raptis DA, Velázquez PS, Sauvanet A, de Leon AR, Oba A, Koerkamp BG, Lovasik B, Chan C, Yeo C, Bassi C, Ferrone CR, Kooby D, Moskal D, Tamburrino D, Yoon DS, Barroso E, de Santibañes E, Kauffmann EF, Vigia E, Robin F, Casciani F, Burdío F, Belfiori G, Malleo G, Lavu H, Hartog H, Hwang HK, Han HS, Marques HP, Poves I, Rosado ID, Park JS, Lillemoe KD, Roberts K, Sulpice L, Besselink MG, Abuawwad M, Del Chiaro M, de Santibañes M, Falconi M, D'Silva M, Silva M, Hilal MA, Qadan M, Sell NM, Beghdadi N, Napoli N, Busch OR, Mazza O, Muiesan P, Müller PC, Ravikumar R, Schulick R, Powell-Brett S, Abbas SH, Mackay TM, Stoop TF, Gallagher TK, Boggi U, van Eijck C, Clavien PA, Conlon KCP, Fusai GK. The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing Pancreatoduodenectomy with Concomitant Portomesenteric Venous Resection: An International Multicenter Analysis. Ann Surg 2021; 274:721-728. [PMID: 34353988 DOI: 10.1097/sla.0000000000005132] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers. SUMMARY BACKGROUND DATA Limited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in resectable and borderline resectable pancreatic cancer (R/BR-PDAC) patients. METHODS This multicenter study analyzed consecutive patients with R/BR-PDAC who underwent PD with PVR in 23 high-volume centers from 2009 to 2018. RESULTS Data from 1192 patients with PD and PVR were collected and analyzed. The median age was 68 [interquartile range (IQR) 60-73] years and 52% were males. Some 186 (15.6%) and 131 (10.9%) patients received neoadjuvant chemotherapy (NAC) alone and neoadjuvant chemoradiotherapy (NACRT), respectively. The R0/R1/R2 rates were 57%, 39.3%, and 3.2% in patients who received NAT compared to 46.6%, 49.9%, and 3.5% in patients who did not, respectively (p=0.004). The 1-, 3-, and 5-year OS in patients receiving NAT was 79%, 41%, and 29%, while for those that did not it was 73%, 29%, and 18%, respectively (p<0.001). Multivariable analysis showed no administration of NAT, high tumor grade, lymphovascular invasion, R1/R2 resection, no adjuvant chemotherapy, occurrence of Clavien-Dindo grade 3 or higher postoperative complications within 90 days, preoperative diabetes mellitus, male sex and portal vein involvement were negative independent predictive factors for OS. CONCLUSION Patients with PDAC of the pancreatic head expected to undergo venous reconstruction should routinely be considered for NAT.
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Affiliation(s)
- Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK Department of Surgery, Parc de Salut Mar, Barcelona, Spain Department of Surgery, Hôpital Beaujon, University of Paris, AP-HP, Clichy, France Department of Pancreatic Surgery, National Institute of Medical Sciences and Nutrition, Mexico City, Mexico Division of Surgical Oncology, Department of Surgery, University of Colorado, Anschutz Medical Campus, Colorado, CO, USA Department of Surgery, Erasmus MC, University Medical Center Rotterdam, the Netherlands Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA Department of Surgery, Massachusetts General Hospital, Boston, MA, USA Department of Surgery, University Hospital of Verona, "Pancreas Institute," Verona, Italy Department of Surgery, San Raffaele Hospital IRCCS, Vita-Salute University, Milano, Italy Department of Surgery, Curry Cabral Hospital, CHLC, Lisbon, Portugal Department of Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina Division of General and Transplant Surgery, University of Pisa, Pisa, Italy Department of HPB and Digestive Surgery, Rennes University Hospital, Rennes, France Department of Surgery, Seoul Naional University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea Department of HPB Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK Department of HPB Surgery and Liver Transplant, Queen Elizabeth Hospital, Birmingham, UK Department of HPB Surgery, St. Vincent's University Hospital, Dublin, Ireland Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland Department of Surgery, Gangnam Severance Hospital, Yonsei University, Seoul, Korea Department of Surgery, Emory Saint Joseph's Hospital, Emory University, Atlanta, GA, USA Department of Surgery, Poliambulanza Foundation Hospital, Brescia, Italy Division of Surgery and Interventional Sciences, University College London, London, UK
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Chugh P, He K, Sell NM, Stolarski A, Whang E, Kristo G. Gender disparities during the transition into practice of newly trained surgeons: Are female surgeons left behind? Am J Surg 2021; 222:286-287. [DOI: 10.1016/j.amjsurg.2020.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
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Qwaider YZ, Sell NM, Boudreau C, Stafford CE, Ricciardi R, Cauley CE, Bordeianou LG, Berger DL, Kunitake H, Goldstone RN. Zip Code-Related Income Disparities in Patients with Colorectal Cancer. Am Surg 2021; 88:2314-2319. [PMID: 34102899 DOI: 10.1177/00031348211023435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Screening and early detection reduce morbidity and mortality in colorectal cancer. Our aim is to study the effect of income disparities on the clinical characteristics of patients with colorectal cancer in Massachusetts. METHODS Patients were extracted from a database containing all surgically treated colorectal cancers between 2004 and 2015 at a tertiary hospital in Massachusetts. We split patients into 2 groups: "above-median income" and "below-median income" according to the median income of Massachusetts ($74,167). RESULTS The analysis included 817 patients. The above-median income group consisted of 528 patients (65%) and the below-median income group consisted of 289 patients (35%). The mean age of presentation was 64 ± 15 years for the above-median income group and 67 ± 15 years for the below-median income group (P = .04). Patients with below-median income were screened less often (P < .001) and presented more frequently with metastatic disease (P = .02). Patients with above-median income survived an estimated 15 months longer than those with below-median income (P < .001). The survival distribution was statistically significantly different between the groups for stage III disease (P = .004), but not stages I, II, or IV (P = 1, 1, and .2, respectively). For stage III disease, a lower proportion of below-median income patients received chemotherapy (61% vs. 79%, P = .002) and a higher proportion underwent nonelective surgery (5% vs. 2%, P = .007). CONCLUSIONS In Massachusetts, patients with colorectal cancer residing in lower income areas are screened less, received adjuvant chemotherapy less, and have worse outcomes, especially when analyzing those who present with stage III disease.
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Affiliation(s)
- Yasmeen Z Qwaider
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Naomi M Sell
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Chloe Boudreau
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Caitlin E Stafford
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rocco Ricciardi
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christy E Cauley
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hiroko Kunitake
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert N Goldstone
- Department of General and Gastrointestinal Surgery, 2348Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Sell NM, Cassidy DJ, McKinley SK, Petrusa E, Gee DW, Antonoff MB, Phitayakorn R. A Needs Assessment of Video-based Education Resources Among General Surgery Residents. J Surg Res 2021; 263:116-123. [PMID: 33652173 DOI: 10.1016/j.jss.2021.01.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/10/2021] [Accepted: 01/31/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Video-based education (VBE) is an effective tool for knowledge and skill acquisition for medical students, but its utility is less clear for resident physicians. We sought to determine how to incorporate VBE into a general surgery resident operative curriculum. METHODS We conducted a single-institution, survey-based needs assessment of general surgery residents to determine desired content and format of an operative VBE module. RESULTS The response rate was 84% (53/63), with 66% senior (postgraduate year ≥3) resident respondents. VBE was the most commonly cited resource that residents used to prepare for an operation (93%) compared with surgical textbooks (89%) and text-based website content (57%). Junior residents were more likely to utilize text-based website content than senior residents (P < 0.01). The three most important operative video components were accuracy, length, and cost. Senior residents significantly preferred videos that were peer-reviewed (P < 0.05) and featured attending surgeons whom they knew (P = 0.03). A majority of residents (59%) believed 5-10 min is the ideal length of an operative video. Across all postgraduate year levels, residents indicated that detailed instruction of each operative step was the most important content of a VBE module. Senior residents believed that the overall indications and details of each step of the operation were the most important contents of VBE for a junior resident. CONCLUSIONS At this institution, general surgery residents preferentially use VBE resources for operative preparation. A centralized, standardized operative resource would likely improve resident studying efficiency, but would require personalized learning options to work for both junior and senior surgery residents.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Denise W Gee
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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13
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Atre ID, Eurboonyanun K, Noda Y, Parakh A, O'Shea A, Lahoud RM, Sell NM, Kunitake H, Harisinghani MG. Utility of texture analysis on T2-weighted MR for differentiating tumor deposits from mesorectal nodes in rectal cancer patients, in a retrospective cohort. Abdom Radiol (NY) 2021; 46:459-468. [PMID: 32700214 DOI: 10.1007/s00261-020-02653-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/01/2020] [Revised: 06/27/2020] [Accepted: 07/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of the study was to evaluate the utility of MR texture analysis for differentiating tumor deposits from mesorectal nodes in rectal cancer. MATERIALS AND METHODS Pretreatment MRI of 40 patients performed between 2006 and 2018 with pathologically proven tumor deposits and/or malignant nodes in the setting of rectal cancer were retrospectively reviewed. In total, 25 tumor deposits (TDs) and 71 positive lymph nodes (LNs) were analyzed for morphological and first-order texture analysis features on T2-weighted axial images. MR morphological features (lesion shape, size, signal heterogeneity, contrast enhancement) were analyzed and agreed in consensus by two experienced radiologists followed by assessment with Fisher's exact test. Texture analysis of the lesions was performed using TexRAD, a proprietary software algorithm. First-order texture analysis features (mean, standard deviation, skewness, entropy, kurtosis, MPP) were obtained after applying spatial scaling filters (SSF; 0, 2, 3, 4, 5, 6). Univariate analysis was performed with non-parametric Mann-Whitney U test. The results of univariate analysis were reassessed with generalized estimating equations followed by multivariate analysis. Using histopathology as a gold standard, diagnostic accuracy was assessed by obtaining area under the receiver operating curve. RESULTS MR morphological parameter, lesion shape was a strong discriminator between TDs and LNs with a p value of 0.02 (AUC: 0.76, 95% CI of 0.66 to 0.84, SE: 0.06) and sensitivity, specificity of 90% and 68%, respectively. Skewness extracted at fine filter (SSF-2) was the only significant texture analysis parameter for distinguishing TDs from LNs with p value of 0.03 (AUC: 0.70, 95% CI of 0.59 to 0.79, SE: 0.06) and sensitivity, specificity of 70% and 72%, respectively. When lesion shape and skewness-2 were combined into a single model, the diagnostic accuracy was improved with AUC of 0.82 (SE: 0.05, 95% CI of 0.72 to 0.88 with p value of < 0.01). This model also showed a high sensitivity of 91% with specificity of 68%. CONCLUSION Lesion shape on MR can be a useful predictor for distinguishing TDs from positive LNs in rectal cancer patients. When interpreted along with MR texture parameter of skewness, accuracy is further improved.
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Affiliation(s)
- Isha D Atre
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA.
| | - Kulyada Eurboonyanun
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Yoshifumi Noda
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Anushri Parakh
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Aileen O'Shea
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Rita Maria Lahoud
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Mukesh G Harisinghani
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Room 270, White Building, Boston, MA, 02114, USA
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14
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Ren W, Sell NM, Ferrone CR, Tanabe KK, Lillemoe KD, Qadan M. Size of the Largest Colorectal Liver Metastasis Is an Independent Prognostic Factor in the Neoadjuvant Setting. J Surg Res 2020; 259:253-260. [PMID: 33160635 DOI: 10.1016/j.jss.2020.09.039] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/31/2020] [Accepted: 09/22/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Up to 50% of patients diagnosed with colorectal cancer develop metastases during the course of their disease. Surgical resection remains the only curative treatment option for colorectal liver metastases (CRLM), frequently in conjunction with neoadjuvant chemotherapy. This study sought to determine if the pathologic size of the largest CRLM impacted disease-free survival (DFS) and disease-specific survival (DSS) in the setting of neoadjuvant chemotherapy. METHODS All patients diagnosed with CRLM who underwent neoadjuvant chemotherapy for liver resection at the Massachusetts General Hospital between 2004 and 2016 were reviewed. The median size of the largest liver lesion was used as the cutoff for grouped evaluation. RESULTS A total of 214 patients were included. Median follow-up was 100.0 mo (interquartile range 68.9-133.8 mo). The median size of the largest lesion was 21 mm. Patients with lesions ≥21 mm exhibited significantly worse median DFS (12.5 mo versus 16.6 mo; P = 0.033) and median DSS (71.3 mo versus 103.5 mo; P = 0.038). CRLM lesions ≥21 mm were associated with poorer DFS on univariate analysis (hazard ratio (HR) = 1.42, 95% confidence interval (CI) 1.03-1.95 P = 0.033) and multivariable analysis (HR = 1.58, 95% CI 1.07-2.35, P = 0.023). CRLM lesions ≥21 mm were also independently associated with poorer DSS after liver resection on univariate analysis (HR = 1.51, 95% CI 1.02-2.24; P = 0.037) and multivariable analysis (HR = 1.98, 95% CI: 1.27-3.07; P = 0.002). CONCLUSIONS The size of the largest CRLM is an important prognostic factor for both DFS and DSS after neoadjuvant therapy and serves as a useful indicator of tumor biology.
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Affiliation(s)
- Weizheng Ren
- Department of Hepatopancreatobiliary Surgery, PLA General Hospital, First Medical Center, Beijing, PR China; Harvard Medical School, Boston, Massachusetts
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Cristina R Ferrone
- Harvard Medical School, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Kenneth K Tanabe
- Harvard Medical School, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Keith D Lillemoe
- Harvard Medical School, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Motaz Qadan
- Harvard Medical School, Boston, Massachusetts; Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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McKinley SK, Cassidy DJ, Sell NM, Mullen JT, Saillant N, Petrusa E, Phitayakorn R, Gee D. A qualitative study of the perceived value of participation in a new Department of Surgery Research Residents as teachers program. Am J Surg 2020; 220:1194-1200. [PMID: 32723491 DOI: 10.1016/j.amjsurg.2020.06.056] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 05/06/2020] [Accepted: 06/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study aims to understand the perspectives of surgical residents who completed a Research Residents as Teachers Program (RRATP). METHODS Our RRATP included a 6 h workshop followed by formal teaching opportunities across one academic year. Resident teachers participated in semi-structured interviews, which were inductively analyzed for prominent themes. RESULTS Eight surgical research residents completed the RRATP workshop and taught 330 h (median = 26 h, range: 8-105). Interview participation rate was 100%; kappa was 0.81. Residents reported four themes: 1) increased knowledge of teaching principles with subsequent teaching changes, specific factors that contributed to their development as a teacher, numerous personal benefits to participation, and broad positive consequences for the surgical department including improved culture and patient care. CONCLUSION A RRATP can generate a significant number of formal teaching hours by surgical research residents, who perceive a high value of formal education training to themselves and their surgical residency program.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Douglas J Cassidy
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - John T Mullen
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
| | - Denise Gee
- Department of Surgery, Massachusetts General Hospital, 55 Fruit Street GRB 425, Boston, MA, 02114, USA.
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Qwaider YZ, Sell NM, Stafford CE, Kunitake H, Cusack JC, Ricciardi R, Bordeianou LG, Deshpande V, Goldstone RN, Cauley CE, Berger DL. Infiltrating Tumor Border Configuration is a Poor Prognostic Factor in Stage II and III Colon Adenocarcinoma. Ann Surg Oncol 2020; 28:3408-3414. [PMID: 33105502 DOI: 10.1245/s10434-020-09281-0] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/03/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Tumor border configuration (TBC) is a prognostic factor in colorectal adenocarcinoma; however, the significance of TBC is not well-documented in colon adenocarcinoma alone. OBJECTIVE Our aim was to study the effect of TBC on overall and disease-free survival in stage II and III colon adenocarcinoma. METHODS We included patients with stage II and III colon adenocarcinoma who were surgically treated at a tertiary medical center between 2004 and 2015, to ensure long-term follow-up. Patients were stratified into four groups based on stage and TBC. A Cox regression was used to model the relationship of groups while accounting for relevant confounders. RESULTS The cohort consisted of 700 patients (371 stage II and 329 stage III). Infiltrating TBC was statistically significantly associated with stage (p < 0.001) and extramural vascular invasion (p < 0.001), but not histologic grade (p = 0.7). Compared with pushing TBC, infiltrating TBC increased the hazard of death by a factor of 1.8 [95% confidence interval (CI) 1.4-2.4; p < 0.001] and 1.7 (95% CI 1.3-2.2; p < 0.001). The hazard of death in patients with stage II disease (infiltrating TBC) or stage III disease (pushing TBC) was not significantly different (adjusted hazard ratio 1.1, 95% CI 0.7-1.7; p = 0.8). CONCLUSION Infiltrating TBC is a high-risk feature in patients with stage II and III colon adenocarcinoma. Stage II disease patients with infiltrating TBC and who are node-negative should be considered for adjuvant chemotherapy.
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Affiliation(s)
- Yasmeen Z Qwaider
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Naomi M Sell
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Caitlin E Stafford
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hiroko Kunitake
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - James C Cusack
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rocco Ricciardi
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Robert N Goldstone
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christy E Cauley
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Division of General and Gastrointestinal Surgery, Department of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Sell NM, Qwaider YZ, Goldstone RN, Stafford CE, Cauley CE, Francone TD, Ricciardi R, Bordeianou LG, Berger DL, Kunitake H. Octogenarians present with a less aggressive phenotype of colon adenocarcinoma. Surgery 2020; 168:1138-1143. [PMID: 33041068 DOI: 10.1016/j.surg.2020.08.025] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/08/2020] [Accepted: 08/16/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Octogenarians constitute a growing percentage of patients diagnosed with colon malignancies. This study aims to determine if the clinical and pathologic presentation of octogenarians with colon cancer differs from that of patients diagnosed at a younger age. METHODS Data were collected retrospectively for all patients diagnosed with colon cancer who underwent resection at a single institution between January 1, 2004 and December 31, 2017; patients with rectal cancer were excluded. Patients were categorized by age at diagnosis: either 50 to 79 years of age or ≥80 years of age; those <50 years of age were excluded because of the greater risk of a hereditary etiology. The primary outcome was the correlation between patient age and pathologic features of the tumor, including tumor size, lymph node metastases, perineural invasion, and extramural venous invasion. RESULTS Of 1,301 patients, 329 (25%) were ≥80. Female patients predominated the octogenarian cohort (61% vs 39%; P < .001). Octogenarians presented with larger tumors when compared to patients age 50 to 79 (5.2 cm vs 4.5 cm; P < .001). More patients ≥80 had tumors which were >8 cm (17.3% vs 8.9%; P < .001). Tumors in younger patients were more often detected on screening colonoscopy (23.1% vs 7.3%; P < .001). Regardless of tumor size, octogenarians were less likely to have positive lymph nodes than younger patients (P = .02). In addition, octogenarians were less likely to exhibit extramural venous invasion compared to younger patients across all tumor sizes (P < .001). Younger patients had greater median overall survival (6.4 years vs 4.4 years; P < .001), yet 3-year disease-free survival was comparable between age groups (P = .12). CONCLUSION Octogenarians with colon cancer present with larger tumors but appear to have less aggressive disease, as reflected in a lower pathologic stage, less extramural venous invasion, and less lymph node metastases, than younger patients with similar size tumors. Three-year disease-free survival is comparable between octogenarians and patients aged 50 to 79.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA.
| | | | | | | | - Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Todd D Francone
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | | | - David L Berger
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, MA
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18
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Sell NM, Qwaider YZ, Goldstone RN, Cauley CE, Cusack JC, Ricciardi R, Bordeianou LG, Berger DL, Kunitake H. Ten-year survival after pathologic complete response in rectal adenocarcinoma. J Surg Oncol 2020; 123:293-298. [PMID: 33022797 DOI: 10.1002/jso.26247] [Citation(s) in RCA: 6] [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: 09/16/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multimodal treatment is the standard of care for rectal adenocarcinoma, with a subset of patients achieving a pathologic complete response (pCR). While pCR is associated with improved overall survival (OS), long-term data on patients with pCR is limited. METHODS This is a single institution retrospective cohort study of all patients with clinical stages II/III rectal adenocarcinoma who underwent neoadjuvant chemoradiation therapy and operative resection (January 1, 2004-December 31, 2017). PCR was defined as no tumor identified in the rectum or associated lymph nodes by final pathology. RESULTS Of 370 patients in this cohort, 50 had a pCR (13.5%). For pCR patients, 5-year disease-free survival (DFS) was 92%, 5-year OS was 95%. Twenty-six patients had surgery > 10 years before the study end date, of which 20 had an OS > 10 years (77%) with median OS 12.1 years and 95% alive to date (19/20). Of the 50 pCR patients, there was a single recurrence in the lung at 44.3 months after proctectomy which was surgically resected. CONCLUSION For patients with rectal adenocarcinoma that undergo neoadjuvant chemoradiation and surgical resection, pCR is associated with excellent long-term DFS and OS. Many patients live greater than 10 years with no evidence of disease recurrence.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yasmeen Z Qwaider
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert N Goldstone
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christy E Cauley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James C Cusack
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rocco Ricciardi
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Liliana G Bordeianou
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David L Berger
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hiroko Kunitake
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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19
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Fong ZV, Sell NM, Fernandez-Del Castillo C, Del Carmen G, Ferrone CR, Chang DC, Warshaw AL, Polk HC, Lillemoe KD, Qadan M. Does preoperative pharmacologic prophylaxis reduce the rate of venous thromboembolism in pancreatectomy patients? HPB (Oxford) 2020; 22:1020-1024. [PMID: 31732463 DOI: 10.1016/j.hpb.2019.10.2437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/05/2019] [Accepted: 10/16/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Whether the risk of venous thromboembolism (VTE) may be reduced by preoperative administration of prophylactic heparin is unknown. We hypothesized that timing of heparin administration does not significantly alter the incidence of VTE in pancreatic surgery. METHODS An analysis was conducted using data from Massachusetts General Hospital's National Surgical Quality Improvement Program from 2012 to 2017. All patients admitted for elective pancreatic resection were included. The primary outcome was development of VTE. Multivariable regression was performed, adjusting for patient demographics and various clinical factors. RESULTS In total, 1448 patients were analyzed, of whom 1062 received preoperative heparin (73.3%). Overall, 36 (2.5%) patients developed VTE. On unadjusted analysis, there was no statistically significant difference between patients who received preoperative heparin compared with those who did not (2.6% vs. 1.3%, respectively; p = 0.079). On adjusted analysis, there was an association with increased VTE rates among patients who received preoperative heparin (OR 2.93, 95% CI 1.10-7.81; p = 0.031). CONCLUSION There was an association between preoperative heparin administration and increased incidence of VTE on adjusted analysis, possibly reflecting appropriate surgical judgment in patient selection for prophylaxis. These data question the inclusion of preoperative VTE pharmacologic prophylaxis as a reliable quality indicator.
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Affiliation(s)
- Zhi V Fong
- Department of Surgery, Massachusetts General Hospital, 55, Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, 55, Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | | | - Gabriel Del Carmen
- Department of Surgery, Massachusetts General Hospital, 55, Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, 55, Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, 55, Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, 55, Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Hiram C Polk
- Department of Surgery, Massachusetts General Hospital, 55, Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, 55, Fruit Street, Yawkey 7B, Boston, MA, 02114, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, 55, Fruit Street, Yawkey 7B, Boston, MA, 02114, USA.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston
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McKinley SK, Sell NM, Saillant N, Coe TM, Lau T, Cooper CM, Haynes AB, Petrusa E, Phitayakorn R. Enhancing the Formal Preclinical Curriculum to Improve Medical Student Perception of Surgery. J Surg Educ 2020; 77:788-798. [PMID: 32192888 DOI: 10.1016/j.jsurg.2020.02.009] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 01/03/2020] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND This study aims to determine the effect of formal, preclinical curricular interventions on medical students' perceptions of surgeons, surgical learning objectives, and concerns regarding the surgical clerkship. METHODS Thirty-eight medical students underwent a newly required, formal introduction to surgery during the preclinical curriculum. Two months later, these students were given surveys regarding their perception of surgery before and after a bootcamp-style transitions to the wards workshop that immediately preceded their core clinical rotations. Student responses were compared to historical peers. RESULTS Thirty-seven students participated in the study (97.4%). Relative to historical peers, students demonstrated improved overall perception of surgery (71.2 vs 66.6, p = 0.046). A smaller proportion of students indicated that they were worried about evaluation (18.9% in 2018 vs 55.3% in 2017, p = 0.001) and interactions with surgical educators (18.9% vs 50%, p = 0.005). Students' overall perception of surgery significantly improved after participation in the transition to the wards workshop (71.2 to 77.8, p ≤ 0.0001), as did student agreement with 9 of 21 specific items. Improvement in surgical perception across the bootcamp-style workshop was similar to that of a prior workshop (8.6 in 2018 vs 6.4 in 2017, p = 0.21). CONCLUSIONS A preclinical introduction to surgery can have a positive impact on medical student perception of surgery prior to entry to the wards and may mitigate student fears regarding their surgical rotation.
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Affiliation(s)
- Sophia K McKinley
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts.
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Noelle Saillant
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Taylor M Coe
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Trevin Lau
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Massachusetts
| | - Cynthia M Cooper
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Alex B Haynes
- Surgery and Perioperative Care, Dell Medical School at the University of Texas Austin, Austin, Texas
| | - Emil Petrusa
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Roy Phitayakorn
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
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Molina G, Sell NM, Fernández-Del Castillo C, Ferrone CR, Lillemoe KD, Qadan M. Diagnosis of Depression is Associated with Readmission Following Elective Pancreatectomy. Ann Surg Oncol 2020; 27:4544-4550. [PMID: 32356271 DOI: 10.1245/s10434-020-08522-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Diagnosis of depression may be associated with adverse outcomes following surgery. The aim of this study is to investigate whether depression is associated with an increased readmission rate following elective pancreatectomy, which is currently unknown. METHODS The 2014 Nationwide Readmissions Database was used to evaluate whether diagnosis of depression was associated with 30-day readmission following elective pancreatectomy in adult patients. Univariate and multivariate logistic regression models were adjusted for clustering by facility. A secondary analysis was performed to evaluate whether the risk of diagnosis of depression on 30-day readmission rates was modified by length of stay (median 8 days). All multivariate models were adjusted for patient-level characteristics. RESULTS There were an estimated 11,992 patients who underwent elective pancreatectomy. Mean age was 63 years, and 48.9% were male. Approximately 10.2% (n = 1223) had diagnosis of depression. Depression was associated with higher odds of 30-day readmission following elective pancreatectomy on univariate [odds ratio (OR) 1.26, 95% confidence interval (CI) 1.01-1.59; P = 0.043] and multivariate analyses (OR 1.29, 95% CI 1.01-1.65; P = 0.039). Although length of stay > 8 days was independently associated with higher odds of 30-day readmission (P = 0.005), length of stay did not alter the association between diagnosis of depression and odds of readmission (P = 0.90). CONCLUSIONS Diagnosis of depression was associated with higher odds of 30-day readmission following pancreatectomy, regardless of length of stay. Enhanced focus on evaluation and optimization of perioperative mental health is warranted to identify patients at high risk for readmission and reduce the burden related to readmission following pancreatic surgery.
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Affiliation(s)
- George Molina
- Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | | | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA.
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23
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Fong ZV, Chang DC, Hur C, Jin G, Tramontano A, Sell NM, Warshaw AL, Fernandez-Del Castillo C, Ferrone CR, Lillemoe KD, Qadan M. Variation in long-term oncologic outcomes by type of cancer center accreditation: An analysis of a SEER-Medicare population with pancreatic cancer. Am J Surg 2020; 220:29-34. [PMID: 32265013 DOI: 10.1016/j.amjsurg.2020.03.035] [Citation(s) in RCA: 19] [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: 03/23/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cancer center accreditation is designed to identify centers that provide high-quality cancer care. This also guides patients and referring physicians towards centers of excellence for specialized care. We sought to examine if cancer center accreditation was associated with improved long-term oncologic outcomes in patients with pancreatic adenocarcinoma. METHODS Using the SEER-Medicare database, we identified patients who underwent pancreatectomy for pancreatic adenocarcinoma from 1996 to 2013. Hospitals were categorized into three groups: National Cancer Institute-designated (NCI-designated) centers, Commission on Cancer (CoC)-accredited centers, and "non-accredited" (NA) centers. Multilevel mixed-effects models were used to calculate adjusted examined lymph nodes, disease-specific survival (DSS), and overall survival (OS). RESULTS We identified 5,118 patients who underwent pancreatectomy at 632 hospitals (41.0% NA, 49.6% CoC, 9.4% NCI). NCI-designated centers had a greater median number of lymph nodes examined compared with CoC-accredited or NA centers (14 vs. 10 vs. 11.0 nodes, respectively; p < 0.001). Patients treated at NCI centers had a higher 5-year DSS compared to those treated at CoC or NA centers (31.2% vs. 23.6% vs. 23.0%, respectively; p < 0.001). Finally, patients treated at NCI centers had a higher 5-year OS compared to those treated at CoC or NA centers (23.5% vs. 18.9% vs. 17.9%, respectively; p < 0.001). The associations held true when adjusted analyses were performed. CONCLUSION Patients with resected pancreatic cancer treated at NCI-designated centers were associated with improved long-term oncologic outcomes. There was no difference between CoC-accredited centers compared with NA centers. Meticulous validation of accreditation is warranted globally prior to implementation.
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Affiliation(s)
- Zhi Ven Fong
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David C Chang
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Chin Hur
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Ginger Jin
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Angela Tramontano
- Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, USA
| | - Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew L Warshaw
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | | | | | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
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24
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Sell NM, Ferrone CR. ASO Author Reflections: Staging Laparoscopy Improves Overall Survival of Patients with Pancreatic Adenocarcinoma Found to Have Occult Metastatic Disease. Ann Surg Oncol 2018; 25:830-831. [PMID: 30430323 DOI: 10.1245/s10434-018-7049-6] [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: 11/01/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Naomi M Sell
- Department of Surgery, Massachusetts General Hospital, Boston, USA
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25
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Sell NM, Fong ZV, del Castillo CF, Qadan M, Warshaw AL, Chang D, Lillemoe KD, Ferrone CR. Staging Laparoscopy Not Only Saves Patients an Incision, But May Also Help Them Live Longer. Ann Surg Oncol 2018; 25:1009-1016. [DOI: 10.1245/s10434-017-6317-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Indexed: 12/15/2022]
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Sell NM, Pucci MJ, Gabale S, Leiby BE, Rosato EL, Winter JM, Yeo CJ, Lavu H. The influence of transection site on the development of pancreatic fistula in patients undergoing distal pancreatectomy: A review of 294 consecutive cases. Surgery 2015; 157:1080-7. [PMID: 25791028 DOI: 10.1016/j.surg.2015.01.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 12/15/2014] [Accepted: 01/11/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND Pancreatic fistula (PF) is a significant cause of morbidity in patients undergoing distal pancreatectomy (DP), with an incidence of 15-40%. It remains unclear if the location of pancreatic transection affects the rate of PF occurrence. This study examines the correlation between the transection site of the pancreas during DP and the incidence of PF. METHODS All cases of DP from October 2005 to January 2012 were reviewed retrospectively from an institutional review board-approved database at the Thomas Jefferson University Hospital. Patient demographics and perioperative outcomes were analyzed. The pancreatic transection location was determined by review of operative reports, and then dichotomized into 2 groups: neck/body or tail. PF were graded following the International Study Group on Pancreatic Fistula guidelines. RESULTS During the study period, 294 DP were performed with 244 pancreas transections at the neck/body and 50 at the tail. Of the 294 patients, 52 (17.7%) developed a postoperative PF. The incidence of PF after transection at the tail of the pancreas was higher (28%) when compared with transection at the neck/body (15.6%; P = .04). When stratified by PF grade, grade A PF occurred more commonly when transection of the gland was at the tail (22% tail vs 8.2% neck/body; P = .007); however, no difference was found for grade B/C PF (6% tail vs 7.4% neck/body; P = 1). CONCLUSION Our data suggest that PF occurs more often when the tail is transected during DP, although the majority are low grade and of minimal clinical significance. More severe PF occurred equally between the transection sites.
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Affiliation(s)
- Naomi M Sell
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Michael J Pucci
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Salil Gabale
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin E Leiby
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Ernest L Rosato
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Jordan M Winter
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Charles J Yeo
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Harish Lavu
- Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
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