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Pather K, Mobley EM, Awad ZT. Utility of gastrostomy tube placement at the time of pancreaticoduodenectomy. Surg Endosc 2024; 38:2205-2211. [PMID: 38448619 DOI: 10.1007/s00464-024-10735-9] [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: 08/27/2023] [Accepted: 01/28/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE The aim of this study is to investigate the utility of gastrostomy tube (G-tube) placement in reducing delayed gastric emptying (DGE) among patients undergoing pancreaticoduodenectomy (PD). METHODS We retrospectively reviewed consecutive patients undergoing PD from 2015 to 2020 at our institution. Thirty-day patient outcomes including DGE, length of stay (LOS), reoperation rates, and morbidity were analyzed in patients with or without G-tube placement. RESULTS 128 patients with resectable pancreatic head cancer (54 females, median age 68.50 [59.00-74.00]) underwent PD (66 had G-tube placement and 62 did not). There was no significant difference in the incidence of DGE (n = 17 vs. n = 17, p = 0.612), and LOS between the groups. Postoperative ileus (p = 0.007) was significantly lower while atrial fibrillation (p = 0.037) was higher among the G-tube group. Gastrostomy-related complications (p = 0.001) developed in ten patients: skin-related complications (n = 6), tube dislodgement (n = 3) and clogging (n = 1). Nine patients required reoperation during index admission (n = 4 vs. n = 5, p = 1.000). There was no difference in 30-day readmissions (n = 7 vs. n = 5, p = 0.471) and no difference in 30 or 90-day mortality. CONCLUSION Gastrostomy tube placement during index PD did not affect the incidence of DGE. However, patients experienced significant morbidities due to G-tube-related complications. Placement of gastrostomy tubes at the index PD offers no clinical benefits.
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Affiliation(s)
- Keouna Pather
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 655 W. 8th Street, Jacksonville, FL, 32209, USA
| | - Erin M Mobley
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 655 W. 8th Street, Jacksonville, FL, 32209, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 655 W. 8th Street, Jacksonville, FL, 32209, USA.
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Mobley EM, Guerrier C, Tfirn I, Gutter MS, Vigal K, Pather K, Braithwaite D, Nataliansyah MM, Tsai S, Baskovich B, Awad ZT, Parker AS. Impact of Medicaid Expansion on Stage at Diagnosis for US Adults with Pancreatic Cancer: a Population-Based Study. J Racial Ethn Health Disparities 2023; 10:2826-2835. [PMID: 36596980 DOI: 10.1007/s40615-022-01459-4] [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: 10/04/2021] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION We evaluated whether Medicaid expansion is associated with earlier stage at diagnosis for pancreatic cancer taking into account key demographic, clinical, and geographic factors. METHODS We obtained Surveillance, Epidemiology, and End-Results (SEER-18) data on individuals diagnosed with pancreatic cancer from 2007 to 2016 (< 65 years of age). We defined non-metastatic as either local or regional disease (vs. metastatic disease). To estimate the association of Medicaid expansion with pancreatic cancer stage at diagnosis, we used a difference-in-differences model, at the individual level, comparing those from early-adopting states in 2014 to non-early-adopting states. We utilized cluster-robust standard errors and explored the role of demographic factors (race, sex, insurance at diagnosis), clinical indicator (disease in the head of the pancreas), and county characteristics (Urban Influence Code, Social Deprivation Index). RESULTS In the univariable setting, the probability of non-metastatic disease at diagnosis increased by 3.9 percentage points (ppt) for those from Medicaid expansion states post-expansion (n = 36,609). After adjustment for covariates, the ppt was attenuated to 2.7. Of particular note, we observed evidence of interactions with sex and race. The beneficial effect was less pronounced for men (increase in the probability of non-metastatic stage at diagnosis by 2.1ppt) than women (3.6ppt) and non-existent for blacks (- 3.1ppt) compared to whites (4.9ppt) and other races (4.8ppt). CONCLUSION Medicaid expansion is associated with increased probability of non-metastatic stage at diagnosis for pancreatic cancer; however, this beneficial effect is not uniform across sex and race. This underscores the need to investigate the impact of policy and implementation strategies on pancreatic cancer survival disparities.
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Affiliation(s)
- Erin M Mobley
- Department of Surgery, Division of General Surgery and Surgical Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA.
- University of Florida Health Cancer Center, Gainesville, FL, USA.
| | - Christina Guerrier
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Ian Tfirn
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Michael S Gutter
- University of Florida Health Cancer Center, Gainesville, FL, USA
- Institute for Food and Agricultural Sciences, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Kim Vigal
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Keouna Pather
- Department of Surgery, Division of General Surgery and Surgical Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Dejana Braithwaite
- University of Florida Health Cancer Center, Gainesville, FL, USA
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Mochamad M Nataliansyah
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Susan Tsai
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Brett Baskovich
- Department of Pathology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Ziad T Awad
- Department of Surgery, Division of General Surgery and Surgical Oncology, College of Medicine, University of Florida, Jacksonville, FL, USA
| | - Alexander S Parker
- University of Florida Health Cancer Center, Gainesville, FL, USA
- College of Medicine, University of Florida, Jacksonville, FL, USA
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Mobley EM, Chen G, Xu J, Edgar L, Pather K, Daly MC, Awad ZT, Parker AS, Xie Z, Suk R, Mathews S, Hong YR. Association of Medicaid expansion with 2-year survival and time to treatment initiation in gastrointestinal cancer patients: A National Cancer Database study. J Surg Oncol 2023; 128:1285-1301. [PMID: 37781956 DOI: 10.1002/jso.27456] [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: 07/12/2023] [Revised: 09/10/2023] [Accepted: 09/17/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION We evaluated whether Medicaid expansion (ME) was associated with improved 2-year survival and time to treatment initiation (TTI) among patients with gastrointestinal (GI) cancer. METHODS GI cancer patients diagnosed 40-64 years were queried from the National Cancer Database. Those diagnosed from 2010 to 2012 were considered pre-expansion; those diagnosed from 2014 to 2016 were considered post-expansion. Cox models estimated hazard ratios and 95% confidence intervals (CIs) for 2-year overall survival. Generalized estimating equations (GEE) estimated odds ratios (OR) and 95% CI of TTI within 30- and 90 days. Multivariable Difference-in-Difference models were used to compare expansion/nonexpansion cohorts pre-/post-expansion, adjusting for patient, clinical, and hospital factors. RESULTS 377,063 patients were included. No significant difference in 2-year survival was demonstrated across ME and non-ME states overall or in site-based subgroup analysis. In stage-based subgroup analysis, 2-year survival significantly improved among stage II cancer, with an 8% decreased hazard of death at 2 years (0.92; 0.87-0.97). Those with stage IV had a 4% increased hazard of death at 2 years (1.04; 1.01-1.07). Multivariable GEE models showed increased TTI within 30 days (1.12; 1.09-1.16) and 90 days (1.22; 1.17-1.27). Site-based subgroup analyses indicated increased likelihood of TTI within 30 and 90 days among colon, liver, pancreas, rectum, and stomach cancers, by 30 days for small intestinal cancer, and by 90 days for esophageal cancer. In subgroup analyses, all stages experienced improved odds of TTI within 30 and 90 days. CONCLUSION ME was not associated with significant improvement in 2-year survival for those with GI cancer. Although TTI increased after ME for both cohorts, the 30- and 90-day odds of TTI was higher for those from ME compared with non-ME states. Our findings add to growing evidence of associations with ME for those diagnosed with GI cancer.
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Affiliation(s)
- Erin M Mobley
- Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Guanming Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jie Xu
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Lauren Edgar
- Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Keouna Pather
- Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Meghan C Daly
- Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | - Ziad T Awad
- Division of General Surgery and Surgical Oncology, Department of Surgery, College of Medicine, University of Florida, Jacksonville, Florida, USA
| | | | - Zhigang Xie
- Department of Public Health, University of North Florida, Jacksonville, Florida, USA
| | - Ryan Suk
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida, USA
| | - Simon Mathews
- Division of Gastroenterology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Young-Rock Hong
- Department of Health Services Research, Management, and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
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Alabbas H, Mobley EM, Pather K, Andrews WG, Awad ZT. Does Fixation of the Gastric Conduit Reduce the Incidence of Gastric Volvulus After Esophagectomy? J Gastrointest Surg 2023; 27:3092-3095. [PMID: 37940809 DOI: 10.1007/s11605-023-05871-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Acute volvulus of the gastric conduit is a rare complication after esophagectomy that warrants surgical intervention and is associated with increased morbidity and mortality. The aim of the study is to evaluate whether fixation of the gastric conduit would reduce the incidence of postoperative volvulus following esophagectomy. METHODS This single-center retrospective analysis of patients who underwent esophagectomy was conducted to determine the incidence of acute postoperative volvulus following a change in practice. All patients who underwent an esophagectomy from September 2013 to November 2022 were included. We compared postoperative outcomes of gastric conduit volvulus, reoperations, morbidity, and mortality among those who had fixation versus non-fixation of the conduit to the right pleural edge. RESULTS Two hundred and forty-two consecutive patients underwent minimally invasive esophagectomy (81% male, 41% were < 67 years old). The first 121 (50%) patients did not undergo fixation of the gastric conduit, while the subsequent 121 (50%) patients did undergo fixation. Comparing both groups, there were no significant differences in major complications, anastomotic leak, and 30-day and 90-day all-cause mortality. Four (2%) patients developed gastric conduit volvulus in the non-fixation group, requiring reoperative intervention. Following implementation of fixation, no patient experienced gastric volvulus. CONCLUSION Acute volvulus of the gastric conduit is a rare complication after esophagectomy. Early diagnosis and surgical intervention are critical. In this study, although not statistically significant, fixation of the gastric conduit did reduce the number of patients who experienced postoperative volvulus. Additional future studies are needed to validate this technique and the prevention of postoperative acute gastric conduit volvulus among a diverse patient population.
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Affiliation(s)
- Haytham Alabbas
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, USA
- Department of Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Erin M Mobley
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, USA
| | - Keouna Pather
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, USA
| | - Weston G Andrews
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, USA.
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Cameron ME, Ayzengart AL, Oduntan O, Judge SM, Judge AR, Awad ZT. Low Muscle Mass and Radiodensity Associate with Impaired Pulmonary Function and Respiratory Complications in Patients with Esophageal Cancer. J Am Coll Surg 2023; 236:677-684. [PMID: 36728466 PMCID: PMC10023327 DOI: 10.1097/xcs.0000000000000535] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sixty percent of patients with esophageal cancer display signs of cachexia at diagnosis. Changes in body composition are common, and muscle mass and quality are measurable through imaging studies. Cachexia leads to functional impairments that complicate treatments, including surgery. We hypothesize that low muscle mass and quality associate with pulmonary function testing parameters, highlighting ventilatory deficits, and postoperative complications in patients receiving esophagectomy. STUDY DESIGN We performed a retrospective review of patients receiving esophagectomy between 2012 and 2021 at our facility. PET/CT scans were used to quantify skeletal muscle at the L3 and T4 levels. Patient characteristics were recorded, including pulmonary function testing parameters. Regression models were created to characterize predictive associations. RESULTS One hundred eight patients were identified. All were included in the final analysis. In linear regression adjusted for sex, age, and COPD status, low L3 muscle mass independently associated with low forced vital capacity (p < 0.005, β 0.354) and forced expiratory volume in 1 second (p < 0.001, β 0.392). Similarly, T4 muscle mass independently predicted forced vital capacity (p < 0.005, β 0.524) and forced expiratory volume in 1 second (p < 0.01, β 0.480). L3 muscle quality correlated with total lung capacity ( R 0.2463, p < 0.05). Twenty-six patients had pleural effusions postoperatively, associated with low muscle quality on L3 images (p < 0.05). Similarly, patients with hospitalization more than 2 weeks presented with lower muscle quality (p < 0.005). CONCLUSIONS Cachexia and low muscle mass are common. Reduced muscle mass and quality independently associate with impaired forced vital capacity, forced expiratory volume in 1 second, and total lung capacity. We propose that respiratory muscle atrophy occurs with weight loss. Body composition analyses may aid in stratifying patients. Pulmonary function testing may also serve as a functional endpoint for clinical trials. These findings highlight the need to study mechanisms that lead to respiratory muscle pathology and dysfunction in tumor-bearing hosts.
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Affiliation(s)
- Miles E Cameron
- Department of Physical Therapy, University of Florida, Gainesville, FL
- MD-PhD Training Program, University of Florida, Gainesville, FL
| | - Alexander L Ayzengart
- Department of Surgery, University of Nevada, Reno, NV
- Nevada Surgical Associates, Reno, NV
| | - Olusola Oduntan
- Department of Surgery, University of Florida, Gainesville, FL
| | - Sarah M Judge
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Andrew R Judge
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Ziad T Awad
- Department of Surgery, University of Florida, Jacksonville, FL
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Pather K, Mobley EM, Guerrier C, Esma R, Awad ZT. A Comparison of Clinical and Cost Outcomes After Pancreatectomies at a Safety-net Hospital using a National Registry. Surg Laparosc Endosc Percutan Tech 2023; 33:184-190. [PMID: 36971522 DOI: 10.1097/sle.0000000000001163] [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: 09/26/2022] [Accepted: 02/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Our institution (UFHJ) meets the criteria of both a large, specialized medical center (LSCMC) and a safety-net hospital (AEH). Our aim is to compare pancreatectomy outcomes at UFHJ against other LSCMCs, AEHs, and against institutions that meet criteria for both LSCMC and AEH. In addition, we sought to evaluate differences between LSCMCs and AEHs. MATERIALS AND METHODS Pancreatectomies for pancreatic cancer were queried from the Vizient Clinical Data Base (2018 to 2020). Clinical and cost outcomes were compared between UFHJ and LSCMCs, AEHs, and a combined group, respectively. Indices >1 indicated the observed value was greater than the expected national benchmark value. RESULTS The mean number of pancreatectomy cases performed per institution in the LSCMC group was 12.15, 11.73, and 14.31 in 2018, 2019, and 2020, respectively. At AEHs, 25.33, 24.56, and 26.37 mean cases per institution per year, respectively. In the combined group of both LSCMCs and AEHs, 8.10, 7.60, and 7.22 mean cases, respectively. At UFHJ, 17, 34, and 39 cases were performed each year, respectively. Length of stay index decreased below national benchmarks at UFHJ (1.08 to 0.82), LSCMCs (0.91 to 0.85), and AEHs (0.94 to 0.93), with an increasing case mix index at UFHJ (3.33 to 4.20) from 2018 to 2020. In contrast, length of stay index increased in the combined group (1.14 to 1.18) and overall was the lowest at LSCMCs (0.89). Mortality index declined at UFHJ (5.07 to 0.00) below national benchmarks compared with LSCMCs (1.23 to 1.29), AEHs (1.19 to 1.45), and the combined group (1.92 to 1.99), and was significantly different between all groups ( P <0.001). Thirty-day re-admissions were lower at UFHJ (6.25% to 10.26%) compared with LSCMCs (17.62% to 16.83%) and AEHs (18.93% to 15.51%), and significantly lower at AEHs compared with LSCMCs ( P <0.001). Notably, 30-day re-admissions were lower at AEHs compared with LSCMCs ( P <0.001) and declined over time and were the lowest in the combined group in 2020 (17.72% to 9.52%). Direct cost index at UFHJ declined (1.00 to 0.67) below the benchmark compared with LSCMCs (0.90 to 0.93), AEHs (1.02 to 1.04), and the combined group (1.02 to 1.10). When comparing LSCMCs and AEHs, there were no significant differences between direct cost percentages ( P =0.56); however, the direct cost index was significantly lower at LSCMCs. CONCLUSION Pancreatectomy outcomes at our institution have improved over time exceeding national benchmarks and often were significant to LSCMCs, AEHs, and a combined comparator group. In addition, AEHs were able to maintain good quality care when compared with LSCMCs. This study highlights the role that safety-net hospitals can provide high-quality care to a medically vulnerable patient population in the presence of high-case volume.
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Affiliation(s)
- Keouna Pather
- University of Florida College of Medicine Jacksonville
| | - Erin M Mobley
- University of Florida College of Medicine Jacksonville
| | | | | | - Ziad T Awad
- University of Florida College of Medicine Jacksonville
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Ghannam AD, Crandall ML, Woodruff G, Ra J, Kerwin AJ, Awad ZT, Tepas J. National Surgical Quality Improvement Program Adverse Events Combined With Clavien-Dindo Scores Can Direct Quality Improvement Processes in Surgical Patients. J Patient Saf 2022; 18:e900-e902. [PMID: 35135982 DOI: 10.1097/pts.0000000000000987] [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: 11/25/2022]
Abstract
OBJECTIVE The burden of postoperative adverse events (AE) weighs immediately on the patient as unanticipated stress and on the healthcare system as unreimbursed cost. Applying the Clavien-Dindo (C-D) system of AE gradation as a surrogate of cost, we analyzed 4 years' data from a single-state National Surgical Quality Improvement Program (NSQIP) collaboration, hypothesizing that trends of AE were consistent over time and that more frequently performed cases would be associated with less and more minor AE. METHODS The NSQIP defined AEs, consisting of 21 listed postoperative occurrences, which were analyzed using deidentified 30-day postoperative data for 2015 to 2018. Each AE was graded using (C-D) severity (1, lowest; 4, highest with survival). The C-D severity weight, as defined in previous multi-institutional studies, was used as a surrogate for cost and unplanned patient burden. Adverse event incidence was calculated as sum AE/case volume, and population burden as total AE burden/case volume. RESULTS There were 12,567 surgical cases recorded by members of the state collaborative. The overall data demonstrated no significant difference in AE incidence; however, the burden of AE increased by 18.8%. The 8 most common Current Procedural Terminology codes had approximately 50% lower AE incidence compared with overall cases; however, the incidence increased by 56.0% and the AE burden/case increased by 48.0%. CONCLUSIONS Although the 8 most common Current Procedural Terminology codes showed a 50% lower AE incidence compared with overall cases, the incidence increased over the study period. Surgical quality initiatives should be patient centered and focus on high burden AE.
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Affiliation(s)
- Alexander D Ghannam
- From the Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Marie L Crandall
- From the Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Grant Woodruff
- From the Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Jin Ra
- Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Andrew J Kerwin
- From the Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Ziad T Awad
- From the Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Joseph Tepas
- From the Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
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Pather K, Mobley EM, Guerrier C, Esma R, Kendall H, Awad ZT. Long-term survival outcomes of esophageal cancer after minimally invasive Ivor Lewis esophagectomy. World J Surg Oncol 2022; 20:50. [PMID: 35209914 PMCID: PMC8876443 DOI: 10.1186/s12957-022-02518-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 02/10/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives The aim of this study was to determine the long-term overall and disease-free survival and factors associated with overall survival in patients with esophageal cancer undergoing a totally minimally invasive Ivor Lewis esophagectomy (MILE) at a safety-net hospital. Methods This was a single-center retrospective review of consecutive patients who underwent MILE from September 2013 to November 2017. Overall and disease-free survival were analyzed by Kaplan-Meier estimates, and hazard ratios (HR) were derived from multivariable Cox regression models. Results Ninety-six patients underwent MILE during the study period. Overall survival at 1, 3, and 5 years was 83.2%, 61.9%, and 55.9%, respectively. Disease-free survival at 1, 3, and 5 years was 83.2%, 60.6%, and 47.5%, respectively. Overall survival (p < 0.001) and disease-free survival (p < 0.001) differed across pathological stages. By multivariable analysis, increasing age (HR, 1.06; p = 0.02), decreasing Karnofsky performance status score (HR, 0.94; p = 0.002), presence of stage IV disease (HR, 5.62; p = 0.002), locoregional recurrence (HR, 2.94; p = 0.03), and distant recurrence (HR, 4.78; p < 0.001) were negatively associated with overall survival. Overall survival significantly declined within 2 years and was independently associated with stage IV disease (HR, 3.29; p = 0.04) and distant recurrence (HR, 5.78; p < 0.001). Conclusion MILE offers favorable long-term overall and disease-free survival outcomes. Age, Karnofsky performance status score, stage IV, and disease recurrence are shown to be prognostic factors of overall survival. Prospective studies comparing long-term outcomes after different MIE approaches are warranted to validate survival outcomes after MILE. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-022-02518-0.
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Affiliation(s)
- Keouna Pather
- Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA. .,Division of General Surgery, Faculty Clinic, UF College of Medicine - Jacksonville, 653 West 8th Street, FC12, 3rd Floor, Jacksonville, FL, 32209, USA.
| | - Erin M Mobley
- Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Christina Guerrier
- Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
| | - Rhemar Esma
- UF Health Jacksonville, Jacksonville, Florida, USA
| | | | - Ziad T Awad
- Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida, USA
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Mobley EM, Tfirn I, Guerrier C, Gutter MS, Vigal K, Pather K, Baskovich B, Awad ZT, Parker AS. Impact of Medicaid Expansion on Pancreatic Cancer: An Examination of Sociodemographic Disparity in 1-Year Survival. J Am Coll Surg 2022; 234:75-84. [PMID: 35213464 PMCID: PMC9132328 DOI: 10.1097/xcs.0000000000000018] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND This study examined the effect of Medicaid expansion on 1-year survival of pancreatic cancer for nonelderly adults. We further evaluated whether sociodemographic and county characteristics alter the association of Medicaid expansion and 1-year survival. STUDY DESIGN We obtained data from the Surveillance Epidemiology and End-Results dataset on individuals diagnosed with pancreatic cancer from 2007 to 2015. A Difference-in-Differences model compared those from early-adopting states to non-early-adopting states, before and after adoption (2014), while taking into consideration sociodemographic and county characteristics to estimate the effect of Medicaid expansion on 1-year survival. RESULTS In the univariable Difference-in-Differences model, the probability of 1-year survival for pancreatic cancer increased by 4.8 percentage points (ppt) for those from Medicaid expansion states postexpansion (n = 35,347). After adjustment for covariates, the probability of 1-year survival was reduced to 0.8 ppt. Interestingly, after multivariable adjustment the effect of living in an expansion state on 1-year survival was similar for men and women (0.6 ppt for men vs 1.2 ppt for women), was also similar for Whites (2.6 ppt), and was higher in those of other races (5.9 ppt) but decreased for Blacks (-2.0 ppt). Those who were insured (-0.1 ppt) or uninsured (-2.2 ppt) experienced a decrease in the probability of 1-year survival; however, those who were covered by Medicaid at diagnosis experienced an increase in the probability of 1-year survival (7.4 ppt). CONCLUSIONS Medicaid expansion during or after 2014 is associated with an increase in the probability of 1-year survival for pancreatic cancer; however, this effect is attenuated after adjustment for sociodemographic characteristics. Of note, the positive association was more pronounced in certain categories of key covariates suggesting further inquiry focused on these subgroups.
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Affiliation(s)
- Erin M. Mobley
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, FL
| | - Ian Tfirn
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL
| | - Christina Guerrier
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL
| | - Michael S. Gutter
- Institute for Food and Agricultural Sciences, College of Medicine, University of Florida, Gainesville, FL
| | - Kim Vigal
- Center for Data Solutions, College of Medicine, University of Florida, Jacksonville, FL
| | - Keouna Pather
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, FL
| | - Brett Baskovich
- Department of Pathology, College of Medicine, University of Florida, Jacksonville, FL
| | - Ziad T. Awad
- Department of Surgery, College of Medicine, University of Florida, Jacksonville, FL
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Hacker S, Pather K, Guerrier C, Esma R, Mobley E, Awad ZT. Utility of Gastrostomy Tubes in Pancreaticoduodenectomy Patients. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.07.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mobley EM, Guerrier C, Tfirn I, Vigal K, Hacker S, Pather K, Esma R, Baskovich B, Awad ZT, alexander parker P. Impact of Medicaid Expansion on Pancreatic Cancer Survival: An Examination of Geographic, Racial, and Access Disparities. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pather K, Ravindran K, Guerrier C, Esma R, Kendall H, Hacker S, Awad ZT. Improved Quality of Care and Efficiency Do Not Always Mean Cost Recovery After Minimally Invasive Ivor Lewis Esophagectomy. J Gastrointest Surg 2021; 25:2742-2749. [PMID: 33528787 DOI: 10.1007/s11605-021-04931-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/15/2021] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study is to determine the financial impact of clinical complications and outcomes after minimally invasive Ivor Lewis esophagectomy (MILE) at a safety-net hospital. METHODS This was a single-center retrospective analysis of consecutive patients undergoing MILE from 2013 to 2018. Postoperative complications were classified by Clavien-Dindo grade and associated total and direct recovered costs were assessed. Direct cost and LOS index were defined as the ratio of observed to expected values (>1 denotes above nationwide expectations). Annual outcomes were based on Medicare fiscal years. RESULTS One hundred twenty-four patients (99 males, mean age 65.7 ± 9.3) were surgically treated for esophageal malignancy (n = 118) and benign disease (n = 6) by MILE between 2014 and 2018. Mean ICU LOS (5.8 ± 6.6 versus 4.3 ± 6.3 days) and LOS index (1.16 versus 0.76) improved from 2014 to 2018. Both direct cost index (1.03 versus 0.99) and indirect costs (43.4% versus 41.4%) decreased over time. However, direct costs recovered (213.6 to 159.0%) and total costs recovered (119.1 to 92.5%) declined during this period. Clinical complications grade was not associated with total costs recovered (p = 0.69). Extent of recovered expenditure was significantly higher from commercial/private payers as compared to government-sponsored payers (p < 0.05). CONCLUSION Improvement in clinical outcomes and efficiency of care are not reflected by annual recovered expenditure. Furthermore, clinical complications do not correlate with the ability to recover hospital spending. Financial recovery was primary payer dependent. Enhanced collaboration with hospital administration may be needed in an effort to maximize financial fidelity in the presence of good quality of care after highly complex procedures.
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Affiliation(s)
| | | | - Christina Guerrier
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA
| | - Rhemar Esma
- UF Health-Jacksonville, Jacksonville, FL, USA
| | | | | | - Ziad T Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA.
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Pather K, Ghannam AD, Hacker S, Guerrier C, Mobley EM, Esma R, Awad ZT. Reoperative Surgery After Minimally Invasive Ivor Lewis Esophagectomy. Surg Laparosc Endosc Percutan Tech 2021; 32:60-65. [PMID: 34516475 PMCID: PMC8814731 DOI: 10.1097/sle.0000000000000996] [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: 06/07/2021] [Accepted: 08/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study is to identify factors influencing reoperations following minimally invasive Ivor Lewis esophagectomy and associated mortality and hospital costs. MATERIALS AND METHODS Between 2013 and 2018, 125 patients were retrospectively analyzed. Outcomes included reoperations, mortality, and hospital costs. Multivariable logistic regression analyses determined factors associated with reoperations. RESULTS In-hospital reoperations (n=10) were associated with in-hospital mortality (n=3, P<0.01), higher hospital costs (P<0.01), and longer hospital stay (P<0.01). Conversely, reoperations after discharge were not associated with mortality. By multivariable analysis, baseline cardiovascular (P=0.02) and chronic kidney disease (P=0.01) were associated with reoperations. However, anastomotic leaks were not associated with reoperations nor mortality. CONCLUSION The majority of reoperations occur within 30 days often during index hospitalization. Reoperations were associated with increased in-hospital mortality and hospital costs. Notably, anastomotic leaks did not influence reoperations nor mortality. Efforts to optimize patient baseline comorbidities should be emphasized to minimize reoperations following minimally invasive Ivor Lewis esophagectomy.
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Affiliation(s)
- Keouna Pather
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Alexander D. Ghannam
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Shoshana Hacker
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Christina Guerrier
- Center for Data Solutions, University of Florida College of Medicine, Jacksonville, FL
| | - Erin M. Mobley
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Rhemar Esma
- University of Florida Health, Jacksonville, FL
| | - Ziad T. Awad
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL
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14
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Permuth JB, Dezsi KB, Vyas S, Ali KN, Basinski TL, Utuama OA, Denbo JW, Klapman J, Dam A, Carballido E, Kim DW, Pimiento JM, Powers BD, Otto AK, Choi JW, Chen DT, Teer JK, Beato F, Ward A, Cortizas EM, Whisner SY, Williams IE, Riner AN, Tardif K, Velanovich V, Karachristos A, Douglas WG, Legaspi A, Allan BJ, Meredith K, Molina-Vega MA, Bao P, St. Julien J, Huguet KL, Green L, Odedina FT, Kumar NB, Simmons VN, George TJ, Vadaparampil ST, Hodul PJ, Arnoletti JP, Awad ZT, Bose D, Jiang K, Centeno BA, Gwede CK, Malafa M, Judge SM, Judge AR, Jeong D, Bloomston M, Merchant NB, Fleming JB, Trevino JG. The Florida Pancreas Collaborative Next-Generation Biobank: Infrastructure to Reduce Disparities and Improve Survival for a Diverse Cohort of Patients with Pancreatic Cancer. Cancers (Basel) 2021; 13:809. [PMID: 33671939 PMCID: PMC7919015 DOI: 10.3390/cancers13040809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Well-annotated, high-quality biorepositories provide a valuable platform to support translational research. However, most biorepositories have poor representation of minority groups, limiting the ability to address health disparities. Methods: We describe the establishment of the Florida Pancreas Collaborative (FPC), the first state-wide prospective cohort study and biorepository designed to address the higher burden of pancreatic cancer (PaCa) in African Americans (AA) compared to Non-Hispanic Whites (NHW) and Hispanic/Latinx (H/L). We provide an overview of stakeholders; study eligibility and design; recruitment strategies; standard operating procedures to collect, process, store, and transfer biospecimens, medical images, and data; our cloud-based data management platform; and progress regarding recruitment and biobanking. Results: The FPC consists of multidisciplinary teams from fifteen Florida medical institutions. From March 2019 through August 2020, 350 patients were assessed for eligibility, 323 met inclusion/exclusion criteria, and 305 (94%) enrolled, including 228 NHW, 30 AA, and 47 H/L, with 94%, 100%, and 94% participation rates, respectively. A high percentage of participants have donated blood (87%), pancreatic tumor tissue (41%), computed tomography scans (76%), and questionnaires (62%). Conclusions: This biorepository addresses a critical gap in PaCa research and has potential to advance translational studies intended to minimize disparities and reduce PaCa-related morbidity and mortality.
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Affiliation(s)
- Jennifer B. Permuth
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (K.B.D.); (S.V.); (K.N.A.); (T.L.B.); (O.A.U.); (N.B.K.)
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Kaleena B. Dezsi
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (K.B.D.); (S.V.); (K.N.A.); (T.L.B.); (O.A.U.); (N.B.K.)
| | - Shraddha Vyas
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (K.B.D.); (S.V.); (K.N.A.); (T.L.B.); (O.A.U.); (N.B.K.)
| | - Karla N. Ali
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (K.B.D.); (S.V.); (K.N.A.); (T.L.B.); (O.A.U.); (N.B.K.)
| | - Toni L. Basinski
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (K.B.D.); (S.V.); (K.N.A.); (T.L.B.); (O.A.U.); (N.B.K.)
| | - Ovie A. Utuama
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (K.B.D.); (S.V.); (K.N.A.); (T.L.B.); (O.A.U.); (N.B.K.)
| | - Jason W. Denbo
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Jason Klapman
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Aamir Dam
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Estrella Carballido
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Dae Won Kim
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Jose M. Pimiento
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Benjamin D. Powers
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Amy K. Otto
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL 33612, USA;
| | - Jung W. Choi
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.C.); (D.J.)
| | - Dung-Tsa Chen
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (D.-T.C.); (J.K.T.)
| | - Jamie K. Teer
- Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (D.-T.C.); (J.K.T.)
| | - Francisca Beato
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Alina Ward
- Lee Health Regional Cancer Center, Fort Myers, FL 33905, USA; (A.W.); (B.J.A.); (M.B.)
| | - Elena M. Cortizas
- Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | | | - Iverson E. Williams
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.E.W.); (A.N.R.); (J.G.T.)
| | - Andrea N. Riner
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.E.W.); (A.N.R.); (J.G.T.)
| | - Kenneth Tardif
- Department of Surgery, St. Anthony’s Hospital, St. Petersburg, FL 33705, USA; (K.T.); (J.S.J.); (K.L.H.)
| | - Vic Velanovich
- Tampa General Hospital, University of South Florida, Tampa, FL 33606, USA; (V.V.); (A.K.)
| | - Andreas Karachristos
- Tampa General Hospital, University of South Florida, Tampa, FL 33606, USA; (V.V.); (A.K.)
| | - Wade G. Douglas
- Division of Surgery, Tallahassee Memorial Healthcare, Department of Clinical Sciences, College of Medicine, Florida State University, Tallahassee, FL 32308, USA;
| | - Adrian Legaspi
- Center for Advanced Surgical Oncology at Palmetto General Hospital, Tenet Healthcare Palmetto General, Hialeah, FL 33016, USA;
| | - Bassan J. Allan
- Lee Health Regional Cancer Center, Fort Myers, FL 33905, USA; (A.W.); (B.J.A.); (M.B.)
| | - Kenneth Meredith
- Department of Gastrointestinal Oncology, Brian Jellison Cancer Institute, Sarasota Memorial Hospital, Sarasota, FL 34239, USA;
| | | | - Philip Bao
- Department of Surgical Oncology, Mount Sinai Medical Center, Miami Beach, FL 33140, USA;
| | - Jamii St. Julien
- Department of Surgery, St. Anthony’s Hospital, St. Petersburg, FL 33705, USA; (K.T.); (J.S.J.); (K.L.H.)
| | - Kevin L. Huguet
- Department of Surgery, St. Anthony’s Hospital, St. Petersburg, FL 33705, USA; (K.T.); (J.S.J.); (K.L.H.)
| | - Lee Green
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (L.G.); (V.N.S.); (S.T.V.); (C.K.G.)
| | - Folakemi T. Odedina
- Department of Pharmacotherapy and Translational Research, University of Florida, Gainesville, FL 32610, USA;
| | - Nagi B. Kumar
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (K.B.D.); (S.V.); (K.N.A.); (T.L.B.); (O.A.U.); (N.B.K.)
| | - Vani N. Simmons
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (L.G.); (V.N.S.); (S.T.V.); (C.K.G.)
| | - Thomas J. George
- Division of Oncology, Department of Medicine, University of Florida, Gainesville, FL 32610, USA;
| | - Susan T. Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (L.G.); (V.N.S.); (S.T.V.); (C.K.G.)
- Office of Community Outreach, Engagement, and Equity, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA
| | - Pamela J. Hodul
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - J. Pablo Arnoletti
- Center for Surgical Oncology, Advent Health Orlando, Orlando, FL 32804, USA;
| | - Ziad T. Awad
- Surgery, University of Florida-Jacksonville, Jacksonville, FL 32209, USA;
| | - Debashish Bose
- Surgical Oncology, University of Florida-Orlando, Orlando, FL 32806, USA;
| | - Kun Jiang
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (K.J.); (B.A.C.)
| | - Barbara A. Centeno
- Department of Pathology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (K.J.); (B.A.C.)
| | - Clement K. Gwede
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (L.G.); (V.N.S.); (S.T.V.); (C.K.G.)
| | - Mokenge Malafa
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Sarah M. Judge
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, USA; (S.M.J.); (A.R.J.)
| | - Andrew R. Judge
- Department of Physical Therapy, University of Florida, Gainesville, FL 32610, USA; (S.M.J.); (A.R.J.)
| | - Daniel Jeong
- Department of Diagnostic Imaging and Interventional Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.C.); (D.J.)
| | - Mark Bloomston
- Lee Health Regional Cancer Center, Fort Myers, FL 33905, USA; (A.W.); (B.J.A.); (M.B.)
| | - Nipun B. Merchant
- Department of Surgical Oncology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Jason B. Fleming
- Department of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA; (J.W.D.); (J.K.); (A.D.); (E.C.); (D.W.K.); (J.M.P.); (B.D.P.); (F.B.); (P.J.H.); (M.M.); (J.B.F.)
| | - Jose G. Trevino
- College of Medicine, University of Florida, Gainesville, FL 32610, USA; (I.E.W.); (A.N.R.); (J.G.T.)
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Virginia Commonwealth University, Richmond, VA 23219, USA
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Pather K, Deladisma AM, Guerrier C, Kriley IR, Awad ZT. Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy. Surg Endosc 2021; 36:896-903. [PMID: 33580319 DOI: 10.1007/s00464-021-08346-9] [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: 10/24/2020] [Accepted: 01/27/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Anastomotic leak is a serious complication following esophagectomy. The aim of the study was to report our experience with indocyanine green fluorescence angiography (ICG-FA)-PINPOINT® assisted minimally invasive Ivor Lewis esophagectomy (MILE) and assess factors associated with anastomotic leak. METHODS We reviewed consecutive patients undergoing MILE from 2013 to 2018. Intraoperative real-time assessment of gastric conduit was performed using ICG-FA with PINPOINT®. Perfusion was categorized as good perfusion (brisk ICG visualization to conduit tip) or non-perfusion (any demarcation along the conduit). RESULTS 100 patients (81 males, median age 68 [60-72]) underwent MILE for malignancy in 96 patients and benign disease in 4 patients. There were six anastomotic leaks all managed with endoscopic stent placement. There was no intraoperative mortality and no 30-day mortality in leak patients. Patients with a leak were more likely to be overweight with BMI > 25 (100% versus 53%, p = 0.03), have pre-existing diabetes (50% versus 13%, p = 0.04), and have higher intraoperative estimated blood loss (260 mL [95-463] versus 75 mL [48-150], p = 0.03). Anastomotic leaks occurred more frequently in the non-perfusion (67%) versus the good perfusion category (33%, p = 0.03). By multivariable analysis, diabetes (odds ratio [OR] 6.42; p = 0.04) and non-perfusion (OR 6.60; p = 0.04) were independently associated with leak. CONCLUSION Intraoperative use of ICG-FA may be a useful adjunct to assess perfusion of the gastric conduit with non-perfusion being independently associated with a leak. While perfusion plays an important role in anastomotic integrity, development of a leak is multifactorial, and ICG-FA should be used in conjunction with the optimization of patient and procedural components to minimize leak rates. Prospective, randomized studies are required to validate the interpretation, efficacy, and application of this novel technology in minimally invasive esophagectomies.
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Affiliation(s)
- Keouna Pather
- Department of Surgery, UF Health, 653 West 8th Street, Jacksonville, FL, 32209, USA.
| | - Adeline M Deladisma
- Department of Surgery, UF Health, 653 West 8th Street, Jacksonville, FL, 32209, USA
| | | | - Isaac R Kriley
- Department of Surgery, UF Health, 653 West 8th Street, Jacksonville, FL, 32209, USA
| | - Ziad T Awad
- Department of Surgery, UF Health, 653 West 8th Street, Jacksonville, FL, 32209, USA.,University of Florida, Jacksonville, FL, USA
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Awad ZT, Rhemar R, Guerrier C. Quality of Care and Efficiency Does Not Always Mean Cost Recovery. J Am Coll Surg 2020. [DOI: 10.1016/j.jamcollsurg.2020.08.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Awad ZT, Abbas S, Puri R, Dalton B, Chesire DJ. Minimally Invasive Ivor Lewis Esophagectomy (MILE): technique and outcomes of 100 consecutive cases. Surg Endosc 2020; 34:3243-3255. [DOI: 10.1007/s00464-020-07529-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
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Weyh AM, Gurien L, Awad ZT. Esophageal Squamous Cell Carcinoma in a 31-Year-Old Woman with Chronic Congenital Tracheoesophageal Fistula. Am Surg 2020; 86:e20-e21. [PMID: 32077427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Weyh AM, Gurien L, Awad ZT. Esophageal Squamous Cell Carcinoma in a 31-Year-Old Woman with Chronic Congenital Tracheoesophageal Fistula. Am Surg 2020. [DOI: 10.1177/000313482008600111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashleigh M. Weyh
- Department of Oral Maxillofacial Surgery University of Florida Jacksonville Jacksonville, Florida
| | - Lori Gurien
- Department of Surgery University of Florida Jacksonville Jacksonville, Florida
| | - Ziad T. Awad
- Department of Surgery University of Florida Jacksonville Jacksonville, Florida
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Abbas S, Awad ZT, Dalton B, Puri R. Perfusion Assessment during Minimally Invasive Ivor Lewis Esophagectomy: Experience of 100 Consecutive Patients. J Am Coll Surg 2019. [DOI: 10.1016/j.jamcollsurg.2019.08.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sabra MJ, Crandall M, Smotherman C, Awad ZT. Does serum albumin explain observed racial disparities in mortality for cancer patients undergoing esophagectomy? Am J Surg 2018; 216:778-781. [PMID: 30077314 DOI: 10.1016/j.amjsurg.2018.07.047] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/11/2018] [Accepted: 07/17/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND African Americans with esophageal cancer have a higher mortality rate than Caucasians. We hypothesized that nutritional status, as reflected by preoperative albumin, might explain these disparities. METHODS The National Surgical Quality Improvement Program database was queried for patients undergoing esophagectomy for esophageal cancer between 2005 and 2015. Preoperative albumin was divided into five categories (<3.0, 3.0-3.4, 3.5-3.9, 4.0-4.4, and >4.4). Univariate and multivariable regression statistics were performed to determine an association between preoperative albumin levels on mortality. RESULTS 3228 patients were studied. While preoperative albumin was associated with lower body mass index, more severe preoperative weight loss, and more respiratory comorbidities (p-values <0.05), albumin levels were not associated with race. On multivariable models including race and other covariates, we found no association of serum albumin and mortality. CONCLUSIONS We found that race was an independent predictor of mortality for patients undergoing esophagectomy. However, preoperative albumin did not explain these disparities.
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Affiliation(s)
- Michel J Sabra
- Department of Surgery, University of Florida College of Medicine Jacksonville, USA
| | - Marie Crandall
- Department of Surgery, University of Florida College of Medicine Jacksonville, USA.
| | - Carmen Smotherman
- Center for Health Equity and Quality Research (CHEQR) at the University of Florida College of Medicine Jacksonville, USA
| | - Ziad T Awad
- Department of Surgery, University of Florida College of Medicine Jacksonville, USA
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Gurien LA, Tepas JJ, Lind DS, Chesire DJ, Sabra MJ, Dalton BGA, Awad ZT. How Safe Is the Safety Net? Comparison of Ivor-Lewis Esophagectomy at a Safety-Net Hospital Using the NSQIP Database. J Am Coll Surg 2018; 226:680-684. [DOI: 10.1016/j.jamcollsurg.2017.12.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 12/11/2017] [Indexed: 11/28/2022]
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Dalton BGA, Ali AA, Crandall M, Awad ZT. Near infrared perfusion assessment of gastric conduit during minimally invasive Ivor Lewis esophagectomy. Am J Surg 2017; 216:524-527. [PMID: 29203037 DOI: 10.1016/j.amjsurg.2017.11.026] [Citation(s) in RCA: 16] [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: 09/27/2017] [Revised: 10/31/2017] [Accepted: 11/06/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Anastomotic leak and conduit necrosis are devastating complications following Ivor Lewis esophagectomy. Near infrared imaging (NIR) using IndoCyanine Green allows for real time tissue perfusion assessment which may reduce anastomotic leak during minimally invasive Ivor Lewis esophagectomy (MIE). METHODS Forty consecutive MIE were performed by a single surgeon at a tertiary referral center. The first 20 were assessed for gastric conduit perfusion by clinical criteria (Group 1). The second 20 were also assessed using NIR laparoscopic system (Group 2). RESULTS Comparing Group 1 to Group 2, no significant differences were found in overall complication rate, readmission or reoperation rate. NIR resulted in resection of the non perfused proximal portion of the conduit in 30% (6/20). Two patients in group 2 group developed anastomotic leak (2/20) compared to 0 in Group 1 (p = 0.49). Graft necrosis led to one mortality in Group 1, while there were 0 mortalities in Group 2. (p = 1.0). CONCLUSION Although NIR plays a role in assessment of tissue perfusion, in our study its use did not result in reduction of anastomotic leak rate.
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Affiliation(s)
- Brian G A Dalton
- Department of Surgery, University of Florida Health- Jacksonville, United States
| | - Abubaker A Ali
- Department of Surgery, University of Florida Health- Jacksonville, United States
| | - Marie Crandall
- Department of Surgery, University of Florida Health- Jacksonville, United States
| | - Ziad T Awad
- Department of Surgery, University of Florida Health- Jacksonville, United States.
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Sabra MJ, Smotherman C, Kraemer DF, Nussbaum MS, Tepas JJ, Awad ZT. The effects of neoadjuvant therapy on morbidity and mortality of esophagectomy for esophageal cancer: American college of surgeons national surgical quality improvement program (ACS-NSQIP) 2005-2012. J Surg Oncol 2016; 115:296-300. [DOI: 10.1002/jso.24493] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Michel J. Sabra
- Department of Surgery; University of Florida College of Medicine; Jacksonville Florida
| | - Carmen Smotherman
- Center for Health Equity and Quality Research (CHEQR); University of Florida; Jacksonville Florida
| | - Dale F. Kraemer
- Center for Health Equity and Quality Research (CHEQR); University of Florida; Jacksonville Florida
| | - Michael S. Nussbaum
- Department of Surgery; University of Florida College of Medicine; Jacksonville Florida
| | - Joseph J. Tepas
- Department of Surgery; University of Florida College of Medicine; Jacksonville Florida
| | - Ziad T. Awad
- Department of Surgery; University of Florida College of Medicine; Jacksonville Florida
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Jalaj S, Lee SY, McGaw C, John BK, Li Z, Awad ZT, Scolapio JS, Munoz JC. Proton radiotherapy dose perturbations caused by esophageal stents of varying material composition are negligible in an experimental model. Endosc Int Open 2015; 3:E46-50. [PMID: 26134771 PMCID: PMC4423262 DOI: 10.1055/s-0034-1390709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 09/08/2014] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Self-expanding metal and plastic esophageal stents (SEMS and SEPS, respectively) are used in conjunction with chemoradiation for palliation of malignant dysphagia. To date, the dosimetric effects of stents undergoing proton radiotherapy are not known. STUDY AIM To investigate the proton radiotherapy dose perturbations caused by esophageal stents of varying designs and materials undergoing external beam treatment for esophageal cancer. PATIENTS AND METHODS Simulated clinical protocol. Solid acrylic phantom was used to mimic the esophageal tissue environment. Stents made of nitinol, stainless steel and polyester were tested. Proton beam dose of 2 Gy-E was delivered to each stent in a single anterior to posterior field. Film and image based evidence of dose perturbation were main outcomes measured. RESULTS Only the stainless steel and plastic stents demonstrated slight overall dose attenuations (- 0.5 % and - 0.4 %, respectively). All the nitinol-based stents demonstrated minimal overall dose perturbations ranging from 0.0 % to 1.2 %. Negligible dose perturbations were observed on each of the stent surfaces proximal to the radiation source, ranging from - 0.8 % (stainless steel stent) to 1.0 % (nitinol stent). Negligible dose effects were also observed on the distal surfaces of each stent ranging from - 0.5 % (plastic and stainless steel stents) to 1.0 % (nitinol stent). CONCLUSION Proton radiotherapy dose perturbations caused by stents of varying designs and material composition are negligible. Negligible dose perturbation is in keeping with the inherent advantage of proton therapy over traditional radiotherapy composed of photons - given its relative large mass, protons have little side scatter.
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Affiliation(s)
- Sujai Jalaj
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States,Corresponding author Sujai Jalaj, MD Division of Gastroenterology, Department of MedicineUniversity of Florida, Jacksonville College of Medicine655 West 8th Street, B0138-C290Jacksonville, FL 32209+1–904–244–2165
| | - Sang Yeob Lee
- Department of Radiation Oncology, University of Florida, Proton Therapy Institute, Jacksonville, Florida, United States
| | - Camille McGaw
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
| | - Bijo K John
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
| | - Zuofeng Li
- Department of Radiation Oncology, University of Florida, Proton Therapy Institute, Jacksonville, Florida, United States
| | - Ziad T Awad
- Department of Surgery, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
| | - James S Scolapio
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
| | - Juan C Munoz
- Division of Gastroenterology, Department of Medicine, University of Florida, Jacksonville College of Medicine, Jacksonville, Florida, United States
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Awad ZT. Totally laparoscopic pancreaticoduodenectomy for pancreatic head cancer with involvement of the superior mesenteric vein-portal vein confluence. Ann Surg Oncol 2014; 21:3439. [PMID: 24841345 DOI: 10.1245/s10434-014-3736-0] [Citation(s) in RCA: 10] [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] [Received: 03/11/2014] [Indexed: 11/18/2022]
Abstract
UNLABELLED Laparoscopic pancreaticoduodenectomy is a technically demanding procedure. In this video, we demonstrate the technical aspects of performing the procedure. In a 50-year-old male with ascending cholangitis, endoscopic retrograde cholangiopancreatography was unsuccessful, and percutaneous transhepatic cholangiography was carried out for biliary decompression. Endoscopic ultrasound plus fine-needle aspiration showed pancreatic head adenocarcinoma. The procedure was carried out using five trocars, and extensive lymphadenectomy was undertaken. The uncinate process was skeletonized off the superior mesenteric artery. The right lateral aspect of the superior mesenteric vein-portal vein confluence was involved with the cancer. The laparoscopic linear stapler was used to transect part of the vein en bloc with the specimen. All margins were negative and all the anastomoses were done using laparoscopic intracorporeal suturing. Operative time was 8 h 20 min, and hospital stay was 5 days. Final pathology was T3 N1 (one lymph node out of 40 was positive). CONCLUSION Laparoscopic pancreaticoduodenectomy can be performed safely in selected cases of pancreatic head cancer with vascular involvement. Skilled laparoscopic skills are necessary to execute such procedures safely.
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Affiliation(s)
- Ziad T Awad
- Division of Minimally Invasive Surgery, Department of Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA,
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Awad ZT, Griffin R. Laparoscopic right hemicolectomy: a comparison of natural orifice versus transabdominal specimen extraction. Surg Endosc 2014; 28:2871-6. [PMID: 24789131 DOI: 10.1007/s00464-014-3540-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 03/10/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Conventional laparoscopic right hemicolectomy (LRH) involves making an abdominal incision to remove the specimen and perform the anastomosis. Totally laparoscopic right hemicolectomy with natural orifice specimen extraction (NOSE) may lead to better outcomes compared to LRH. STUDY DESIGN Forty consecutive female patients total were reviewed: 20 LRH and 20 NOSE. The two groups were matched for sex, age, race, American Society of Anesthesiologist score, benign and malignant disease, tumor stage, lymph node number, tumor size, specimen length, body mass index, previous abdominal surgeries, and comorbidities. RESULTS The two groups were comparable for all categories. Follow-up was available on all patients (100%). The mean follow-up was 38.93 months (range 15-63 months). There was no difference between postoperative pain score between the two groups on postoperative day (POD) 1, POD 2, and POD day 14 (p = 0.571), (p = 0.861), (p = 0.688), respectively. There was no difference in the postoperative in-hospital morphine equivalents (p = 0.963). The NOSE group had no postoperative hernia formation or wound infections compared to the LRH, however, the difference was not significant (p = 0.439) and (p = 0.267), respectively. There was no difference in postoperative ileus (p = 0.192), septic complications (p = 1.000), readmission rate (p = 0.394), time interval for postoperative chemotherapy (p = 0.645), SDS (p = 0.446) or QLI (p = 0.175). There was no difference in length of hospital stay with 5.3 days for the LRH group and 7.7 days for the NOSE group (p = 0.183). The NOSE group had statistically significant better cosmetic scores (p = 0.018). CONCLUSION NOSE is comparable LRH with regard to postoperative outcomes and quality of life. NOSE is safe and maintains strict oncologic standards. NOSE is associated with a better cosmetic outcome compared to LRH.
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Affiliation(s)
- Ziad T Awad
- Department of Surgery, University of Florida College of Medicine Jacksonville, 633 W 8th Street, Jacksonville, FL, 32209, USA,
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Lee RY, Nichols RC, Huh SN, Ho MW, Li Z, Zaiden R, Awad ZT, Ahmed B, Hoppe BS. Proton therapy may allow for comprehensive elective nodal coverage for patients receiving neoadjuvant radiotherapy for localized pancreatic head cancers. J Gastrointest Oncol 2013; 4:374-9. [PMID: 24294509 DOI: 10.3978/j.issn.2078-6891.2013.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/17/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Neoadjuvant radiotherapy has the potential to improve local disease control for patients with localized pancreatic cancers. Concern about an increased risk of surgical complications due to small bowel and gastric exposure, however, has limited enthusiasm for this approach. Dosimetric studies have demonstrated the potential for proton therapy to reduce intestinal exposure compared with X-ray-based therapy. We sought to determine if neoadjuvant proton therapy allowed for field expansions to cover high-risk nodal stations in addition to the primary tumor. METHODS Twelve consecutive patients with nonmetastatic cancers of the pancreatic head underwent proton-based planning for neoadjuvant radiotherapy. Gross tumor volume was contoured using diagnostic computed tomography (CT) scans with oral and intravenous contrast. Four-dimensional planning scans were utilized to define an internal clinical target volume (ICTV). Five-mm planning target volume (PTV) expansions on the ICTV were generated to establish an initial PTV (PTV1). A second PTV was created using the initial PTV but was expanded to include the high-risk nodal targets as defined by the RTOG contouring atlas (PTV2). Optimized proton plans were generated for both PTVs for each patient. All PTVs received a dose of 50.4 cobalt gray equivalent (CGE). Normal-tissue exposures to the small bowel space, stomach, right kidney, left kidney and liver were recorded. Point spinal cord dose was limited to 45 CGE. RESULTS Median PTV1 volume was 308.75 cm(3) (range, 133.33-495.61 cm(3)). Median PTV2 volume was 541.75 cm(3) (range, 399.44-691.14 cm(3)). In spite of the substantial enlargement of the PTV when high-risk lymph nodes were included in the treatment volume, normal-tissue exposures (stomach, bowel space, liver, and kidneys) were only minimally increased relative to the exposures seen when only the gross tumor target was treated. CONCLUSIONS Proton therapy appears to allow for field expansions to cover high-risk lymph nodes without significantly increasing critical normal-tissue exposure in the neoadjuvant setting.
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Affiliation(s)
- Richard Y Lee
- Radiation Medicine, Roswell Park Cancer Institute, University at Buffalo, NY, USA
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Nichols RC, George TJ, Zaiden RA, Awad ZT, Asbun HJ, Huh S, Ho MW, Mendenhall NP, Morris CG, Hoppe BS. Proton therapy with concomitant capecitabine for pancreatic and ampullary cancers is associated with a low incidence of gastrointestinal toxicity. Acta Oncol 2013; 52:498-505. [PMID: 23477361 DOI: 10.3109/0284186x.2012.762997] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND To review treatment toxicity for patients with pancreatic and ampullary cancer treated with proton therapy at our institution. MATERIAL AND METHODS From March 2009 through April 2012, 22 patients were treated with proton therapy and concomitant capecitabine (1000 mg PO twice daily) for resected (n = 5); marginally resectable (n = 5); and unresectable/inoperable (n = 12) biopsy-proven pancreatic and ampullary adenocarcinoma. Two patients with unresectable disease were excluded from the analysis for reasons unrelated to treatment. Proton doses ranged from 50.40 cobalt gray equivalent (CGE) to 59.40 CGE. RESULTS Median follow-up for all patients was 11 (range 5-36) months. No patient demonstrated any grade 3 toxicity during treatment or during the follow-up period. Grade 2 gastrointestinal toxicities occurred in three patients, consisting of vomiting (n = 3); and diarrhea (n = 2). Median weight loss during treatment was 1.3 kg (1.75% of body weight). Chemotherapy was well-tolerated with a median 99% of the prescribed doses delivered. Percentage weight loss was reduced (p = 0.0390) and grade 2 gastrointestinal toxicity was eliminated (p = 0.0009) in patients treated with plans that avoided anterior and left lateral fields which were associated with reduced small bowel and gastric exposure. DISCUSSION Proton therapy may allow for significant sparing of the small bowel and stomach and is associated with a low rate of gastrointestinal toxicity. Although long-term follow-up will be needed to assess efficacy, we believe that the favorable toxicity profile associated with proton therapy may allow for radiotherapy dose escalation, chemotherapy intensification, and possibly increased acceptance of preoperative radiotherapy for patients with resectable or marginally resectable disease.
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Affiliation(s)
- R. Charles Nichols
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Thomas J. George
- Department of Hematology and Medical Oncology, University of Florida,
Gainesville and Jacksonville, Florida, USA
| | - Robert A. Zaiden
- Department of Hematology and Medical Oncology, University of Florida,
Gainesville and Jacksonville, Florida, USA
| | - Ziad T. Awad
- Department of Surgery, University of Florida,
Jacksonville, FL, USA
| | | | - Soon Huh
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | - Meng Wei Ho
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
| | | | | | - bradford S. Hoppe
- University of Florida Proton Therapy Institute,
Jacksonville, Florida, USA
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Griffin R, Villas B, Davis C, Awad ZT. Carcinoma of the tail of the pancreas presenting as acute abdomen. JOP 2012; 13:58-60. [PMID: 22233948] [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] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 12/03/2011] [Indexed: 05/31/2023]
Abstract
CONTEXT Large bowel obstruction with perforation is an anomalous presentation of pancreatic tail carcinoma. Pancreatic cancer is often difficult to diagnose clinically and is especially furtive when it is located in the tail of the pancreas. CASE REPORT We describe a patient who presented with large bowel obstruction due to splenic flexure mass which proved to be due to pancreatic mucinous adenocarcinoma. CONCLUSIONS Pancreatic adenocarcinoma can rarely have the same presentation as colon cancer, and should therefore be considered in the differential diagnosis of large bowel obstruction.
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Affiliation(s)
- Reginald Griffin
- Department of Surgery, University of FloridaCollege of Medicine, Jacksonville, FL32209, USA
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Wood M, Lazo C, Hassid V, Awad ZT. Replaced common hepatic artery from superior mesenteric artery during pancreaticoduodenectomy. Gulf J Oncolog 2012:60-62. [PMID: 22227547] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2011] [Indexed: 05/31/2023]
Abstract
The hepatic arterial anatomy is highly variable. A 67 year female with pancreatic mass and replaced common hepatic artery originating from the superior mesenteric artery underwent pancreaticoduodenectomy (PD). The anomalous vessel was discovered on preoperative CT scan and MRI. The vessel was dissected and preserved as it passed dorsal to the pancreas. Preservation of the blood supply to the liver and biliary tree is important after PD to prevent biliary fistula and hepatic ischaemia.
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Affiliation(s)
- M Wood
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA
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32
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Awad ZT. Laparoscopic subtotal colectomy with transrectal extraction of the colon and ileorectal anastomosis. Surg Endosc 2011; 26:869-71. [PMID: 21938571 DOI: 10.1007/s00464-011-1926-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 03/24/2011] [Accepted: 06/02/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite the growing acceptance of laparoscopic colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. METHODS Five trocars (one 12 mm and four 5 mm) were used. The video describes the technique of performing laparoscopic subtotal colectomy, laparoscopic cholecystectomy, transrectal removal of the gallbladder and the entire colon, and intracorporeal stapled ileorectal anastomosis in a 27-year-old female with colonic inertia and biliary dyskinesia. RESULTS There were no intraoperative complications. The operating time was 180 min. Blood loss was 10 cc. The patient was discharged home on postoperative day 4. CONCLUSION Laparoscopic subtotal colectomy with transrectal removal of the colon is a safe and effective procedure that can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to NOTES colon surgery.
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Affiliation(s)
- Ziad T Awad
- Division of Minimally Invasive Surgery, Department of Surgery, University of Florida College of Medicine Jacksonville, 633 West 8th Street, Jacksonville, FL 32209, USA.
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Abstract
BACKGROUND Despite the growing acceptance of laparoscopic colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. METHODS Five trocars (one 12 mm and four 5 mm) were used. The video describes the technique of performing laparoscopic subtotal colectomy, laparoscopic cholecystectomy, transrectal removal of the gallbladder and the entire colon, and intracorporeal stapled ileorectal anastomosis in a 27-year-old female with colonic inertia and biliary dyskinesia. RESULTS There were no intraoperative complications. The operating time was 180 min. Blood loss was 10 cc. The patient was discharged home on postoperative day 4. CONCLUSION Laparoscopic subtotal colectomy with transrectal removal of the colon is a safe and effective procedure that can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to NOTES colon surgery.
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Affiliation(s)
- Ziad T Awad
- Division of Minimally Invasive Surgery, Department of Surgery, University of Florida College of Medicine Jacksonville, 633 West 8th Street, Jacksonville, FL 32209, USA.
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Sharma SK, Awad ZT, Narasanna C, Rimmalapudi V, Hester S. P-34 Single center experience of SILS gastric bypass using EEA technique. Surg Obes Relat Dis 2011. [DOI: 10.1016/j.soard.2011.04.035] [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] [Indexed: 10/18/2022]
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Suresh A, Celso BG, Awad ZT. Seprafilm slurry does not increase complication rates after laparoscopic colectomy. Surg Endosc 2011; 25:2661-5. [DOI: 10.1007/s00464-011-1624-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 02/06/2011] [Indexed: 10/18/2022]
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Affiliation(s)
- Amanda K. Hester
- University of Florida College of Medicine-Jacksonville Faculty Clinic Jacksonville, Florida
| | - Daryhl L. Johnson
- University of Florida College of Medicine-Jacksonville Faculty Clinic Jacksonville, Florida
| | - Ziad T. Awad
- University of Florida College of Medicine-Jacksonville Faculty Clinic Jacksonville, Florida
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37
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Hester AK, Johnson DL, Awad ZT. Spontaneous splenic rupture due to splenic metastasis of esophageal cancer. Am Surg 2010; 76:1025. [PMID: 20836358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Abstract
This case of sigmoidorectal intussusception was caused by a large tubovillous adenoma and managed with laparoscopic sigmoidectomy. Adult intussusception is an uncommon entity. Surgical resection is required because of the high incidence of pathological lead point. We report a case of sigmoidorectal intussusception caused by a large tubulovillous adenoma. The patient underwent laparoscopic sigmoidectomy.
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Affiliation(s)
- C Travis Greenley
- Department of Surgery, Minimally Invasive Surgery, University of Florida, Jacksonville, Florida 32209, USA
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Affiliation(s)
- J C Munoz
- Division of Gastroenterology, University of Florida College of Medicine/Jacksonville, Jacksonville, Florida 32207, USA
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40
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Hassid VJ, Orlando FA, Awad ZT, Tan D, Khoury T, Ahmed BH, Alrawi SJ. Genetic and molecular abnormalities in cholangiocarcinogenesis. Anticancer Res 2009; 29:1151-6. [PMID: 19414358 PMCID: PMC4011011] [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: 03/18/2023]
Abstract
Cholangiocarcinomas are biliary tree neoplasms of cholangiocyte origin. Several clinical risk factors are associated with cholangiocarcinogenesis. During the last decade, there has been an increasing interest in the causative molecular mechanisms of cholangiocarcinoma because of its poor prognosis and the lack of effective therapies. A better understanding of cholangiocarcinoma tumor initiation, promotion, and progression, as well as neurotransmitter, neuroendocrine, and endocrine growth effects, may elucidate molecular targets for diagnostic and therapeutic purposes.
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Affiliation(s)
- Victor J Hassid
- Surgical Oncology Specialties, Cancer Center of Jacksonville, Jacksonville, FL 32256, USA
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41
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Geiger TM, Awad ZT, Burgard M, Singh A, Davis W, Thaler K, Miedema BW. Prognostic indicators of quality of life after cholecystectomy for biliary dyskinesia. Am Surg 2008; 74:400-404. [PMID: 18481495] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Approximately 30 per cent of patients who undergo cholecystectomy for biliary dyskinesia will continue to have symptoms after surgery. Quality of life has not been evaluated but may be decreased in these patients. The purpose of this study was to measure quality of life after laparoscopic cholecystectomy in these patients to better define optimal treatment of biliary dyskinesia. All patients with biliary dyskinesia (defined as the absence of gallstones, and a gallbladder ejection fraction of <35%) who underwent cholecystectomy at our institution from January 31, 2000 to January 31, 2005 were identified. Preoperative data including ultrasound, biochemical data, and pathology were retrieved by chart review. Postoperative assessment included the Gastrointestinal Quality of Life Index and a symptom survey. The postoperative quality of life was compared with historic standards. The quality of life was also compared with preoperative variables to determine if any variables predicted outcome. A total of 66 patients were identified as fitting the inclusion criteria. Forty-three patients were reached by phone and 30 agreed to participate. Patients were noted to have good recall as to preoperative symptoms when the retrospective survey of symptoms was compared with the medical record. The mean +/- SD postoperative quality of life in the study population was 113 +/- 20. This is higher than in historic patients with gallbladder disease before (84 +/- 19) and after (102 +/- 13) cholecystectomy. Quality of life in the study group was lower than the healthy control (125 +/- 13). Patients having both postprandial nausea and vomiting before surgery had a lower quality of life (P < 0.029) after surgery as compared with those without these preoperative symptoms. When adjusted for nausea and vomiting, the quality of life in study patients (119 +/- 14) was similar to normal controls. No other symptom, laboratory, pathologic, or sonographic data were predictive of a lower quality of life. Cholecystectomy is beneficial for most patients with biliary dyskinesia. Nausea and vomiting were negative predictors of quality of life after cholecystectomy. These patients with nausea and vomiting may have a global gastrointestinal motility disorder and are less likely to benefit from cholecystectomy.
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Affiliation(s)
- Timothy M Geiger
- Department of General Surgery, University of Missouri-Columbia,Columbia, Missouri 65212, USA
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Geiger TM, Awad ZT, Burgard M, Singh A, Davis W, Thaler K, Miedema BW. Prognostic Indicators of Quality of Life after Cholecystectomy for Biliary Dyskinesia. Am Surg 2008. [DOI: 10.1177/000313480807400507] [Citation(s) in RCA: 9] [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: 11/15/2022]
Abstract
Approximately 30 per cent of patients who undergo cholecystectomy for biliary dyskinesia will continue to have symptoms after surgery. Quality of life has not been evaluated but may be decreased in these patients. The purpose of this study was to measure quality of life after laparoscopic cholecystectomy in these patients to better define optimal treatment of biliary dyskinesia. All patients with biliary dyskinesia (defined as the absence of gallstones, and a gallbladder ejection fraction of <35%) who underwent cholecystectomy at our institution from January 31, 2000 to January 31, 2005 were identified. Preoperative data including ultrasound, biochemical data, and pathology were retrieved by chart review. Postoperative assessment included the Gastrointestinal Quality of Life Index and a symptom survey. The postoperative quality of life was compared with historic standards. The quality of life was also compared with preoperative variables to determine if any variables predicted outcome. A total of 66 patients were identified as fitting the inclusion criteria. Forty-three patients were reached by phone and 30 agreed to participate. Patients were noted to have good recall as to preoperative symptoms when the retrospective survey of symptoms was compared with the medical record. The mean ± SD postoperative quality of life in the study population was 113 ± 20. This is higher than in historic patients with gallbladder disease before (84 ± 19) and after (102 ± 13) cholecystectomy. Quality of life in the study group was lower than the healthy control (125 ± 13). Patients having both postprandial nausea and vomiting before surgery had a lower quality of life ( P < 0.029) after surgery as compared with those without these preoperative symptoms. When adjusted for nausea and vomiting, the quality of life in study patients (119 ± 14) was similar to normal controls. No other symptom, laboratory, pathologic, or sonographic data were predictive of a lower quality of life. Cholecystectomy is beneficial for most patients with biliary dyskinesia. Nausea and vomiting were negative predictors of quality of life after cholecystectomy. These patients with nausea and vomiting may have a global gastrointestinal motility disorder and are less likely to benefit from cholecystectomy.
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Affiliation(s)
- Timothy M. Geiger
- From the Department of General Surgery, University of Missouri-Columbia, Columbia, Missouri; the
| | - Ziad T. Awad
- Department of Surgery, University of Florida-Shands Jacksonville, Jacksonville, Florida
| | - Michael Burgard
- From the Department of General Surgery, University of Missouri-Columbia, Columbia, Missouri; the
| | - Amolak Singh
- From the Department of General Surgery, University of Missouri-Columbia, Columbia, Missouri; the
| | - Wade Davis
- Department of Health Management and Informatics, University of Missouri-Columbia, Columbia, Missouri
- Department of Statistics, University of Missouri-Columbia, Columbia, Missouri
| | - Klaus Thaler
- From the Department of General Surgery, University of Missouri-Columbia, Columbia, Missouri; the
| | - Brent W. Miedema
- From the Department of General Surgery, University of Missouri-Columbia, Columbia, Missouri; the
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Ahmed BH, Ahmed A, Tan D, Awad ZT, Al-Aali AY, Kilkenny J, Orlando FA, Al-Chalabi A, Crass R, Alrawi SJ. Post-laparoscopic cholecystectomy pain: effects of intraperitoneal local anesthetics on pain control--a randomized prospective double-blinded placebo-controlled trial. Am Surg 2008; 74:201-209. [PMID: 18376682] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Postoperative pain after laparoscopic cholecystectomy (LC) is generally less than open cholecystectomy; however, the postoperative shoulder and abdominal pain experienced by patients still causes preventable distress. Intraperitoneal irrigation of the diaphragmatic surface and gallbladder fossa using normal saline, bupivacaine, or lignocaine may effectively control visceral abdominal pain after an LC. Two hundred patients with similar demographics undergoing elective LC were randomized to one of four groups of 50 patients each, including Group A placebo control, Group B with isotonic saline irrigation, Group C with bupivacaine irrigation, and Group D with lignocaine irrigation. All patients received preperitoneal abdominal wall infiltration with 0.25 per cent bupivacaine to control parietal (somatic) abdominal pain. The visual analogue and verbal rating pain scores at 0, 4, 8, 12 and 24 hours for both shoulder and abdominal pain were recorded in a prospective double-blind fashion at four points during the first 24 postoperative hours. Analgesia requirements, vital signs, blood glucose, and incidence of nausea and vomiting were also recorded. Patients in each group demonstrated a significant difference in visual analogue and verbal rating pain scores and analgesic consumption when compared with controls. Lignocaine controlled pain significantly better than saline or bupivacaine. Bowel function recovery was similar in all patients, and there were no significant complications. We conclude that intraperitoneal irrigation with either saline, bupivacaine, or lignocaine can significantly reduce visceral abdominal pain after LC. Lignocaine was the most efficacious local anesthetic in this trial and has a high safety profile when used at recommended doses.
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Affiliation(s)
- Bestoun H Ahmed
- Department of General Surgery, University of Florida, Jacksonville, Florida 32209, USA.
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Ahmed BH, Ahmed A, Tan D, Awad ZT, Al-Aali AY, Kilkenny J, Orlando FA, Al-Chalabi A, Crass R, Alrawi SJ. Post-Laparoscopic Cholecystectomy Pain: Effects of Intraperitoneal Local Anesthetics on Pain Control–A Randomized Prospective Double-Blinded Placebo-Controlled Trial. Am Surg 2008. [DOI: 10.1177/000313480807400304] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Postoperative pain after laparoscopic cholecystectomy (LC) is generally less than open cholecystectomy; however, the postoperative shoulder and abdominal pain experienced by patients still causes preventable distress. Intraperitoneal irrigation of the diaphragmatic surface and gallbladder fossa using normal saline, bupivacaine, or lignocaine may effectively control visceral abdominal pain after an LC. Two hundred patients with similar demographics undergoing elective LC were randomized to one of four groups of 50 patients each, including Group A placebo control, Group B with isotonic saline irrigation, Group C with bupivacaine irrigation, and Group D with lignocaine irrigation. All patients received preperitoneal abdominal wall infiltration with 0.25 per cent bupivacaine to control parietal (somatic) abdominal pain. The visual analogue and verbal rating pain scores at 0, 4, 8, 12 and 24 hours for both shoulder and abdominal pain were recorded in a prospective double-blind fashion at four points during the first 24 postoperative hours. Analgesia requirements, vital signs, blood glucose, and incidence of nausea and vomiting were also recorded. Patients in each group demonstrated a significant difference in visual analogue and verbal rating pain scores and analgesic consumption when compared with controls. Lignocaine controlled pain significantly better than saline or bupivacaine. Bowel function recovery was similar in all patients, and there were no significant complications. We conclude that intraperitoneal irrigation with either saline, bupivacaine, or lignocaine can significantly reduce visceral abdominal pain after LC. Lignocaine was the most efficacious local anesthetic in this trial and has a high safety profile when used at recommended doses.
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Affiliation(s)
- Bestoun H. Ahmed
- Department of General Surgery, University of Florida, Jacksonville, Florida
| | - Aryan Ahmed
- Department of General Surgery/Anesthesia/Biostatistics, Hamad General Hospital, Qatar; and the
| | - Dongfeng Tan
- Department of General Surgery/Anesthesia/Biostatistics, Hamad General Hospital, Qatar; and the
| | - Ziad T. Awad
- Department of General Surgery, University of Florida, Jacksonville, Florida
| | - Ali Yousef Al-Aali
- Department of General Surgery/Anesthesia/Biostatistics, Hamad General Hospital, Qatar; and the
| | - John Kilkenny
- Department of General Surgery, University of Florida, Jacksonville, Florida
| | - Frank A. Orlando
- Department of General Surgery, University of Florida, Jacksonville, Florida
| | - Abbas Al-Chalabi
- Department of General Surgery/Anesthesia/Biostatistics, Hamad General Hospital, Qatar; and the
| | - Richard Crass
- Department of General Surgery, University of Florida, Jacksonville, Florida
| | - Sadir J. Alrawi
- Department of General Surgery, University of Florida, Jacksonville, Florida
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Liess BD, Awad ZT, Eubanks WS. Laparoscopic cholecystectomy for isolated traumatic rupture of the gallbladder following blunt abdominal injury. J Laparoendosc Adv Surg Tech A 2007; 16:623-5. [PMID: 17243883 DOI: 10.1089/lap.2006.16.623] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 01/13/2023] Open
Abstract
Gallbladder rupture following blunt abdominal trauma is a rare event usually recognized on evaluation and treatment of other visceral injuries during laparotomy. Isolated gallbladder rupture secondary to blunt abdominal trauma is even more uncommon. Delay in the diagnosis of the injury for several days due to no, or vague, symptoms and an insidious course is common. Early diagnosis is essential, as protracted treatment may result in significant morbidity and mortality. We report the case of a patient who suffered isolated gallbladder rupture due to blunt abdominal trauma from a fall. We propose laparoscopic cholecystectomy as a safe and effective surgical treatment for this solitary injury.
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Affiliation(s)
- Benjamin D Liess
- Department of General Surgery, University of Missouri Hospital and Clinics, Columbia, Missouri 65212, USA
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Kolder D, Geiger T, Tharakan AK, Kessel JW, Awad ZT. Massive hemoperitoneum from transhepatic perforation of the gallbladder. Mt Sinai J Med 2006; 73:1135-6. [PMID: 17285213] [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] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Perforation of the gallbladder occurs in 1.6%-2.8% of cases of gallbladder disease. Transhepatic rupture of the gall bladder is rare, with fewer than 20 cases reported in literature. We report a case of transhepatic rupture of the gall bladder with massive hemoperitoneum, which required emergency laparotomy and control of hemorrhage.
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Affiliation(s)
- Dan Kolder
- Department of Surgery, University of Missouri Hospital and Clinics, MC 418 McHaney Hall, One Hospital Drive, Columbia, MO 65212, USA.
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Geiger TM, Tebb ZD, Sato E, Miedema BW, Awad ZT. Laparoscopic resection of colon cancer and synchronous liver metastasis. J Laparoendosc Adv Surg Tech A 2006; 16:51-3. [PMID: 16494549 DOI: 10.1089/lap.2006.16.51] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The recommended surgical approach to synchronous colorectal metastasis has not been clarified. Simultaneous open liver and colon resection for synchronous colorectal carcinoma has been shown beneficial when compared to staged resections. A review of the literature has shown the benefits of both laparoscopic colon resection for colorectal cancer and laparoscopic left lateral segmentectomy in liver disease. We present the case of a 60-year-old male with sigmoid colon carcinoma and a synchronous solitary liver metastasis localized to the left lateral segment. Using laparoscopic techniques, we were able to achieve simultaneous resection of the sigmoid colon and left lateral liver segment.
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Affiliation(s)
- Timothy M Geiger
- Department of Surgery, University of Missouri-Columbia, McHaney Hall 4th Floor, 1 Hospital Drive, Columbia, MO 65212. USA.
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Abstract
Small-bowel obstruction secondary to internal hernia is a known postoperative complication of laparoscopic Roux-en-Y gastric bypass (RYGBP). Petersen's defect is the most common site of postoperative internal herniation. The authors describe their technique of closure of the infracolic component of the Petersen's defect using continuous non-absorbable suture material. The method has been used successfully to reduce the incidence of internal herniation after laparoscopic RYGBP.
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Affiliation(s)
- Melissa H Coleman
- Division of Laparoscopic Bariatric Surgery, New York Presbyterian Hospital-Weill Cornell Medical Center, New York, NY 10021, USA
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Bessler M, Awad ZT. Editorial comment. Surg Obes Relat Dis 2006. [DOI: 10.1016/j.soard.2006.03.003] [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: 11/30/2022]
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