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Nayak AL, Pickett AT, Delisle M, Dingley B, Mallick R, Hamilton T, Stuart H, Talbot M, McKinnon G, Jost E, Thiboutot E, Francescutti V, Samman S, Easson A, Schellenberg A, Merchant S, La J, Vanderbeck K, Wright F, Berger-Richardson D, Hebbard P, Hershorn O, Younan R, Patocskai E, Rodriguez-Qizilbash S, Meguerditichian A, Tchuente V, Kazandjian S, Mathieson A, Hossain F, Hetu J, Corsten M, Tohmé A, Nessim C, Johnson-Obaseki S. Survival of Patients With Head and Neck Merkel Cell Cancer: Findings From the Pan-Canadian Merkel Cell Cancer Collaborative. JAMA Netw Open 2023; 6:e2344127. [PMID: 37983027 PMCID: PMC10660167 DOI: 10.1001/jamanetworkopen.2023.44127] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/10/2023] [Indexed: 11/21/2023] Open
Abstract
Importance Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine carcinoma. Due to its relatively low incidence and limited prospective trials, current recommendations are guided by historical single-institution retrospective studies. Objective To evaluate the overall survival (OS) of patients in Canada with head and neck MCC (HNMCC) according to American Joint Committee on Cancer 8th edition staging and treatment modalities. Design, Setting, and Participants A retrospective cohort study of 400 patients with a diagnosis of HNMCC between July 1, 2000, and June 31, 2018, was conducted using the Pan-Canadian Merkel Cell Cancer Collaborative, a multicenter national registry of patients with MCC. Statistical analyses were performed from January to December 2022. Main Outcomes and Measures The primary outcome was 5-year OS. Multivariable analysis using a Cox proportional hazards regression model was performed to identify factors associated with survival. Results Between 2000 and 2018, 400 patients (234 men [58.5%]; mean [SD] age at diagnosis, 78.4 [10.5] years) with malignant neoplasms found in the face, scalp, neck, ear, eyelid, or lip received a diagnosis of HNMCC. At diagnosis, 188 patients (47.0%) had stage I disease. The most common treatment overall was surgery followed by radiotherapy (161 [40.3%]), although radiotherapy alone was most common for stage IV disease (15 of 23 [52.2%]). Five-year OS was 49.8% (95% CI, 40.7%-58.2%), 39.8% (95% CI, 26.2%-53.1%), 36.2% (95% CI, 25.2%-47.4%), and 18.5% (95% CI, 3.9%-41.5%) for stage I, II, III, and IV disease, respectively, and was highest among patients treated with surgery and radiotherapy (49.9% [95% CI, 39.9%-59.1%]). On multivariable analysis, patients treated with surgery and radiotherapy had greater OS compared with those treated with surgery alone (hazard ratio [HR], 0.76 [95% CI, 0.46-1.25]); however, this was not statistically significant. In comparison, patients who received no treatment had significantly worse OS (HR, 1.93 [95% CI, 1.26-2.96)]. Conclusions and Relevance In this cohort study of the largest Canada-wide evaluation of HNMCC survival outcomes, stage and treatment modality were associated with survival. Multimodal treatment was associated with greater OS across all disease stages.
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Affiliation(s)
- Ameeta Lubina Nayak
- Department of Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Arthur Travis Pickett
- Department of Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Megan Delisle
- Department of Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Brittany Dingley
- Department of Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ranjeeta Mallick
- Department of Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Trevor Hamilton
- BC Cancer, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Heather Stuart
- BC Cancer, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Martha Talbot
- BC Cancer, Department of Surgery, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Gregory McKinnon
- Department of Surgery, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Evan Jost
- Department of Surgery, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Eva Thiboutot
- Department of Surgery, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Valerie Francescutti
- Department of Surgery, Hamilton Health Sciences Center, McMaster University, Hamilton, Ontario, Canada
| | - Sal Samman
- Department of Surgery, Hamilton Health Sciences Center, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra Easson
- Department of Surgery, Princess Margaret Hospital, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Angela Schellenberg
- Department of Surgery, Princess Margaret Hospital, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
| | - Shaila Merchant
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Julie La
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
| | - Kaitlin Vanderbeck
- Department of Surgery, Queen’s University, Kingston, Ontario, Canada
- Now with Department of Pathology, Queen’s University, Kingston, Ontario, Canada
| | - Frances Wright
- Department of Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | | | - Pamela Hebbard
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Olivia Hershorn
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rami Younan
- Department of Surgery, Centre Hospitalier de L’Université de Montreal, Montreal, Quebec, Canada
| | - Erica Patocskai
- Department of Surgery, Centre Hospitalier de L’Université de Montreal, Montreal, Quebec, Canada
| | | | - Ari Meguerditichian
- Department of Surgery, McGill University Health Network, Montreal, Quebec, Canada
| | - Vanina Tchuente
- Department of Surgery, McGill University Health Network, Montreal, Quebec, Canada
| | - Suzanne Kazandjian
- Department of Surgery, McGill University Health Network, Montreal, Quebec, Canada
| | - Alex Mathieson
- Department of Surgery, Memorial University, St-John’s, Newfoundland, Canada
| | - Farisa Hossain
- Department of Surgery, Memorial University, St-John’s, Newfoundland, Canada
| | - Jessika Hetu
- Department of Surgery, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Martin Corsten
- Head and Neck Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Angelina Tohmé
- Department of Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Carolyn Nessim
- Department of Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stephanie Johnson-Obaseki
- Department of Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
- Department of Otolaryngology-Head and Neck Surgery, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
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Sioufi J, Hall B, Antel R, Moussa S, Subasri M, Fakih M, Islam N, Hamdy RC, Chopra S, Harley JM, Keuhl A, Bassilious E, Sherbino J, Bilgic E, Bondok MS, Bondok M, Martel L, Law C, Posel N, Fleiszer D, Daud A, Hauer T, Carr-Pries N, Hali K, Wolfstadt J, Ferguson P, Ghasroddashti A, Sorefan-Mangou F, Del Fernandes R, Williams E, Choi K, Zevin B, Patterson ED, Kirupaharan S, Mann S, Winthrop A, Zevin B, Bondok M, Ghanmi N, Etherington C, Saddiki Y, Lefebvre I, Berthelot P, Dion PM, Raymond B, Seguin J, Sekhavati P, Islam S, Boet S, Tee T, Pachchigar P, Tarabay B, Yilmaz R, Hamdan NA, Agu C, Almansouri A, Harley J, Del Maestro R, Bondok M, Bondok MS, Nguyen AXL, Law C, Nathoo N, Bakshi N, Ahuja N, Damji KF, Grewal K, Azher S, Moreno M, Pekrun R, Wiseman J, Fried GM, Lajoie S, Brydges R, Hadwin A, Sun NZ, Khalil E, Harley JM, Nguyen ELV, Patel P, Muaddi H, Rukavina N, Bucur R, Shwaartz C, Islam N, Moussa S, Subasri M, Fakih M, Hamdy RC, Wong E, Tewari A, Brydges R, Louridas M, Balaji S, Patel P, Muaddi H, Gaebe K, Luzzi C, Kay A, Rukavina N, Selzner M, Reichman T, Shwaartz C, Balaji S, Muaddi H, Shahabinezhad A, Patel P, Rukavina N, Reichman T, Jayaraman S, Shwaartz C, Nashed J, Ramelli L, Kolasky O, Dickenson T, Dullege M, Kang A, Winthrop A, Mann S, Lau D, Henkelman E, Jacob J, Watson I, Haji F, McEwen CC, Jaffer I, Sibbald M, Blouin V, Bénard F, Pelletier F, Abdo S, Meloche-Dumas L, Kapralos B, Dubrowski A, Patocskai E, Pachchigar P, Agu C, Yilmaz R, Tee T, Maestro RD, Adedipe I, Stephens C, Ghebretatios M, Laplante S, Patel P, Balaji S, Muaddi H, Rukavina N, Shwaartz C, Brodovsky M, Lai C, Behzadi A, Blair G, Almansouri A, Hamdan NA, Yilmaz R, Tee T, Pachchigar P, Eskandari M, Agu C, Giglio B, Balasubramaniam N, Bierbrier J, Collins DL, Gueziri HE, Del Maestro RF, Koonar E, Ramazani F, Hart R, Henley J, Roberts S, Chandarana S, Matthews W, Schrag C, Matthews J, Mackenzie D, Cutting C, Lui J, Delisle É, Cordoba T, Cordoba C, Giglio B, Lacroix A, Cairns J, Alsayegh A, Alhantoobi M, Balasubramaniam N, Safih W, Hamel M, Del Maestro R, Francis G, Moise A, Omar Y, Hathi K, Mavedatnia D, Grose E, Philips T, Schneider C, Corbin D, Lesage F, Pellerin M, Ben-Ali W, Tamani Z, Joly-Chevrier M, Bénard F, Meloche-Dumas L, Laflamme L, Boulva K, Younan R, Dubrowski A, Patocskai E, Sticca G, Petruccelli J, Dorion D, Osman Y, Bénard F, Habti M, Meloche-Dumas L, Duranleau X, Boulva K, Kaviani A, Younan R, Dubrowski A, Vessella K, Patocskai E, Valji R, Turner S, Lam T, Mobilio MH, Hirsh J, Lising D, Cil T, Marcon E, Moulton CA, D'Souza A, Milazzo T, Datta S, Valiquette C, Avery E, Voineskos S, Musgrave M, Wanzel K, Schneidman J, Armstrong N, Gerardis G, Silver J, Azzam MA, Fisher R, Banks I, Young M, Nguyen LH, Skakum M, Hancock BJ, Min SL, Youssef F, Keijzer R, Morris M, Shawyer A, Retrosi G. C-CASE 2023: Promoting Excellence in Surgical Education: Canadian Conference for the Advancement of Surgical Education, Oct. 12-13, 2023, Montréal, Quebec. Can J Surg 2023; 66:S137-S150. [PMID: 38065582 PMCID: PMC10718643 DOI: 10.1503/cjs.014523] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Affiliation(s)
- Jeffrey Sioufi
- From the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que
- From the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Moussa, Subasri, Fakih, Islam); and the Shriners Hospital for Children and Division of Orthopaedics, Montreal Children's Hospital, Montréal, Que. (Hamdy)
| | - Brandon Hall
- From the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que
- From the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Moussa, Subasri, Fakih, Islam); and the Shriners Hospital for Children and Division of Orthopaedics, Montreal Children's Hospital, Montréal, Que. (Hamdy)
| | - Ryan Antel
- From the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que
- From the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Moussa, Subasri, Fakih, Islam); and the Shriners Hospital for Children and Division of Orthopaedics, Montreal Children's Hospital, Montréal, Que. (Hamdy)
| | | | | | | | | | | | - Sonaina Chopra
- From McMaster University, Hamilton, Ont. (Chopra, Keuhl, Bassilious, Sherbino, Bilgic); and McGill University, Montreal, Que. (Harley)
| | - Jason M Harley
- From McMaster University, Hamilton, Ont. (Chopra, Keuhl, Bassilious, Sherbino, Bilgic); and McGill University, Montreal, Que. (Harley)
| | - Amy Keuhl
- From McMaster University, Hamilton, Ont. (Chopra, Keuhl, Bassilious, Sherbino, Bilgic); and McGill University, Montreal, Que. (Harley)
| | - Ereny Bassilious
- From McMaster University, Hamilton, Ont. (Chopra, Keuhl, Bassilious, Sherbino, Bilgic); and McGill University, Montreal, Que. (Harley)
| | - Jonathan Sherbino
- From McMaster University, Hamilton, Ont. (Chopra, Keuhl, Bassilious, Sherbino, Bilgic); and McGill University, Montreal, Que. (Harley)
| | - Elif Bilgic
- From McMaster University, Hamilton, Ont. (Chopra, Keuhl, Bassilious, Sherbino, Bilgic); and McGill University, Montreal, Que. (Harley)
| | - Mohamed S Bondok
- From the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the UBC Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); and the Department of Ophthalmology, School of Medicine, Queen's University, Kingston, Ont. (Law)
- From McGill University, Montréal, Que
| | - Mostafa Bondok
- From the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the UBC Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); and the Department of Ophthalmology, School of Medicine, Queen's University, Kingston, Ont. (Law)
- From McGill University, Montréal, Que
| | - Liana Martel
- From the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the UBC Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); and the Department of Ophthalmology, School of Medicine, Queen's University, Kingston, Ont. (Law)
- From McGill University, Montréal, Que
| | - Christine Law
- From the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the UBC Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Martel); and the Department of Ophthalmology, School of Medicine, Queen's University, Kingston, Ont. (Law)
- From McGill University, Montréal, Que
| | | | | | - Anser Daud
- From the University of Toronto, Toronto, Ont
| | - Tyler Hauer
- From the University of Toronto, Toronto, Ont
| | | | - Kalter Hali
- From the University of Toronto, Toronto, Ont
| | | | | | | | | | | | | | - Ken Choi
- From Queen's University, Kingston, Ont
| | | | - Ethan D Patterson
- From Queen's University, Kingston, Ont
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (Bondok); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Ghanmi, Saddiki, Lefebvre, Berthelot, Dion, Raymond, Seguin, Sekhavati, Islam); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Etherington, Boet); the Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Ont (Boet); and the Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ont. (Boet)
| | - Sawmmiya Kirupaharan
- From Queen's University, Kingston, Ont
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (Bondok); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Ghanmi, Saddiki, Lefebvre, Berthelot, Dion, Raymond, Seguin, Sekhavati, Islam); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Etherington, Boet); the Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Ont (Boet); and the Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ont. (Boet)
| | - Steve Mann
- From Queen's University, Kingston, Ont
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (Bondok); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Ghanmi, Saddiki, Lefebvre, Berthelot, Dion, Raymond, Seguin, Sekhavati, Islam); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Etherington, Boet); the Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Ont (Boet); and the Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ont. (Boet)
| | - Andrea Winthrop
- From Queen's University, Kingston, Ont
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (Bondok); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Ghanmi, Saddiki, Lefebvre, Berthelot, Dion, Raymond, Seguin, Sekhavati, Islam); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Etherington, Boet); the Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Ont (Boet); and the Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ont. (Boet)
| | - Boris Zevin
- From Queen's University, Kingston, Ont
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (Bondok); the Faculty of Medicine, University of Ottawa, Ottawa, Ont. (Ghanmi, Saddiki, Lefebvre, Berthelot, Dion, Raymond, Seguin, Sekhavati, Islam); the Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ont. (Etherington, Boet); the Department of Anesthesiology & Pain Medicine, The Ottawa Hospital, Ottawa, Ont (Boet); and the Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ont. (Boet)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Trisha Tee
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que. (Tee, Pachchigar, Tarabay, Yilmaz, Abou Hamdan, Agu, Almansouri, Del Maestro); the Department of Neurology and Neurosurgery, McGill University, Montréal, Que. (Del Maestro); the University of Montreal Health Centre, Montréal, Que. (Tarabay); and the Simulation, Affect, Innovation, Learning, and Surgery Laboratory, Montreal Neurological Institute, McGill University, Montréal, Que. (Harley)
| | - Puja Pachchigar
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que. (Tee, Pachchigar, Tarabay, Yilmaz, Abou Hamdan, Agu, Almansouri, Del Maestro); the Department of Neurology and Neurosurgery, McGill University, Montréal, Que. (Del Maestro); the University of Montreal Health Centre, Montréal, Que. (Tarabay); and the Simulation, Affect, Innovation, Learning, and Surgery Laboratory, Montreal Neurological Institute, McGill University, Montréal, Que. (Harley)
| | - Bilal Tarabay
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que. (Tee, Pachchigar, Tarabay, Yilmaz, Abou Hamdan, Agu, Almansouri, Del Maestro); the Department of Neurology and Neurosurgery, McGill University, Montréal, Que. (Del Maestro); the University of Montreal Health Centre, Montréal, Que. (Tarabay); and the Simulation, Affect, Innovation, Learning, and Surgery Laboratory, Montreal Neurological Institute, McGill University, Montréal, Que. (Harley)
| | - Recai Yilmaz
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que. (Tee, Pachchigar, Tarabay, Yilmaz, Abou Hamdan, Agu, Almansouri, Del Maestro); the Department of Neurology and Neurosurgery, McGill University, Montréal, Que. (Del Maestro); the University of Montreal Health Centre, Montréal, Que. (Tarabay); and the Simulation, Affect, Innovation, Learning, and Surgery Laboratory, Montreal Neurological Institute, McGill University, Montréal, Que. (Harley)
| | - Nour Abou Hamdan
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que. (Tee, Pachchigar, Tarabay, Yilmaz, Abou Hamdan, Agu, Almansouri, Del Maestro); the Department of Neurology and Neurosurgery, McGill University, Montréal, Que. (Del Maestro); the University of Montreal Health Centre, Montréal, Que. (Tarabay); and the Simulation, Affect, Innovation, Learning, and Surgery Laboratory, Montreal Neurological Institute, McGill University, Montréal, Que. (Harley)
| | - Chinyelum Agu
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que. (Tee, Pachchigar, Tarabay, Yilmaz, Abou Hamdan, Agu, Almansouri, Del Maestro); the Department of Neurology and Neurosurgery, McGill University, Montréal, Que. (Del Maestro); the University of Montreal Health Centre, Montréal, Que. (Tarabay); and the Simulation, Affect, Innovation, Learning, and Surgery Laboratory, Montreal Neurological Institute, McGill University, Montréal, Que. (Harley)
| | - Abdulrahman Almansouri
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que. (Tee, Pachchigar, Tarabay, Yilmaz, Abou Hamdan, Agu, Almansouri, Del Maestro); the Department of Neurology and Neurosurgery, McGill University, Montréal, Que. (Del Maestro); the University of Montreal Health Centre, Montréal, Que. (Tarabay); and the Simulation, Affect, Innovation, Learning, and Surgery Laboratory, Montreal Neurological Institute, McGill University, Montréal, Que. (Harley)
| | - Jason Harley
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que. (Tee, Pachchigar, Tarabay, Yilmaz, Abou Hamdan, Agu, Almansouri, Del Maestro); the Department of Neurology and Neurosurgery, McGill University, Montréal, Que. (Del Maestro); the University of Montreal Health Centre, Montréal, Que. (Tarabay); and the Simulation, Affect, Innovation, Learning, and Surgery Laboratory, Montreal Neurological Institute, McGill University, Montréal, Que. (Harley)
| | - Rolando Del Maestro
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que. (Tee, Pachchigar, Tarabay, Yilmaz, Abou Hamdan, Agu, Almansouri, Del Maestro); the Department of Neurology and Neurosurgery, McGill University, Montréal, Que. (Del Maestro); the University of Montreal Health Centre, Montréal, Que. (Tarabay); and the Simulation, Affect, Innovation, Learning, and Surgery Laboratory, Montreal Neurological Institute, McGill University, Montréal, Que. (Harley)
| | - Mostafa Bondok
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Nguyen); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Law); the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C. (Nathoo); the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. (Bakshi); the Division of Ophthalmology, McMaster University, Hamilton, Ont. (Ahuja); and the Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan (Damji)
| | - Mohamed S Bondok
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Nguyen); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Law); the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C. (Nathoo); the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. (Bakshi); the Division of Ophthalmology, McMaster University, Hamilton, Ont. (Ahuja); and the Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan (Damji)
| | - Anne Xuan-Lan Nguyen
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Nguyen); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Law); the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C. (Nathoo); the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. (Bakshi); the Division of Ophthalmology, McMaster University, Hamilton, Ont. (Ahuja); and the Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan (Damji)
| | - Christine Law
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Nguyen); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Law); the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C. (Nathoo); the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. (Bakshi); the Division of Ophthalmology, McMaster University, Hamilton, Ont. (Ahuja); and the Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan (Damji)
| | - Nawaaz Nathoo
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Nguyen); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Law); the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C. (Nathoo); the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. (Bakshi); the Division of Ophthalmology, McMaster University, Hamilton, Ont. (Ahuja); and the Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan (Damji)
| | - Nupura Bakshi
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Nguyen); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Law); the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C. (Nathoo); the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. (Bakshi); the Division of Ophthalmology, McMaster University, Hamilton, Ont. (Ahuja); and the Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan (Damji)
| | - Nina Ahuja
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Nguyen); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Law); the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C. (Nathoo); the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. (Bakshi); the Division of Ophthalmology, McMaster University, Hamilton, Ont. (Ahuja); and the Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan (Damji)
| | - Karim F Damji
- From the Faculty of Medicine, University of British Columbia, Vancouver, B.C. (M. Bondok); the Cumming School of Medicine, University of Calgary, Calgary, Alb. (M.S. Bondok); the Faculty of Medicine and Health Sciences, McGill University, Montréal, Que. (Nguyen); the Department of Ophthalmology, Queen's University, Kingston, Ont. (Law); the Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, B.C. (Nathoo); the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont. (Bakshi); the Division of Ophthalmology, McMaster University, Hamilton, Ont. (Ahuja); and the Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan (Damji)
| | - Keerat Grewal
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Sayed Azher
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Matthew Moreno
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Reinhard Pekrun
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Jeffrey Wiseman
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Gerald M Fried
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Susanne Lajoie
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Ryan Brydges
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Allyson Hadwin
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Ning-Zi Sun
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Elene Khalil
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Jason M Harley
- From McGill University, Montréal, Que. (Grewal, Azher, Moreno, Wiseman, Fried, Lajoie, Sun, Harley); the University of Essex, Colchester, UK (Pekrun); the Ludwig Maximilian University of Munich, Munich, Germany (Pekrun); the Australian Catholic University, Sydney, Australia (Pekrun); the University of Toronto, Toronto, Ont. (Brydges); the University of Victoria, Victoria, B.C. (Hadwin); the McGill University Health Centre for Interprofessional Simulation, McGill University, Montréal, Que. (Khalil); and the Research Institute of the McGill University Health Centre, McGill University, Montréal, Que. (Harley)
| | - Emily Lan-Vy Nguyen
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Nguyen); Abdominal Transplant, University Health Network, Toronto, Ont. (Shwaartz); General Surgery, University of Toronto, Toronto, Ont. (Shwaartz, Muaddi); and HPB Surgical Oncology, University Health Network, Toronto, Ont. (Shwaartz, Bucur, Rukavina, Patel)
| | - Prachikumari Patel
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Nguyen); Abdominal Transplant, University Health Network, Toronto, Ont. (Shwaartz); General Surgery, University of Toronto, Toronto, Ont. (Shwaartz, Muaddi); and HPB Surgical Oncology, University Health Network, Toronto, Ont. (Shwaartz, Bucur, Rukavina, Patel)
| | - Hala Muaddi
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Nguyen); Abdominal Transplant, University Health Network, Toronto, Ont. (Shwaartz); General Surgery, University of Toronto, Toronto, Ont. (Shwaartz, Muaddi); and HPB Surgical Oncology, University Health Network, Toronto, Ont. (Shwaartz, Bucur, Rukavina, Patel)
| | - Nadia Rukavina
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Nguyen); Abdominal Transplant, University Health Network, Toronto, Ont. (Shwaartz); General Surgery, University of Toronto, Toronto, Ont. (Shwaartz, Muaddi); and HPB Surgical Oncology, University Health Network, Toronto, Ont. (Shwaartz, Bucur, Rukavina, Patel)
| | - Roxana Bucur
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Nguyen); Abdominal Transplant, University Health Network, Toronto, Ont. (Shwaartz); General Surgery, University of Toronto, Toronto, Ont. (Shwaartz, Muaddi); and HPB Surgical Oncology, University Health Network, Toronto, Ont. (Shwaartz, Bucur, Rukavina, Patel)
| | - Chaya Shwaartz
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Nguyen); Abdominal Transplant, University Health Network, Toronto, Ont. (Shwaartz); General Surgery, University of Toronto, Toronto, Ont. (Shwaartz, Muaddi); and HPB Surgical Oncology, University Health Network, Toronto, Ont. (Shwaartz, Bucur, Rukavina, Patel)
| | - Nehal Islam
- From McGill University Health Centre, McGill University, Montréal, Que
| | - Sarah Moussa
- From McGill University Health Centre, McGill University, Montréal, Que
| | - Mathushan Subasri
- From McGill University Health Centre, McGill University, Montréal, Que
| | - Moustafa Fakih
- From McGill University Health Centre, McGill University, Montréal, Que
| | | | - Evan Wong
- From McGill University Health Centre, McGill University, Montréal, Que
| | - Aradhana Tewari
- From St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Tewari, Brydges, Louridas); and the University of Toronto, Toronto, Ont. (Brydges, Louridas)
| | - Ryan Brydges
- From St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Tewari, Brydges, Louridas); and the University of Toronto, Toronto, Ont. (Brydges, Louridas)
| | - Marisa Louridas
- From St. Michael's Hospital, Unity Health Toronto, Toronto, Ont. (Tewari, Brydges, Louridas); and the University of Toronto, Toronto, Ont. (Brydges, Louridas)
| | - Shilpa Balaji
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Prachi Patel
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Hala Muaddi
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Karolina Gaebe
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Carla Luzzi
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Aileigh Kay
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Nadia Rukavina
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Markus Selzner
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Trevor Reichman
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Chaya Shwaartz
- From the University of Toronto, Toronto, Ont. (Balaji, Gaebe, Selzner, Reichman, Shwaartz); the University Health Network, Toronto, Ont. (Patel, Luzzi, Kay, Rukavina, Reichman, Shwaartz); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Shilpa Balaji
- From the University of Toronto, Toronto, Ont. (Balaji, Reichman, Jayaraman, Shwaartz); the University Health Network, Toronto, Ont. (Shahabinezhad, Patel, Rukavina, Reichman, Shwaartz); Unity Health Toronto, Toronto, Ont. (Jayaraman); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Hala Muaddi
- From the University of Toronto, Toronto, Ont. (Balaji, Reichman, Jayaraman, Shwaartz); the University Health Network, Toronto, Ont. (Shahabinezhad, Patel, Rukavina, Reichman, Shwaartz); Unity Health Toronto, Toronto, Ont. (Jayaraman); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Ali Shahabinezhad
- From the University of Toronto, Toronto, Ont. (Balaji, Reichman, Jayaraman, Shwaartz); the University Health Network, Toronto, Ont. (Shahabinezhad, Patel, Rukavina, Reichman, Shwaartz); Unity Health Toronto, Toronto, Ont. (Jayaraman); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Prachi Patel
- From the University of Toronto, Toronto, Ont. (Balaji, Reichman, Jayaraman, Shwaartz); the University Health Network, Toronto, Ont. (Shahabinezhad, Patel, Rukavina, Reichman, Shwaartz); Unity Health Toronto, Toronto, Ont. (Jayaraman); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Nadia Rukavina
- From the University of Toronto, Toronto, Ont. (Balaji, Reichman, Jayaraman, Shwaartz); the University Health Network, Toronto, Ont. (Shahabinezhad, Patel, Rukavina, Reichman, Shwaartz); Unity Health Toronto, Toronto, Ont. (Jayaraman); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Trevor Reichman
- From the University of Toronto, Toronto, Ont. (Balaji, Reichman, Jayaraman, Shwaartz); the University Health Network, Toronto, Ont. (Shahabinezhad, Patel, Rukavina, Reichman, Shwaartz); Unity Health Toronto, Toronto, Ont. (Jayaraman); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Shiva Jayaraman
- From the University of Toronto, Toronto, Ont. (Balaji, Reichman, Jayaraman, Shwaartz); the University Health Network, Toronto, Ont. (Shahabinezhad, Patel, Rukavina, Reichman, Shwaartz); Unity Health Toronto, Toronto, Ont. (Jayaraman); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Chaya Shwaartz
- From the University of Toronto, Toronto, Ont. (Balaji, Reichman, Jayaraman, Shwaartz); the University Health Network, Toronto, Ont. (Shahabinezhad, Patel, Rukavina, Reichman, Shwaartz); Unity Health Toronto, Toronto, Ont. (Jayaraman); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | | | | | | | | | | | | | | | | | - Davy Lau
- From the University of British Columbia and the B.C. Children's Hospital Research Institute, Vancouver, B.C. (Lau, Henkelman, Watson, Haji); and the B.C. Children's Hospital Digital Laboratory, Vancouver, B.C., (Jacob)
| | - Erika Henkelman
- From the University of British Columbia and the B.C. Children's Hospital Research Institute, Vancouver, B.C. (Lau, Henkelman, Watson, Haji); and the B.C. Children's Hospital Digital Laboratory, Vancouver, B.C., (Jacob)
| | - John Jacob
- From the University of British Columbia and the B.C. Children's Hospital Research Institute, Vancouver, B.C. (Lau, Henkelman, Watson, Haji); and the B.C. Children's Hospital Digital Laboratory, Vancouver, B.C., (Jacob)
| | - Isabella Watson
- From the University of British Columbia and the B.C. Children's Hospital Research Institute, Vancouver, B.C. (Lau, Henkelman, Watson, Haji); and the B.C. Children's Hospital Digital Laboratory, Vancouver, B.C., (Jacob)
| | - Faizal Haji
- From the University of British Columbia and the B.C. Children's Hospital Research Institute, Vancouver, B.C. (Lau, Henkelman, Watson, Haji); and the B.C. Children's Hospital Digital Laboratory, Vancouver, B.C., (Jacob)
| | - Charlotte C McEwen
- From the Faculty of Health Sciences, McMaster University, Hamilton, Ont. (McEwen, Jaffer, Sibbald); Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (McEwen, Jaffer); Division of Cardiology, McMaster University, Hamilton, Ont. (Sibbald); and the McMaster Education Research, Innovation and Theory Program, McMaster University, Hamilton, Ont. (Sibbald)
| | - Iqbal Jaffer
- From the Faculty of Health Sciences, McMaster University, Hamilton, Ont. (McEwen, Jaffer, Sibbald); Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (McEwen, Jaffer); Division of Cardiology, McMaster University, Hamilton, Ont. (Sibbald); and the McMaster Education Research, Innovation and Theory Program, McMaster University, Hamilton, Ont. (Sibbald)
| | - Matthew Sibbald
- From the Faculty of Health Sciences, McMaster University, Hamilton, Ont. (McEwen, Jaffer, Sibbald); Division of Cardiac Surgery, McMaster University, Hamilton, Ont. (McEwen, Jaffer); Division of Cardiology, McMaster University, Hamilton, Ont. (Sibbald); and the McMaster Education Research, Innovation and Theory Program, McMaster University, Hamilton, Ont. (Sibbald)
| | - Victoria Blouin
- From l'Université de Montréal, Montréal, Que. (Blouin, Bénard, Pelletier, Meloche-Dumas, Patocskai); and Ontario Tech University, Oshawa, Ont. (Abdo, Kapralos, Dubrowski)
| | - Florence Bénard
- From l'Université de Montréal, Montréal, Que. (Blouin, Bénard, Pelletier, Meloche-Dumas, Patocskai); and Ontario Tech University, Oshawa, Ont. (Abdo, Kapralos, Dubrowski)
| | - Florence Pelletier
- From l'Université de Montréal, Montréal, Que. (Blouin, Bénard, Pelletier, Meloche-Dumas, Patocskai); and Ontario Tech University, Oshawa, Ont. (Abdo, Kapralos, Dubrowski)
| | - Sandy Abdo
- From l'Université de Montréal, Montréal, Que. (Blouin, Bénard, Pelletier, Meloche-Dumas, Patocskai); and Ontario Tech University, Oshawa, Ont. (Abdo, Kapralos, Dubrowski)
| | - Léamarie Meloche-Dumas
- From l'Université de Montréal, Montréal, Que. (Blouin, Bénard, Pelletier, Meloche-Dumas, Patocskai); and Ontario Tech University, Oshawa, Ont. (Abdo, Kapralos, Dubrowski)
| | - Bill Kapralos
- From l'Université de Montréal, Montréal, Que. (Blouin, Bénard, Pelletier, Meloche-Dumas, Patocskai); and Ontario Tech University, Oshawa, Ont. (Abdo, Kapralos, Dubrowski)
| | - Adam Dubrowski
- From l'Université de Montréal, Montréal, Que. (Blouin, Bénard, Pelletier, Meloche-Dumas, Patocskai); and Ontario Tech University, Oshawa, Ont. (Abdo, Kapralos, Dubrowski)
| | - Erica Patocskai
- From l'Université de Montréal, Montréal, Que. (Blouin, Bénard, Pelletier, Meloche-Dumas, Patocskai); and Ontario Tech University, Oshawa, Ont. (Abdo, Kapralos, Dubrowski)
| | - Puja Pachchigar
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Que. (Pachchigar, Agu, Yilmaz, Tee Del Maestro); and l'École polytechnique universitaire de Marseille, Marseille, France (Agu)
| | - Chinyelum Agu
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Que. (Pachchigar, Agu, Yilmaz, Tee Del Maestro); and l'École polytechnique universitaire de Marseille, Marseille, France (Agu)
| | - Recai Yilmaz
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Que. (Pachchigar, Agu, Yilmaz, Tee Del Maestro); and l'École polytechnique universitaire de Marseille, Marseille, France (Agu)
| | - Trisha Tee
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Que. (Pachchigar, Agu, Yilmaz, Tee Del Maestro); and l'École polytechnique universitaire de Marseille, Marseille, France (Agu)
| | - Rolando Del Maestro
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology & Neurosurgery, Montreal Neurological Institute, McGill University, Montréal, Que. (Pachchigar, Agu, Yilmaz, Tee Del Maestro); and l'École polytechnique universitaire de Marseille, Marseille, France (Agu)
| | - Ifeoluwa Adedipe
- From the Cumming School of Medicine, University of Calgary, Calgary, Alb
| | - Carolyn Stephens
- From the Cumming School of Medicine, University of Calgary, Calgary, Alb
| | - Merry Ghebretatios
- From the Cumming School of Medicine, University of Calgary, Calgary, Alb
| | - Simon Laplante
- From the University Health Network, Toronto, Ont. (Patel, Laplante, Rukavina, Shwaartz); the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Balaji); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Prachi Patel
- From the University Health Network, Toronto, Ont. (Patel, Laplante, Rukavina, Shwaartz); the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Balaji); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Shilpa Balaji
- From the University Health Network, Toronto, Ont. (Patel, Laplante, Rukavina, Shwaartz); the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Balaji); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Hala Muaddi
- From the University Health Network, Toronto, Ont. (Patel, Laplante, Rukavina, Shwaartz); the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Balaji); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Nadia Rukavina
- From the University Health Network, Toronto, Ont. (Patel, Laplante, Rukavina, Shwaartz); the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Balaji); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Chaya Shwaartz
- From the University Health Network, Toronto, Ont. (Patel, Laplante, Rukavina, Shwaartz); the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (Balaji); and the Mayo Clinic, Rochester, Minn. (Muaddi)
| | - Maren Brodovsky
- From the University of Toronto, Toronto, Ont. (Brodovsky, Behzadi); the Sunnybrook Health Sciences Centre, Toronto, Ont. (Lai); and the University of British Columbia, Vancouver, B.C. (Blair)
| | - Carolyn Lai
- From the University of Toronto, Toronto, Ont. (Brodovsky, Behzadi); the Sunnybrook Health Sciences Centre, Toronto, Ont. (Lai); and the University of British Columbia, Vancouver, B.C. (Blair)
| | - Abdollah Behzadi
- From the University of Toronto, Toronto, Ont. (Brodovsky, Behzadi); the Sunnybrook Health Sciences Centre, Toronto, Ont. (Lai); and the University of British Columbia, Vancouver, B.C. (Blair)
| | - Geoffrey Blair
- From the University of Toronto, Toronto, Ont. (Brodovsky, Behzadi); the Sunnybrook Health Sciences Centre, Toronto, Ont. (Lai); and the University of British Columbia, Vancouver, B.C. (Blair)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ella Koonar
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Fatemeh Ramazani
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Robert Hart
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Jessica Henley
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Sam Roberts
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Shamir Chandarana
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Wayne Matthews
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Christiaan Schrag
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Jennifer Matthews
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - David Mackenzie
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Court Cutting
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Justin Lui
- From the University of Calgary, Calgary, Alb. (Koonar, Ramazani, Hart, Henley, Roberts, Chandarana, W. Matthews, Schrag, J. Matthews, Mackenzie, Lui); and New York University, New York, NY (Cutting)
| | - Éolie Delisle
- From the Université de Montréal, Montréal, Que. (Delisle, T. Cordoba); and the Centre hospitalier universitaire de Montréal, Montréal, Que. (C. Cordoba)
| | - Tomas Cordoba
- From the Université de Montréal, Montréal, Que. (Delisle, T. Cordoba); and the Centre hospitalier universitaire de Montréal, Montréal, Que. (C. Cordoba)
| | - Carlos Cordoba
- From the Université de Montréal, Montréal, Que. (Delisle, T. Cordoba); and the Centre hospitalier universitaire de Montréal, Montréal, Que. (C. Cordoba)
| | - Bianca Giglio
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que
| | - Adrien Lacroix
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que
| | - Julianne Cairns
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que
| | - Ahmad Alsayegh
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que
| | - Mohamed Alhantoobi
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que
| | - Neevya Balasubramaniam
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que
| | - Widad Safih
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que
| | - Meriem Hamel
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que
| | - Rolando Del Maestro
- From the Neurosurgical Simulation and Artificial Intelligence Learning Centre, McGill University, Montréal, Que
| | - Gizelle Francis
- From Dalhousie University, Halifax, N.S. (Francis, Hathi); McGill University, Montréal, Que. (Moise); the University of Saskatchewan, Saskatoon, Sask. (Omar); the University of Toronto, Toronto, Ont. (Mavedatnia, Grose); and Queen's University, Kingston, Ont. (Philips)
| | - Alexander Moise
- From Dalhousie University, Halifax, N.S. (Francis, Hathi); McGill University, Montréal, Que. (Moise); the University of Saskatchewan, Saskatoon, Sask. (Omar); the University of Toronto, Toronto, Ont. (Mavedatnia, Grose); and Queen's University, Kingston, Ont. (Philips)
| | - Youssef Omar
- From Dalhousie University, Halifax, N.S. (Francis, Hathi); McGill University, Montréal, Que. (Moise); the University of Saskatchewan, Saskatoon, Sask. (Omar); the University of Toronto, Toronto, Ont. (Mavedatnia, Grose); and Queen's University, Kingston, Ont. (Philips)
| | - Kalpesh Hathi
- From Dalhousie University, Halifax, N.S. (Francis, Hathi); McGill University, Montréal, Que. (Moise); the University of Saskatchewan, Saskatoon, Sask. (Omar); the University of Toronto, Toronto, Ont. (Mavedatnia, Grose); and Queen's University, Kingston, Ont. (Philips)
| | - Dorsa Mavedatnia
- From Dalhousie University, Halifax, N.S. (Francis, Hathi); McGill University, Montréal, Que. (Moise); the University of Saskatchewan, Saskatoon, Sask. (Omar); the University of Toronto, Toronto, Ont. (Mavedatnia, Grose); and Queen's University, Kingston, Ont. (Philips)
| | - Elysia Grose
- From Dalhousie University, Halifax, N.S. (Francis, Hathi); McGill University, Montréal, Que. (Moise); the University of Saskatchewan, Saskatoon, Sask. (Omar); the University of Toronto, Toronto, Ont. (Mavedatnia, Grose); and Queen's University, Kingston, Ont. (Philips)
| | - Timothy Philips
- From Dalhousie University, Halifax, N.S. (Francis, Hathi); McGill University, Montréal, Que. (Moise); the University of Saskatchewan, Saskatoon, Sask. (Omar); the University of Toronto, Toronto, Ont. (Mavedatnia, Grose); and Queen's University, Kingston, Ont. (Philips)
| | - Clément Schneider
- From the Institut de Cardiologie de Montréal, Montréal, Que.; and the Université de Montréal, Montréal, Que
| | - Denis Corbin
- From the Institut de Cardiologie de Montréal, Montréal, Que.; and the Université de Montréal, Montréal, Que
| | - François Lesage
- From the Institut de Cardiologie de Montréal, Montréal, Que.; and the Université de Montréal, Montréal, Que
| | - Michel Pellerin
- From the Institut de Cardiologie de Montréal, Montréal, Que.; and the Université de Montréal, Montréal, Que
| | - Walid Ben-Ali
- From the Institut de Cardiologie de Montréal, Montréal, Que.; and the Université de Montréal, Montréal, Que
| | - Zakaria Tamani
- From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Tamani, Joly-Chevrier, Laflamme); General Surgery, Université de Montréal, Montréal, Que. (Bénard, Meloche-Dumas); Surgical Oncology, Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Younan); and Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski, Patocskai)
| | - Maxine Joly-Chevrier
- From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Tamani, Joly-Chevrier, Laflamme); General Surgery, Université de Montréal, Montréal, Que. (Bénard, Meloche-Dumas); Surgical Oncology, Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Younan); and Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski, Patocskai)
| | - Florence Bénard
- From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Tamani, Joly-Chevrier, Laflamme); General Surgery, Université de Montréal, Montréal, Que. (Bénard, Meloche-Dumas); Surgical Oncology, Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Younan); and Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski, Patocskai)
| | - Léamarie Meloche-Dumas
- From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Tamani, Joly-Chevrier, Laflamme); General Surgery, Université de Montréal, Montréal, Que. (Bénard, Meloche-Dumas); Surgical Oncology, Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Younan); and Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski, Patocskai)
| | - Laurence Laflamme
- From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Tamani, Joly-Chevrier, Laflamme); General Surgery, Université de Montréal, Montréal, Que. (Bénard, Meloche-Dumas); Surgical Oncology, Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Younan); and Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski, Patocskai)
| | - Kerianne Boulva
- From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Tamani, Joly-Chevrier, Laflamme); General Surgery, Université de Montréal, Montréal, Que. (Bénard, Meloche-Dumas); Surgical Oncology, Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Younan); and Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski, Patocskai)
| | - Rami Younan
- From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Tamani, Joly-Chevrier, Laflamme); General Surgery, Université de Montréal, Montréal, Que. (Bénard, Meloche-Dumas); Surgical Oncology, Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Younan); and Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski, Patocskai)
| | - Adam Dubrowski
- From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Tamani, Joly-Chevrier, Laflamme); General Surgery, Université de Montréal, Montréal, Que. (Bénard, Meloche-Dumas); Surgical Oncology, Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Younan); and Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski, Patocskai)
| | - Erica Patocskai
- From the Faculty of Medicine, Université de Montréal, Montréal, Que. (Tamani, Joly-Chevrier, Laflamme); General Surgery, Université de Montréal, Montréal, Que. (Bénard, Meloche-Dumas); Surgical Oncology, Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Younan); and Health Sciences, maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski, Patocskai)
| | - Giancarlo Sticca
- From the Université de Montréal, Montréal, Que. (Sticca); McGill University, Montréal, Que. (Petruccelli); and the University of Sherbrooke, Sherbrooke, Que. (Dorion)
| | - Joseph Petruccelli
- From the Université de Montréal, Montréal, Que. (Sticca); McGill University, Montréal, Que. (Petruccelli); and the University of Sherbrooke, Sherbrooke, Que. (Dorion)
| | - Dominique Dorion
- From the Université de Montréal, Montréal, Que. (Sticca); McGill University, Montréal, Que. (Petruccelli); and the University of Sherbrooke, Sherbrooke, Que. (Dorion)
| | - Yasmin Osman
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Florence Bénard
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Merieme Habti
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Léamarie Meloche-Dumas
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Xaviery Duranleau
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Kerianne Boulva
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Ahmad Kaviani
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Rami Younan
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Adam Dubrowski
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Kiara Vessella
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Erica Patocskai
- From the Université de Montréal, Montréal, Que. (Osman, Bénard, Habti, Meloche-Dumas); McGill University, Montréal, Que. (Duranleau); the Centre hospitalier de l'université de Montréal, Montréal, Que. (Boulva, Kaviani, Younan, Patocskai); the maxSIMhealth Laboratory, Ontario Tech University, Oshawa, Ont. (Dubrowski); and Dawson College, Montréal, Que. (Vessella)
| | - Rahim Valji
- From the University of Alberta, Edmonton, Alb
| | | | - Tobi Lam
- From the University of Toronto, Toronto, Ont
| | | | - Jacob Hirsh
- From the University of Toronto, Toronto, Ont
| | - Dean Lising
- From the University of Toronto, Toronto, Ont
| | - Tulin Cil
- From the University of Toronto, Toronto, Ont
| | | | | | - Alexandra D'Souza
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (D'Souza, Milazzo, Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel); and the Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ont. (Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel)
| | - Thomas Milazzo
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (D'Souza, Milazzo, Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel); and the Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ont. (Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel)
| | - Shaishav Datta
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (D'Souza, Milazzo, Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel); and the Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ont. (Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel)
| | - Chantal Valiquette
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (D'Souza, Milazzo, Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel); and the Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ont. (Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel)
| | - Emma Avery
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (D'Souza, Milazzo, Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel); and the Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ont. (Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel)
| | - Sophocles Voineskos
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (D'Souza, Milazzo, Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel); and the Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ont. (Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel)
| | - Melinda Musgrave
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (D'Souza, Milazzo, Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel); and the Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ont. (Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel)
| | - Kyle Wanzel
- From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ont. (D'Souza, Milazzo, Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel); and the Division of Plastic, Reconstructive & Aesthetic Surgery, University of Toronto, Toronto, Ont. (Datta, Valiquette, Avery, Voineskos, Musgrave, Wanzel)
| | - Jillian Schneidman
- From McGill University, Montréal, Que. (Schneidman); and the University of Oxford, Oxford, UK (Schneidman, Armstrong)
| | - Neil Armstrong
- From McGill University, Montréal, Que. (Schneidman); and the University of Oxford, Oxford, UK (Schneidman, Armstrong)
| | | | | | | | | | | | | | | | | | - B J Hancock
- From the University of Manitoba, Winnipeg, Man
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3
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Guérard-Poirier N, Meloche-Dumas L, Beniey M, Torres A, Kapralos B, Dhane M, Mercier F, Younan R, Dubrowski A, Patocskai E. The exploration of remote simulation strategies for the acquisition of psychomotor skills in medicine: a pilot randomized controlled trial. Discov Educ 2023; 2:19. [PMID: 37469757 PMCID: PMC10352422 DOI: 10.1007/s44217-023-00041-2] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/24/2023] [Indexed: 07/21/2023]
Abstract
Background Progress in remote educational strategies was fueled by the advent of the COVID-19 pandemic. This pilot RCT explored the efficacy of a decentralized model of simulation based on principles of observational and peer-to-peer learning for the acquisition of surgical skills. Methods Sixty medical students from the University of Montreal learned the running subcuticular suture in four different conditions: (1) Control group (2) Self-learning (3) Peer-learning (4) Peer-learning with expert feedback. The control group learned with error-free videos, while the others, through videos illustrating strategic sub-optimal performances to be identified and discussed by students. Performance on a simulator at the end of the learning period, was assessed by an expert using a global rating scale (GRS) and checklist (CL). Results Students engaging in peer-to-peer learning strategies outperformed students who learned alone. The presence of an expert, and passive vs active observational learning strategies did not impact performance. Conclusion This study supports the efficacy of a remote learning strategy and demonstrates how collaborative discourse optimizes the students' acquisition of surgical skills. These remote simulation strategies create the potential for implantation in future medical curriculum design.Trial Registration: NCT04425499 2020-05-06.
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Affiliation(s)
| | | | - Michèle Beniey
- Department of Surgery, Université de Montréal, Montreal, QC H2X3E4 Canada
| | - Andrei Torres
- Faculty of Business and IT, OntarioTech University, Oshawa, ON L1G 0C5 Canada
| | - Bill Kapralos
- Faculty of Health Sciences, OntarioTech University, Oshawa, ON L1G 0C5 Canada
| | - Malek Dhane
- Faculty of Medicine, Université de Montréal, Montreal, QC H2X3E4 Canada
| | - Frédéric Mercier
- Department of Surgical Oncology, Centre Hospitalier de L’Université de Montréal, 1051 Rue Sanguinet, Montreal, QC H2X3E4 Canada
| | - Rami Younan
- Department of Surgical Oncology, Centre Hospitalier de L’Université de Montréal, 1051 Rue Sanguinet, Montreal, QC H2X3E4 Canada
| | - Adam Dubrowski
- Faculty of Health Sciences, OntarioTech University, Oshawa, ON L1G 0C5 Canada
| | - Erica Patocskai
- Department of Surgical Oncology, Centre Hospitalier de L’Université de Montréal, 1051 Rue Sanguinet, Montreal, QC H2X3E4 Canada
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4
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Yordanova M, Sideris L, Dubé P, Boileau JF, Lemieux J, Mihalcioiu C, Levesque S, Guertin MC, Patocskai E, Younan R, Robidoux A, Hassan S. Abstract P6-01-39: The impact of the 21-gene Recurrence Score® assay upon physician treatment recommendations in the neoadjuvant setting in lymph node-negative breast cancer patients in a multicenter prospective study in Quebec. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-01-39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Although the role of the 21-gene Breast Recurrence Score® assay is well established to predict response to adjuvant chemotherapy in the setting of node-negative hormone receptor (HR)-positive, HER2-negative breast cancers (BC), fewer studies have evaluated the assay in the neoadjuvant setting. Due to the correlation between a high Recurrence Score® (RS) result and pathological complete response (pCR), the Breast Recurrence Score assay has been used to aid in selecting between chemotherapy (CT) or endocrine therapy. We wanted to further understand the impact of the assay upon physician treatment recommendations and the use of chemotherapy in this patient cohort. Methods: We conducted a multicenter, prospective, observational study in patients with clinically node-negative HR-positive, HER2-negative BC with T2-T3 disease being considered for neoadjuvant therapy. Physicians were required to complete two questionnaires indicating treatment choice, including CT, endocrine therapy, or surgery, prior to and post availability of RS result. Patients were followed up for 6 months after commencement of neoadjuvant therapy. The primary objective was to evaluate the change in the physician’s recommendation for neoadjuvant CT prior to and post assay results. As a secondary objective, we also evaluated the impact of the RS result on physician’s expressed level of confidence. Results: A total of 70 patients were enrolled between April 2018 and November 2021 at five hospital centers, as part of the McPeak Sirois Group of Quebec. The median age of the cohort was 60 years (range, 30 to 79 years). 24.3 % (n=17) of the cohort consisted of patients aged < 50 years, and 75.7% (n=53) were ≥ to 50 years. 29.0% (n=20) of the patients had a RS < 16, 39.1% (n=27) had a RS between 16-25, and 31.9% (n=22) had a RS > 25. For the entire cohort, the RS result led to a net reduction in chemotherapy recommendation by 33.3% (OR (odds of having CT post-RS recommendation versus pre-RS recommendation) = 0.23 [95% CI: 0.12-0.44]; P< 0.0001), and 39.2% net reduction in the use of chemotherapy at 6-month follow-up (OR = 0.18 [95% CI: 0.09-0.35]; P< 0.0001). Furthermore, the RS result led to a 35.3% net reduction in physician recommendation of CT for patients < 50 years (OR = 0.19 [95% CI: 0.04-0.83]; P=0.027) and a 32.7% net reduction for patients ≥ 50 years (OR = 0.24 [95% CI: 0.11-0.50]; P=0.0001). For patients with a RS < 16, there was a reduction in CT recommendation by 75.0%, and by 44.4% for patients with a RS between 16 - 25 (OR = 0.15 [95% CI: 0.06-0.38]; P< 0.0001). Moreover, RS results led to an increase in confidence in physician treatment decisions for 59.4% of patients (OR = 12.53 [95% CI: 5.46-28.78]; P< 0.0001). Conclusion: We determined that the 21-gene Breast Recurrence Score assay altered neoadjuvant treatment decisions, leading to a reduction in the use of chemotherapy by about one-third, regardless of age. Additionally, the assay increased physician confidence in their treatment recommendation for about 60% of patients. This demonstrates the potential clinical utility of the assay to decrease the use of CT in the neoadjuvant setting amongst HR-positive, node-negative BC patients in Quebec.
Citation Format: Mariya Yordanova, Lucas Sideris, Pierre Dubé, Jean-Francois Boileau, Julie Lemieux, Catalin Mihalcioiu, Sylvie Levesque, Marie-Claude Guertin, Erica Patocskai, Rami Younan, André Robidoux, Saima Hassan. The impact of the 21-gene Recurrence Score® assay upon physician treatment recommendations in the neoadjuvant setting in lymph node-negative breast cancer patients in a multicenter prospective study in Quebec [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-01-39.
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Affiliation(s)
- Mariya Yordanova
- 1Université de Sherbrooke, Faculté de Médecine et des Sciences de la Santé, Sherbrooke, Quebec, Canada
| | - Lucas Sideris
- 2Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Pierre Dubé
- 3Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Jean-Francois Boileau
- 4Jewish General Hospital Segal Cancer Centre, McGill University, Montréal, Quebec, Canada, Montréal, Quebec, Canada
| | - Julie Lemieux
- 5Oncologist - Centre des maladies du sein du CHU de Québec-Université Laval, Hôpital St-Sacrement, Québec, Quebec, Canada
| | | | - Sylvie Levesque
- 7Montreal Health Innovations Coordinating Center, Montréal, Quebec, Canada
| | | | - Erica Patocskai
- 9Centre hospitaler de l’Université de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Rami Younan
- 10Centre hospitalier de l’Université de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - André Robidoux
- 11Centre hospitaler de l’Université de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Saima Hassan
- 12Centre Hospitalier de l’Université de Montréal, Université de Montréal, Montreal, Quebec, Canada
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Hassan S, Younan R, Patocskai E, Provencher L, Poirier B, Sideris L, Dubé P, Mihalcioiu C, Chabot-Blanchet M, Guertin MC, Boileau JF, Robidoux A. Impact of the 21-Gene Recurrence Score Assay on Treatment Decisions and Cost in Patients with Node-Positive Breast Cancer: A Multicenter Study in Quebec. Oncologist 2022; 27:822-831. [PMID: 35830543 PMCID: PMC9526502 DOI: 10.1093/oncolo/oyac123] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/26/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The 21-gene Breast Recurrence Score (RS) assay, "the assay", has led to a paradigm shift for patients with hormone receptor-positive, node-negative early breast cancer and is emerging as an important tool to assist physician-patient decisions in foregoing chemotherapy in node-positive patients. We wanted to better understand the impact of the RS assay in node-positive patients upon physician treatment decisions and treatment cost in Quebec, Canada. PATIENTS AND METHODS We conducted a multicenter, prospective observational trial for Estrogen/Progesterone Receptor (ER/PR)- positive, Human Epidermal Growth Factor Receptor 2 (HER2)-negative breast cancer patients with 1-3 positive lymph nodes. Physicians completed a questionnaire indicating treatment choice prior to and post availability of RS results. The primary endpoint was change in the physician's recommendation for chemotherapy prior to and post assay results. Secondary endpoints included change in physician's expressed level of confidence, and changes in estimated cost of recommended treatments prior to and post assay results. RESULTS For the entire cohort, physician recommendation for chemotherapy was reduced by an absolute 67.1% by knowledge of the RS assay result (P < .0001). Physician recommendation of chemotherapy was decreased by 75.9% for patients RS result <14 (P < .0001); and 67.5% for patients with RS result 14-25 (P < .0001). Changes in treatment recommendations were associated with an overall reduction in cost by 73.7% per patient, and after incorporating the cost of the RS test, a cost benefit of $823 CAN at 6-month follow-up. CONCLUSION Altogether, we established that the assay led to a two-third reduction in the use of chemotherapy, and was a cost-effective approach for hormone receptor-positive, node-positive breast cancer.
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Affiliation(s)
- Saima Hassan
- McPeak Sirois Group, Montreal, QC, Canada
- Division of Surgical Oncology, Department of Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de CHUM (CRCHUM), Institut de Cancer de Montréal, Montreal, QC, Canada
| | - Rami Younan
- McPeak Sirois Group, Montreal, QC, Canada
- Division of Surgical Oncology, Department of Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Erica Patocskai
- McPeak Sirois Group, Montreal, QC, Canada
- Division of Surgical Oncology, Department of Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
| | - Louise Provencher
- McPeak Sirois Group, Montreal, QC, Canada
- Centre Hospitalier Universitaire de Quebec, Université Laval, Quebec, QC, Canada
| | - Brigitte Poirier
- McPeak Sirois Group, Montreal, QC, Canada
- Centre Hospitalier Universitaire de Quebec, Université Laval, Quebec, QC, Canada
| | - Luca Sideris
- McPeak Sirois Group, Montreal, QC, Canada
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada
| | - Pierre Dubé
- McPeak Sirois Group, Montreal, QC, Canada
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, QC, Canada
| | - Catalin Mihalcioiu
- McPeak Sirois Group, Montreal, QC, Canada
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | - Jean-François Boileau
- McPeak Sirois Group, Montreal, QC, Canada
- Jewish General Hospital, Segal Cancer Centre, McGill University, Montreal, QC, Canada
| | - André Robidoux
- McPeak Sirois Group, Montreal, QC, Canada
- Division of Surgical Oncology, Department of Surgery, Centre hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, QC, Canada
- Centre de Recherche de CHUM (CRCHUM), Institut de Cancer de Montréal, Montreal, QC, Canada
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Delisle ME, Dingley B, Apte S, Mallick R, Hamilton TD, Stuart H, Francescutti V, McKinnon G, Jost E, Easson A, Merchant SJ, Hebbard P, Wright FC, Berger Richardson D, Younan R, Meguerditchian A, Mathieson A, Hetu J, Johnson S, Nessim C. Sentinel lymph node biopsy in Merkel cell carcinoma: A multi-institutional study from the Pan-Canadian Merkel Cell Collaborative. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.9583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9583 Background: There is controversy regarding sentinel lymph node biopsy (SLNB) in clinically node-negative Merkel Cell Carcinoma (MCC). We compared MCC recurrence and survival between patients who did versus did not undergo a SLNB. Methods: Patients with MCC across 13 Canadian centers were reviewed, from 2000-2018. Of a total cohort of 750 patients, 485 had clinically node-negative disease at presentation. A propensity score was created. The association between SLNB and local, regional and distant recurrence, and cancer-specific and overall survival were evaluated using competing risks and Cox proportional hazards regression. Results: 195 patients (40.2%) underwent a SLNB. SLNB was performed more commonly in younger, healthier patients with MCC located in the extremities or torso (Table). The results of 177 SLNBs were available; 60 (33.9%) were positive. SLNB-positive patients underwent completion dissection (n=15, 25%), completion dissection and nodal radiation (n=22, 36.7%), nodal radiation alone (n=18, 30%) or observation (n=5, 8.3%). Patients who did not undergo a SLNB underwent nodal radiation alone (n=40, 13.8%) or observation (n=250, 86.2%). The median follow-up was 2.7 years (range 0.2-14.4). The regional recurrence rate was 14.5% (n=17) among SLNB-negative versus 15% (n=9) among SLNB-positive patients. Among patients who did not undergo a SLNB, the regional recurrence rate was 25.2% (n=63) among those who underwent observation and 15% (n=6) among those who received nodal radiation alone. After propensity score matching, SLNB patients had a lower risk of regional recurrence (sHR 0.54 95% CI 0.34-0.86 p=0.01) and improved overall survival (HR 0.32 95% CI 0.23-0.45 p<0.01), but there was no difference in local recurrence (sHR 0.92 95% CI 0.50-1.69 p=0.79), distant recurrence (sHR 0.88 95% CI 0.52-1.49 p=0.63), or cancer-specific survival (HR 0.67 95% CI 0.31-1.45 p=0.31). Conclusions: SLNB is associated with a reduced risk of regional recurrence and improved overall survival. The role of SLNB in selecting patients for emerging therapies, such as immunotherapy, needs to be evaluated. [Table: see text]
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Affiliation(s)
| | | | | | | | | | - Heather Stuart
- BC Cancer, Vancouver General Hospital/BC Cancer, BC, Canada
| | | | | | - Evan Jost
- Department of Surgery, University Hospital of Northern British Columbia, Prince George, BC, Canada
| | - Alexandra Easson
- General Surgery and Surgical Oncology, Mount Sinai Hospital and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | | | - Carolyn Nessim
- Department of Surgery, University of Ottawa-Ottawa General Hospital, Ottawa, ON, Canada
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Nassabein R, Younan R, Loungarath R, Mercier F, Dagbert F, Aubin F, Ayoub JP, Tehfé M. A Canadian single-centre experience with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for abdominal malignancies. Can J Surg 2022; 65:E342-E351. [PMID: 35580884 PMCID: PMC9188801 DOI: 10.1503/cjs.004320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Cytoreductive surgery in combination with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) has recently shown promise for the treatment of patients with various types of peritoneal carcinomatosis (PC). However, it is an extensive procedure that is associated with a variety of morbidities. We evaluated the safety and clinical outcomes of CRS-HIPEC performed at our centre. METHODS Patients with abdominal malignancies who underwent CRS-HIPEC between February 2005 and December 2018 at the Centre hospitalier de l'Université de Montréal (CHUM) were retrospectively reviewed. RESULTS A total of 141 patients were identified (66 with appendiceal cancer, 62 with colorectal cancer, 10 with mesothelioma and 3 with small intestinal tumours). The median age was 55 years. Median overall survival (OS) was not reached for patients with appendiceal tumours; it was 38.3 months for colorectal cancers. Among patients with colorectal cancer, survival was significantly better for those who received intraperitoneal HIPEC with oxaliplatin (74.9 mo) compared with mitomycin C (29.1 mo) (p = 0.006). Complete cytoreductive surgery and low peritoneal carcinomatosis index were associated with the highest overall survival in patients with appendiceal tumours and those with colorectal tumours. CONCLUSION CRS-HIPEC can be performed with acceptable morbidity in patients with PC. These results validate the outcomes of previously reported trials, but further prospective trials are warranted to determine which patients will most benefit from the addition of HIPEC to CRS.
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Affiliation(s)
- Rami Nassabein
- Department of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Nassabein, Aubin, Ayoub, Tehfé); and the Department of Surgery, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Younan, Loungarath, Mercier, Dagbert)
| | - Rami Younan
- Department of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Nassabein, Aubin, Ayoub, Tehfé); and the Department of Surgery, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Younan, Loungarath, Mercier, Dagbert)
| | - Rasmy Loungarath
- Department of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Nassabein, Aubin, Ayoub, Tehfé); and the Department of Surgery, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Younan, Loungarath, Mercier, Dagbert)
| | - Frederic Mercier
- Department of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Nassabein, Aubin, Ayoub, Tehfé); and the Department of Surgery, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Younan, Loungarath, Mercier, Dagbert)
| | - Francois Dagbert
- Department of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Nassabein, Aubin, Ayoub, Tehfé); and the Department of Surgery, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Younan, Loungarath, Mercier, Dagbert)
| | - Francine Aubin
- Department of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Nassabein, Aubin, Ayoub, Tehfé); and the Department of Surgery, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Younan, Loungarath, Mercier, Dagbert)
| | - Jean Pierre Ayoub
- Department of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Nassabein, Aubin, Ayoub, Tehfé); and the Department of Surgery, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Younan, Loungarath, Mercier, Dagbert)
| | - Mustapha Tehfé
- Department of Hematology-Oncology, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Nassabein, Aubin, Ayoub, Tehfé); and the Department of Surgery, Centre hospitalier de l'Université de Montréal, Montréal, Que. (Younan, Loungarath, Mercier, Dagbert)
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8
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Mercier F, Passot G, Bonnot PE, Cashin P, Ceelen W, Decullier E, Villeneuve L, Walter T, Levine EA, Glehen O, Baik SH, Baratti D, Bhatt A, De Hingh I, De Simone M, Dubé P, Edwards RP, Franko J, Gonzalez-Bayon L, Gushchin V, Holtzman MP, Hsieh MC, Kecmanovic D, Lee KW, Lehmann K, Liu Y, Mehta S, Morris DL, O’Dwyer S, Orsenigo E, Pande PK, Park EJ, Pingpank JF, Piso P, Rajan F, Rau B, Sardi A, Sideris L, Sommariva A, Spiliotis J, Tentes AAK, Teo M, Yarema R, Younan R, Zaveri SS, Zeh HJ, Abba J, Abboud K, Alyami M, Arvieux C, Bakrin N, Bereder JM, Bouzard D, Brigand C, Carrère S, Delroeux D, Dumont F, Eveno C, Facy O, Guyon F, Ferron G, Kianmanesh R, Dico RL, Lorimier G, Marchal F, Mariani P, Meeus P, Msika S, Ortega-Deballon P, Paquette B, Peyrat P, Pirro N, Pocard M, Porcheron J, Quenet F, Rat P, Sgarbura O, Thibaudeau E, Tuech JJ, Zinzindohoue F. An International Registry of Peritoneal Carcinomatosis from Appendiceal Goblet Cell Carcinoma Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. World J Surg 2022; 46:1336-1343. [PMID: 35286418 DOI: 10.1007/s00268-022-06498-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Peritoneal carcinomatosis from appendiceal goblet cell carcinoma (A-GCC) is a rare and aggressive form of appendiceal tumor. Cytoreductive surgery (CRS) and hyperthermic intra peritoneal chemotherapy (HIPEC) was reported as an interesting alternative regarding survival compared to surgery without HIPEC and/or systemic chemotherapy. Our aim was to evaluate the impact of CRS and HIPEC for patients presenting A-GCC through an international registry. METHODS A prospective multicenter international database was retrospectively searched to identify all patients with A-GCC tumor and peritoneal metastases who underwent CRS and HIPEC through the Peritoneal Surface Oncology Group International (PSOGI). The post-operative complications, long-term results, and principal prognostic factors were analyzed. RESULTS The analysis included 83 patients. After a median follow-up of 47 months, the median overall survival (OS) was 34.6 months. The 3- and 5-year OS was 48.5% and 35.7%, respectively. Patients who underwent complete macroscopic CRS had a significantly better survival than those treated with incomplete CRS. The 5-year OS was 44% and 0% for patients who underwent complete, and incomplete CRS, respectively (HR 9.65, p < 0.001). Lymph node involvement and preoperative chemotherapy were also predictive of a worse prognosis. There were 3 postoperative deaths, and 30% of the patients had major complications. CONCLUSION CRS and HIPEC may increase long-term survival in selected patients with peritoneal metastases of A-GCC origin, especially when complete CRS is achieved. Ideally, randomized control trials or more retrospective data are needed to confirm CRS and HIPEC as the gold standard in this pathology.
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Affiliation(s)
- Frederic Mercier
- Department of Surgical Oncology, CHU Montreal, University of Montreal, 1000 St-Denis, Montreal, QC, H2X 0C1, Canada. .,The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.
| | - Guillaume Passot
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
| | | | - Peter Cashin
- Department of Surgery, Akademiska Sjukhuset, Uppsala University Hospital, Uppasala, Sweden
| | - Wim Ceelen
- Department of Gastrointestinal Surgery, Gent University Hospital, Ghent, Belgium
| | - Evelyne Decullier
- Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Laurent Villeneuve
- EMR 37-38, Lyon 1 University, Lyon, France.,Hospices Civils de Lyon, Pôle Santé Publique, Unité de Recherche Clinique, Lyon, France
| | - Thomas Walter
- Department of Gastroenterology and Oncology, Hospices Civils de Lyon, Edouard Herriot Hospital University of Lyon, Lyon, France
| | - Edward A Levine
- Section of Surgical Oncology, Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Olivier Glehen
- The Department of Surgical Oncology, CHU Lyon Sud, Hospices civils de Lyon, University of Lyon, Lyon, France.,EMR 37-38, Lyon 1 University, Lyon, France
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Johnson G, Vergis A, Unger B, Park J, Gillman L, Hickey K, Pace D, Azin A, Guidolin K, Lam-Tin-Cheung K, Chadi S, Quereshy F, Guidolin K, Catton J, Rubin B, Bell J, Marangos J, Heesters A, Stuart-McEwan T, Quereshy F, Shariff F, Wright F, Ahmed N, Nadler A, Hallet J, Gentles J, Chen L, Hwang H, Parapini M, Hirpara D, Sidhu R, Scott T, Karimuddin A, Guo R, Nguyen A, Osborn J, Wiseman S, Nabata K, Ertel E, Hwang H, Lenet T, Baker L, Park L, Vered M, Zahrai A, Shorr R, Davis A, McIsaac D, Tinmouth A, Fergusson D, Martel G, Nabata K, Rummel S, Stefic-Cubic M, Karimuddin A, Stewart M, Melck A, McKechnie T, Anpalagan T, Ichhpuniani S, Lee Y, Ramji K, Eskicioglu C, Zhu A, Deng S, Greene B, Tsang M, Palter V, Jayaraman S, McKechnie T, Mann A, Tittley J, Cadeddu M, Nguyen M, Madani A, Pasternak J, McKechnie T, Ramji K, Hong D, Qu L, Istl A, Tang E, Gray D, Zuckerman J, Coburn N, Callum J, McLeod R, Pearsall E, Lin Y, Turgeon A, Martel G, Hallet J, Mahar A, Kammili A, Kriviraltcheva-Kaneva P, Lee L, Cools-Lartigue J, Ferri L, Mueller C, Zuckerman J, Haas B, Tillman B, Guttman M, Chesney T, Zuk V, Mahar A, Hsu A, Chan W, Vasdev R, Coburn N, Hallet J, D'Souza K, Huynh C, Ling LCJ, Warburton R, Hwang H, Hameed M, Glass L, Williamson H, Murphy P, Tang E, Leslie K, Hawel J, Kerr L, Zablotny S, Roldan H, He W, Jiang X, Zheng B, Lee L, Fiore J, Feldman L, Fried G, Mueller C, Valanci S, Balvardi S, Cipolla J, Kaneva P, Demyttenaere S, Boutros M, Lee L, Feldman L, Fiore J, Balvardi S, Alhashemi M, Cipolla J, Lee L, Fiore J, Feldman L, Miles A, Purich K, Verhoeff K, Shapiro J, Bigam D, Kung J, Fecso A, Chesney T, Mosko J, Skubleny D, Hamilton P, Ghosh S, Widder S, Schiller D, Do U, El Kefraoui C, Pook M, Barone N, Balvardi S, Montgomery H, Nguyen-Powanda P, Rajabiyazdi F, Elhaj H, Lapointe-Gagner M, Olleik G, Kaneva P, Antoun A, Safa N, Di Lena E, Meterissian S, Meguerditchian A, Fried G, Alhashemi M, Lee F, Baldini G, Feldman L, Fiore J, Serrano Aybar PE, Parpia S, Ruo L, Tywonek K, Lee S, O'Neill C, Faisal N, Alfayyadh A, Gundayao M, Meyers BM, Habashi R, Kruse C, McKechnie T, Levin M, Aldrich K, Grantcharov T, Langerman A, Forbes H, Anantha R, Fawcett V, Hetherington A, Pravong V, Gervais M, Rakovich G, Selvam R, Hu R, Musselman R, Raiche I, Moloo H, Liu R, Elnahas A, Alkhamesi N, Hawel J, Tang E, Alnumay A, Schlachta C, Walser E, Zhang C, Cristancho S, Ott M, Lee A, Niu B, Balaa F, Gawad N, Ren K, Qiu Y, Hamann K, How N, Leveille C, Davidson A, Eqbal A, Sardiwalla Y, Korostensky M, McKechnie T, Lee E, Yang I, Ren K, Muaddi H, Stukel T, de Mestral C, Nathens A, Karanicolas P, Frigault J, Lemieux S, Breton D, Bouchard P, Bouchard A, Grégoire R, Letarte F, Bouchard G, Drolet S, Frigault J, Avoine S, Drolet S, Letarte F, Bouchard A, Gagné J, Thibault C, Grégoire R, Jutras Bouthillette N, Gosselin M, Bouchard P, Rosenzveig A, Stuleanu T, Jarrar A, Kolozsvari N, Skelhorne-Gross G, Nenshi R, Jerath A, Gomez D, Singh K, Amir T, Liu E, Farquharson S, Mao R, Lan L, Yan J, Allard-Coutu A, Mierzwa A, Tin R, Brisebois R, Bradley N, Wigen R, Walser E, Hartford L, Van Koughnett J, Vogt K, Hilsden R, Parry N, Allen L, Leslie K, Raskin R, Jones J, Neumann K, Dwyer C, Strickland M, Bradley N, O'Dochartaigh D, Lobay K, Kabaroff A, Chang E, Widder S, Anantha R, Sun W, Beck J, Anantha R, Liu R, Davidson J, Jones S, Van Hooren T, Van Koughnett J, Ott M, Schmitz E, Raiche I, Sun W, El Hafid M, Dang J, Mocanu V, Lutzak G, Sultanian R, Wong C, Karmali S, Schmitz E, Petrera M, Pickell M, Auer R, Patro N, Li B, Lee Y, Wilson H, Mocanu V, Sun W, Dang J, Jogiat U, Kung J, Switzer N, Karmali S, Wong C, Li C, Al Hinai A, Cieply A, Hawes H, Joos E, Saleh A, Li C, Saleh A, Engels P, Drung J, Allen L, Leslie K, Pang G, Kwong M, Schlachta C, Alkhamesi N, Hawel J, Elnahas A, Guidolin K, Ellsmere J, Chadi S, Quereshy F, Chang D, Hutter M, Spence R, Abou Khalil M, Boutros M, Vasilevsky C, Morin N, Longtin Y, Liberman S, Demyttenaere S, Montpetit P, Poirier M, Mukherjee K, Sebajang H, Younan R, Schwenter F, De Broux E, Larsen K, Skelhorne-Gross G, Beckett A, Nantais J, Gomez D, Lan L, Mao R, Kay J, Lohre R, Ayeni O, Goel D, de Sa D, He R, Hylton D, Bedard E, Johnson S, Laing B, Valji A, Hanna W, Turner S, Akhtar-Danesh G, Akhtar-Danesh N, Shargall Y, Akhtar-Danesh G, Akhtar-Danesh N, Shargall Y, Hirpara D, Gupta V, Kidane B, Limbachia J, Sullivan K, Farrokhyar F, Leontiadis G, Patel Y, Churchill I, Hylton D, Xie F, Seely A, Spicer J, Kidane B, Turner S, Yasufuku K, Hanna W, Jogiat U, Sun W, Dang J, Mocanu V, Kung J, Karmali S, Turner S, Switzer N, Patel Y, Churchill I, Sullivan K, Beauchamp M, Wald J, Mbuagbaw L, Agzarian J, Shargall Y, Finley C, Fahim C, Hanna W, Abbas M, Olaiya O, Begum H, Mbuagbaw L, Finley C, Hanna W, Agzarian J, Shargall Y, Ednie A, Palma D, Warner A, Malthaner R, Fortin D, Qiabi M, Nayak R, Nguyen T, Louie A, Rodrigues G, Yaremko B, Laba J, Inculet R, Alaichi J, Patel Y, Hanna W, Turner S, Mador B, Lai H, White J, Kim M, Hirpara D, Kidane B, Louie A, Zuk V, Darling G, Rousseau M, Chesney T, Coburn N, Hallet J, Lee Y, Samarasinghe Y, Lee M, Thiru L, Shargall Y, Finley C, Hanna W, Levine O, Juergens R, Agzarian J, Nayak R, Brogly S, Li W, Lougheed D, Petsikas D, Mistry N, Gatti A, Churchill I, Patel Y, Hanna W, Abdul S, Anestee C, Gilbert S, Sundaresan S, Seely A, Villeneuve P, Maziak D, Razzak R, Ashrafi A, Tregobov N, Hassanzadeh N, Stone S, Panjwani A, Bong T, Bond R, Hafizi A, De Meo M, Rayes R, Milette S, Vagai M, Usatii M, Chandrasekaran A, Giannias B, Bourdeau F, Sangwan V, Bertos N, Moraes C, Huang S, Quail D, Walsh L, Camilleri-Broet S, Fiset P, Cools-Lartigue J, Ferri L, Spicer J, Kammili A, Bilgic E, Quaiattini A, Maurice-Ventouris M, Najmeh S, Mueller C, Esther L, Begum H, Agzarian J, Hanna W, Finley C, Shargall Y, Lee Y, Lu J, Malhan R, Shargall Y, Finley C, Hanna W, Agzarian J, Brophy S, Brennan K, French D, Resende V, Momtazi M, Solaja O, Gilbert S, Maziak D, Seely A, Sundaresan S, Villeneuve P, Sisson D, Donahoe L, Bedard P, Hansen A, De Perrot M, Alghamedi A, Simone A, Begum H, Hanna W, Shargall Y, Turner S, Huang J, Lai H, Bedard E, Shargall Y, Murthy S, Lin J, Darling G, Malthaner R, Kidane B, Seely A, Li H, Crowther M, Linkins L, Lau E, Schneider L, Hanna W, Finley C, Agzarian J, Douketis J, Greenberg B, Gupta V, Allen-Avodabo C, Davis L, Zhao H, Kidane B, Darling G, Coburn N, Huynh C, Cools-Lartigue J, Ferri L, Najmeh S, Sirois C, Mulder D, Spicer J, Al Rawahi A, Aftab Abdul S, Nguyen D, Anstee C, Delic E, Gilbert S, Maziak D, Villeneuve P, Seely A, Sisson D, Sasewich H, Islam T, Low D, Darling G, Turner S, Humer M, Abdul S, Nguyen D, Al Rawahi A, Anstee C, Delic E, Gilbert S, Villeneuve P, Maziak D, Seely A, Le Nguyen D, Aftab Abdul S, Al Rawahi A, Anstee C, Delic E, Gilbert S, Villeneuve P, Maziak D, Seely A, Patel Y, Kay M, Churchill I, Sullivan K, Shargall Y, Shayegan B, Adili A, Hanna W, Kaafarani M, Huynh C, Chouiali F, Muthukrishnan N, Maleki F, Ovens K, Gold M, Sorin M, Falutz R, Rayes R, Forghani R, Spicer J, Hunka N, Kennedy R, Bigsby R, Bharadwaj S, Gowing S, Churchill I, Gatti A, Hylton D, Sullivan K, Patel Y, Farrokhyar F, Leontiadis G, Hanna W, Finley C, Begum H, Pearce K, Agzarian J, Hanna W, Shargall Y, Akhtar-Danesh N, Jones D, Anstee C, Kumar S, Gingrich M, Simone A, Ahmadzai Z, Thavorn K, Seely A, Gupta V, Namavarian A, Mohammed A, Uddin S, Jones D, Behzadi A, Brar A, Qu L, Qiabi M, Nayak R, Malthaner R, Peters E, Buduhan G, Tan L, Liu R, Srinathan S, Kidane B, Gupta V, Levy J, Kidane B, Mahar A, Ringash J, Sutradhar R, Darling G, Coburn N, Robinson M, Bednarek L, Buduhan G, Liu R, Tan L, Srinathan S, Kidane B, Wang H, French D, MacDonald D, Graham K, Enns S, Buduhan G, Srinathan S, Liu R, Tan A, Kidane B, Bruinooge A, Poole E, Pascoe C, Karakach T, Buduhan G, Tan L, Srinathan S, Halayko A, Kidane B, Verhoeff K, Mocanu V, Fang B, Dang J, Kung J, Switzer N, Birch D, Karmali S, Johnson G, Singh H, Vergis A, Park J, Hershorn O, Hochman D, Helewa R, Johnson G, Robertson R, Vergis A, Johnson G, Vergis A, Singh H, Park J, Helewa R, Azin A, Cahill C, Lipson M, Afzal A, Maclean A, Wong C, Roen S, Buie W, McKechnie T, Anpalagan T, Chu M, Lee Y, Amin N, Hong D, Eskicioglu C, McKechnie T, Ramji K, Kruse C, Jaffer H, Rebello R, Amin N, Doumouras A, Hong D, Eskicioglu C, Hajjar R, Oliero M, Cuisiniere T, Fragoso G, Calvé A, Djediai S, Annabi B, Richard C, Santos M, Purich K, Zhou Y, Dodd S, Ring B, Yuan Y, White J, Garfinkle R, Dell'Aniello S, Bhatnagar S, Morin N, Ghitulescu G, Faria J, Vasilevsky C, Brassard P, Boutros M, Garfinkle R, Salama E, Amar-Zifkin A, Morin N, Ghitulescu G, Faria J, Vasilevsky C, Boutros M, Talwar G, Daniel R, McKechnie T, Levine O, Eskicioglu C, AlSulaim H, Alqahtani M, Garfinkle R, Al-Masrouri S, Vasilevsky C, Morin N, Boutros M, McKechnie T, Chen A, Patel A, Lee Y, Doumouras A, Hong D, Eskicioglu C, Brissette V, Al Busaidi N, Rajabiyazdi F, Moon J, Demian M, Vasilevsky C, Morin N, Boutros M, Selvam R, Moloo H, MacRae H, Alam F, Raiche I, Holland J, Cwintal M, Rigas G, Vasilevsky C, Morin N, Ghitulescu G, Faria J, Pang A, Boutros M, Holland J, Moon J, Marinescu D, Morin N, Ghitulescu G, Pang A, Vasilevsky C, Boutros M, Brown C, Karimuddin A, Raval M, Phang P, Ghuman A, Li M, Muncner S, Mihajlovic I, Dykstra M, Snelgrove R, Wang H, Monton O, Smith A, Moon J, Demian M, Garfinkle R, Vasilevsky C, Rajabiyazdi F, Boutros M, AlAamer O, AlSelaim N, AlMalki M, Al-Osail A, Ruxton R, Manuel P, Mohamed F, Motamedi MK, Serahati S, Rajendran L, Brown C, Raval M, Karimuddin A, Ghuman A, Phang T, Caminsky N, Moon J, Rajabiyazdi F, Chadi S, Alavi K, Paquette I, MacLean T, Wexner S, Liberman S, Steele S, Park J, Patel S, Bordeianou L, Auer R, Sylla P, Morin N, Ghuman A, Boutros M, Bayat Z, Kennedy E, Victor C, Govindarajan A, Liang J, Vasilevsky C, Pang A, Ghitulescu G, Faria J, Morin N, Boutros M, Marinescu D, Roy H, Baig Z, Karimmudin A, Raval M, Brown C, Phang T, Gill D, Ginther N, Moon J, Marinescu D, Pang A, Ghitulescu G, Faria J, Morin N, Vasilevsky C, Boutros M, Moon J, Pang A, Ghitulescu G, Faria J, Morin N, Vasilevsky C, Boutros M, Salama E, Alrashid F, Vasilevsky C, Ghitulescu G, Faria J, Morin N, Boutros M, Wiseman V, Zhang L, MacDonald P, Merchant SM, Wattie Barnett K, Caycedo-Marulanda A, Patel SV, Harra Z, Vasilevsky C, Ghitulescu G, Morin N, Boutros M, Pang A, Hegagi M, Alqahtani M, Morin N, Ghitulescu G, Vasilevsky C, Boutros M, Alghaithi N, Marinescu D, Al-Masrouri S, Pang A, Vasilevsky C, Boutros M, Papillon E, Kasteel N, Kaur G, Bindra S, Malhotra A, Graham C, MacLean A, Beck P, Jijon H, Ferraz J, Buie W, Szwimer R, Moon J, Demian M, Pang A, Morin N, Vasilevsky C, Rajabiyazdi F, Boutros M, Azin A, Merchant S, Kong W, Gyawali B, Hanna T, Chung W, Nanji S, Patel S, Booth C, Li V, Awan A, Serrano P, Jacobson M, Chanco M, Wen V, Singh N, Peiris L, Pasieka J, Ghatage P, Buie D, MacLean T, Bouchard-Fortier A, Mack L, Marini W, Zheng W, Swallow C, Reedijk M, DiPasquale A, Peiris L, Prus-Czrnecka Z, Delmar L, Gagnon N, Villiard R, Martel É, Cadrin-Chênevert A, Ledoux É, Racicot C, Mysuria S, Bazzarelli A, Pao J, Chen L, Zhang M, McKevitt E, Warburton R, Kuusk U, Van Laeken N, Bovill E, Isaac K, Dingee C, Hunter-Smith A, Cuthbert C, Fergus K, Barbera L, Efegoma Y, Howell D, Isherwood S, Levasseur N, Scheer A, Simmons C, Srikantham A, Temple-Orberle C, Xu Y, Metcalfe K, Quan M, Alqaydi A, la J, Merchant S, Digby G, Pravong V, Brind'Amour A, Sidéris L, Dubé P, De Guerke L, Fortin S, Auclair M, Trilling B, Tremblay J, Di Lena É, Hopkins B, Wong S, Meterissian S, Di Lena É, Barone N, Hopkins B, Dumitra S, Kaneva P, Fiore J, Meterissian S, Mysuria S, McKevitt E, Warburton R, Chen L, Bazzarelli A, Pao J, Bovill E, Zhang M, Kuusk U, Isaac K, Van Laeken N, Dingee C, Kapur H, McKevitt E, Warburton R, Pao J, Dingee C, Bazarelli A, Kuusk U, Chen L, Cadili L, DeGirolamo K, McKevitt E, Pao J, Dingee C, Bazzarelli A, Warburton R, Ng D, Ali A, Eymae D, Lee K, Brar S, Conner J, Magalhaes M, Swallow C, Allen K, Baliski C, Cyr D, Sari A, Messenger D, Driman D, Assarzadegan N, Juda A, Swallow C, Kennedy E, Brar M, Conner J, Kirsch R, Allard-Coutu A, Singh K, Lamontagne A, Gamache Y, Allard-Coutu A, Mardinger C, Lee C, Duckworth R, Brindle M, Fraulin F, Austen L, Kortbeek J, Hyndman M, Nguyen D, Jamjoum G, Meguerditchian A, Langer S, Yuan Xu Y, Kong S, Quan M, Lim D, Retrouvey H, Kerrebijn I, Butler K, O'Neill A, Cil T, Zhong T, Hofer S, McCready D, Metcalfe K, Lim D, Greene B, Look Hong N, Parapini M, Skipworth J, Mah A, Desai S, Chung S, Scudamore C, Segedi M, Vasilyeva E, Li J, Kim P, Verhoeff K, Deprato A, Purich K, Kung J, Bigam D, Dajani K, Lenet T, Gilbert R, Smoot R, Martel G, Tzeng C, Rocha F, Yohanathan L, Cleary S, Bertens K, Reyna-Sepulveda F, Badrudin D, Gala-Lopez B, Hanna N, Brogly S, Wei X, Booth C, Nanji S, Zuckerman J, Coburn N, Mahar A, Callum J, Kaliwal Y, Jayaraman S, Wei A, Martel G, Hallet J, Zuckerman J, Jayaraman S, Wei A, Mahar A, Kaliwal Y, Martel G, Coburn N, Hallet J, Henault D, Barrette B, Pelletier S, Thebault P, Beaudry-Simoneau E, Rong Z, Plasse M, Dagenais ARM, Létourneau R, Lapointe R, Vandenbroucke-Menu F, Nguyen B, Soucy G, Turcotte S, Lemke M, Waugh E, Leslie K, Quan D, Skaro A, Tang E, Lund M, Allen L, Glinka J, Jada G, Quan D, Skaro A, Tang E, Park L, Daza J, Li V, Msallak H, Zhang B, Workneh A, Faisal S, Faisal R, Fabbro M, Gu C, Claassen M, Zuk V, Hallet J, Martel G, Sapisochin G, Serrano P, Glinka J, Skaro A, Leslie K, Jada G, Quan D, Tang E, Waugh E, Lemke M, Glinka J, Skaro A, Leslie K, Tang E, Waugh E, Breadner D, Liu R, Tang E, Allen L, Welch S, Skaro A, Leslie K, Glinka J, Waugh E, Tang E, Jada G, Quan D, Skaro A, Webb A, Lester E, Shapiro A, Eurich D, Bigam D, Essaji Y, Shrader H, Nayyar A, Suraju M, Williams-Perez S, Ear P, Chan C, Smith V, Rivers-Bowerman M, Costa A, Stueck A, Campbell N, Allen S, Gala-Lopez B, Gilbert R, Lenet T, Cleary S, Smoot R, Tzeng C, Rocha F, Martel G, Bertens K, Mir Z, Golding H, McKeown S, Nanji S, Flemming J, Groome P, Mir Z, Djerboua M, Nanji S, Flemming J, Groome P, Elbekri S, Turcotte S, Girard E, Morency-Potvin P, Lapointe R, Vandenbroucke-Menu F, Dagenais M, Roy A, Letourneau R, Plasse M, Simoneau E, Rong Z, Zuker N, Oakley M, Chartrand G, Misheva B, Bendavid Y, Frigault J, Lemieux S, Breton D, Bouchard G, Drolet S, Melland-Smith M, Smith L, Tan J, Kahn U, McLean C, Mocanu V, Birch D, Karmali S, Switzer N, Fortin M, Paré X, Doyon A, Keshavjee S, Schwenger K, Yadav J, Fischer S, Jackson T, Allard J, Okrainec A, Lee Y, Anvari S, Chu M, Lovrics O, Aditya I, Malhan R, Khondker A, Walsh M, Doumouras A, Hong D, He W, Vergis A, Hardy K, Romanescu R, Deaninck F, Linton J, Fowler-Woods M, Fowler-Woods A, Shingoose G, Vergis A, Hardy K, Zmudzinski M, Cloutier Z, McKechnie T, Lee Y, Archer V, Doumouras A, Shiroky J, Abu Halimah J, Ramji K, Boudreau V, Mierzwa A, Mocanu V, Marcil G, Dang J, Switzer N, Birch D, Karmali S, Mierzwa A, Jarrar A, Hardy-Henry A, Kolozsvari N, Lin W, Hagen J, Connell M, Sun W, Dang J, Mocanu V, Kung J, Switzer N, Birch D, Karmali S. 2021 Canadian Surgery Forum01. Design and validation of a unique endoscopy simulator using a commercial video game03. Is ethnicity an appropriate measure of health care marginalization?: A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in the Aboriginal population04. Racial disparities in surgery — a cross-specialty matched comparison between black and white patients05. Starting late does not increase the risk of postoperative complications in patients undergoing common general surgical procedures06. Ethical decision-making during a health care crisis: a resource allocation framework and tool07. Ensuring stability in surgical training program leadership: a survey of program directors08. Introducing oncoplastic breast surgery in a community hospital09. Leadership development programs for surgical residents: a review of the literature10. Superiority of non-opioid postoperative pain management after thyroid and parathyroid operations: a systematic review and meta-analysis11. Timing of ERCP relative to cholecystectomy in patients with ductal gallstone disease12. A systematic review and meta-analysis of randomized controlled trials comparing intraoperative red blood cell transfusion strategies13. Postoperative outcomes after frail elderly preoperative assessment clinic: a single-institution Canadian perspective14. Selective opioid antagonists following bowel resection for prevention of postoperative ileus: a systematic review and meta-analysis15. Peer-to-peer coaching after bile duct injury16. Laparoscopic median arcuate ligament release: a video abstract17. Retroperitoneoscopic approach to adrenalectomy19. Endoscopic Zenker diverticulotomy: a video abstract20. Variability in surgeons’ perioperative management of pheochromocytomas in Canada21. The contribution of surgeon and hospital variation in transfusion practice to outcomes for patients undergoing elective gastrointestinal cancer surgery: a population-based analysis22. Perioperative transfusions for gastroesophageal cancers: risk factors and short- and long-term outcomes23. The association between frailty and time alive and at home after cancer surgery among older adults: a population-based analysis24. Psychological and workplace-related effects of providing surgical care during the COVID-19 pandemic in British Columbia, Canada25. Safety of venous thromboembolism prophylaxis in endoscopic retrograde cholangiopancreatography: a systematic review26. Complications and reintervention following laparoscopic subtotal cholecystectomy: a systematic review and meta-analysis27. Synchronization of pupil dilations correlates with team performance in a simulated laparoscopic team coordination task28. Receptivity to and desired design features of a surgical peer coaching program: an international survey9. Impact of the COVID-19 pandemic on rates of emergency department utilization due to general surgery conditions30. The impact of the current COVID-19 pandemic on the exposure of general surgery trainees to operative procedures31. Association between academic degrees and research productivity: an assessment of academic general surgeons in Canada32. Laparoscopic endoscopic cooperative surgery (LECS) for subepithelial gastric lesion: a video presentation33. Effect of the COVID-19 pandemic on acute care general surgery at an academic Canadian centre34. Opioid-free analgesia after outpatient general surgery: a pilot randomized controlled trial35. Impact of neoadjuvant immunotherapy or targeted therapies on surgical resection in patients with solid tumours: a systematic review and meta-analysis37. Surgical data recording in the operating room: a systematic review of modalities and metrics38. Association between nonaccidental trauma and neighbourhood socioeconomic status during the COVID-19 pandemic: a retrospective analysis39. Laparoscopic repair of a transdiaphragmatic gastropleural fistula40. Video-based interviewing in medicine: a scoping review41. Indocyanine green fluorescence angiography for prevention of anastomotic leakage in colorectal surgery: a cost analysis from the hospital payer’s perspective43. Perception or reality: surgical resident and faculty assessments of resident workload compared with objective data45. When illness and loss hit close to home: Do health care providers learn how to cope?46. Remote video-based suturing education with smartphones (REVISE): a randomized controlled trial47. The evolving use of robotic surgery: a population-based analysis48. Prophylactic retromuscular mesh placement for parastomal hernia prevention: a retrospective cohort study of permanent colostomies and ileostomies49. Intracorporeal versus extracorporeal anastomosis in laparoscopic right hemicolectomy: a retrospective cohort study on anastomotic complications50. A lay of the land — a description of Canadian academic acute care surgery models51. Emergency general surgery in Ontario: interhospital variability in structures, processes and models of care52. Trauma 101: a virtual case-based trauma conference as an adjunct to medical education53. Assessment of the National Surgical Quality Improvement Program Surgical Risk Calculator for predicting patient-centred outcomes of emergency general surgery patients in a Canadian health care system54. Sustainability of a narcotic reduction initiative: 1 year following the Standardization of Outpatient Procedure (STOP) Narcotics Study55. Barriers to transanal endoscopic microsurgery referral56. Geospatial analysis of severely injured rural patients in a geographically complex landscape57. Implementation of an incentive spirometry protocol in a trauma ward: a single-centre pilot study58. Impostor phenomenon is a significant risk factor for burnout and anxiety in Canadian resident physicians: a cross-sectional survey59. Understanding the influence of perioperative education on performance among surgical trainees: a single-centre experience60. The effect of COVID-19 pandemic on current and future endoscopic personal protective equipment practices: a national survey of 77 endoscopists61. Case report: delayed presentation of perforated sigmoid diverticulitis as necrotizing infection of the lower limb62. Investigating disparities in surgical outcomes in Canadian Indigenous populations63. Fundoplication is superior to medical therapy for Barrett esophagus disease regression and progression: a systematic review and meta-analysis64. Development of a novel online general surgery learning platform and a qualitative preimplementation analysis65. Hagfish slime exudate as a potential novel hemostatic agent: developing a standardized assessment protocol66. The effect of the first wave of the COVID-19 pandemic on surgical oncology case volumes and wait times67. Safety of same-day discharge in high-risk patients undergoing ambulatory general surgery68. External validation of the Codman score in colorectal surgery: a pragmatic tool to drive quality improvement69. Improved morbidity and gastrointestinal restoration rates without compromising survival rates for diverting loop ileostomy with colonic lavage versus total abdominal colectomy for fulminant Clostridioides difficile colitis: a multicentre retrospective cohort study70. Potential access to emergency general surgical care in Ontario71. Immersive virtual reality (iVR) improves procedural duration, task completion and accuracy in surgical trainees: a systematic review01. Clinical validation of the Canada Lymph Node Score for endobronchial ultrasound02. Venous thromboembolism in surgically treated esophageal cancer patients: a provincial population-based study03. Venous thromboembolism in surgically treated lung cancer patients: a population-based study04. Is frailty associated with failure to rescue after esophagectomy? A multi-institutional comparative analysis of outcomes05. Routine systematic sampling versus targeted sampling of lymph nodes during endobronchial ultrasound: a feasibility randomized controlled trial06. Gastric ischemic conditioning reduces anastomotic complications in patients undergoing esophagectomy: a systematic review and meta-analysis07. Move For Surgery, a novel preconditioning program to optimize health before thoracic surgery: a randomized controlled trial08. In case of emergency, go to your nearest emergency department — Or maybe not?09. Does preoperative SABR increase the risk of complications from lung cancer resection? A secondary analysis of the MISSILE trial10. Segmental resection for lung cancer: the added value of near-infrared fluorescence mapping diminishes with surgeon experience11. Toward competency-based continuing professional development for practising surgeons12. Stereotactic body radiotherapy versus surgery in older adults with NSCLC — a population-based, matched analysis of long-term dependency outcomes13. Role of adjuvant therapy in esophageal cancer patients after neoadjuvant therapy and curative esophagectomy: a systematic review and meta-analysis14. Evaluation of population characteristics on the incidence of thoracic empyema: an ecological study15. Determining the optimal stiffness colour threshold and stiffness area ratio cut-off for mediastinal lymph node staging using EBUS elastography and AI: a pilot study16. Quality assurance on the use of sequential compression stockings in thoracic surgery (QUESTs)17. The relationship between fissureless technique and prolonged air leak for patients undergoing video-assisted thoracoscopic lobectomy18. CXCR2 inhibition as a candidate for immunomodulation in the treatment of K-RAS-driven lung adenocarcinoma19. Assessment tools for evaluating competency in video-assisted thoracoscopic lobectomy: a systematic review20. Understanding the current practice on chest tube management following lung resection among thoracic surgeons across Canada21. Effect of routine jejunostomy tube insertion in esophagectomy: a systematic review and meta-analysis22. Recurrence of primary spontaneous pneumothorax following bullectomy with pleurodesis or pleurectomy: a retrospective analysis23. Surgical outcomes following chest wall resection and reconstruction24. Outcomes following surgical management of primary mediastinal nonseminomatous germ cell tumours25. Does robotic approach offer better nodal staging than thoracoscopic approach in anatomical resection for non–small cell lung cancer? A single-centre propensity matching analysis26. Competency assessment for mediastinal mass resection and thymectomy: design and Delphi process27. The contemporary significance of venous thromboembolism (deep venous thrombosis [DVT] and pulmonary embolus [PE]) in patients undergoing esophagectomy: a prospective, multicentre cohort study to evaluate the incidence and clinical outcomes of VTE after major esophageal resections28. Esophageal cancer: symptom severity at the end of life29. The impact of pulmonary artery reconstruction on postoperative and oncologic outcomes: a systematic review30. Association with surgical technique and recurrence after laparoscopic repair of paraesophageal hernia: a single-centre experience31. Enhanced recovery after surgery (ERAS) in esophagectomy32. Surgical treatment of esophageal cancer: trends in surgical approach and early mortality at a single institution over the past 18 years34. Adverse events and length of stay following minimally invasive surgery in paraesophageal hernia repair35. Long-term symptom control comparison of Dor and Nissen fundoplication following laparoscopic para-esophageal hernia repair: a retrospective analysis36. Willingness to pay: a survey of Canadian patients’ willingness to contribute to the cost of robotic thoracic surgery37. Radiomics in early-stage lung adenocarcinoma: a prediction tool for tumour immune microenvironments38. Effectiveness of intraoperative pyloric botox injection during esophagectomy: how often is endoscopic intervention required?39. An artificial intelligence algorithm for predicting lymph node malignancy during endobronchial ultrasound40. The effect of major and minor complications after lung surgery on length of stay and readmission41. Measuring cost of adverse events following thoracic surgery: a scoping review42. Laparoscopic paraesophageal hernia repair: characterization by hospital and surgeon volume and impact on outcomes43. NSQIP 5-Factor Modified Frailty Index predicts morbidity but not mortality after esophagectomy44. Trajectory of perioperative HRQOL and association with postoperative complications in thoracic surgery patients45. Variation in treatment patterns and outcomes for resected esophageal cancer at designated thoracic surgery centres46. Patient-reported pretreatment health-related quality of life (HRQOL) predicts short-term survival in esophageal cancer patients47. Analgesic efficacy of surgeon-placed paravertebral catheters compared with thoracic epidural analgesia after Ivor Lewis esophagectomy: a retrospective noninferiority study48. Rapid return to normal oxygenation after lung surgery49. Examination of local and systemic inflammatory changes during lung surgery01. Implications of near-infrared imaging and indocyanine green on anastomotic leaks following colorectal surgery: a systematic review and meta-analysis02. Repeat preoperative endoscopy after regional implementation of electronic synoptic endoscopy reporting: a retrospective comparative study03. Consensus-derived quality indicators for operative reporting in transanal endoscopic surgery (TES)04. Colorectal lesion localization practices at endoscopy to facilitate surgical and endoscopic planning: recommendations from a national consensus Delphi process05. Black race is associated with increased mortality in colon cancer — a population-based and propensity-score matched analysis06. Improved survival in a cohort of patients 75 years and over with FIT-detected colorectal neoplasms07. Laparoscopic versus open loop ileostomy reversal: a systematic review and meta-analysis08. Posterior mesorectal thickness as a predictor of increased operative time in rectal cancer surgery: a retrospective cohort study09. Improvement of colonic anastomotic healing in mice with oral supplementation of oligosaccharides10. How can we better identify patients with rectal bleeding who are at high risk of colorectal cancer?11. Assessment of long-term bowel dysfunction in rectal cancer survivors: a population-based cohort study12. Observational versus antibiotic therapy for acute uncomplicated diverticulitis: a noninferiority meta-analysis based on a Delphi consensus13. Radiotherapy alone versus chemoradiotherapy for stage I anal squamous cell carcinoma: a systematic review and meta-analysis14. Is the Hartmann procedure for diverticulitis obsolete? National trends in colectomy for diverticulitis in the emergency setting from 1993 to 201515. Sugammadex in colorectal surgery: a systematic review and meta-analysis16. Sexuality and rectal cancer treatment: a qualitative study exploring patients’ information needs and expectations on sexual dysfunction after rectal cancer treatment17. Video-based interviews in selection process18. Impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention19. Opioid use disorder associated with increased anastomotic leak and major complications after colorectal surgery20. Effectiveness of a rectal cancer education video on patient expectations21. Robotic-assisted rectosigmoid and rectal cancer resection: implementation and early experience at a Canadian tertiary centre22. An online educational app for rectal cancer survivors with low anterior resection syndrome: a pilot study23. The effects of surgeon specialization on the outcome of emergency colorectal surgery24. Outcomes after colorectal cancer resections in octogenarians and older in a regional New Zealand setting — What are the predictors of mortality?25. Long-term outcomes after seton placement for perianal fistulae with and without Crohn disease26. A survey of patient and surgeon preference for early ileostomy closure following restorative proctectomy for rectal cancer — Why aren’t we doing it?27. Crohn disease independently associated with longer hospital admission after surgery28. Short-stay (≤ 1 d) diverting loop ileostomy closure can be selectively implemented without an increase in readmission and complication rates: an ACS-NSQIP analysis29. A comparison of perineal stapled rectal prolapse resection and the Altemeier procedure at 2 Canadian academic hospitals30. Mental health and substance use disorders predict 90-day readmission and postoperative complications following rectal cancer surgery31. Early discharge after colorectal cancer resection: trends and impact on patient outcomes32. Oral antibiotics without mechanical bowel preparation prior to emergency colectomy reduces the risk of organ space surgical site infections: a NSQIP propensity score matched study33. The impact of robotic surgery on a tertiary care colorectal surgery program, an assessment of costs and short-term outcomes — a Canadian perspective34. Should we scope beyond the age limit of guidelines? Adenoma detection rates and outcomes of screening and surveillance colonoscopies in patients aged 75–79 years35. Emergency department admissions for uncomplicated diverticulitis: a nationwide study36. Obesity is associated with a complicated episode of acute diverticulitis: a nationwide study37. Green indocyanine angiography for low anterior resection in patients with rectal cancer: a prospective before-and-after study38. The impact of age on surgical recurrence of fibrostenotic ileocolic Crohn disease39. A qualitative study to explore the optimal timing and approach for the LARS discussion01. Racial, ethnic and socioeconomic disparities in diagnosis, treatment and survival of patients with breast cancer: a SEER-based population analysis02. First-line palliative chemotherapy for esophageal and gastric cancer: practice patterns and outcomes in the general population03. Frailty as a predictor for postoperative outcomes following pancreaticoduodenectomy04. Synoptic electronic operative reports identify practice variation in cancer surgery allowing for directed interventions to decrease variation05. The role of Hedgehog signalling in basal-like breast cancer07. Clinical and patient-reported outcomes in oncoplastic breast conservation surgery from a single surgeon’s practice in a busy community hospital in Canada08. Upgrade rate of atypical ductal hyperplasia: 10 years of experience and predictive factors09. Time to first adjuvant treatment after oncoplastic breast reduction10. Preparing to survive: improving outcomes for young women with breast cancer11. Opioid prescription and consumption in patients undergoing outpatient breast surgery — baseline data for a quality improvement initiative12. Rectal anastomosis and hyperthermic intraperitoneal chemotherapy: Should we avoid diverting loop ileostomy?13. Delays in operative management of early-stage, estrogen-receptor positive breast cancer during the COVID-19 pandemic — a multi-institutional matched historical cohort study14. Opioid prescribing practices in breast oncologic surgery15. Oncoplastic breast reduction (OBR) complications and patient-reported outcomes16. De-escalating breast cancer surgery: Should we apply quality indicators from other jurisdictions in Canada?17. The breast cancer patient experience of telemedicine during COVID-1918. A novel ex vivo human peritoneal model to investigate mechanisms of peritoneal metastasis in gastric adenocarcinoma (GCa)19. Preliminary uptake and outcomes utilizing the BREAST-Q patient-reported outcomes questionnaire in patients following breast cancer surgery20. Routine elastin staining improves detection of venous invasion and enhances prognostication in resected colorectal cancer21. Analysis of exhaled volatile organic compounds: a new frontier in colon cancer screening and surveillance22. A clinical pathway for radical cystectomy leads to a shorter hospital stay and decreases 30-day postoperative complications: a NSQIP analysis23. Fertility preservation in young breast cancer patients: a population-based study24. Investigating factors associated with postmastectomy unplanned emergency department visits: a population-based analysis25. Impact of patient, tumour and treatment factors on psychosocial outcomes after treatment in women with invasive breast cancer26. The relationship between breast and axillary pathologic complete response in women receiving neoadjuvant chemotherapy for breast cancer01. The association between bacterobilia and the risk of postoperative complications following pancreaticoduodenectomy02. Surgical outcome and quality of life following exercise-based prehabilitation for hepatobiliary surgery: a systematic review and meta-analysis03. Does intraoperative frozen section and revision of margins lead to improved survival in patients undergoing resection of perihilar cholangiocarcinoma? A systematic review and meta-analysis04. Prolonged kidney procurement time is associated with worse graft survival after transplantation05. Venous thromboembolism following hepatectomy for colorectal metastases: a population-based retrospective cohort study06. Association between resection approach and transfusion exposure in liver resection for gastrointestinal cancer07. The association between surgeon volume and use of laparoscopic liver resection for gastrointestinal cancer08. Immune suppression through TIGIT in colorectal cancer liver metastases09. “The whole is greater than the sum of its parts” — a combined strategy to reduce postoperative pancreatic fistula after pancreaticoduodenectomy10. Laparoscopic versus open synchronous colorectal and hepatic resection for metastatic colorectal cancer11. Identifying prognostic factors for overall survival in patients with recurrent disease following liver resection for colorectal cancer metastasis12. Modified Blumgart pancreatojejunostomy with external stenting in laparoscopic Whipple reconstruction13. Laparoscopic versus open pancreaticoduodenectomy: a single centre’s initial experience with introduction of a novel surgical approach14. Neoadjuvant chemotherapy versus upfront surgery for borderline resectable pancreatic cancer: a single-centre cohort analysis15. Thermal ablation and telemedicine to reduce resource utilization during the COVID-19 pandemic16. Cost-utility analysis of normothermic machine perfusion compared with static cold storage in liver transplantation in the Canadian setting17. Impact of adjuvant therapy on overall survival in early-stage ampullary cancers: a single-centre retrospective review18. Presence of biliary anaerobes enhances response to neoadjuvant chemotherapy in pancreatic ductal adenocarcinoma19. How does tumour viability influence the predictive capability of the Metroticket model? Comparing predicted-to-observed 5-year survival after liver transplant for hepatocellular carcinoma20. Does caudate resection improve outcomes in patients undergoing curative resection for perihilar cholangiocarcinoma? A systematic review and meta-analysis21. Appraisal of multivariable prognostic models for postoperative liver decompensation following partial hepatectomy: a systematic review22. Predictors of postoperative liver decompensation events following resection in patients with cirrhosis and hepatocellular carcinoma: a population-based study23. Characteristics of bacteriobilia and impact on outcomes after Whipple procedure01. Inverting the y-axis: the future of MIS abdominal wall reconstruction is upside down02. Progressive preoperative pneumoperitoneum: a single-centre retrospective study03. The role of radiologic classification of parastomal hernia as a predictor of the need for surgical hernia repair: a retrospective cohort study04. Comparison of 2 fascial defect closure methods for laparoscopic incisional hernia repair01. Hypoalbuminemia predicts serious complications following elective bariatric surgery02. Laparoscopic adjustable gastric band migration inducing jejunal obstruction associated with acute pancreatitis: aurgical approach of band removal03. Can visceral adipose tissue gene expression determine metabolic outcomes after bariatric surgery?04. Improvement of kidney function in patients with chronic kidney disease and severe obesity after bariatric surgery: a systematic review and meta-analysis05. A prediction model for delayed discharge following gastric bypass surgery06. Experiences and outcomes of Indigenous patients undergoing bariatric surgery: a mixed-methods scoping review07. What is the optimal common channel length in revisional bariatric surgery?08. Laparoscopic management of internal hernia in a 34-week pregnant woman09. Characterizing timing of postoperative complications following elective Roux-en-Y gastric bypass and sleeve gastrectomy10. Canadian trends in bariatric surgery11. Common surgical stapler problems and how to correct them12. Management of choledocholithiasis following Roux-en-Y gastric bypass: a systematic review and meta-analysis. Can J Surg 2021; 64:S80-S159. [PMID: 35483046 PMCID: PMC8677574 DOI: 10.1503/cjs.021321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - B Unger
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - L Gillman
- From the University of Manitoba, Winnipeg, Man
| | - K Hickey
- From Memorial University, St. John's, Nfld
| | - D Pace
- From Memorial University, St. John's, Nfld
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | | | | | - S Chadi
- University Health Network, Toronto, Ont
| | | | | | - J Catton
- University Health Network, Toronto, Ont
| | - B Rubin
- University Health Network, Toronto, Ont
| | - J Bell
- University Health Network, Toronto, Ont
| | | | | | | | | | - F Shariff
- From the University of Toronto, Toronto, Ont
| | - F Wright
- From the University of Toronto, Toronto, Ont
| | - N Ahmed
- From the University of Toronto, Toronto, Ont
| | - A Nadler
- From the University of Toronto, Toronto, Ont
| | - J Hallet
- From the University of Toronto, Toronto, Ont
| | - J Gentles
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - M Parapini
- University of British Columbia, Vancouver, B.C
| | | | - R Sidhu
- University of British Columbia, Vancouver, B.C
| | - T Scott
- University of British Columbia, Vancouver, B.C
| | | | - R Guo
- From the University of British Columbia, Vancouver, B.C
| | - A Nguyen
- From the University of British Columbia, Vancouver, B.C
| | - J Osborn
- From the University of British Columbia, Vancouver, B.C
| | - S Wiseman
- From the University of British Columbia, Vancouver, B.C
| | - K Nabata
- From the University of British Columbia, Vancouver, B.C
| | - E Ertel
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - T Lenet
- University of Ottawa, Ottawa, Ont
| | - L Baker
- University of Ottawa, Ottawa, Ont
| | - L Park
- University of Ottawa, Ottawa, Ont
| | - M Vered
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Zahrai
- University of Ottawa, Ottawa, Ont
| | - R Shorr
- The Ottawa Hospital, Ottawa, Ont
| | - A Davis
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - D Fergusson
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - G Martel
- The Ottawa Hospital, Ottawa, Ont
| | - K Nabata
- From the University of British Columbia, Vancouver, B.C
| | - S Rummel
- From the University of British Columbia, Vancouver, B.C
| | | | - A Karimuddin
- From the University of British Columbia, Vancouver, B.C
| | - M Stewart
- From the University of British Columbia, Vancouver, B.C
| | - A Melck
- From the University of British Columbia, Vancouver, B.C
| | | | | | | | - Y Lee
- From McMaster University, Hamilton, Ont
| | - K Ramji
- From McMaster University, Hamilton, Ont
| | | | - A Zhu
- From the University of Toronto, Toronto, Ont
| | - S Deng
- From the University of Toronto, Toronto, Ont
| | - B Greene
- From the University of Toronto, Toronto, Ont
| | - M Tsang
- From the University of Toronto, Toronto, Ont
| | - V Palter
- From the University of Toronto, Toronto, Ont
| | - S Jayaraman
- From the University of Toronto, Toronto, Ont
| | | | - A Mann
- From McMaster University, Hamilton, Ont
| | - J Tittley
- From McMaster University, Hamilton, Ont
| | - M Cadeddu
- From McMaster University, Hamilton, Ont
| | - M Nguyen
- University of Toronto, Toronto, Ont
| | - A Madani
- University Health Network, Toronto, Ont
| | | | | | - K Ramji
- From McMaster University, Hamilton, Ont
| | - D Hong
- From McMaster University, Hamilton, Ont
| | - L Qu
- Western University, London, Ont
| | - A Istl
- Johns Hopkins Hospital, Baltimore, Md
| | - E Tang
- Western University, London, Ont
| | - D Gray
- Western University, London, Ont
| | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Callum
- Queen's University, Kingston, Ont
| | - R McLeod
- University of Toronto, Toronto, Ont
| | | | - Y Lin
- University of Toronto, Toronto, Ont
| | | | - G Martel
- University of Ottawa, Ottawa, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - A Kammili
- From the McGill University Health Centre, Montreal, Que
| | | | - L Lee
- From the McGill University Health Centre, Montreal, Que
| | | | - L Ferri
- From the McGill University Health Centre, Montreal, Que
| | - C Mueller
- From the McGill University Health Centre, Montreal, Que
| | | | - B Haas
- University of Toronto, Toronto, Ont
| | | | | | | | - V Zuk
- Sunnybrook Research Institute, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - A Hsu
- University of Ottawa, Ottawa, Ont
| | | | - R Vasdev
- Sunnybrook Research Institute, Toronto, Ont
| | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - K D'Souza
- From the University of British Columbia, Vancouver, B.C
| | - C Huynh
- From the University of British Columbia, Vancouver, B.C
| | | | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - H Hwang
- From the University of British Columbia, Vancouver, B.C
| | - M Hameed
- From the University of British Columbia, Vancouver, B.C
| | - L Glass
- Western University, London, Ont
| | | | - P Murphy
- Medical College of Wisconsin, Milwaukee, Wis
| | - E Tang
- Western University, London, Ont
| | | | - J Hawel
- Western University, London, Ont
| | - L Kerr
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - S Zablotny
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - H Roldan
- From the Northern Ontario School of Medicine, Thunder Bay, Ont
| | - W He
- University of Manitoba, Winnipeg, Man
| | - X Jiang
- Memorial University of Newfoundland, St. John's, Nfld
| | - B Zheng
- University of Alberta, Edmonton, Alta
| | - L Lee
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - G Fried
- From McGill University, Montreal, Que
| | - C Mueller
- From McGill University, Montreal, Que
| | - S Valanci
- From McGill University, Montreal, Que
| | | | - J Cipolla
- From McGill University, Montreal, Que
| | - P Kaneva
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - L Lee
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | | | | | - J Cipolla
- From McGill University, Montreal, Que
| | - L Lee
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | - L Feldman
- From McGill University, Montreal, Que
| | - A Miles
- From the University of Alberta, Edmonton, Alta
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - J Shapiro
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - A Fecso
- From the University of Toronto, Toronto, Ont
| | - T Chesney
- From the University of Toronto, Toronto, Ont
| | - J Mosko
- From the University of Toronto, Toronto, Ont
| | - D Skubleny
- From the University of Alberta, Edmonton, Alta
| | - P Hamilton
- From the University of Alberta, Edmonton, Alta
| | - S Ghosh
- From the University of Alberta, Edmonton, Alta
| | - S Widder
- From the University of Alberta, Edmonton, Alta
| | - D Schiller
- From the University of Alberta, Edmonton, Alta
| | - U Do
- McGill University, Montreal, Que
| | | | - M Pook
- McGill University, Montreal, Que
| | - N Barone
- McGill University, Montreal, Que
| | | | | | | | | | - H Elhaj
- McGill University Health Centre, Montreal, Que
| | | | - G Olleik
- McGill University, Montreal, Que
| | - P Kaneva
- McGill University Health Centre, Montreal, Que
| | - A Antoun
- McGill University, Montreal, Que
| | - N Safa
- McGill University, Montreal, Que
| | | | | | | | - G Fried
- McGill University Health Centre, Montreal, Que
| | - M Alhashemi
- McGill University Health Centre, Montreal, Que
| | - F Lee
- McGill University Health Centre, Montreal, Que
| | - G Baldini
- McGill University Health Centre, Montreal, Que
| | - L Feldman
- McGill University Health Centre, Montreal, Que
| | - J Fiore
- McGill University Health Centre, Montreal, Que
| | | | - S Parpia
- McMaster University, Hamilton, Ont
| | - L Ruo
- McMaster University, Hamilton, Ont
| | | | - S Lee
- McMaster University, Hamilton, Ont
| | | | - N Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Alfayyadh
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | | | | - C Kruse
- McMaster University, Hamilton, Ont
| | | | - M Levin
- University of Toronto, Toronto, Ont
| | - K Aldrich
- Center for Medical Interoperability, Nashville, Tenn
| | - T Grantcharov
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ont
| | - A Langerman
- Vanderbilt University Medical Center, Nashville, Tenn
| | - H Forbes
- From the University of Alberta, Edmonton, Alta
| | - R Anantha
- From the University of Alberta, Edmonton, Alta
| | - V Fawcett
- From the University of Alberta, Edmonton, Alta
| | | | - V Pravong
- University of Montreal, Montreal, Que
| | - M Gervais
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - G Rakovich
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - R Selvam
- From the University of Ottawa, Ottawa, Ont
| | - R Hu
- From the University of Ottawa, Ottawa, Ont
| | | | - I Raiche
- From the University of Ottawa, Ottawa, Ont
| | - H Moloo
- From the University of Ottawa, Ottawa, Ont
| | - R Liu
- Western University, London, Ont
| | - A Elnahas
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - N Alkhamesi
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - J Hawel
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - E Tang
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - A Alnumay
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - C Schlachta
- Western University, Canadian Surgical Technologies & Advanced Robotics, London Health Sciences Centre, London, Ont
| | - E Walser
- From Western University, London, Ont
| | - C Zhang
- From Western University, London, Ont
| | | | - M Ott
- From Western University, London, Ont
| | - A Lee
- From the University of Ottawa, Ottawa, Ont
| | - B Niu
- From the University of Ottawa, Ottawa, Ont
| | - F Balaa
- From the University of Ottawa, Ottawa, Ont
| | - N Gawad
- From the University of Ottawa, Ottawa, Ont
| | - K Ren
- From McMaster University, Hamilton, Ont
| | - Y Qiu
- From McMaster University, Hamilton, Ont
| | - K Hamann
- From McMaster University, Hamilton, Ont
| | - N How
- From McMaster University, Hamilton, Ont
| | | | | | - A Eqbal
- From McMaster University, Hamilton, Ont
| | | | | | | | - E Lee
- From McMaster University, Hamilton, Ont
| | - I Yang
- From McMaster University, Hamilton, Ont
| | - K Ren
- From McMaster University, Hamilton, Ont
| | - H Muaddi
- University of Toronto, Toronto, Ont
| | - T Stukel
- ICES, University of Toronto, Toronto, Ont
| | - C de Mestral
- St. Michael's Hospital, University of Toronto, Toronto, Ont
| | - A Nathens
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - P Karanicolas
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Lemieux
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - D Breton
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - P Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - A Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - R Grégoire
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - F Letarte
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - G Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Avoine
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - F Letarte
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - A Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - J Gagné
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - C Thibault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - R Grégoire
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - M Gosselin
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - P Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - T Stuleanu
- From the University of Ottawa, Ottawa, Ont
| | - A Jarrar
- From the University of Ottawa, Ottawa, Ont
| | | | | | - R Nenshi
- McMaster University, Hamilton, Ont
| | - A Jerath
- University of Toronto, Toronto, Ont
| | - D Gomez
- University of Toronto, Toronto, Ont
| | - K Singh
- University of Toronto, Toronto, Ont
| | - T Amir
- McMaster University, Hamilton, Ont
| | - E Liu
- McMaster University, Hamilton, Ont
| | | | - R Mao
- McMaster University, Hamilton, Ont
| | - L Lan
- McMaster University, Hamilton, Ont
| | - J Yan
- University of British Columbia, Vancouver, B.C
| | | | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - R Tin
- From the University of Alberta, Edmonton, Alta
| | - R Brisebois
- From the University of Alberta, Edmonton, Alta
| | - N Bradley
- From the University of Alberta, Edmonton, Alta
| | - R Wigen
- From Western University, London, Ont
| | - E Walser
- From Western University, London, Ont
| | | | | | - K Vogt
- From Western University, London, Ont
| | - R Hilsden
- From Western University, London, Ont
| | - N Parry
- From Western University, London, Ont
| | - L Allen
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - R Raskin
- From Dalhousie University, Halifax, N.S
| | - J Jones
- From Dalhousie University, Halifax, N.S
| | - K Neumann
- From Dalhousie University, Halifax, N.S
| | - C Dwyer
- University of Alberta, Edmonton, Alta
| | | | - N Bradley
- University of Alberta, Edmonton, Alta
| | | | - K Lobay
- University of Alberta, Edmonton, Alta
| | | | - E Chang
- University of Alberta, Edmonton, Alta
| | - S Widder
- University of Alberta, Edmonton, Alta
| | - R Anantha
- University of Alberta, Edmonton, Alta
| | - W Sun
- University of Alberta, Edmonton, Alta
| | - J Beck
- Royal Alexandra Hospital, Edmonton, Alta
| | - R Anantha
- University of Alberta, Edmonton, Alta
| | - R Liu
- From Western University, London, Ont
| | | | - S Jones
- From Western University, London, Ont
| | | | | | - M Ott
- From Western University, London, Ont
| | - E Schmitz
- From the University of Ottawa, Ottawa, Ont
| | - I Raiche
- From the University of Ottawa, Ottawa, Ont
| | - W Sun
- University of Alberta, Edmonton, Alta
| | | | - J Dang
- University of Alberta, Edmonton, Alta
| | - V Mocanu
- University of Alberta, Edmonton, Alta
| | - G Lutzak
- University of Alberta, Edmonton, Alta
| | | | - C Wong
- University of Alberta, Edmonton, Alta
| | - S Karmali
- University of Alberta, Edmonton, Alta
| | - E Schmitz
- From the University of Ottawa, Ottawa, Ont
| | - M Petrera
- From the University of Ottawa, Ottawa, Ont
| | - M Pickell
- From the University of Ottawa, Ottawa, Ont
| | - R Auer
- From the University of Ottawa, Ottawa, Ont
| | - N Patro
- From McMaster University, Hamilton, Ont
| | - B Li
- From McMaster University, Hamilton, Ont
| | - Y Lee
- From McMaster University, Hamilton, Ont
| | - H Wilson
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - U Jogiat
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - C Wong
- From the University of Alberta, Edmonton, Alta
| | - C Li
- University of Alberta, Edmonton, Alta
| | | | - A Cieply
- University of Alberta, Edmonton, Alta
| | - H Hawes
- University of British Columbia, Vancouver, B.C
| | - E Joos
- University of British Columbia, Vancouver, B.C
| | - A Saleh
- University of Alberta, Edmonton, Alta
| | - C Li
- University of Alberta, Edmonton, Alta
| | - A Saleh
- University of Alberta, Edmonton, Alta
| | - P Engels
- McMaster University, Hamilton, Ont
| | - J Drung
- From the University of Western Ontario, London, Ont
| | - L Allen
- From the University of Western Ontario, London, Ont
| | - K Leslie
- From the University of Western Ontario, London, Ont
| | - G Pang
- From Western University, London, Ont
| | - M Kwong
- From Western University, London, Ont
| | | | | | - J Hawel
- From Western University, London, Ont
| | - A Elnahas
- From Western University, London, Ont
| | | | | | - S Chadi
- University of Toronto, Toronto, Ont
| | | | - D Chang
- Harvard University, Cambridge, Mass
| | - M Hutter
- Harvard University, Cambridge, Mass
| | - R Spence
- Dalhousie University, Halifax, N.S
| | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | - Y Longtin
- Jewish General Hospital, Montreal, Que
| | - S Liberman
- McGill University Health Centre, Montreal, Que
| | | | | | - M Poirier
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Que
| | | | - H Sebajang
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - R Younan
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - F Schwenter
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E De Broux
- Centre hospitalier de l'Université de Montreal, Montreal, Que
| | - K Larsen
- University of Toronto, Toronto, Ont
| | | | | | - J Nantais
- University of Manitoba, Winnipeg, Man
| | - D Gomez
- University of Toronto, Toronto, Ont
| | - L Lan
- McMaster University, Hamilton, Ont
| | - R Mao
- McMaster University, Hamilton, Ont
| | - J Kay
- McMaster University, Hamilton, Ont
| | - R Lohre
- University of British Columbia, Vancouver, B.C
| | - O Ayeni
- McMaster University, Hamilton, Ont
| | - D Goel
- University of British Columbia, Vancouver, B.C
| | - D de Sa
- McMaster University, Hamilton, Ont
| | - R He
- University of Alberta, Edmonton, Alta
| | - D Hylton
- McMaster University, Hamilton, Ont
| | - E Bedard
- University of Alberta, Edmonton, Alta
| | - S Johnson
- University of Alberta, Edmonton, Alta
| | - B Laing
- University of Alberta, Edmonton, Alta
| | - A Valji
- University of Alberta, Edmonton, Alta
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | | | | | | | | | | | | | | | - V Gupta
- University of Toronto, Toronto, Ont
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | | | | | | | | | - Y Patel
- McMaster University, Hamilton, Ont
| | | | - D Hylton
- McMaster University, Hamilton, Ont
| | - F Xie
- McMaster University, Hamilton, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - J Spicer
- McGill University, Montreal, Que
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - S Turner
- University of Alberta, Edmonton, Alta
| | | | - W Hanna
- McMaster University, Hamilton, Ont
| | - U Jogiat
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - S Turner
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - Y Patel
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - I Churchill
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - K Sullivan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Beauchamp
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - J Wald
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - L Mbuagbaw
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - J Agzarian
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Y Shargall
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - C Finley
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - C Fahim
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - W Hanna
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Abbas
- From McMaster University, Hamilton, Ont
| | - O Olaiya
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | | | - C Finley
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | | | | | - A Ednie
- Western University, London, Ont
| | - D Palma
- Western University, London, Ont
| | | | | | | | - M Qiabi
- Western University, London, Ont
| | - R Nayak
- Western University, London, Ont
| | | | - A Louie
- Sunnybrook Health Sciences Centre
| | | | | | - J Laba
- Western University, London, Ont
| | | | - J Alaichi
- From McMaster University, Hamilton, Ont
| | - Y Patel
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | - S Turner
- From the University of Alberta, Edmonton, Alta
| | - B Mador
- From the University of Alberta, Edmonton, Alta
| | - H Lai
- From the University of Alberta, Edmonton, Alta
| | - J White
- From the University of Alberta, Edmonton, Alta
| | - M Kim
- From the University of Alberta, Edmonton, Alta
| | | | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Louie
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - V Zuk
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - G Darling
- Toronto General Hospital, Toronto, Ont
| | | | - T Chesney
- St. Michael's Hospital, Toronto, Ont
| | - N Coburn
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - J Hallet
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Y Lee
- McMaster University, Hamilton, Ont
| | | | - M Lee
- University of Toronto, Toronto, Ont
| | - L Thiru
- McMaster University, Hamilton, Ont
| | | | - C Finley
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | - O Levine
- McMaster University, Hamilton, Ont
| | | | | | - R Nayak
- Western University, London, Ont
| | - S Brogly
- Queen's University, Kingston, Ont
| | - W Li
- ICES Queen's, Kingston, Ont
| | | | | | - N Mistry
- From McMaster University, Hamilton, Ont
| | - A Gatti
- From McMaster University, Hamilton, Ont
| | | | - Y Patel
- From McMaster University, Hamilton, Ont
| | - W Hanna
- From McMaster University, Hamilton, Ont
| | - S Abdul
- University of Ottawa, Ottawa, Ont
| | - C Anestee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - A Seely
- University of Ottawa, Ottawa, Ont
| | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - R Razzak
- University of Manitoba, Winnipeg, Man
| | - A Ashrafi
- University of British Columbia, Vancouver, B.C
| | | | | | - S Stone
- University of British Columbia, Vancouver, B.C
| | | | - T Bong
- Fraser Health Authority, B.C
| | - R Bond
- University of British Columbia, Vancouver, B.C
| | - A Hafizi
- Surrey Thoracic Surgery Group, Surrey, B.C
| | - M De Meo
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - R Rayes
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - S Milette
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - M Vagai
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - M Usatii
- Research Institute of the McGill University Health Centre, Montreal, Que
| | | | - B Giannias
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - F Bourdeau
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - V Sangwan
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - N Bertos
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - C Moraes
- McGill University, Montreal, Que
| | - S Huang
- McGill University, Montreal, Que
| | - D Quail
- McGill University, Montreal, Que
| | - L Walsh
- McGill University, Montreal, Que
| | - S Camilleri-Broet
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - P Fiset
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - J Cools-Lartigue
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - L Ferri
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - J Spicer
- Research Institute of the McGill University Health Centre, Montreal, Que
| | - A Kammili
- McGill University Health Centre, Montreal, Que
| | - E Bilgic
- McGill University Health Centre, Montreal, Que
| | | | | | - S Najmeh
- McGill University Health Centre, Montreal, Que
| | - C Mueller
- McGill University Health Centre, Montreal, Que
| | - L Esther
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | | | - Y Lee
- McMaster University, Hamilton, Ont
| | - J Lu
- University of Toronto, Toronto, Ont
| | - R Malhan
- McMaster University, Hamilton, Ont
| | | | - C Finley
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | | | - S Brophy
- From Dalhousie University, Halifax, N.S
| | - K Brennan
- From Dalhousie University, Halifax, N.S
| | - D French
- From Dalhousie University, Halifax, N.S
| | - V Resende
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | - O Solaja
- The Ottawa Hospital, Ottawa, Ont
| | | | - D Maziak
- The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - D Sisson
- From the University of Toronto, Toronto, Ont
| | - L Donahoe
- From the University of Toronto, Toronto, Ont
| | - P Bedard
- From the University of Toronto, Toronto, Ont
| | - A Hansen
- From the University of Toronto, Toronto, Ont
| | - M De Perrot
- From the University of Toronto, Toronto, Ont
| | | | - A Simone
- University of Ottawa, Ottawa, Ont
| | - H Begum
- McMaster University, Hamilton, Ont
| | - W Hanna
- McMaster University, Hamilton, Ont
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | - J Huang
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - H Lai
- University of Alberta, Edmonton, Alta
| | - E Bedard
- University of Alberta, Edmonton, Alta
| | | | - S Murthy
- Cleveland Clinic, Cleveland, Ohio
| | - J Lin
- University of Michigan, Ann Arbor, Mich
| | | | | | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - H Li
- Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | | | | | - E Lau
- McMaster University, Hamilton, Ont
| | | | - W Hanna
- McMaster University, Hamilton, Ont
| | - C Finley
- McMaster University, Hamilton, Ont
| | | | | | | | - V Gupta
- University of Toronto, Toronto, Ont
| | | | - L Davis
- McGill University, Montreal, Que
| | | | - B Kidane
- University of Toronto, Toronto, Ont
| | - G Darling
- University Health Network, Toronto, Ont
| | - N Coburn
- Sunnybrook Health Sciences Centre, Toronto, Ont
| | - C Huynh
- From McGill University, Montreal, Que
| | | | - L Ferri
- From McGill University, Montreal, Que
| | - S Najmeh
- From McGill University, Montreal, Que
| | - C Sirois
- From McGill University, Montreal, Que
| | - D Mulder
- From McGill University, Montreal, Que
| | - J Spicer
- From McGill University, Montreal, Que
| | | | | | - D Nguyen
- From the University of Ottawa, Ottawa, Ont
| | - C Anstee
- From the University of Ottawa, Ottawa, Ont
| | - E Delic
- From the University of Ottawa, Ottawa, Ont
| | - S Gilbert
- From the University of Ottawa, Ottawa, Ont
| | - D Maziak
- From the University of Ottawa, Ottawa, Ont
| | | | - A Seely
- From the University of Ottawa, Ottawa, Ont
| | - D Sisson
- University of Toronto, Toronto, Ont
| | | | | | - D Low
- Virginia Mason Medical Center, Seattle, Wash
| | | | - S Turner
- University of Alberta, Edmonton, Alta
| | - M Humer
- From the University of British Columbia, Kelowna, B.C
| | - S Abdul
- University of Ottawa, Ottawa, Ont
| | - D Nguyen
- University of Ottawa, Ottawa, Ont
| | - A Al Rawahi
- Department of Surgery, University of Ottawa, Ottawa, Ont
| | - C Anstee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - E Delic
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | | | | | | | - C Anstee
- Ottawa Hospital Research Institute, Ottawa, Ont
| | - E Delic
- Ottawa Hospital Research Institute, Ottawa, Ont
| | | | | | - D Maziak
- University of Ottawa, Ottawa, Ont
| | - A Seely
- University of Ottawa, Ottawa, Ont
| | - Y Patel
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - M Kay
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - I Churchill
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - K Sullivan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - Y Shargall
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - B Shayegan
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - A Adili
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | - W Hanna
- From McMaster University and St. Joseph's Healthcare Hamilton, Hamilton, Ont
| | | | - C Huynh
- From McGill University, Montreal, Que
| | | | | | - F Maleki
- From McGill University, Montreal, Que
| | - K Ovens
- From McGill University, Montreal, Que
| | - M Gold
- From McGill University, Montreal, Que
| | - M Sorin
- From McGill University, Montreal, Que
| | - R Falutz
- From McGill University, Montreal, Que
| | - R Rayes
- From McGill University, Montreal, Que
| | | | - J Spicer
- From McGill University, Montreal, Que
| | - N Hunka
- From the University of Saskatchewan, Saskatoon, Sask
| | - R Kennedy
- From the University of Saskatchewan, Saskatoon, Sask
| | - R Bigsby
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Bharadwaj
- From the University of Saskatchewan, Saskatoon, Sask
| | - S Gowing
- From the University of Saskatchewan, Saskatoon, Sask
| | | | - A Gatti
- From McMaster University, Hamilton, Ont
| | - D Hylton
- From McMaster University, Hamilton, Ont
| | | | - Y Patel
- From McMaster University, Hamilton, Ont
| | | | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | - C Finley
- From McMaster University, Hamilton, Ont
| | - H Begum
- From McMaster University, Hamilton, Ont
| | - K Pearce
- From McMaster University, Hamilton, Ont
| | | | - W Hanna
- From McMaster University, Hamilton, Ont
| | | | | | - D Jones
- From The Ottawa Hospital, Ottawa, Ont
| | - C Anstee
- From The Ottawa Hospital, Ottawa, Ont
| | - S Kumar
- From The Ottawa Hospital, Ottawa, Ont
| | | | - A Simone
- From The Ottawa Hospital, Ottawa, Ont
| | | | - K Thavorn
- From The Ottawa Hospital, Ottawa, Ont
| | - A Seely
- From The Ottawa Hospital, Ottawa, Ont
| | - V Gupta
- From the University of Toronto, Toronto, Ont
| | | | - A Mohammed
- From the University of Toronto, Toronto, Ont
| | - S Uddin
- From the University of Toronto, Toronto, Ont
| | - D Jones
- From the University of Toronto, Toronto, Ont
| | - A Behzadi
- From the University of Toronto, Toronto, Ont
| | - A Brar
- From the University of Toronto, Toronto, Ont
| | - L Qu
- From Western University, London, Ont
| | - M Qiabi
- From Western University, London, Ont
| | - R Nayak
- From Western University, London, Ont
| | | | - E Peters
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - L Tan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | - V Gupta
- University of Toronto, Toronto, Ont
| | - J Levy
- University of Toronto, Toronto, Ont
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | | | | | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - M Robinson
- From the University of Manitoba, Winnipeg, Man
| | - L Bednarek
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - L Tan
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | - H Wang
- From Dalhousie University, Halifax, N.S
| | - D French
- From Dalhousie University, Halifax, N.S
| | | | - K Graham
- From the University of Manitoba, Winnipeg, Man
| | - S Enns
- From the University of Manitoba, Winnipeg, Man
| | - G Buduhan
- From the University of Manitoba, Winnipeg, Man
| | - S Srinathan
- From the University of Manitoba, Winnipeg, Man
| | - R Liu
- From the University of Manitoba, Winnipeg, Man
| | - A Tan
- From the University of Manitoba, Winnipeg, Man
| | - B Kidane
- From the University of Manitoba, Winnipeg, Man
| | | | - E Poole
- University of Manitoba, Winnipeg, Man
| | - C Pascoe
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - T Karakach
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - G Buduhan
- University of Manitoba, Winnipeg, Man
| | - L Tan
- University of Manitoba, Winnipeg, Man
| | | | - A Halayko
- Children's Hospital Research Institute of Manitoba, Winnipeg, Man
| | - B Kidane
- University of Manitoba, Winnipeg, Man
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - B Fang
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - H Singh
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - O Hershorn
- From the University of Manitoba, Winnipeg, Man
| | - D Hochman
- From the University of Manitoba, Winnipeg, Man
| | - R Helewa
- From the University of Manitoba, Winnipeg, Man
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - R Robertson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - G Johnson
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - H Singh
- From the University of Manitoba, Winnipeg, Man
| | - J Park
- From the University of Manitoba, Winnipeg, Man
| | - R Helewa
- From the University of Manitoba, Winnipeg, Man
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | - C Cahill
- University of Calgary, Calgary, Alta
| | - M Lipson
- University of Calgary, Calgary, Alta
| | - A Afzal
- University of Calgary, Calgary, Alta
| | - A Maclean
- University of Calgary, Calgary, Alta
| | - C Wong
- University of Alberta, Edmonton, Alta
| | - S Roen
- University of Calgary, Calgary, Alta
| | - W Buie
- University of Calgary, Calgary, Alta
| | | | | | - M Chu
- From McMaster University, Hamilton, Ont
| | - Y Lee
- From McMaster University, Hamilton, Ont
| | - N Amin
- From McMaster University, Hamilton, Ont
| | - D Hong
- From McMaster University, Hamilton, Ont
| | | | | | - K Ramji
- McMaster University, Hamilton, Ont
| | - C Kruse
- McMaster University, Hamilton, Ont
| | - H Jaffer
- University of Toronto, Toronto, Ont
| | | | - N Amin
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | | | - R Hajjar
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Oliero
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - T Cuisiniere
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - G Fragoso
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - A Calvé
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - S Djediai
- Université du Québec à Montréal, Montreal, Que
| | - B Annabi
- Université du Québec à Montréal, Montreal, Que
| | - C Richard
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Santos
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - Y Zhou
- From the University of Alberta, Edmonton, Alta
| | - S Dodd
- From the University of Alberta, Edmonton, Alta
| | - B Ring
- From the University of Alberta, Edmonton, Alta
| | - Y Yuan
- From the University of Alberta, Edmonton, Alta
| | - J White
- From the University of Alberta, Edmonton, Alta
| | | | | | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | | | - J Faria
- Jewish General Hospital, Montreal, Que
| | | | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | | | - E Salama
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | | | - J Faria
- Jewish General Hospital, Montreal, Que
| | | | - M Boutros
- Jewish General Hospital, Montreal, Que
| | - G Talwar
- McMaster University, Hamilton, Ont
| | - R Daniel
- University of Toronto, Toronto, Ont
| | | | - O Levine
- McMaster University, Hamilton, Ont
| | | | | | | | | | | | | | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | | | - A Chen
- McMaster University, Hamilton, Ont
| | - A Patel
- Western University, London, Ont
| | - Y Lee
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | | | | | | | | | - J Moon
- Jewish General Hospital, Montreal, Que
| | - M Demian
- Jewish General Hospital, Montreal, Que
| | | | - N Morin
- Jewish General Hospital, Montreal, Que
| | - M Boutros
- Jewish General Hospital, Montreal, Que
| | - R Selvam
- University of Ottawa, Ottawa, Ont
| | - H Moloo
- University of Ottawa, Ottawa, Ont
| | - H MacRae
- University of Toronto, Toronto, Ont
| | - F Alam
- University of Toronto, Toronto, Ont
| | - I Raiche
- University of Ottawa, Ottawa, Ont
| | - J Holland
- From McGill University, Montreal, Que
| | - M Cwintal
- From McGill University, Montreal, Que
| | - G Rigas
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - J Holland
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - C Brown
- From St. Paul's Hospital, Vancouver, B.C
| | | | - M Raval
- From St. Paul's Hospital, Vancouver, B.C
| | - P Phang
- From St. Paul's Hospital, Vancouver, B.C
| | - A Ghuman
- From St. Paul's Hospital, Vancouver, B.C
| | - M Li
- University of Calgary, Calgary, Alta
| | - S Muncner
- University of Alberta, Edmonton, Alta
| | | | - M Dykstra
- University of Alberta, Edmonton, Alta
| | | | - H Wang
- University of Alberta, Edmonton, Alta
| | - O Monton
- McMaster University, Hamilton, Ont
| | - A Smith
- Western University, London, Ont
| | - J Moon
- McGill University, Montreal, Que
| | - M Demian
- McGill University, Montreal, Que
| | | | | | | | | | - O AlAamer
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - N AlSelaim
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - M AlMalki
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - A Al-Osail
- From King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - R Ruxton
- From Southland Hospital, Invercargill, New Zealand
| | - P Manuel
- From Southland Hospital, Invercargill, New Zealand
| | - F Mohamed
- From Southland Hospital, Invercargill, New Zealand
| | | | - S Serahati
- University of Saskatchewan, Saskatoon, Saskatchewan
| | | | - C Brown
- Providence Health Care, Vancouver, B.C
| | - M Raval
- Providence Health Care, Vancouver, B.C
| | | | - A Ghuman
- Providence Health Care, Vancouver, B.C
| | - T Phang
- Providence Health Care, Vancouver, B.C
| | | | - J Moon
- McGill University, Montreal, Que
| | | | - S Chadi
- University Health Network, Toronto, Ont
| | - K Alavi
- University of Massachusetts, Amherst, Mass
| | - I Paquette
- University of Cincinnati, Cincinnati, Ohio
| | - T MacLean
- University of Calgary, Calgary, Alta
| | - S Wexner
- Cleveland Clinic Florida, Weston, Fla
| | | | - S Steele
- Cleveland Clinic, Cleveland, Ohio
| | - J Park
- University of Manitoba, Winnipeg, Man
| | - S Patel
- Queen's University, Kingston, Ont
| | | | - R Auer
- The Ottawa Hospital, Ottawa, Ont
| | - P Sylla
- Icahn School of Medicine at Mount Sinai, New York, N.Y
| | - N Morin
- McGill University, Montreal, Que
| | - A Ghuman
- McGill University, Montreal, Que
| | | | - Z Bayat
- From the University of Toronto, Toronto, Ont
| | - E Kennedy
- From the University of Toronto, Toronto, Ont
| | - C Victor
- From the University of Toronto, Toronto, Ont
| | | | - J Liang
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | | | - H Roy
- University of Saskatchewan, Saskatoon, Sask
| | - Z Baig
- University of Saskatchewan, Saskatoon, Sask
| | | | - M Raval
- University of British Columbia, Vancouver, B.C
| | - C Brown
- University of British Columbia, Vancouver, B.C
| | - T Phang
- University of British Columbia, Vancouver, B.C
| | - D Gill
- University of Saskatchewan, Saskatoon, Sask
| | - N Ginther
- University of Saskatchewan, Saskatoon, Sask
| | - J Moon
- From McGill University, Montreal, Que
| | | | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | - E Salama
- From McGill University, Montreal, Que
| | | | | | | | - J Faria
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - V Wiseman
- From Queen's University, Kingston, Ont
| | - L Zhang
- From Queen's University, Kingston, Ont
| | | | | | | | | | - S V Patel
- From Queen's University, Kingston, Ont
| | - Z Harra
- From McGill University, Montreal, Que
| | | | | | - N Morin
- From McGill University, Montreal, Que
| | - M Boutros
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - M Hegagi
- From McGill University, Montreal, Que
| | | | - N Morin
- From McGill University, Montreal, Que
| | | | | | - M Boutros
- From McGill University, Montreal, Que
| | | | | | | | - A Pang
- From McGill University, Montreal, Que
| | | | - M Boutros
- From McGill University, Montreal, Que
| | | | - N Kasteel
- University of Calgary, Calgary, Alta
| | - G Kaur
- University of Calgary, Calgary, Alta
| | - S Bindra
- University of Calgary, Calgary, Alta
| | - A Malhotra
- Vardhman Mahavir Medical College, New Delhi, India
| | - C Graham
- University of Calgary, Calgary, Alta
| | - A MacLean
- University of Calgary, Calgary, Alta
| | - P Beck
- University of Calgary, Calgary, Alta
| | - H Jijon
- University of Calgary, Calgary, Alta
| | - J Ferraz
- University of Calgary, Calgary, Alta
| | - W Buie
- University of Calgary, Calgary, Alta
| | - R Szwimer
- From McGill University, Montreal, Que
| | - J Moon
- From McGill University, Montreal, Que
| | - M Demian
- From McGill University, Montreal, Que
| | - A Pang
- From McGill University, Montreal, Que
| | - N Morin
- From McGill University, Montreal, Que
| | | | | | - M Boutros
- From McGill University, Montreal, Que
| | - A Azin
- From the University of Toronto, Toronto, Ont
| | | | - W Kong
- Queen's Cancer Research Institute, Kingston, Ont
| | | | - T Hanna
- Queen's University, Kingston, Ont
| | - W Chung
- Queen's University, Kingston, Ont
| | - S Nanji
- Queen's University, Kingston, Ont
| | - S Patel
- Queen's University, Kingston, Ont
| | - C Booth
- Queen's University, Kingston, Ont
| | - V Li
- From McMaster University, Hamilton, Ont
| | - A Awan
- From McMaster University, Hamilton, Ont
| | - P Serrano
- From McMaster University, Hamilton, Ont
| | - M Jacobson
- From the University of Calgary, Calgary, Alta
| | - M Chanco
- From the University of Calgary, Calgary, Alta
| | - V Wen
- From the University of Calgary, Calgary, Alta
| | - N Singh
- From the University of Calgary, Calgary, Alta
| | - L Peiris
- From the University of Calgary, Calgary, Alta
| | - J Pasieka
- From the University of Calgary, Calgary, Alta
| | - P Ghatage
- From the University of Calgary, Calgary, Alta
| | - D Buie
- From the University of Calgary, Calgary, Alta
| | - T MacLean
- From the University of Calgary, Calgary, Alta
| | | | - L Mack
- From the University of Calgary, Calgary, Alta
| | - W Marini
- From the University of Toronto, Toronto, Ont
| | - W Zheng
- From the University of Toronto, Toronto, Ont
| | - C Swallow
- From the University of Toronto, Toronto, Ont
| | - M Reedijk
- From the University of Toronto, Toronto, Ont
| | | | - L Peiris
- From the University of Alberta, Edmonton, Alta
| | | | - L Delmar
- From the University of Alberta, Edmonton, Alta
| | - N Gagnon
- Université de Sherbrooke, Sherbrooke, Que
| | | | | | | | | | | | - S Mysuria
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - M Zhang
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - N Van Laeken
- From the University of British Columbia, Vancouver, B.C
| | - E Bovill
- From the University of British Columbia, Vancouver, B.C
| | - K Isaac
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | | | | | | | - L Barbera
- University of Calgary, Calgary, Alta
| | - Y Efegoma
- University of Calgary, Calgary, Alta
| | - D Howell
- Princess Margaret Research Institute, Toronto, Ont
| | | | | | - A Scheer
- St. Michael's Hospital, Toronto, Ont
| | - C Simmons
- University of British Columbia, Vancouver, B.C
| | | | | | - Y Xu
- University of Calgary, Calgary, Alta
| | | | - M Quan
- University of Calgary, Calgary, Alta
| | - A Alqaydi
- From Queen's University, Kingston, Ont
| | - J la
- From Queen's University, Kingston, Ont
| | | | - G Digby
- From Queen's University, Kingston, Ont
| | - V Pravong
- University of Montreal, Montreal, Que
| | | | - L Sidéris
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - P Dubé
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | | | - S Fortin
- University of Montreal, Montreal, Que
| | - M Auclair
- University of Montreal, Montreal, Que
| | - B Trilling
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - J Tremblay
- Maisonneuve-Rosemont Hospital, Montreal, Que
| | - É Di Lena
- From McGill University, Montreal, Que
| | - B Hopkins
- From McGill University, Montreal, Que
| | - S Wong
- From McGill University, Montreal, Que
| | | | - É Di Lena
- From McGill University, Montreal, Que
| | - N Barone
- From McGill University, Montreal, Que
| | - B Hopkins
- From McGill University, Montreal, Que
| | - S Dumitra
- From McGill University, Montreal, Que
| | - P Kaneva
- From McGill University, Montreal, Que
| | - J Fiore
- From McGill University, Montreal, Que
| | | | - S Mysuria
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - E Bovill
- From the University of British Columbia, Vancouver, B.C
| | - M Zhang
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - K Isaac
- From the University of British Columbia, Vancouver, B.C
| | - N Van Laeken
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - H Kapur
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - A Bazarelli
- From the University of British Columbia, Vancouver, B.C
| | - U Kuusk
- From the University of British Columbia, Vancouver, B.C
| | - L Chen
- From the University of British Columbia, Vancouver, B.C
| | - L Cadili
- From the University of British Columbia, Vancouver, B.C
| | - K DeGirolamo
- From the University of British Columbia, Vancouver, B.C
| | - E McKevitt
- From the University of British Columbia, Vancouver, B.C
| | - J Pao
- From the University of British Columbia, Vancouver, B.C
| | - C Dingee
- From the University of British Columbia, Vancouver, B.C
| | - A Bazzarelli
- From the University of British Columbia, Vancouver, B.C
| | - R Warburton
- From the University of British Columbia, Vancouver, B.C
| | - D Ng
- From the University of Toronto, Toronto, Ont
| | - A Ali
- From the University of Toronto, Toronto, Ont
| | - D Eymae
- From the University of Toronto, Toronto, Ont
| | - K Lee
- From the University of Toronto, Toronto, Ont
| | - S Brar
- From the University of Toronto, Toronto, Ont
| | - J Conner
- From the University of Toronto, Toronto, Ont
| | - M Magalhaes
- From the University of Toronto, Toronto, Ont
| | - C Swallow
- From the University of Toronto, Toronto, Ont
| | - K Allen
- From the University of British Columbia, Vancouver, B.C
| | - C Baliski
- From the University of British Columbia, Vancouver, B.C
| | - D Cyr
- University of Toronto, Toronto, Ont
| | - A Sari
- Sinai Health System, Toronto, Ont
| | | | - D Driman
- London Health Sciences Centre, London, Ont
| | | | - A Juda
- Sinai Health System, Toronto, Ont
| | | | | | - M Brar
- University of Toronto, Toronto, Ont
| | - J Conner
- Sinai Health System, Toronto, Ont
| | - R Kirsch
- Sinai Health System, Toronto, Ont
| | | | - K Singh
- University of Toronto, Toronto, Ont
| | | | - Y Gamache
- ASDevices, Spira Innovations, Thetford, Que
| | | | - C Mardinger
- From the University of Calgary, Calgary, Alta
| | - C Lee
- From the University of Calgary, Calgary, Alta
| | - R Duckworth
- From the University of Calgary, Calgary, Alta
| | - M Brindle
- From the University of Calgary, Calgary, Alta
| | - F Fraulin
- From the University of Calgary, Calgary, Alta
| | - L Austen
- From the University of Calgary, Calgary, Alta
| | - J Kortbeek
- From the University of Calgary, Calgary, Alta
| | - M Hyndman
- From the University of Calgary, Calgary, Alta
| | - D Nguyen
- From McGill University, Montreal, Que
| | - G Jamjoum
- From McGill University, Montreal, Que
| | | | - S Langer
- University of Calgary, Calgary, Alta
| | - Y Yuan Xu
- University of Calgary, Calgary, Alta
| | - S Kong
- Alberta Health Services, Calgary, Alta
| | - M Quan
- University of Calgary, Calgary, Alta
| | - D Lim
- Women's College Hospital, Toronto, Ont
| | | | | | - K Butler
- University Health Network, Toronto, Ont
| | | | - T Cil
- University of Toronto, Toronto, Ont
| | - T Zhong
- University of Toronto, Toronto, Ont
| | - S Hofer
- University of Toronto, Toronto, Ont
| | | | | | - D Lim
- Women's College Hospital, Toronto, Ont
| | - B Greene
- University of Toronto, Toronto, Ont
| | | | - M Parapini
- University of British Columbia, Vancouver, B.C
| | - J Skipworth
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, U.K
| | - A Mah
- University of British Columbia, Vancouver, B.C
| | - S Desai
- University of British Columbia, Vancouver, B.C
| | - S Chung
- University of British Columbia, Vancouver, B.C
| | - C Scudamore
- University of British Columbia, Vancouver, B.C
| | - M Segedi
- University of British Columbia, Vancouver, B.C
| | - E Vasilyeva
- University of British Columbia, Vancouver, B.C
| | - J Li
- University of British Columbia, Vancouver, B.C
| | - P Kim
- University of British Columbia, Vancouver, B.C
| | - K Verhoeff
- From the University of Alberta, Edmonton, Alta
| | - A Deprato
- From the University of Alberta, Edmonton, Alta
| | - K Purich
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - K Dajani
- From the University of Alberta, Edmonton, Alta
| | - T Lenet
- University of Ottawa, Ottawa, Ont
| | | | - R Smoot
- Mayo Clinic, Rochester, Minn
| | - G Martel
- The Ottawa Hospital, Ottawa, Ont
| | - C Tzeng
- MD Anderson Cancer Center, Houston, Tex
| | - F Rocha
- Oregon Health & Science University, Portland, Ore
| | | | | | | | | | | | | | - N Hanna
- Queen's University, Kingston, Ont
| | - S Brogly
- Queen's University, Kingston, Ont
| | | | - C Booth
- Queen's University, Kingston, Ont
| | - S Nanji
- Queen's University, Kingston, Ont
| | | | - N Coburn
- University of Toronto, Toronto, Ont
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | - J Callum
- Queen's University, Kingston, Ont
| | | | | | - A Wei
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | | | - J Hallet
- University of Toronto, Toronto, Ont
| | | | | | - A Wei
- Memorial Sloan Kettering Cancer Center, New York, N.Y
| | - A Mahar
- University of Manitoba, Winnipeg, Man
| | | | - G Martel
- University of Ottawa, Ottawa, Ont
| | - N Coburn
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - D Henault
- From the University of Montreal, Montreal, Que
| | - B Barrette
- From the University of Montreal, Montreal, Que
| | - S Pelletier
- From the University of Montreal, Montreal, Que
| | - P Thebault
- From the University of Montreal, Montreal, Que
| | | | - Z Rong
- From the University of Montreal, Montreal, Que
| | - M Plasse
- From the University of Montreal, Montreal, Que
| | | | | | - R Lapointe
- From the University of Montreal, Montreal, Que
| | | | - B Nguyen
- From the University of Montreal, Montreal, Que
| | - G Soucy
- From the University of Montreal, Montreal, Que
| | - S Turcotte
- From the University of Montreal, Montreal, Que
| | - M Lemke
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - D Quan
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - M Lund
- From the University of Western Ontario, London, Ont
| | - L Allen
- From the University of Western Ontario, London, Ont
| | - J Glinka
- From the University of Western Ontario, London, Ont
| | - G Jada
- From the University of Western Ontario, London, Ont
| | - D Quan
- From the University of Western Ontario, London, Ont
| | - A Skaro
- From the University of Western Ontario, London, Ont
| | - E Tang
- From the University of Western Ontario, London, Ont
| | - L Park
- McMaster University, Hamilton, Ont
| | - J Daza
- University of Toronto, Toronto, Ont
| | - V Li
- McMaster University, Hamilton, Ont
| | | | - B Zhang
- McMaster University, Hamilton, Ont
| | | | - S Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - R Faisal
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - M Fabbro
- University of Toronto, Toronto, Ont
| | - C Gu
- McMaster University, Hamilton, Ont
| | | | - V Zuk
- University of Toronto, Toronto, Ont
| | - J Hallet
- University of Toronto, Toronto, Ont
| | - G Martel
- University of Ottawa, Ottawa, Ont
| | | | | | - J Glinka
- From the Western University, London, Ont
| | - A Skaro
- From the Western University, London, Ont
| | - K Leslie
- From the Western University, London, Ont
| | - G Jada
- From the Western University, London, Ont
| | - D Quan
- From the Western University, London, Ont
| | - E Tang
- From the Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - M Lemke
- From Western University, London, Ont
| | - J Glinka
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | | | - R Liu
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - L Allen
- From Western University, London, Ont
| | - S Welch
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - K Leslie
- From Western University, London, Ont
| | - J Glinka
- From Western University, London, Ont
| | - E Waugh
- From Western University, London, Ont
| | - E Tang
- From Western University, London, Ont
| | - G Jada
- From Western University, London, Ont
| | - D Quan
- From Western University, London, Ont
| | - A Skaro
- From Western University, London, Ont
| | - A Webb
- From the University of Alberta, Edmonton, Alta
| | - E Lester
- From the University of Alberta, Edmonton, Alta
| | - A Shapiro
- From the University of Alberta, Edmonton, Alta
| | - D Eurich
- From the University of Alberta, Edmonton, Alta
| | - D Bigam
- From the University of Alberta, Edmonton, Alta
| | - Y Essaji
- From Virginia Mason Medical Center, Seattle, Wash
| | - H Shrader
- From the University of Iowa, Iowa City, Iowa
| | - A Nayyar
- From the University of Iowa, Iowa City, Iowa
| | - M Suraju
- From the University of Iowa, Iowa City, Iowa
| | | | - P Ear
- From the University of Iowa, Iowa City, Iowa
| | - C Chan
- From the University of Iowa, Iowa City, Iowa
| | - V Smith
- From Dalhousie University, Halifax, N.S
| | | | - A Costa
- From Dalhousie University, Halifax, N.S
| | - A Stueck
- From Dalhousie University, Halifax, N.S
| | | | - S Allen
- From Dalhousie University, Halifax, N.S
| | | | | | - T Lenet
- University of Ottawa, Ottawa, Ont
| | | | - R Smoot
- Mayo Clinic, Rochester, Minn
| | - C Tzeng
- MD Anderson Cancer Center, Houston, Tex
| | - F Rocha
- Oregon Health and Science University, Portland, Ore
| | - G Martel
- University of Ottawa, Ottawa, Ont
| | | | - Z Mir
- From Queen's University, Kingston, Ont
| | - H Golding
- From Queen's University, Kingston, Ont
| | - S McKeown
- From Queen's University, Kingston, Ont
| | - S Nanji
- From Queen's University, Kingston, Ont
| | | | - P Groome
- From Queen's University, Kingston, Ont
| | - Z Mir
- From Queen's University, Kingston, Ont
| | | | - S Nanji
- From Queen's University, Kingston, Ont
| | | | - P Groome
- From Queen's University, Kingston, Ont
| | - S Elbekri
- University of Sherbrooke, Sherbrooke, Que
| | - S Turcotte
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E Girard
- Centre hospitalier universitaire de Grenoble Alpes, Grenoble, France
| | | | - R Lapointe
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | | | - M Dagenais
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - A Roy
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - R Letourneau
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - M Plasse
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - E Simoneau
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - Z Rong
- Centre hospitalier de l'Université de Montréal, Montreal, Que
| | - N Zuker
- From SUNY Upstate Medical University, Syracuse, N.Y
| | - M Oakley
- From SUNY Upstate Medical University, Syracuse, N.Y
| | - G Chartrand
- From the University of Montreal, Montreal, Que
| | - B Misheva
- From the University of Montreal, Montreal, Que
| | - Y Bendavid
- From the University of Montreal, Montreal, Que
| | - J Frigault
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Lemieux
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - D Breton
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - G Bouchard
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | - S Drolet
- From the Centre hospitalier universitaire de Québec - Université Laval, Québec, Que
| | | | - L Smith
- North York General Hospital, North York, Ont
| | - J Tan
- Humber River Hospital, North York, Ont
| | - U Kahn
- University of Toronto, Toronto, Ont
| | - C McLean
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - M Fortin
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | - X Paré
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | - A Doyon
- Centre hospitalier affilié universitaire régional de Trois-Rivières, Trois-Rivières, Que
| | | | | | - J Yadav
- University of Toronto, Toronto, Ont
| | - S Fischer
- University Health Network, Toronto, Ont
| | - T Jackson
- University Health Network, Toronto, Ont
| | - J Allard
- University Health Network, Toronto, Ont
| | | | - Y Lee
- McMaster University, Hamilton, Ont
| | - S Anvari
- McMaster University, Hamilton, Ont
| | - M Chu
- McMaster University, Hamilton, Ont
| | | | - I Aditya
- University of Toronto, Toronto, Ont
| | - R Malhan
- McMaster University, Hamilton, Ont
| | | | - M Walsh
- McMaster University, Hamilton, Ont
| | | | - D Hong
- McMaster University, Hamilton, Ont
| | - W He
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man
| | - R Romanescu
- From the University of Manitoba, Winnipeg, Man
| | - F Deaninck
- From the University of Manitoba, Winnipeg, Man
| | - J Linton
- From the University of Manitoba, Winnipeg, Man
| | | | | | - G Shingoose
- From the University of Manitoba, Winnipeg, Man
| | - A Vergis
- From the University of Manitoba, Winnipeg, Man
| | - K Hardy
- From the University of Manitoba, Winnipeg, Man
| | | | | | | | - Y Lee
- From McMaster University, Hamilton, Ont
| | - V Archer
- From McMaster University, Hamilton, Ont
| | | | - J Shiroky
- From McMaster University, Hamilton, Ont
| | | | - K Ramji
- From McMaster University, Hamilton, Ont
| | | | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - G Marcil
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
| | - A Mierzwa
- From the University of Alberta, Edmonton, Alta
| | - A Jarrar
- The Ottawa Hospital, Ottawa, Ont
| | | | | | - W Lin
- University of Toronto, Toronto, Ont
| | - J Hagen
- Humber River Hospital, North York, Ont
| | - M Connell
- From the University of Alberta, Edmonton, Alta
| | - W Sun
- From the University of Alberta, Edmonton, Alta
| | - J Dang
- From the University of Alberta, Edmonton, Alta
| | - V Mocanu
- From the University of Alberta, Edmonton, Alta
| | - J Kung
- From the University of Alberta, Edmonton, Alta
| | - N Switzer
- From the University of Alberta, Edmonton, Alta
| | - D Birch
- From the University of Alberta, Edmonton, Alta
| | - S Karmali
- From the University of Alberta, Edmonton, Alta
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10
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Beniey M, Boulva K, Rodriguez-Qizilbash S, Kaviani A, Younan R, Patocskai E. Targeted Axillary Dissection in Node-Positive Breast Cancer: A Retrospective Study and Cost Analysis. Cureus 2021; 13:e14610. [PMID: 34040910 PMCID: PMC8139537 DOI: 10.7759/cureus.14610] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Targeted axillary dissection (TAD) is a novel technique in the field of surgical oncology. During TAD, patients with node-positive breast cancer who clinically responded to neoadjuvant chemotherapy undergo resection of a previously proven metastatic node together with sentinel lymph node dissection (SLND). We aimed to assess the success rates of seed insertion and seed retrieval in the Canadian setting, as well as hospital costs of the procedure. Methods Patients converted to clinically node-negative status post-neoadjuvant chemotherapy underwent TAD. Before surgery, an iodine-125 radioactive seed was inserted in the previously proven metastatic node. The seed node was resected together with an SLND. Axillary lymph node dissection (ALND) was performed in all patients with residual metastases. Results Radioactive seeds were successfully inserted in 34/35 patients. In 34 patients, the targeted node was successfully resected with the radioactive probe during TAD. In one patient, the seed was retrieved inferiorly in the axilla during surgery. There was no adverse event. In total, 50% (17/34) of patients had no residual metastases and were able to avoid ALND. Eight out of 17 patients who underwent ALND did not have any residual disease in their specimen. The mean cost of TAD was 25% superior to the mean cost of ALND (p = 0.02). However, the mean total cost of the hospital stay for TAD was 20% superior to the mean cost of ALND (p = 0.11). The mean cost of TAD was 4,322 Can$ (Canadian dollars), similar to the mean cost of both ALND and SLND performed during the same procedure (4,479 Can$). Conclusions TAD was successful in 97% of patients. Despite increased procedural costs, with a lesser impact on total hospital stay costs, TAD was beneficial in 50% of patients. These patients avoided the unnecessary morbidity associated with ALND.
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Affiliation(s)
- Michèle Beniey
- Department of General Surgery, Université de Montréal, Montreal, CAN
| | - Kerianne Boulva
- Department of Surgical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, CAN
| | | | - Ahmad Kaviani
- Department of Surgical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, CAN
| | - Rami Younan
- Department of Surgical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, CAN
| | - Erica Patocskai
- Department of Surgical Oncology, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, CAN
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11
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Hassan S, Younan R, Patocskai E, Provencher L, Poirier B, Sideris L, Dubé P, Boileau JF, Mihalcioiu C, Robidoux A. Abstract PS4-27: A prospective multicenter study evaluating the impact of the 21-Gene Breast Recurrence Score® upon physician treatment decision and cost in lymph node-positive breast cancer patients in Quebec. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps4-27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Locoregional lymph node involvement has historically been used as the most important deciding factor for the administration of chemotherapy in the adjuvant setting of breast cancer patients. The 21-gene Breast Recurrence Score® assay (the assay) is emerging as an important tool to assist with chemotherapy decisions amongst hormone receptor (HR)-positive, node-positive breast cancer (BC) patients. Previous studies have suggested that node-positive patients with low Recurrence Score (RS) results do not benefit from chemotherapy. We wanted to better understand the impact of the assay upon physician treatment decisions and treatment cost in this patient cohort.
Methods: We conducted a multicenter prospective observational trial for ER/PR-positive HER2-negative BC patients that have undergone surgical treatment for T1-T3 disease and 1-3 positive lymph nodes. Physicians were required to complete a questionnaire indicating treatment choice prior to and post availability of Recurrence Score results. Patients were enrolled in the study from the time of consent to 6 months after the start of adjuvant therapy. The primary endpoint was change in the physician’s recommendation for chemotherapy prior to and post assay results. Secondary endpoints include the change in recommendation for additional growth factor (GF) supportive therapy, change in physician’s expressed level of confidence, and changes in estimated cost of recommended treatments prior to and post assay results.
Results: 70 patients were enrolled between March 2018 and September 2019 at five hospital centers, as part of the McPeak Sirois Group of Quebec. The median age of the cohort was 61 years (range, 38 to 82 years). 18.5% (n=13) of the cohort consisted of patients < 50 years, and 81.4% (n=57) were > or = to 50 years. 64.3% (n=45) of the patients had one positive lymph node and 35.7% (n=25) of the patients had 2 or 3 positive lymph nodes. 25.7% (n=18) of the patients had a RS < 11 and 68.6% (n=48) had a RS result between 11-25. For the entire cohort, we found that the proportion of patients for whom chemo-hormonal therapy was recommended was reduced by an absolute 67.1% by knowledge of the RS result (OR (odds of having chemo-hormonal therapy post-RS recommendation versus pre-RS recommendation) = 0.03 [95% CI: 0.01-0.08]; P<0.0001). The RS results led to an absolute reduction in physician recommendation in chemo-hormonal therapy by 38.5% for patients < 50 years, and by 73.7% of patients (OR=0.02 [95% CI: 0.01-0.06]; P <0.0001) for patients > or = to 50 years. Changes in treatment recommendation were identified for patients with one positive node, 73.3% (OR=0.02 [95% CI: 0.01-0.07]; P<0.0001); and for patients with two or three positive nodes, 56.0% (OR=0.06 [95% CI: 0.02-0.23]; P<0.0001). Recommendations for GF supportive therapy due to RS results decreased by 42.6% (OR=0.16 [95% CI: 0.07-0.34]; P <0.0001). Moreover, RS results led to an increase in confidence in physician treatment decisions for 68.6% of patients (OR=18.3 [95% CI: 7.90-42.28]; P <0.0001). We found that the cost of chemotherapy, in addition to anti-emetics and GF supportive therapy, decreased by 69.9% per patient (pre-RS mean, $3,968 CAN; versus post-RS mean, $1,196 CAN) (P <0.0001).
Conclusions: Overall, we found that the 21-gene Breast Recurrence Score® assay changed physician treatment decisions in about two-thirds of all patients with hormone receptor-positive, node-positive BC, regardless of the number of positive nodes (up to 3). The assay increased physician confidence and was associated with an important decrease in treatment cost. Taken together, the assay is a cost-effective approach that can decrease the use of chemotherapy amongst HR-positive, node-positive BC patients in Quebec.
Citation Format: Saima Hassan, Rami Younan, Erica Patocskai, Louise Provencher, Brigitte Poirier, Lucas Sideris, Pierre Dubé, Jean-Francois Boileau, Catalin Mihalcioiu, André Robidoux. A prospective multicenter study evaluating the impact of the 21-Gene Breast Recurrence Score® upon physician treatment decision and cost in lymph node-positive breast cancer patients in Quebec [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-27.
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Affiliation(s)
- Saima Hassan
- 1Centre Hospitalier de l'Université de Montréal, McPeak Sirois Group, Montréal, QC, Canada
| | - Rami Younan
- 1Centre Hospitalier de l'Université de Montréal, McPeak Sirois Group, Montréal, QC, Canada
| | - Erica Patocskai
- 1Centre Hospitalier de l'Université de Montréal, McPeak Sirois Group, Montréal, QC, Canada
| | - Louise Provencher
- 2Centre Hospitalier Universitaire de Québec - Université Laval, McPeak Sirois Group, Québec, QC, Canada
| | - Brigitte Poirier
- 2Centre Hospitalier Universitaire de Québec - Université Laval, McPeak Sirois Group, Québec, QC, Canada
| | - Lucas Sideris
- 3Hôpital Maisonneuve-Rosemont, McPeak Sirois Group, Montréal, QC, Canada
| | - Pierre Dubé
- 3Hôpital Maisonneuve-Rosemont, McPeak Sirois Group, Montréal, QC, Canada
| | - Jean-Francois Boileau
- 4Jewish General Hospital Segal Cancer Centre, McGill University, McPeak Sirois Group, Montréal, QC, Canada
| | - Catalin Mihalcioiu
- 5McGill University Health Centre, McPeak Sirois Group, Montréal, QC, Canada
| | - André Robidoux
- 1Centre Hospitalier de l'Université de Montréal, McPeak Sirois Group, Montréal, QC, Canada
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12
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Brind'Amour A, Dubé P, Tremblay JF, Soucisse ML, Mack L, Bouchard-Fortier A, McCart JA, Govindarajan A, Bischof D, Haase E, Giacomantonio C, Hebbard P, Younan R, MacNeill A, Boulanger-Gobeil C, Sidéris L. Canadian guidelines on the management of colorectal peritoneal metastases. Curr Oncol 2020; 27:e621-e631. [PMID: 33380878 PMCID: PMC7755452 DOI: 10.3747/co.27.6919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Modern management of colorectal cancer (crc) with peritoneal metastasis (pm) is based on a combination of cytoreductive surgery (crs), systemic chemotherapy, and hyperthermic intraperitoneal chemotherapy (hipec). Although the role of hipec has recently been questioned with respect to results from the prodige 7 trial, the role and benefit of a complete crs were confirmed, as observed with a 41-month gain in median survival in that study, and 15% of patients remaining disease-free at 5 years. Still, crc with pm is associated with a poor prognosis, and good patient selection is essential. Many questions about the optimal management approach for such patients remain, but all patients with pm from crc should be referred to, or discussed with, a pm surgical oncologist, because cure is possible. The objective of the present guideline is to offer a practical approach to the management of pm from crc and to reflect on the new practice standards set by recent publications on the topic.
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Affiliation(s)
- A Brind'Amour
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, chu de Québec-Université Laval, Quebec City
| | - P Dubé
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
| | - J F Tremblay
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
| | - M L Soucisse
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
| | - L Mack
- Department of Surgery, University of Calgary, Calgary, AB
| | | | - J A McCart
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - A Govindarajan
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - D Bischof
- Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON
- Department of Surgery, University of Toronto, Toronto, ON
| | - E Haase
- Department of Surgery, University of Alberta, Edmonton, AB
| | | | - P Hebbard
- Department of Surgery, University of Manitoba, Winnipeg, MB
| | - R Younan
- Department of Surgery, University of Montreal, Montreal, QC
- Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - A MacNeill
- Department of Surgery, University of British Columbia, Vancouver, BC
| | | | - L Sidéris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal
- Department of Surgery, University of Montreal, Montreal, QC
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13
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Shariff F, Bischof D, Govindarajan A, Prince R, Burkes R, Haase E, Mack L, Temple W, Hebbard P, Boulanger-Gobeil C, Giacomantonio C, Brind’Amour A, Sidéris L, Dubé P, Hamilton T, MacNeill A, Bouchard-Fortier A, Younan R, McCart A. Evidence-Based Strategies for the Treatment of Peritoneal Malignancies during Health Care Resource Restriction: The COVID-19 Pandemic. ACTA ACUST UNITED AC 2020; 28:40-51. [PMID: 33704173 PMCID: PMC7816179 DOI: 10.3390/curroncol28010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 12/11/2022]
Abstract
Background: The COVID-19 pandemic has put enormous pressure on hospital resources, and has affected all aspects of patient care. As operative volumes decrease, cancer surgeries must be triaged and prioritized with careful thought and attention to ensure maximal benefit for the maximum number of patients. Peritoneal malignancies present a unique challenge, as surgical management can be resource intensive, but patients have limited non-surgical treatment options. This review summarizes current data on outcomes and resource utilization to help inform decision-making and case prioritization in times of constrained health care resources. Methods: A rapid literature review was performed, examining surgical and non-surgical outcomes data for peritoneal malignancies. Narrative data synthesis was cross-referenced with relevant societal guidelines. Peritoneal malignancy surgeons and medical oncologists reviewed recommendations to establish a national perspective on case triage and mitigating treatment strategies. Results and Conclusions: Triage of peritoneal malignancies during this time of restricted health care resource is nuanced and requires multidisciplinary discussion with consideration of individual patient factors. Prioritization should be given to patients where delay may compromise resectability of disease, and where alternative treatment options are lacking. Mitigating strategies such as systemic chemotherapy and/or surgical deferral may be utilized with close surveillance for disease stability or progression, which may affect surgical urgency. Unique hospital capacity, and ability to manage the complex post-operative course for these patients must also be considered to ensure patient and system needs are aligned.
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Affiliation(s)
- Farhana Shariff
- University Health Network, Toronto, ON M5G 1L7, Canada; (D.B.); (A.G.); (R.P.); (R.B.)
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1L7, Canada
- Mount Sinai Hospital, Toronto, ON M5G 1L7, Canada
- Correspondence: (F.S.); (A.M.)
| | - Danielle Bischof
- University Health Network, Toronto, ON M5G 1L7, Canada; (D.B.); (A.G.); (R.P.); (R.B.)
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1L7, Canada
- Mount Sinai Hospital, Toronto, ON M5G 1L7, Canada
| | - Anand Govindarajan
- University Health Network, Toronto, ON M5G 1L7, Canada; (D.B.); (A.G.); (R.P.); (R.B.)
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1L7, Canada
- Mount Sinai Hospital, Toronto, ON M5G 1L7, Canada
| | - Rebecca Prince
- University Health Network, Toronto, ON M5G 1L7, Canada; (D.B.); (A.G.); (R.P.); (R.B.)
- Mount Sinai Hospital, Toronto, ON M5G 1L7, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Ronald Burkes
- University Health Network, Toronto, ON M5G 1L7, Canada; (D.B.); (A.G.); (R.P.); (R.B.)
- Mount Sinai Hospital, Toronto, ON M5G 1L7, Canada
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Erika Haase
- Department of Surgery, University of Alberta, Edmonton, AB T6G 2R3, Canada;
| | - Lloyd Mack
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (L.M.); (W.T.); (A.B.-F.)
| | - Walley Temple
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (L.M.); (W.T.); (A.B.-F.)
| | - Pamela Hebbard
- Department of Surgery, University of Manitoba, Cancer Care Manitoba, Winnipeg, MN R3T 2N2, Canada;
| | - Cindy Boulanger-Gobeil
- CHU de Québec, Département de Chirurgie, Université Laval, Quebec City, QC G1V 4G2, Canada;
| | | | | | - Lucas Sidéris
- Maisonneuve-Rosemont Hospital, Montréal, QC H1T 2M4, Canada; (A.B.); (L.S.); (P.D.)
| | - Pierre Dubé
- Maisonneuve-Rosemont Hospital, Montréal, QC H1T 2M4, Canada; (A.B.); (L.S.); (P.D.)
| | - Trevor Hamilton
- Department of Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (T.H.); (A.M.)
| | - Andrea MacNeill
- Department of Surgery, University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (T.H.); (A.M.)
| | - Antoine Bouchard-Fortier
- Department of Surgery and Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (L.M.); (W.T.); (A.B.-F.)
| | - Rami Younan
- Centre Hospitalier de l’Université de Montréal, Montréal, QC H2X 3E4, Canada;
| | - Andrea McCart
- University Health Network, Toronto, ON M5G 1L7, Canada; (D.B.); (A.G.); (R.P.); (R.B.)
- Division of Surgical Oncology, Department of Surgery, University of Toronto, Toronto, ON M5G 1L7, Canada
- Mount Sinai Hospital, Toronto, ON M5G 1L7, Canada
- Correspondence: (F.S.); (A.M.)
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14
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Diehl JL, Peron N, Chocron R, Debuc B, Guerot E, Hauw-Berlemont C, Hermann B, Augy JL, Younan R, Novara A, Langlais J, Khider L, Gendron N, Goudot G, Fagon JF, Mirault T, Smadja DM. Respiratory mechanics and gas exchanges in the early course of COVID-19 ARDS: a hypothesis-generating study. Ann Intensive Care 2020; 10:95. [PMID: 32676824 PMCID: PMC7364286 DOI: 10.1186/s13613-020-00716-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/08/2020] [Indexed: 12/11/2022] Open
Abstract
Rationale COVID-19 ARDS could differ from typical forms of the syndrome. Objective Pulmonary microvascular injury and thrombosis are increasingly reported as constitutive features of COVID-19 respiratory failure. Our aim was to study pulmonary mechanics and gas exchanges in COVID-2019 ARDS patients studied early after initiating protective invasive mechanical ventilation, seeking after corresponding pathophysiological and biological characteristics. Methods Between March 22 and March 30, 2020 respiratory mechanics, gas exchanges, circulating endothelial cells (CEC) as markers of endothelial damage, and D-dimers were studied in 22 moderate-to-severe COVID-19 ARDS patients, 1 [1–4] day after intubation (median [IQR]). Measurements and main results Thirteen moderate and 9 severe COVID-19 ARDS patients were studied after initiation of high PEEP protective mechanical ventilation. We observed moderately decreased respiratory system compliance: 39.5 [33.1–44.7] mL/cmH2O and end-expiratory lung volume: 2100 [1721–2434] mL. Gas exchanges were characterized by hypercapnia 55 [44–62] mmHg, high physiological dead-space (VD/VT): 75 [69–85.5] % and ventilatory ratio (VR): 2.9 [2.2–3.4]. VD/VT and VR were significantly correlated: r2 = 0.24, p = 0.014. No pulmonary embolism was suspected at the time of measurements. CECs and D-dimers were elevated as compared to normal values: 24 [12–46] cells per mL and 1483 [999–2217] ng/mL, respectively. Conclusions We observed early in the course of COVID-19 ARDS high VD/VT in association with biological markers of endothelial damage and thrombosis. High VD/VT can be explained by high PEEP settings and added instrumental dead space, with a possible associated role of COVID-19-triggered pulmonary microvascular endothelial damage and microthrombotic process.
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Affiliation(s)
- J-L Diehl
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006, Paris, France. .,Intensive Care Unit and Biosurgical Research Lab (Carpentier Foundation), AH-HP, Georges Pompidou European Hospital, 20 Rue Leblanc, 75015, Paris, France.
| | - N Peron
- Intensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - R Chocron
- Université de Paris, PARCC, INSERM, 75015, Paris, France.,Emergency Department, AP-HP, Georges Pompidou European Hospital, 75015, Paris, France
| | - B Debuc
- Plastic Surgery Department, AP-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - E Guerot
- Intensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - C Hauw-Berlemont
- Intensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - B Hermann
- Intensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - J L Augy
- Intensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - R Younan
- Intensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - A Novara
- Intensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - J Langlais
- Intensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - L Khider
- Vascular Medicine Department and Biosurgical Research Lab (Carpentier Foundation), AP-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - N Gendron
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006, Paris, France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation), AH-HP, Georges Pompidou European Hospital, 75015, Paris, France
| | - G Goudot
- Emergency Department, AP-HP, Georges Pompidou European Hospital, 75015, Paris, France
| | - J-F Fagon
- Intensive Care Unit, AH-HP, Georges Pompidou European Hospital, Université de Paris, 75015, Paris, France
| | - T Mirault
- Université de Paris, PARCC, INSERM, 75015, Paris, France.,Vascular Medicine Department, AP-HP, Georges Pompidou European Hospital, 75015, Paris, France
| | - D M Smadja
- Université de Paris, Innovative Therapies in Haemostasis, INSERM, 75006, Paris, France.,Hematology Department and Biosurgical Research Lab (Carpentier Foundation), AH-HP, Georges Pompidou European Hospital, 75015, Paris, France
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15
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Meloche-Dumas L, Christopoulos A, Ayad T, Younan R, Kaviani A, Boulva K, Liberman M, Berrnard AA, Beaulieu J, Borduas P, El Sayed N, Ma X, Sédillot È, Patocskai É. Breast Cancer with Supraclavicular and Internal Mammary Node Metastases: Therapeutic Options. Eur J Surg Oncol 2020. [DOI: 10.1016/j.ejso.2019.11.114] [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: 11/25/2022] Open
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16
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Beniey M, Boulva K, Rodriguez-Qizilbash S, Younan R, Robidoux A, Patocskai E. Targeted axillary dissection in node positive breast cancer and amongst high-risk patients: a retrospective study. European Journal of Surgical Oncology 2020. [DOI: 10.1016/j.ejso.2019.11.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Deban M, Younan R, Charpentier D, Yelle L, Tran-Thanh D, Patocskai E. Systemic Therapy in Local Recurrence of Breast Cancer, Report of a case and Decision Making in MDT Meeting. Arch Breast Cancer 2019. [DOI: 10.32768/abc.201963120-123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Locoregional recurrence of breast cancer has significantly decreased over the last decades, particularly due to effective systemic therapy. While there is little controversy regarding local management of locoregional recurrences, in light of previous systemic treatment, additional chemotherapy regimens and their benefit to the patient are still subject to debate in tumors boards.Case Presentation: A 45-year-old woman was referred to our tertiary care center with a local recurrence of breast cancer 9 years after modified radical mastectomy for a ypT2N2a invasive ductal carcinoma. She received neoadjuvant treatment consisting of FEC-D (5-FU-epirubicin-cyclophosphamide, followed by docetaxel) for hormone receptor positive, HER-2-neu negative cancer in 2009, as well as adjuvant radiotherapy and tamoxifen for 9 years. After R0 resection of the hormone receptor positive, HER-2-neu negative recurrence in 2019, adjuvant therapy with ovarian suppression and an aromatase inhibitor was undertaken. A multigene assay identified a recurrence score at 37 and benefit from chemotherapy > 15%.Question: What would the ideal chemotherapy regimen consist of for this patient with an R0 resection of late recurrence of breast cancer?Conclusion: After reviewing history, imaging and pathology, members of the multidisciplinary team recommended treatment with Taxotere and cyclophosphamide (TC) x 4 for our patient.
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Péron J, Mercier F, Tuech JJ, Younan R, Sideris L, Gelli M, Dumont F, Le Roy B, Sgarbura O, Lo Dico R, Bibeau F, Glehen O, Passot G. The location of the primary colon cancer has no impact on outcomes in patients undergoing cytoreductive surgery for peritoneal metastasis. Surgery 2018; 165:476-484. [PMID: 30197280 DOI: 10.1016/j.surg.2018.07.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The impact of the location of colorectal cancer on patient outcomes has been reported in several settings. The objective of this study was to assess the prognostic impact of the location of the primary colon cancer among patients with colorectal cancer peritoneal metastases undergoing complete cytoreductive surgery. METHODS Using the prospectively maintained clinical and biological digestive peritoneal metastasis database of the BIG-RENAPE network, we identified 796 patients treated by a complete cytoreductive surgery between January 2004 and January 2017 for colorectal cancer peritoneal metastases in 16 different institutions. The 2 primary endpoints were overall survival and progression-free survival. To evaluate the impact on overall survival and progression-free survival of potential prognostic factors (including the location of the primary colorectal cancer), these factors were included in univariate and multivariate Cox proportional hazard models. RESULTS Right-sided colorectal cancers were more often BRAF mutated and had microsatellite instability, whereas the frequency of RAS mutation was similar between right-sided and left-sided colorectal cancers. After a median follow-up time of 3.3 years, there was no significant difference in overall survival or progression-free survival according to tumor side. The lack of effect of tumor location on overall survival and progression-free survival was consistent across subgroups. CONCLUSION Among patients undergoing complete cytoreductive surgery for peritoneal metastases, the site of the primary colorectal cancer was not associated with differences in progression-free survival or overall survival. Tumor side should not be used as a stratification factor in trials of colorectal cancer peritoneal metastases and should not be used in the selection process of patients for cytoreductive surgery.
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Affiliation(s)
- Julien Péron
- Hospices Civils de Lyon, Oncology Department, Pierre-Benite, France; Hospices Civils de Lyon, Service de Biostatistique et Bioinformatique, Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France; BIG-RENAPE Working Group-all collaborators of BIG-RENAPE Working Group are listed at the end of the manuscript.
| | - Frederic Mercier
- Department of Surgical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Jacques Tuech
- BIG-RENAPE Working Group-all collaborators of BIG-RENAPE Working Group are listed at the end of the manuscript; Department of Surgery, Rouen University Hospital, Rouen, France
| | - Rami Younan
- Department of Surgical Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Lucas Sideris
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montreal, Quebec, Canada
| | - Maximiliano Gelli
- BIG-RENAPE Working Group-all collaborators of BIG-RENAPE Working Group are listed at the end of the manuscript; Institut Gustave Roussy, Department of Surgical Oncology, Villejuif, France
| | - Frederic Dumont
- BIG-RENAPE Working Group-all collaborators of BIG-RENAPE Working Group are listed at the end of the manuscript; ICO-Centre René Gauducheau, Department of Surgical Oncology, St Herblain, France
| | - Bertrand Le Roy
- BIG-RENAPE Working Group-all collaborators of BIG-RENAPE Working Group are listed at the end of the manuscript; CHU Estaing, Department of Digestive Surgery, Clermont-Ferrand, France
| | - Olivia Sgarbura
- BIG-RENAPE Working Group-all collaborators of BIG-RENAPE Working Group are listed at the end of the manuscript; Institut de Cancer Montpellier, Department of Surgical Oncology, Montpellier, France; University of Montpellier
| | - Rea Lo Dico
- BIG-RENAPE Working Group-all collaborators of BIG-RENAPE Working Group are listed at the end of the manuscript; Service de Chirurgie Digestive et Cancérologique Hôpital Lariboisière; Unité INSERM U965 / CART / Paris 7 Diderot Carcinose Angiogenèse et Recherche translationnelle; Paris, France
| | - Frederic Bibeau
- Pathology Department, Caen University Hospital, Caen, France
| | - Olivier Glehen
- Université Lyon 1, Villeurbanne, France; BIG-RENAPE Working Group-all collaborators of BIG-RENAPE Working Group are listed at the end of the manuscript; Hospices Civils de Lyon, Department of General Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
| | - Guillaume Passot
- Université Lyon 1, Villeurbanne, France; BIG-RENAPE Working Group-all collaborators of BIG-RENAPE Working Group are listed at the end of the manuscript; Hospices Civils de Lyon, Department of General Surgery, Centre Hospitalier Lyon Sud, Pierre Bénite, France; EMR 3738, Lyon 1 University, Lyon, France
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19
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Amblard I, Mercier F, Bartlett D, Ahrendt S, Lee K, Zeh H, Levine E, Baratti D, Deraco M, Piso P, Morris D, Rau B, Tentes A, Tuech JJ, Quenet F, Akaishi E, Pocard M, Yonemura Y, Lorimier G, Delroeux D, Villeneuve L, Glehen O, Passot G, Abba J, Abboud K, Alyami M, Arvieux C, Bakrin N, Bereder JM, Bouzard D, Brigand C, Carrère S, Delroeux D, Dumont F, Eveno C, Facy O, Guyon F, Kianmanesh R, Lo Dico R, Lorimier G, Marchal F, Mariani P, Meeus P, Msika S, Ortega-Deballon P, Paquette B, Peyrat P, Pirro N, Pocard M, Porcheron J, Quenet F, Rat P, Sgarbura O, Thibaudeau E, Tuech JJ, Zinzindohoue F, Ahrendt S, Akaishi E, Baik S, Baratti D, Bhatt A, Cachin P, Ceelen W, De Hingh I, De Simone M, Dubé P, Edwards R, Franko J, Gonzalez-Bayon L, Gushchin V, Holtzman M, Hsieh MC, Kecmanovic D, Lee K, Lehmann K, Liu Y, Mehta S, Morris D, O'Dwyer S, Orsevigo E, Pande P, Park E, Pingpank J, Piso P, Rajan F, Rau B, Sardi A, Sideris L, Sommariva A, Spiliotis J, Sugarbaker P, Tentes A, Teo M, Yarema R, Younan R, Zaveri S, Zeh H. Cytoreductive surgery and HIPEC improve survival compared to palliative chemotherapy for biliary carcinoma with peritoneal metastasis: A multi-institutional cohort from PSOGI and BIG RENAPE groups. Eur J Surg Oncol 2018; 44:1378-1383. [PMID: 30131104 DOI: 10.1016/j.ejso.2018.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 12/12/2022] Open
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Boulva K, Rodriguez-Qizilbash S, Guilarte L, Lazizi S, Robidoux A, Younan R, Patocskai E. Abstract P5-22-21: Radioactive seed and targeted axillary dissection: A feasibility study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-22-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Targeted axillary dissection (TAD) with a radioactive seed is a new and promising technique to evaluate the axillary status in post-neoadjuvant chemotherapy (NACT) node-positive breast cancer patients. This study aims to evaluate the feasibility of TAD with a radioactive seed in a Canadian setting.
We conducted a retrospective observational study of a prospectively gathered database of patients having undergone TAD with a radioactive seed implanted in a proven metastatic axillary node, between 2015 and 2017 in our institution. An iodine-125 radioactive seed was implanted under ultrasound guidance by trained radiologists. Patients then underwent standard sentinel lymph node biopsy (SLNB) using technicium-99 and blue dye, as well as selective removal of the node containing the radioactive seed. Data was gathered from electronic medical records and chart review.
Nine patients with a median age of 54 underwent TAD for unilateral breast cancer post-NACT between 2015 and 2017, three of which were "triple-negative". A median of 3 lymph nodes were removed, including that which contained the radioactive seed. Postoperative pathological evaluation showed 4 patients with positive nodes and 5 pathologic complete responses in the axilla. In all patients, the seed had been accurately positioned in a positive node (no false negatives). The seed also located a positive retropectoral node that would otherwise have been missed using standard dual tracer SLNB. No complications due to the use of the radioactive seed were encountered. All implanted seeds were identified and retrieved within the pathology specimen.
In our experience, TAD with a radioactive seed combined to dual tracer SLNB is an accurate and safe method of evaluating the axillary lymph node status in post-NACT node positive breast cancer patients. Further studies with larger cohorts are warranted to ensure continued feasibility and reproducibility of our positive results.
Citation Format: Boulva K, Rodriguez-Qizilbash S, Guilarte L, Lazizi S, Robidoux A, Younan R, Patocskai E. Radioactive seed and targeted axillary dissection: A feasibility study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-21.
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Affiliation(s)
- K Boulva
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - L Guilarte
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - S Lazizi
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - A Robidoux
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - R Younan
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - E Patocskai
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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21
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Verwaal VJ, Rau B, Jamali F, Gilly FN, de Hingh I, Takala H, Syk I, Pelz J, Mulsow J, van der Speeten K, Shigeki K, Iversen LH, Mohamed F, Glehen O, Younan R, Yarema R, Gonzalez-Moreno S, O’Dwyer S, Yonemura Y, Sugarbaker P. Registries on peritoneal surface malignancies throughout the world, their use and their options. Int J Hyperthermia 2017; 33:528-533. [PMID: 28540833 DOI: 10.1080/02656736.2017.1315178] [Citation(s) in RCA: 9] [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] [Indexed: 12/29/2022] Open
Affiliation(s)
| | - Beate Rau
- Charite Campus Mitte, Surgery, Berlin, Germany
| | - Faek Jamali
- American University of Beirut, Beirut, Lebanon
| | | | - Ignace de Hingh
- Catharina Ziekenhuis, Surgical Oncology, Eindhoven, the Netherlands
| | | | - Ingvar Syk
- Lunds Universitet Institutionen for kliniska vetenskaper Malmo, Sweden
| | - Jorg Pelz
- Zentrum fur Operative Medizin, Wurtzburg, Germany
| | - Jurgen Mulsow
- Mater Misericordiae University Hospital, Dublin, Ireland
| | | | | | - Lene H. Iversen
- Aarhus Universitet Hospital, Department of Surgery, Aarhus, Denmark
| | - Faheez Mohamed
- Department of Surgery, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | | | | | | | | | | | - Yukata Yonemura
- NPO Organization to Support Peritoneal Dissemination Treatment, Osaka, Japan
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22
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Tan S, David J, Lalonde L, El Khoury M, Labelle M, Younan R, Patocskai E, Richard J, Trop I. Breast magnetic resonance imaging: are those who need it getting it? Curr Oncol 2017; 24:e205-e213. [PMID: 28680288 PMCID: PMC5486393 DOI: 10.3747/co.24.3441] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Indications for breast magnetic resonance imaging (mri), a very sensitive but less-specific tool for breast investigation, remain controversial, and accessibility is limited. The purposes of our study were to determine the proportion of breast mri exams performed for various clinical indications, to assess the wait times for breast mri, and to create a list of evidence-based indications for breast mri. METHODS The indications for breast mri exams performed in September 2013 at our academic centre were audited. A multidisciplinary meeting held in May 2014 established a list of evidence-based indications for breast mri, after which, in September 2014 and 2015, breast mri exams were re-audited for clinical indications, and pending requests were calculated. RESULTS In September 2013, surveillance of women with a prior diagnosis of breast cancer represented 21% of breast mri exams (24 of 113), with preoperative staging representing 18% of exams (20 of 113) and high-risk screening representing 12% (13 of 113). Of pending mri requests, 230 were within the recommended delay period, and 457 exceeded the recommended delay. After elaboration of evidence-based guidelines, repeat audits in September 2014 and September 2015 showed that mri performed for women with a prior breast cancer diagnosis represented 23% (33 of 141) and 7% (10 of 143) of exams respectively, with preoperative staging having declined to 9% (13 of 141) and 11% (16 of 143) of exams, and high-risk screening having increased to 36% (51 of 141) and 46% (66 of 143) of exams. Overall, wait times were improved for all breast mri indications. CONCLUSIONS Through multidisciplinary discussion, we actualized a list of breast mri indications, prioritized requests more adequately, and improved wait times.
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Affiliation(s)
| | | | | | | | | | | | | | - J. Richard
- Department of General Medicine, l’Université de Montréal, Montreal, QC
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23
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Dubé P, Sideris L, Law C, Mack L, Haase E, Giacomantonio C, Govindarajan A, Krzyzanowska MK, Major P, McConnell Y, Temple W, Younan R, McCart JA. Guidelines on the use of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with peritoneal surface malignancy arising from colorectal or appendiceal neoplasms. ACTA ACUST UNITED AC 2015; 22:e100-12. [PMID: 25908915 DOI: 10.3747/co.22.2058] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
To meet the needs of patients, Canadian surgical and medical oncology leaders in the treatment of peritoneal surface malignancies (psms), together with patient representatives, formed the Canadian HIPEC Collaborative Group (chicg). The group is dedicated to standardizing and improving the treatment of psm in Canada so that access to treatment and, ultimately, the prognosis of Canadian patients with psm are improved. Patients with resectable psm arising from colorectal or appendiceal neoplasms should be reviewed by a multidisciplinary team including surgeons and medical oncologists with experience in treating patients with psm. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy should be offered to appropriately selected patients and performed at experienced centres. The aim of this publication is to present guidelines that we recommend be applied across the country for the treatment of psm.
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Affiliation(s)
- P Dubé
- Department of Surgery, University of Montreal, Montreal, QC. ; Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal, QC
| | - L Sideris
- Department of Surgery, University of Montreal, Montreal, QC. ; Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal, QC
| | - C Law
- Department of Surgery, University of Toronto, Toronto, ON. ; Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, ON
| | - L Mack
- Department of Surgery, University of Calgary, Calgary, AB
| | - E Haase
- Department of Surgery, University of Alberta, Edmonton, AB
| | | | - A Govindarajan
- Department of Surgery, University of Toronto, Toronto, ON. ; Department of Surgery, Mount Sinai Hospital, Toronto, ON
| | - M K Krzyzanowska
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, ON
| | - P Major
- Department of Medical Oncology and Hematology, Juravinski Cancer Centre, Hamilton, ON
| | - Y McConnell
- Department of Surgery, University of British Columbia, Vancouver, BC
| | - W Temple
- Department of Surgery, University of Calgary, Calgary, AB
| | - R Younan
- Department of Surgery, University of Montreal, Montreal, QC. ; Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC
| | - J A McCart
- Department of Surgery, University of Toronto, Toronto, ON. ; Department of Surgery, Mount Sinai Hospital, Toronto, ON
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24
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Ben Abdallah SS, Letarte N, Messier C, Charpentier D, Yelle L, Younan R, Bestawros A. Abstract P3-15-09: Impact of granulocyte colony-stimulating factors on febrile neutropenia risk during early-stage breast cancer treatment. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p3-15-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Febrile neutropenia (FN) is a significant cause of both mortality and morbidity in patients undergoing adjuvant or neoadjuvant chemotherapy for early-stage breast cancer (ESBC). The risk of FN varies with respect to the type of chemotherapy used and patient-specific characteristics. Granulocyte colony-stimulating factors (G-CSF) are recommended, but not mandatory, as primary prophylaxis for patients at high-risk of FN. This study aimed to evaluate the impact of filgrastim and pegfilgastrim on the incidence of FN during adjuvant and neoadjuvant chemotherapy for ESBC. Risk factors for FN were also assessed.
We conducted a retrospective cohort study that included 297 consecutive patients undergoing adjuvant or neoadjuvant chemotherapy for ESBC between May 2010 and May 2012. Patients on clinical trials were excluded. 173 patients (58%) received primary G-CSF prophylaxis whereas 124 (42%) did not. In patients receiving G-CSF prophylaxis, filgrastim was more commonly prescribed (59.9%), due to reimbursement reasons in Quebec. In total, 38 patients (12.8%) manifested at least one episode of FN. The incidence of FN was significantly reduced in patients receiving primary prophylaxis with G-CSF (p = 0.012).
The most commonly prescribed chemotherapy protocols were FEC-D (5-Fluorouracil, epirubicin, cyclophosphamide followed by docetaxel), AC-T (Adriamycin, cyclophosphamide followed by paclitaxel), and TC (docetaxel and cyclophosphamide). The use of G-CSF as primary prophylaxis was associated with a decrease in FN incidence in patients receiving FEC-D and TC.
Table 1 Incidence of febrile neutropenia in early-stage breast cancer chemotherapy G-CSF primary prophylaxis N = 173Absence of G-CSF prophylaxis N = 124 N (%)N (%) Febrile neutropenia (all chemotherapy)15 (9)23 (19)p = 0.012*TC4/51 (8)5/11 (45)p = 0.01*FEC-D6/59 (10)8/27 (30)p = 0.023*AC-T3/31 (10)8/63 (13)p = 0.668* denotes statistical significance at p < 0.05
One death occurred in a patient receiving FEC-D who had not received prophylaxis. There was no significant difference in the dosing of filgrastim between patients with FN (mean dose received = 5.289 mcg/kg) and those without FN (mean = 5.167mcg/kg) (p = 0.742). Furthermore, previously described risk factors for FN such as age, comorbidities and decreased baseline albumin were not associated with an increased of FN in our study.
Although this was a retrospective study with inherent limitations, our cohort included, to our knowledge, the largest number of patients in a study of G-CSF use in ESBC. We found a statistically significant reduction of FN in patients receiving primary G-CSF prophylaxis. Primary prophylaxis should be routinely offered to patients undergoing chemotherapy for ESBC and in particular, to those receiving docetaxel-containing regimens.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-15-09.
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Affiliation(s)
- SS Ben Abdallah
- Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montréal, QC, Canada
| | - N Letarte
- Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montréal, QC, Canada
| | - C Messier
- Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montréal, QC, Canada
| | - D Charpentier
- Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montréal, QC, Canada
| | - L Yelle
- Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montréal, QC, Canada
| | - R Younan
- Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montréal, QC, Canada
| | - A Bestawros
- Centre Hospitalier de l'Université de Montréal Hôpital Notre-Dame, Montréal, QC, Canada
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25
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Abstract
For the last 60 years, only a few cases of tick-borne encephalitis (TBE) have been detected in Bulgaria. Considering the remarkable increase in TBE morbidity in Europe over the past two decades, we conducted a study of TBE among patients with acute viral meningitis who were hospitalised in Bulgaria during 2009 to 2012. A total of 86 patients with viral meningitis of unknown aetiology during this period were tested. Acute TBE was confirmed in three of these patients. The last TBE case was detected in October 2012; the other two were diagnosed in 2009. To the best of our knowledge, these three patients are the first confirmed TBE cases reported in Bulgaria. The risk of TBE is underestimated in Bulgaria due to the low awareness of medical doctors.
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Affiliation(s)
- E Mohareb
- United States Naval Medical Research Unit-3, Cairo, Egypt
| | - I Christova
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - A Soliman
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - R Younan
- United States Naval Medical Research Unit-3, Cairo, Egypt
| | - T Kantardjiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
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Boileau JF, Poirier B, Basik M, Holloway C, Gaboury L, Sideris L, Meterissian SH, Arnaout A, Brackstone M, McCready DR, Karp SE, Wright FC, Younan R, Provencher L, Patocskai E, Omeroglu A, Robidoux A. Sentinel node biopsy after neoadjuvant therapy: Relevance of sentinel node micrometastases, isolated tumor cells, and value of immunohistochemistry. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.26_suppl.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
52 Background: Sentinel node biopsy (SNB) is used in breast cancer patients that present with clinically negative nodes. In this setting, most guidelines do not support the use of immunohistochemistry (IHC) and recommend against completion node dissection (CND) when only isolated tumor cells (pN0(i+)) or micrometasases (pN1mi) are identified. When SNB is used after neoadjuvant therapy (NAT), the relevance of ypN0(i+) and ypN1mi sentinel nodes (SNs) and the value of IHC are not well established. The goals of this study are to determine if CND should be recommended in the presence of ypN0(i+) or ypN1mi SNs and if IHC should be used to evaluate SNs after NAT. Methods: From March 2009 to December 2012, 152 women with biopsy proven node positive breast cancer were accrued to the multicentric prospective SN FNAC trial. After NAT, SNB was followed by a CND in all participants. SNs were cut in serial slices no thicker than 2 mm. Hematoxylin and eosin stains (H and E) were done on all slices, and if negative, IHC was used. The size of the largest SN metastasis and the primary method of identification (H and E or IHC) were recorded. ypN0(i+), ypN1mi and ypN1 SNs were considered as positive. Pathology was centrally reviewed. Results: 145 women were eligible for the trial. Axillary pathologic complete response rate = 34% (49/145). SNB success rate = 88% (127/145). False negative rate = 8.4% (7/83). If ypN0(i+) SNs are classified as node negative, the false negative rate is increased to 13.3% (11/83). For patients with ypN0(i+) (n=7), ypN1mi (n=8) and ypN1 (n=61) SNs, the rates of non-SN involvement are 57%, 38% and 56% respectively (p=NS). 40% (27/68) of positive SNBs are primarily detected by IHC. This is increased to 64% (9/14) for the identification of SN metastases ≤ 2mm. Conclusions: After NAT, particularly when presenting with biopsy proven node positive breast cancer, patients with ypN0(i+) and ypN1mi SNs have a significant rate of non-SN involvement. In the absence of evidence to show that a CND can be safely avoided, efforts should be made to identify even minimal amounts of disease when SNBs are done following NAT. IHC is useful to increase the detection of small SN metastases in this setting. Clinical trial information: NCT00909441.
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Affiliation(s)
| | | | - Mark Basik
- Segal Cancer Center/Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Claire Holloway
- Odette Cancer Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada
| | - Louis Gaboury
- Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, QC, Canada
| | | | | | | | | | - David R. McCready
- University Health Network-Princess Margaret Hospital, Toronto, ON, Canada
| | | | | | - Rami Younan
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Louise Provencher
- Centre des Maladies du sein Deschênes-Fabia, Centre de Recherche du CHU de Québec, Faculté de Médecine, Université Laval, Quebec City, QC, Canada
| | - Erika Patocskai
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Andre Robidoux
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
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Ghadirian P, Robidoux A, Nassif E, Martin G, Potvin C, Patocskai E, Younan R, Larouche N, Venne A, Zhang S, Royer R, Narod SA. Screening for BRCA1 and BRCA2 mutations among French-Canadian breast cancer cases attending an outpatient clinic in Montreal. Clin Genet 2013; 85:31-5. [DOI: 10.1111/cge.12174] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 04/19/2013] [Accepted: 04/19/2013] [Indexed: 02/01/2023]
Affiliation(s)
- P Ghadirian
- Epidemiology Research Unit; Centre Hospitalier de l'Université de Montreal (CRCHUM) Hotel-Dieu; Montreal Quebec Canada
| | - A Robidoux
- Department of Surgery, Scotia Chair in Breast Cancer Diagnosis and Treatment, Breast Cancer Centre, CHUM; University of Montreal; Montreal Quebec Canada
| | - E Nassif
- Department of Surgery, Hotel-Dieu de Montreal; University of Montreal Hospital; Montreal Quebec Canada
| | - G Martin
- Department of Surgery, Hotel-Dieu de Montreal; University of Montreal Hospital; Montreal Quebec Canada
| | - C Potvin
- Department of Surgery, Hotel-Dieu de Montreal; University of Montreal Hospital; Montreal Quebec Canada
| | - E Patocskai
- Department of Surgery, Hotel-Dieu de Montreal; University of Montreal Hospital; Montreal Quebec Canada
| | - R Younan
- Department of Surgery, Hotel-Dieu de Montreal; University of Montreal Hospital; Montreal Quebec Canada
| | - N Larouche
- Department of Surgery, Hotel-Dieu de Montreal; University of Montreal Hospital; Montreal Quebec Canada
| | - A Venne
- Epidemiology Research Unit; Centre Hospitalier de l'Université de Montreal (CRCHUM) Hotel-Dieu; Montreal Quebec Canada
| | - S Zhang
- Familial Breast Cancer Research; Women's College Hospital Research Institute; Toronto Ontario Canada
| | - R Royer
- Familial Breast Cancer Research; Women's College Hospital Research Institute; Toronto Ontario Canada
| | - SA Narod
- Familial Breast Cancer Research; Women's College Hospital Research Institute; Toronto Ontario Canada
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Boileau JF, Poirier B, Basik M, Holloway C, Gaboury L, Sideris L, Meterissian SH, Arnaout A, Brackstone M, McCready DR, Karp SE, Wright FC, Younan R, Provencher L, Patocskai E, Omeroglu A, Robidoux A. Sentinel node biopsy following neoadjuvant chemotherapy in biopsy proven node positive breast cancer: The SN FNAC study. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.1018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1018 Background: A significant and increasing proportion of patients (>30%) with biopsy proven node positive breast cancer will obtain a pathological complete response (pCR) in the axilla after neoadjuvant chemotherapy (NAC). If sentinel node biopsy (SNB) can accurately identify these patients, they could potentially avoid the morbidity of an axillary node dissection. The primary aim of this study is to evaluate the identification rate (IR), false negative rate (FNR) and accuracy of SNB in this setting. The accuracy of post NAC axillary ultrasound and clinical examination are evaluated as secondary endpoints. Methods: Patients with biopsy proven node positive breast cancer (T0-3, N1-2, M0) treated with NAC were eligible to participate in this multi-centre prospective trial. Following NAC, axillary ultrasound and clinical examination results were obtained. At time of surgery, all participants underwent both a SNB and a completion node dissection. A SNB IR greater than 90% and a FNR of less than 10% were pre-determined as being optimal. Results: From September 2009 to December 2012, 153 patients were accrued to the study. 7 patients were not eligible and 5 patients had not yet undergone surgery at the time of analysis. Axillary pCR rate = 34.0% (48/141). SNB IR = 87.2% (123/141), 95% CI [81.7%-92.7%] and FNR = 9.9% (8/81), 95% CI [3.4%-16.4%]. If only one sentinel node was removed, FNR = 19.0%(4/21); if there were 2 or more sentinel nodes, FNR = 6.6% (4/61) (p < 0.0001). Accuracy of SNB, axillary ultrasound and clinical examination were 93.5%, 63.2%, and 45.5% respectively. Conclusions: SNB following NAC in biopsy proven node positive breast cancer is associated with a suboptimal IR. FNR (less than 10%) and accuracy of SNB in this study are comparable to that of patients that present with clinically negative nodes. The FNR decreases when more than one sentinel node is identified. However, in an era where regional nodal radiation is increasingly used, the relevance of leaving residual disease in the undissected axilla after NAC is unknown and remains to be investigated. Clinical trial information: NCT00909441.
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Affiliation(s)
| | | | - Mark Basik
- Jewish General Hospital Segal Cancer Centre, Montreal, QC, Canada
| | - Claire Holloway
- Odette Cancer Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada
| | - Louis Gaboury
- Institute for Research in Immunology and Cancer, Université de Montréal, Montreal, QC, Canada
| | | | | | | | | | - David R. McCready
- University Health Network-Princess Margaret Hospital, Toronto, ON, Canada
| | | | - Frances Catriona Wright
- Odette Cancer Centre, Sunnybrook Health Sciences Centre; University of Toronto, Toronto, ON, Canada
| | - Rami Younan
- Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Erika Patocskai
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - Andre Robidoux
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Deslauriers N, Olney H, Younan R. Splenectomy revisited in 2011: Impact on hematologic toxicities while performing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Gastrointest Oncol 2012; 2:61-3. [PMID: 22811831 DOI: 10.3978/j.issn.2078-6891.2011.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 04/25/2011] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nancy Deslauriers
- Department of Surgical Oncology, CHUM-University of Montreal Health Center
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Lemieux J, Maunsell E, Provencher L, Lauzier S, Younan R, Abdous B. Prospective cohort study of chemotherapy-induced alopecia with or without scalp cooling. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.9138] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9138 Background: Scalp cooling can prevent chemotherapy-induced alopecia. Success varies according to the type of chemotherapy. A controversy exists regarding the use of scalp cooling because of the lack of efficacy data with modern chemotherapy regimen and safety data. We present a prospective cohort study design to measure alopecia. Methods: The prospective study was conducted at the Centre des Maladies du Sein Deschênes-Fabia (CMS) in Quebec City (where scalp cooling is offered routinely and 85% of women use it) and at the Centre Hospitalier Universitaire de Montreal (CHUM), in Montreal (where scalp cooling is not available). Women were eligible if they were going to receive neoadjuvant or adjuvant chemotherapy for breast cancer. The study involved completion of questionnaires (on degree of alopecia, hair type, hair care, use of head accessories, tolerance to scalp cooling and questions related to sick leave from work) and having pictures taken at baseline, cycle 3 and at the last cycle of chemotherapy. For the last 43 patients, the EORTC QLQ-C30/BR23 and an adaptation for Hairdex were added. Results: A total of 136 patients were recruited (110 at CMS over 2 years and 26 at the CHUM over a 9-month period). Preliminary efficacy results are shown in the Table (data on quality of life have not yet been analyzed). Hair preservation was defined as a SUCCESS for hair loss (since the beginning of chemotherapy) characterized as “not at all”, “a little” or “moderate” and “FAILURE” when characterized as “a lot” or “all” or “hair shaved”. Overall, in the scalp cooling group, 34% were considered a “success” using hairdresser evaluation and 49% using patient evaluation; for the non scalp-cooling group, these rates were 9% and 4% respectively. Conclusions: Scalp cooling appears to be efficacious for preventing chemotherapy-induced alopecia in this exploratory cohort study. [Table: see text]
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Affiliation(s)
- Julie Lemieux
- URESP, Centre de Recherche FRSQ du CHA Universitaire de Québec, Quebec City, QC, Canada
| | - Elizabeth Maunsell
- URESP, Centre de Recherche FRSQ du CHA Universitaire de Québec, Quebec City, QC, Canada
| | - Louise Provencher
- Centre des Maladies du Sein Deschênes-Fabia, CHA-Hôpital du Saint-Sacrement, Quebec City, QC, Canada
| | - Sophie Lauzier
- URESP, Centre de Recherche FRSQ du CHA Universitaire de Québec, Quebec City, QC, Canada
| | - Rami Younan
- Centre Hospitalier Universitaire de Montréal, Montréal, QC, Canada
| | - Belkacem Abdous
- URESP, Centre de Recherche FRSQ du CHA Universitaire de Québec, Quebec city, QC, Canada
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Abstract
Complete surgical cytoreduction of peritoneal implants and immediate intraperitoneal (lP) chemotherapy offers the greatest survival in selected patients with peritoneal carcinomatosis. This study was undertaken to describe the metabolism and pharmacokinetics of normothermic intraperitoneal CPT-11, free and glucuronized SN-38, in a pig model. Thirteen pigs were used for experimentation. Animals were grouped for IV and IP CPT-1 1 administration. Eleven pigs underwent laparotomy through a midline incision and instillation of 100, 200, and 400mg IP CPT-11. Systemic venous blood, portal blood and peritoneal fluid samples were taken at 5, 10, 20, 30, and 45 min, then every hour up to 8 hr for the 100 mg. For the three groups, peritoneal CPT-11 exposition was on average 4.9 times greater in the peritoneum than in the systemic venous or portal circulations and the systemic CPT-11 fraction absorbed from the peritoneum linearly increased with time. Free SN-38 was measurable in the earliest peritoneal samples taken. The initial instillation dose of CPT-11 did not impact on the SN-38 converted fraction, which remained stable at approximately 0.04% during the first 4 hour. Mean peritoneal SN-38: CPT-11 AUC ratio was 0.043. OPT-11 peritoneal conversion into SN-38 appeared slightly Inferior to the systemic conversion ratio. This norrnothermic IP OPT-11 pharmacokinetic study performed in a pig model confirms the possibility to achieve at least a 30 times higher peritoneal than systemic exposure. Peritoneal exposure to active SN-38 begins at the moment of CPT-11 peritoneal instillation. A fixed and small traction of less than 0.1% of CPT-11 is converted into SN-38, underlying the importance of a sufficient initial IP dose of CPT-11.
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Affiliation(s)
- Simon Turcotte
- Department of Surgery, Université de Montréal, Montréal, Québec, Canada
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Daghistani W, Younan R, Brutus JP. Merkel cell carcinoma of the hand: case report and literature review. ACTA ACUST UNITED AC 2010; 29:128-31. [PMID: 20202882 DOI: 10.1016/j.main.2009.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Revised: 11/18/2009] [Accepted: 12/28/2009] [Indexed: 10/19/2022]
Abstract
We are reporting on a 72-year-old male who was diagnosed with Merkel cell carcinoma on the dorsal aspect of his left index finger. This rare highly aggressive malignancy of the skin has only exceptionally been described on the finger or hand. This case report helps review important findings associated with this rare malignancy and reviews the pertinent literature.
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Affiliation(s)
- W Daghistani
- Division of plastic surgery, hôpital Notre-Dame, centre hospitalier de l'université de Montréal, Montréal, Quebec, Canada
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Ghadirian P, Robidoux A, Zhang P, Royer R, Akbari M, Zhang S, Fafard E, Costa M, Martin G, Potvin C, Patocskai E, Larouche N, Younan R, Nassif E, Giroux S, Narod SA, Rousseau F, Foulkes WD. The contribution of founder mutations to early-onset breast cancer in French-Canadian women. Clin Genet 2010; 76:421-6. [PMID: 19863560 DOI: 10.1111/j.1399-0004.2009.01277.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In an ethnically-homogeneous population, it is valuable to identify founder mutations in cancer-predisposing genes. Founder mutations have been found in four breast-cancer-predisposing genes in French-Canadian breast cancer families. The frequencies of the mutant alleles have been measured neither in a large series of unselected breast cancer patients from Quebec, nor in healthy controls. These estimates are necessary to measure their contribution to the hereditary burden of breast cancer in Quebec and to help develop genetic screening policies which are appropriate for the province. We studied 564 French-Canadian women with early-onset invasive breast cancer who were treated at a single Montreal hospital. Patients had been diagnosed at age 50 or less, and were ascertained between 2004 and 2008. We screened all 564 patients for nine founder mutations: four in BRCA1, three in BRCA2 and one each in PALB2 and CHEK2. We also studied 6433 DNA samples from newborn infants from the Quebec City area to estimate the frequency of the nine variant alleles in the French-Canadian population. We identified a mutation in 36 of the 564 breast cancer cases (6.4%) and in 35 of 6443 controls (0.5%). In the breast cancer patients, the majority of mutations were in BRCA2 (54%). However, in the general population (newborn infants), the majority of mutations were in CHEK2 (54%). The odds ratio for breast cancer to age 50, given a BRCA1 mutation, was 10.1 (95% CI: 3.7-28) and given a BRCA2 mutation was 29.5 (95% CI: 12.9-67). The odds ratio for breast cancer to age 50, given a CHEK2 mutation, was 3.6 (95% CI: 1.4-9.1). One-half of the women with a mutation had a first- or second-degree relative diagnosed with breast or ovarian cancer. Thus, it can be concluded that a predisposing mutation in BRCA1, BRCA2, CHEK2 or PALB2 is present in approximately 6% of French-Canadian women with early-onset breast cancer. It is reasonable to offer screening for founder mutations to all French-Canadian women with breast cancer before age 50. The frequency of these mutations in the general population (0.5%) is too low to advocate population-based screening.
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Affiliation(s)
- P Ghadirian
- Epidemiology Research Unit, Research Centre, Centre hospitalier de l'Universite de Montreal-Hotel-Dieu, Montreal, Quebec, Canada
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Younan R, Bougrine A, Watters K, Mahboubi A, Bouchereau-Eyegue M, Loutfi A, Tremblay F, Bouffard D, Belisle A, Leblanc G, Nassif E, Martin G, Patocskai E, Alenezi M, Meterissian S. Validation Study of the S Classification for Melanoma Patients with Positive Sentinel Nodes: The Montreal Experience. Ann Surg Oncol 2010; 17:1414-21. [DOI: 10.1245/s10434-009-0876-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Indexed: 11/18/2022]
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35
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Ghadirian P, Robidoux A, Royer R, Zhang P, Akbari M, Zhang S, Fafard E, Costa M, Martin G, Potvin C, Patocskai E, Larouche N, Younan R, Nassif E, Giroux S, Narod S, Foulkes W. The Contribution of Founder Mutations to Early-Onset Breast Cancer in French-Canadian Women. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-09-902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In an ethnically-homogeneous population, it is valuable to identify founder mutations in cancer-predisposing genes. Founder mutations have been found in four breast cancer predisposing genes in French-Canadian breast cancer families. The frequencies of the mutant alleles have not been measured in a large series of unselected breast cancer patients from Quebec, nor in healthy controls. These estimates are necessary to measure their contribution to the hereditary burden of breast cancer in Quebec and to help develop genetic screening policies which are appropriate for the province.Methods: We studied 564 French-Canadian women with early-onset invasive breast cancer who were treated at a single Montreal hospital. Patients had been diagnosed at age 50 or less, and were ascertained between 2004 and 2008. We screened all 564 patients for nine founder mutations; four in BRCA1, three in BRCA2 and one each in PALB2 and CHEK2. We also studied 6433 DNA samples from newborn infants from the Quebec City area to estimate the frequency of the nine variant alleles in the French-Canadian population.Results: We identified a mutation in 36 of the 564 breast cancer cases (6.4%) and in 35 of 6443 controls (0.5%). In the breast cancer patients, the majority of mutations were in BRCA2 (54%). However, in the general population (newborn infants), the majority of mutations were in CHEK2 (54%). The odds ratio for breast cancer to age 50, given a BRCA1 mutation was 10.1 (95% CI: 3.7 to 28) and given a BRCA2 mutation was 29.5 (95% CI: 12.9 – 67). The odds ratio for breast cancer to age 50, given a CHEK2 mutation was 3.6 (95% CI: 1.4 – 9.1). One-half of the women with a mutation had a first or second-degree relative diagnosed with breast or ovarian cancer.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 902.
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Affiliation(s)
- P. Ghadirian
- 1Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - A. Robidoux
- 2Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - R. Royer
- 3University of Toronto, ON, Canada
| | - P. Zhang
- 3University of Toronto, ON, Canada
| | | | - S. Zhang
- 3University of Toronto, ON, Canada
| | - E. Fafard
- 1Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - M. Costa
- 1Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - G. Martin
- 2Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - C. Potvin
- 2Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - E. Patocskai
- 2Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - N. Larouche
- 2Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - R. Younan
- 2Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | - E. Nassif
- 2Centre Hospitalier de l'Université de Montréal (CHUM), QC, Canada
| | | | - S. Narod
- 3University of Toronto, ON, Canada
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Bejjani J, Lemieux B, Gariepy G, Younan R. Complete anemia reversal after surgical excision of mesenteric hyaline-vascular unicentric Castleman disease. Can J Surg 2009; 52:E197-E198. [PMID: 19865557 PMCID: PMC2769091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- Jimmy Bejjani
- Department of Surgery, Surgical Oncology Unit, and the
| | | | - Gilles Gariepy
- Pathology and Cellular Biology, University of Montreal Health Centre (CHUM), Montréal, Que
| | - Rami Younan
- Department of Surgery, Surgical Oncology Unit, and the
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Alabdulkarim Y, Younan R, Martin G, Boileau J, Nassif E. 5121 The relation between sentinel lymph node micro-metastasis, isolated tumour cells and the final axillary lymph node status after complete dissection. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71013-4] [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] Open
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Kusamura S, Dominique E, Baratti D, Younan R, Deraco M. Drugs, carrier solutions and temperature in hyperthermic intraperitoneal chemotherapy. J Surg Oncol 2008; 98:247-52. [PMID: 18726886 DOI: 10.1002/jso.21051] [Citation(s) in RCA: 79] [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: 12/24/2022]
Abstract
At the Fifth International Workshop on Peritoneal Surface Malignancy, in Milan, the consensus on technical aspects of cytoreductive surgery (CRS) for peritoneal surface malignancy was obtained through the Delphi process. Conflicting points concerning drugs, carrier solution and optimal temperature for hyperthermic intraperitoneal chemotherapy (HIPEC) were discussed.
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Affiliation(s)
- Shigeki Kusamura
- Department of Surgery, National Cancer Institute of Milan, Italy
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Kusamura S, Baratti D, Younan R, Deraco M. The Delphi approach to Attain consensus in methodology of local regional therapy for peritoneal surface malignancy. J Surg Oncol 2008; 98:217-9. [PMID: 18726907 DOI: 10.1002/jso.21059] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
At the Fifth International Workshop on Peritoneal Surface Malignancy (PSM), held in Milan, December 2006, the consensus on technical aspects of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) was obtained through the Delphi process. The following topics were discussed: pre-operative workup; eligibility to CRS + HIPEC; intra-operative staging system; technical aspects of surgery; residual disease classification systems; HIPEC: nomenclature and modalities; drugs, carrier solution and optimal temperature; morbidity grading systems. Conflicting points regarding above-mentioned topics were elaborated and voted in two rounds by a panel of international experts in local-regional therapy. The purpose of this manuscript is to describe the organization and the methodology of the consensus statements and to interpret and discuss the implications of the most striking results.
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Affiliation(s)
- Shigeki Kusamura
- Department of Surgery, National Cancer Institute of Milan, Milan, Italy
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40
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Younan R, Kusamura S, Baratti D, Cloutier AS, Deraco M. Morbidity, toxicity, and mortality classification systems in the local regional treatment of peritoneal surface malignancy. J Surg Oncol 2008; 98:253-7. [DOI: 10.1002/jso.21057] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Kusamura S, Baratti D, Antonucci A, Younan R, Laterza B, Oliva GD, Gavazzi C, Deraco M. Incidence of Postoperative Pancreatic Fistula and Hyperamylasemia after Cytoreductive surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2007; 14:3443-52. [PMID: 17909918 DOI: 10.1245/s10434-007-9551-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [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: 05/04/2007] [Revised: 07/10/2007] [Accepted: 07/13/2007] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The purpose of this study was to analyze the postoperative pancreatic morbidity of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal surface malignancies (PSM). PATIENTS AND METHODS Two hundred and sixty five patients (87M/178F) with PSM underwent 270 consecutive procedures. The mean age was 52 years (range: 22-79 years). CRS was performed using peritonectomy procedures. HIPEC through the closed abdomen technique was conducted using cisplatin (CDDP 25 mg/m2/L of perfusate)+mitomycin C (MMC 3.3 mg/m2/L of perfusate) or CDDP (43 mg/L of perfusate)+doxorubicin (Dx 15.25 mg/L of perfusate), at 42.5 degrees C. Diagnosis and classification of postoperative pancreatic fistula (POPF) were performed according to the international study group on pancreatic fistula criteria. Serum amylase alterations were graded according to the National Cancer Institute (NCI) common terminology criteria for adverse events (CTCAE) v3. RESULTS POPF was observed in 13 (4.8%) cases. Three cases were classified as major (grade C). Two cases presented postoperative pancreatitis. G3-4 alteration of amylase was observed in 12.3% of the cases. Performing splenectomy and CDDP dosage for HIPEC >240 mg were proven to be independent risk factors for both G3-4 hyperamylasemia and POPF. CONCLUSIONS CRS+HIPEC presented an acceptable rate of pancreatic morbidity which did not contribute to the mortality related to the procedure. Most of the POPF were mild and/or easily controlled by conservative measures. Although not specific a normal amylasemia could be a useful marker of pancreatic integrity after CRS+HIPEC.
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Affiliation(s)
- Shigeki Kusamura
- Dept of Surgery, National Cancer Institute of Milan, Milan, Italy
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Kusamura S, Baratti D, Younan R, Laterza B, Oliva GD, Costanzo P, Favaro M, Gavazzi C, Grosso F, Deraco M. Impact of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy on Systemic Toxicity. Ann Surg Oncol 2007; 14:2550-8. [PMID: 17558537 DOI: 10.1245/s10434-007-9429-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [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: 01/09/2007] [Accepted: 03/21/2007] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The purpose of this study was to analyze the postoperative systemic toxicity and procedure-related mortality (PRM) of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of peritoneal surface malignancies (PSMs). PATIENTS AND METHODS A total of 242 (84 males/158 females) patients with PSM underwent 247 consecutive procedures. The mean age was 52 years (range 22-79). CRS was performed using peritonectomy procedures. The HIPEC technique through the closed abdomen was conducted with cisplatin (CDDP 25 mg/m(2)/l of perfusate)+mitomycin C (MMC 3.3 mg/m(2)/l perfusate) or CDDP (43 mg/l perfusate)+doxorubicin (Dx 15.25 mg/l perfusate) at 42.5 degrees C. These dosages were reduced by 30% when the patient had received systemic chemotherapy before the CRS+HIPEC. Systemic toxicities were graded according to the NCI CTCAE v3 criteria. RESULTS G3-5 systemic toxicity rate was 11.7 % and adverse events were bone marrow suppression, 13; nephrotoxicity, 14; neutropenic infection, 2 and pulmonary toxicity, 1. Independent risk factors for G3-5 systemic toxicity after multivariate analysis were a dose of CDDP for HIPEC of 240 mg or more (OR 2.78, CI 95% 1.20-6.45) and CDDP+Dx schedule for HIPEC (OR 2.36, CI 95% 1.02-5.45). PRM was 1.2%. CONCLUSIONS CRS+HIPEC presented acceptable systemic toxicity and PRM rates. Independent risk factors for systemic toxicity were the CDDP+Dx schedule and CDDP dose for HIPEC.
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Affiliation(s)
- Shigeki Kusamura
- Department of Surgery, National Cancer Institute of Milan, Via Venezian 1, 20133, Milano, Italy
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Abstract
AIMS CDX-2 is a highly sensitive and specific marker of intestinal epithelial cells and their neoplastic counterparts. CDX-2 status in pseudomyxoma peritonei (PMP) has been barely reported. The aim of this study was to investigate the clinicopathological features of 42 cases of PMP with a special emphasis on CDX-2. METHODS AND RESULTS All patients were treated by cytoreduction. Immunohistochemistry was performed for CDX-2, MUC-2, MUC-5AC, cytokeratin (CK) 7 and CK20. Statistical correlation was evaluated for age, sex, completeness of cytoreduction and histological subtype with overall and progression-free survival (OS and PFS). PMP consisted of 32 cases of disseminated peritoneal adenomucinosis and 10 cases of peritoneal mucinous carcinomatosis. The appendix evaluated in 25 cases showed two mucinous adenocarcinomas and 21 low-grade appendiceal mucinous neoplasms. CDX-2 was diffusely positive in 40 cases, with the remaining two cases being focally positive. All cases demonstrated diffuse reactions to CK20 and MUC-2, and variable reactions to MUC-5AC, while CK7 was variably positive in 38 cases. Five-year OS was 97%. Histological type was significantly correlated with PFS (P=0.02). CONCLUSIONS CDX-2 is diffusely and strongly positive in PMP. This is a useful marker to confirm an appendiceal origin of PMP, particularly when used in conjunction with CK7, CK20, MUC-2 and MUC-5AC.
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Affiliation(s)
- D Nonaka
- Department of Pathology, New York University Medical Center, New York, NY 10016, USA.
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Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, Baratti D, Bartlett D, Barone R, Barrios P, Bieligk S, Bretcha-Boix P, Chang CK, Chu F, Chu Q, Daniel S, de Bree E, Deraco M, Dominguez-Parra L, Elias D, Flynn R, Foster J, Garofalo A, Gilly FN, Glehen O, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Goodman M, Gushchin V, Hanna N, Hartmann J, Harrison L, Hoefer R, Kane J, Kecmanovic D, Kelley S, Kuhn J, Lamont J, Lange J, Li B, Loggie B, Mahteme H, Mann G, Martin R, Misih RA, Moran B, Morris D, Onate-Ocana L, Petrelli N, Philippe G, Pingpank J, Pitroff A, Piso P, Quinones M, Riley L, Rutstein L, Saha S, Alrawi S, Sardi A, Schneebaum S, Shen P, Shibata D, Spellman J, Stojadinovic A, Stewart J, Torres-Melero J, Tuttle T, Verwaal V, Villar J, Wilkinson N, Younan R, Zeh H, Zoetmulder F, Sebbag G. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 2006. [PMID: 17072675 DOI: 10.1245/s10434-007-9599-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Esquivel J, Sticca R, Sugarbaker P, Levine E, Yan TD, Alexander R, Baratti D, Bartlett D, Barone R, Barrios P, Bieligk S, Bretcha-Boix P, Chang CK, Chu F, Chu Q, Daniel S, de Bree E, Deraco M, Dominguez-Parra L, Elias D, Flynn R, Foster J, Garofalo A, Gilly FN, Glehen O, Gomez-Portilla A, Gonzalez-Bayon L, Gonzalez-Moreno S, Goodman M, Gushchin V, Hanna N, Hartmann J, Harrison L, Hoefer R, Kane J, Kecmanovic D, Kelley S, Kuhn J, Lamont J, Lange J, Li B, Loggie B, Mahteme H, Mann G, Martin R, Misih RA, Moran B, Morris D, Onate-Ocana L, Petrelli N, Philippe G, Pingpank J, Pitroff A, Piso P, Quinones M, Riley L, Rutstein L, Saha S, Alrawi S, Sardi A, Schneebaum S, Shen P, Shibata D, Spellman J, Stojadinovic A, Stewart J, Torres-Melero J, Tuttle T, Verwaal V, Villar J, Wilkinson N, Younan R, Zeh H, Zoetmulder F, Sebbag G. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of peritoneal surface malignancies of colonic origin: a consensus statement. Society of Surgical Oncology. Ann Surg Oncol 2006; 14:128-33. [PMID: 17072675 DOI: 10.1245/s10434-006-9185-7] [Citation(s) in RCA: 294] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Revised: 06/02/2006] [Accepted: 06/02/2006] [Indexed: 12/11/2022]
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Raspagliesi F, Kusamura S, Campos Torres JC, de Souza GA, Ditto A, Zanaboni F, Younan R, Baratti D, Mariani L, Laterza B, Deraco M. Cytoreduction combined with intraperitoneal hyperthermic perfusion chemotherapy in advanced/recurrent ovarian cancer patients: The experience of National Cancer Institute of Milan. Eur J Surg Oncol 2006; 32:671-5. [PMID: 16621425 DOI: 10.1016/j.ejso.2006.03.011] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [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: 07/07/2005] [Accepted: 03/02/2006] [Indexed: 12/31/2022] Open
Abstract
AIMS We report the effects of cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP) in the treatment of advanced/recurrent epithelial ovarian cancer (EOC) on survival, morbidity and mortality. PATIENTS Forty EOC patients were studied. Median age was 52.5 years (range: 30-68) and median follow-up 26.1 months (range: 0.3-117.6). Most patients presented advanced disease (stage III/IV). Previous systemic chemotherapy included cisplatin-based, taxol-based or taxol/platinum containing regimens. RESULTS After the CRS, 33 patients presented no macroscopic residual disease. Five-year overall survival was 15%; the mean overall and progression-free survivals were 41.4 and 23.9 months, respectively. The morbidity, toxicity and mortality rates were 5%, 15% and 0%, respectively. CONCLUSION Our results suggest that CRS + IPHP merits further evaluation by a formal prospective trial.
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Affiliation(s)
- F Raspagliesi
- Department of Surgery-Gynaecology Unit, National Cancer Institute of Milan, Milan, Italy
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Kusamura S, Younan R, Baratti D, Costanzo P, Favaro M, Gavazzi C, Deraco M. Cytoreductive surgery followed by intraperitoneal hyperthermic perfusion: analysis of morbidity and mortality in 209 peritoneal surface malignancies treated with closed abdomen technique. Cancer 2006; 106:1144-53. [PMID: 16456817 DOI: 10.1002/cncr.21708] [Citation(s) in RCA: 205] [Impact Index Per Article: 11.4] [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: 12/27/2022]
Abstract
BACKGROUND The purpose of this prospective Phase II study was to analyze morbidity and mortality of cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP) in the treatment of peritoneal surface malignancies. METHODS A total of 205 patients (50 with peritoneal mesothelioma, 49 with pseudomyxoma peritonei, 41 with ovarian cancer, 32 with abdominal sarcomatosis, 13 with colon cancer, 12 with gastric cancer, and 8 with carcinomatosis from other origins) underwent 209 consecutive procedures. Four patients underwent the intervention twice because of disease relapse. There were 70 men and 135 women. Mean age was 52 years (range, 22-76 yrs). CRS was performed by using peritonectomy procedures. IPHP through the closed abdomen technique was conducted with a preheated (42.5 degrees C) perfusate containing cisplatin + mitomycin C or cisplatin + doxorubicin. RESULTS Major morbidity rate was 12%. The most significant complications were 23 anastomotic leaks or bowel perforations, 4 abdominal bleeds, and 4 sepses. Operative mortality rate was 0.9%. On logistic regression model multivariate analysis, extent of cytoreduction (odds ratio [OR], 2.88; 95% confidence interval [CI], 1.29-6.40) and dose of cisplatin for IPHP > or = 240 mg (OR, 3.13; 95% CI, 1.24-7.90) were independent risk factors for major morbidity. Ten patients presented with Grade 3 to 4 toxicity. CONCLUSIONS CRS + IPHP presented acceptable morbidity, toxicity, and mortality rates, all of which support prospective Phase III clinical trials.
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Affiliation(s)
- Shigeki Kusamura
- Department of Surgery, National Cancer Institute of Milan, Milan, Italy
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Deraco M, Nonaka D, Baratti D, Casali P, Rosai J, Younan R, Salvatore A, Cabras Ad AD, Kusamura S. Prognostic analysis of clinicopathologic factors in 49 patients with diffuse malignant peritoneal mesothelioma treated with cytoreductive surgery and intraperitoneal hyperthermic perfusion. Ann Surg Oncol 2006; 13:229-37. [PMID: 16444562 DOI: 10.1245/aso.2006.03.045] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Accepted: 08/16/2005] [Indexed: 01/01/2023]
Abstract
BACKGROUND Diffuse malignant peritoneal mesothelioma (DMPM) is a subset of peritoneal mesothelioma with a poor clinical outcome. We performed a prognostic analysis in a cohort of DMPM patients treated homogeneously by cytoreductive surgery and intraperitoneal hyperthermic perfusion (IPHP). METHODS Forty-nine DMPM patients who underwent 52 consecutive procedures were enrolled onto the study. Cytoreductive surgery was performed according to the peritonectomy technique, and the IPHP was performed with cisplatin plus doxorubicin or cisplatin plus mitomycin C. We assessed the correlation of the clinicopathologic variables (previous surgical score, age, sex, performance status, previous systemic chemotherapy, carcinomatosis extension, completeness of cytoreduction, IPHP drug schedule, mitotic count [MC], nuclear grade, and biological markers [epidermal growth factor receptor, p16, matrix metalloproteinase 2 and matrix metalloproteinase 9]) with overall and progression-free survival. RESULTS The mean age was 52 years (range, 22-74 years). The mean follow-up was 20.3 months (range, 1-89 months). Regarding the biological markers, the rates of immunoreactivity of epidermal growth factor receptor, p16, matrix metalloproteinase 2, and matrix metalloproteinase 9 were 94%, 60%, 100%, and 85%, respectively. The strongest factors influencing overall survival were completeness of cytoreduction and MC, whereas those for progression-free survival were performance status and MC. No biological markers were shown to be of prognostic value. CONCLUSIONS Completeness of cytoreduction, performance status, and MC seem to be the best determinants of outcome. These data warrant confirmation by a further prospective formal trial. No biological markers presented a significant correlation with the outcome. The overexpression of epidermal growth factor receptor, matrix metalloproteinase 2, and matrix metalloproteinase 9 and absent or reduced expression of p16 might be related to the underlining tumor kinetics of DMPM and warrant further investigation with other methods.
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Affiliation(s)
- Marcello Deraco
- Department of Surgery, National Cancer Institute, Via Venezian, 1, 20133, Milan, Italy.
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Nonaka D, Kusamura S, Baratti D, Casali P, Cabras AD, Younan R, Rosai J, Deraco M. Diffuse malignant mesothelioma of the peritoneum: a clinicopathological study of 35 patients treated locoregionally at a single institution. Cancer 2006; 104:2181-8. [PMID: 16206294 DOI: 10.1002/cncr.21239] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [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: 02/04/2023]
Abstract
BACKGROUND In the current study, the authors report the clinicopathologic features of patients with peritoneal diffuse malignant mesothelioma (DMM) who were treated in a uniform fashion at a single institution to assess prognostic factors. METHODS Thirty-five patients were treated with cytoreductive surgery (CRS) and intraperitoneal hyperthermic perfusion (IPHP). The tumors were classified into epithelial, sarcomatoid, and biphasic types. Immunohistochemistry stains were performed for calretinin, WT-1, pCEA, Ber-EP4, epidermal growth factor receptor (EGFR), p16, matrix metalloprotease-2 (MMP-2), and MMP-9. Statistical correlation was evaluated for age, gender, completeness of cytoreduction (CC), tumor histotype, mitotic count (MC), necrosis, nuclear grade (NG), and biologic markers with regard to overall survival (OS) and progression-free survival (PFS). RESULTS The patient group was comprised of 15 men and 20 women with a median age of 52 years (range, 24-73 yrs). Twenty-five patients underwent optimal cytoreduction. There were 32 epithelial tumors and 3 biphasic tumors, and 3 patients had an NG of 1, 19 had an NG of 2, and 13 had an NG of 3. The mean MC was 14.1 (range, 0-160 per 50 high-power fields). Necrosis was present in 11 cases. All the tumors were found to be positive for calretinin and WT-1 and were negative for pCEA and Ber-EP4. The NG and MC were found to be significantly associated with OS (P = 0.02 and P = 0.01, respectively) whereas CC was found to be associated with both OS (P = 0.05) and PFS (P = 0.03). No biologic markers were found to be of prognostic significance. CONCLUSIONS The results of the current study indicate that NG, MC, and CC may be useful prognostic factors in patients treated with CRS and IPHP. The expression of EGFR, MMP-2, and MMP-9 and absent and/or reduced expression of p16 in DMMs confirms the results of previous studies suggesting their role in tumor pathogenesis and kinetics.
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Affiliation(s)
- Daisuke Nonaka
- Department of Pathology, National Cancer Institute, Milan, Italy.
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