1
|
Bansal VV, Mitchell O, Bregio C, Witmer HDD, Dhiman A, Godley FA, Ong C, Berger Y, Reddy B, Churpek JE, Drazer MW, Eng OS, Kindler HL, Turaga KK. Venous Thromboembolism in Peritoneal Mesothelioma: Uncovering the Hidden Risk. Ann Surg Oncol 2024; 31:3339-3349. [PMID: 38372861 DOI: 10.1245/s10434-024-15030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Venous thromboembolism (VTE) is a common complication in patients with abdominal malignancies. Despite known associations between pleural mesothelioma and increased VTE risk, the characteristics of VTE in patients with peritoneal mesothelioma (PeM) remain undescribed. METHODS Patients treated for PeM were retrospectively identified from our institutional database. The frequency of VTE was assessed and logistic regression modeling was employed to assess VTE risk factors. The association between VTE and overall survival was also ascertained. Recommended thromboprophylaxis for patients who underwent surgery at our institution comprised a single preoperative dose of prophylactic anticoagulation, followed by daily dosing for four weeks postoperatively. RESULTS Among 120 PeM patients, 26 (21.7%) experienced VTE, including 19/91 (20.9%) surgical patients, 4/23 (17.4%) patients who received systemic therapy, and 3/6 (50%) patients who underwent observation (p = 0.21). Most events were symptomatic (n = 16, 62%) and were attributable to pulmonary emboli (n = 16, 62%). The 90-day postoperative VTE rate was 4.4% (4/91), including 1 of 60 patients who underwent index surgical intervention at our institution and 3 patients with surgery elsewhere. A low serum albumin concentration was associated with VTE in non-surgical patients (odds ratio 0.12, confidence interval [CI] 0.02-0.72; p = 0.03). No significant difference in overall survival was observed between patients with and without VTE (median 46.0 months [CI 24.9-67.0] vs. 55.0 months [CI 27.5-82.5]; hazard ratio 0.98 [CI 0.54-1.81], p = 0.98). CONCLUSIONS A high risk of VTE was observed in PeM patients, warranting suspicion throughout the disease trajectory. Postoperative VTE rates were within acceptable limits with 4-week thromboprophylaxis.
Collapse
Affiliation(s)
- Varun V Bansal
- Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Owen Mitchell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Celyn Bregio
- Pritzker School of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Hunter D D Witmer
- Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Ankit Dhiman
- Department of Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Frederick A Godley
- Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Cecilia Ong
- Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, Sheba Medical Center, Tel Hashomer, Tel Aviv University, Tel Aviv, Israel
| | - Biren Reddy
- Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Jane E Churpek
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Michael W Drazer
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Oliver S Eng
- Division of Surgical Oncology, Department of Surgery, University of California Irvine, Orange, CA, USA
| | - Hedy L Kindler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Kiran K Turaga
- Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
2
|
Berger Y, Zelezetsky M, Israeli A, Shomsky N, Nachmany I, Justo D, Gutman M. [THE MULTIDISCIPLINARY GERIATRIC SURGERY UNIT AT THE CHAIM SHEBA MEDICAL CENTER - FIRST YEAR OF ACTIVITY]. Harefuah 2024; 163:211-216. [PMID: 38616629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
INTRODUCTION Recently, a Geriatric Surgery Unit (GSU) was established in the Sheba Medical Center. The Unit's aims include: professional assessment of surgical candidates, approval of the surgical plan by a multidisciplinary team discussion (MTD), and meeting the specific needs of the geriatric patient undergoing surgery. METHODS We describe the establishment of the GSU and preliminary results from the first year of its activity (January-December 2022). The GSU team consisted of a geriatric nurse practitioner (NP), a geriatric physician, surgeons, anesthesiologists and a physiotherapist. Inclusion criteria for GSU assessment/treatment were age>80 years or substantial baseline geriatric morbidity. RESULTS In 2022, 276 patients were treated by the GSU: 110 underwent elective comprehensive preoperative assessment in the NP clinic and the rest were assessed urgently/semi-electively during their hospitalization. One hundred and fifteen cases (median age 86 (65-98) years) were brought to MTD and considered for elective cholecystectomy (46.1%), colorectal procedures (16.5%), hernia repair (13.9%), hepatobiliary procedures (9.6%) or other surgeries (13.9%); of those, 49 patients (median age 86 (72-98) years) eventually proceeded to surgery, following which the median length of hospital stay (LOS) was 3.5 (1-60) days and the rate of postoperative complications was 46.7%. After discharge, the median duration of follow-up was 2.5 (0-18) months during which 4 patients died. Compared with geriatric patients who underwent cholecystectomy during 2021-2023 without MTD (n=39), in the cases discussed by the MTD, patients (n=17) had a shorter LOS (2.0±0.9 vs. 2.4±2.1 days), less 30-day Emergency Department referrals (12.5% vs. 28.2%) and less 30-day re-admissions (6.2% vs. 15.4%; all p≥0.3). CONCLUSIONS Geriatric surgical patients require a designated professional approach to meet their unique perioperative needs. The effect of GSUs on perioperative outcomes merits further prospective studies.
Collapse
Affiliation(s)
- Yaniv Berger
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Mila Zelezetsky
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Alon Israeli
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Natalia Shomsky
- Department of Anesthesia, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Ido Nachmany
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Dan Justo
- Division of Geriatric Medicine, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| | - Mordechai Gutman
- Department of General Surgery, the Chaim Sheba Medical Center, Tel Hashomer, Israel, affiliated to the Faculty of Medicine, Tel Aviv University
| |
Collapse
|
3
|
Bansal VV, Mitchell O, Bregio C, Witmer HDD, Dhiman A, Godley FA, Ong C, Berger Y, Reddy B, Churpek JE, Drazer MW, Eng OS, Kindler HL, Turaga KK. ASO Visual Abstract: Venous Thromboembolism in Peritoneal Mesothelioma-Uncovering the Hidden Risk. Ann Surg Oncol 2024:10.1245/s10434-024-15146-7. [PMID: 38457102 DOI: 10.1245/s10434-024-15146-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Varun V Bansal
- Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Owen Mitchell
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Celyn Bregio
- Pritzker School of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Hunter D D Witmer
- Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Ankit Dhiman
- Department of Surgery, Medical College of Georgia, Augusta, GA, USA
| | - Frederick A Godley
- Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Cecilia Ong
- Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Biren Reddy
- Division of General Surgery and Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Jane E Churpek
- Division of Hematology, Medical Oncology, and Palliative Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Michael W Drazer
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, Division of Surgical Oncology, University of California Irvine, Orange, CA, USA
| | - Hedy L Kindler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Kiran K Turaga
- Division of Surgical Oncology, Yale School of Medicine, New Haven, CT, USA.
| |
Collapse
|
4
|
Zager Y, Khalilieh S, Mansour A, Cohen K, Nadler R, Anteby R, Ram E, Horesh N, Nachmany I, Gutman M, Berger Y. Correction to: The value of CA125 in predicting acute complicated colonic diverticulitis. Int J Colorectal Dis 2023; 38:209. [PMID: 37556027 DOI: 10.1007/s00384-023-04486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Affiliation(s)
- Yaniv Zager
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Saed Khalilieh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aiham Mansour
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Karin Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Nadler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Edward Ram
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Berger
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| |
Collapse
|
5
|
Zager Y, Khalilieh S, Mansour A, Cohen K, Nadler R, Anteby R, Ram E, Horesh N, Nachmany I, Gutman M, Berger Y. The value of CA125 in predicting acute complicated colonic diverticulitis. Int J Colorectal Dis 2023; 38:182. [PMID: 37389666 DOI: 10.1007/s00384-023-04478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND CA125 is a widely used serum marker for epithelial ovarian cancer which levels may also rise in benign conditions involving peritoneal irritation. We aimed to determine if serum CA125 levels can predict disease severity in patients presenting with acute diverticulitis. METHODS We conducted a single-center prospective observational study, analyzing CA125 serum levels in patients who presented to the emergency department with computerized tomography-proven acute left-sided colonic diverticulitis. Univariate, multivariate, and receiver operating characteristic (ROC) analyses were used to correlate CA125 serum levels at time of initial presentation with the primary outcome (complicated diverticulitis) and secondary clinical outcomes (need for urgent intervention, length of hospital stay (LOS) and readmission rates). RESULTS One hundred and fifty-one patients were enrolled between January 2018 and July 2020 (66.9% females, median age 61 years). Twenty-five patients (16.5%) presented with complicated diverticulitis. CA125 levels were significantly higher among patients with complicated (median: 16 (7-159) u/ml) vs. uncomplicated (8 (3-39) u/ml) diverticulitis (p < 0.001) and also correlated with the Hinchey severity class (p < 0.001). Higher CA125 levels upon admission were associated with a longer LOS and a greater chance to undergo invasive procedure during the hospitalization. In patients with a measurable intra-abdominal abscess (n = 24), CA125 levels were correlated with the size of the abscess (Spearman's r = 0.46, p = 0.02). On ROC analysis to predict complicated diverticulitis, the area under the curve (AUC) for CA125 (AUC = 0.82) was bigger than for the leukocyte count (AUC = 0.53), body temperature (AUC = 0.59), and neutrophil-lymphocyte ratio (AUC = 0.70) - all p values < 0.05. On multivariate analysis of factors available at presentation, CA125 was found to be the only independent predictor of complicated diverticulitis (OR 1.12 (95% CI 1.06-1.19), p < 0.001). CONCLUSIONS The results from this feasibility study suggest that CA125 may accurately discriminate between simple and complicated diverticulitis, meriting further prospective investigation.
Collapse
Affiliation(s)
- Yaniv Zager
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Saed Khalilieh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Aiham Mansour
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Karin Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roy Nadler
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Roi Anteby
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Edward Ram
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
- Department of Colon and Rectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Ido Nachmany
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordechai Gutman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Berger
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| |
Collapse
|
6
|
Berger Y, Gadiraju M, Dhiman A, Gilliam K, Opalecky B, Chen H, Helgeson M, Eng OS, Husain AN, Drazer MW, Kindler HL, Churpek JE, Turaga KK. Surgical phenotype of patients with peritoneal mesothelioma and a germline mutation. Cancer 2023. [PMID: 37042570 DOI: 10.1002/cncr.34763] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/20/2023] [Accepted: 02/02/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND This study aimed to investigate if peritoneal mesothelioma (PM) patients with germline mutations (GM) have distinct surgical characteristics when compared to those without GM. METHODS PM patients were selected from an ongoing prospective study that conducts germline testing of 82 susceptibility genes. Germline status was correlated with surgical data obtained from a prospectively collected database using univariate, multivariate, and receiver operating characteristic (ROC) analyses. RESULTS Out of 88 PM patients enrolled between 2009 and 2019, 18 GMs (20.5%) were identified in BRCA1-associated protein 1 (BAP1) (n = 11, 12.5% of all patients), SDHA (n = 2) and WT1, CDKN2A, CHEK2, ATM, and BRCA2 (n = 1 patient each). Surgical procedures were performed in 71 patients, the most common of which were cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy (n = 61). Patients with GM presented with a higher prevalence of other prior cancers (61.1% vs. 31.4%, p = .02) and lower platelet count (251 [160-413] vs. 367 [196-780] K/µL, p = .005) compared to those without GM (n = 70). Survival outcomes did not differ significantly between the groups. Patients with BAP1 GMs were more likely to develop bicavitary disease and to present with lower platelet count and mitotic count score, and higher peritoneal cancer index (PCI, all p ≤ .04) compared with those without GM. On ROC analysis, the combination of PCI, platelet count and mitotic score yielded an area under the curve of 0.96 (95% CI, 0.91-1.0) for BAP1 GM detection among operated PM patients. CONCLUSION Higher intraoperative tumor burden and lower platelet count and mitotic score are suggestive of BAP1 GMs in surgical PM patients and should prompt germline testing.
Collapse
Affiliation(s)
- Yaniv Berger
- Department of Surgery, Sheba Medical Center, Tel Hashomer, Affiliated to the Tel-Aviv University, Tel-Aviv, Israel
| | - Meghana Gadiraju
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Ankit Dhiman
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Katie Gilliam
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Buerkley Opalecky
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Heather Chen
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Maria Helgeson
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Oliver S Eng
- Division of Surgical Oncology, Department of Surgery, University of California Irvine, Orange, California, USA
| | - Aliya N Husain
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Michael W Drazer
- Department of Pathology, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Hedy L Kindler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Jane E Churpek
- Division of Hematology, Medical Oncology and Palliative Care, Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Kiran K Turaga
- Section of Surgical Oncology, Department of Surgery, University of Chicago Medical Center, Chicago, Illinois, USA
| |
Collapse
|
7
|
Berger Y, Primessnig U, Huettemeister J, Parwani AS, Boldt LH, Pieske B, Falk V, Grubitzsch H, Blaschke F, Heinzel FR. Effects of doxorubicin and ibrutinib on atrial arrhythmogenity: ex-vivo assessment in human myocardium. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
The cytostatic drugs doxorubicin (Dox) and ibrutinib (Ibr) are established in the treatment of various tumor diseases. In (pre-) clinical studies, both chemotherapeutic agents showed cardiotoxic side effects, including atrial fibrillation [1]. In this context, patients with limited cardiac performance or diabetes might be particularly vulnerable, as these pre-existing conditions represent independent risk factors for cardiac complications [2].
Objectives
The dose-dependency of acute pro-arrhythmogenic effects of Dox and Ibr on the contractile activity of human atrial muscle tissue was investigated.
Patients and methods
Atrial samples were taken intraoperatively during cardiac procedures. Functional muscle strips were prepared from the cardiac trabeculae, followed by incubation with different concentrations of Dox or Ibr for 30 minutes. Subsequently, functional measurements were performed. Isometric contraction force and arrhythmogenic occurrences were recorded. The samples were consecutively exposed to external stressors during measurement (Fig. 1).
We evaluated the overall occurrence of arrhythmogenic contractions and during which phase of the protocol they occurred. The latter was expressed as degree of arrhythmogenesis (Fig. 1).
Following the functional measurements, the muscle strips were conserved at −80°C.
Results
We isolated 127 muscle strips from 29 patients. Highest rates of overall arrhythmic contractions were observed at 10μM Dox and 0.5μM Ibr (77.8 & 100% vs. 58.4% (control)). Mean degree of arrhythmogenesis increased from 1.63 (control) to 2.17 (10μM Dox) and 3.11 (0.5μM Ibr).
Analyzing our data according to the included individuals, treatment with Dox and Ibr enhanced the degree of arrhythmogenesis in the majority of patients. (Fig. 2)
Conclusion
Our protocol is suitable for investigating drug related acute pro-arrhythmogenic effects on human atrial myocardium. Treatment of isolated atrial myocardium with Dox and Ibr enhanced its susceptibility to arrhythmogenic occurrences. Optimal pro-arrhythmogenic conditions were observed at 10μM Dox and 0.5μM Ibr. The treated samples showed higher overall rates of arrhythmogenic contractions and the arrhythmogenic activity occurred earlier within our protocol.
Outlook
We will correlate the experimentally obtained data with clinical patient data, such as LVEF, BMI and diabetic status. The conserved muscle strips will be analyzed using standardized assays comparing post-translational modification (e.g. phosphorylation and oxidation) of key regulators of excitation contraction coupling (e.g. PKA, CaMKII, Ca2+ channels).
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): DZHK (German Centre for Cardiovascular Research), partner site Berlin
Collapse
Affiliation(s)
- Y Berger
- Charité - University Medicine Berlin , Berlin , Germany
| | - U Primessnig
- Charité - University Medicine Berlin , Berlin , Germany
| | | | - A S Parwani
- Charité - University Medicine Berlin , Berlin , Germany
| | - L H Boldt
- Charité - University Medicine Berlin , Berlin , Germany
| | - B Pieske
- Charité - University Medicine Berlin , Berlin , Germany
| | - V Falk
- Charité - University Medicine Berlin , Berlin , Germany
| | - H Grubitzsch
- Charité - University Medicine Berlin , Berlin , Germany
| | - F Blaschke
- Charité - University Medicine Berlin , Berlin , Germany
| | - F R Heinzel
- Charité - University Medicine Berlin , Berlin , Germany
| |
Collapse
|
8
|
Dhiman A, Malina Y, Gao L, West-Szymanski D, Rivas M, Cui XL, Witmer HDD, Berger Y, Ulrich L, Dougherty U, Kwesi A, Zhang W, He C, Bissonnette M, Turaga K. Utilization of nano-hmC-seal technology to detect epigenetic signatures of peritoneal metastasis in cell-free DNA (cfDNA) in patients with colorectal and high-grade appendiceal cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e15510] [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
e15510 Background: Peritoneal metastases from lower GI tumors are common and cause significant morbidity. Assays of circulating-tumor DNA (ctDNA) to identify peritoneal recurrence after curative-surgical intent are limited due to the low abundance of DNA shed by these tumors, especially mucinous tumors. We demonstrate for the first time an ultra-sensitive test to detect biomarkers modified by the epigenetic mark 5-hydroxymethylcytosine (5hmC) in human cfDNA utilizing nano-hmC seal technology to identify patients with peritoneal metastases (PM) after curative-intent resection. Methods: Patients treated with curative intent resection of colorectal (CRC) and high-grade appendiceal (HGA) cancers underwent prospective plasma collection. Peritoneal disease was documented by direct visual inspection (laparoscopy/laparotomy). Plasma samples were analysed using nano-hmC-seal technique to obtain 5hmC signatures. Genome-wide differential analysis was used to identify significant 5hmC- differentially modified gene body regions (p-value < 0.01 and log-fold change > 10%). Functional annotation analysis was performed to further characterize differentially 5hmC -modified genes noted on multivariate logistic models. Results: Of 64 patients included in the study (CRC = 26; HGA = 38), 47 (73%) were PM+. The median DNA extracted per sample was 23.5 ng (IQR: 15.8-38.3), and no sample failed sequencing criteria. After genome-wide analysis, 39 gene body regions were identified as differentially 5hmC-modified, and 14 genes remained significant after multivariate adjustment. The signatures for PM+ patients were distinguishable from PM- patients using hierarchical clustering and principal component analyses. Functional annotation analysis based on the 14 genes point to alterations in immune and microbiome-related pathways in PM+ group (Table). Conclusions: We report for the first time the detection of peritoneal metastasis in cfDNA from human lower GI cancers using nano-5hmC seal epigenomic technology. This technology could be exploited to detect recurrences in tumors that shed very low levels of cfDNA. This signature is being validated in a prospective clinical trial (NCT 04157322).[Table: see text]
Collapse
Affiliation(s)
- Ankit Dhiman
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| | | | - Lu Gao
- University of Chicago, Chicago, IL
| | | | | | - Xiao-Long Cui
- Department of Chemistry, The University of Chicago, Chicago, IL
| | | | | | | | | | | | | | - Chuan He
- Department of Chemistry, The University of Chicago, Chicago, IL
| | | | - Kiran Turaga
- Department of Surgery, Section of Surgical Oncology, University of Chicago, Chicago, IL
| |
Collapse
|
9
|
Alliot-Launois F, Grange L, Berger Y, Buchon D, Clairaz B, Delgutte A, Tattevin P, Haas H, Gherardi N, Moore N, Perrot S. Revue exhaustive de la littérature sur le bon usage des AINS, dont l’ibuprofène, en période de Covid-19. Revue du Rhumatisme 2021. [PMCID: PMC8626123 DOI: 10.1016/j.rhum.2021.10.513] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction Le GRAINS, groupe de réflexion sur les AINS, est composé d’experts pluridisciplinaire hospitalier et de ville qui regroupe plusieurs médecins spécialistes. Il s’est constitué en vue de réfléchir sur le bon usage des anti-inflammatoires non-stéroïdiens (AINS) dans le contexte de la pandémie de COVID-19, et est soutenu par GlaxoSmithKline Santé Grand Public. Les travaux effectués par le GRAINS ont été publiés dans une revue de littérature exhaustive. L’objectif du GRAINS est d’avoir une discussion ouverte sur l’utilisation des AINS dans la gestion de la douleur dans le contexte de la COVID-19 et des infections en général, considérant les progrès réalisés dans la production de connaissances et les preuves de la littérature scientifique. Matériels et méthodes Ce groupe pluridisciplinaire d’experts constitué de rhumatologues, infectiologues, pédiatre, médecin généraliste, pharmacologue et pharmaciens, a pointé l’inquiétude et le manque d’informations énoncés par les patients à leur pharmacien. Les experts du GRAINS se sont réunis au travers de différentes assemblées et se sont accordés sur la nécessité de mettre à disposition des professionnels de santé une information synthétique de la littérature scientifique et des outils pour vulgariser cette information pour le grand public. La revue de littérature réalisée par les experts du GRAINS porte sur plus de 40 études internationales récentes concernant l’utilisation des AINS dans un contexte de la COVID-19. Résultats Le recours aux anti-inflammatoires non stéroïdiens (AINS) en général, et à l’ibuprofène en particulier, n’expose pas à un risque accru de la Covid-19 ni à des formes grave de cette infection. Discussion Encourager la discussion sur le bon usage des AINS en automédication. Les experts pointent l’inquiétude et le manque d’information énoncés par les patients à leur pharmacien. Par leur action ils souhaitent alerter sur les risques liés au surdosage d’alternatives aux AINS en particulier dans le traitement de la fièvre et de la douleur. Ils encouragent à ne pas se priver davantage de l’arsenal thérapeutique des AINS et militent pour une utilisation raisonnée de ces traitements. Conclusion Il n’existe actuellement aucune preuve scientifique établissant un lien entre l’ibuprofène et l’aggravation de l’infection due au SARS-CoV-2.
Collapse
|
10
|
Nizri E, Berger Y, Green E, Matan Kyzer, Aizic A, Nevo N, Gerstenhaber F, Klausner JM, Gutman M, Lahat G, Hoffman A, Geva R. ASO Visual Abstract: Lymph Node Metastases from Visceral Peritoneal Colorectal Metastases are Associated with Systemic Recurrence. Ann Surg Oncol 2021. [PMID: 34812986 DOI: 10.1245/s10434-021-10966-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Eran Nizri
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel. .,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yaniv Berger
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eraan Green
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Matan Kyzer
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel- Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nadav Nevo
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Fabian Gerstenhaber
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel
| | - Joseph M Klausner
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechai Gutman
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Guy Lahat
- Department of Surgery A, Peritoneal Surface Malignancy and Melanoma Unit, Tel-Aviv Sourasky Medical Center, 6 Weizman Street, 6423906, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviad Hoffman
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ravit Geva
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Oncology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| |
Collapse
|
11
|
Nizri E, Berger Y, Green E, Kyzer M, Aizic A, Nevo N, Gerstenhaber F, Klausner JM, Gutman M, Lahat G, Hoffman A, Geva R. Lymph Node Metastases from Visceral Peritoneal Colorectal Metastases are Associated with Systemic Recurrence. Ann Surg Oncol 2021; 29:2069-2075. [PMID: 34622371 DOI: 10.1245/s10434-021-10869-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 09/13/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Visceral peritoneal colorectal metastases (VPCMs) may further metastasize to lymph nodes that drain those organs. The rate of lymph node metastases (LNMs) from VPCMs and their clinical and prognostic significance are unknown. METHODS This study retrospectively analyzed the authors' institutional databases of 160 patients with peritoneal colorectal metastases who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Patients with LNM-VPCM (n = 12) were identified by pathologic reports, and both their short- and long-term outcomes were compared with those of patients without LNM-VPCM. RESULTS The clinical presentation and primary tumor pathologic characteristics did not differ between the two groups. The patients with LNM-VPCM had a higher tumor burden (measured by the peritoneal carcinomatosis index [PCI]) and visible remnant disease compared with those who had no LNM-VPI (10 vs 5.5 [p = 0.03] vs 33.3% vs 6.8% [p = 0.007], respectively). The postoperative outcomes also were comparable. The patients with LNM-VPCM had a shorter overall survival (OS) than those without LNM-VPCM (median OS, 22.5 months; 95% confidence interval [CI], 15.1-29.9 months vs 40.1 months; 95% CI, 38.1-42 months; p = 0.02). However, only tumor grade and PCI were predictors of OS in the multivariate analysis (hazard ratio [HR], 2.33 [p = 0.001]; 1.77 [p = 0.03], respectively). The study showed that LNM-VPCM was associated with systemic but not peritoneal recurrence compared with non-LNM-VPCM (81.8% vs 51.6% for systemic recurrence, respectively; p = 0.05). CONCLUSION The small distinct group of patients defined by LNM-VPCM were prone to systemic recurrence. Given its correlation with systemic recurrence, LNM-VPCM may indicate the need for adjuvant treatment.
Collapse
Affiliation(s)
- Eran Nizri
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel. .,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Yaniv Berger
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Eraan Green
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Matan Kyzer
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Asaf Aizic
- Institute of Pathology, Tel- Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Nadav Nevo
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Fabian Gerstenhaber
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Joseph M Klausner
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Mordechai Gutman
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Guy Lahat
- Peritoneal Surface Malignancy and Melanoma Unit, Department of Surgery A, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviad Hoffman
- Department of General Surgery, Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ravit Geva
- The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.,Oncology Division, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| |
Collapse
|
12
|
Belkhodja Y, Loreau J, van der Avoird A, Berger Y, Asselin P. Intermolecular dynamics of NH 3-rare gas complexes in the ν 2 umbrella region of NH 3 investigated by rovibrational laser jet-cooled spectroscopy and ab initio calculations. Phys Chem Chem Phys 2021; 23:10864-10874. [PMID: 33908499 DOI: 10.1039/d1cp00316j] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
High resolution jet-cooled spectroscopy experiments have been realized to investigate the intermolecular dynamics of van der Waals (vdW) heterodimers between NH3 and rare gas (Rg) atoms in the ν2 umbrella mode region of NH3. With respect to a previous study dedicated to NH3-Ar [Asselin et al. Mol. Phys. 116, 3642 (2018)], the sensitivity and spectral resolution of our laser spectrometer coupled to a pulsed supersonic jet have been significantly improved to derive more accurate excited state spectroscopic parameters from rovibrational analyses. In addition, we calculated the ground and ν2 excited vibration-rotation-tunneling (VRT) states of these complexes on the four-dimensional ab initio potential energy surfaces from Loreau et al. [J. Chem. Phys. 141, 224303 (2014), ibid. 143, 184303 (2015).] Transition frequencies and intensities of the allowed ν2 = 1 ← 0 transitions obtained from the calculated energy levels and wave functions agree well with the experimental data and are helpful in their analysis. By means of a pseudodiatomic model with the assumption of weak Coriolis coupling, the rovibrational analysis of both the Πe/f(j = 1,k = 0) ←Σf(j = 0,k = 0) and Σf(j = 1,k = 0) ←Σf(j = 0,k = 0) transitions in ortho NH3-Rg (Rg = Ne, Ar, Kr, Xe) complexes enabled us to determine reliable excited state parameters and derive accurate values of the effective vdW bond length Reff, force constant ks, and vdW stretching frequency νs. Comparison between the experimental structural parameters and those from the ab initio calculated VRT levels shows good agreement for NH3-Ne, NH3-Ar and NH3-Kr, and a similar variation of Reff, ks, and νs with the polarizability of Rg in the ground and ν2 excited states. Anomalously small values of νs and ks derived for NH3-Xe in the Πe/f(j = 1,k = 0) state suggest that the applied model is not valid in this case, due to the presence of another state coupling to the perturbed Πf state. Such a state could not be found, however.
Collapse
Affiliation(s)
- Y Belkhodja
- Sorbonne Université, CNRS, MONARIS, UMR 8233, 4 place Jussieu, Paris, F-75005, France.
| | | | | | | | | |
Collapse
|
13
|
Goldberg EM, Berger Y, Sood D, Kurnit KC, Kim JS, Lee NK, Yamada SD, Turaga KK, Eng OS. ASO Visual Abstract: Differences in Sociodemographic Disparities in Patients Undergoing Surgery for Advanced Colorectal and Ovarian Cancer. Ann Surg Oncol 2021. [PMID: 33978887 DOI: 10.1245/s10434-021-10130-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ellen M Goldberg
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Katherine C Kurnit
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Josephine S Kim
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
14
|
Goldberg EM, Berger Y, Sood D, Kurnit KC, Kim JS, Lee NK, Yamada SD, Turaga KK, Eng OS. Differences in Sociodemographic Disparities Between Patients Undergoing Surgery for Advanced Colorectal or Ovarian Cancer. Ann Surg Oncol 2021; 28:7795-7806. [PMID: 33959831 DOI: 10.1245/s10434-021-10086-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/16/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Cytoreductive surgery (CRS) for ovarian cancer with peritoneal metastases (OPM) is an established treatment, yet access-related racial and socioeconomic disparities are well documented. CRS for colorectal cancer with peritoneal metastases (CRPM) is garnering more widespread acceptance, and it is unknown what disparities exist with regards to access. METHODS This retrospective cross-sectional multicenter study analyzed medical records from the National Cancer Database from 2010 to 2015. Patients diagnosed with CRPM or ORP only and either no or confirmed resection were included. Patient- and facility-level characteristics were analyzed using uni- and multivariable logistic regressions to identify associations with receipt of CRS. RESULTS A total of 6634 patients diagnosed with CRPM and 14,474 diagnosed with OPM were included in this study. Among patients with CRPM, 18.1% underwent CRS. On multivariable analysis, female gender (odds ratio [95% CI] 2.04 [1.77-2.35]; P < 0.001) and treatment at an academic or research facility (OR 1.55 [1.17-2.05]; P = 0.002) were associated with CRS. Among patients with OPM, 87.1% underwent CRS. On multivariable analysis, treatment at facilities with higher-income patient populations was positively associated with CRS, while age (OR 0.97 [0.96-0.98]; P < .0001), use of nonprivate insurance (OR 0.69 [0.56-0.85]; P = 0.001), and listed as Black (OR 0.62 [0.45-0.86]; P = 0.004) were negatively associated with CRS. CONCLUSION There were more systemic barriers to CRS for patients with OPM than for patients with CRPM. As CRS becomes more widely practiced for CRPM, it is likely that more socioeconomic and demographic barriers will be elucidated.
Collapse
Affiliation(s)
- Ellen M Goldberg
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Divya Sood
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Katherine C Kurnit
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Josephine S Kim
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Nita K Lee
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - S Diane Yamada
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
15
|
Vining CC, Kuchta K, Berger Y, Paterakos P, Schuitevoerder D, Roggin KK, Talamonti MS, Hogg ME. Robotic pancreaticoduodenectomy decreases the risk of clinically relevant post-operative pancreatic fistula: a propensity score matched NSQIP analysis. HPB (Oxford) 2021; 23:367-378. [PMID: 32811765 DOI: 10.1016/j.hpb.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 06/08/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND A single-institution study demonstrated robotic pancreaticoduodenectomy (RPD) was protective against clinically-relevant postoperative pancreatic fistula (CR-POPF) compared to open pancreaticoduodenectomy (OPD). We sought to compare the national rate of CR-POPF by approach. METHODS Procedure-targeted pancreatectomy Participant User Data File was queried from 2014 to 2017 for all patients undergoing pancreaticoduodenectomy. A modified fistula risk score was calculated and patients were stratified into risk categories. Multivariate logistic regression and propensity score matching was used. RESULTS The rate of CR-POPF (15.6% vs. 11.9%; p = 0.026) was higher in OPD compared to RPD. On subgroup analysis, OPD had higher CR-POPF in high risk patients (32.9% vs. 19.4%; p = 0.007). On multivariable analysis OPD was a predictor of increased CR-POPF (Odds Ratio [OR] = 1.61 [1.15-2.25]; p = 0.005). Other operative factors associated with increased CR-POPF included soft pancreatic texture (OR = 2.65 [2.27-3.09]; p < 0.001) and concomitant visceral resection (OR = 1.41 [1.03-1.93]; p = 0.031). Increased duct size (reference <3 mm) was predictive of decreased CR-POPF: 3-6 mm (OR = 0.70 [0.61-0.81]; p < 0.001) and ≥6 mm (OR = 0.47 [0.37-0.60]; p < 0.001). Following propensity score matching, RPD continued to be protective against the occurrence of CR-POPF (OR = 1.54 [1.09-2.17]; p = 0.013). CONCLUSIONS This is the largest multicenter study to evaluate the impact of RPD on POPF. It suggests that RPD can be protective against POPF, especially for high risk patients.
Collapse
Affiliation(s)
| | - Kristine Kuchta
- NorthShore University HealthSystem, Department of Surgery, USA
| | - Yaniv Berger
- University of Chicago, Department of Surgery, USA
| | | | | | | | | | - Melissa E Hogg
- NorthShore University HealthSystem, Department of Surgery, USA.
| |
Collapse
|
16
|
White MG, Schulte JJ, Xue L, Berger Y, Schuitevoerder D, Vining CC, Kindler HL, Husain A, Turaga KK, Eng OS. Heterogeneity in PD-L1 expression in malignant peritoneal mesothelioma with systemic or intraperitoneal chemotherapy. Br J Cancer 2021; 124:564-566. [PMID: 33100328 PMCID: PMC7851380 DOI: 10.1038/s41416-020-01130-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/05/2020] [Accepted: 10/08/2020] [Indexed: 11/09/2022] Open
Abstract
Programmed death-ligand 1 (PD-L1) expression has been described in patients with malignant peritoneal mesothelioma (MPM), but treatment strategies utilising immune checkpoint inhibition are yet to be defined. Here, we examine levels of PD-L1 expression in MPM patients treated with systemic and/or intraperitoneal chemotherapy using tissue from patient tumour biopsies or resections at multiple time points. We found the mean PD-L1 expression was higher in those with a germline mutation and/or those with a higher somatic mutation burden. Moreover, PD-L1 expression was lower in patients who had received prior chemotherapy as compared to the treatment-naive cohort. Twenty patients who received chemotherapy, either systemic and/or peritoneal, between PD-L1 measurements showed marked heterogeneity. Six (30%) patients demonstrated upregulation of PD-L1, while eight (40%) demonstrated downregulation. Heterogeneity in PD-L1 expression in MPM before and after cytotoxic therapies may present an additional consideration when initiating immune checkpoint inhibition in this rare and challenging disease.
Collapse
Affiliation(s)
- Michael G White
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jefree J Schulte
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Lai Xue
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL, USA
| | - Darryl Schuitevoerder
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL, USA
| | - Charles C Vining
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL, USA
| | - Hedy L Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA
| | - Aliya Husain
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
17
|
Berger Y, Giurcanu M, Vining CC, Schuitevoerder D, Posner MC, Roggin KK, Polite BN, Liao CY, Eng OS, Catenacci DVT, Turaga KK. Cytoreductive Surgery for Selected Patients Whose Metastatic Gastric Cancer was Treated with Systemic Chemotherapy. Ann Surg Oncol 2021; 28:4433-4443. [PMID: 33420565 DOI: 10.1245/s10434-020-09475-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 12/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The authors hypothesized that cytoreductive surgery (CRS, comprising gastrectomy combined with metastasectomy) in addition to systemic chemotherapy (SC) is associated with a better survival than chemotherapy alone for patients with metastatic gastric adenocarcinoma (MGA). METHODS Patients with MGA who received SC between 2004 and 2016 were identified using the National Cancer Database (NCDB). Nearest-neighbor 1:1 propensity score-matching was used to create comparable groups. Overall survival (OS) was compared between subgroups using Kaplan-Meier analyses. Immortal bias analysis was performed among those who survived longer than 90 days. RESULTS The study identified 29,728 chemotherapy-treated patients, who were divided into the following four subgroups: no surgery (NS, n = 25,690), metastasectomy alone (n = 1170), gastrectomy alone (n = 2248), and CRS (n = 620) with median OS periods of 8.6, 10.9, 14.8, and 16.3 months, respectively (p < 0.001). Compared with the patients who underwent NS, the patients who had CRS were younger (58.9 ± 13.4 vs 62.0 ± 13.1 years), had a lower proportion of disease involving multiple sites (4.6% vs 19.1%), and were more likely to be clinically occult (cM0 stage: 59.2% vs 8.3%) (p < 0.001 for all). The median OS for the propensity-matched patients who underwent CRS (n = 615) was longer than for those with NS (16.4 vs 9.3 months; p < 0.001), including in those with clinical M1 stage (n = 210). In the Cox regression model using the matched data, the hazard ratio for CRS versus NS was 0.56 (95% confidence interval [CI], 0.49-0.63). In the immortal-matched cohort, the corresponding median OS was 17.0 versus 9.5 months (p < 0.001). CONCLUSIONS In addition to SC, CRS may be associated with an OS benefit for a selected group of MGA patients meriting further prospective investigation.
Collapse
Affiliation(s)
- Yaniv Berger
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Mihai Giurcanu
- Department of Public Health Sciences, University of Chicago Medical Center, Chicago, IL, USA
| | - Charles C Vining
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Mitchell C Posner
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Kevin K Roggin
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Blase N Polite
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Chih-Yi Liao
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Kiran K Turaga
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
| |
Collapse
|
18
|
Zager Y, Hoffman A, Dreznik Y, Jacoby H, Cordoba M, Horesh N, Nevler A, Gutman M, Berger Y. Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer: The prognostic impact of baseline neutrophil-lymphocyte, platelet-lymphocyte and lymphocyte-monocyte ratios. Surg Oncol 2020; 35:321-327. [PMID: 32977104 DOI: 10.1016/j.suronc.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/14/2020] [Accepted: 09/06/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE In this retrospective analysis we sought to determine if the preoperative neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) and lymphocyte-monocyte ratio (LMR) were predictive of both operability and survival in those patients presenting with peritoneal carcinomatosis (PC) from colorectal cancer (CRC) who underwent cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). METHODS Analysis included all patients admitted between 2009 and 2017 with PC from CRC who were treated with curative intent by CRS-Mitomycin C-HIPEC. Patients were assessed pre- and intra-operatively by the PC index (PCI) and by a completeness of cytoreduction (CC) score with calculation of Kaplan-Meier survival curves and multivariate analysis of prognostic factors. Discrimination was made for NLR >3.5, PLR >168.8 and LMR >4.4. RESULTS We identified 98 CRC patients undergoing 105 CRS-HIPEC procedures. There were no associations detected between NLR/PLR/LMR and the rates of incomplete or abandoned CRS cases. Overall survival (OS) after CRS-HIPEC was worse with high versus low NLR (19.9 mths vs. 45.7 mths, respectively; P = 0.009) and also with low versus high LMR (27.1 mths vs. 53.2 mths, respectively; P = 0.01). On multivariate analysis, a low LMR (P = 0.008), the preoperative CT PCI value (P = 0.004), poor tumor differentiation (P = 0.023) and the preoperative CEA level (P < 0.001) were all independent variables associated with a worse OS after surgery. CONCLUSIONS The baseline LMR value may have potential value as a selection tool for CRS-HIPEC in patients with CRC-related PC.
Collapse
Affiliation(s)
- Yaniv Zager
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Aviad Hoffman
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yael Dreznik
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Harel Jacoby
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mordehay Cordoba
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Nir Horesh
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Avinoam Nevler
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel; Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mordechai Gutman
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Yaniv Berger
- Department of Surgery and Transplantation B, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| |
Collapse
|
19
|
Berger Y, Schuitevoerder D, Vining CC, Alpert L, Fenton E, Hindi E, Liao CY, Shergill A, Catenacci DVT, Polite BN, Eng OS, Turaga KK. Novel Application of Iterative Hyperthermic Intraperitoneal Chemotherapy for Unresectable Peritoneal Metastases from High-Grade Appendiceal Ex-Goblet Adenocarcinoma. Ann Surg Oncol 2020; 28:1777-1785. [PMID: 32892267 DOI: 10.1245/s10434-020-09064-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/09/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Peritoneal metastases (PMs) from appendiceal ex-goblet adenocarcinoma (AEGA) are associated with a poor prognosis. While cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has been shown to prolong survival, the majority of patients are ineligible for complete cytoreduction. We describe a novel approach to the management of such patients with iterative HIPEC (IHIPEC). METHODS Patients with signet ring/poorly differentiated AEGA with high Peritoneal Cancer Index (PCI) and extensive bowel involvement underwent IHIPEC with mitomycin C at 6-week intervals for a total of three cycles. Survival outcomes for these patients were compared with patients with high-grade appendiceal tumors matched for tumor burden who were treated with other conventional approaches, i.e. systemic chemotherapy only (SCO) or complete CRS + HIPEC. RESULTS Between 2016 and 2019, seven AEGA patients with high PCI (median 32.5 [range 21-36]) underwent 18 IHIPEC cycles (median cycles per patient 3 [2-3]) in combination with systemic chemotherapy (median 2 lines [1-3], 12 cycles [10-28]). IHIPEC was delivered laparoscopically in 14/18 cases. Postoperatively, the median length of stay was 1 day (1-8 days), no procedure-related complications were reported, and five (28%) 90-day readmissions for bowel obstruction were documented. Median overall survival after IHIPEC was better compared with a matched group of patients (n = 16) receiving SCO (24.6 vs. 7.9 months; p = 0.005), and similar to those (n = 7) who underwent CRS + HIPEC (24.6 vs. 16.5 months; p = 0.62). CONCLUSIONS IHIPEC in combination with systemic chemotherapy is tolerable, safe, and may be associated with encouraging survival outcomes compared with SCO in selected patients with high-grade, high-burden AEGA PM.
Collapse
Affiliation(s)
- Yaniv Berger
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Charles C Vining
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Lindsay Alpert
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, USA
| | - Emily Fenton
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Enal Hindi
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Chih-Yi Liao
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Ardaman Shergill
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | | | - Blase N Polite
- Department of Medicine, University of Chicago Medical Center, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
| |
Collapse
|
20
|
Liu JB, Schuitevoerder D, Vining CC, Berger Y, Turaga KK, Eng OS. Benchmarking Perioperative Outcomes of Cytoreductive Surgery for Cancer: Implications for Quality Measurement. Ann Surg Oncol 2020; 27:5039-5046. [PMID: 32729047 DOI: 10.1245/s10434-020-08815-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/19/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Understanding variation and heterogeneity in practice patterns allows programs to develop effective strategies to improve patient outcomes. Cytoreductive surgery is a potentially highly morbid operation that could benefit from systematic assessments directed towards quality improvement. We describe the hospital-level variation and benchmarks for programs performing cytoreductive surgery. PATIENTS AND METHODS Cytoreductive and tumor debulking operations with or without hyperthermic intraperitoneal chemotherapy performed for cancer between January 1, 2013 and June 30, 2018 were identified in the American College of Surgeons National Surgical Quality Improvement Program registry. Risk-adjusted hospital-level variation in 30-day death, serious morbidity, reoperation, readmission, and a composite of death or serious morbidity (DSM) were evaluated using hierarchical models. National Cancer Institute (NCI)-designated cancer center (NCI-CC) status was also explored. RESULTS A total of 6203 operations across 589 hospitals were included, of which 56 were at NCI-CCs. Unadjusted rates of death, serious morbidity, reoperation, readmission, and DSM were 1.4%, 12.9%, 3.6%, 8.6%, and 13.4%, respectively. The coefficients of variation for hospital-level performance were 4.7%, 2.1%, 4.6%, 14.4%, and 1.0% for DSM, death, serious morbidity, unplanned reoperation, and unplanned readmissions, respectively. When compared with other hospitals, NCI-CCs had better risk-adjusted 30-day mortality (median odds ratio 0.984 versus 0.998, p < 0.001), but not for the other outcomes studied. CONCLUSIONS Hospital-level variation was modestly detected using the usual measures of perioperative outcomes. Given the increasing interest in cytoreductive surgery, we demonstrate a clear opportunity to not only improve the quality of our care but to also better improve the way quality is measured for these patients.
Collapse
Affiliation(s)
- Jason B Liu
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
| | | | - Charles C Vining
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Yaniv Berger
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Kiran K Turaga
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Oliver S Eng
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| |
Collapse
|
21
|
Vining CC, Kuchta K, Schuitevoerder D, Paterakos P, Berger Y, Roggin KK, Talamonti MS, Hogg ME. Risk factors for complications in patients undergoing pancreaticoduodenectomy: A NSQIP analysis with propensity score matching. J Surg Oncol 2020; 122:183-194. [DOI: 10.1002/jso.25942] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/05/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Charles C. Vining
- Department of Surgery University of Chicago Medicine Chicago Illinois
| | - Kristine Kuchta
- Department of Surgery NorthShore University Health System Evanston Illinois
| | | | - Pierce Paterakos
- Department of Surgery NorthShore University Health System Evanston Illinois
| | - Yaniv Berger
- Department of Surgery University of Chicago Medicine Chicago Illinois
| | - Kevin K. Roggin
- Department of Surgery University of Chicago Medicine Chicago Illinois
| | - Mark S. Talamonti
- Department of Surgery NorthShore University Health System Evanston Illinois
| | - Melissa E. Hogg
- Department of Surgery NorthShore University Health System Evanston Illinois
| |
Collapse
|
22
|
Berger Y, Cui XL, West D, Rivas M, Hsu P, Dougherty U, Deng Z, Hindi E, Eng O, Bissonnette M, Polite BN, Turaga K. 5-hydroxymethylation signatures in plasma circulating cell-free DNA as markers for appendiceal and colorectal peritoneal metastasis. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.195] [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
195 Background: Noninvasive tests for peritoneal metastasis (PM) detection lack sensitivity. Genome-wide mapping of 5-hydroxymethylcytosine (5hmC) on nanogram quantities of peripheral plasma circulating cell-free DNA (PcfDNA) was previously shown to differentiate non-metastatic colorectal cancer from healthy subjects. We aimed to examine if patients with colorectal cancer (CRC), high grade appendiceal cancer (HGA) or low grade appendiceal cancer (LGA) with PM have distinct signatures of 5hmC in PcfDNA compared to each other and to patients matched for tumors without PM. Methods: We analyzed plasma samples from a prospectively collected tissue bank. To correlate 5hmC signatures with intraoperative findings, only patients who underwent abdominal surgery in proximity to plasma collection were selected. Key steps of PcfDNA processing included extraction from plasma, nano-hmC-Seal chemical labeling and enrichment of 5hmC-modified fragments, next-generation sequencing, and mapping to the reference human genome. DESeq2 R package was finally used to compare relative 5hmC enrichment and detect distinct 5hmC signatures according to disease histology and PM presence. Results: Plasma samples were collected between 11/2016 – 3/2019 from 46 patients with CRC (n = 21), HGA (n = 17) and LGA (n = 8). Of those, 32 (70%) had PM based on intraoperative findings (median peritoneal cancer index score = 15, range 2-39) and 14 did not have PM. Most samples (91%) were collected on the same day as surgery. An average of 24 million paired-end reads were sequenced for each sample. Four samples (8.7%) were excluded from the analysis due to low sequencing coverage or high duplication level. Unique 5hmC enrichment patterns were found to discriminate with p < 0.05 between CRC PM and HGA PM (n = 616 differentially hydroxymethylated genes (DHMGs)), CRC/HGA PM and LGA PM (n = 1074 DHMGs), and CRC/HGA PM and CRC/HGA patients without PM (n = 1576 DHMGs). Conclusions: Distinct signatures of 5hmC in PcfDNA could differentiate patients with CRC/HGA/LGA PM from each other and from patients with similar tumor histologies without PM. Thus 5hmC signatures in PcfDNA might potentially serve as a sensitive marker of occult PM.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Kiran Turaga
- University of Chicago, Department of Surgery, Chicago, IL
| |
Collapse
|
23
|
Berger Y, Schuitevoerder D, Vining CC, Giurcanu M, Posner MC, Roggin KK, Polite BN, Liao CY, Eng O, Catenacci DV, Turaga K. Cytoreductive surgery in selected patients with metastatic gastric cancer treated with systemic chemotherapy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.409] [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
409 Background: Cytoreductive surgery (CRS – gastrectomy combined with metastasectomy) for non-palliative indications is controversial for patients with metastatic gastric adenocarcinoma (MGA). We hypothesized that CRS in addition to systemic chemotherapy is associated with an improved survival when compared to patients with MGA receiving chemotherapy alone. Methods: Patients with MGA who received systemic chemotherapy between 2004-2016 were identified using the National Cancer Database (NCDB). Nearest neighbor 1:1 propensity score matching of demographic, tumor-related and treatment-related factors was used to create comparable groups. Overall survival (OS) was compared between subgroups using Kaplan-Meier analyses. Immortal bias analysis was performed among those that survived at least 90 days. Results: We identified 29,728 chemotherapy-treated patients who were divided into 4 subgroups: No surgery (NS, n = 25,690), metastasectomy alone (n = 1170), gastrectomy alone (n = 2248) and CRS (n = 620) with a median OS of 8.6, 10.9, 14.8 and 16.3 months, respectively (p < 0.001). Compared to patients who underwent no surgery, patients who underwent CRS were younger (58.9±13.4 vs. 62.0±13.1 years), had lower proportion of disease involving multiple sites (5.0% vs. 26.2%), and were more likely to have clinically occult disease (cM0 58.9% vs. 7.3%) - all p < 0.001. OS for propensity matched patients who underwent CRS (n = 490) was longer than NS (16.3 vs. 8.8 months, p < 0.001), including those with clinical M1 stage (n = 203) in both unmatched and propensity matched (median OS 19.7 vs. 8.6 months, p < 0.001) cohorts. On Cox regression model using the matched data, the hazard ratio for CRS vs. NS was 0.80 (95%CI 0.76-0.84). In the immortal matched cohort, the corresponding median OS was 16.7 vs. 9.7 months, p < 0.001. Conclusions: CRS in addition to systemic chemotherapy may be associated with an OS benefit in a selected group of patients with metastatic gastric adenocarcinoma. Suboptimal matching for tumor burden is our major limitation. In contrast to studies that focus on gastrectomy alone in the setting of MGA, this study highlights the role of CRS among patients receiving systemic chemotherapy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Kiran Turaga
- University of Chicago, Department of Surgery, Chicago, IL
| |
Collapse
|
24
|
Poli EC, Millis AM, Berger Y, Sherman SK, Schuitevoerder D, Dahdaleh F, Kamm A, Eng OS, Turaga KK. Implementation of bundled care to reduce surgical site infections after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Oncol 2019; 120:1044-1045. [DOI: 10.1002/jso.25668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/12/2022]
Affiliation(s)
| | | | - Yaniv Berger
- Department of SurgeryUniversity of Chicago Chicago Illinois
| | | | | | - Fadi Dahdaleh
- Department of Surgical OncologyEdward‐Elmhurst Hospital Elmhurst Illinois
| | - Alaine Kamm
- Department of SurgeryUniversity of Chicago Chicago Illinois
| | - Oliver S. Eng
- Department of SurgeryUniversity of Chicago Chicago Illinois
| | | |
Collapse
|
25
|
Dori A, Shelestovich N, Gayster A, Lebedyev A, Berger Y, Rosin D. [THE VALUE OF MUSCLE BIOPSY IN PATIENTS WITHOUT WEAKNESS, HIGH CREATINE KINASE OR MYOPATHY ON ELECTROMYOGRAPHY]. Harefuah 2019; 158:372-377. [PMID: 31215189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Muscle biopsy is an important diagnostic procedure for the evaluation of neuromuscular disorders, commonly employed when patients present with muscle weakness, high creatine-kinase or electromyography which suggest myopathy. The diagnostic value of this procedure when these are normal is unclear. AIMS To characterize the pathology in muscle biopsies of patients without clinical, laboratory or electromyographic suggestion for myopathy. METHODS Retrospective chart and pathology review of consecutive patients who were evaluated by muscle biopsy at Sheba Medical Center. RESULTS Of 109 patients, 12 (11%) had no indication for myopathy prior to biopsy. Pathology was identified in 2/3 of cases. Inflammation was detected in 5 cases (42%), with a perivascular infiltrate in four, and endomysial in one. A mild myopathy was present in 3/5 of these cases. Type-2 muscle fiber atrophy as the primary or only pathology was seen in 2 cases (17%) and mild neurogenic changes in one (8%). A history of systemic disease, additional laboratory tests or imaging suggestive for inflammation were predictive for inflammatory pathology in 4/5 of cases (P = 0.006). CONCLUSIONS Perivascular inflammation without significant muscle fiber damage is common and meaningful in patients with inflammatory conditions in spite of normal evaluation for myopathy. DISCUSSION Muscle disease is characterized by damage to muscle fibers, connective tissue or vessels. In the absence of fiber damage, muscle strength, creatine-kinase and electromyography may remain normal. These tests therefore do not rule-out perivascular inflammation and mild myopathy. Muscle biopsy is effective for the detection of inflammation in patients with inflammatory conditions in spite of normal strength creatine-kinase and electromyography.
Collapse
Affiliation(s)
- Amir Dori
- Department of Neurology, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalia Shelestovich
- Department of Pathology and Surgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexandra Gayster
- Department of Pathology and Surgery, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexander Lebedyev
- Department of Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaniv Berger
- Department of Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dan Rosin
- Department of Transplantation, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
26
|
Berger Y, Jacoby H, Zager Y, Lebedyev A, Gutman M, Hoffman A. [CYTOREDUCTIVE SURGERY AND HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY FOR PERITONEAL CARCINOMATOSIS OF COLORECTAL ORIGIN - FIRST 100 CASES]. Harefuah 2019; 158:227-232. [PMID: 31032553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an effective treatment for selected patients with peritoneal carcinomatosis of colorectal origin. We present our experience with the first 100 consecutive cases of this combined treatment. METHODS CRS/HIPEC procedures were performed between 4/2009-8/2016. HIPEC was initially delivered using the "Open" abdomen technique; beginning in January 2014, HIPEC was delivered using the "Closed" technique. As a chemotherapeutic agent we used Mitomycin-C, perfused for duration of 90 minutes at 41 degrees Celsius. RESULTS A total of 100 procedures were performed in 94 patients (64% females, median age 62 (22-83) years) with colon (n=89) or rectal (n=5) cancer. Complete cytoreduction (CC score≤1) was achieved in 91 procedures. The average duration of surgery was 7.5±2.3 hours, the median number of organs resected was 2 (0-6) and the median length of hospital stay was 9 (5-101) days. Postoperative complications occurred in 54% of procedures and the incidence of major complications (Clavien-Dindo 3-4) was 12%. Three patients (3%) died within 90 days postoperatively. Higher peritoneal cancer index (PCI) score, higher number of organs resected/anastomoses created and longer duration of surgery were associated with perioperative morbidity (all p≤0.05). The median follow-up period was 2.1 years during which 50 patients died. The median overall survival (OS) and disease free survival were 3.1 years and 10.7 months, respectively; 7 patients survived ≥5 years after surgery. Higher PCI score and occurrence of major postoperative complications were associated with poorer OS. CONCLUSIONS CRS/HIPEC for peritoneal carcinomatosis of colorectal cancer origin is feasible and safe. This treatment may benefit selected patients in terms of OS.
Collapse
Affiliation(s)
- Yaniv Berger
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Harel Jacoby
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Yaniv Zager
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Alexander Lebedyev
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Mordechai Gutman
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| | - Aviad Hoffman
- Department of Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to the Faculty of Medicine, Tel Aviv University
| |
Collapse
|
27
|
Berger Y, Jacoby H, Kaufmann MI, Ben-Yaacov A, Westreich G, Sharon I, Barda L, Sharif N, Nadler R, Horesh N, Nissan A, Gutman M, Hoffman A. Correlation Between Intraoperative and Pathological Findings for Patients Undergoing Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 2019; 26:1103-1109. [PMID: 30746598 DOI: 10.1245/s10434-019-07219-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to examine the correlation between intraoperative and pathological findings for patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and to determine their prognostic significance. METHODS Pathological reports of all colorectal cancer (CRC) patients undergoing CRS/HIPEC between 2009 and 2016 were retrospectively reviewed. Pathological specimens lacking tumor cells were defined as negative pathological specimens (NPS). The intraoperative peritoneal cancer index (PCI) and pathological PCI (excluding NPS) were calculated separately. Receiver operating characteristic (ROC) curves were applied to compare the prognostic value of intraoperative and pathological scoring systems. RESULTS For 108 CRC patients, 113 CRS/HIPEC procedures were performed. Of 959 pathological specimens examined, 178 (18.6%) were NPS. Overall, 78 procedures (69%) showed NPS. In 52 procedures (46%), the pathological PCI differed from the intraoperative PCI (∆PCI > 0). The ROC areas for intraoperative PCI and pathological PCI were similar in predicting 1-year overall survival (OS), 2-year OS, and 1-year disease-free survival (all p values not significant). However, for the patients with NPS, the number of positive specimens (containing tumor tissue) was superior to intraoperative PCI in predicting 2-year OS (ROC under the curve areas, 0.69 vs. 0.58, respectively; p = 0.012). In addition, a subgroup of 15 patients with a high ∆PCI (≥ 3) had a more favorable median OS than a matched group of 30 patients with similar intraoperative PCI and a ∆PCI of 0 (median survival not reached vs. 21.6 months, respectively; p = 0.05). CONCLUSIONS In the majority of CRC CRS/HIPEC procedures, NPS may be found. Among patients with NPS, pathological correlation may have a prognostic significance.
Collapse
Affiliation(s)
- Y Berger
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel.
| | - H Jacoby
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - M I Kaufmann
- Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - A Ben-Yaacov
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - G Westreich
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - I Sharon
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - L Barda
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - N Sharif
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - R Nadler
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - N Horesh
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - A Nissan
- Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - M Gutman
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| | - A Hoffman
- Department of General Surgery and Transplantation-Surgery B, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel
| |
Collapse
|
28
|
Savi P, Combalbert J, Gaich C, Rouchon MC, Maffrand JP, Berger Y, Herbert JM. The Antiaggregating Activity of Clopidogrel Is due to a Metabolic Activation by the Hepatic Cytochrome P450-1A. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1648859] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryClopidogrel and ticlopidine are two well known selective anti-ADP agents which are inactive in vitro and must be administered in vivo to fully exhibit their antiaggregating and antithrombotic effects. Since previous studies have clearly demonstrated that the activation steps take place in the liver, we examined the effect of specific induction or inhibition of cytochrome P450 subfamilies on the antiaggregating activity of clopidogrel. SKF 525-A, a global cytochrome P450 inhibitor, dramatically decreased the antiaggregating effect of clopidogrel, therefore indicating that cytochrome P450 enzymes are involved in the hepatic activation of clopidogrel. The efficacy of clopidogrel was increased in animals pretreated with 3-methylcholanthrene and (3-naphthoflavone, indicating that the cytochrome P450-1A subfamily pathway was mainly involved in the activating metabolism of clopidogrel. The use of specific antibodies directed against the various cytochrome P450 subfamilies ascertained this observation.
Collapse
Affiliation(s)
- P Savi
- Sanofi Recherche, Toulouse, France
| | | | - C Gaich
- Sanofi Recherche, Toulouse, France
| | | | | | - Y Berger
- Sanofi Recherche, Montpellier, France
| | | |
Collapse
|
29
|
Dreznik Y, Hoffman A, Hamburger T, Ben-Yaacov A, Dux Y, Jacoby H, Berger Y, Nissan A, Gutman M. Hospital readmission rates and risk factors for readmission following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal surface malignancies. Surgeon 2018; 16:278-282. [PMID: 29429947 DOI: 10.1016/j.surge.2018.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 01/05/2018] [Accepted: 01/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cytoreductive surgery and Hyperthermic intra-peritoneal chemotherapy (CRS/HIPEC) for peritoneal surface malignancies is associated with high morbidity. The increased numbers of patients undergoing CRS/HIPEC in recent years mandates risk analysis and quality assurance. However, only scarce data exist regarding causative parameters for readmission. The aim of this study was to assess readmission rates and risk factors associated with readmission. METHODS A retrospective-cohort study including patients from two high-volume centers who underwent CRS/HIPEC surgery between the years 2007-2016 was performed. Patients' demographics, peri-operative data and readmission rates were recorded. RESULTS 223 patients were included in the study. The 7 and 30-day readmission rates were 3.5% (n = 8) and 11% (n = 25), respectively. Late readmission rates (up to 90 days) were 11% (n = 25). The most common causes of readmission were surgical related infections (35%), small bowel obstruction (17.5%) and dehydration (14%). Post-operative complications were associated with higher readmission rates (p = 0.0001). PCI score was not associated with higher rates of readmission. CONCLUSION Readmissions following CRS/HIPEC occur mainly due to infectious complications and dehydrations. Patients following CRS/HIPEC should be discharged after careful investigation to a community based continuing care with access for IV fluid replacement or antibiotics administration when required.
Collapse
Affiliation(s)
- Yael Dreznik
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Aviad Hoffman
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamar Hamburger
- Division of Clinical Research, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Almog Ben-Yaacov
- Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Yossi Dux
- Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Harel Jacoby
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaniv Berger
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviram Nissan
- Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of General and Oncological Surgery-Surgery C, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Mordechai Gutman
- Department of Surgery B, Chaim Sheba Medical Center, Tel-Hashomer, Israel; Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
30
|
Berger Y, Spivack JH, Heskel M, Aycart SN, Labow DM, Sarpel U. Extrahepatic metastasectomy for hepatocellular carcinoma: Predictors of long-term survival. J Surg Oncol 2017; 115:505-506. [PMID: 28334437 DOI: 10.1002/jso.24555] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Yaniv Berger
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John H Spivack
- Department of Population, Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marina Heskel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha N Aycart
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
31
|
Horesh N, Wasserberg N, Zbar AP, Gravetz A, Berger Y, Gutman M, Rosin D, Zmora O. Changing paradigms in the management of diverticulitis. Int J Surg 2016; 33 Pt A:146-50. [DOI: 10.1016/j.ijsu.2016.07.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 12/15/2022]
|
32
|
Berger Y, Spivack JH, Heskel M, Aycart SN, Labow DM, Sarpel U. Extrahepatic metastasectomy for hepatocellular carcinoma: Predictors of long-term survival. J Surg Oncol 2016; 114:469-74. [PMID: 27334650 DOI: 10.1002/jso.24340] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 06/11/2016] [Indexed: 12/16/2022]
Abstract
INTRODUCTION We report our institutional experience with extrahepatic metastasectomy (EM) in a cohort of hepatocellular carcinoma (HCC) patients with focus on predictors of survival. METHODS All patients diagnosed with metastatic HCC from 2001 to 2014 were retrospectively reviewed to identify those who underwent EM with therapeutic intent. Associations among multiple clinicopathological variables and survival after EM were analyzed by univariate and multivariate analyses. RESULTS Out of 440 metastatic HCC cases, we identified 85 patients (mean age 58.8 ± 11.7 years, 81.2% males) who underwent lung (n = 36), peritoneal (n = 22), lymph node (n = 19), musculoskeletal (n = 18), and adrenal (n = 9) metastasectomy. Most patients (84.7%) underwent metachronous EM following primary liver resection or transplantation. The median follow-up period was 20.9 months, during which 55 patients (64.7%) died. The 1-/2-/5-year overall survival rates after EM were 77.4, 53.1, and 25.1%, respectively. On multivariate analysis, number of metastases resected >2 correlated independently with poor survival (HR = 2.058, P = 0.0099). EM patients had superior median survival compared to all (n = 194) metastatic HCC patients treated with sorafenib without EM during the study period (27.2 vs. 7.4 months, P < 0.001). CONCLUSION Long-term survival may be achieved in highly selected HCC patients following EM. The presence of greater than two extrahepatic lesions correlates independently with poor survival. J. Surg. Oncol. 2016;114:469-474. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Yaniv Berger
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John H Spivack
- Department of Population, Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marina Heskel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Samantha N Aycart
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
33
|
Horesh N, Saeed Y, Horesh H, Berger Y, Speter C, Pery R, Rosin D, Gutman M, Zmora O. Colonoscopy after the first episode of acute diverticulitis: challenging management paradigms. Tech Coloproctol 2016; 20:383-387. [PMID: 27170283 DOI: 10.1007/s10151-016-1478-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 04/28/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Colonoscopy is commonly recommended after the first episode of acute diverticulitis to exclude colorectal neoplasia. Recent data have challenged this paradigm due to insufficient diagnostic yield. The aim of this study was to assess whether colonoscopy after the first episode of acute diverticulitis is needed to exclude colorectal neoplasia. METHODS We performed a retrospective cohort analysis of medical records of patients admitted for the first episode of acute diverticulitis between January 2008 and December 2012. Ambulatory colonoscopy was routinely recommended at discharge. Clinical follow-up and telephone surveys were used for data collection. RESULTS Four hundred and twenty-five patients with a mean age of 62.6 years (range 21-98 years) were admitted during the 5-year period. Three hundred and ten (72.9 %) patients underwent colonoscopy at median time of 3.2 months after discharge. Five patients (1.6 %) of the 310 available for evaluation had malignant findings in colonoscopy. Of those, one patient had rectal carcinoma away from the inflamed site and one had colonic lymphoma. None of the 95 patients <50 years of age was found to have adenocarcinoma of the colon. CONCLUSIONS Cancer is rarely detected in colonoscopy following the first episode of acute diverticulitis. These results question this indication for colonoscopy, especially in patients under 50.
Collapse
Affiliation(s)
- N Horesh
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel.
| | - Y Saeed
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - H Horesh
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - Y Berger
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - C Speter
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - R Pery
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - D Rosin
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - M Gutman
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| | - O Zmora
- Department of Surgery and Transplantations B, Chaim Sheba Medical Center (Affiliated to the Faculty of Medicine, Tel Aviv University), 52621, Tel-Hashomer, Ramat Gan, Israel
| |
Collapse
|
34
|
Sarpel U, Spivack JH, Berger Y, Heskel M, Aycart SN, Sweeney R, Edwards MP, Labow DM, Kim E. The effect of locoregional therapies in patients with advanced hepatocellular carcinoma treated with sorafenib. HPB (Oxford) 2016; 18:411-8. [PMID: 27154804 PMCID: PMC4857060 DOI: 10.1016/j.hpb.2016.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS It is unknown whether the addition of locoregional therapies (LRTx) to sorafenib improves prognosis over sorafenib alone in patients with advanced hepatocellular carcinoma (HCC). The aim of this study was to assess the effect of LRTx in this population. METHODS A retrospective analysis was performed of patients with advanced HCC as defined by extrahepatic metastasis, lymphadenopathy >2 cm, or gross vascular invasion. Sorafenib therapy was required for inclusion. Survival of patients who received LRTx after progression to advanced stage was compared to those who did not receive LRTx. RESULTS Using an intention to treat analysis of 312 eligible patients, a propensity weighted proportional hazards model demonstrated LRTx as a predictor of survival (HR = 0.505, 95% CI: 0.407-0.628; P < 0.001). The greatest benefit was seen in patients with the largest tumor burden (HR = 0.305, 95% CI: 0.236-0.393; P < 0.01). Median survival in the sorafenib arm was 143 days (95% CI: 118-161) vs. 247 days (95% CI: 220-289) in the sorafenib plus LRTx arm (P < 0.001). CONCLUSIONS These results demonstrate a survival benefit with the addition of LRTx to sorafenib for patients with advanced HCC. These findings should prompt a prospective clinical trial to further assess the role of LRTx in patients with advanced HCC.
Collapse
Affiliation(s)
- Umut Sarpel
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA,Correspondence Umut Sarpel, Division of Surgical Oncology, 19 East 98th St, New York, NY 10029, USA. Tel: +1 212 241 2891. Fax: +1 212 241 1572.
| | - John H. Spivack
- Department of Population, Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yaniv Berger
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marina Heskel
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samantha N. Aycart
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Robert Sweeney
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Martin P. Edwards
- Department of Radiology, Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel M. Labow
- Department of Surgery, Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edward Kim
- Department of Radiology, Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
35
|
Sarpel U, Suprun M, Sofianou A, Berger Y, Tedjasukmana A, Sekendiz Z, Bagiella E, Schwartz ME. Disentangling the effects of race and socioeconomic factors on liver transplantation rates for hepatocellular carcinoma. Clin Transplant 2016; 30:714-21. [PMID: 27027869 DOI: 10.1111/ctr.12739] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Liver transplantation is the most effective treatment for hepatocellular carcinoma (HCC) in eligible patients, but is not accessed equally by all. We explored the effects of race and socioeconomic factors on transplantation for HCC while controlling for stage, resection status, and transplant candidacy. PATIENTS AND METHODS All HCC patients, 2003-2013, were retrospectively analyzed using multivariate analysis to explore differences in transplantation rates among cohorts. RESULTS Of 3078 HCC patients, 754 (24%) were considered transplant eligible. Odds of transplantation were significantly higher for those with commercial insurance (OR = 1.99, 95% CI [1.42, 2.79]) and lower for black patients (OR = 0.55, 95% CI [0.33, 0.91]). Asians were more likely to be resected than white patients with similarly staged tumors and transplant criteria (p < 0.001). Patients not listed for transplantation for non-medical reasons were more likely to be government-insured (p = 0.02) and not white (p = 0.05). No step along the transplantation pathway was identified as the dominant hurdle. DISCUSSION Patients who are black or government-insured are significantly less likely to undergo transplantation for HCC despite controlling for tumor stage, resection status, and transplant eligibility. Asian patients have higher rates of hepatic resection, but also appear to have lower transplantation rates beyond this effect.
Collapse
Affiliation(s)
- Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, New York, NY, USA
| | - Maria Suprun
- Department of Population, Health Science and Policy, New York, NY, USA
| | | | - Yaniv Berger
- Division of Surgical Oncology, Department of Surgery, New York, NY, USA
| | | | | | - Emilia Bagiella
- Department of Population, Health Science and Policy, New York, NY, USA
| | - Myron E Schwartz
- The Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
36
|
Tuvin D, Berger Y, Aycart SN, Shtilbans T, Hiotis S, Labow DM, Sarpel U. Prophylactic hyperthermic intraperitoneal chemotherapy in patients with epithelial appendiceal neoplasms. Int J Hyperthermia 2016; 32:311-5. [PMID: 27050712 DOI: 10.3109/02656736.2016.1152514] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/29/2022] Open
Abstract
Background Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) is a promising approach for preventing peritoneal carcinomatosis in high-risk patients. We report our initial experience with prophylactic HIPEC in a series of patients with appendiceal neoplasms. Methods We retrospectively reviewed our prospectively maintained database to identify patients who underwent HIPEC in the absence of peritoneal disease. Patients with previously documented peritoneal surface disease were excluded. Data regarding clinical, operative and pathological features were analysed. Results Out of 322 HIPEC procedures performed between March 2007and August 2015, we identified 16 patients who underwent surgery with prophylactic intent. Primary diagnoses included high-grade and low-grade appendiceal neoplasms. Most patients presented originally with appendiceal perforation; all patients underwent initial surgery during which the appendix or right colon were resected. Following a median time interval of 2.2 months, a second surgery performed at our institution consisted of completion of omentectomy, partial colectomy and oophorectomy, with administration of prophylactic HIPEC (using mitomycin C). A totally laparoscopic approach was attempted and achieved in 11 patients in whom the median duration of surgery, estimated intraoperative blood loss and length of hospitalisation were 251 min, 100 cm(3) and 4 days, respectively. There were no cases of major perioperative morbidity or mortality. Conclusions Prophylactic HIPEC for appendiceal neoplasms is feasible, safe and may be performed laparoscopically. Larger studies with long-term follow-up are needed to determine whether a survival benefit is associated with this treatment.
Collapse
Affiliation(s)
- Daniel Tuvin
- a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York
| | - Yaniv Berger
- a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York
| | - Samantha N Aycart
- a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York
| | - Tatiana Shtilbans
- b Department of Pathology , Icahn School of Medicine at Mount Sinai , New York , USA
| | - Spiros Hiotis
- a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York
| | - Daniel M Labow
- a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York
| | - Umut Sarpel
- a Department of Surgery, Division of Surgical Oncology , Icahn School of Medicine at Mount Sinai , New York
| |
Collapse
|
37
|
Berger Y, Aycart S, Tabrizian P, Agmon Y, Mandeli J, Heskel M, Hiotis S, Sarpel U, Labow DM. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients with liver involvement. J Surg Oncol 2016; 113:432-7. [PMID: 26804119 DOI: 10.1002/jso.24153] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 12/16/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND We examined outcomes of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) combined with liver resection. METHODS All patients undergoing CRS/HIPEC between 2007 and 2014 were retrospectively reviewed: patients who underwent synchronous liver resection (group 1) were compared with those who did not (group 2) in terms of perioperative and long-term results. RESULTS Group 1 included 103 patients with colorectal cancer (CRC, n = 28), appendiceal cancer (n = 34), and other malignancies. Compared with group 2 (n = 166), group 1 had higher number of organs resected, increased intraoperative blood loss, and longer hospital stay (all P ≤ 0.004) but similar major morbidity (24.3% vs. 18.1%, P = 0.22) and perioperative mortality rates. Two patients from group 1 developed liver resection-related complications. A comparison between patients who underwent parenchymal liver resection (n = 42) and matched pairs from group 2 with similar extent of cytoreduction did not yield significant differences in morbidity/mortality. CRC patients from group 1 had poorer median overall survival (45.1 vs. 73.5 months from stage IV diagnosis, P = 0.009). CONCLUSIONS Liver involvement denotes high peritoneal carcinomatosis burden, which often requires resection of multiple organs in order to achieve optimal cytoreduction. However, liver resection-related morbidity is low and overall morbidity/mortality rates are comparable to other extensive CRS/HIPEC procedures. J. Surg. Oncol. 2016;113:432-437. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Yaniv Berger
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - Samantha Aycart
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - Parissa Tabrizian
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - Yahel Agmon
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - John Mandeli
- Department of Preventive Medicine, Mount Sinai School of Medicine, New York, New York
| | - Marina Heskel
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - Spiros Hiotis
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, New York
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Medical Center, New York, New York
| |
Collapse
|
38
|
Berger Y, Aycart S, Mandeli JP, Heskel M, Sarpel U, Labow DM. Extreme cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Outcomes from a single tertiary center. Surg Oncol 2015; 24:264-9. [DOI: 10.1016/j.suronc.2015.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/21/2015] [Indexed: 11/30/2022]
|
39
|
Berger Y, Nevler A, Shwaartz C, Lahat E, Zmora O, Gutman M, Shabtai M. Elevations of serum CA-125 predict severity of acute appendicitis in males. ANZ J Surg 2015; 86:260-3. [DOI: 10.1111/ans.13128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Yaniv Berger
- Department of Surgery and Transplantation; Chaim Sheba Medical Center; Tel-Hashomer Israel
| | - Avinoam Nevler
- Department of Surgery and Transplantation; Chaim Sheba Medical Center; Tel-Hashomer Israel
- The Dr. Pinchas Borenstein Talpiot Medical Leadership Program 2012; Chaim Sheba Medical Center; Tel-Hashomer Israel
| | - Chaya Shwaartz
- Department of Surgery and Transplantation; Chaim Sheba Medical Center; Tel-Hashomer Israel
| | - Eylon Lahat
- Department of Surgery and Transplantation; Chaim Sheba Medical Center; Tel-Hashomer Israel
| | - Oded Zmora
- Department of Surgery and Transplantation; Chaim Sheba Medical Center; Tel-Hashomer Israel
| | - Mordechai Gutman
- Department of Surgery and Transplantation; Chaim Sheba Medical Center; Tel-Hashomer Israel
| | - Moshe Shabtai
- Department of Surgery and Transplantation; Chaim Sheba Medical Center; Tel-Hashomer Israel
| |
Collapse
|
40
|
Berger Y, Superina RA, Zbar A, Balint-Lahat N, Horesh N, Bilik R. A case series of congenital hepatic hilar cyst: recommendations for diagnosis and management. Isr Med Assoc J 2015; 17:32-36. [PMID: 25739174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Congenital hepatic hilar cysts are rare. Some are simple and do not require intervention, but some biliary cystic malformations impose the risk of morbidity and mortality. OBJECTIVES To assess a series of five patients presenting with congenital hepatic hilar cysts. METHODS We retrospectively reviewed all cases presenting to our pediatric surgical service between January 2010 and December 2012 and found to have a congenital hepatic hilar cyst. Data regarding clinical, radiological, operative and pathological features were analyzed. RESULTS Five children with congenital cyst of the hepatic hilum were identified; four of them were diagnosed prenatally. Four children had undergone surgical intervention: one with intrahepatic choledochal cyst, one with epidermoid cyst, and two with biliary atresia and an associated cyst of the common bile duct. In another case of choledochal cyst the treatment was conservative. All children except one had a good prognosis; one child with biliary atresia required liver transplantation. CONCLUSIONS The differential diagnosis of congenital hepatic hilar cyst includes a broad spectrum of pathologies. It is essential to diagnose biliary atresia as early as possible. Signs such as smaller cysts in association with a hypoplastic gallbladder and direct hyperbilirubinemia may be suggestive of biliary atresia.
Collapse
|
41
|
Berger Y, Zbar AP, Lebedyev A, Levi Y, Nevler A, Aderka D, Golan T, Purim O, Brenner B, Natur M, Gutman M. [Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis of colorectal and appendiceal origin]. Harefuah 2014; 153:315-368. [PMID: 25095601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND We report our initial experience combining cytoreductive surgery (CRS) plus intraperitoneal chemotherapy with hyperthermia (HIPEC) in a selected group of patients presenting with disseminated peritoneal carcinomatosis (PC) of colorectaL or appendiceaL origin at a single tertiary referral institution. METHODS The study included patients who underwent CRS with HIPEC at the Sheba Medical Center between April 2009 and December 2011. The HIPEC technique was administered with the open Coliseum technique reaching a steady state of mitomycin-C delivery at 410 C for perfusion duration of 90 minutes. RESULTS AnaLysis included 45 patients (18 males) incorporating 42 cases of primary colorectal cancer (CRC) or appendiceal cancer and 3 cases of pseudomyxoma peritonei. Thirty-seven patients (82%) underwent CC-0 resections with a median overall hospital stay of 8 days (range 5-43). There was one perioperative death at 90 days. The perioperative complication rate was 31.1%. The median follow-up was 12 months (range 2-36) during which 13 patients died. Among the CRC and appendiceal cancer group the median overall survival was 20.2 months and the median progression free survival was 16.4 months (Kaplan-Meier analysis). During follow-up, 23 patients experienced disease progression. CONCLUSION The selective use of cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for patients with peritoneal carcinomatosis from colorectal or appendiceal origin is safe with acceptable morbidity and low mortality.
Collapse
|
42
|
Berger Y, Har Zahav Y, Kassif Y, Kogan A, Kuperstein R, Freimark D, Lavee J. Tricuspid valve regurgitation after orthotopic heart transplantation: prevalence and etiology. J Transplant 2012; 2012:120702. [PMID: 23097690 PMCID: PMC3477771 DOI: 10.1155/2012/120702] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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] [Received: 05/12/2012] [Revised: 07/13/2012] [Accepted: 07/27/2012] [Indexed: 01/22/2023] Open
Abstract
Background. Tricuspid valve regurgitation (TR) after orthotopic heart transplantation (OHT) is common. The aims of this study were to determine the prevalence of TR after OHT, to examine the correlation between its development and various variables, and to determine its outcomes. Methods. All 163 OHT patients who were followed up between 1988 and 2009 for a minimal period of 12 months were divided into those with no TR/mild TR and those with at least mild-moderate TR, as assessed by doppler echocardiography. These groups were compared regarding preoperative hemodynamic variables, surgical technique employed, number of endomyocardial biopsies, number of acute cellular rejections, incidence of graft vasculopathy, and clinical outcomes. Results. At the end of the followup (average 8.2 years) significant TR was evident in 14.1% of the patients. The development of late TR was found by univariate, but not multivariate, analysis to be significantly correlated with the biatrial surgical technique (P < 0.01) and the presence of graft vasculopathy (P < 0.001). TR development was found to be correlated with the need for tricuspid valve surgery but not with an increased mortality. Conclusions. The development of TR after OHT may be related to the biatrial anastomosis technique and to graft vasculopathy.
Collapse
Affiliation(s)
- Yaniv Berger
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Yedael Har Zahav
- Heart Institute, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Yigal Kassif
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Alexander Kogan
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Rafael Kuperstein
- Heart Institute, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Dov Freimark
- Heart Institute, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| | - Jacob Lavee
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, and the Sackler Faculty of Medicine, Tel Aviv University, 52621 Ramat Gan, Israel
| |
Collapse
|
43
|
Srinivasan S, Dollin M, McAllum P, Berger Y, Rootman DS, Slomovic AR. Fibrin glue versus sutures for attaching the conjunctival autograft in pterygium surgery: a prospective observer masked clinical trial. Br J Ophthalmol 2008; 93:215-8. [DOI: 10.1136/bjo.2008.145516] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
44
|
Sion R, Schumer A, Van Durme E, Gouyette A, Geslin M, Fournier JP, Berger Y, Roger P. Synthese du methyl [(chloro-2 ethyl)-3 nitroso-3 ureido]-3 didesoxy-2, 3 α-D-arabino-hexopyrannoside marque AU carbone-14 OU −AU carbone-13 (CY 233 - SR 90098). J Labelled Comp Radiopharm 2006. [DOI: 10.1002/jlcr.2580280605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
45
|
Pointeau P, Berger Y. Synthesis of [2-14C] fantofarone or 1-[4-[3-N-methyl N-[3,4-dimethyl β-phenethyl] amino propyloxy] benzene sulfonyl]-2-isopropyl [2-14C] indolizine. J Labelled Comp Radiopharm 2006. [DOI: 10.1002/jlcr.2580341104] [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: 11/06/2022]
|
46
|
Berger Y, Greppi A, Siri O, Neier R, Juillerat-Jeanneret L. Ethylene glycol and amino acid derivatives of 5-aminolevulinic acid as new photosensitizing precursors of protoporphyrin IX in cells. J Med Chem 2000; 43:4738-46. [PMID: 11123982 DOI: 10.1021/jm000981q] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Protoporphyrin IX (PpIX) is used as a photosensitizing agent in photodynamic detection and therapy (PDT) of cancer and is synthesized intracellularly from aminolevulinic acid (ALA) precursors. To evaluate means to specifically target ALA derivatives to defined cells, we have synthesized and characterized ethylene glycol esters and amino acid pseudodipeptide derivatives of ALA as potential specific substrates for cellular esterases and aminopeptidases, respectively. The PpIX formation induced by these products was investigated using cultures of human and rat cell lines of carcinoma and endothelial origins. The cytotoxicity of these compounds in the absence of light was also controlled. The results have shown that ethylenglycol esters can induce high levels of PpIX and are useful at concentrations below their cytotoxicity threshold. From the ALA-amino acid derivatives which were evaluated, the highest PpIX production was obtained using ALA derivatives of neutral amino acids, as compared to acidic or basic amino acids.
Collapse
Affiliation(s)
- Y Berger
- Institute of Chemistry, Neuchâtel University, avenue de Bellevaux, P.O. Box 2, CH-2007 Neuchâtel, Switzerland
| | | | | | | | | |
Collapse
|
47
|
Reist M, Roy-de Vos M, Montseny JP, Mayer JM, Carrupt PA, Berger Y, Testa B. Very slow chiral inversion of clopidogrel in rats: a pharmacokinetic and mechanistic investigation. Drug Metab Dispos 2000; 28:1405-10. [PMID: 11095576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Clopidogrel hydrogen sulfate, a thienopyridine derivative, is an ADP receptor antagonist that inhibits platelet aggregation. Clopidogrel is an enantiopure carboxylic ester of S-configuration. The R-enantiomer is devoid of antithrombotic activity and can provoke convulsions at high doses in animals. During preclinical safety evaluation, the possible chiral inversion of clopidogrel has, therefore, been investigated in vivo after repeated oral administration of different dose levels of clopidogrel to male and female rats. Due to rapid metabolism in the liver and low plasma levels of unchanged drug, possible chiral inversion was assessed by monitoring the plasma concentrations of the carboxylic acid metabolites, i.e., the (S)- and (R)-acid, by means of a stereoselective assay. The production of 4 to 8% of (R)-acid was observed. This could be the result of chiral inversion of either clopidogrel or its main metabolite, the (S)-acid. Thus, the possibility of nonenzymatic and enzymatic inversion of clopidogrel and its carboxylic acid metabolite was studied in vitro by chiral HPLC and (1)H NMR. Nonenzymatic chiral inversion of clopidogrel at 37 degrees C in 0.1 M phosphate buffers could be observed but was found to be slow, with estimated half-lives of 7 to 12 days, depending on the pH. The (S)-acid was configurationally fully stable up to 45 days in phosphate buffers. Neither clopidogrel nor its carboxylic acid metabolites were subject to enzymatic chiral inversion in isolated rat hepatocyte suspensions. We conclude that the nonenzymatic inversion of clopidogrel accounts for the 4 to 8% of chiral inversion seen in vivo in the rat.
Collapse
Affiliation(s)
- M Reist
- Université de Lausanne, Institut de Chimie Thérapeutique, Ecole de Pharmacie, Lausanne, Switzerland
| | | | | | | | | | | | | |
Collapse
|
48
|
Meunier V, Bourrié M, Julian B, Marti E, Guillou F, Berger Y, Fabre G. Expression and induction of CYP1A1/1A2, CYP2A6 and CYP3A4 in primary cultures of human hepatocytes: a 10-year follow-up. Xenobiotica 2000; 30:589-607. [PMID: 10923861 DOI: 10.1080/004982500406426] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
1. The aims were to refine experimental conditions (using 76 human hepatocyte preparations) in terms of the selection of enzyme inducers and their optimal concentration, the treatment duration with inducers and the choice of specific cytochrome P450 isoform(s) probes to optimize the use of primary hepatocytes for predicting the potential induction by new chemical entities of cytochrome P450 isoforms in vivo in man. 2. In the absence of any inducer, basal cytochrome P450 isoform(s)-mediated activities decreased to 20% of their initial activity (end of the seeding period) by 72-96 h. In contrast, UGT-dependent enzyme activities remained at a constant level (+/- 20%) up to the fifth day of culture. 3. Beta-naphthoflavone, at an optimal concentration of 50 microM and after a 3-day treatment, specifically and potently induced 7-ethoxyresorufin (10.4 +/- 10.4-fold, n = 74) and phenacetin (6.6 +/- 6.4-fold, n = 60) O-deethylation processes, markers for CYP1A1 and CYP1A2 isoforms respectively. Only a 2-fold increase was noted following treatment with 2 mM phenobarbitone, whereas dexamethasone and rifampicin had no effect at all. 4. A 3-day treatment of human hepatocytes with 50 microM dexamethasone was associated with a major induction of both coumarin 7-hydroxylation (9.4 +/- 11.4-fold, n = 49) and nifedipine dehydrogenation (4.7 +/- 3.8-fold, n = 61), markers for CYP2A6 and CYP3A4 respectively. Phenobarbitone, however, exhibited a broad but moderate inducing effect on 7-ethoxyresorufin (2.2 +/- 1.5-fold, n = 55) and phenacetin (1.7 +/- 0.9-fold, n = 54) O-deethylation, coumarin 7-hydroxylation (3.9 +/- 9.2-fold, n = 50) and nifedipine dehydrogenation (2.1 +/- 2.0-fold, n = 47). 5. Km obtained for the different cytochrome P450 isoform substrates in untreated hepatocytes were in the same range of magnitude that those determined on human hepatic microsomal fractions. Enzyme induction processes were characterized by a large increase in apparent Vmax whereas apparent Km were not affected. 6. These studies demonstrate that human hepatocytes in primary culture can respond specifically and quantitatively to model inducers. This in vitro system offers a useful approach to study the regulation of human hepatic biotransformation activities and should facilitate the demand for a reproducible method for addressing cytochrome P450 induction.
Collapse
Affiliation(s)
- V Meunier
- Sanofi Recherche, Department of Preclinical Metabolism and Pharmacokinetics, Montpellier, France
| | | | | | | | | | | | | |
Collapse
|
49
|
Davi H, Tronquet C, Miscoria G, Perrier L, DuPont P, Caix J, Simiand J, Berger Y. Disposition of irbesartan, an angiotensin II AT1-receptor antagonist, in mice, rats, rabbits, and macaques. Drug Metab Dispos 2000; 28:79-88. [PMID: 10611144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
Metabolism and disposition of irbesartan, an angiotensin II AT(1) receptor antagonist, were investigated in mice, rats, rabbits, and macaques. In both rats and macaques, irbesartan was characterized by a rapid oral absorption, a large volume of distribution, a low plasma clearance, and a long terminal half-life. The oral bioavailability in macaques was notably higher than in rats. Irbesartan was highly protein bound in rats and macaques. A lower binding rate was found in mice and rabbits. In distribution studies performed in rats, mice, and rabbits, irbesartan was rapidly distributed into most organs and tissues including brain, intrauterine area, and milk. No retention of radioactivity in tissues other than liver and kidney was noted. Irbesartan was the main circulating compound in rats, rabbits, and macaques representing a maximum of 67, 68, and 80% of plasma radioactivity, respectively. The drug was metabolized mainly by glucuronidation (primarily on the tetrazole ring), hydroxylation, and additional oxidation. The overall pathways within the different species generated 18 metabolites identified from bile, urine, and feces samples. Irbesartan did not significantly induce or inhibit most of the isoenzymes commonly associated with drug metabolism in either rats or macaques after oral administration for 1 month. In most species irbesartan and its metabolites were mainly excreted in feces with more than 80% of a radioactive dose recovered within 24 or 48 h. Enterohepatic circulation was demonstrated in rats and macaques.
Collapse
Affiliation(s)
- H Davi
- Preclinical Drug Metabolism and Pharmacokinetics, Sanofi, Montpellier, France.
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Abstract
The disposition of tiludronate in mouse, rat, rabbit, dog and monkey has been studied after oral and intravenous doses. Like other bisphosphonates, tiludronate was characterized by poor absorption from the gastrointestinal tract. Peak plasma concentrations appeared shortly (0.5-1 h) after dosing, except for the baboon (4.5 h). Food intake highly impaired intestinal absorption The affinity of tiludronate for bone and the slow release from this deep compartment could account for the large volume of distribution and the low plasma clearance found in all species. Tiludronate has low affinity for red blood cells and binds moderately to serum proteins, mainly to serum albumin. Calcified tissues appeared to be the main target for deposition. Distribution into bone was not homogenous, with higher levels in the trabecular bone than in the corticol part of the long bones. The uptake of tiludronate into bone was unequivocally less in the older animal. No metabolism occurred in the tested animal species. The major route of elimination of the absorbed drug is urine. Preclinical observations made with tiludronate, like with other bisphosphonates, were predictive of results obtained in clinical investigation.
Collapse
Affiliation(s)
- H Davi
- Sanofi Recherche, Montpellier, France.
| | | | | | | | | | | | | |
Collapse
|