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Vulasala SS, Virarkar M, Gopireddy D, Waters R, Alkhasawneh A, Awad Z, Maxwell J, Ramani N, Kumar S, Onteddu N, Morani AC. Small Bowel Neuroendocrine Neoplasms-A Review. J Comput Assist Tomogr 2023:00004728-990000000-00270. [PMID: 38110305 DOI: 10.1097/rct.0000000000001541] [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: 12/20/2023]
Abstract
ABSTRACT Neuroendocrine neoplasms (NENs) are rapidly evolving small bowel tumors, and the patients are asymptomatic at the initial stages. Metastases are commonly observed at the time of presentation and diagnosis. This review addresses the small bowel NEN (SB-NEN) and its molecular, histological, and imaging features, which aid diagnosis and therapy guidance. Somatic cell number alterations and epigenetic mutations are studied to be responsible for sporadic and familial SB-NEN. The review also describes the grading of SB-NEN in addition to rare histological findings such as mixed neuroendocrine-non-NENs. Anatomic and nuclear imaging with conventional computed tomography, magnetic resonance imaging, computed tomographic enterography, and positron emission tomography are adopted in clinical practice for diagnosing, staging, and follow-up of NEN. Along with the characteristic imaging features of SB-NEN, the therapeutic aspects of imaging, such as peptide receptor radionuclide therapy, are discussed in this review.
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Affiliation(s)
- Sai Swarupa Vulasala
- From the Department of Radiology, University of Florida College of Medicine, Jacksonville
| | - Mayur Virarkar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Dheeraj Gopireddy
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Rebecca Waters
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ziad Awad
- Surgery, University of Florida College of Medicine, Jacksonville, FL
| | - Jessica Maxwell
- Department of Surgical Oncology, University of Texas MD Anderson Cancer Center
| | - Nisha Ramani
- Department of Pathology, Michael E. DeBakey VA Medical Center, Houston, TX
| | - Sindhu Kumar
- Department of Radiology, University of Florida College of Medicine, Jacksonville, FL
| | - Nirmal Onteddu
- Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX
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2
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Ceppa EP, Collings AT, Abdalla M, Onkendi E, Nelson DW, Ozair A, Miraflor E, Rahman F, Whiteside J, Shah MM, Ayloo S, Dirks R, Kumar SS, Ansari MT, Sucandy I, Ali K, Douglas S, Polanco PM, Vreeland TJ, Buell J, Abou-Setta AM, Awad Z, Kwon CH, Martinie JB, Sbrana F, Pryor A, Slater BJ, Richardson W, Jeyarajah R, Alseidi A. SAGES/AHPBA guidelines for the use of microwave and radiofrequency liver ablation for the surgical treatment of hepatocellular carcinoma or colorectal liver metastases less than 5 cm. Surg Endosc 2023; 37:8991-9000. [PMID: 37957297 DOI: 10.1007/s00464-023-10468-1] [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: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the liver's two most common malignant neoplasms. Liver-directed therapies such as ablation have become part of multidisciplinary therapies despite a paucity of data. Therefore, an expert panel was convened to develop evidence-based recommendations regarding the use of microwave ablation (MWA) and radiofrequency ablation (RFA) for HCC or CRLM less than 5 cm in diameter in patients ineligible for other therapies. METHODS A systematic review was conducted for six key questions (KQ) regarding MWA or RFA for solitary liver tumors in patients deemed poor candidates for first-line therapy. Subject experts used the GRADE methodology to formulate evidence-based recommendations and future research recommendations. RESULTS The panel addressed six KQs pertaining to MWA vs. RFA outcomes and laparoscopic vs. percutaneous MWA. The available evidence was poor quality and individual studies included both HCC and CRLM. Therefore, the six KQs were condensed into two, recognizing that these were two disparate tumor groups and this grouping was somewhat arbitrary. With this significant limitation, the panel suggested that in appropriately selected patients, either MWA or RFA can be safe and feasible. However, this recommendation must be implemented cautiously when simultaneously considering patients with two disparate tumor biologies. The limited data suggested that laparoscopic MWA of anatomically more difficult tumors has a compensatory higher morbidity profile compared to percutaneous MWA, while achieving similar overall 1-year survival. Thus, either approach can be appropriate depending on patient-specific factors (very low certainty of evidence). CONCLUSION Given the weak evidence, these guidelines provide modest guidance regarding liver ablative therapies for HCC and CRLM. Liver ablation is just one component of a multimodal approach and its use is currently limited to a highly selected population. The quality of the existing data is very low and therefore limits the strength of the guidelines.
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Affiliation(s)
- Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
| | - Amelia T Collings
- Hiram C. Polk, Jr. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Moustafa Abdalla
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Edwin Onkendi
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Daniel W Nelson
- Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA
| | - Ahmad Ozair
- King George's Medical University, Lucknow, India
| | - Emily Miraflor
- UCSF East Bay Department of Surgery, UCSF, Oakland, CA, USA
| | - Faique Rahman
- Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, India
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University Winship Cancer Institute, Atlanta, GA, USA
| | | | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Sunjay S Kumar
- Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Kchaou Ali
- Department of Surgery A, Sfax Medical School, Sfax, Tunisia
| | - Sam Douglas
- Department of Surgery, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Patricio M Polanco
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Joseph Buell
- Department of Surgery, Mission Health Care System, Asheville, NC, USA
| | | | - Ziad Awad
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - Choon Hyuck Kwon
- Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA
| | | | - Fabio Sbrana
- Department of Surgery, Chicago Medical School, Rosalind Franklin University, Chicago, IL, USA
| | - Aurora Pryor
- Department of Surgery, Long Island Jewish Medical Center, Northwell Health, Great Neck, NY, USA
| | | | | | | | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, CA, USA
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3
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Aboushelib MF, Morcos AB, Nawar S, Shalabiea OM, Awad Z. UBVRI night sky brightness at Kottamia Astronomical Observatory. Sci Rep 2023; 13:16754. [PMID: 37798327 PMCID: PMC10556021 DOI: 10.1038/s41598-023-43844-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/28/2023] [Indexed: 10/07/2023] Open
Abstract
Photoelectric observations of night sky brightness (NSB) at different zenith distances and azimuths, covering all the sky, at the Egyptian Kottamia Astronomical observatory (KAO) site of coordinates ϕ = 29° 55.9' N and λ = 31° 49.5' E, were done using a fully automated photoelectric photometer (FAPP). The Bessel wide range system (UBVRI) is used for the first time to observe NSB for three consecutive nights (1-3 August, 2022) under good seeing conditions after the moon sets. The deduced results were taken in photons and converted into mag/arcsec2. The average zenith sky brightness for U, B, V, R and I filters are found to be 20.49, 20.38, 19.41, 18.60 and 17.94 mag/arcsec2 respectively. The average color indices (U-B), (B-V), (V-R) and (R-I), at the zenith are detected to be 0.11, 0.98, 0.81 and 0.66, respectively. We plotted the isophotes of the sky brightness at KAO in U, B, V, R and I colors (filters) and determined both the average atmospheric extinction and sky transparency through these UBVRI filters. The atmospheric and other meteorological conditions were taken into our consideration during the observational nights. The results of the current study illustrate the main impact of the new cities built around KAO on the sky glow over it, and which astronomical observations are affected.
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Affiliation(s)
| | - A B Morcos
- National Research Institute of Astronomy and Geophysics, Helwan, Cairo, Egypt
| | - S Nawar
- National Research Institute of Astronomy and Geophysics, Helwan, Cairo, Egypt
| | - O M Shalabiea
- Astronomy, Space Science and Meteorology Department, Faculty of Science, Cairo University, Giza, Egypt
- Faculty of Navigation Science and Space Technology, Beni-Suef University, Beni-Suef, Egypt
| | - Z Awad
- Astronomy, Space Science and Meteorology Department, Faculty of Science, Cairo University, Giza, Egypt
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Pather K, Mobley EM, Alabbas HH, Awad Z. A Comparison of Whipple Outcomes Between a Safety-Net Hospital and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in African Americans. Cureus 2023; 15:e43487. [PMID: 37588132 PMCID: PMC10425274 DOI: 10.7759/cureus.43487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 08/14/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose The aim of this study was to compare 30-day adverse events following pancreaticoduodenectomy between our safety-net hospital and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) in a matched cohort of Black/African American (AA) patients. Methods We retrospectively reviewed consecutive Black/AA patients undergoing pancreaticoduodenectomies from 2015 to 2020 at our safety-net institution. The corresponding patients from the ACS-NSQIP (2015-2019) were queried. Propensity-score matching was performed between safety-net and ACS-NSQIP Black/AA cohorts to equate baseline characteristics, and 30-day outcomes were compared between propensity-matched cohorts. Results Thirty-two Black/AAs (16 females; 62.1±10.7 years) were identified from 128 patients undergoing pancreaticoduodenectomies at our safety-net institution and were propensity-score matched to 32 ACS-NSQIP patients. After matching, baseline characteristics did not significantly differ between cohorts. Postoperatively, surgical site infections, wound disruptions, respiratory events, cardiovascular events, urinary tract infections, acute renal failure, sepsis, delayed gastric emptying, and pancreatic fistulas were not significantly different between our safety-net and ACS-NSQIP cohorts. Our length of stay (LOS) was longer (17.0(12.3-27.0) versus 10.0(7.0-16.0) days); however, patients with a LOS>30 days were comparable. Furthermore, 30-day readmissions were similar, and 30-day reoperations were lower (p=0.03) at our safety-net institution. Conclusions Black/AA patients who underwent pancreatectomies at a safety-net hospital had similar outcomes and fewer reoperations compared to a corresponding national cohort. Although we illustrate comparable outcomes, clinical pathways to mitigate and alleviate health disparities in marginalized populations at a safety-net hospital should be emphasized to continue improving outcomes.
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Affiliation(s)
- Keouna Pather
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Erin M Mobley
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Haytham H Alabbas
- Surgery/General and Oncology Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, SAU
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
| | - Ziad Awad
- Surgery, University of Florida College of Medicine - Jacksonville, Jacksonville, USA
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Alkhasawneh A, Rashid T, Mohammed I, Elhaddad B, Al-Balas H, Virarkar M, Awad Z, Baskovich B, Gopinath A. The prognostic significance of duodenal wall invasion in pancreatic adenocarcinoma. World J Surg Oncol 2023; 21:79. [PMID: 36872330 PMCID: PMC9987094 DOI: 10.1186/s12957-023-02962-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/23/2023] [Indexed: 03/07/2023] Open
Abstract
OBJECTIVE The most recent edition of the American Joint Committee on Cancer Staging Manual (AJCC, 8th edition) relies only on tumor size for staging resectable pancreatic adenocarcinoma, and the presence of duodenal wall invasion (DWI) no longer has an impact on staging. However, very few studies have evaluated its significance. In this study, we aim to evaluate the prognostic significance of DWI in pancreatic adenocarcinoma. METHODS We reviewed 97 consecutive internal cases of resected pancreatic head ductal adenocarcinoma, and clinicopathologic parameters were recorded. All cases were staged according to the 8th edition of AJCC, and the patients were divided into two groups based on the presence or absence of DWI. RESULTS Out of our 97 cases, 53 patients had DWI (55%). In univariate analysis, DWI was significantly associated with lymphovascular invasion and lymph node metastasis (AJCC 8th edition pN stage). In univariate analysis of overall survival, age > 60, absence of DWI, and African American race were associated with worse overall survival. In multivariate analysis, age > 60, absence of DWI, and African American race were associated with worse progression-free survival and overall survival. CONCLUSION Although DWI is associated with lymph node metastasis, it is not associated with inferior disease-free/overall survival.
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Affiliation(s)
| | - Tasnuva Rashid
- UF Health Jacksonville, 655 W 8th st, Jacksonville, FL, USA
| | | | - Basma Elhaddad
- UF Health Jacksonville, 655 W 8th st, Jacksonville, FL, USA
| | | | - Mayur Virarkar
- UF Health Jacksonville, 655 W 8th st, Jacksonville, FL, USA
| | - Ziad Awad
- UF Health Jacksonville, 655 W 8th st, Jacksonville, FL, USA. .,University of Florida College of Medicine, Jacksonville, 653 West 8th Street, Jacksonville, FL, 32209, USA.
| | | | - Arun Gopinath
- UF Health Jacksonville, 655 W 8th st, Jacksonville, FL, USA
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6
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Vreeland TJ, Collings AT, Ozair A, Adams AM, Dirks R, Kushner BS, Sucandy I, Morrell D, Whiteside J, Ansari MT, Cloyd J, Cleary SP, Ceppa E, Abou-Setta AM, Alseidi A, Awad Z, Ayloo S, Buell J, Orthopoulos G, Richardson W, Sbayi S, Wakabayashi G, Asbun H, Slater BJ, Pryor AD, Jeyarajah DR. SAGES/AHPBA guidelines for the use of minimally invasive surgery for the surgical treatment of colorectal liver metastases (CRLM). Surg Endosc 2023; 37:2508-2516. [PMID: 36810687 DOI: 10.1007/s00464-023-09895-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/16/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Colorectal liver metastases (CRLM) occur in roughly half of patients with colorectal cancer. Minimally invasive surgery (MIS) has become an increasingly acceptable and utilized technique for resection in these patients, but there is a lack of specific guidelines on the use of MIS hepatectomy in this setting. A multidisciplinary expert panel was convened to develop evidence-based recommendations regarding the decision between MIS and open techniques for the resection of CRLM. METHODS Systematic review was conducted for two key questions (KQ) regarding the use of MIS versus open surgery for the resection of isolated liver metastases from colon and rectal cancer. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Additionally, the panel developed recommendations for future research. RESULTS The panel addressed two KQs, which pertained to staged or simultaneous resection of resectable colon or rectal metastases. The panel made conditional recommendations for the use of MIS hepatectomy for both staged and simultaneous resection when deemed safe, feasible, and oncologically effective by the surgeon based on the individual patient characteristics. These recommendations were based on low and very low certainty of evidence. CONCLUSIONS These evidence-based recommendations should provide guidance regarding surgical decision-making in the treatment of CRLM and highlight the importance of individual considerations of each case. Pursuing the identified research needs may help further refine the evidence and improve future versions of guidelines for the use of MIS techniques in the treatment of CRLM.
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Affiliation(s)
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, San Antonio, TX, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - David Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jordan Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | | | - Joseph Buell
- Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA
| | - Georgios Orthopoulos
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Worcester, USA
| | | | - Samer Sbayi
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan
| | - Horacio Asbun
- Baptist Health Miami Cancer Institute, Miami, FL, USA
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, USA
| | - Aurora D Pryor
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
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7
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Abdalla M, Collings AT, Dirks R, Onkendi E, Nelson D, Ozair A, Miraflor E, Rahman F, Whiteside J, Shah MM, Ayloo S, Abou-Setta A, Sucandy I, Kchaou A, Douglas S, Polanco P, Vreeland T, Buell J, Ansari MT, Pryor AD, Slater BJ, Awad Z, Richardson W, Alseidi A, Jeyarajah DR, Ceppa E. Surgical approach to microwave and radiofrequency liver ablation for hepatocellular carcinoma and colorectal liver metastases less than 5 cm: a systematic review and meta-analysis. Surg Endosc 2022; 37:3340-3353. [PMID: 36542137 DOI: 10.1007/s00464-022-09815-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Primary hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) represent the two most common malignant neoplasms of the liver. The objective of this study was to assess outcomes of surgical approaches to liver ablation comparing laparoscopic versus percutaneous microwave ablation (MWA), and MWA versus radiofrequency ablation (RFA) in patients with HCC or CRLM lesions smaller than 5 cm. METHODS A systematic review was conducted across seven databases, including PubMed, Embase, and Cochrane, to identify all comparative studies between 1937 and 2021. Two independent reviewers screened for eligibility, extracted data for selected studies, and assessed study bias using the modified Newcastle Ottawa Scale. Random effects meta-analyses were subsequently performed on all available comparative data. RESULTS From 1066 records screened, 11 studies were deemed relevant to the study and warranted inclusion. Eight of the 11 studies were at high or uncertain risk for bias. Our meta-analyses of two studies revealed that laparoscopic MW ablation had significantly higher complication rates compared to a percutaneous approach (risk ratio = 4.66; 95% confidence interval = [1.23, 17.22]), but otherwise similar incomplete ablation rates, local recurrence, and oncologic outcomes. The remaining nine studies demonstrated similar efficacy of MWA and RFA, as measured by incomplete ablation, complication rates, local/regional recurrence, and oncologic outcomes, for both HCC and CRLM lesions less than 5 cm (p > 0.05 for all outcomes). There was no statistical subgroup interaction in the analysis of tumors < 3 cm. CONCLUSION The available comparative evidence regarding both laparoscopic versus percutaneous MWA and MWA versus RFA is limited, evident by the few studies that suffer from high/uncertain risk of bias. Additional high-quality randomized trials or statistically matched cohort studies with sufficient granularity of patient variables, institutional experience, and physician specialty/training will be useful in informing clinical decision making for the ablative treatment of HCC or CRLM.
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Affiliation(s)
- Moustafa Abdalla
- Department of Surgery, Harvard Medical School & Massachusetts General Hospital, Boston, MA, USA
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Edwin Onkendi
- Department of Surgery, Texas Tech University Health Sciences, Lubbock, TX, USA
| | - Daniel Nelson
- Department of Surgery, William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Ahmad Ozair
- King George's Medical University, Chowk, Lucknow, India
| | - Emily Miraflor
- Department of Surgery, University of California, San Francisco - East Bay, CA, USA
| | - Faique Rahman
- Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, India
| | - Jake Whiteside
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA
| | - Mihir M Shah
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Winship Cancer Institute, Atlanta, GA, USA
| | - Subhashini Ayloo
- Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Ahmed Abou-Setta
- Knowledge Synthesis, University of Manitoba, Winnipeg, MB, Canada
| | - Iswanto Sucandy
- Department of Surgery, University of Central Florida, Tampa, FL, USA
| | - Ali Kchaou
- Department of Surgery, University of Sfax, Sfax, Tunisia
| | | | - Patricio Polanco
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Timothy Vreeland
- Department of Surgery, Brooke Army Medical Center, Houston, TX, USA
| | - Joseph Buell
- Department of Surgery and Pediatrics, Tulane University, New Orleans, LA, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Aurora D Pryor
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | | | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU and UNTHSC School of Medicine, Fort Worth, TX, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University School of Medicine, I545 Barnhill Dr, EH541, Indianapolis, IN, 46202, USA.
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8
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Rutenberg MS, Hoppe BS, Starr JS, Awad Z, Thomas M, Morris CG, Johnson P, Henderson RH, Jones JC, Gharia B, Bowers S, Wolfsen HC, Krishnan S, Ko SJ, Babiker HM, Nichols RC. Proton Therapy With Concurrent Chemotherapy for Thoracic Esophageal Cancer: Toxicity, Disease Control, and Survival Outcomes. Int J Part Ther 2022; 9:18-29. [PMID: 36721483 PMCID: PMC9875824 DOI: 10.14338/ijpt-22-00021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/26/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose When treating esophageal cancer with radiation therapy, it is critical to limit the dose to surrounding structures, such as the lung and/or heart, as much as possible. Proton radiation therapy allows a reduced radiation dose to both the heart and lungs, potentially reducing the risk of cardiopulmonary toxicity. Here, we report disease control, survival, and toxicity outcomes among patients with esophageal cancer treated with proton radiation therapy and concurrent chemotherapy (chemoradiation therapy; CRT) with or without surgery. Materials and Methods We enrolled 17 patients with thoracic esophageal carcinoma on a prospective registry between 2010 and 2021. Patients received proton therapy to a median dose of 50.4-GyRBE (range, 50.4-64.8) in 1.8-Gy fractions.Acute and late toxicities were graded per the Common Terminology Criteria for Adverse Events, version 4.0 (US National Cancer Institute, Bethesda, Maryland). In addition, disease control, patterns of failure, and survival outcomes were collected. Results Nine patients received preoperative CRT, and 8 received definitive CRT. Overall, 88% of patients had adenocarcinoma, and 12% had squamous cell carcinoma. With a median follow-up of 2.1 years (range, 0.5-9.4), the 3-year local progression-free, disease-free, and overall survival rates were 85%, 66%, and 55%, respectively. Two patients (1 with adenocarcinoma and 1 with squamous cell carcinoma) recurred at the primary site after refusing surgery after a complete clinical response to CRT. The most common acute nonhematologic and hematologic toxicities, respectively, were grades 1 to 3 esophagitis and grades 1 to 4 leukopenia, both affecting 82% of patients. No acute cardiopulmonary toxicities were observed in the absence of surgical resection. Reagarding surgical complications, 3 postoperative cardiopulmonary complications occurred as follows: 1 grade 1 pleural effusion, 1 grade 3 pleural effusion, and 1 grade 2 anastomotic leak. Two severe late CRT toxicities occurred: 1 grade 5 tracheoesophageal fistula and 1 grade 3 esophageal stenosis requiring a feeding tube. Conclusion Proton radiation therapy is a safe, effective treatment for esophageal cancer with increasing evidence supporting its role in reducing cardiopulmonary toxicity.
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Affiliation(s)
| | - Bradford S. Hoppe
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Jason S. Starr
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Mathew Thomas
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Christopher G. Morris
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Perry Johnson
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Randal H. Henderson
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Jeremy C. Jones
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Bharatsinh Gharia
- Department of Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Steven Bowers
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | - Herbert C. Wolfsen
- Department of Gastroenterology and Hepatology, Mayo Clinic Jacksonville, FL, USA
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Stephen J. Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Hani M. Babiker
- Division of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Romaine C. Nichols
- Department of Radiation Oncology, University of Florida College of Medicine, Jacksonville, FL, USA
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9
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Ozair A, Collings A, Adams AM, Dirks R, Kushner BS, Sucandy I, Morrell D, Abou-Setta AM, Vreeland T, Whiteside J, Cloyd JM, Ansari MT, Cleary SP, Ceppa E, Richardson W, Alseidi A, Awad Z, Ayloo S, Buell JF, Orthopoulos G, Sbayi S, Wakabayashi G, Slater BJ, Pryor A, Jeyarajah DR. Minimally invasive versus open hepatectomy for the resection of colorectal liver metastases: a systematic review and meta-analysis. Surg Endosc 2022; 36:7915-7937. [PMID: 36138246 DOI: 10.1007/s00464-022-09612-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 05/19/2022] [Accepted: 09/05/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND While surgical resection has a demonstrated utility for patients with colorectal liver metastases (CRLM), it is unclear whether minimally invasive surgery (MIS) or an open approach should be used. This review sought to assess the efficacy and safety of MIS versus open hepatectomy for isolated, resectable CRLM when performed separately from (Key Question (KQ) 1) or simultaneously with (KQ2) the resection of the primary tumor. METHODS PubMed, Embase, Google Scholar, Cochrane CENTRAL, International Clinical Trials Registry Platform (ICTRP), and ClinicalTrials.gov databases were searched to identify both randomized controlled trials (RCTs) and non-randomized comparative studies published during January 2000-September 2020. Two independent reviewers screened literature for eligibility, extracted data from included studies, and assessed internal validity using the Cochrane Risk of Bias 2.0 Tool and the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed using risk ratios (RR) and mean differences (MD). RESULTS From 2304 publications, 35 studies were included for meta-analysis. For staged resections, three RCTs and 20 observational studies were included. Data from RCTs indicated MIS having similar disease-free survival (DFS) at 1-year (RR 1.03, 95%CI 0.70-1.50), overall survival (OS) at 5-years (RR 1.04, 95%CI 0.84-1.28), fewer complications of Clavien-Dindo Grade III (RR 0.62, 95%CI 0.38-1.00), and shorter hospital length of stay (LOS) (MD -6.6 days, 95%CI -10.2, -3.0). For simultaneous resections, 12 observational studies were included. There was no evidence of a difference between MIS and the open group for DFS-1-year, OS-5-year, complications, R0 resections, blood transfusions, along with lower blood loss (MD -177.35 mL, 95%CI -273.17, -81.53) and shorter LOS (MD -3.0 days, 95%CI -3.82, -2.17). CONCLUSIONS Current evidence regarding the optimal approach for CRLM resection demonstrates similar oncologic outcomes between MIS and open techniques, however MIS hepatectomy had a shorter LOS, lower blood loss and complication rate, for both staged and simultaneous resections.
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Affiliation(s)
- Ahmad Ozair
- Faculty of Medicine, King George's Medical University, Uttar Pradesh, Lucknow, India
| | - Amelia Collings
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Alexandra M Adams
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Rebecca Dirks
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Bradley S Kushner
- Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Iswanto Sucandy
- Digestive Health Institute, AdventHealth Tampa, Tampa, FL, USA
| | - David Morrell
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Timothy Vreeland
- Department of Surgery, Brooke Army Medical Centre, Fort Sam Houston, San Antonio, TX, USA
| | - Jake Whiteside
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | - Jordan M Cloyd
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sean P Cleary
- Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eugene Ceppa
- Department of Surgery, Indiana University, Indianapolis, IN, USA
| | | | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Subhashini Ayloo
- Department of Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Joseph F Buell
- Division of Surgery, Mission Healthcare System, HCA Healthcare, Asheville, NC, USA
| | - Georgios Orthopoulos
- Department of Surgery, University of Massachusetts Chan Medical School-Baystate, Springfield, MA, USA
| | - Samer Sbayi
- Department of Surgery, Renaissance School of Medicine, Stony Brook University, New York, NY, USA
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Department of Surgery, Ageo Central General Hospital, Ageo City, Japan
| | - Bethany J Slater
- Department of Surgery, University of Chicago Medicine, Chicago, IL, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook University, Stony Brook, NY, USA
| | - D Rohan Jeyarajah
- Department of Surgery, TCU School of Medicine, and Methodist Richardson Medical Center, 2805 East President George Bush Highway, Fort Worth, TX, USA.
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10
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Cheema BS, Ghali M, Schey R, Awad Z, Ribeiro B. Esophageal Perforation after Using a Single-Use Disposable Duodenoscope. Case Rep Gastroenterol 2021; 15:972-977. [PMID: 35110984 PMCID: PMC8787548 DOI: 10.1159/000519685] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022] Open
Abstract
The Food and Drug Administration (FDA) has recently released a safety communication recommending transition to duodenoscopes with innovative designs that facilitate or eliminate the need for reprocessing. Thus, there has been a significant amount of development into disposable duodenoscope components and single-use duodenoscopes, with variable tactile feedback. We describe a case of esophageal perforation after using a single-use disposable duodenoscope (EXALT Model D; Boston Scientific Corporation, Marlborough, MA, USA). To our knowledge, this is the first reported case of an esophageal perforation since FDA approval of this device in December 2019. ERCP was performed with the EXALT Model D single-use duodenoscope (Boston Scientific Corporation) by an experienced gastroenterologist. During the procedure, gentle force applied through the gastroesophageal junction caused a liner perforation in the distal esophagus. An esophageal stent was placed with satisfactory wound healing and no fistula formation. There have been a few reports in the last 2 years showing promising results using this device; however, the differences in the tactile feedback, navigation, and pushability of the device may make it prone to unintended consequences.
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Affiliation(s)
- Bakht S. Cheema
- Division of Gastroenterology, Department of Internal Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
| | - Maged Ghali
- Division of Gastroenterology, Department of Internal Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
| | - Ron Schey
- Division of Gastroenterology, Department of Internal Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
| | - Bruno Ribeiro
- Division of Gastroenterology, Department of Internal Medicine, University of Florida College of Medicine – Jacksonville, Jacksonville, Florida, USA
- *Bruno Ribeiro,
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11
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Kindel TL, Dirks RC, Collings AT, Scholz S, Abou-Setta AM, Alli VV, Ansari MT, Awad Z, Broucek J, Campbell A, Cripps MW, Hollands C, Lim R, Quinteros F, Ritchey K, Whiteside J, Zagol B, Pryor AD, Walsh D, Haggerty S, Stefanidis D. Guidelines for the performance of minimally invasive splenectomy. Surg Endosc 2021; 35:5877-5888. [PMID: 34580773 DOI: 10.1007/s00464-021-08741-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive splenectomy (MIS) is increasingly favored for the treatment of benign and malignant diseases of the spleen over open access approaches. While many studies cite the superiority of MIS in terms of decreased morbidity and length of stay over a traditional open approach, the comparative effectiveness of specific technical and peri-operative approaches to MIS is unclear. OBJECTIVE To develop evidence-based guidelines that support clinicians, patients, and others in decisions on the peri-operative performance of MIS. METHODS A guidelines committee panel of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) including methodologists used the Grading of Recommendations Assessment, Development and Evaluation approach to grade the certainty of evidence and formulate recommendations. RESULTS Informed by a systematic review of the evidence, the panel agreed on eight recommendations for the peri-operative performance of MIS for adults and children in elective situations addressing six key questions. CONCLUSIONS Conditional recommendations were made in favor of lateral positioning for non-hematologic disease, intra-operative platelet administration for patients with idiopathic thrombocytopenic purpura instead of preoperative administration, and the use of mechanical devices to control the splenic hilum. Further, a conditional recommendation was made against routine intra-operative drain placement.
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Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Wauwatosa, USA
| | - Rebecca C Dirks
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Amelia T Collings
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Stefan Scholz
- Department of Surgery, Division of Pediatric Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Ahmed M Abou-Setta
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Vamsi V Alli
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, USA
| | - Mohammed T Ansari
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, USA
| | - Joseph Broucek
- Department of Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - Andre Campbell
- Department of Surgery, University of California, San Francisco, San Francisco, USA
| | - Michael W Cripps
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, USA
| | - Celeste Hollands
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Robert Lim
- Department of Surgery, University of Oklahoma School of Medicine Tulsa, Tulsa, USA
| | | | - Kim Ritchey
- Division of Pediatric Hematology and Oncology, University of Pittsburgh, Pittsburgh, USA
| | - Jake Whiteside
- Indiana University School of Medicine, Indianapolis, USA
| | - Bradley Zagol
- Charles George Veterans Affairs Medical Center, Asheville, USA
| | - Aurora D Pryor
- Department of Surgery, Stony Brook University, Stony Brook, USA
| | - Danielle Walsh
- Department of Surgery, East Carolina University, Greenville, USA
| | | | - Dimitrios Stefanidis
- Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
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12
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Blake C, Hunter B, Awad Z, Gujral D. PO-0990 Treatment package time and Hb in head and neck SCC treated with surgery and post-operative RT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Latzko M, Awad Z. ASO Author Reflections: Minimally Invasive Ivor-Lewis Esophagectomy for Esophageal Cancer After Gastric Bypass. Ann Surg Oncol 2020; 27:793-794. [PMID: 32588267 DOI: 10.1245/s10434-020-08756-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Michael Latzko
- Department of Surgery, Advent Health Sebring, Sebring, FL, USA.
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA
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14
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Abstract
The increasing prevalence of morbid obesity in the United States has been accompanied by a concomitant rise in bariatric surgery to help combat the epidemic. The relationship between obesity and certain cancers, such as esophageal adenocarcinoma, is well established. The need for minimally invasive techniques to treat esophageal cancer in patients with previous bariatric surgery is growing and can present a unique surgical challenge. This report presents the case of a 55-year-old woman with a previous Roux-en-Y gastric bypass who was shown by endoscopy to have an invasive adenocarcinoma located in the distal thoracic esophagus. This necessitated an excision of the thoracic esophagus and the gastric pouch. A laparoscopic and thoracoscopic Ivor-Lewis esophagogastrectomy was performed for this complex patient with esophageal adenocarcinoma. The remnant stomach was fashioned into a gastric conduit using a 60-mm linear stapler with a staple height of 4.1 mm (Echelon, Ethicon Endosurgery, Blue Ash, OH). The reconstruction was performed using a 25-mm Orvil (Covidien, Minneapolis, MN, USA) and EEA 25-mm DST XL (Covidien) to create a circular stapled thoracic esophagogastric anastomosis. A feeding jejunostomy was placed in the residual 130-cm Roux limb. The study demonstrated that minimally invasive esophagectomy is safe and technically feasible with appropriate oncologic outcomes for patients with previous gastric bypass. This cohort of patients will undoubtedly continue to grow in the coming years.
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Affiliation(s)
- Michael Latzko
- Department of Surgery, Advent Health Sebring, 4301 Sun N' Lake Boulevard #102, Sebring, FL, 33870, USA.
| | - Bestoun Ahmed
- Department of Surgery, University of Pittsburgh Magee-Women's Hospital Medicine, Pittsburgh, PA, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL, USA
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15
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Gopinath A, Alkhasawneh A, Gopinath A, Baskovich B, Altunkaynak C, Marji N, Awad Z. Upper Abdominal Primary Retroperitoneal Cyst with Unusual Urothelial Histogenesis - An Uncommon Presentation Masquerading as a Hepatic Cyst. Surg Case Rep 2020. [DOI: 10.31487/j.scr.2020.01.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Benign retroperitoneal cysts are uncommon. There is a paucity of literature on primary upper
abdominal retroperitoneal cysts of urothelial histogenesis. We report an uncommon presentation of
urothelial cyst clinically mimicking a hepatic cyst.
Case presentation: A 21-year old female patient was admitted with intermittent abdominal pain of 9
months duration diagnosed on radiology as a right hepatic cyst. Laparoscopic resection and pathologic
examination revealed a primary retroperitoneal cyst with a urothelial histogenesis. This is an unusual clinical
presentation of a rare lesion mimicking a hepatic cyst.
Conclusion: This case highlights the unusual anatomic location and the rare occurrence of an upper
abdominal retroperitoneal urothelial cyst.
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16
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Gujral D, Ingle M, Podesta C, Virk J, Awad Z. PO-056 Management of the N3 neck after radical chemoradiation for head and neck cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30222-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Virk J, Ingle M, Podesta C, Gujral D, Awad Z. PO-085 Post-radiotherapy N3 nodal response in HPV positive SCC: a systematic review. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30251-8] [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: 11/28/2022]
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18
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Pham DC, Awad Z, Hoppe BS, Hew J, Ning K. Metastasectomy of Solitary Adrenal Metastasis From Small Cell Lung Cancer. J Investig Med High Impact Case Rep 2017; 5:2324709617740909. [PMID: 29147667 PMCID: PMC5672992 DOI: 10.1177/2324709617740909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 09/30/2017] [Accepted: 10/11/2017] [Indexed: 11/15/2022] Open
Abstract
Most extensive-stage small cell lung cancers have disseminated disease at diagnosis, and solitary adrenal metastasis from small cell lung cancer is rare. We report the case of a 51-year-old man with extensive-stage small cell lung cancer with solitary right adrenal metastasis (T2N0M1), who was cured with resection of primary tumor, chemotherapy (cisplatin, etoposide), adrenalectomy, consolidative thoracic radiotherapy, and prophylactic cranial irradiation. He remained cancer free, 7.5 years since diagnosis. For small cell lung cancer with solitary adrenal gland metastasis, metastasectomy combined with chemotherapy and radiotherapy can be curative and enable long-term survival. This treatment approach should be further studied, and similar cases should be reported.
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Affiliation(s)
| | | | | | | | - Ke Ning
- UF Health Jacksonville, FL, USA
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19
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Abstract
Right aortic arch (RAA) is a rare congenital vascular abnormality in which the aorta descends in the right thorax and encircles the esophagus. Historically, esophagectomy for patients for RAA is done through a left thoracotomy as exposure and mobilization of the esophagus is difficult through a right thoracotomy. A 73-year-old male was found to have an esophageal adenocarcinoma. Endoscopic ultrasound showed a T3N0 lesion in the lower third of the esophagus. PET CT demonstrated a circumferential lesion without evidence of distant disease or involved lymph nodes and a RAA which was not associated with congenital heart disease or symptoms. The patient received neo-adjuvant chemoradiation (50.4 Gy) with carboplatin and paclitaxel. Minimally invasive Ivor-Lewis esophagectomy (MIE) utilizing conventional right thoracoscopy was done. Esophageal mobilization, transection and mediastinal lymph node dissection was performed through anteriorly placed trocars, thereby avoiding the right side descending aorta that is lying anterior and to the right of the esophagus. In this video we demonstrate MIE utilizing right thoracoscopy. Total operative time was 250 minutes and the patient was discharged home on post-operative day 8. Final pathology showed complete pathological response, with 0/22 involved lymph nodes and uninvolved surgical margins. Minimally invasive esophagectomy has been reported to deliver superior outcomes to the open approach. MIE can be performed in selected patients with RAA, and herein we demonstrate a minimally invasive option for the treatment of distal esophageal cancer in patients with RAA. To our knowledge this is the 1st reported case in the English literature utilizing this approach in patient with RAA.
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Affiliation(s)
- Jeremy Linson
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA
| | - Michael Latzko
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA
| | - Bestoun Ahmed
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA
| | - Ziad Awad
- Department of Surgery, University of Florida College of Medicine, Jacksonville, FL 32209, USA
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20
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Walker A, Awad Z, Tolley N, Narula A, Bradley P. Non-clinical demands are pushing experienced UK surgeons out of the NHS†. International Journal of Healthcare Management 2016. [DOI: 10.1080/20479700.2015.1125081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Mahalingam S, Awad Z, Tolley NS, Khemani S. Ventilation tube insertion simulation: a literature review and validity assessment of five training models. Clin Otolaryngol 2016; 41:321-6. [PMID: 26385050 DOI: 10.1111/coa.12543] [Citation(s) in RCA: 8] [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] [Accepted: 07/25/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study was to identify and investigate the face and content validity of ventilation tube insertion (VTI) training models described in the literature. DESIGN A review of literature was carried out to identify articles describing VTI simulators. Feasible models were replicated and assessed by a group of experts. SETTING Postgraduate simulation centre. PARTICIPANTS Experts were defined as surgeons who had performed at least 100 VTI on patients. Seventeen experts were participated ensuring sufficient statistical power for analysis. MAIN OUTCOME MEASURES A standardised 18-item Likert-scale questionnaire was used. This addressed face validity (realism), global and task-specific content (suitability of the model for teaching) and curriculum recommendation. RESULTS The search revealed eleven models, of which only five had associated validity data. Five models were found to be feasible to replicate. None of the tested models achieved face or global content validity. Only one model achieved task-specific validity, and hence, there was no agreement on curriculum recommendation. CONCLUSIONS The quality of simulation models is moderate and there is room for improvement. There is a need for new models to be developed or existing ones to be refined in order to construct a more realistic training platform for VTI simulation.
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Affiliation(s)
- S Mahalingam
- Department of Otolaryngology, Head and Neck Surgery, East Surrey Hospital, Redhill, UK
| | - Z Awad
- Department of Otolaryngology, Head and Neck Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - N S Tolley
- Department of Otolaryngology, Head and Neck Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - S Khemani
- Department of Otolaryngology, Head and Neck Surgery, East Surrey Hospital, Redhill, UK
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22
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Awad Z, Patel B, Hayden L, Sandhu G, Tolley N. Simulation in laryngology training; what should we invest in? Our experience with 64 porcine larynges and a literature review. Clin Otolaryngol 2015; 40:269-73. [DOI: 10.1111/coa.12360] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Z. Awad
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology, Head and Neck Surgery; St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
| | - B. Patel
- Department of Surgery and Cancer; Imperial College; London UK
| | - L. Hayden
- School of Medicine; Imperial College; London UK
| | - G.S. Sandhu
- Department of Otolaryngology, Head and Neck Surgery; Charing Cross Hospital; Imperial College Healthcare NHS Trust; London UK
| | - N.S. Tolley
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology, Head and Neck Surgery; St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
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23
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Awad Z, Hayden L, Muthuswamy K, Tolley NS. Utilisation, Reliability and Validity of Clinical Evaluation Exercise in Otolaryngology Training. Clin Otolaryngol 2015; 40:456-61. [PMID: 25702537 DOI: 10.1111/coa.12400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the utilisation, reliability and validity of clinical evaluation exercise (CEX) in otolaryngology training. DESIGN Retrospective database analysis. SETTING Online assessment database. PARTICIPANTS We analysed all CEXs submitted by north London core (CT) and speciality trainees (ST) in otolaryngology from 2010 to 2013. MAIN OUTCOME MEASURES Internal consistency of the 7 CEX items rated as either O: outstanding, S: satisfactory or D: development required. Overall performance rating (pS) of 1-4 assessed against completion of training level. Receiver operating characteristic was used to describe CEX sensitivity and specificity. Overall score (cS), pS and the number of 'D'-rated items were used to investigate construct validity. RESULTS One thousand one hundred and sixty CEXs from 45 trainees were included. CEX showed good internal consistency (Cronbach's alpha= 0.85). CEX was highly sensitive (99%), yet not specific (6%). cS and pS for ST was higher than CT (99.1% ± 0.4 versus 96.6% ± 0.8 and 3.06 ± 0.05 versus 1.92 ± 0.04, respectively P < 0.001). pS showed a significant stepwise increase from CT1 to ST6 (P < 0.001). In contrast, cS only showed improvement up to ST4 (P = 0.025). The most frequently utilised item 'management and follow-up planning' was found to be the best predictor of cS and pS (rs = +0.69 and +0.21, respectively). CONCLUSION CEX is reliable in assessing early years otolaryngology trainees in clinical examination, but not at higher level. It has the potential to be used in a summative capacity in selecting trainees for ST positions. This would also encourage trainees to master all domains of otolaryngology clinical examination by end of CT.
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Affiliation(s)
- Z Awad
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Otolaryngology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - L Hayden
- School of Medicine, Imperial College, London, UK
| | - K Muthuswamy
- School of Medicine, Imperial College, London, UK
| | - N S Tolley
- Department of Surgery and Cancer, Imperial College, London, UK.,Department of Otolaryngology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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24
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Sachsman S, Nichols RC, Morris CG, Zaiden R, Johnson EA, Awad Z, Bose D, Ho MW, Huh SN, Li Z, Kelly P, Hoppe BS. Proton Therapy and Concomitant Capecitabine for Non-Metastatic Unresectable Pancreatic Adenocarcinoma. Int J Part Ther 2014. [DOI: 10.14338/ijpt.14-00006.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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25
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Wong G, Awad Z, Wong P, Wood S, Farrell R. Clinical applicability of the Thy3a cytological category in thyroid nodules aspirates. Our experience in one hundred and fifty-seven patients with Thy3 cytology. Clin Otolaryngol 2014; 39:393-6. [DOI: 10.1111/coa.12307] [Citation(s) in RCA: 4] [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] [Accepted: 08/14/2014] [Indexed: 11/29/2022]
Affiliation(s)
- G. Wong
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - Z. Awad
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - P.Y. Wong
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
| | - S. Wood
- Department of Otolaryngology, Head and Neck Surgery; Wexham Park Hospital; Slough Berkshire UK
| | - R. Farrell
- Department of Otolaryngology, Head and Neck Surgery; Northwick Park Hospital; Middlesex UK
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Awad Z, Hayden L, Muthuswamy K, Ziprin P, Darzi A, Tolley NS. Utilisation and outcomes of case-based discussion in otolaryngology training. Clin Otolaryngol 2014; 40:86-92. [PMID: 25311553 DOI: 10.1111/coa.12321] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the reliability, validity and outcomes of Case-based Discussion (CBD) in otolaryngology training. DESIGN Retrospective database analysis. SETTING National electronic database. PARTICIPANTS North London otolaryngology trainees. MAIN OUTCOME MEASURES We tested the tool's reliability along with its capacity to denote trainee progress. A score was calculated (cS) and compared across core (CT) and specialty trainees (ST) at all levels. The number of items rated as "development required" (D) was also examined. RESULTS One thousand four hundred and fifty-six CBDs were submitted by 46 trainees from 2007 to 2013, averaging 13.6 per trainee per year. Items relating to knowledge, management and judgement were more popular (98% usage), and better predictors of cS compared to other parameters (rs: +0.74, +0.70 and +0.72, respectively). CBD was found to be reliable (Cronbach's α = 0.848) and highly sensitive (99%), yet not specific. cS was significantly higher in ST than CT (95.3% ± 0.6 versus 88.7% ± 1.3). pS showed a similar pattern (3.15 ± 0.4 versus 2.0 ± 0.05) (P < 0.001). cS and pS increased from CT1 to ST8 (rs: +0.60 and +0.34, respectively). The number of D-rated items decreased with increasing year of training. CONCLUSION Case-based discussion is a reliable and valid tool in otolaryngology training. It is highly sensitive but not specific. Trainees should be encouraged to use it at all levels.
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Affiliation(s)
- Z Awad
- Department of Surgery and Cancer, Imperial College, London, UK; Department of Otolaryngology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Affiliation(s)
- J S Virk
- ENT Department, Queen's Hospital, Havering and Redbridge University Hospitals NHS Trust, Romford, Essex, UK
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Awad Z, Hayden L, Muthuswamy K, Ziprin P, Darzi A, Tolley N. Does direct observation of procedural skills reflect trainee's progress in otolaryngology? Clin Otolaryngol 2014; 39:169-73. [DOI: 10.1111/coa.12251] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Z. Awad
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology; St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
| | - L. Hayden
- School of Medicine; Imperial College; London UK
| | | | - P. Ziprin
- Department of Surgery and Cancer; Imperial College; London UK
| | - A. Darzi
- Department of Surgery and Cancer; Imperial College; London UK
| | - N.S. Tolley
- Department of Surgery and Cancer; Imperial College; London UK
- Department of Otolaryngology; St Mary's Hospital; Imperial College Healthcare NHS Trust; London UK
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Abstract
BACKGROUND The abdominal incision extraction site continues to be major source of morbidity after laparoscopic colectomy: mainly, incisional pain, wound infection, and incisional hernia. Also, in selected cases, it may delay initiating chemotherapy. METHODS The video describes the technique of performing laparoscopic total colectomy, transvaginal removal of the entire colon, and intracorporeal ileorectal anastomosis in a 40-year-old woman with a sigmoid cancer and multiple endoscopically unresectable polyps throughout the colon. Computed tomography scan showed 2 liver lesions with carcinoembryonic antigen 138. Familial adenomatous polyposis gene analysis was negative. Six trocars (one 12 mm and five 5 mm) were used. The whole colon was removed through the transvaginal route. The anvil was introduced through the vagina, and circular stapled ileorectal anastomosis was done. RESULTS There were no intraoperative complications. The operating time was 210 min. Blood loss was 20 mL. The patient was discharged home on postoperative day 2. Final pathology was T3N1bM1, and 2 of 23 lymph nodes were metastatic. All polyps were tubulovillous. She was commenced on chemotherapy 2 weeks after surgery. At 6-month follow-up, the patient was doing well, had no abdominal pain, and had no vaginal discharge or dyspareunia. CONCLUSIONS Natural orifice specimen extraction (NOSE) surgery can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal incision-related morbidity and a bridge to pure natural orifice transluminal endoscopic surgery (NOTES) colon surgery. Large-number patient data with long-term follow-up is needed.
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Affiliation(s)
- Ziad Awad
- Department of Surgery, University of Florida, Jacksonville, USA,
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Affiliation(s)
- Z Awad
- ENT Department, Northwick Park Hospital, North West London Hospitals NHS Trust, London, UK
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Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D, Fanelli RD. Guidelines for the management of hiatal hernia. Surg Endosc 2013; 27:4409-28. [PMID: 24018762 DOI: 10.1007/s00464-013-3173-3] [Citation(s) in RCA: 244] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 08/02/2013] [Indexed: 02/08/2023]
Affiliation(s)
- Geoffrey Paul Kohn
- Department of Surgery, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia,
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Nichols RC, Morris CG, Zaiden RA, Awad Z, Colaco R, Hoppe BS, Mendenhall WM, Mendenhall NP. Presenting characteristics of insured and uninsured patients with anorectal malignancy referred for radiotherapy at an urban safety net hospital. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.4_suppl.363] [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
363 Background: This retrospective study compares: presenting characteristics; time intervals between symptom emergence, tissue diagnosis and initiation of therapy; and survival, for insured (IP) and uninsured patients (UP) with anal (22) or rectal (39) malignancy referred for radiotherapy at University of Florida Shands Hospital in Jacksonville. Methods: From 5/2002 to 8/2012, 63 newly diagnosed patients were evaluated. 2 patients were excluded due to mental illness. Records were reviewed to capture: 1.) Patient demographics; 2.) Stage at diagnosis; 3.) Weight loss at diagnosis; 4.) Patient reported date of symptom onset; 5.) Date of tissue confirmation of malignancy; 6.) Date of first therapeutic intervention (i.e. surgery, chemotherapy or radiotherapy); 7.) Insurance status at each of the above time points; and 8.) Survival data. Results: At the time of symptom emergence, 32 patients were uninsured and 29 were insured. Median age of UP was 52 years vs. 64 years for IP (P=0.0005). UP experienced median intervals of 258.5 days between symptom emergence and tissue confirmation of malignancy vs. 58 days for IP (P=0.0013). UP experienced median intervals of 314.5 days between symptom emergence and treatment initiation vs. 120 days for IP (P=0.0024). UP presented with T4 primary tumors in 41% of cases vs. 7% for IP (P=0.0027). UP presented with a median weight loss of 10 lbs vs. 0 lbs for IP (P=0.0158). UP presented with lymph node metastasis in 66% of cases vs. 45% for IP (P=0.1264). With a median follow up of 22 months for UP and 32 months for IP, 2 year actuarial overall survival was 87% for UP and 74% for IP (P=0.5503). Conclusions: UP presented at a younger age than IP (P=0.0005) and demonstrated:1.) Longer intervals between symptom emergence and tissue confirmation of malignancy (P=0.0013); 2.) Longer intervals between symptom emergence and treatment initiation (P=0.0024); 3.) Greater likelihood of presenting with a T4 tumor (P=0.0027); 4.) Greater weight loss at presentation (P=0.0158); 5.) A trend toward a greater likelihood of presenting with lymph node metastasis (P=0.1264); 6.) No difference in actuarial 2 year survival from date of diagnosis compared to IP. (P=0.54).
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Affiliation(s)
- Romaine Charles Nichols
- University of Florida Department of Radiation Oncology and University of Florida Proton Therapy Institute, Jacksonville, FL
| | - Christopher G. Morris
- University of Florida Department of Radiation Oncology and University of Florida Proton Therapy Institute, Jacksonville, FL
| | | | - Ziad Awad
- University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - Rovel Colaco
- University of Florida Department of Radiation Oncology and University of Florida Proton Therapy Institute, Jacksonville, FL
| | - Bradford S. Hoppe
- University of Florida Department of Radiation Oncology and University of Florida Proton Therapy Institute, Jacksonville, FL
| | - William M. Mendenhall
- University of Florida Department of Radiation Oncology and University of Florida Proton Therapy Institute, Jacksonville, FL
| | - Nancy Price Mendenhall
- University of Florida Department of Radiation Oncology and University of Florida Proton Therapy Institute, Jacksonville, FL
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Zerey M, Hawver LM, Awad Z, Stefanidis D, Richardson W, Fanelli RD. SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 2012; 27:1-10. [PMID: 23239291 DOI: 10.1007/s00464-012-2592-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 06/11/2012] [Indexed: 02/07/2023]
Affiliation(s)
- Marc Zerey
- Department of Surgery, Sansum Clinic, Santa Barbara, CA, USA.
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Abstract
INTRODUCTION Floseal® (Baxter, Hayward, CA, US) can be of value in reducing blood loss and haematoma rates. The manufacturer’s warnings include allergic reaction, poor wound healing and intravascular thrombosis. We aimed to determine whether Floseal® is safe to use in various head and neck surgery (HNS) procedures. METHODS A prospective trial was conducted using Floseal® in 42 various consecutive head and neck surgery procedures. Adverse incidents were used as the main outcome measure, including allergic reaction, wound breakdown, wound infection and thrombosis. Secondary outcome measures included haematoma formation, hospital stay, drain times and output. RESULTS No adverse incidents were recorded in the trial period. Two patients developed haematomas and required surgical exploration where a bleeding vessel was identified and dealt with. CONCLUSIONS Floseal® is safe to be used in head and neck surgery with no adverse effects. A larger number and a control group are required to ascertain its value in reducing blood loss, haematoma formation, drain usage and hospital stay.
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Affiliation(s)
- A Ujam
- North West London Hospitals NHS Trust, UK.
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Griffin R, Qureshi I, Awad Z. Laparoscopic right hemicolectomy: A comparison of natural orifice vs. transabdominal specimen extraction. J Am Coll Surg 2012. [DOI: 10.1016/j.jamcollsurg.2012.06.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Nichols R, George T, Zaiden R, Hochwald S, Awad Z, Ho M, Li Z, Mendenhall N, Mendenhall W, Hoppe B. EP-1089 PROTON THERAPY FOR PANCREATIC AND AMPULLARY CANCER IS ASSOCIATED WITH A LOW INCIDENCE OF GASTROINTESTINAL TOXICITY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71422-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nichols RC, Huh SN, Getman N, Ho MW, Li Z, Awad Z, Zaiden RA, Mendenhall NP, Mendenhall WM, Hoppe BS. Effect of protons on bone marrow and small-bowel exposure for patients receiving neoadjuvant radiotherapy for resectable rectal cancer. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.4_suppl.669] [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
669 Background: Determine the potential role for protons in the preoperative treatment of resectable rectal cancer. Methods: Eight consecutive patients with resectable (T2-T3) rectal cancers underwent 3D conformal photon (3DCRT); intensity-modulated photon (IMRT); and 3D conformal proton (PT) treatment planning. Initial target volumes (PTV1) were contoured using the RTOG anorectal atlas guidelines. Boost target volumes (PTV2) consisted of the gross rectal tumor plus a uniform 2cm expansion. Plans delivered 45Gray (Gy) or Cobalt Gray Equivalent (CGE) to the PTV1 and a 5.4 Gy (CGE) boost to the PTV2. Ninety-five percent of PTVs received 100% of the target dose and 100% of the PTVs received 95% of the target dose. Standard normal tissue constraints were utilized. Wilcoxon paired t-tests were performed to compare various dosimetric points between the 3 plans for each patient. Results: All plans met all normal-tissue constraints and were isoeffective in terms of PTV coverage. Proton plans offered significantly reduced median normal-tissue exposure over the 3DCRT and IMRT plans with respect to: pelvic bone marrow (PBM) at the V5Gy, V10Gy, V15Gy and V20Gy levels and small bowel (SB) at the V10Gy and V20Gy levels. Proton plans also offered significantly reduced median normal-tissue exposure over the 3DCRT plans with respect to the SB at the V30Gy and V40Gy levels. Conclusions: 1.) By reducing bone marrow exposure, protons may reduce the acute hematologic toxicity of neoadjuvant chemoradiation and increase the likelihood of uninterrupted chemotherapy delivery. Bone marrow sparing may also facilitate the delivery of salvage chemotherapy for patients who go on to develop hematogenous metastasis. 2.) By reducing small bowel exposure, protons may reduce toxicity and possibly facilitate the use of more aggressive concomitant chemotherapy with radiotherapy. [Table: see text]
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Affiliation(s)
- Romaine Charles Nichols
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - Soon N. Huh
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - Nataliya Getman
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - Meng Wei Ho
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - Zuofeng Li
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - Ziad Awad
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - Robert Anthony Zaiden
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - Nancy Price Mendenhall
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - William M. Mendenhall
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
| | - Bradford S. Hoppe
- University of Florida Proton Therapy Institute, Jacksonville, FL; University of Florida, Jacksonville, FL; University of Florida Health Science Center Jacksonville, Jacksonville, FL
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Amirlak B, Amirlak I, Awad Z, Zahmatkesh M, Pipinos I, Forse A. Pneumothorax following feeding tube placement: precaution and treatment. Acta Med Iran 2012; 50:355-358. [PMID: 22837092] [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: 06/01/2023] Open
Abstract
Nasojejunal feeding tubes are being used at an increased frequency, but it is not without complications that could be life-threatening. We report two cases of pneumothorax following small-bore feeding tube insertion into the pleural cavity, resulting in pneumothorax. We further discuss the potential measures that can be taken to prevent and treat this serious complication.
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Affiliation(s)
- Bardia Amirlak
- Department of Plastic Surgery, University of Texas, South Western Medical Center, Texas, USA.
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Nichols R, Hoppe B, Xu N, Huh S, Ho M, Zaiden R, Awad Z, Li Z, Mendenhall N, Mendenhall W. Early Outcomes for Pancreatic Cancer Patients Treated with Proton Therapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.1824] [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: 11/28/2022]
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Awad Z, Jayaraj S. Re: Flap retraction during septoplasty. Clin Otolaryngol 2010; 35:239-40; author reply 240-1. [PMID: 20636751 DOI: 10.1111/j.1749-4486.2010.02122.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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O’Flynn P, Awad Z, Kothari P, Vaz F. The first UK report of the applications of flexible CO2laser in head and neck surgery: how we do it. Clin Otolaryngol 2010; 35:139-42. [DOI: 10.1111/j.1749-4486.2010.02082.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Affiliation(s)
- Z Awad
- Department of Otolaryngology, Head and Neck Surgery, Basildon and Thurrock University Hospitals, Basildon, Essex, UK.
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Abstract
A left aberrant gallbladder is a rare presentation that requires awareness of biliary anatomy and selective use of intraoperative cholangiography to assist in safe laparoscopic gallbladder resection. Background: Aberrant gallbladder transposed to the left side is a rare congenital anomaly that has been seen in as many as 0.7% of the population. These gallbladders are situated under the left lobe of the liver between Segment III and IV and to the left of the falciform ligament. Many preoperative studies fail to identify the anomaly, causing confusion to the surgeon during laparoscopic resection. Selective use of intraoperative cholangiography and meticulous dissection can aid in safe resection. Methods: A 61-year-old female was admitted with ultra-sound confirmation of cholecystitis and subsequently taken to the operating room for a laparoscopic cholecystectomy. Results: Evaluation of the gallbladder under laparoscopic view revealed an inflamed left aberrant gallbladder. An intraoperative cholangiogram was obtained to delineate the biliary anatomy that showed the cystic duct entering the common hepatic duct on the right side. Conclusion: A left aberrant gallbladder is a rare presentation that requires awareness of biliary anatomy and selective use of intraoperative cholangiography to aid in the safe laparoscopic resection of the gallbladder.
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Affiliation(s)
- Irfan Qureshi
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida 32209, USA
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Anwar M, Awad Z. Re: Digital tonsil dissection. Clin Otolaryngol 2009; 33:631-2. [PMID: 19126150 DOI: 10.1111/j.1749-4486.2008.01801.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anwar M, Awad Z, Ghufoor K. Contamination of postoperative head and neck wounds with urogenital microbes. Clin Otolaryngol 2008. [DOI: 10.1111/j.1749-4486.2008.01843_2.x] [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: 11/29/2022]
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Abstract
OBJECTIVES Previous studies have shown that nasendoscopy is made easier with the use of lubrication at the expense of the quality of the view obtained, but had no effect on the discomfort or pain experienced by the patient. We set out to determine whether the advantages of lubrication with a standard lubricant (KY Jelly) could be achieved by using water, without incurring the same disadvantages. DESIGN Single blind randomized controlled trial. SETTING Outpatient Departments at two District General Hospitals. PARTICIPANTS One hundred and fifty participants selected sequentially from patients requiring a nasendoscopy where the endoscope would be passed far enough to view the larynx. Patients requiring topical anaesthetic were excluded. METHODS Patients were randomly assigned to have either water or standard lubricant applied to the nasendosope prior to nasendoscopy. Levels of pain experienced by the patient were recorded on a visual analogue score as well as visual analogue scores from the clinician for the levels of difficulty in passing the endoscope. All participants who were entered the study completed the study. Endoscopy was performed by all grades of medical staff. MAIN OUTCOME MEASURES Levels of pain experienced by the participants were assessed by a visual analogue scale. Difficulty of passing the scope was indicated by the endoscopist using a visual analogue scale, as was the quality of image obtained. RESULTS Endoscopists found the insertion of the endoscope was easier and the image better when water was used rather than KY Jelly. There was no significant difference in reported in levels of pain experienced by the patient. CONCLUSION Although the use of water as a lubricant during nasendoscopy confers no additional benefit in term of the levels of pain suffered by patients during the procedure, it makes the insertion of the endoscope easier and provides a better quality image than standard lubrication.
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Affiliation(s)
- D D Pothier
- Department of ENT, Gloucestershire Royal Hospital, Gloucestershire.
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Persaud RAP, Awad Z, Trinidade A, Kalan A. Use of systemic prophylactic antibiotics with anterior nasal packing in England, UK. Clin Otolaryngol 2007; 32:399; author reply 399-400. [PMID: 17883566 DOI: 10.1111/j.1749-4486.2007.01457.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Persaud RAP, Awad Z, Kalan A. Diagrammatic recording of tympanomastoid procedures. Clin Otolaryngol 2007; 32:210-2; author reply 212. [PMID: 17550518 DOI: 10.1111/j.1365-2273.2007.01420.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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