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Olga Kantor, Henry A Pitt, Mark S Talamonti, Kevin K Roggin, David J Bentrem, Richard A Prinz, Marshall S Baker
BACKGROUND: Studies evaluating the efficacy of minimally invasive approaches to pancreatoduodenectomy (MIS-PD) compared to open pancreatioduodenectomy (OPD) have been limited by selection bias and mixed outcomes. METHODS: ACS-NSQIP 2014-2015 pancreas procedure-targeted data were used to identify patients undergoing PD. Intention-to-treat analysis was performed. RESULTS: Of 7907 PD patients, 1277 (16%) underwent MIS-PD: 776 (61%) robotic or laparoscopic PD, 304 (24%) hybrid, and 197 (15%) unplanned conversions...
March 2018: Surgery
Andrew J Benjamin, Talia B Baker, Mark S Talamonti, Adam S Bodzin, Andrew B Schneider, David J Winschester, Kevin K Roggin, David J Bentrem, Nicholas R Suss, Marshall S Baker
BACKGROUND: Studies comparing orthotopic liver transplantation to margin negative resection for patients with small unifocal hepatocellular carcinoma have not controlled for degree of cirrhosis. METHODS: The National Cancer Database was used to identify patients with preserved liver function (Model for End-stage Liver Disease score ≤12) who underwent orthotopic liver transplantation or margin negative resection for American Joint Committee on Cancer stage I hepatocellular carcinoma lesions <3 cm between 2010 and 2013...
January 19, 2018: Surgery
Nicholas R Suss, Mark S Talamonti, Darren S Bryan, Chi-Hsiung Wang, Kristine M Kuchta, Susan J Stocker, David J Bentrem, Kevin K Roggin, David J Winchester, Robert Marsh, Richard A Prinz, Faris M Murad, Marshall S Baker
BACKGROUND: The benefit of adding external beam radiation to adjuvant chemotherapy in patients that have undergone a margin positive resection for early stage, pancreatic ductal adenocarcinoma has not been determined definitively. METHODS: The National Cancer Data Base was queried to evaluate the utility of adjuvant radiation in patients with pathologic stage I-II pancreatic ductal adenocarcinoma who underwent upfront pancreatoduodenectomy with a positive margin (margin positive resection) between 2004 and 2013...
January 11, 2018: Surgery
Bartlomiej Bartkowiak, Ashley M Snyder, Andrew Benjamin, Andrew Schneider, Nicole M Twu, Matthew M Churpek, Kevin K Roggin, Dana P Edelson
OBJECTIVE: Assess the accuracy of 3 early warning scores for predicting severe adverse events in postoperative inpatients. SUMMARY OF BACKGROUND DATA: Postoperative clinical deterioration on inpatient hospital services is associated with increased morbidity, mortality, and cost. Early warning scores have been developed to detect inpatient clinical deterioration and trigger rapid response activation, but knowledge regarding the application of early warning scores to postoperative inpatients is limited...
January 12, 2018: Annals of Surgery
Jukes P Namm, Kiran H Thakrar, Chi-Hsiung Wang, Susan J Stocker, Malini D Sur, Jonathan Berlin, William Dale, Mark S Talamonti, Kevin K Roggin
Background: Sarcopenia has been associated with increased adverse outcomes after major abdominal surgery. Sarcopenia defined as decreased muscle volume or increased fatty infiltration may be a proxy for frailty. In conjunction with other preoperative clinical risk factors, radiographic measures of sarcopenia using both muscle size and density may enhance prediction of outcomes after pancreaticoduodenectomy (PD) for malignancy. Methods: Preoperative computed tomography (CT) scans of patients undergoing PD for malignancy were analyzed from a prospective pancreatic surgery database...
December 2017: Journal of Gastrointestinal Oncology
Olga Kantor, Mark S Talamonti, Chi-Hsiung Wang, Kevin K Roggin, David J Bentrem, David J Winchester, Richard A Prinz, Marshall S Baker
BACKGROUND: Few studies have examined the relation between extent of vascular resection and morbidity following pancreaticoduodenectomy (PD) with vein resection (PDVR). METHODS: Patients undergoing PD for malignancy were identified using the American College of Surgeons National Surgical Quality Improvement Project from 2006 to 2013. Current procedural terminology codes were used to characterize PDVR. RESULTS: 9235 patients underwent PD, 977 (10...
November 27, 2017: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Robert de W Marsh, Mark S Talamonti, Marshall S Baker, Mitchell Posner, Kevin Roggin, Jeffrey Matthews, Daniel Catenacci, Mark Kozloff, Blase Polite, Michele Britto, Chi Wang, Hedy Kindler
BACKGROUND AND OBJECTIVES: Surgery followed by gemcitabine and/or a fluoropyrimidine is standard therapy for resectable PDAC. mFOLFIRINOX (oxaliplatin 85 mg/m(2) , irinotecan 180 mg/m(2) , leucovorin 400 mg/m(2) Day 1, 5-FU 2400 mg/m(2)  × 48 h IV, peg-filgrastim 6 mg SQ day 3, every 14 days) has substantial activity in metastatic PDAC. We wished to determine the tolerability/efficacy of peri-operative mFOLFIRINOX in resectable PDAC. METHODS: Patients with resectable PDAC (ECOG PS 0/1) received four cycles of mFOLFIRINOX pre- and post-surgery...
October 16, 2017: Journal of Surgical Oncology
Eirini Pectasides, Matthew D Stachler, Sarah Derks, Yang Liu, Steven Maron, Mirazul Islam, Lindsay Alpert, Heewon Kwak, Hedy Kindler, Blase Polite, Manish R Sharma, Kenisha Allen, Emily O'Day, Samantha Lomnicki, Melissa Maranto, Rajani Kanteti, Carrie Fitzpatrick, Christopher Weber, Namrata Setia, Shu-Yuan Xiao, John Hart, Rebecca Nagy, Kyoung-Mee Kim, Min-Gew Choi, Byung Hoon Min, Katie S Nason, Lea O'Keefe, Masayuki Watanabe, Hideo Baba, Rick Lanman, Agoston T Agoston, David J Oh, Andrew Dunford, Aaron R Thorner, Matthew D Ducar, Bruce M Wollison, Haley A Coleman, Yuan Ji, Mitchell C Posner, Kevin K Roggin, Kiran Turaga, Paul Chang, Kyle Hogarth, Uzma Siddiqui, Andres Gelrud, Gavin Ha, Samuel S Freeman, Justin Rhoades, Sarah Reed, Greg Gydush, Denisse Rotem, Jon Davison, Yu Imamura, Viktor Adalsteinsson, Jeeyun Lee, Adam J Bass, Daniel V Catenacci
Gastroesophageal adenocarcinoma (GEA) is a lethal disease where targeted therapies, even when guided by genomic biomarkers, have had limited efficacy. A potential reason for the failure of such therapies is that genomic profiling results could commonly differ between the primary and metastatic tumor. To evaluate genomic heterogeneity, we sequenced paired primary GEA and synchronous metastatic lesions across multiple cohorts, finding extensive differences in genomic alterations, including discrepancies in potentially clinically relevant alterations...
October 4, 2017: Cancer Discovery
Jason B Liu, Talia B Baker, Nicholas R Suss, Mark S Talamonti, Kevin K Roggin, David J Winchester, Marshall S Baker
BACKGROUND: Prior studies comparing the efficacy of orthotopic liver transplantation to resection in patients with hepatocellular carcinoma have not controlled for underlying severity of liver disease. METHODS: Patients with stage I to III hepatocellular carcinoma and preserved liver function (model for end-stage liver disease <12) who underwent resection or orthotopic liver transplantation between 2010 and 2013 were identified from the National Cancer Database...
November 2017: Surgery
Andrew J Benjamin, Mary M Buschmann, Andrew Schneider, Brian A Derstine, Jeffrey F Friedman, Stewart C Wang, William Dale, Kevin K Roggin
We aimed to determine whether comprehensive imaging analysis with analytic morphomics (AM) enhances or replaces geriatric assessment (GA) in risk-stratifying pancreatic surgery patients. One hundred thirty-four pancreatic surgery patients were identified from a prospective cohort. Sixty-three patients in the cohort had preoperative CT scans in addition to comprehensive geriatric assessments. CT scans were processed using AM. Associations with National Surgical Quality Improvement Program (NSQIP) serious complications were evaluated using univariate analysis and robust elastic net modeling to obtain AUROC curves by adding AM and GA measures to our previously defined clinical base risk model (age, body mass index, American Society of Anesthesiologists classification, and Charlson comorbidity index)...
June 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Waseem Lutfi, Mark S Talamonti, Olga Kantor, Chi-Hsiung Wang, Susan J Stocker, David J Bentrem, Kevin K Roggin, David J Winchester, Robert Marsh, Richard A Prinz, Marshall S Baker
OBJECTIVE: Neoadjuvant protocols for early stage pancreatic adenocarcinoma (PDAC) frequently involve external beam radiation used in combination with systemic chemotherapy. The benefit of radiation in these protocols has not been determined. METHODS: We examined patients with stage I and II PDAC within the National Cancer Data Base between 2006 and 2012. Propensity score matching was used to compare patients receiving neoadjuvant chemotherapy including radiation (NCRT) to those receiving neoadjuvant chemotherapy without radiation (NCT) prior to pancreaticoduodenectomy...
March 2017: American Journal of Surgery
Olga Kantor, Mark S Talamonti, Susan Sharpe, Waseem Lutfi, David J Winchester, Kevin K Roggin, David J Bentrem, Richard A Prinz, Marshall S Baker
BACKGROUND: The long-term efficacy of laparoscopic pancreaticoduodenectomy (LPD) relative to open pancreaticoduodenectomy (OPD) for pancreatic adenocarcinoma has not been well studied. METHODS: The National Cancer Data Base was used to compare patients undergoing LPD and OPD for stage I-II pancreatic adenocarcinoma between 2010 and 2013. RESULTS: 828 (10%) patients underwent LPD and 7385 (90%) OPD. There were no differences in tumor or demographic characteristics between groups...
March 2017: American Journal of Surgery
Olga Kantor, Andrew B Schneider, Marko Rojnica, Andrew J Benjamin, Nancy Schindler, Mitchell C Posner, Jeffrey B Matthews, Kevin K Roggin
BACKGROUND: To simulate the duties and responsibilities of an attending surgeon and allow senior residents more intraoperative and perioperative autonomy, our program created a new resident acute care surgery consult service. METHODS: We structured resident acute care surgery as a new admitting and inpatient consult service managed by chief and senior residents with attending supervision. When appropriate, the chief resident served as a teaching assistant in the operation...
March 2017: Surgery
Waseem Lutfi, Mark S Talamonti, Olga Kantor, Chi-Hsiung Wang, Erik Liederbach, Susan J Stocker, David J Bentrem, Kevin K Roggin, David J Winchester, Robert Marsh, Richard A Prinz, Marshall S Baker
BACKGROUND: The value of neoadjuvant chemotherapy in the treatment of early stage pancreatic cancer is not yet clear. METHODS: We evaluated patients from the National Cancer Data Base who underwent pancreaticoduodenectomy for clinical stage I and II pancreatic adenocarcinoma between 2006 and 2012. RESULTS: In total, 7,881 patients were identified. Of these, 27.5% received no chemotherapy, 57.4% received adjuvant chemotherapy, 10.2% received neoadjuvant chemotherapy alone, and 4...
September 2016: Surgery
Malini D Sur, Jukes P Namm, Joshua A Hemmerich, Mary M Buschmann, Kevin K Roggin, William Dale
INTRODUCTION: Sarcopenia is linked to poor outcomes after abdominal surgery. We hypothesized that radiographic sarcopenia metrics enhance prediction of complications after pancreaticoduodenectomy (PD) when combined with clinical and frailty data. METHODS: Preoperative geriatric assessments and CT scans of patients undergoing PD were reviewed. Sarcopenia was assessed at L3 using total psoas area index (TPAI) and weighted average Hounsfield units (HU), i.e., estimates of psoas muscle volume and density...
November 2015: Annals of Surgical Oncology
Susan M Sharpe, Mark S Talamonti, Chihsiung E Wang, Richard A Prinz, Kevin K Roggin, David J Bentrem, David J Winchester, Robert D W Marsh, Susan J Stocker, Marshall S Baker
BACKGROUND: There is considerable debate about the safety and clinical equivalence of laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) for pancreatic ductal adenocarcinoma (PDCA). STUDY DESIGN: We queried the National Cancer Data Base to identify patients undergoing LPD and OPD for PDCA between 2010 and 2011. Chi-square and Student's t-tests were used to evaluate differences between the 2 approaches. Multivariable logistic regression modeling was performed to identify patient, tumor, or facility factors associated with perioperative mortality...
July 2015: Journal of the American College of Surgeons
Susan M Sharpe, Mark S Talamonti, Edward Wang, David J Bentrem, Kevin K Roggin, Richard A Prinz, Robert D W Marsh, Susan J Stocker, David J Winchester, Marshall S Baker
BACKGROUND: The oncologic equivalence of laparoscopic distal pancreatectomy (LDP) to open pancreatectomy (ODP) for ductal adenocarcinoma (DAC) is not established. METHODS: The National Cancer Data Base was used to compare perioperative outcomes following LDP and ODP for DAC between 2010 and 2011. RESULTS: One hundred forty-five patients underwent LDP; 625 underwent ODP. Compared with ODP, patients undergoing LDP were older (68 ± 10.1 vs 66 ± 10...
March 2015: American Journal of Surgery
Shaun C Daly, Matthew Klairmont, Bulent Arslan, Yalini Vigneswaran, Kevin F Roggin, Michael B Ujiki, Woody Denham, Keith W Millikan, Minh B Luu, Daniel J Deziel, Jonathan A Myers
INTRODUCTION: To date, no study has compared laparoscopy (LB) to percutaneous (PB) biopsy for the diagnosis of abdominal lymphoma. The objective of this study is to compare the success rate and safety profile of laparoscopic lymph node biopsy to the percutaneous approach in patients with intra-abdominal lymphadenopathy concerning for lymphoma. MATERIALS AND METHODS: We performed a multi-institution, retrospective review of patients undergoing lymph node biopsy for suspected intra-abdominal lymphoma between 2005 and 2013...
September 2015: Surgical Endoscopy
Jovenel Cherenfant, Mark S Talamonti, Curtis R Hall, Tiffany A Thurow, Mistry K Gage, Susan J Stocker, Brittany Lapin, Edward Wang, Jonathan C Silverstein, Kathy Mangold, Melanie Odeleye, Karen L Kaul, Ihab Lamzabi, Paolo Gattuso, David J Winchester, Robert W Marsh, Kevin K Roggin, David J Bentrem, Marshall S Baker, Richard A Prinz
BACKGROUND: This study compares the predictability of 5 tumor markers for distant metastasis and mortality in pancreatic neuroendocrine tumors (PNETs). METHODS: A total of 128 patients who underwent pancreatectomy for nonfunctioning PNETs between 1998 and 2011 were evaluated. Tumor specimens were stained via immunochemistry for cytoplasmic and nuclear survivin, cytokeratin 19 (CK19), c-KIT, and Ki67. Univariate and multivariate regression analyses and receiver operating characteristics curve were used to evaluate the predictive value of these markers...
December 2014: Surgery
Katherine J Baxter, Nicholas Govsyeyev, Jukes P Namm, Ricardo J Gonzalez, Kevin K Roggin, Kenneth Cardona
BACKGROUND AND OBJECTIVES: The treatment of patients with pure (<5% round cell component) myxoid liposarcomas (pMLS) has not been well characterized. We hypothesized that multimodality therapy (oncological resection with radiation therapy) may not be necessary for pMLS. METHODS: Patients who underwent resection of localized pMLS at three institutions from 2000 to 2010 were identified and treatment variables were analyzed. RESULTS: Of 75 pts with pMLS, the median tumor size was 10 cm, the majority (95%) were deep tumors, and located in lower extremity...
February 2015: Journal of Surgical Oncology
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