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Blazer III, Dan German

Positions:

Associate Professor of Surgery

Surgery, Advanced Oncologic and Gastrointestinal Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1999

M.D. — Duke University

News:

Duke doctor duo share same name, ethics

June 17, 2013 — Durham Herald-Sun

Grants:

Delcath FOCUS

Administered By
Duke Cancer Institute
AwardedBy
Delcath Systems, Inc.
Role
Principal Investigator
Start Date
March 01, 2016
End Date
February 28, 2021

Surgical Fellowship Award

Administered By
Surgery, Advanced Oncologic and Gastrointestinal Surgery
AwardedBy
Foundation for Surgical Fellowships
Role
Principal Investigator
Start Date
August 01, 2016
End Date
July 31, 2018

Clinical Trials Umbrella - Scanned Beam

Administered By
Radiation Oncology
AwardedBy
Massachusetts General Hospital
Role
Principal Investigator
Start Date
November 09, 2016
End Date
December 31, 2017

Surgical Fellowship Award

Administered By
Surgery, Advanced Oncologic and Gastrointestinal Surgery
AwardedBy
Foundation for Surgical Fellowships
Role
Principal Investigator
Start Date
July 01, 2016
End Date
June 30, 2017
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Awards:

Society of University Surgeons. Society of University Surgeons.

Type
National
Awarded By
Society of University Surgeons
Date
January 01, 2015

The David C. Sabiston, Jr. Teaching Award for Excellence in Resident Education. Department of Surgery.

Type
Department
Awarded By
Department of Surgery
Date
January 01, 2013

Alpha Omega Alpha. School of Medicine.

Type
School
Awarded By
School of Medicine
Date
January 01, 1999

Publications:

Pulmonary toxicity after intraperitoneal mitomycin C: A case report of a rare complication of HIPEC

© 2016 The Author(s).Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has become a common treatment approach for disseminated appendiceal neoplasms. Systemic absorption of intraperitoneal chemotherapeutics may lead to drug-induced toxicity, most commonly neutropenia. Mitomycin C has been the most commonly used chemotherapeutic in HIPEC for the past several decades. Case presentation: Here, we describe a rare pulmonary complication secondary to intraperitoneal administration of mitomycin C. Conclusions: While rare, intraperitoneal mitomycin C has the potential to cause serious pulmonary toxicity that should be considered with administration. To our knowledge, this report represents only the second case described in the literature.

Authors
Abel, ML; Kokosis, G; Blazer, DG
MLA Citation
Abel, ML, Kokosis, G, and Blazer, DG. "Pulmonary toxicity after intraperitoneal mitomycin C: A case report of a rare complication of HIPEC." World Journal of Surgical Oncology 15.1 (February 20, 2017).
Source
scopus
Published In
World Journal of Surgical Oncology
Volume
15
Issue
1
Publish Date
2017
DOI
10.1186/s12957-016-1047-6

Simultaneous Primary Presacral Myelolipomas: Case Report and Review of the Literature.

Authors
Lazarides, AL; Scott, EJ; Cardona, DM; Blazer, DG; Brigman, BE; Eward, WC
MLA Citation
Lazarides, AL, Scott, EJ, Cardona, DM, Blazer, DG, Brigman, BE, and Eward, WC. "Simultaneous Primary Presacral Myelolipomas: Case Report and Review of the Literature." Journal of gastrointestinal cancer 47.3 (September 2016): 331-335.
PMID
26164122
Source
epmc
Published In
Journal of Gastrointestinal Cancer
Volume
47
Issue
3
Publish Date
2016
Start Page
331
End Page
335
DOI
10.1007/s12029-015-9749-5

Going the Extra Mile: Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers.

This study compares outcomes following pancreaticoduodenectomy (PD) for patients treated at local, low-volume centers and those traveling to high-volume centers.Although outcomes for PD are superior at high-volume institutions, not all patients live in proximity to major medical centers. Theoretical advantages for undergoing surgery locally exist.The 1998 to 2012 National Cancer Data Base was queried for T1-3N0-1M0 pancreatic adenocarcinoma patients who underwent PD. Travel distances to treatment centers were calculated. Overlaying the upper and lower quartiles of travel distance with institutional volume established short travel/low-volume (ST/LV) and long travel/high-volume (LT/HV) cohorts. Overall survival was evaluated.Of 7086 patients, 773 ST/LV patients traveled ≤6.3 (median 3.2) miles to centers performing ≤3.3 PDs yearly, and 758 LT/HV patients traveled ≥45 (median 97.3) miles to centers performing ≥16 PDs yearly. LT/HV patients had higher stage disease (P < 0.001), but lower margin positivity (20.5% vs 25.9%, P = 0.01) and improved lymphadenectomy (16 vs 11 nodes, P < 0.01). Moreover, LT/HV patients had shorter hospitalizations (9 vs 12 days, P < 0.01) and lower 30-day mortality (2.0% vs 6.3%, P < 0.01) with similar 30-day readmission rates (10.1% vs 9.8%, P = 0.83). Despite more advanced disease, LT/HV patients had superior unadjusted survival (20.3 vs 15.7 months). After adjustment, travel to a high-volume center remained associated with reduced long-term mortality (hazard ratio 0.75, P < 0.01).Despite an increased travel burden, patients treated at high-volume centers had improved perioperative outcomes, short-term mortality, and overall survival. These data support ongoing efforts to centralize care for patients undergoing PD.

Authors
Lidsky, ME; Sun, Z; Nussbaum, DP; Adam, MA; Speicher, PJ; Blazer, DG
MLA Citation
Lidsky, ME, Sun, Z, Nussbaum, DP, Adam, MA, Speicher, PJ, and Blazer, DG. "Going the Extra Mile: Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers." July 15, 2016.
PMID
27429020
Source
epmc
Published In
Annals of Surgery
Publish Date
2016

Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database.

Recruitment into clinical trials for retroperitoneal sarcoma has been challenging, resulting in termination of the only randomised multicentre trial in the USA investigating perioperative radiotherapy. Nonetheless, use of radiotherapy for retroperitoneal sarcoma has increased over the past decade, substantiated primarily by its established role in extremity sarcoma. In this study, we used a nationwide clinical oncology database to separately compare overall survival for patients with retroperitoneal sarcoma who had surgery and preoperative radiotherapy or surgery and postoperative radiotherapy versus surgery alone.We did two case-control, propensity score-matched analyses of the National Cancer Data Base, which included adult patients with retroperitoneal sarcoma who were diagnosed from 2003 to 2011. Patients were included if they had localised, primary retroperitoneal sarcoma. Patients were classified into three groups based on use of radiotherapy: preoperative radiotherapy, postoperative radiotherapy, and no radiotherapy (surgery alone). Patients were excluded if they received both preoperative radiotherapy and postoperative radiotherapy, or if they received intraoperative radiotherapy. Parallel propensity score-matched datasets were created for patients who received preoperative radiotherapy versus those who received no radiotherapy and for patients who received postoperative therapy versus those who received no radiotherapy. Propensity scores were calculated with logistic regression, with multiple imputation and backwards elimination, with a significance level to stay of 0·05. Matching was done with a nearest-neighbour algorithm and matched 1:2 for the preoperative radiotherapy dataset and 1:1 for the postoperative radiotherapy dataset. The primary objective of interest was overall survival for patients who received preoperative radiotherapy or postoperative radiotherapy compared with those who received no radiotherapy within the propensity score-matched datasets.9068 patients were included in this analysis: 563 in the preoperative radiotherapy group, 2215 in the postoperative radiotherapy group, and 6290 in the no radiotherapy group. Matching resulted in two comparison groups (preoperative radiotherapy vs no radiotherapy, and postoperative radiotherapy vs no radiotherapy) with negligible differences in all demographic, clinicopathological, and treatment-level variables. In the matched case-control analysis for preoperative radiotherapy median follow-up time was 42 months (IQR 27-70) for the preoperative radiotherapy group versus 43 months (25-64) for the no radiotherapy group; median overall survival was 110 months (95% CI 75-not estimable) versus 66 months (61-76), respectively. In the matched case-control analysis for postoperative radiotherapy median follow-up time was 54 months (IQR 32-79) for patients in the postoperative radiotherapy group and 47 months (26-72) for patients in the no radiotherapy group; median overall survival was 89 months (95% CI 79-100) versus 64 months (59-69), respectively. Both preoperative radiotherapy (HR 0·70, 95% CI 0·59-0·82; p<0·0001) and postoperative radiotherapy (HR 0·78, 0·71-0·85; p<0·0001) were significantly associated with improved overall survival compared with surgery alone.To the best of our knowledge, this is the largest study to date of the effect of radiotherapy on overall survival in patients with retroperitoneal sarcoma. Radiotherapy was associated with improved overall survival compared with surgery alone when delivered as either preoperative radiotherapy or postoperative radiotherapy. Together with the results from the ongoing randomised EORTC trial (62092-22092; NCT01344018) investigating preoperative radiotherapy for retroperitoneal sarcoma pending, these data might provide additional support for the increasing use of radiotherapy for patients with retroperitoneal sarcoma undergoing surgical resection.Department of Surgery, Duke University School of Medicine.

Authors
Nussbaum, DP; Rushing, CN; Lane, WO; Cardona, DM; Kirsch, DG; Peterson, BL; Blazer, DG
MLA Citation
Nussbaum, DP, Rushing, CN, Lane, WO, Cardona, DM, Kirsch, DG, Peterson, BL, and Blazer, DG. "Preoperative or postoperative radiotherapy versus surgery alone for retroperitoneal sarcoma: a case-control, propensity score-matched analysis of a nationwide clinical oncology database." The Lancet. Oncology 17.7 (July 2016): 966-975.
PMID
27210906
Source
epmc
Published In
The Lancet Oncology
Volume
17
Issue
7
Publish Date
2016
Start Page
966
End Page
975
DOI
10.1016/s1470-2045(16)30050-x

Minimally Invasive Pancreaticoduodenectomy Does Not Improve Use or Time to Initiation of Adjuvant Chemotherapy for Patients With Pancreatic Adenocarcinoma.

The modifiable variable best proven to improve survival after resection of pancreatic adenocarcinoma is the addition of adjuvant chemotherapy. A theoretical advantage of minimally invasive pancreaticoduodenectomy (MI-PD) is the potential for greater use and earlier initiation of adjuvant therapy, but this benefit remains unproven.The 2010-2012 National Cancer Data Base (NCDB) was queried for patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma. Subjects were classified as MI-PD versus open pancreaticoduodenectomy (O-PD). Baseline variables were compared between groups. The independent effect of surgical approach on the use and timing of adjuvant chemotherapy was estimated using multivariable regression analyses.For this study, 7967 subjects were identified: 1191 MI-PD (14.9%) and 6776 O-PD (85.1%) patients. Patients who underwent MI-PD were more likely to have been treated at academic hospitals. Otherwise, the groups had no baseline differences. In both the MI-PD and O-PD groups, approximately 50% of the patients received adjuvant chemotherapy, initiated at a median of 54 versus 55 days postoperatively (p = 0.08). After multivariable adjustment, surgical approach was not independently associated with use (odds ratio 1.00; p = 0.99) or time to initiation of adjuvant chemotherapy (-2.3 days; p = 0.07). Younger age, insured status, lower comorbidity score, higher tumor stage, and the presence of lymph node metastases were independently associated with the use of adjuvant chemotherapy.At a national level, MI-PD does not result in greater use or earlier initiation of adjuvant chemotherapy. As surgeons and institutions continue to gain experience with this complex procedure, it will be important to revisit this benchmark as a justification for its increasing use for patients with pancreatic cancer.

Authors
Nussbaum, DP; Adam, MA; Youngwirth, LM; Ganapathi, AM; Roman, SA; Tyler, DS; Sosa, JA; Blazer, DG
MLA Citation
Nussbaum, DP, Adam, MA, Youngwirth, LM, Ganapathi, AM, Roman, SA, Tyler, DS, Sosa, JA, and Blazer, DG. "Minimally Invasive Pancreaticoduodenectomy Does Not Improve Use or Time to Initiation of Adjuvant Chemotherapy for Patients With Pancreatic Adenocarcinoma." March 2016.
PMID
26542590
Source
epmc
Published In
Annals of Surgical Oncology
Volume
23
Issue
3
Publish Date
2016
Start Page
1026
End Page
1033
DOI
10.1245/s10434-015-4937-x

Feeding jejunostomy tube placement during resection of gastric cancers.

Feeding tube placement is common among patients undergoing gastrectomy, and national guidelines currently recommend consideration of a feeding jejunostomy tube (FJT) for all patients undergoing resection for gastric cancer. However, data are limited regarding the safety of FJT placement at the time of gastrectomy for gastric cancer.The 2005-2011 American College of Surgeons National Surgical Quality Improvement Program Participant User Files were queried to identify patients who underwent gastrectomy for gastric cancer. Subjects were classified by the concomitant placement of an FJT. Groups were then propensity matched using a 1:1 nearest neighbor algorithm, and outcomes were compared between groups. The primary outcomes of interest were overall 30-d overall complications and mortality. Secondary end points included major complications, surgical site infection, and early reoperation.In total, 2980 subjects underwent gastrectomy for gastric cancer, among whom 715 (24%) also had an FJT placed. Patients who had an FJT placed were more likely to be male (61.6% versus 56.6%, P = 0.02), have recent weight loss (21.0% versus 14.8%, P < 0.01), and have undergone recent chemotherapy (7.9% versus 4.2%, P < 0.01) and radiation therapy (4.2% versus 1.3%, P < 0.01). They were also more likely to have undergone total (compared with partial) gastrectomy (66.6% versus 28.6%, P < 0.01) and have concomitant resection of an adjacent organ (40.4 versus 24.1%, P < 0.01). After adjustment with propensity matching, however, all baseline characteristics and treatment variables were highly similar. Between groups, there were no statistically significant differences in 30-d overall complications (38.8% versus 36.1%, P = 0.32) or mortality (5.8 versus 3.7%, P = 0.08). There were also no differences in major complications, surgical site infection, or early reoperation. Operative time was slightly longer among patients with feeding tubes placed (median, 248 versus 233 min, P = 0.01), but otherwise there were no significant differences in any outcomes between groups.Concomitant placement of FJT at the time of gastrectomy may result in slightly increased operative times but does not appear to lead to increased perioperative morbidity or mortality. Further investigation is needed to identify the patients most likely to benefit from FJT placement.

Authors
Sun, Z; Shenoi, MM; Nussbaum, DP; Keenan, JE; Gulack, BC; Tyler, DS; Speicher, PJ; Blazer, DG
MLA Citation
Sun, Z, Shenoi, MM, Nussbaum, DP, Keenan, JE, Gulack, BC, Tyler, DS, Speicher, PJ, and Blazer, DG. "Feeding jejunostomy tube placement during resection of gastric cancers." The Journal of surgical research 200.1 (January 2016): 189-194.
PMID
26248478
Source
epmc
Published In
Journal of Surgical Research
Volume
200
Issue
1
Publish Date
2016
Start Page
189
End Page
194
DOI
10.1016/j.jss.2015.07.014

A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer.

Local recurrence is a common cause of treatment failure for patients with solid tumors. Intraoperative detection of microscopic residual cancer in the tumor bed could be used to decrease the risk of a positive surgical margin, reduce rates of reexcision, and tailor adjuvant therapy. We used a protease-activated fluorescent imaging probe, LUM015, to detect cancer in vivo in a mouse model of soft tissue sarcoma (STS) and ex vivo in a first-in-human phase 1 clinical trial. In mice, intravenous injection of LUM015 labeled tumor cells, and residual fluorescence within the tumor bed predicted local recurrence. In 15 patients with STS or breast cancer, intravenous injection of LUM015 before surgery was well tolerated. Imaging of resected human tissues showed that fluorescence from tumor was significantly higher than fluorescence from normal tissues. LUM015 biodistribution, pharmacokinetic profiles, and metabolism were similar in mouse and human subjects. Tissue concentrations of LUM015 and its metabolites, including fluorescently labeled lysine, demonstrated that LUM015 is selectively distributed to tumors where it is activated by proteases. Experiments in mice with a constitutively active PEGylated fluorescent imaging probe support a model where tumor-selective probe distribution is a determinant of increased fluorescence in cancer. These co-clinical studies suggest that the tumor specificity of protease-activated imaging probes, such as LUM015, is dependent on both biodistribution and enzyme activity. Our first-in-human data support future clinical trials of LUM015 and other protease-sensitive probes.

Authors
Whitley, MJ; Cardona, DM; Lazarides, AL; Spasojevic, I; Ferrer, JM; Cahill, J; Lee, C-L; Snuderl, M; Blazer, DG; Hwang, ES; Greenup, RA; Mosca, PJ; Mito, JK; Cuneo, KC; Larrier, NA; O'Reilly, EK; Riedel, RF; Eward, WC; Strasfeld, DB; Fukumura, D; Jain, RK; Lee, WD; Griffith, LG; Bawendi, MG; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Lazarides, AL, Spasojevic, I, Ferrer, JM, Cahill, J, Lee, C-L, Snuderl, M, Blazer, DG, Hwang, ES, Greenup, RA, Mosca, PJ, Mito, JK, Cuneo, KC, Larrier, NA, O'Reilly, EK, Riedel, RF, Eward, WC, Strasfeld, DB, Fukumura, D, Jain, RK, Lee, WD, Griffith, LG, Bawendi, MG, Kirsch, DG, and Brigman, BE. "A mouse-human phase 1 co-clinical trial of a protease-activated fluorescent probe for imaging cancer." Science translational medicine 8.320 (January 2016): 320ra4-.
PMID
26738797
Source
epmc
Published In
Science Translational Medicine
Volume
8
Issue
320
Publish Date
2016
Start Page
320ra4
DOI
10.1126/scitranslmed.aad0293

Minimally Invasive Distal Pancreatectomy for Cancer: Short-Term Oncologic Outcomes in 1,733 Patients.

Data from high-volume institutions suggest that minimally invasive distal pancreatectomy (MIDP) provides favorable perioperative outcomes and adequate oncologic resection for pancreatic cancer; however, these outcomes may not be generalizable. This study examines patterns of use and short-term outcomes from MIDP (laparoscopic or robotic) versus open distal pancreatectomy (ODP) for pancreatic adenocarcinoma in the United States.Adult patients undergoing distal pancreatectomy were identified from the National Cancer Database, 2010-2011. Multivariable modeling was applied to compare short-term outcomes from MIDP versus ODP for pancreatic adenocarcinoma.1733 patients met inclusion criteria: 535 (31 %) had MIDP and 1198 (69 %) ODP. Use of MIDP increased 43 % between 2010 and 2011; the conversion rate from MIDP to ODP was 23 %. MIDP cases were performed at 215 hospitals, with 85 % of hospitals performing <10 cases overall. After adjustment, pancreatic adenocarcinoma patients undergoing MIDP versus ODP had a similar likelihood of complete resection (OR 1.48, p = 0.10), number of lymph nodes removed (RR 1.01, p = 0.91), and 30-day readmission rate (OR 1.02, p = 0.96); however, length of stay was shorter (RR 0.84, p < 0.01).Use of MIDP for cancer is increasing, with most centers performing a low volume of these procedures. Use of MIDP for body and tail pancreatic adenocarcinoma appears to have short-term outcomes that are similar to those of open procedures with the benefit of a shorter hospital stay. Larger studies with longer follow-up are needed.

Authors
Adam, MA; Choudhury, K; Goffredo, P; Reed, SD; Blazer, D; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Choudhury, K, Goffredo, P, Reed, SD, Blazer, D, Roman, SA, and Sosa, JA. "Minimally Invasive Distal Pancreatectomy for Cancer: Short-Term Oncologic Outcomes in 1,733 Patients." World journal of surgery 39.10 (October 2015): 2564-2572.
PMID
26154576
Source
epmc
Published In
World Journal of Surgery
Volume
39
Issue
10
Publish Date
2015
Start Page
2564
End Page
2572
DOI
10.1007/s00268-015-3138-x

Minimally Invasive Gastrectomy for Gastric Cancer: A National Perspective on Oncologic Outcomes and Overall Survival

Authors
Leung, K; Sun, Z; Nussbaum, DP; Adam, M; Worni, M; III, BDG
MLA Citation
Leung, K, Sun, Z, Nussbaum, DP, Adam, M, Worni, M, and III, BDG. "Minimally Invasive Gastrectomy for Gastric Cancer: A National Perspective on Oncologic Outcomes and Overall Survival." October 2015.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
221
Issue
4
Publish Date
2015
Start Page
S142
End Page
S143

The use of radiation therapy in localized high-grade soft tissue sarcoma and potential impact on survival.

It is a consensus that radiation therapy (RT) should be applied for all large, deep, high-grade soft tissue sarcomas (STS). Therefore, we investigated the National Cancer Database (NCDB) to study how these guidelines are being followed, to determine what factors may be associated with the decision not to use RT, and to see whether there was an association of RT use and survival.We retrospectively analyzed localized high-grade STS patients in the NCDB from 1998 through 2006. They were further stratified into two groups: no radiation (NRT) group and radiation (RT) group. Then, long-term survival between the two groups was evaluated using the Kaplan-Meier (KM) method with comparisons based on the log-rank test. Multiple variables were analyzed between the two groups. Propensity matching was performed secondarily to minimize the influence of confounding variables.A total of 3982 of 10,290 patients (37.8 %) did not receive RT and 6,308 patients (62.2 %) did receive RT. Patients in the NRT group were more likely to have a below-median education level (median 58.2 % vs. 60.7 %; p = 0.015) and a below-median income level (65.1 % vs. 68.6 %; p < 0.001). In addition, these patients lived farther from their treatment centers (20.2 vs. 14.8 miles, p = 0.002) and were more likely to be uninsured (5.3 % vs. 3.5 %, p < 0.001). They were less likely to receive a radical excision (55.2 % vs. 70.1 %; p < 0.001) and more likely to receive amputation (20.9 % vs. 3.3 %; p < 0.001). The 30-day mortality (1.2 % vs. 0.2 %; p < 0.001) and readmission rate (3.8 % vs. 2.8 %; p = 0.031) were higher for the NRT group. KM analysis showed that long-term survival for patients who did not receive RT was significantly lower, even after propensity score matching (p < 0.001).This large database review reveals a striking lack of utilization of RT to treat high-grade STS, which correlates with poorer survival even after propensity matching. Lower education and income levels and diminished access to medical care (insurance and distance to the facility) are associated with failing to receive RT.

Authors
Hou, C-H; Lazarides, AL; Speicher, PJ; Nussbaum, DP; Blazer, DG; Kirsch, DG; Brigman, BE; Eward, WC
MLA Citation
Hou, C-H, Lazarides, AL, Speicher, PJ, Nussbaum, DP, Blazer, DG, Kirsch, DG, Brigman, BE, and Eward, WC. "The use of radiation therapy in localized high-grade soft tissue sarcoma and potential impact on survival." Annals of surgical oncology 22.9 (September 2015): 2831-2838.
PMID
26040605
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
9
Publish Date
2015
Start Page
2831
End Page
2838
DOI
10.1245/s10434-015-4639-4

Analysis of perioperative radiation therapy in the surgical treatment of primary and recurrent retroperitoneal sarcoma.

Radiation therapy (RT) is increasingly utilized in conjunction with surgery for the treatment of retroperitoneal soft tissue sarcomas (RPS). Despite multiple theoretical advantages of RT, its role in the surgical management of this disease remains ill defined.Patients undergoing surgery for RPS from 1990 to 2011 were identified. Patients were classified as having primary or recurrent disease, and then further stratified by the use of perioperative RT. Primary outcomes, including overall survival (OS) and recurrence-free survival (RFS), were estimated using the Kaplan-Meier method with comparisons based on the log rank test. Cox-proportional hazards modeling was used to estimate the independent effect of RT on survival.Ninety-four patients met final inclusion criteria. After adjusting for confounding variables, perioperative RT remained independently associated with a reduced risk of recurrence (HR 0.34, P < 0.01) and death (HR 0.30, P = 0.02).In this retrospective series, perioperative RT is an independent predictor of improved OS and RFS. These results provide additional support for the use of RT in the multimodality treatment of retroperitoneal sarcoma.

Authors
Lane, WO; Cramer, CK; Nussbaum, DP; Speicher, PJ; Gulack, BC; Czito, BG; Kirsch, DG; Tyler, DS; Blazer, DG
MLA Citation
Lane, WO, Cramer, CK, Nussbaum, DP, Speicher, PJ, Gulack, BC, Czito, BG, Kirsch, DG, Tyler, DS, and Blazer, DG. "Analysis of perioperative radiation therapy in the surgical treatment of primary and recurrent retroperitoneal sarcoma." Journal of surgical oncology 112.4 (September 2015): 352-358.
PMID
26238282
Source
epmc
Published In
Journal of Surgical Oncology
Volume
112
Issue
4
Publish Date
2015
Start Page
352
End Page
358
DOI
10.1002/jso.23996

Minimally Invasive Versus Open Pancreaticoduodenectomy for Cancer: Practice Patterns and Short-term Outcomes Among 7061 Patients.

To describe national practice patterns regarding utilization of minimally invasive pancreaticoduodenectomy (MIPD) and compare short-term outcomes with those following open pancreaticoduodenectomy for cancer.There is increasing interest in use of MIPD; however, published data are limited to single institutional experiences.Adult patients undergoing pancreaticoduodenectomy were identified from the National Cancer Database, 2010-2011. Descriptive statistics and multivariable modeling were employed to characterize use of MIPD (laparoscopic or robotic) and compare short-term outcomes to those following open pancreaticoduodenectomy.A total of 7061 patients underwent pancreaticoduodenectomy: 983 had MIPD and 6078 had open procedures. The use of MIPD increased by 45% (179 cases) from 2010 to 2011. The majority of hospitals (92%) performing MIPD were low volume (≤ 10 cases/2 years). Factors independently associated with undergoing MIPD included fewer comorbidities, treatment at an academic institution, and a neuroendocrine tumor diagnosis (all P < 0.01). The unadjusted 30-day mortality rate was 5.1% for MIPD versus 3.1% after open surgery. For patients with adenocarcinoma, there were no differences between MIPD and open pancreaticoduodenectomy after multivariable adjustment in number of lymph nodes removed, rate of positive surgical margins, length of stay, or readmissions. However, 30-day mortality was higher for patients undergoing MIPD versus open surgery (odds ratio = 1.87, confidence interval: 1.25-2.80, P = 0.002).While there is increasing interest in employing MIPD for adenocarcinoma, its use is associated with increased 30-day mortality. The majority of hospitals performing MIPD were low volume. These results may suggest that MIPD is a complex procedure for which comprehensive protocols outlining criteria for implementation might be warranted to optimize patient safety.

Authors
Adam, MA; Choudhury, K; Dinan, MA; Reed, SD; Scheri, RP; Blazer, DG; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Choudhury, K, Dinan, MA, Reed, SD, Scheri, RP, Blazer, DG, Roman, SA, and Sosa, JA. "Minimally Invasive Versus Open Pancreaticoduodenectomy for Cancer: Practice Patterns and Short-term Outcomes Among 7061 Patients." Annals of surgery 262.2 (August 2015): 372-377.
PMID
26158612
Source
epmc
Published In
Annals of Surgery
Volume
262
Issue
2
Publish Date
2015
Start Page
372
End Page
377
DOI
10.1097/sla.0000000000001055

Neoadjuvant radiation therapy does not increase perioperative morbidity among patients undergoing gastrectomy for gastric cancer.

BACKGROUND: Neoadjuvant radiation therapy (RT) as a component of the multimodality treatment of gastric cancer has demonstrated promising results. Data regarding its effect on perioperative safety are limited. METHODS: Adults undergoing gastrectomy for gastric cancer in the 2005-2011 National Surgical Quality Improvement Program were included. Groups were defined by neoadjuvant RT use, and then propensity-matched based on preoperative variables. Multivariable logistic regression was performed to assess neoadjuvant RT as an independent predictor of outcomes. RESULTS: Among 2,764 patients identified, 55 (2.0%) were treated with neoadjuvant RT. Patients who received neoadjuvant RT were more likely to have received preoperative chemotherapy and steroids, and experienced weight loss (all P < 0.01). After matching, however, there were no preoperative differences. At time of surgery, total (vs. partial) gastrectomy was more common among patients who underwent neoadjuvant RT (70.9 vs. 46.7%, P < 0.01), and operative time was longer (290 vs. 236 min, P < 0.01). There were no differences in overall complications (23.6 vs. 29.7%, P = 0.49) or 30-day mortality (3.6 vs. 3.6%, P = 0.99). CONCLUSIONS: Neoadjuvant RT was not associated with increased morbidity or mortality following resection for gastric cancer. These findings support the ongoing investigation of neoadjuvant RT as part of the multidisciplinary management of resectable gastric cancer.

Authors
Sun, Z; Nussbaum, DP; Speicher, PJ; Czito, BG; Tyler, DS; Blazer, DG
MLA Citation
Sun, Z, Nussbaum, DP, Speicher, PJ, Czito, BG, Tyler, DS, and Blazer, DG. "Neoadjuvant radiation therapy does not increase perioperative morbidity among patients undergoing gastrectomy for gastric cancer." Journal of surgical oncology 112.1 (July 14, 2015): 46-50.
PMID
26179329
Source
epmc
Published In
Journal of Surgical Oncology
Volume
112
Issue
1
Publish Date
2015
Start Page
46
End Page
50
DOI
10.1002/jso.23957

Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas.

To evaluate long-term survival among patients undergoing radiation therapy (RT), followed by surgical resection of retroperitoneal sarcomas (RPS).Despite a lack of level 1 evidence supporting neoadjuvant RT for RPS, its use has increased substantially over the past decade.The 1998-2011 National Cancer Data Base was queried to identify patients who underwent resection of RPS. Subjects were grouped by use of neoadjuvant RT. Perioperative variables and outcomes were compared. Multivariable logistic regression was performed to assess predictors of neoadjuvant RT. Groups were propensity matched using a 2:1 nearest neighbor algorithm and short-term outcomes were compared. Finally, long-term survival was evaluated using the Kaplan-Meier method, with comparisons based on the log-rank test.A total of 11,324 patients were identified. Neoadjuvant RT was administered to 696 patients (6.1%). During the study period, preoperative RT use increased from 4% to nearly 15%. Male sex, tumor size larger than 5 cm, treatment at an academic/research program, and higher tumor grade all predicted neoadjuvant RT administration. After propensity matching, the only difference in baseline characteristics was the use of neoadjuvant chemotherapy. Although neoadjuvant RT was associated with a higher rate of negative margins (77.5% vs 73.0%; P = 0.014), there was no corresponding improvement in 5-year survival (53.2% vs 54.2%; P = 0.695).Despite the increasing use of neoadjuvant RT for patients with RPS, the survival benefit associated with this treatment modality remains unclear. Continued investigation is needed to better define the role of RT among patients with RPS.

Authors
Nussbaum, DP; Speicher, PJ; Gulack, BC; Ganapathi, AM; Englum, BR; Kirsch, DG; Tyler, DS; Blazer, DG
MLA Citation
Nussbaum, DP, Speicher, PJ, Gulack, BC, Ganapathi, AM, Englum, BR, Kirsch, DG, Tyler, DS, and Blazer, DG. "Long-term Oncologic Outcomes After Neoadjuvant Radiation Therapy for Retroperitoneal Sarcomas." Annals of surgery 262.1 (July 2015): 163-170.
PMID
25185464
Source
epmc
Published In
Annals of Surgery
Volume
262
Issue
1
Publish Date
2015
Start Page
163
End Page
170
DOI
10.1097/sla.0000000000000840

Adherence to Guidelines for Adjuvant Imatinib Therapy for GIST: A Multi-institutional Analysis.

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy improves recurrence-free and overall survival following surgery for patients with high-risk GIST; however, the factors associated with use of adjuvant imatinib therapy are unclear, and adherence to adjuvant imatinib has not been investigated. We sought to determine the clinicopathologic predictors of therapy with adjuvant imatinib following surgical resection for GIST and to determine the utilization of adjuvant imatinib in patients who underwent surgical resection of primary GIST in 2009 or later as recommended by National Comprehensive Cancer network (NCCN) guidelines.A multi-institutional cohort including 171 patients who underwent surgery for primary GIST at seven high-volume cancer centers in the USA and Canada between January 2009-December 2012 was used in this study. Receipt of adjuvant imatinib therapy was ascertained, and factors associated with imatinib therapy were analyzed.Following surgery for primary GIST, tumor size (<5.0 cm: ref; 5.0-9.9 cm: odds ratio (OR) 2.36, 95 % confidence interval (CI) 0.74-7.55; >10.0 cm: OR 9.15, 95 % CI 2.28-36.75; p = 0.007), mitotic rate (≤5/50 mitoses per 50 high powered field [HPF]: ref; 6-10/50 HPF: OR 24.91, 95 % CI 3.64-170.35; >10/50 HPF: OR 5.80, 95 % CI 3.64-170.35; p < 0.001), and neoadjuvant therapy (OR 9.52; 95 % CI 2.51-36.14; p = 0.001) were associated with receipt of adjuvant imatinib therapy. Overall, 75 % of patients received appropriate treatment, 23 % of patients were undertreated, and 2 % of patients were overtreated as compared to NCCN guidelines. Adjuvant imatinib therapy was administered in only 53 % of patients for which the NCCN guidelines recommended adjuvant therapy.The clinicopathologic factors associated with use of adjuvant imatinib therapy in patients following resection of primary GIST are consistent with established risk factors for recurrence. Adjuvant imatinib therapy remains underutilized in patients with intermediate and high-risk GIST and in patients who receive neoadjuvant therapy. Barriers to adjuvant imatinib therapy in this group of patients needs to be further explored.

Authors
Bischof, DA; Dodson, R; Jimenez, MC; Behman, R; Cocieru, A; Blazer, DG; Fisher, SB; Squires, MH; Kooby, DA; Maithel, SK; Groeschl, RT; Gamblin, TC; Bauer, TW; Karanicolas, PJ; Law, C; Quereshy, FA; Pawlik, TM
MLA Citation
Bischof, DA, Dodson, R, Jimenez, MC, Behman, R, Cocieru, A, Blazer, DG, Fisher, SB, Squires, MH, Kooby, DA, Maithel, SK, Groeschl, RT, Gamblin, TC, Bauer, TW, Karanicolas, PJ, Law, C, Quereshy, FA, and Pawlik, TM. "Adherence to Guidelines for Adjuvant Imatinib Therapy for GIST: A Multi-institutional Analysis." Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 19.6 (June 2015): 1022-1028.
PMID
25731828
Source
epmc
Published In
Journal of Gastrointestinal Surgery
Volume
19
Issue
6
Publish Date
2015
Start Page
1022
End Page
1028
DOI
10.1007/s11605-015-2782-7

Management of 1- to 2-cm Carcinoid Tumors of the Appendix: Using the National Cancer Data Base to Address Controversies in General Surgery.

BACKGROUND: The management of 1- to 2-cm appendiceal carcinoid tumors remains controversial. Here we use the National Cancer Data Base (NCDB) to compare long-term outcomes for patients treated via resection of the primary tumor alone vs right hemicolectomy (RHC). STUDY DESIGN: The 1998 to 2011 NCDB User File was queried to identify patients with 1- to 2-cm appendiceal carcinoids. Patients were stratified by surgical technique: resection of the primary tumor alone vs RHC with regional lymphadenectomy. Multivariable logistic regression was used to compare short-term outcomes. Survival was estimated using the Kaplan-Meier method with comparisons based on the log-rank test. RESULTS: A total of 916 patients were identified, including 42% managed with primary resection and 58% with RHC. Patients who underwent RHC had slightly larger tumors and higher-stage tumors; otherwise, there were no baseline differences between groups. The rates of positive margins were similar (5.5% vs 4.5%; p = 0.60). Among all patients, 1- and 5-year survival were 98.1% and 88.7% vs 96.7% and 87.4% (p = 0.52) for those managed via primary resection vs RHC, respectively. Among patients with moderate/high-grade/anaplastic carcinoids, 1- and 5-year survival were 93.3% and 72.0% vs 92.3% and 71.9%, respectively (p = 0.78). After adjustment with Cox proportional hazards modeling, we confirmed that there was no survival benefit for patients undergoing RHC (hazard ratio = 1.14; p = 0.72). CONCLUSIONS: For 1- to 2-cm appendiceal carcinoids, formal resection of the right colon does not appear to improve survival, even for higher-grade tumors. Our findings suggest that resection of the primary tumor alone is adequate for all carcinoids <2 cm.

Authors
Nussbaum, DP; Speicher, PJ; Gulack, BC; Keenan, JE; Ganapathi, AM; Englum, BR; Tyler, DS; Blazer, DG
MLA Citation
Nussbaum, DP, Speicher, PJ, Gulack, BC, Keenan, JE, Ganapathi, AM, Englum, BR, Tyler, DS, and Blazer, DG. "Management of 1- to 2-cm Carcinoid Tumors of the Appendix: Using the National Cancer Data Base to Address Controversies in General Surgery." Journal of the American College of Surgeons 220.5 (May 2015): 894-903.
PMID
25840530
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
220
Issue
5
Publish Date
2015
Start Page
894
End Page
903
DOI
10.1016/j.jamcollsurg.2015.01.005

Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients.

Gastrointestinal stromal tumors (GISTs) are the most commonly diagnosed mesenchymal tumors of the gastrointestinal tract. The risk of recurrence following surgical resection of GISTs is typically reported from the date of surgery. However, disease-free survival (DFS) over time is dynamic and changes based on disease-free time already accumulated following surgery.To assess the comparative performance of established GIST recurrence risk prognostic scoring systems and to characterize conditional DFS following surgical resection of GISTs.A retrospective cohort study of 502 patients who underwent surgery for a primary, nonmetastatic GIST between January 1, 1998, and December 31, 2012, at 7 major academic cancer centers in the United States and Canada.Disease-free survival of the patients was classified according to 5 prognostic scoring systems, including the National Institutes of Health criteria, modified National Institutes of Health criteria, Memorial Sloan Kettering Cancer Center GIST nomogram, and American Joint Committee on Cancer gastric and nongastric categories. The concordance index (also known as the C statistic or the area under the receiver operating curve) of established GIST recurrence risk prognostic scoring systems. Conditional DFS estimates were calculated.Overall 1-year, 3-year, and 5-year DFS following resection of GISTs was 95%, 83%, and 74%, respectively. All the prognostic scoring systems had fair prognostic ability. For all tumor sites, the American Joint Committee on Cancer gastric category demonstrated the best discrimination (C = 0.79). Using conditional DFS, the probability of remaining disease free for an additional 3 years given that a patient was disease free at 1 year, 3 years, and 5 years was 82%, 89%, and 92%, respectively. Patients with the highest initial recurrence risk demonstrated the greatest increase in conditional survival as time elapsed.Conditional DFS improves over time following resection of GISTs. This is valuable information about long-term prognosis to communicate to patients who are disease free after a period following surgery.

Authors
Bischof, DA; Kim, Y; Dodson, R; Jimenez, MC; Behman, R; Cocieru, A; Fisher, SB; Groeschl, RT; Squires, MH; Maithel, SK; Blazer, DG; Kooby, DA; Gamblin, TC; Bauer, TW; Quereshy, FA; Karanicolas, PJ; Law, CHL; Pawlik, TM
MLA Citation
Bischof, DA, Kim, Y, Dodson, R, Jimenez, MC, Behman, R, Cocieru, A, Fisher, SB, Groeschl, RT, Squires, MH, Maithel, SK, Blazer, DG, Kooby, DA, Gamblin, TC, Bauer, TW, Quereshy, FA, Karanicolas, PJ, Law, CHL, and Pawlik, TM. "Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients." JAMA surgery 150.4 (April 2015): 299-306.
PMID
25671681
Source
epmc
Published In
JAMA Surgery
Volume
150
Issue
4
Publish Date
2015
Start Page
299
End Page
306
DOI
10.1001/jamasurg.2014.2881

Outcomes following splenectomy in patients with myeloid neoplasms.

BACKGROUND AND OBJECTIVES: Myeloid neoplasms are classified into five major categories. These patients may develop splenomegaly and require splenectomy to alleviate mechanical symptoms, to ameliorate transfusion-dependent cytopenias, or to enhance stem cell transplantation. The objective of this study was to determine which clinical variables significantly impacted morbidity, mortality, and survival in patients with myeloid neoplasms undergoing splenectomy, and to determine if operative outcomes have improved over time. METHODS: The records of all patients with myeloid neoplasms undergoing splenectomy from 1993 to 2010 were retrospectively reviewed. RESULTS: Eighty-nine patients (n = 89) underwent splenectomy for myeloid neoplasms. Over half of patients who had symptoms preoperatively had resolution of their symptoms post-splenectomy. The morbidity rate was 38%, with the most common complications being bleeding (14%) or infection (20%). Thirty-day mortality rate was 18% and median survival after splenectomy was 278 days. Decreased survival was associated with a diagnosis of myelodysplastic syndrome/myeloproliferative neoplasm, anemia, abnormal white blood cell count, and hypoalbuminemia. Patients who underwent stem cell transplantation did not show an increased risk for morbidity or mortality. CONCLUSIONS: Patients with myeloid neoplasms have a poor prognosis after splenectomy and the decision to operate is a difficult one, associated with high morbidity and mortality.

Authors
Rialon, KL; Speicher, PJ; Ceppa, EP; Rendell, VR; Vaslef, SN; Beaven, A; Tyler, DS; Blazer, DG
MLA Citation
Rialon, KL, Speicher, PJ, Ceppa, EP, Rendell, VR, Vaslef, SN, Beaven, A, Tyler, DS, and Blazer, DG. "Outcomes following splenectomy in patients with myeloid neoplasms." Journal of surgical oncology 111.4 (March 2015): 389-395.
PMID
25488568
Source
epmc
Published In
Journal of Surgical Oncology
Volume
111
Issue
4
Publish Date
2015
Start Page
389
End Page
395
DOI
10.1002/jso.23846

Nationwide Trends and Outcomes associated with Neoadjuvant Therapy in Pancreatic Cancer: An Analysis of 18,243 Patients

Authors
Youngwirth, LM; Adam, MA; Nussbaum, DP; Goffredo, P; Robinson, TJ; Blazer, DG; Roman, SA; Sosa, JA
MLA Citation
Youngwirth, LM, Adam, MA, Nussbaum, DP, Goffredo, P, Robinson, TJ, Blazer, DG, Roman, SA, and Sosa, JA. "Nationwide Trends and Outcomes associated with Neoadjuvant Therapy in Pancreatic Cancer: An Analysis of 18,243 Patients." February 2015.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
22
Publish Date
2015
Start Page
S177
End Page
S178

A Phase I Clinical Trial of LUM015: A Protease-activated Fluorescent Imaging Agent to Detect Cancer during Surgery

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, E; Greenup, RA; Mosca, PJ; Cahill, J; Mito, JK; Cuneo, KC; Larrier, N; O'Reilly, E; Spasojevic, I; Riedel, RF; Eward, WC; Griffith, LG; Bawendi, MG; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, E, Greenup, RA, Mosca, PJ, Cahill, J, Mito, JK, Cuneo, KC, Larrier, N, O'Reilly, E, Spasojevic, I, Riedel, RF, Eward, WC, Griffith, LG, Bawendi, MG, Kirsch, DG, and Brigman, BE. "A Phase I Clinical Trial of LUM015: A Protease-activated Fluorescent Imaging Agent to Detect Cancer during Surgery." February 2015.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
22
Publish Date
2015
Start Page
S11
End Page
S12

A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy.

BACKGROUND: In this retrospective review, we evaluate a standardized care plan (SCP) for patients undergoing pancreaticoduodenectomy, which included selective placement of feeding jejunostomy tubes (FJTs) and a perioperative fast-track recovery pathway (FTRP). METHODS: A review of 242 patients undergoing pancreaticoduodenectomy was completed. Patients treated pre- and post-SCP implementation were compared. Univariate comparison followed by multivariable linear regression were performed to identify predictors of hospital length of stay (HLOS). RESULTS: SCP patients (n = 100) were slightly older but otherwise similar to pre-SCP patients (n = 142). FJT placement occurred less frequently in SCP patients (38 versus 94%, P < 0.001). All SCP patients were initiated on the FTRP. Among SCP patients, an oral diet was introduced earlier (5 versus 8.5 d, P < 0.001) and HLOS was shorter (11 versus 13 d, P = 0.015). Readmission rates were similar. Following adjustment with linear regression, we confirmed SCP status as a predictor of HLOS. To assess SCP components, HLOS was evaluated separately based on FTRP status and FJT placement. Although both were highly associated with HLOS, neither was independently predictive in multivariable analysis. CONCLUSIONS: Implementation of an SCP resulted in shorter HLOS without an increase in readmissions. Future studies are necessary to identify specific components of SCPs that most influence outcomes.

Authors
Nussbaum, DP; Penne, K; Stinnett, SS; Speicher, PJ; Cocieru, A; Blazer, DG; Zani, S; Clary, BM; Tyler, DS; White, RR
MLA Citation
Nussbaum, DP, Penne, K, Stinnett, SS, Speicher, PJ, Cocieru, A, Blazer, DG, Zani, S, Clary, BM, Tyler, DS, and White, RR. "A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenectomy." The Journal of surgical research 193.1 (January 2015): 237-245.
PMID
25062813
Source
epmc
Published In
Journal of Surgical Research
Volume
193
Issue
1
Publish Date
2015
Start Page
237
End Page
245
DOI
10.1016/j.jss.2014.06.036

The Use of Radiation Therapy in Well-Differentiated Soft Tissue Sarcoma of the Extremities: An NCDB Review.

Objective. This study investigated patterns of utilization of radiation therapy (RT) and correlated this with overall survival by assessing patients with well-differentiated soft tissue sarcoma of the extremity (STS-E) in the National Cancer Database (NCDB). Methods. All patients diagnosed with well-differentiated STS-E between 1998 and 2006 were identified in the NCDB. Patients were stratified by use of surgery alone versus use of adjuvant RT after surgery and analyzed using multivariate analysis, Kaplan-Meier analysis, and propensity matching. Results. 2113 patients with well-differentiated STS-E were identified in the NCDB for inclusion with a mean follow-up time of 74 months. 69% of patients were treated with surgery alone, while 26% were treated with surgery followed by adjuvant RT. Patients undergoing amputation were less likely to receive adjuvant RT. There was no difference in overall survival between patients with well-differentiated STS treated with surgery alone and those patients who received adjuvant RT. Conclusions. In the United States, adjuvant RT is being utilized in a quarter of patients being treated for well-differentiated STS-E. While the use of adjuvant RT may be viewed as a means to facilitate limb salvage, this large national database review confirms no survival benefit, regardless of tumor size or margin status.

Authors
Lazarides, AL; Eward, WC; Speicher, PJ; Hou, C-H; Nussbaum, DP; Green, C; Blazer, DG; Kirsch, DG; Brigman, BE
MLA Citation
Lazarides, AL, Eward, WC, Speicher, PJ, Hou, C-H, Nussbaum, DP, Green, C, Blazer, DG, Kirsch, DG, and Brigman, BE. "The Use of Radiation Therapy in Well-Differentiated Soft Tissue Sarcoma of the Extremities: An NCDB Review." Sarcoma 2015 (January 2015): 186581-.
PMID
26064077
Source
epmc
Published In
Sarcoma
Volume
2015
Publish Date
2015
Start Page
186581
DOI
10.1155/2015/186581

Wound classification reporting in HPB surgery: can a single word change public perception of institutional performance?

The drive to improve outcomes and the inevitability of mandated public reporting necessitate uniform documentation and accurate databases. The reporting of wound classification in patients undergoing hepato-pancreatico-biliary (HPB) surgery and the impact of inconsistencies on quality metrics were investigated.The 2005-2011 National Surgical Quality Improvement Program (NSQIP) participant use file was interrogated to identify patients undergoing HPB resections. The effect of wound classification on post-operative surgical site infection (SSI) rates was determined through logistic regression. The impact of variations in wound classification reporting on perceived outcomes was modelled by simulating observed-to-expected (O/E) ratios for SSI.In total, 27,376 patients were identified with significant heterogeneity in wound classification. In spite of clear guidelines prompting at least 'clean-contaminated' designation for HPB resections, 8% of all cases were coded as 'clean'. Contaminated [adjusted odds ratio (AOR): 1.39, P = 0.001] and dirty (AOR: 1.42, P = 0.02] cases were associated with higher odds of SSI, whereas clean-contaminated were not (P = 0.99). O/E ratios were highly sensitive to modest changes in wound classification.Perceived performance is affected by heterogeneous reporting of wound classification. As institutions work to improve outcomes and prepare for public reporting, it is imperative that all adhere to consistent reporting practices to provide accurate and reproducible outcomes.

Authors
Speicher, PJ; Nussbaum, DP; Scarborough, JE; Zani, S; White, RR; Blazer, DG; Mantyh, CR; Tyler, DS; Clary, BM
MLA Citation
Speicher, PJ, Nussbaum, DP, Scarborough, JE, Zani, S, White, RR, Blazer, DG, Mantyh, CR, Tyler, DS, and Clary, BM. "Wound classification reporting in HPB surgery: can a single word change public perception of institutional performance?." HPB : the official journal of the International Hepato Pancreato Biliary Association 16.12 (December 2014): 1068-1073.
PMID
24852206
Source
epmc
Published In
HPB
Volume
16
Issue
12
Publish Date
2014
Start Page
1068
End Page
1073
DOI
10.1111/hpb.12275

A nomogram to predict disease-free survival after surgical resection of GIST.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. Adjuvant imatinib therapy has resulted in improved disease-free survival (DFS) following resection of primary GIST. The aim of our study was to create a nomogram to predict DFS following resection of GIST.Using a multi-institutional cohort of patients who underwent surgery for primary GIST at 7 academic hospitals in the USA and Canada between January 1998 and December 2012, a multivariable Cox proportional hazards model predicting DFS was created using backward stepwise selection. A nomogram to predict DFS following surgical resection of GIST was constructed with the variables selected in the multivariable model. We tested nomogram discrimination by calculating the C-statistic and compared the nomogram to four existing GIST prognostic stratification systems.A total of 365 patients who underwent surgery for primary GIST was included in the study. Using backward stepwise selection, sex, tumor size, tumor site, and mitotic rate were selected for incorporation into the nomogram. The nomogram demonstrated superior discrimination compared to the NIH criteria, modified NIH criteria, and Memorial Sloan-Kettering Nomogram and had similar discrimination to the Miettinen criteria (C-statistic 0.77 vs 0.73, 0.71, 0.71, and 0.78, respectively).Four independent predictors of recurrence following surgery for primary GIST were used to create a nomogram to predict DFS. The nomogram stratified patients into prognostic groups and performed well on internal validation.

Authors
Bischof, DA; Kim, Y; Behman, R; Karanicolas, PJ; Quereshy, FA; Blazer, DG; Maithel, SK; Gamblin, TC; Bauer, TW; Pawlik, TM
MLA Citation
Bischof, DA, Kim, Y, Behman, R, Karanicolas, PJ, Quereshy, FA, Blazer, DG, Maithel, SK, Gamblin, TC, Bauer, TW, and Pawlik, TM. "A nomogram to predict disease-free survival after surgical resection of GIST." Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 18.12 (December 2014): 2123-2129.
PMID
25245766
Source
epmc
Published In
Journal of Gastrointestinal Surgery
Volume
18
Issue
12
Publish Date
2014
Start Page
2123
End Page
2129
DOI
10.1007/s11605-014-2658-2

Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy.

BACKGROUND: The purpose of this study was to define the learning curves for laparoscopic pancreaticoduodenectomy (LPD) with and without laparoscopic reconstruction, using paired surgical teams consisting of advanced laparoscopic-trained surgeons and advanced oncologic-trained surgeons. METHODS: All patients undergoing PD without vein resection at a single institution were retrospectively analyzed. LPD was introduced by initially focusing on laparoscopic resection followed by open reconstruction (hybrid) for 18 months prior to attempting a totally LPD (TLPD) approach. Cases were compared with Chi square, Fisher's exact test, and Kruskal-Wallis analysis of variance (ANOVA). RESULTS: Between March 2010 and June 2013, 140 PDs were completed at our institution, of which 56 (40 %) were attempted laparoscopically. In 31/56 procedures we planned to perform only the resection laparoscopically (hybrid), of which 7 (23 %) required premature conversion before completion of resection. Following the first 23 of these hybrid cases, a total of 25 TLPDs have been performed, of which there were no conversions to open. For all LPD, a significant reduction in operative times was identified following the first 10 patients (median 478.5 vs. 430.5 min; p = 0.01), approaching open PD levels. After approximately 50 cases, operative times and estimated blood loss were consistently lower than those for open PD. CONCLUSIONS: In our experience of building an LPD program, the initial ten cases represent the biggest hurdle with respect to operative times. For an experienced teaching center using a staged and team-based approach, LPD appears to offer meaningful reductions in operative time and blood loss within the first 50 cases.

Authors
Speicher, PJ; Nussbaum, DP; White, RR; Zani, S; Mosca, PJ; Blazer, DG; Clary, BM; Pappas, TN; Tyler, DS; Perez, A
MLA Citation
Speicher, PJ, Nussbaum, DP, White, RR, Zani, S, Mosca, PJ, Blazer, DG, Clary, BM, Pappas, TN, Tyler, DS, and Perez, A. "Defining the learning curve for team-based laparoscopic pancreaticoduodenectomy." November 2014.
PMID
24923222
Source
epmc
Published In
Annals of Surgical Oncology
Volume
21
Issue
12
Publish Date
2014
Start Page
4014
End Page
4019
DOI
10.1245/s10434-014-3839-7

Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma.

BACKGROUND: Concomitant placement of feeding jejunostomy tubes (FJT) during pancreaticoduodenectomy is common, yet there are limited data regarding catheter-specific morbidity and associated outcomes. This information is crucial to appropriately select patients for feeding tube placement and to optimize perioperative nutrition strategies. METHODS: A review of all patients undergoing pancreaticoduodenectomy with FJT placement was completed. Patients were grouped by the occurrence of FJT-related morbidity. Multivariable logistic regression was performed to identify predictors of FJT morbidity; these complications were then further defined. Finally, associated postoperative outcomes were compared between groups. RESULTS: In total, 126 patients were included, of which 18 (14 %) had complications directly related to their FJT, including pericatheter infection (n = 6), pneumatosis intestinalis (n = 4), severe tube feed intolerance (n = 3), and primary catheter malfunction (n = 7). Following adjustment with logistic regression, preoperative hypoalbuminemia was identified as the only independent predictor of FJT complications (OR 2.23, p = 0.035). Patients with FJT complications were more likely to be initiated on total parenteral nutrition (TPN; 55.6 vs. 7.4 %, p -0.035) and to require TPN at discharge (16.7 vs. 0%, p = 0.003). Correspondingly, these patients resumed an oral diet later (14 vs. 8 days, p = 0.06). Both reoperation (50.0 vs. 6.5%, p < 0.001) and readmission (50.0 vs. 22.4%, p = 0.041) rates were higher among patients with FJT complications. CONCLUSIONS: FJT-related morbidity is common among patients undergoing pancreaticoduodenectomy and is associated with inferior outcomes and other performance metrics. Preoperative malnutrition appears to predict FJT complications, creating an ongoing dilemma regarding FJT placement. In the future, it will be important to better define criteria for FJT placement during pancreaticoduodenectomy.

Authors
Nussbaum, DP; Zani, S; Penne, K; Speicher, PJ; Stinnett, SS; Clary, BM; White, RR; Tyler, DS; Blazer, DG
MLA Citation
Nussbaum, DP, Zani, S, Penne, K, Speicher, PJ, Stinnett, SS, Clary, BM, White, RR, Tyler, DS, and Blazer, DG. "Feeding jejunostomy tube placement in patients undergoing pancreaticoduodenectomy: an ongoing dilemma." Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 18.10 (October 2014): 1752-1759.
PMID
24961442
Source
epmc
Published In
Journal of Gastrointestinal Surgery
Volume
18
Issue
10
Publish Date
2014
Start Page
1752
End Page
1759
DOI
10.1007/s11605-014-2581-6

Management of 1-2 centimeter carcinoid tumors of the appendix: using the National Cancer Data Base to resolve controversies in general surgery

Authors
Nussbaum, DP; Speicher, PJ; Gulack, BC; Ganapathi, A; Englum, BR; Tyler, DS; III, BDG
MLA Citation
Nussbaum, DP, Speicher, PJ, Gulack, BC, Ganapathi, A, Englum, BR, Tyler, DS, and III, BDG. "Management of 1-2 centimeter carcinoid tumors of the appendix: using the National Cancer Data Base to resolve controversies in general surgery." October 2014.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
219
Issue
4
Publish Date
2014
Start Page
E93
End Page
E93

Poor outcomes following emergent surgery for bowel obstruction in patients with disseminated malignancy

Authors
Gulack, BC; Speicher, PJ; Englum, BR; Nussbaum, DP; Ganapathi, A; Scarborough, JE; Blazer, DG
MLA Citation
Gulack, BC, Speicher, PJ, Englum, BR, Nussbaum, DP, Ganapathi, A, Scarborough, JE, and Blazer, DG. "Poor outcomes following emergent surgery for bowel obstruction in patients with disseminated malignancy." October 2014.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
219
Issue
4
Publish Date
2014
Start Page
E95
End Page
E96

Surgical management of advanced gastrointestinal stromal tumors: an international multi-institutional analysis of 158 patients.

BACKGROUND: Patients with advanced gastrointestinal stromal tumors (GIST) are at high risk for recurrence after surgery. The aim of this study was to characterize outcomes of advanced GIST treated with surgery from a large multi-institutional database in the tyrosine kinase inhibitor (TKI) era. STUDY DESIGN: Patients who underwent surgery for an advanced GIST from 1998 through 2012 were identified. Demographic, clinicopathologic, perioperative, and survival data were collected and analyzed. RESULTS: There were 87 patients with locally advanced GIST and 71 patients with recurrent/metastatic GIST. The vast majority (95%) of patients with locally advanced GIST required a multivisceral resection; most patients (87%) underwent a microscopically complete (R0) resection. Although 82% of patients had high-risk tumors according to modified NIH criteria or had recurrent/metastatic disease, only 56% of patients received adjuvant TKI therapy. Among patients with locally advanced GIST, 3-year recurrence-free survival and overall survival rates were 65% and 87%, respectively. In contrast, 3-year recurrence-free survival and overall survival rates among patients with recurrent/metastatic GIST were 49% and 82%, respectively. On multivariate analysis, predictors of worse outcomes included high mitotic rate and male sex for patients with locally advanced GIST, and age and lack of adjuvant TKI therapy were associated with adverse outcomes among patients with recurrent/metastatic GIST (all p < 0.05). CONCLUSIONS: Resection of advanced GIST can be safely accomplished with high rates of R0 resection. Among patients with advanced GIST, TKI therapy was underused. Barriers to the use of TKI therapy in this population should be explored.

Authors
Bischof, DA; Kim, Y; Blazer, DG; Behman, R; Karanicolas, PJ; Law, CH; Quereshy, FA; Maithel, SK; Gamblin, TC; Bauer, TW; Pawlik, TM
MLA Citation
Bischof, DA, Kim, Y, Blazer, DG, Behman, R, Karanicolas, PJ, Law, CH, Quereshy, FA, Maithel, SK, Gamblin, TC, Bauer, TW, and Pawlik, TM. "Surgical management of advanced gastrointestinal stromal tumors: an international multi-institutional analysis of 158 patients." September 2014.
PMID
25065359
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
219
Issue
3
Publish Date
2014
Start Page
439
End Page
449
DOI
10.1016/j.jamcollsurg.2014.02.037

Open versus minimally invasive resection of gastric GIST: a multi-institutional analysis of short- and long-term outcomes.

BACKGROUND: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the gastrointestinal tract. Overall surgical experience with minimally invasive surgery (MIS) has increased; however, published reports on MIS resection of GIST are limited to small, single-institution experiences. METHODS: A total of 397 patients who underwent open surgery (n = 230) or MIS (n = 167) for a gastric GIST between 1998 and 2012 were identified from a multicenter database. The impact of MIS approach on recurrence and survival was analyzed using propensity-score matching by comparing clinicopathologic factors between patients who underwent MIS versus open resection. RESULTS: There were 19 conversions (10 %) to open; the most common reasons for conversion were tumor more extensive than anticipated (26 %) and unclear anatomy (21 %). On multivariate analysis, smaller tumor size and higher body mass index (BMI) were associated with receipt of MIS. In the propensity-matched cohort (n = 248), MIS resection was associated with decreased length of stay (MIS, 3 days vs open, 8 days) and fewer ≥ grade 3 complications (MIS, 3 % vs open, 14 %) compared with open surgery. High rates of R0 resection and low rates of tumor rupture were seen in both groups. After propensity-score matching, there was no difference in recurrence-free or overall survival comparing the MIS and the open group (both p > 0.05). CONCLUSIONS: An MIS approach for gastric GIST was associated with low morbidity and a high rate of R0 resection. The long-term oncological outcome following MIS was excellent, and therefore the MIS approach should be considered the preferred approach for gastric GIST in well-selected patients.

Authors
Bischof, DA; Kim, Y; Dodson, R; Carolina Jimenez, M; Behman, R; Cocieru, A; Blazer, DG; Fisher, SB; Squires, MH; Kooby, DA; Maithel, SK; Groeschl, RT; Clark Gamblin, T; Bauer, TW; Karanicolas, PJ; Law, C; Quereshy, FA; Pawlik, TM
MLA Citation
Bischof, DA, Kim, Y, Dodson, R, Carolina Jimenez, M, Behman, R, Cocieru, A, Blazer, DG, Fisher, SB, Squires, MH, Kooby, DA, Maithel, SK, Groeschl, RT, Clark Gamblin, T, Bauer, TW, Karanicolas, PJ, Law, C, Quereshy, FA, and Pawlik, TM. "Open versus minimally invasive resection of gastric GIST: a multi-institutional analysis of short- and long-term outcomes." Annals of surgical oncology 21.9 (September 2014): 2941-2948.
PMID
24763984
Source
epmc
Published In
Annals of Surgical Oncology
Volume
21
Issue
9
Publish Date
2014
Start Page
2941
End Page
2948
DOI
10.1245/s10434-014-3733-3

The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas.

Neoadjuvant radiation therapy (RT) has several theoretical benefits in the treatment of retroperitoneal sarcoma (RPS), but concerns remain about treatment toxicity and perioperative morbidity. There are limited data regarding its effect on perioperative outcomes, most of which come from small, single-institution series. The purpose of this study was to evaluate the short-term (30-day) postoperative morbidity and mortality associated with neoadjuvant RT following resection of RPS.The 2005-2011 National Surgical Quality Improvement Program Participant User File was queried for patients undergoing RPS resection. Subjects were stratified by use of neoadjuvant RT. Perioperative variables and short-term 30-day outcomes were compared. Groups were then propensity matched using a 2:1 nearest-neighbor algorithm and multivariable logistic regression was performed to assess neoadjuvant RT as a predictor of short-term 30-day outcomes.A total of 785 patients were identified. Neoadjuvant RT was administered to 71 (9.0%). Patients who received neoadjuvant RT were slightly younger (56 vs. 62 years, p < 0.001), but otherwise the groups were similar. After propensity matching, all baseline characteristics were highly similar. Median operative time was longer in the neoadjuvant RT group (279 vs. 219 min, p < 0.01), but there were no differences in mortality (1.4 vs. 2.1%, p = 0.71), major complications (28.2 vs. 25.2%, p = 0.69), overall complications (35.2 vs.33.2%, p = 0.83), early reoperation (5.6 vs. 7.4%, p = 0.81), or length of stay (7 vs. 7 days, p = 0.56). Following further adjustment with logistic regression, we confirmed that there were no differences in 30-day mortality or morbidity between patients who did and did not receive neoadjuvant RT.Neoadjuvant RT does not appear to increase short-term (30-day) morbidity or mortality following resection of RPS. Continued investigation is needed to better define the role for radiation therapy among patients with this disease.

Authors
Nussbaum, DP; Speicher, PJ; Gulack, BC; Ganapathi, AM; Keenan, JE; Stinnett, SS; Kirsch, DG; Tyler, DS; Blazer, DG
MLA Citation
Nussbaum, DP, Speicher, PJ, Gulack, BC, Ganapathi, AM, Keenan, JE, Stinnett, SS, Kirsch, DG, Tyler, DS, and Blazer, DG. "The effect of neoadjuvant radiation therapy on perioperative outcomes among patients undergoing resection of retroperitoneal sarcomas." Surgical oncology 23.3 (September 2014): 155-160. (Review)
PMID
25085344
Source
epmc
Published In
Surgical Oncology
Volume
23
Issue
3
Publish Date
2014
Start Page
155
End Page
160
DOI
10.1016/j.suronc.2014.07.001

The role of clinical care pathways: an experience with distal pancreatectomy.

BACKGROUND: Previous studies have indicated that clinical pathways may shorten hospital length of stay (HLOS) among patients undergoing distal pancreatectomy (DP). Here, we evaluate an institutional standardized care pathway (SCP) for patients undergoing DP. MATERIALS AND METHODS: A retrospective review of patients undergoing DP from November 2006 to November 2012 was completed. Patients treated before and after implementation of the SCP were compared. Multivariable linear regression was then performed to identify independent predictors of HLOS. RESULTS: There were no differences in patient characteristics between SCP (n=50) and pre-SCP patients (n=100). Laparoscopic technique (62% versus 13%, P<0.001), splenectomy (52% versus 38%, P=0.117), and concomitant major organ resection (24% versus 13%, P=0.106) were more common among SCP patients. Overall, important complication rates were similar (24% versus 26%, P=0.842). SCP patients resumed a normal diet earlier (4 versus 5 d, P=0.025) and had shorter HLOS (6 versus 7 d, P=0.026). There was no increase in 30-d resurgery or readmission. In univariate comparison, SCP, cancer diagnoses, intraductal papillary mucinous neoplasm diagnoses, neoadjuvant therapy, operative technique, major organ resection, and feeding tube placement were associated with HLOS; however, after multivariable adjustment, only laparoscopic technique (-33%, P=0.001), concomitant major organ resection (+38%, P<0.001), and feeding tube placement (+68%, P<0.001) were independent predictors of HLOS. CONCLUSIONS: Implementation of a clinical pathway did not improve HLOS at our institution. The increasing use of laparoscopy likely accounts for shorter HLOS in the SCP cohort. In the future, it will be important to identify clinical scenarios most likely to benefit from implementation of a clinical pathway.

Authors
Nussbaum, DP; Penne, K; Speicher, PJ; Stinnett, SS; Perez, A; White, RR; Clary, BM; Tyler, DS; Blazer, DG
MLA Citation
Nussbaum, DP, Penne, K, Speicher, PJ, Stinnett, SS, Perez, A, White, RR, Clary, BM, Tyler, DS, and Blazer, DG. "The role of clinical care pathways: an experience with distal pancreatectomy." The Journal of surgical research 190.1 (July 2014): 64-71.
PMID
24666986
Source
epmc
Published In
Journal of Surgical Research
Volume
190
Issue
1
Publish Date
2014
Start Page
64
End Page
71
DOI
10.1016/j.jss.2014.02.026

Metastatic ampullary adenocarcinoma presenting as a hydrocele: a case report.

CONTEXT: Metastases from ampullary malignancies are common, but spread to the testicle and paratesticular tissue is exceedingly rare with only 2 reported cases in the literature. CASE REPORT: We report a case of a 70 year-old male with a history of ampullary adenocarcinoma status post pancreaticoduodenectomy who presented with a symptomatic right-sided hydrocele. Subsequent pathology revealed metastatic ampullary adenocarcinoma. CONCLUSIONS: Metastasis to the testicle and paratesticular tissue from ampullary malignancies is rare, but must be considered in the evaluation of scrotal masses in patients with a history of ampullary malignancy.

Authors
Lane, WO; Bentley, RC; Hurwitz, HI; Howard, LA; Polascik, TJ; Anderson, MR; Blazer, DG
MLA Citation
Lane, WO, Bentley, RC, Hurwitz, HI, Howard, LA, Polascik, TJ, Anderson, MR, and Blazer, DG. "Metastatic ampullary adenocarcinoma presenting as a hydrocele: a case report." JOP : Journal of the pancreas 15.3 (May 27, 2014): 266-268.
PMID
24865540
Source
epmc
Published In
JOP : Journal of the pancreas
Volume
15
Issue
3
Publish Date
2014
Start Page
266
End Page
268
DOI
10.6092/1590-8577/2407

A phase I study of the safety and activation of a cathepsin-activalable fluorescent cancer-specific probe LUM015.

Authors
Whitley, MJ; Cardona, DM; Blazer, DG; Hwang, SE; Mosca, PJ; Cahill, J; Ferrer, JM; Strasfeld, DB; Mlto, JK; Cuneo, KC; Lanier, N; Williams, O; Spasojevic, I; Riedel, RF; Eward, W; Lee, WD; Griffith, LG; Bawendi, M; Kirsch, DG; Brigman, BE
MLA Citation
Whitley, MJ, Cardona, DM, Blazer, DG, Hwang, SE, Mosca, PJ, Cahill, J, Ferrer, JM, Strasfeld, DB, Mlto, JK, Cuneo, KC, Lanier, N, Williams, O, Spasojevic, I, Riedel, RF, Eward, W, Lee, WD, Griffith, LG, Bawendi, M, Kirsch, DG, and Brigman, BE. "A phase I study of the safety and activation of a cathepsin-activalable fluorescent cancer-specific probe LUM015." May 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
15
Publish Date
2014

Feeding jejunostomy during Whipple is associated with increased morbidity.

BACKGROUND: Placement of a feeding jejunostomy tube (FJ) is often performed during pancreaticoduodenectomy (PD). Few studies, however, have sought to determine whether such placement affects postoperative outcomes after PD. MATERIALS AND METHODS: This is a retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) database to determine the 30-d-postoperative mortality rate, major complication rate, and overall complication rate of jejunostomy tube placement at the time of PD. Univariate and multivariate comparison of postoperative outcomes between patients with and without FJ placement during PD was performed on a total of 4930 patients. RESULTS: Thirty-day-postoperative mortality did not differ between the two groups (4.0% for patients with FJ versus 2.7% without, P = 0.13), whereas overall morbidity (43.3% with FJ versus 34.6% without, P < 0.0001) and serious morbidity (29.5% with FJ versus 22.8% without, P < 0.0001) were significantly higher in patients undergoing FJ placement during PD. The specific complications that occurred more frequently in FJ patients than patients without FJ included deep space surgical site infection, pneumonia, unplanned reintubation, acute renal failure, and sepsis. CONCLUSION: Although FJ placement during PD is considered to be routine at many institutions, our analysis of data from NSQIP suggest that FJ placement may be associated with increased postoperative morbidity.

Authors
Padussis, JC; Zani, S; Blazer, DG; Tyler, DS; Pappas, TN; Scarborough, JE
MLA Citation
Padussis, JC, Zani, S, Blazer, DG, Tyler, DS, Pappas, TN, and Scarborough, JE. "Feeding jejunostomy during Whipple is associated with increased morbidity." The Journal of surgical research 187.2 (April 2014): 361-366.
PMID
24525057
Source
epmc
Published In
Journal of Surgical Research
Volume
187
Issue
2
Publish Date
2014
Start Page
361
End Page
366
DOI
10.1016/j.jss.2012.10.010

Gastroesophageal heterotopia and HER2/neu overexpression in an adenocarcinoma arising from a small bowel duplication.

Small bowel duplications are congenital structures commonly lined by heterotopic gastric or pancreatic mucosa. Though benign in children, small bowel duplications have the potential for malignant degeneration in adulthood. Here, we present the first reported case of metastatic adenocarcinoma arising from a small bowel duplication lined by gastroesophageal mucosa. The cancer demonstrated overexpression of the HER2/neu oncoprotein and amplification of the HER2/neu gene. This represents the only report of HER2 overexpression in this type of lesion. The patient is being treated with traditional chemotherapeutic agents in addition to monoclonal antibody therapy directed at the HER2 protein, and has demonstrated a clinical benefit from treatment. This case demonstrates that the anatomic location of a mass may be distinct from its biological origin, and this difference may have important practical implications for diagnostic testing and treatment.

Authors
Nussbaum, DP; Bhattacharya, SD; Jiang, X; Cardona, DM; Strickler, JH; Blazer, DG
MLA Citation
Nussbaum, DP, Bhattacharya, SD, Jiang, X, Cardona, DM, Strickler, JH, and Blazer, DG. "Gastroesophageal heterotopia and HER2/neu overexpression in an adenocarcinoma arising from a small bowel duplication." Archives of pathology & laboratory medicine 138.3 (March 2014): 428-431.
PMID
24576036
Source
epmc
Published In
Archives of Pathology and Laboratory Medicine
Volume
138
Issue
3
Publish Date
2014
Start Page
428
End Page
431
DOI
10.5858/arpa.2012-0523-cr

Open versus Minimally Invasive Management of Gastric Gastrointestinal Stromal Tumors: An International Multi-institutional Analysis of Short- and Long-term Outcomes

Authors
Bischof, D; Kim, Y; III, BDG; Maithel, SK; Gamblin, TC; Bauer, T; Karanicolas, P; Law, C; Quereshy, F; Pawlik, T
MLA Citation
Bischof, D, Kim, Y, III, BDG, Maithel, SK, Gamblin, TC, Bauer, T, Karanicolas, P, Law, C, Quereshy, F, and Pawlik, T. "Open versus Minimally Invasive Management of Gastric Gastrointestinal Stromal Tumors: An International Multi-institutional Analysis of Short- and Long-term Outcomes." February 2014.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
21
Publish Date
2014
Start Page
S29
End Page
S29

Neoadjuvant Radiation does not Increase Morbidity following Resection of Retroperitoneal Sarcoma

Authors
Nussbaum, DP; Speicher, PJ; Ganapathi, AM; Keenan, JE; Kirsch, DG; Tyler, DS; III, BDG
MLA Citation
Nussbaum, DP, Speicher, PJ, Ganapathi, AM, Keenan, JE, Kirsch, DG, Tyler, DS, and III, BDG. "Neoadjuvant Radiation does not Increase Morbidity following Resection of Retroperitoneal Sarcoma." February 2014.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
21
Publish Date
2014
Start Page
S143
End Page
S144

Use of Neoadjuvant Tyrosine-kinase Inhibitors can Aid in Resection of Gastrointestinal Stromal Tumors

Authors
Cocieru, A; Shah, KN; Speicher, PJ; Bischoff, D; Tyler, DS; Pawlik, T; III, BDG
MLA Citation
Cocieru, A, Shah, KN, Speicher, PJ, Bischoff, D, Tyler, DS, Pawlik, T, and III, BDG. "Use of Neoadjuvant Tyrosine-kinase Inhibitors can Aid in Resection of Gastrointestinal Stromal Tumors." February 2014.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
21
Publish Date
2014
Start Page
S145
End Page
S146

Ascites Is A Risk Factor for Increased Postoperative Morbidity and Mortality in Patients That Undergo Pancreatic Necrosectomy for Acute Pancreatic Necrosis

Authors
Agee, N; De La Fuente, S; Arnoletti, J; Eubanks, S; Blazer, DG; Pappas, T; Scarborough, J
MLA Citation
Agee, N, De La Fuente, S, Arnoletti, J, Eubanks, S, Blazer, DG, Pappas, T, and Scarborough, J. "Ascites Is A Risk Factor for Increased Postoperative Morbidity and Mortality in Patients That Undergo Pancreatic Necrosectomy for Acute Pancreatic Necrosis." Journal of Surgical Research 186.2 (February 2014): 502-502.
Source
crossref
Published In
Journal of Surgical Research
Volume
186
Issue
2
Publish Date
2014
Start Page
502
End Page
502
DOI
10.1016/j.jss.2013.11.172

Open versus minimally invasive management of gastric GIST: An international multi-institutional analysis of short- and long-term outcomes

Authors
Bischof, DA; Kim, Y; Blazer, DG; Maithel, SK; Gamblin, TC; Bauer, TW; Karanicolas, PJ; Law, C; Quereshy, FA; Pawlik, TM
MLA Citation
Bischof, DA, Kim, Y, Blazer, DG, Maithel, SK, Gamblin, TC, Bauer, TW, Karanicolas, PJ, Law, C, Quereshy, FA, and Pawlik, TM. "Open versus minimally invasive management of gastric GIST: An international multi-institutional analysis of short- and long-term outcomes." January 20, 2014.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
32
Issue
3
Publish Date
2014

Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy

© 2014, Society of Surgical Oncology.Background: The purpose of this study was to define the learning curves for laparoscopic pancreaticoduodenectomy (LPD) with and without laparoscopic reconstruction, using paired surgical teams consisting of advanced laparoscopic-trained surgeons and advanced oncologic-trained surgeons.Methods: All patients undergoing PD without vein resection at a single institution were retrospectively analyzed. LPD was introduced by initially focusing on laparoscopic resection followed by open reconstruction (hybrid) for 18 months prior to attempting a totally LPD (TLPD) approach. Cases were compared with Chi square, Fisher’s exact test, and Kruskal–Wallis analysis of variance (ANOVA).Results: Between March 2010 and June 2013, 140 PDs were completed at our institution, of which 56 (40 %) were attempted laparoscopically. In 31/56 procedures we planned to perform only the resection laparoscopically (hybrid), of which 7 (23 %) required premature conversion before completion of resection. Following the first 23 of these hybrid cases, a total of 25 TLPDs have been performed, of which there were no conversions to open. For all LPD, a significant reduction in operative times was identified following the first 10 patients (median 478.5 vs. 430.5 min; p = 0.01), approaching open PD levels. After approximately 50 cases, operative times and estimated blood loss were consistently lower than those for open PD.Conclusions: In our experience of building an LPD program, the initial ten cases represent the biggest hurdle with respect to operative times. For an experienced teaching center using a staged and team-based approach, LPD appears to offer meaningful reductions in operative time and blood loss within the first 50 cases.

Authors
Speicher, PJ; Nussbaum, DP; White, RR; Zani, S; Mosca, PJ; Blazer, DG; Clary, BM; Pappas, TN; Tyler, DS; Perez, A
MLA Citation
Speicher, PJ, Nussbaum, DP, White, RR, Zani, S, Mosca, PJ, Blazer, DG, Clary, BM, Pappas, TN, Tyler, DS, and Perez, A. "Defining the Learning Curve for Team-Based Laparoscopic Pancreaticoduodenectomy." Annals of Surgical Oncology 21.12 (January 1, 2014): 4014-4019.
Source
scopus
Published In
Annals of Surgical Oncology
Volume
21
Issue
12
Publish Date
2014
Start Page
4014
End Page
4019
DOI
10.1245/s10434-014-3839-7

Surgical management of advanced gastrointestinal stromal tumors: An international multi-institutional analysis of 158 patients

Background Patients with advanced gastrointestinal stromal tumors (GIST) are at high risk for recurrence after surgery. The aim of this study was to characterize outcomes of advanced GIST treated with surgery from a large multi-institutional database in the tyrosine kinase inhibitor (TKI) era. Study Design Patients who underwent surgery for an advanced GIST from 1998 through 2012 were identified. Demographic, clinicopathologic, perioperative, and survival data were collected and analyzed. Results There were 87 patients with locally advanced GIST and 71 patients with recurrent/metastatic GIST. The vast majority (95%) of patients with locally advanced GIST required a multivisceral resection; most patients (87%) underwent a microscopically complete (R0) resection. Although 82% of patients had high-risk tumors according to modified NIH criteria or had recurrent/metastatic disease, only 56% of patients received adjuvant TKI therapy. Among patients with locally advanced GIST, 3-year recurrence-free survival and overall survival rates were 65% and 87%, respectively. In contrast, 3-year recurrence-free survival and overall survival rates among patients with recurrent/metastatic GIST were 49% and 82%, respectively. On multivariate analysis, predictors of worse outcomes included high mitotic rate and male sex for patients with locally advanced GIST, and age and lack of adjuvant TKI therapy were associated with adverse outcomes among patients with recurrent/metastatic GIST (all p < 0.05). Conclusions Resection of advanced GIST can be safely accomplished with high rates of R0 resection. Among patients with advanced GIST, TKI therapy was underused. Barriers to the use of TKI therapy in this population should be explored. © 2014 by the American College of Surgeons.

Authors
Bischof, DA; Kim, Y; III, DGB; Behman, R; Karanicolas, PJ; Law, CH; Quereshy, FA; Maithel, SK; Gamblin, TC; Bauer, TW; Pawlik, TM
MLA Citation
Bischof, DA, Kim, Y, III, DGB, Behman, R, Karanicolas, PJ, Law, CH, Quereshy, FA, Maithel, SK, Gamblin, TC, Bauer, TW, and Pawlik, TM. "Surgical management of advanced gastrointestinal stromal tumors: An international multi-institutional analysis of 158 patients." Journal of the American College of Surgeons 219.3 (2014): 439-449.
Source
scival
Published In
Journal of The American College of Surgeons
Volume
219
Issue
3
Publish Date
2014
Start Page
439
End Page
449
DOI
10.1016/j.jamcollsurg.2014.02.037

Modest advances in survival for patients with colorectal-associated peritoneal carcinomatosis in the era of modern chemotherapy.

BACKGROUND: The treatment of metastatic colorectal cancer (CRC) has evolved rapidly over the last decade, with combination chemotherapy and targeted biologic agents leading to significant improvements in survival. Despite these advances, little is known about their effectiveness in CRC-associated peritoneal carcinomatosis. The purpose of this study was to evaluate outcomes in patients with CRC-associated PC treated in the era of modern chemotherapy. METHODS: We retrospectively reviewed an institutional tumor database from 1996 to 2008. Survival data were evaluated for patients treated with PC before and after 2003. No patients before 2003 were treated with combination chemotherapy or biologic therapy. The modern chemotherapy group consisted of patients treated after 2003. Survival curves were estimated. RESULTS: Overall, 173 patients were identified. Median follow-up was 8.6 months. Median survival in the historic group (n = 91) was 8.9 months and 16.3 months in the modern chemotherapy group (n = 82) (P < 0.004). Age was the only significant covariate. The survival difference between the modern chemotherapy cohort and control cohort persisted after adjustment for age. In a subset of patients in the modern chemotherapy era group, for which treatment regimen could be definitively identified, survival was even greater-23.8 months. CONCLUSIONS: Patients with CRC-associated PC treated with modern combination chemotherapy and biologic therapy have a significantly longer median survival compared to our historical cohort. Despite these improvements, outcomes still remain poor. Therapeutic adjuncts such as surgical cytoreduction and hyperthermic intraperitoneal chemotherapy (HIPEC) in appropriately selected patients remain promising options to improve outcomes for patients with peritoneal-based disease.

Authors
Zani, S; Papalezova, K; Stinnett, S; Tyler, D; Hsu, D; Blazer, DG
MLA Citation
Zani, S, Papalezova, K, Stinnett, S, Tyler, D, Hsu, D, and Blazer, DG. "Modest advances in survival for patients with colorectal-associated peritoneal carcinomatosis in the era of modern chemotherapy." J Surg Oncol 107.4 (March 2013): 307-311.
PMID
22811275
Source
pubmed
Published In
Journal of Surgical Oncology
Volume
107
Issue
4
Publish Date
2013
Start Page
307
End Page
311
DOI
10.1002/jso.23222

Neoadjuvant Chemoradiation in Patients Undergoing Pancreaticoduodenectomy: Do the Ends Justify the Means?

Authors
Hanna, JM; Penne, K; Rialon, K; Bashir, M; III, BDG; Clary, B; White, R; Pappas, T; Tyler, DS
MLA Citation
Hanna, JM, Penne, K, Rialon, K, Bashir, M, III, BDG, Clary, B, White, R, Pappas, T, and Tyler, DS. "Neoadjuvant Chemoradiation in Patients Undergoing Pancreaticoduodenectomy: Do the Ends Justify the Means?." February 2013.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
20
Publish Date
2013
Start Page
S138
End Page
S138

Preoperative chemoradiotherapy for locally advanced gastric cancer.

BACKGROUND: To examine toxicity and outcomes for patients treated with preoperative chemoradiotherapy (CRT) for gastric cancer. METHODS: Patients with gastroesophageal (GE) junction (Siewert type II and III) or gastric adenocarcinoma who underwent neoadjuvant CRT followed by planned surgical resection at Duke University between 1987 and 2009 were reviewed. Overall survival (OS), local control (LC) and disease-free survival (DFS) were estimated using the Kaplan-Meier method. Toxicity was graded according to the Common Toxicity Criteria for Adverse Events version 4.0. RESULTS: Forty-eight patients were included. Most (73%) had proximal (GE junction, cardia and fundus) tumors. Median radiation therapy dose was 45 Gy. All patients received concurrent chemotherapy. Thirty-six patients (75%) underwent surgery. Pathologic complete response and R0 resection rates were 19% and 86%, respectively. Thirty-day surgical mortality was 6%. At 42 months median follow-up, 3-year actuarial OS was 40%. For patients undergoing surgery, 3-year OS, LC and DFS were 50%, 73% and 41%, respectively. CONCLUSIONS: Preoperative CRT for gastric cancer is well tolerated with acceptable rates of perioperative morbidity and mortality. In this patient cohort with primarily advanced disease, OS, LC and DFS rates in resected patients are comparable to similarly staged, adjuvantly treated patients in randomized trials. Further study comparing neoadjuvant CRT to standard treatment approaches for gastric cancer is indicated.

Authors
Pepek, JM; Chino, JP; Willett, CG; Palta, M; Blazer Iii, DG; Tyler, DS; Uronis, HE; Czito, BG
MLA Citation
Pepek, JM, Chino, JP, Willett, CG, Palta, M, Blazer Iii, DG, Tyler, DS, Uronis, HE, and Czito, BG. "Preoperative chemoradiotherapy for locally advanced gastric cancer. (Published online)" Radiat Oncol 8 (January 4, 2013): 6-.
PMID
23286735
Source
pubmed
Published In
Radiation Oncology
Volume
8
Publish Date
2013
Start Page
6
DOI
10.1186/1748-717X-8-6

Gallbladder cancer

Authors
Shah, AA; Reddy, SK; Blazer, DG; Clary, BM
MLA Citation
Shah, AA, Reddy, SK, Blazer, DG, and Clary, BM. "Gallbladder cancer." Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Disease. January 1, 2013. 323-332.
Source
scopus
Publish Date
2013
Start Page
323
End Page
332
DOI
10.1142/9789814293068_0025

Surgical treatment of hepatic metastases

Authors
de Rosa, N; Blazer, DG; Clary, BM
MLA Citation
de Rosa, N, Blazer, DG, and Clary, BM. "Surgical treatment of hepatic metastases." Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Disease. January 1, 2013. 91-108.
Source
scopus
Publish Date
2013
Start Page
91
End Page
108
DOI
10.1142/9789814293068_0007

Regional therapies for hepatic malignancy

Authors
Talbot, L; Blazer, DG
MLA Citation
Talbot, L, and Blazer, DG. "Regional therapies for hepatic malignancy." Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Disease. January 1, 2013. 209-216.
Source
scopus
Publish Date
2013
Start Page
209
End Page
216
DOI
10.1142/9789814293068_0015

Benign gallbladder disease: Cholelithiasis, polyps, gallstone ileus

Authors
Hutcheson, K; Blazer, DG
MLA Citation
Hutcheson, K, and Blazer, DG. "Benign gallbladder disease: Cholelithiasis, polyps, gallstone ileus." Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Disease. January 1, 2013. 273-282.
Source
scopus
Publish Date
2013
Start Page
273
End Page
282
DOI
10.1142/9789814293068_0020

Hepatic abscess

Authors
Beasley, G; Blazer, DG
MLA Citation
Beasley, G, and Blazer, DG. "Hepatic abscess." Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Disease. January 1, 2013. 35-46.
Source
scopus
Publish Date
2013
Start Page
35
End Page
46
DOI
10.1142/9789814293068_0003

Contemporary surgical management of liver, biliary tract, and pancreatic disease

© 2014 by World Scientific Publishing Co. Pte. Ltd. All rights reserved.Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Diseases presents an excellent resource for surgical residents, hepatobiliary fellows and practicing surgeons interested in hepatobiliary surgery. This textbook offers a readable, concise and practical alternative. It is divided into three sections: liver, biliary tract, and pancreatic diseases. Each section covers the spectrum of benign and malignant disease. In addition, several chapters in each section are devoted to surgical techniques. This textbook should ultimately serve as an essential source for the rapidly evolving field of hepatobiliary surgery and its practitioners.

Authors
Blazer, DG; Kuo, PC; Pappas, T; Clary, BM
MLA Citation
Blazer, DG, Kuo, PC, Pappas, T, and Clary, BM. Contemporary surgical management of liver, biliary tract, and pancreatic disease. January 1, 2013.
Source
scopus
Publish Date
2013
Start Page
1
End Page
652
DOI
10.1142/9789814293068

Surgical techniques: Bile duct injury repair

Authors
Desai, S; Blazer, DG
MLA Citation
Desai, S, and Blazer, DG. "Surgical techniques: Bile duct injury repair." Contemporary Surgical Management of Liver, Biliary Tract, and Pancreatic Disease. January 1, 2013. 377-384.
Source
scopus
Publish Date
2013
Start Page
377
End Page
384
DOI
10.1142/9789814293068_0031

Consensus Guidelines from The American Society of Peritoneal Surface Malignancies on Standardizing the Delivery of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Colorectal Cancer Patients in the United States

Background: The American Society of Peritoneal Surface Malignancies (ASPSM) is a consortium of cancer centers performing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). This is a position paper from the ASPSM on the standardization of the delivery of HIPEC. Methods: A survey was conducted of all cancer centers performing HIPEC in the United States. We attempted to obtain consensus by the modified method of Delphi on seven key HIPEC parameters: (1) method, (2) inflow temperature, (3) perfusate volume, (4) drug, (5) dosage, (6) timing of drug delivery, and (7) total perfusion time. Statistical analysis was performed using nonparametric tests. Results: Response rates for ASPSM members (n = 45) and non-ASPSM members (n = 24) were 89 and 33 %, respectively. Of the responders from ASPSM members, 95 % agreed with implementing the proposal. Majority of the surgical oncologists favored the closed method of delivery with a standardized dual dose of mitomycin for a 90-min chemoperfusion for patients undergoing cytoreductive surgery for peritoneal carcinomatosis of colorectal origin. Conclusions: This recommendation on a standardized delivery of HIPEC in patients with colorectal cancer represents an important first step in enhancing research in this field. Studies directed at maximizing the efficacy of each of the seven key elements will need to follow. © 2013 Society of Surgical Oncology.

Authors
Turaga, K; Levine, E; Barone, R; Sticca, R; Petrelli, N; Lambert, L; Nash, G; Morse, M; Adbel-Misih, R; Alexander, HR; Attiyeh, F; Bartlett, D; Bastidas, A; Blazer, T; Chu, Q; Chung, K; Dominguez-Parra, L; Espat, NJ; Foster, J; Fournier, K; Garcia, R; Goodman, M; Hanna, N; Harrison, L; Hoefer, R; Holtzman, M; Kane, J; Labow, D; Li, B; Lowy, A; Mansfield, P; Ong, E; Pameijer, C; Pingpank, J; Quinones, M; Royal, R; Salti, G; Sardi, A; Shen, P; Skitzki, J; Spellman, J; Stewart, J; Esquivel, J
MLA Citation
Turaga, K, Levine, E, Barone, R, Sticca, R, Petrelli, N, Lambert, L, Nash, G, Morse, M, Adbel-Misih, R, Alexander, HR, Attiyeh, F, Bartlett, D, Bastidas, A, Blazer, T, Chu, Q, Chung, K, Dominguez-Parra, L, Espat, NJ, Foster, J, Fournier, K, Garcia, R, Goodman, M, Hanna, N, Harrison, L, Hoefer, R, Holtzman, M, Kane, J, Labow, D, Li, B, Lowy, A, Mansfield, P, Ong, E, Pameijer, C, Pingpank, J, Quinones, M, Royal, R, Salti, G, Sardi, A, Shen, P, Skitzki, J, Spellman, J, Stewart, J, and Esquivel, J. "Consensus Guidelines from The American Society of Peritoneal Surface Malignancies on Standardizing the Delivery of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Colorectal Cancer Patients in the United States." Annals of Surgical Oncology (2013): 1-5.
PMID
23793364
Source
scival
Published In
Annals of Surgical Oncology
Publish Date
2013
Start Page
1
End Page
5
DOI
10.1245/s10434-013-3061-z

The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database.

BACKGROUND: Several single-center reports suggest that vascular resection (VR) during pancreaticoduodenectomy (PD) for patients with pancreatic adenocarcinoma is feasible without affecting early postoperative mortality or morbidity. Our objective is to review the outcomes associated with VR during PD using a large multicenter data source. METHODS: A retrospective cohort analysis was performed using the National Surgical Quality Improvement Program Participant User Files for 2005-2009. All patients undergoing PD for a postoperative diagnosis of malignant neoplasm of the pancreas were included. Forward stepwise multivariate regression analysis was used to determine the association between VR during PD and 30-day postoperative mortality and morbidity after adjustment for patient demographics and comorbidities. RESULTS: 3,582 patients were included for analysis, 281 (7.8 %) of whom underwent VR during PD. VR during PD was associated with significantly greater risk-adjusted 30-day postoperative mortality [5.7 % with VR versus 2.9 % without VR, adjusted odds ratio (AOR) 2.1, 95 % confidence interval (CI) 1.22-3.73, P = 0.008] and overall morbidity (39.9 % with VR versus 33.3 % without VR, AOR 1.36, 95 % CI 1.05-1.75, P = 0.02). There was no significant difference in risk-adjusted postoperative mortality or morbidity between those patients undergoing VR by the primary surgical team versus those patients undergoing VR by a vascular surgical team. CONCLUSIONS: Contrary to the findings of several previously published single-center analyses, the current study demonstrates increased 30-day postoperative morbidity and mortality in PD with VR when compared with PD alone.

Authors
Castleberry, AW; White, RR; De La Fuente, SG; Clary, BM; Blazer, DG; McCann, RL; Pappas, TN; Tyler, DS; Scarborough, JE
MLA Citation
Castleberry, AW, White, RR, De La Fuente, SG, Clary, BM, Blazer, DG, McCann, RL, Pappas, TN, Tyler, DS, and Scarborough, JE. "The impact of vascular resection on early postoperative outcomes after pancreaticoduodenectomy: an analysis of the American College of Surgeons National Surgical Quality Improvement Program database." Ann Surg Oncol 19.13 (December 2012): 4068-4077.
PMID
22932857
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
19
Issue
13
Publish Date
2012
Start Page
4068
End Page
4077
DOI
10.1245/s10434-012-2585-y

Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer?

The objective of this study was to compare survival between all patients with radiographically resectable adenocarcinoma of the proximal pancreas who underwent preoperative chemoradiation therapy (PRE-OP CRT) or surgical exploration first (SURGERY) with "intention to resect." Pancreatic cancer patients who undergo resection after PREOP CRT live longer than patients who undergo resection without PREOP CRT, a difference that may be attributable to patient selection. We retrospectively identified 236 patients with pancreatic head adenocarcinoma seen between 1999 and 2007 with sufficient data to be confirmed medically and radiographically resectable. The outcomes of 144 patients who underwent PREOP CRT were compared to those of 92 patients who proceeded straight to SURGERY. The groups were similar in age and gender. Tumors were slightly larger in the PREOP CRT group (mean 2.5 cm vs. 2.1 cm, P < 0.01), and there were trends toward more venous abutment (54% vs. 39%, P = 0.06) and a higher Charlson comorbidity index (P = 0.1). In the PREOP CRT group, 76 patients (53%) underwent resection, 28 (19%) had metastatic and 17 (12%) locally unresectable disease after PREOP CRT, and 23 (16%) were not explored due to performance status or loss to follow-up. In the SURGERY group, 68 patients (74%) underwent resection. Sixteen patients (17%) had metastatic and eight patients (9%) locally unresectable disease at exploration. In patients who underwent resection, the PREOP CRT group had smaller pathologic tumor size and lower incidence of positive lymph nodes than the SURGERY group but no difference in positive margins or need for vascular resection. Median overall survival (OS) in patients undergoing resection was 27 months in the PREOP CRT group and 17 months in the SURGERY group (P = 0.04). Median OS in all patients treated with PREOP CRT or surgically explored with intention to resect was 15 and 13 months, respectively, with superimposable survival curves. Despite a lower resection rate, the PREOP CRT group as a whole had a similar OS to the SURGERY group as a whole. For patients who underwent resection, those in the PREOP CRT had longer survival than those in the SURGERY group, suggesting that PREOP CRT allows better patient selection for resection. PREOP CRT should be considered an acceptable alternative for most patients with resectable pancreatic cancer.

Authors
Papalezova, KT; Tyler, DS; Blazer, DG; Clary, BM; Czito, BG; Hurwitz, HI; Uronis, HE; Pappas, TN; Willett, CG; White, RR
MLA Citation
Papalezova, KT, Tyler, DS, Blazer, DG, Clary, BM, Czito, BG, Hurwitz, HI, Uronis, HE, Pappas, TN, Willett, CG, and White, RR. "Does preoperative therapy optimize outcomes in patients with resectable pancreatic cancer?." J Surg Oncol 106.1 (July 1, 2012): 111-118.
PMID
22311829
Source
pubmed
Published In
Journal of Surgical Oncology
Volume
106
Issue
1
Publish Date
2012
Start Page
111
End Page
118
DOI
10.1002/jso.23044

Vascular surgery collaboration during pancreaticoduodenectomy with vascular reconstruction.

BACKGROUND: Once thought to have unresectable disease, pancreatic cancer patients with portal venous involvement are now reported to have comparable survival after pancreaticoduodenectomy (PD) with vascular reconstruction (VR) as compared with patients without vascular involvement. We hypothesize that a multidisciplinary approach involving a vascular surgeon will minimize morbidity and improve patency of VRs. METHODS: We identified 204 patients who underwent PD for pancreatic adenocarcinoma from 1997 to 2008. Patients who underwent PD with VR (N = 42) were compared with those who underwent standard PD (N = 162). VRs were performed by a vascular surgeon and involved primary repair (N = 8), vein patch (N = 25), or interposition grafting (N = 9) with femoral or other venous conduit. RESULTS: Patients undergoing PD with VR had larger tumors (3.0 cm vs. 2.5 cm, P < 0.01) but did not have different rates of tumor-free margins (73% vs. 72%, P = 0.84) or lymph nodes metastases (50% vs. 38%, P = 0.14). The VR group had higher median blood loss (875 mL vs. 550 mL, P = 0<0.01), but no differences in mortality, complication rates, length of stay, or readmission rates were found in a median follow-up of 29 months. Overall survival rates were similar. Predictors of mortality on multivariate analysis included increasing histological grade (P = 0.01), positive lymph nodes (P = 0.01), and increasing tumor size (P = 0.01), but not VR (P = 0.28). When evaluated by computed tomography scans within 6 months postoperatively, 97% of reconstructions remained patent. CONCLUSIONS: The need for VR is not a contraindication to potentially curative resection in patients with pancreatic adenocarcinoma. Assistance of a vascular surgeon during VR may allow moderate-volume centers to achieve outcomes comparable with high-volume centers.

Authors
Turley, RS; Peterson, K; Barbas, AS; Ceppa, EP; Paulson, EK; Blazer, DG; Clary, BM; Pappas, TN; Tyler, DS; McCann, RL; White, RR
MLA Citation
Turley, RS, Peterson, K, Barbas, AS, Ceppa, EP, Paulson, EK, Blazer, DG, Clary, BM, Pappas, TN, Tyler, DS, McCann, RL, and White, RR. "Vascular surgery collaboration during pancreaticoduodenectomy with vascular reconstruction." Ann Vasc Surg 26.5 (July 2012): 685-692.
PMID
22305864
Source
pubmed
Published In
Annals of Vascular Surgery
Volume
26
Issue
5
Publish Date
2012
Start Page
685
End Page
692
DOI
10.1016/j.avsg.2011.11.009

Neoadjuvant chemoradiation for potentially resectable gastric cancer.

Authors
Barfield, ME; Untch, BR; Arcury, JT; Czito, BG; Willett, C; Pappas, TN; White, RR; Tyler, DS; Blazer, DG
MLA Citation
Barfield, ME, Untch, BR, Arcury, JT, Czito, BG, Willett, C, Pappas, TN, White, RR, Tyler, DS, and Blazer, DG. "Neoadjuvant chemoradiation for potentially resectable gastric cancer." May 20, 2012.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
30
Issue
15
Publish Date
2012

Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients

Authors
Rialon, KL; Blazer, DG; Abernethy, AP; Mosca, PJ
MLA Citation
Rialon, KL, Blazer, DG, Abernethy, AP, and Mosca, PJ. "Surgery and the D-Word: Approaching the Topic of Death and Dying with Surgical Patients." Journal of Palliative Care & Medicine 02.03 (March 1, 2012): 108-108.
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
03
Publish Date
2012
Start Page
108
End Page
108
DOI
10.4172/2165-7386.1000108

Comparison of outcomes and the use of multimodality therapy in young and elderly people undergoing surgical resection of pancreatic cancer.

OBJECTIVES: To compare outcomes and the use of multimodality therapy in young and elderly people with pancreatic cancer undergoing surgical resection. DESIGN: Retrospective, single-institution study. SETTING: National Cancer Institute/National Comprehensive Cancer Network cancer center. PARTICIPANTS: Two hundred three individuals who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma at Duke University Medical Center comprised the study population. Participants were divided into three groups based on age (<65, n = 97; 65-74, n = 74; ≥75, N = 32). MEASUREMENTS: Perioperative outcomes, the use of multimodality therapy, and overall survival of the different age groups were compared. RESULTS: Similar rates of perioperative mortality and morbidity were observed in all age groups, but elderly adults were more likely to be discharged to a rehabilitation or skilled nursing facility. A similar proportion of participants received neoadjuvant therapy, but a smaller proportion of elderly participants received adjuvant therapy. Overall survival was similar between the age groups. Predictors of poorer overall survival included coronary artery disease, positive resection margin, and less-differentiated tumor histology. Treatment with neoadjuvant and adjuvant therapy were predictors of better overall survival. CONCLUSION: Carefully selected elderly individuals experience similar perioperative outcomes and overall survival to those of younger individuals after resection of pancreatic cancer. There appears to be a significant disparity in the use of adjuvant therapy between young and elderly individuals.

Authors
Barbas, AS; Turley, RS; Ceppa, EP; Reddy, SK; Blazer, DG; Clary, BM; Pappas, TN; Tyler, DS; White, RR; Lagoo, SA
MLA Citation
Barbas, AS, Turley, RS, Ceppa, EP, Reddy, SK, Blazer, DG, Clary, BM, Pappas, TN, Tyler, DS, White, RR, and Lagoo, SA. "Comparison of outcomes and the use of multimodality therapy in young and elderly people undergoing surgical resection of pancreatic cancer." J Am Geriatr Soc 60.2 (February 2012): 344-350.
PMID
22211710
Source
pubmed
Published In
Journal of American Geriatrics Society
Volume
60
Issue
2
Publish Date
2012
Start Page
344
End Page
350
DOI
10.1111/j.1532-5415.2011.03785.x

Quality of Life Assessment in Palliative Surgery

Authors
de Rosa, N; Blazer, DG
MLA Citation
de Rosa, N, and Blazer, DG. "Quality of Life Assessment in Palliative Surgery." Journal of Palliative Care & Medicine 02.07 (2012).
Source
manual
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.S2-005

Overview of Palliative Surgery: Principles and Priorities

Authors
Hanna, J
MLA Citation
Hanna, J. "Overview of Palliative Surgery: Principles and Priorities." Journal of Palliative Care & Medicine 02.07 (2012).
Source
crossref
Published In
Journal of palliative care & medicine
Volume
02
Issue
07
Publish Date
2012
DOI
10.4172/2165-7386.1000132

Presentation and management of gastrointestinal stromal tumors of the duodenum: A multi-institutional analysis

Background. Duodenal gastrointestinal stromal tumors (GISTs) are a small subset of GISTs, and their management is poorly defined. We evaluated surgical management and outcomes of patients with duodenal GISTs treated with pancreaticoduodenectomy (PD) versus local resection (LR) and defined factors associated with prognosis. Methods. Between January 1994 and January 2011, 96 patients with duodenal GISTs were identified from five major surgical centers. Perioperative and long-term outcomes were compared based on surgical approach (PD vs LR). Results. A total of 58 patients (60.4 %) underwent LR, while 38 (39.6 %) underwent PD. Patients presented with gross bleeding (n = 25; 26.0 %), pain (n = 23; 24.0 %), occult bleeding (n = 19; 19.8 %), or obstruction (n = 3; 3.1 %). GIST lesions were located in first (n = 8, 8.4 %), second (n = 47; 49 %), or third/fourth (n = 41; 42.7 %) portion of duodenum. Most patients (n = 86; 89.6 %) had negative surgical margins (R0) (PD, 92.1 vs LR, 87.9 %) (P = 0.34). Median length of stay was longer for PD (11 days) versus LR (7 days) (P = 0.001). PD also had more complications (PD, 57.9 vs LR, 29.3 %) (P = 0.005). The 1-, 2-, and 3-year actuarial recurrence-free survival was 94.2, 82.3, and 67.3 %, respectively. Factors associated with a worse recurrence-free survival included tumor size [hazard ratio (HR) = 1.09], mitotic count[10 mitosis> 50 HPF (HR = 6.89), AJCC stage III disease (HR = 4.85), and NIH high risk classification (HR = 4.31) (all P<0.05). The 1-, 3-, and 5-year actuarial survival was 98.3, 87.4, and 82.0%, respectively. PD versus LR was not associated with overall survival. Conclusions. Recurrence of duodenal GIST is dependent on tumor biology rather than surgical approach. PD was associated with longer hospital stays and higher risk of perioperative complications. When feasible, LR is appropriate for duodenal GIST and PD should be reserved for lesions not amenable to LR. © Society of Surgical Oncology 2012.

Authors
Johnston, FM; Kneuertz, PJ; Cameron, JL; Sanford, D; Fisher, S; Turley, R; Groeschl, R; Hyder, O; Kooby, DA; III, DB; Choti, MA; Wolfgang, CL; Gamblin, TC; Hawkins, WG; Maithel, SK; Pawlik, TM
MLA Citation
Johnston, FM, Kneuertz, PJ, Cameron, JL, Sanford, D, Fisher, S, Turley, R, Groeschl, R, Hyder, O, Kooby, DA, III, DB, Choti, MA, Wolfgang, CL, Gamblin, TC, Hawkins, WG, Maithel, SK, and Pawlik, TM. "Presentation and management of gastrointestinal stromal tumors of the duodenum: A multi-institutional analysis." Annals of Surgical Oncology 19.11 (2012): 3351-3360.
PMID
22878613
Source
scival
Published In
Annals of Surgical Oncology
Volume
19
Issue
11
Publish Date
2012
Start Page
3351
End Page
3360
DOI
10.1245/s10434-012-2551-8

Gene expression profiling of peritoneal metastases from appendiceal and colon cancer demonstrates unique biologic signatures and predicts patient outcomes

Background: Treatment of peritoneal metastases from appendiceal and colon cancer with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) shows great promise. Although long-term disease-free survival is achieved in some cases with this procedure, many patients have recurrence. Oncologists have treated such recurrences of appendiceal cancer similarly to colorectal carcinoma, which has been largely ineffective. This study uses gene expression analysis of peritoneal metastases to better understand these neoplasms. Study Design: From a prospectively maintained database and tissue bank, 41 snap frozen samples of peritoneal metastases (26 appendiceal, 15 colorectal) from patients undergoing HIPEC with complete cytoreduction and more than 3 years of follow-up underwent global gene expression analysis. Distinct phenotypes were identified using unsupervised hierarchical clustering based on differential gene expression. Survival curves restratified by genotype were generated. Results: Three distinct phenotypes were found, 2 consisting of predominantly low grade appendiceal samples (10 of 13 in Cluster 1 and 15 of 20 in Cluster 2) and 1 consisting of predominantly colorectal samples (7 of 8 in Cluster 3). Cluster 1 consisted of patients with good prognosis and Clusters 2 and 3 consisted of patients with poor prognosis (p = 0.006). Signatures predicted survival of low- (Cluster 1) vs high-risk (Cluster 2) appendiceal (p = 0.04) and low-risk appendiceal (Cluster 1) vs colon primary (Cluster 3) (p = 0.0002). Conclusions: This study represents the first use of gene expression profiling for appendiceal cancer, and demonstrates genomic signatures quite distinct from colorectal cancer, confirming their unique biology. Consequently, therapy for appendiceal lesions extrapolated from colonic cancer regimens may be unfounded. These phenotypes may predict outcomes guiding patient management. © 2012 by the American College of Surgeons.

Authors
Levine, EA; III, DGB; Kim, MK; Shen, P; IV, JHS; Guy, C; Hsu, DS
MLA Citation
Levine, EA, III, DGB, Kim, MK, Shen, P, IV, JHS, Guy, C, and Hsu, DS. "Gene expression profiling of peritoneal metastases from appendiceal and colon cancer demonstrates unique biologic signatures and predicts patient outcomes." Journal of the American College of Surgeons 214.4 (2012): 599-606.
PMID
22342786
Source
scival
Published In
Journal of The American College of Surgeons
Volume
214
Issue
4
Publish Date
2012
Start Page
599
End Page
606
DOI
10.1016/j.jamcollsurg.2011.12.028

Management and recurrence patterns of desmoids tumors: A multi-institutional analysis of 211 patients

Background. Desmoid tumors are rare soft-tissue neoplasms with limited data on their management. We sought to determine the rates of recurrence following surgery for desmoid tumors and identify factors predictive of disease-free survival. Methods. Between January 1983 and December 2011, 211 patients with desmoid tumors were identified from three major surgical centers. Clinicopathologic and treatment characteristics were analyzed to identify predictors of recurrence. Results. Median age was 36 years; patients were predominantly female (68 %). Desmoid tumors most commonly arose in extremities (32 %), abdominal cavity (23 %) or wall (21 %), and thorax (15 %); median size was 7.5 cm. Most patients had an R0 surgical margin (60 %). The 1- and 5-year recurrence-free survival was 81.3 and 52.8 %, respectively. Factors associated with worse recurrence-free survival were: younger age (for each 5-year increase in age, hazard ratio [HR] = 0.90, 95 % confidence interval [95 % CI] 0.82-0.98) and extra-abdominal tumor location (abdominal wall referent: extra-abdominal site, HR = 3.28, 95 % CI, 1.46-7.36) (both P < 0.05). Conclusions. Recurrence remains a problem following resection of desmoid tumors with as many as 50 % of patients experiencing a recurrence within 5 years. Factors associated with recurrence included age, tumor location, and margin status. While surgical resection remains central to the management of patients with desmoid tumors, the high rate of recurrence highlights the need for more effective adjuvant therapies. © 2012 Society of Surgical Oncology.

Authors
Peng, PD; Hyder, O; Mavros, MN; Turley, R; Groeschl, R; Firoozmand, A; Lidsky, M; Herman, JM; Choti, M; Ahuja, N; Anders, R; Blazer, DG; Gamblin, TC; Pawlik, TM
MLA Citation
Peng, PD, Hyder, O, Mavros, MN, Turley, R, Groeschl, R, Firoozmand, A, Lidsky, M, Herman, JM, Choti, M, Ahuja, N, Anders, R, Blazer, DG, Gamblin, TC, and Pawlik, TM. "Management and recurrence patterns of desmoids tumors: A multi-institutional analysis of 211 patients." Annals of Surgical Oncology 19.13 (2012): 4036-4042.
Source
scival
Published In
Annals of Surgical Oncology
Volume
19
Issue
13
Publish Date
2012
Start Page
4036
End Page
4042
DOI
10.1245/s10434-012-2634-6

When a chance to cut is not a chance to cure: a future for palliative surgery?

In the context of healthcare reform, Surgery stands at a critical juncture. Attempting to rein in healthcare spending, legislators and payers can be expected to closely examine the legitimacy and necessity of a variety of medical treatments, including surgical procedures. Among these procedures, the most at risk for dismissal based on perceived ineffectiveness or lack of need may be those performed near the end of life, when the potential benefit of surgical intervention may seem negligible. While procedures may be performed for a variety of reasons toward the end of life--some indeed being inappropriate and/or unnecessary--palliative surgery plays an important role in the management of incurable disease. The purposes of this article are to: describe the place for palliative surgery in the armamentarium of palliative care; discuss potential challenges to patients' access to palliative surgery that may arise from health policy or quality initiatives based on poor evidence; and outline a strategy for (a) systematically differentiating palliative surgeries from other, potentially expendable surgeries performed near the end of life, and (b) defining a plan for generating the evidence base to support best practice.

Authors
Mosca, PJ; Blazer, DG; Wheeler, JL; Abernethy, AP
MLA Citation
Mosca, PJ, Blazer, DG, Wheeler, JL, and Abernethy, AP. "When a chance to cut is not a chance to cure: a future for palliative surgery?." Ann Surg Oncol 18.12 (November 2011): 3235-3239.
PMID
21584829
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
18
Issue
12
Publish Date
2011
Start Page
3235
End Page
3239
DOI
10.1245/s10434-011-1787-z

Use of gene expression profiling to determine prognosis and therapeutic targets for patients with appendiceal carcinoma.

Authors
Kim, MK; III, BDG; Stewart, JH; Guy, C; Shen, P; Levine, E; Hsu, SD
MLA Citation
Kim, MK, III, BDG, Stewart, JH, Guy, C, Shen, P, Levine, E, and Hsu, SD. "Use of gene expression profiling to determine prognosis and therapeutic targets for patients with appendiceal carcinoma." February 1, 2011.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
29
Issue
4
Publish Date
2011

Recurrent granulosa cell tumor presenting with spontaneous retroperitoneal hemorrhage: A case report

Authors
Zani, S; Stoecker, M; Cox, MW; Secord, AA; Blazer, DG
MLA Citation
Zani, S, Stoecker, M, Cox, MW, Secord, AA, and Blazer, DG. "Recurrent granulosa cell tumor presenting with spontaneous retroperitoneal hemorrhage: A case report." Gynecologic Oncology Case Reports 1.1 (2011): 14-16.
PMID
24371592
Source
scival
Published In
Gynecologic Oncology Reports
Volume
1
Issue
1
Publish Date
2011
Start Page
14
End Page
16
DOI
10.1016/j.gynor.2011.09.003

Images: Portal venous gas and pneumatosis intestinalis

Authors
Diesen, DL; III, DGB
MLA Citation
Diesen, DL, and III, DGB. "Images: Portal venous gas and pneumatosis intestinalis." Journal of Surgical Radiology 2.1 (2011): 104-105.
Source
scival
Published In
Journal of Surgical Radiology
Volume
2
Issue
1
Publish Date
2011
Start Page
104
End Page
105

Does neoadjuvant therapy improve survival in patients with resectable pancreatic cancer?

Authors
Papalezova, KT; Kim, VM; Stinnett, SS; III, BDG; Clary, BM; Pappas, TN; Tyler, DS; White, RR
MLA Citation
Papalezova, KT, Kim, VM, Stinnett, SS, III, BDG, Clary, BM, Pappas, TN, Tyler, DS, and White, RR. "Does neoadjuvant therapy improve survival in patients with resectable pancreatic cancer?." February 2010.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
17
Publish Date
2010
Start Page
S70
End Page
S71

Clinical outcomes of molecularly confirmed clear cell sarcoma from a single institution and in comparison with data from the Surveillance, Epidemiology, and End Results registry.

BACKGROUND: The authors compared disease-specific survival (DSS) in stage-specific subgroups of patients with clear cell sarcoma, including those with lymph node metastases (N1M0) and those with distant metastases (N0M1). METHODS: Clinical data regarding soft tissue sarcoma patients were obtained from The University of Texas M. D. Anderson Cancer Center (MDACC) (1980-2007) and the Surveillance, Epidemiology, and End Results (SEER) registry (1988-2004). When possible, clear cell sarcoma diagnoses were confirmed using fluorescence in situ hybridization or reverse-transcription polymerase chain reaction. Kaplan-Meier estimates were used to calculate DSS, and Cox multivariate analysis was performed to identify prognostic factors. RESULTS: Fifty-two patients at MDACC and 130 SEER patients were diagnosed with clear cell sarcoma. Five-year DSS for the MDACC and SEER cohorts were 67% and 62%, respectively. Patients with N1M0 and N0M1 disease demonstrated significant differences in 5-year DSS: 74% versus 14% at MDACC (P = .014) and 52% versus 0% in SEER (P = .014). After adjustment, the hazards ratio (HR) for dying was 2.79 for N1M0 disease (95% confidence interval [95% CI], 1.32-5.91) and 11.37 (95% CI, 5.19-24.91) for N0M1 disease compared with stage II disease (P < .001). Non-Caucasian ethnicity (HR, 3.99; 95% CI, 2.27-6.99 [P < .001]) and truncal tumor site (HR, 2.41; 95% CI, 1.15-5.05 [P = .02]) were also found to be predictors of decreased DSS. CONCLUSIONS: The findings of the current study suggest that patients with N1M0 clear cell sarcoma have 5-year DSS that is more similar to that of patients with stage III than stage IV soft tissue sarcoma.

Authors
Blazer, DG; Lazar, AJ; Xing, Y; Askew, RL; Feig, BW; Pisters, PWT; Pollock, RE; Lev, D; Hunt, KK; Cormier, JN
MLA Citation
Blazer, DG, Lazar, AJ, Xing, Y, Askew, RL, Feig, BW, Pisters, PWT, Pollock, RE, Lev, D, Hunt, KK, and Cormier, JN. "Clinical outcomes of molecularly confirmed clear cell sarcoma from a single institution and in comparison with data from the Surveillance, Epidemiology, and End Results registry." Cancer 115.13 (July 1, 2009): 2971-2979.
PMID
19402173
Source
pubmed
Published In
Cancer
Volume
115
Issue
13
Publish Date
2009
Start Page
2971
End Page
2979
DOI
10.1002/cncr.24322

Reply to D.J. Gallagher et al

Authors
Vauthey, J-N; Zorzi, D; Kopetz, S; Abdalla, EK; Kishi, Y; III, DGB
MLA Citation
Vauthey, J-N, Zorzi, D, Kopetz, S, Abdalla, EK, Kishi, Y, and III, DGB. "Reply to D.J. Gallagher et al." Journal of Clinical Oncology 27.20 (2009): e20-e21.
Source
scival
Published In
Journal of Clinical Oncology
Volume
27
Issue
20
Publish Date
2009
Start Page
e20
End Page
e21
DOI
10.1200/JCO.2009.22.5698

Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases.

PURPOSE: The primary goal of this study was to evaluate whether pathologic response to chemotherapy predicts patient survival after preoperative chemotherapy and resection of colorectal liver metastases (CLM). The secondary goal of the study was to identify the clinical predictors of pathologic response. PATIENTS AND METHODS: A retrospective review was performed of 305 patients who underwent preoperative irinotecan- or oxaliplatin-based chemotherapy, followed by resection of CLM. Pathologic response was systematically evaluated and reported as the mean of the percentage of cancer cells remaining within each tumor. Univariate and multivariate analyses were performed to identify the predictors of pathologic response and survival. RESULTS: Cumulative 5-year overall survival rates by pathologic response status were as follows: 75% complete response (no residual cancer cells), 56% major response (1% to 49% residual cancer cells), and 33% minor response (> or = 50% residual cancer cells; complete v major response, P = .037; major v minor response, P = .028). Multivariate analysis revealed that only surgical margin status (P = .050; hazard ratio [HR], 1.77) and pathologic response (major response: P = .034; HR, 4.80; minor response: P = .007; HR, 6.93) were independent predictors of survival. Multivariate analysis of the predictors of pathologic response revealed that carcinoembryonic antigen level < or = 5 ng/mL, tumor size < or = 3 cm, and chemotherapy with fluoropyrimidine plus oxaliplatin and bevacizumab were independent predictors of pathologic response. CONCLUSION: Pathologic response predicts survival after preoperative chemotherapy and resection of CLM. Degree of pathologic response represents a new outcome end point for prognosis after resection of CLM.

Authors
Blazer, DG; Kishi, Y; Maru, DM; Kopetz, S; Chun, YS; Overman, MJ; Fogelman, D; Eng, C; Chang, DZ; Wang, H; Zorzi, D; Ribero, D; Ellis, LM; Glover, KY; Wolff, RA; Curley, SA; Abdalla, EK; Vauthey, J-N
MLA Citation
Blazer, DG, Kishi, Y, Maru, DM, Kopetz, S, Chun, YS, Overman, MJ, Fogelman, D, Eng, C, Chang, DZ, Wang, H, Zorzi, D, Ribero, D, Ellis, LM, Glover, KY, Wolff, RA, Curley, SA, Abdalla, EK, and Vauthey, J-N. "Pathologic response to preoperative chemotherapy: a new outcome end point after resection of hepatic colorectal metastases." J Clin Oncol 26.33 (November 20, 2008): 5344-5351.
PMID
18936472
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
26
Issue
33
Publish Date
2008
Start Page
5344
End Page
5351
DOI
10.1200/JCO.2008.17.5299

Strategies for resection using portal vein embolization: hepatocellular carcinoma and hilar cholangiocarcinoma.

Preoperative portal vein embolization (PVE) is increasingly used to optimize the volume and function of the future liver remnant (FLR) and to reduce the risk for complications of major hepatectomy for hepatocellular carcinoma (HCC) or hilar cholangiocarcinoma (CCA). In patients with HCC who are candidates for extended hepatectomy and in patients with HCC and well-compensated cirrhosis who are being considered for major hepatectomy, FLR volumetry is routinely performed, and PVE is employed in selected cases to optimize the volume and function of the FLR prior to surgery. Similarly, in patients with hilar CCA who are candidates for extended hepatectomy, careful preoperative preparation using biliary drainage, FLR volumetry, and PVE optimizes the volume and function of the FLR prior to surgery. Appropriate use of PVE has led to improved postoperative outcomes after major hepatectomy for these diseases and oncological outcomes similar to those in patients who undergo resection without PVE. Specific indications for PVE are being clarified. FLR volumetry is necessary for proper selection of patients for PVE. Analysis of the degree of hypertrophy of the FLR after PVE (a dynamic test of liver regeneration) complements analysis of the pre-PVE FLR volume (a static test). Together, FLR degree of hypertrophy and FLR volume are the best predictors of outcome after major hepatectomy in an individual patient, regardless of the degree of underlying liver disease. This article synthesizes the literature on the approach to patients with HCC and CCA who are candidates for major hepatectomy. The rationale and indications for FLR volumetry and PVE and outcomes following PVE and major hepatectomy for HCC and CCA are discussed.

Authors
Anaya, DA; Blazer, DG; Abdalla, EK
MLA Citation
Anaya, DA, Blazer, DG, and Abdalla, EK. "Strategies for resection using portal vein embolization: hepatocellular carcinoma and hilar cholangiocarcinoma." Semin Intervent Radiol 25.2 (June 2008): 110-122.
PMID
21326552
Source
pubmed
Published In
Seminars in Interventional Radiology
Volume
25
Issue
2
Publish Date
2008
Start Page
110
End Page
122
DOI
10.1055/s-2008-1076684

QS23. Adrenalectomy for Cushing’s Syndrome in Children: A 15-Year Institutional Experience

Authors
Blazer, DG; Batista, D; Libuti, SK; Alexander, HR; Stratakis, C; Pingpank, JF
MLA Citation
Blazer, DG, Batista, D, Libuti, SK, Alexander, HR, Stratakis, C, and Pingpank, JF. "QS23. Adrenalectomy for Cushing’s Syndrome in Children: A 15-Year Institutional Experience." Journal of Surgical Research 144.2 (February 2008): 279-280.
Source
crossref
Published In
Journal of Surgical Research
Volume
144
Issue
2
Publish Date
2008
Start Page
279
End Page
280
DOI
10.1016/j.jss.2007.12.261

Distal pancreatectomy for isolated metastasis of endometrial carcinoma to the pancreas.

CONTEXT: The majority of oncological pancreatic resections involve resection of primary pancreatic tumors. Pancreatic resection for metastatic disease is rare but can produce durable palliation or even cure in carefully selected patients. Herein, we report what to our knowledge is the first description of pancreatic resection of metastatic endometrial carcinoma. CASE REPORT: We evaluated a patient who developed a mass in the distal pancreas as identified by screening computed tomography nearly three years after radical abdominal hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic and para-aortic lymph node dissection for an International Federation of Gynecology and Obstetrics stage IIIA, grade 2 endometrial cancer. Findings on cytopathologic examination of tissue obtained by fine needle aspiration of the lesion were consistent with metastatic endometrial carcinoma. Radiographic imaging and physical examination failed to identify additional sites of disease. After receiving counseling as to the risks and projected benefits of surgical resection, the patient underwent a distal pancreatectomy, splenectomy, and partial gastrectomy with en bloc excision of the tumor. On final pathologic examination, all margins were free of tumor. At the time of this report, the patient remains without evidence of disease. CONCLUSION: Metastasis to the pancreas from endometrial cancer is uncommon; however, this possibility should be considered in patients with a new pancreatic lesion and a history of endometrial cancer as pancreatic resection of metastatic disease can benefit selected patients.

Authors
Blazer, DG; Ramirez, PT; Wang, H; Fleming, JB
MLA Citation
Blazer, DG, Ramirez, PT, Wang, H, and Fleming, JB. "Distal pancreatectomy for isolated metastasis of endometrial carcinoma to the pancreas. (Published online)" JOP 9.1 (January 8, 2008): 56-60.
PMID
18182745
Source
pubmed
Published In
JOP : Journal of the pancreas
Volume
9
Issue
1
Publish Date
2008
Start Page
56
End Page
60

Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy.

BACKGROUND: With the introduction of sentinel lymph node (SLN) biopsy for melanoma, inguinal lymph node dissections (ILND) are more commonly performed for microscopic disease than for clinically palpable disease. We sought to examine the effect this change has on the morbidity of the operation. METHODS: A retrospective review was performed of all patients who underwent an ILND for melanoma between October 1997 and April, 2006. Clinical and pathologic data were collected and correlated by multivariate analysis with the incidence of a major wound complication. RESULTS: We identified 212 patients, 132 who underwent an ILND for a positive SLN and 80 for clinically palpable disease. Age, sex, and body mass index (BMI) were similar in both groups. Patients with clinically palpable disease had a significantly greater number of involved nodes (3.0 vs 1.96, P = .0013), more often had >or=4 involved nodes (29% vs 9%, P < .001), and a greater incidence of extranodal extension (47% vs 5%, P < .001). Of the 212 patients, 41 (19%) had a significant wound complication. This complication was significantly higher among patients with clinical disease compared to patients with a positive SLN (28% vs 14%, P = .02). Only BMI (odds ratio of 1.1) and the indication for the procedure (odds ratio of 2.2) were independent predictors of a major wound complication. Lymphedema occurred in 30% of the patients and was only significantly associated with clinical disease (41% vs 24%, P = .025). With a median follow-up of 2 years, regional recurrence was not significantly greater in patients with clinically palpable disease (13% vs 9%, P = not significant [ns]), although this result was possibly due to the significantly greater rate of distant recurrence (49% vs 18%, P < .001) and death (48% vs 21%) in these patients. CONCLUSIONS: Patients undergoing an ILND for a positive SLN have a significantly lower risk of postoperative complication or lymphedema than do patients undergoing ILND for clinically palpable disease. There is a benefit in regard to the morbidity of treatment in surgically staging melanoma patients by SLN biopsy and preventing ILND for palpable disease.

Authors
Sabel, MS; Griffith, KA; Arora, A; Shargorodsky, J; Blazer, DG; Rees, R; Wong, SL; Cimmino, VM; Chang, AE
MLA Citation
Sabel, MS, Griffith, KA, Arora, A, Shargorodsky, J, Blazer, DG, Rees, R, Wong, SL, Cimmino, VM, and Chang, AE. "Inguinal node dissection for melanoma in the era of sentinel lymph node biopsy." Surgery 141.6 (June 2007): 728-735.
PMID
17560249
Source
pubmed
Published In
Surgery
Volume
141
Issue
6
Publish Date
2007
Start Page
728
End Page
735
DOI
10.1016/j.surg.2006.12.018

Surgical therapy of cutaneous melanoma.

For most solid tumors therapy has evolved from surgery alone to a multidisciplinary approach. Malignant melanoma remains an exception, with surgery maintaining the principal role not only for treatment of the primary lesion but also staging and the management of advanced disease. The surgical management of melanoma has evolved over the years, resulting in a substantial decrease in the morbidity associated with treatment without a compromise in outcome. This article will review the changes that have occurred leading to the current surgical approach to melanoma, the evidence behind these recommendations, and new questions that need to be addressed.

Authors
Blazer, DG; Sondak, VK; Sabel, MS
MLA Citation
Blazer, DG, Sondak, VK, and Sabel, MS. "Surgical therapy of cutaneous melanoma." Semin Oncol 34.3 (June 2007): 270-280. (Review)
PMID
17560989
Source
pubmed
Published In
Seminars in Oncology
Volume
34
Issue
3
Publish Date
2007
Start Page
270
End Page
280
DOI
10.1053/j.seminoncol.2007.03.007

Antiangiogenic gene therapy of cancer: recent developments.

With the role of angiogenesis in tumor growth and progression firmly established, considerable effort has been directed to antiangiogenic therapy as a new modality to treat human cancers. Antiangiogenic agents have recently received much widespread attention but strategies for their optimal use are still being developed. Gene therapy represents an attractive alternative to recombinant protein administration for several reasons. This review evaluates the potential advantages of gene transfer for antiangiogenic cancer therapy and describes preclinical gene transfer work with endogenous angiogenesis inhibitors demonstrating the feasibility of effectively suppressing and even eradicating tumors in animal models. Additionally, we describe the advantages and disadvantages of currently available gene transfer vectors and update novel developments in this field. In conclusion, gene therapy holds great promise in advancing antiangiogenesis as an effective cancer therapy and will undoubtedly be evaluated in human clinical trials in the near future.

Authors
Tandle, A; Blazer, DG; Libutti, SK
MLA Citation
Tandle, A, Blazer, DG, and Libutti, SK. "Antiangiogenic gene therapy of cancer: recent developments. (Published online)" J Transl Med 2.1 (June 25, 2004): 22-.
PMID
15219236
Source
pubmed
Published In
Journal of Translational Medicine
Volume
2
Issue
1
Publish Date
2004
Start Page
22
DOI
10.1186/1479-5876-2-22

Is there a role for sentinel lymph node biopsy in the management of sarcoma?

Is there a role for sentinel lymph node (SLN) biopsy in the management of sarcoma? Sentinel node biopsy has dramatically changed the management of melanoma and breast cancer, helping surgeons avoid radical lymphadenectomies in node negative patients who would previously have undergone a more morbid operation with little benefit, or remained pathologically unstaged. Many investigators have explored the use of lymphatic mapping for malignancies other than breast cancer or melanoma. Lymphatic mapping and sentinel node biopsy has not been investigated in the management of sarcomas, which is not surprising given that the majority of sarcomas spread by local extension or hematogenously. Regional lymph node metastases are rare; developing in about 3-10% of patients with localized disease. However, among certain subtypes of high-grade sarcomas there is a propensity for regional lymph node metastases. These include rhabdomyosarcoma, epithelioid sarcoma, clear cell sarcoma, synovial sarcoma, and vascular sarcomas. It is in these particular subtypes that there may be a benefit to SLN biopsy.

Authors
Blazer, DG; Sabel, MS; Sondak, VK
MLA Citation
Blazer, DG, Sabel, MS, and Sondak, VK. "Is there a role for sentinel lymph node biopsy in the management of sarcoma?." Surg Oncol 12.3 (November 2003): 201-206. (Review)
PMID
12957624
Source
pubmed
Published In
Surgical Oncology
Volume
12
Issue
3
Publish Date
2003
Start Page
201
End Page
206

Vitamin D receptor polymorphisms and prostate cancer.

Prostate cancer is a common disease, yet determinants of prostate cancer risk remain largely unidentified. Low circulating levels of 1, 25-dihydroxy vitamin D (1,25-D) have been implicated as a risk factor for prostate cancer. In addition, 1,25-D exhibits significant antineoplastic properties both in vitro and in vivo, and these antiproliferative effects appear to be mediated through the vitamin D receptor (VDR). The VDR has a number of common polymorphisms, including a TaqI restriction fragment length polymorphism in exon 9 and a poly(A) length polymorphism in the 3'-untranslated region. Previous studies have found an association between the TaqI T allele or poly(A) L allele and prostate cancer. To further investigate the putative link between VDR polymorphisms and prostate cancer, we conducted a case-control study of prostate cancer patients from the Piedmont region of North Carolina. Using polymerase chain reaction-based techniques on DNA extracted from peripheral blood, we genotyped 77 cases (70 white, seven black) and 183 controls (169 white, 14 black) for the TaqI and poly(A) alleles. We report here an overall lack of association between either the TaqI or poly(A) genotype and prostate cancer odds ratio (OR)=1.4, 95% confidence interval (CI)=0.7-2.8; and OR=1.2, 95% CI=0.6-2.5, respectively). Using a case-case analysis, we tested whether these polymorphisms might be associated with more advanced disease but found no statistically significant association for the TaqI T or poly(A) L allele (OR=2.5, 95% CI=0.3-21.7; OR=2.8, 95% CI=0.3-23.8, respectively). We report strong evidence of linkage disequilibrium between the TaqI and poly(A) polymorphisms (P < 0.0001), with whites demonstrating stronger linkage disequilibrium than blacks (D=0.24 vs. D=0.18).

Authors
Blazer, DG; Umbach, DM; Bostick, RM; Taylor, JA
MLA Citation
Blazer, DG, Umbach, DM, Bostick, RM, and Taylor, JA. "Vitamin D receptor polymorphisms and prostate cancer." Mol Carcinog 27.1 (January 2000): 18-23.
PMID
10642433
Source
pubmed
Published In
Molecular Carcinogenesis
Volume
27
Issue
1
Publish Date
2000
Start Page
18
End Page
23

Inhibition of established pancreatic cancers following specific active immunotherapy with interleukin-2 gene-transduced tumor cells.

Pancreatic cancer has a poor prognosis even when complete resection can be accomplished. Recent studies have demonstrated that the immune system is capable of mounting effective tumor-specific immune responses even against "nonimmunogenic" tumors. The studies reported herein were conducted to determine if induction of tumor-specific immune responses of inhibiting in vivo pancreatic tumor growth could be achieved through active immunization with pancreatic tumor cells genetically engineered to secrete interleukin-2 (IL-2). A relevant poorly immunogenic subcutaneous model of murine ductal pancreatic cancer was first developed using an implantable tumor cell line Panc02 in C57BL/6 mice. Panc02 cells were then genetically engineered to secrete human IL-2 (Panc02/IL2). The ability of irradiated Panc02/IL2 cells to stimulate an immune response capable of rejecting a subsequent tumor challenge was first demonstrated. Ninety percent of animals vaccinated with irradiated parental Panc02 and subsequently challenged with parental Panc02 cells developed tumors by 48 days (mean tumor volume of 234 mm3) compared to only 40% (P < .05, chi square) of animals vaccinated with irradiated Panc02/IL2 and challenged with parental Panc02 (14 mm3, P < .004, tau test). The therapeutic benefit of active immunization in tumor-bearing animals was then examined. Mice with 3-day-old established subcutaneous tumors were administered a series of 4 weekly vaccinations with irradiated Panc02 or Panc02/IL2 cells. A significant reduction in tumor growth was present in those animals vaccinated with Panc02/IL2 (P < .005, tau test) versus Panc02 or saline. Animals whose established tumors regressed following vaccinations with IL-2-secreting Panc02 cells were found to have long-lasting immunity as demonstrated by rejection of a tumor challenge presented over 140 days following inoculation of the primary tumor. We conclude that an immune response capable of inhibiting established pancreatic tumors can be generated by vaccination with IL-2-secreting tumor cells. Furthermore, long-term immunological memory was established in mice that rejected the original established tumor. These studies provide preclinical evidence to support the use of cytokine gene-transduced tumor cell vaccinations in patients with pancreatic cancer.

Authors
Clary, BM; Coveney, EC; Philip, R; Blazer, DG; Morse, M; Gilboa, E; Lyerly, HK
MLA Citation
Clary, BM, Coveney, EC, Philip, R, Blazer, DG, Morse, M, Gilboa, E, and Lyerly, HK. "Inhibition of established pancreatic cancers following specific active immunotherapy with interleukin-2 gene-transduced tumor cells." Cancer Gene Ther 4.2 (March 1997): 97-104.
PMID
9080118
Source
pubmed
Published In
Cancer Gene Therapy
Volume
4
Issue
2
Publish Date
1997
Start Page
97
End Page
104

Active immunization with tumor cells transduced by a novel AAV plasmid-based gene delivery system.

Ex vivo genetically engineered cytokine-secreting tumor cell vaccines have been shown to prevent metastatic disease in animal models of lung and breast cancer. Because of the inefficiency of existing modes of gene delivery in transducing primary human tumor cells, it has been difficult to clinically apply this strategy. In this study, liposome-mediated delivery of an adeno-associated virus (AAV)-based plasmid containing the sequence for murine gamma-interferon (gamma-IFN) (pMP6A-mIFN-gamma) was used to generate cytokine-secreting murine tumor cell vaccines. High levels of gamma-IFN and elevated class I major histocompatibility complex expression after transfer of pMP6A-mIFN-gamma into the murine lung cancer cell line, D122, was demonstrated. The efficiency of gene transfer was determined by two different methods and was estimated to be 10-15%. Irradiated gamma-IFN D122 cells generated by this novel gene delivery system (D122/pMP6A-mIFN-gamma) and also by standard retroviral methods (DIF2) were administered as weekly vaccinations by intraperitoneal injection to animals bearing 7-day-old intrafootpad D122 tumors. Hindlimb amputation was performed when footpad diameters reached 7 mm, and lungs were harvested 28 days later. Animals vaccinated with gamma-IFN-secreting D122 cells produced by AAV-based plasmids delivery demonstrated a significant delay in footpad tumor growth when compared with controls and DIF2 cells. Fifty-seven percent of animals vaccinated with D122/pMP6A-mIFN-gamma were free of pulmonary metastases 28 days after amputation, significantly improved from the 0, 7, and 15% observed in animals vaccinated with irradiated parental D122 cells, irradiated D122 cells lipofected with an empty-cassette vector (pMP6A), or DIF2 cells, respectively. These results and the ability to transfer genes with this delivery system to a broad range of tumor types support its use in the generation of cytokine-secreting tumor cell vaccinations for use in clinical trials.

Authors
Clary, BM; Coveney, EC; Blazer, DG; Philip, R; Philip, M; Morse, M; Gilboa, E; Lyerly, HK
MLA Citation
Clary, BM, Coveney, EC, Blazer, DG, Philip, R, Philip, M, Morse, M, Gilboa, E, and Lyerly, HK. "Active immunization with tumor cells transduced by a novel AAV plasmid-based gene delivery system." J Immunother 20.1 (January 1997): 26-37.
PMID
9101411
Source
pubmed
Published In
Journal of Immunotherapy
Volume
20
Issue
1
Publish Date
1997
Start Page
26
End Page
37

Active immunotherapy of pancreatic cancer with tumor cells genetically engineered to secrete multiple cytokines.

BACKGROUND: Vaccination of tumor-bearing animals with tumor cells genetically engineered to secrete cytokines including interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) has been shown to induce effective tumor-specific immune responses capable of inhibiting local and metastatic disease. Previous unsuccessful attempts to enhance this immune response by means of the secretion of multiple cytokines possessing different immunologic mechanisms of action may have been due to the inherent inefficiency of the gene transfer systems used. We postulated that tumor cells genetically engineered by means of a novel gene transfer method resulting in high level secretion of both cytokines would be more effective than tumor cells secreting a single cytokine in inhibiting the growth of existing tumors. METHODS: Nonimmunogenic, murine pancreatic cancer cells (Panc02) were engineered to secrete IL-2, IFN-gamma, IL-2 and IFN-gamma, or neomycin phosphotransferase. Mice were inoculated with 5 x 10(5) parental Panc02 tumor cells subcutaneously. Beginning 3 days later, animals then received a series of four weekly vaccinations with irradiated Panc02/Neo, Panc02/IL2, Panc02/IFN, or Panc02/IL-2/IFN. RESULTS: Treatment with Panc02/Neo, Panc02/IL-2, or Panc02/IFN resulted in 0%, 40%, and 30% tumor-free survival, respectively. In contrast, 80% of animals vaccinated with Panc02/IL2/IFN were free of tumor at 100 days. All animals free of disease were resistant to subsequent tumor challenges. CONCLUSIONS: These data show that vaccination with tumor cells that secrete high levels of multiple cytokines was more effective in treating established pancreatic tumors and represents an improvement over existing single cytokine strategies.

Authors
Clary, BM; Coveney, EC; Blazer, DG; Philip, R; Lyerly, HK
MLA Citation
Clary, BM, Coveney, EC, Blazer, DG, Philip, R, and Lyerly, HK. "Active immunotherapy of pancreatic cancer with tumor cells genetically engineered to secrete multiple cytokines." Surgery 120.2 (August 1996): 174-181.
PMID
8751580
Source
pubmed
Published In
Surgery
Volume
120
Issue
2
Publish Date
1996
Start Page
174
End Page
181

Investigation of antiestrogenic properties of unleaded gasoline in female mice.

Chronic exposure of female B6C3F1 mice to a high concentration of unleaded gasoline (UG) vapor induced liver tumors and caused uterine changes suggestive of estrogen antagonism. These effects of UG may be related, since estrogens inhibit hepatocarcinogenesis in mice. The purpose of this study was to determine if antiestrogenic properties of UG could be demonstrated in sensitive short-term assays. Competitive binding to estrogen receptors was assayed in vitro in uterine cytosols prepared from ovariectomized (OVEX) mice. UG did not inhibit specific binding of 17 beta-[3H]estradiol (E2) to uterine cytosols. To determine if UG induced estrogen metabolism, hepatocyte suspensions were prepared from female mice treated by intragastric intubation (ig) for 3 days with corn oil (control) or UG (1800 mg/kg/day). In a quantitative in vitro assay, hepatocytes isolated from UG-treated mice converted E2 and 17 alpha-ethinyl estradiol to water soluble metabolites at a three-fold faster rate than control hepatocytes. Dose-response studies confirmed the induction of E2 metabolism by UG doses as low as 600 mg/kg/day. In a 3-day uterotrophic assay, immature female mice cotreated with UG (600 or 1800 mg/kg/day, ig) and E2 (1 microgram/day, sc) had similar relative uterus weights and uterine peroxidase activity as mice cotreated with corn oil and E2. In a modified uterotrophic assay, OVEX mice treated with corn oil or UG (2400 mg/kg/day, ig) on Days 1-4 and cotreated with E2 (4 micrograms/kg/day, sc) on Days 3-4 had similar uterus weights on Day 5. Thus, while ig treatment of mice with UG induced estrogen metabolism in isolated hepatocytes, this induction did not have functional antiestrogenic consequences as measured by uterotrophic assays. These data suggest that the uterine effects caused by chronic exposure of mice to UG vapor may not be due to direct antiestrogenic effects of UG.

Authors
Standeven, AM; Blazer, DG; Goldsworthy, TL
MLA Citation
Standeven, AM, Blazer, DG, and Goldsworthy, TL. "Investigation of antiestrogenic properties of unleaded gasoline in female mice." Toxicol Appl Pharmacol 127.2 (August 1994): 233-240.
PMID
8048066
Source
pubmed
Published In
Toxicology and Applied Pharmacology
Volume
127
Issue
2
Publish Date
1994
Start Page
233
End Page
240
DOI
10.1006/taap.1994.1157

A Novel Approach: Local Resection for Ampullary GIST—Case Report and Review of Literature

Authors
Leung, K; Worni, M; Galeotti, J; Blazer, D
MLA Citation
Leung, K, Worni, M, Galeotti, J, and Blazer, D. "A Novel Approach: Local Resection for Ampullary GIST—Case Report and Review of Literature (Published online)." Journal of Gastrointestinal Cancer.
Source
crossref
Published In
Journal of Gastrointestinal Cancer
DOI
10.1007/s12029-016-9839-z
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