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Roman, Sanziana Alina

Positions:

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. 1994

M.D. — Columbia University

General Surgery Resident, Yale New Haven Hospital

-

Chief Resident In Surgery, Yale New Haven Hospital

-

Instructor In Surgery,

Yale University School of Medicine

Attending Surgeon, West Haven, Ct

Veterans Administration Medical Center

Assistant Professor Of Surgery,

Yale University School of Medicine

Chief Of D Ivision Of Endocrine Surgery,

Yale University School of Medicine

Director, Endocrine Surgery Fellowship,

Yale University School of Medicine

Associate Professor Of Surgery,

Yale University School of Medicine

Grants:

Thyrogen Utilization Patterns in the Treatment of Thyroid Cancer

Administered By
Duke Clinical Research Institute
AwardedBy
Genzyme Corporation
Role
Co Investigator
Start Date
June 30, 2015
End Date
June 30, 2017

Clinically vs. pathologically negative lymph nodes in patients with papillary thyroid cancer

Administered By
Surgery, Advanced Oncologic and Gastrointestinal Surgery
AwardedBy
Endocrine Fellows Foundation
Role
Mentor
Start Date
May 01, 2015
End Date
April 30, 2016

Publications:

The Impact of Pathologically Positive Lymph Nodes in the Clinically Negative Neck: An Analysis of 39,301 Patients with Papillary Thyroid Cancer.

Management of patients with low-risk papillary thyroid cancer (PTC) with clinically uninvolved lymph nodes (cN0 LNs), but who harbor metastatic central LNs (pN1a), remains unclear. The number of central LNs examined, radioactive iodine (RAI) utilization, and survival were compared across cN0 patients based on pN stage: pN0 (negative) versus pNx (unknown) versus pN1a (pathologically positive).Adults with a PTC ≥1 cm who were cN0 preoperatively were compared based on surgical pathology using the National Cancer Data Base (NCDB; 2003-2011), after univariate and multivariate adjustment. Overall survival (OS) was examined using Kaplan-Meier curves, the log-rank test, and Cox proportional hazards modeling.Overall, 39,301 patients were included; median tumor size was 1.9 cm. More LNs were examined for pN1a versus pN0 diagnosis (pN1a median = 5 LNs vs. pN0 median = 2 LNs; p < 0.0001), with a median of two central LNs found to be positive on surgical resection. Compared with pN0, pN1a patients were 78% more likely to receive RAI (odds ratio 1.78, 95% confidence interval [CI] 1.65-1.91; p < 0.0001). After adjusting for receipt of RAI, no difference in OS was observed for pN1a versus pN0 or pNx patients (p = 0.72). Treatment with RAI was associated with improved OS (hazard ratio 0.78, 95% CI 0.62-0.98, p = 0.03), but the effect of RAI did not differ based on pN stage (interaction p = 0.67).More LNs were examined for positive versus negative pN diagnosis in patients with cN0 PTC. Unsuspected central neck nodal metastases in cN0 PTC patients are associated with increased RAI utilization, but no survival difference.

Authors
Ruel, E; Thomas, S; Perkins, JM; Roman, SA; Sosa, JA
MLA Citation
Ruel, E, Thomas, S, Perkins, JM, Roman, SA, and Sosa, JA. "The Impact of Pathologically Positive Lymph Nodes in the Clinically Negative Neck: An Analysis of 39,301 Patients with Papillary Thyroid Cancer." Annals of surgical oncology (January 26, 2017).
PMID
28127652
Source
epmc
Published In
Annals of Surgical Oncology
Publish Date
2017
DOI
10.1245/s10434-016-5719-9

Impact of minimally invasive vs. open distal pancreatectomy on use of adjuvant chemoradiation for pancreatic adenocarcinoma.

Published data examining the impact of minimally invasive distal pancreatectomy (MIDP) on survival are generally limited to experiences from high-volume institutions. Our aim was to compare utilization of adjuvant chemoradiation and time from surgery until its initiation following MIDP vs. open surgery (ODP) at a national level.Adult patients undergoing distal pancreatectomy for Stage I and II pancreatic adenocarcinoma were identified from the National Cancer Data Base, 2010-2012.A total of 1807 patients underwent distal pancreatectomy for adenocarcinoma at 506 institutions (27.9% MIDP). After adjustment, those who underwent MIDP were more likely to have complete tumor resections and a shorter hospital length of stay. Patients undergoing MIDP vs. ODP were more likely to receive adjuvant chemotherapy; time to initiation of adjuvant chemotherapy or radiation was not different between groups. After adjustment, overall survival for MIDP vs. ODP remained similar (HR 0.85, CI 0.67-1.10, p = 0.21).MIDP is associated with increased use of adjuvant chemotherapy; further study is needed to understand the etiology and impact of this association.

Authors
Anderson, KL; Adam, MA; Thomas, S; Roman, SA; Sosa, JA
MLA Citation
Anderson, KL, Adam, MA, Thomas, S, Roman, SA, and Sosa, JA. "Impact of minimally invasive vs. open distal pancreatectomy on use of adjuvant chemoradiation for pancreatic adenocarcinoma." American journal of surgery (January 7, 2017).
PMID
28093119
Source
epmc
Published In
The American Journal of Surgery
Publish Date
2017
DOI
10.1016/j.amjsurg.2017.01.005

Proposing prognostic thresholds for lymph node yield in clinically lymph node-negative and lymph node-positive cancers of the oral cavity.

Prognostic lymph node yield thresholds have been identified and incorporated into treatment guidelines for multiple cancer sites, but not for oral cancer. The objective of this study was to identify optimal thresholds in elective and therapeutic neck dissection for oral cavity cancers.Patients with oral cavity cancers in the National Cancer Database (NCDB) were stratified into clinically lymph node-negative (cN0) and clinically lymph node-positive (cN+) cohorts to reflect the differing surgical management for these diseases. Univariate and multivariate analyses were performed to assess the relation between lymph node yield and overall survival, adjusting for other prognostic factors. Thresholds derived from the NCDB were validated in the Surveillance, Epidemiology, and End Results database.In patients with cN0 cancers of the oral cavity from the NCDB, those who had <16 lymph nodes had significantly decreased survival. The proportion of positive lymph nodes was higher for patients who had ≥16 lymph nodes (27.2% vs 16.3% for < 16 lymph nodes; P < .001). This threshold was validated in 2715 lymph node-negative cancers from SEER, with a mortality hazard ratio of 0.825 for ≥ 16 lymph nodes (95% confidence interval, 0.764-0.950; P = .004). In patients with cN + oral cavity cancers from the NCDB, groups with <26 lymph nodes had significantly decreased survival. This threshold was validated in 1903 lymph node-positive cancers from SEER, with a mortality hazard ratio of 0.791 (95% confidence interval, 0.692-0.903; P = .001). Academic centers, higher volume centers, and geographic location predicted higher lymph node yields.More extensive neck dissection (≥16 lymph nodes in cN0, ≥ 26 lymph nodes in cN+) was associated with better survival. Further evaluation of practice patterns in lymph node yield may represent an opportunity for improved quality of care. Cancer 2016;122:3624-31. © 2016 American Cancer Society.

Authors
Kuo, P; Mehra, S; Sosa, JA; Roman, SA; Husain, ZA; Burtness, BA; Tate, JP; Yarbrough, WG; Judson, BL
MLA Citation
Kuo, P, Mehra, S, Sosa, JA, Roman, SA, Husain, ZA, Burtness, BA, Tate, JP, Yarbrough, WG, and Judson, BL. "Proposing prognostic thresholds for lymph node yield in clinically lymph node-negative and lymph node-positive cancers of the oral cavity." Cancer 122.23 (December 2016): 3624-3631.
PMID
27479645
Source
epmc
Published In
Cancer
Volume
122
Issue
23
Publish Date
2016
Start Page
3624
End Page
3631
DOI
10.1002/cncr.30227

Exploring the Relationship Between Patient Age and Cancer-Specific Survival in Papillary Thyroid Cancer: Rethinking Current Staging Systems.

Purpose Patient age is considered to play a unique prognostic role in papillary thyroid cancer (PTC), with a distinct staging dichotomization at 45 years of age. This is based on older, limited data demonstrating a marked rise in mortality around the ages of 40 to 50 years. We hypothesized that age is associated with compromised survival from cancer, with no cutoff denoting survival difference. Patients and Methods Patients with PTC who had surgery were identified from the SEER database (1998 to 2012). Multivariable proportional hazards modeling utilizing several flexible smoothing approaches were used to examine the association between age and cancer-specific survival (CSS) and to determine whether there is an age cut point that is associated with CSS decrement. Results A total of 31,802 patients with PTC were included. Median age was 45 years (range, 2 to 105 years). Ten-year CSS according to age was as follows: 2 to 19 years, 99.8%; 20 to 29 years, 99.9%; 30 to 39 years, 99.8%; 40 to 49 years, 99.5%; 50 to 59 years, 98.1%; 60 to 69 years, 94.8%; 70 to 79 years, 91.5%; 80 to 89 years, 79.2%; and ≥ 90 years, 73.9%. After adjustment for patient demographic and clinicopathologic characteristics, increasing age was associated with increasing mortality from the disease in a dose-dependent fashion, without an apparent cut point. Each of the smoothing approaches demonstrated a similar linearity of risk over all ages and provided close measures of goodness of fit to the data. Conclusion Patient age is significantly associated with death from PTC in a linear fashion, without an apparent age cut point demarcating survival difference. These results challenge the appropriateness of a patient age cut point in current staging systems for PTC and argue for considering a revision in how we anticipate prognosis for patients with PTC.

Authors
Adam, MA; Thomas, S; Hyslop, T; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Thomas, S, Hyslop, T, Scheri, RP, Roman, SA, and Sosa, JA. "Exploring the Relationship Between Patient Age and Cancer-Specific Survival in Papillary Thyroid Cancer: Rethinking Current Staging Systems." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.36 (December 2016): 4415-4420.
PMID
27998233
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
36
Publish Date
2016
Start Page
4415
End Page
4420

How Many Lymph Nodes Are Enough? Assessing the Adequacy of Lymph Node Yield for Papillary Thyroid Cancer.

Patients who undergo surgery for papillary thyroid cancer with only a limited lymph node examination are thought to be at risk for potentially harboring occult disease. However, this risk has not been objectively quantified and may have implications for subsequent management and surveillance.Data from the National Cancer Database (1998 to 2012) were used to characterize the distribution of nodal positivity of adult patients diagnosed with localized ≥ 1-cm papillary thyroid cancer who underwent thyroidectomy with one or more lymph nodes (LNs) examined. A β-binomial distribution was used to estimate the probability of occult nodal disease as a function of total number of LNs examined and pathologic tumor stage.A total of 78,724 patients met study criteria; 38,653 patients had node-positive disease. The probability of falsely identifying a patient as node negative was estimated to be 53% for patients with a single node examined and decreased to less than 10% when more than six LNs were examined. To rule out occult nodal disease with 90% confidence, six, nine, and 18 nodes would need to be examined for patients with T1b, T2, and T3 disease, respectively. Sensitivity analyses limited to patients likely undergoing prophylactic central neck dissection resulted in three, four, and eight nodes needed to provide comparable adequacy of LN evaluation.To our knowledge, our study provides the first empirically based estimates of occult nodal disease risk in patients after surgery for papillary thyroid cancer as a function of primary tumor stage and number of LNs examined. Our estimates provide an objective guideline for evaluating adequacy of LN yield for surgeons and pathologists in the treatment of papillary thyroid cancer, and especially intermediate-risk disease, for which use of adjuvant radioactive iodine and surveillance intensity are not currently standardized.

Authors
Robinson, TJ; Thomas, S; Dinan, MA; Roman, S; Sosa, JA; Hyslop, T
MLA Citation
Robinson, TJ, Thomas, S, Dinan, MA, Roman, S, Sosa, JA, and Hyslop, T. "How Many Lymph Nodes Are Enough? Assessing the Adequacy of Lymph Node Yield for Papillary Thyroid Cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 34.28 (October 2016): 3434-3439.
PMID
27528716
Source
epmc
Published In
Journal of Clinical Oncology
Volume
34
Issue
28
Publish Date
2016
Start Page
3434
End Page
3439
DOI
10.1200/jco.2016.67.6437

Leptin Is Produced by Parathyroid Glands and Stimulates Parathyroid Hormone Secretion.

We asked if leptin and its cognate receptor were present in normal and diseased parathyroid glands, and if so, whether they had any functional effects on parathyroid hormone (PTH) secretion in parathyroid neoplasms.The parathyroid glands acting through PTH play a critical role in the regulation of serum calcium. Based on leptin's recently discovered role in bone metabolism, we hypothesized these glands were the sites of a functional interaction between these 2 hormones.From July 2010 to July 2011, 96 patients were enrolled in a prospective study of leptin and hyperparathyroidism, all of whom were enrolled based on their diagnosis of hyperparathyroidism, and their candidacy for surgical intervention provided informed consent. Immediately after parathyroidectomy, 100 to 300 mg of adenomatous or hyperplastic diseased parathyroid tissue was prepared and processed according to requirements of the following: in situ hybridization, immunohistochemistry, immunofluorescence by conventional and spinning disc confocal microscopy, electron microscopy, parathyroid culture, whole organ explant, and animal model assays.Leptin, leptin receptor (long isoform), and PTH mRNA transcripts and protein were detected in an overlapping fashion in parathyroid chief cells in adenoma and hyperplastic glands, and also in normal parathyroid by in situ hybridization, qRT-PCR, and immunohistochemistry. Confocal microscopy confirmed active exogenous leptin uptake in cultured parathyroid cells. PTH secretion in explants increased in response to leptin and decreased with leptin receptor signaling inhibition by AG490, a JAK2/STAT3 inhibitor. Ob/ob mice injected with mouse leptin exhibited increased PTH levels from baseline.Taken together, these data suggest that leptin is a functionally active product of the parathyroid glands and stimulates PTH release.

Authors
Hoang, D; Broer, N; Sosa, JA; Abitbol, N; Yao, X; Li, F; Rivera-Molina, F; Toomre, DK; Roman, SA; Sue, G; Kim, S; Li, AY; Callender, GG; Simpson, C; Narayan, D
MLA Citation
Hoang, D, Broer, N, Sosa, JA, Abitbol, N, Yao, X, Li, F, Rivera-Molina, F, Toomre, DK, Roman, SA, Sue, G, Kim, S, Li, AY, Callender, GG, Simpson, C, and Narayan, D. "Leptin Is Produced by Parathyroid Glands and Stimulates Parathyroid Hormone Secretion." Annals of surgery (September 8, 2016).
PMID
27611607
Source
epmc
Published In
Annals of Surgery
Publish Date
2016

Extrathyroidal Extension is Associated with Compromised Survival in Patients with Thyroid Cancer.

Background Patients with thyroid cancer that have extrathyroidal extension (ETE) are considered to have more advanced tumors. However, data on the impact of ETE on patient outcomes remain limited. The purpose of this study was to evaluate the association between ETE and survival in patients with thyroid cancer. Methods The National Cancer Database (1998-2012) was queried for all adult patients with differentiated thyroid cancer and medullary thyroid cancer. Patients were divided into three groups: no ETE (T1 and T2 tumors), minimal ETE (T3 tumors <4 cm), and extensive ETE (T4 tumors <4 cm). Patient demographic, clinical, and pathologic factors were evaluated for all patients. A Cox proportional hazards model was developed for each histology to identify factors associated with survival. Results In total, 241,118 patients with differentiated thyroid cancer met inclusion criteria; 86.9% had no ETE, 9.1% minimal ETE, and 4.0% extensive ETE. Compared to patients with no ETE, patients with minimal and extensive ETE were more likely to have larger tumors (1.4 cm vs 1.8 cm and 2.0 cm, respectively), lymphovascular invasion (8.6% vs 28.0% and 35.1%), positive margins after thyroidectomy (6.1% vs 35.2% and 45.9%), and regional lymph node metastases (32.5% vs 67.0% and 74.6%) (all p<0.01), respectively. After adjustment, minimal ETE (HR=1.13; p<0.01) and extensive ETE (HR=1.74; p<0.01) were associated with compromised survival for patients with differentiated thyroid cancer. In total, 3,415 patients with medullary thyroid cancer met inclusion criteria; 87.9% had no ETE, 7.1% minimal ETE, and 5.0% extensive ETE. Compared to patients with no ETE, patients with minimal and extensive ETE were more likely to have larger tumors (1.7 cm vs 2.2 cm and 2.2 cm, respectively), lymphovascular invasion (19.2% vs 68.9% and 79.3%), positive margins after thyroidectomy (5.8% vs 44.1% and 51.9%), and regional lymph node metastases (39.0% vs 90.5% and 94.4%) (all p<0.01), respectively. After adjustment, extensive ETE (HR=1.63; p=0.01) was associated with compromised survival for patients with medullary thyroid cancer. Conclusion In patients with differentiated and medullary thyroid cancers, ETE is associated with compromised survival. Given these findings, ETE should be included in the thyroid cancer treatment guidelines.

Authors
Youngwirth, L; Abdelgadir Adam, M; Scheri, R; Roman, S; Sosa, JA
MLA Citation
Youngwirth, L, Abdelgadir Adam, M, Scheri, R, Roman, S, and Sosa, JA. "Extrathyroidal Extension is Associated with Compromised Survival in Patients with Thyroid Cancer." Thyroid : official journal of the American Thyroid Association (September 5, 2016).
PMID
27597378
Source
epmc
Published In
Thyroid
Publish Date
2016

Intensity-modulated radiation therapy use for the localized treatment of thyroid cancer: Nationwide practice patterns and outcomes.

In the absence of randomized data, the optimal approach to adjuvant radiation therapy in locally advanced thyroid cancer remains unclear. We employed a large retrospective analysis to assess the best available evidence of a potential beneficial impact of intensity-modulated versus 3D-conformal radiotherapy (IMRT vs. 3D-CT). Retrospective analysis of adult thyroid cancer diagnosed between 2004 and 2011 within the National Cancer Database. Among patients treated with radiation therapy (N = 855), the use of IMRT (N = 437) increased among both comprehensive and academic centers (both p < 0.001), but not community hospitals (p = 0.43). Receipt of IMRT was associated with adverse clinical factors in multivariable analysis, including positive surgical margins, non-DTC histologies, and nodal metastases (all p < 0.001). IMRT use was associated with a significantly higher dose of radiation (60.7 vs. 52.4 Gy, p < 0.001). In multivariable analyses, receipt of IMRT demonstrated a trend toward improved overall survival (HR, 0.67; 95 % CI, 0.40-1.10; p = 0.115). This study presents the largest cohort to date examining receipt of IMRT in patients with locally advanced thyroid cancer and demonstrates an association between IMRT, treatment at a tertiary care center, higher total dose, and comparable or superior outcomes compared to patients treated with 3D conformal techniques despite more adverse disease features. In the absence of adequately powered prospective randomized trials, our retrospective analysis provides empirical evidence to support the use in these patients of dose escalation and IMRT, particularly at tertiary care centers.

Authors
Goffredo, P; Robinson, TJ; Youngwirth, LM; Roman, SA; Sosa, JA
MLA Citation
Goffredo, P, Robinson, TJ, Youngwirth, LM, Roman, SA, and Sosa, JA. "Intensity-modulated radiation therapy use for the localized treatment of thyroid cancer: Nationwide practice patterns and outcomes." Endocrine 53.3 (September 2016): 761-773.
PMID
27025947
Source
epmc
Published In
Endocrine
Volume
53
Issue
3
Publish Date
2016
Start Page
761
End Page
773
DOI
10.1007/s12020-016-0937-2

T1a Versus T1b Differentiated Thyroid Cancers: Do We Need to Make the Distinction?

The 7th edition of the American Joint Committee on Cancer (AJCC) staging system trialed a subdivision of T1 tumors into T1a (<1 cm) and T1b (1.0-2 cm). The 2009 American Thyroid Association (ATA) guidelines recommended total thyroidectomy for tumors >1 cm, and lobectomy for those ≤1 cm. These AJCC staging parameters remain a focus of debate, and ATA guidelines are in transition. The aim of this study was to determine if the T1 staging subdivision is associated with different treatment strategies and patterns of patient survival.All adult patients with AJCC pT1 differentiated thyroid cancer (DTC) from the National Cancer Data Base (NCDB; 1998-2012) and Surveillance, Epidemiology, and End Results (SEER) program (2004-2012) were divided into two groups based on tumor size: T1a versus T1b. Demographic, clinical, and pathologic features were evaluated. Multivariate regression analysis was used to determine factors associated with undergoing total thyroidectomy and radioactive iodine. Cox proportional hazards models were performed to determine factors associated with overall and disease-specific survival.Among 149,912 DTC patients, 98,111 (65.4%) were T1a and 51,801 (34.6%) T1b in the NCDB; in SEER, among 18,381 patients, 11,208 (61.0%) had T1a and 7173 (39.0%) T1b tumors. Patients with T1b cancers were younger (48 vs. 51 years T1a) and more likely to have private insurance (76.2% vs. 74.1%), no comorbidities (86.0% vs. 83.8%), and undergo treatment at academic medical centers (41.4% vs. 40.3%; all p < 0.01). They also were more likely to undergo total thyroidectomy (87.7% vs. 74.3%), and had more lymphovascular invasion (10.2% vs. 3.3%), positive surgical margins (7.9% vs. 3.8%), metastatic lymph nodes (35.8% vs. 23.8%), and distant metastases (0.4% vs. 0.3%; all p < 0.01). Factors associated with radioactive-iodine use included younger patient age, lower income, having insurance, positive surgical margins, and T1b stage (p < 0.01). After adjustment, overall (p = 0.23) and disease-specific survival (p = 0.93) were similar among patients with T1a versus T1b tumors.These results illustrate that patients with pT1a versus pT1b tumors undergo different treatment strategies. Based on the newly published 2015 ATA guidelines, whereby either lobectomy or total thyroidectomy can be performed for low-risk tumors, it might be anticipated that treatment differences will diminish over time. Therefore, division of AJCC T1 staging into T1a versus T1b subgroups might become obsolete over time.

Authors
Anderson, KL; Youngwirth, LM; Scheri, RP; Stang, MT; Roman, SA; Sosa, JA
MLA Citation
Anderson, KL, Youngwirth, LM, Scheri, RP, Stang, MT, Roman, SA, and Sosa, JA. "T1a Versus T1b Differentiated Thyroid Cancers: Do We Need to Make the Distinction?." Thyroid : official journal of the American Thyroid Association 26.8 (August 2016): 1046-1052.
PMID
27266722
Source
epmc
Published In
Thyroid
Volume
26
Issue
8
Publish Date
2016
Start Page
1046
End Page
1052
DOI
10.1089/thy.2016.0073

Perioperative Management of Adrenalectomy and Inferior Vena Cava Reconstruction in a Patient With a Large, Malignant Pheochromocytoma With Vena Caval Extension.

Authors
Gregory, SH; Yalamuri, SM; McCartney, SL; Shah, SA; Sosa, JA; Roman, S; Colin, BJ; Lentschener, C; Munroe, R; Patel, S; Feinman, JW; Augoustides, JGT
MLA Citation
Gregory, SH, Yalamuri, SM, McCartney, SL, Shah, SA, Sosa, JA, Roman, S, Colin, BJ, Lentschener, C, Munroe, R, Patel, S, Feinman, JW, and Augoustides, JGT. "Perioperative Management of Adrenalectomy and Inferior Vena Cava Reconstruction in a Patient With a Large, Malignant Pheochromocytoma With Vena Caval Extension." Journal of cardiothoracic and vascular anesthesia (July 18, 2016).
PMID
27810406
Source
epmc
Published In
Journal of Cardiothoracic and Vascular Anesthesia
Publish Date
2016
DOI
10.1053/j.jvca.2016.07.019

Radioactive Iodine Treatment Is Associated with Improved Survival for Patients with Hürthle Cell Carcinoma.

Hürthle cell carcinoma (HCC) is not typically iodine avid, raising questions regarding postoperative use of radioactive iodine (RAI). The aims of this study were to describe current practice patterns regarding the use of RAI for HCC and to assess its association with survival.The National Cancer Data Base 1998-2006 was queried for all patients with HCC who underwent total thyroidectomy. Inclusion was limited to T1 tumors with N1/M1 disease, and T2-4 tumors with any N/M disease. Patients were divided into two treatment groups based on receipt of RAI. Baseline patient characteristics were compared between the two groups. Survival was examined using Kaplan-Meier and Cox regression analyses.A total of 1909 patients were included. Of these, 1162 (60.9%) received RAI, and 747 (39.1%) did not. Patients treated with RAI were younger (57 vs. 61 years for no RAI, p < 0.001), more often had private insurance (61.7% vs. 53.5% for no RAI, p < 0.003), and were more likely to be treated at an academic center (40.0% vs. 33.1% for no RAI, p < 0.001). Five- and 10-year survival rates were improved for patients who received RAI compared with those who did not (88.9 vs. 83.1% and 74.4 vs. 65.0%, respectively, p < 0.001). RAI administration was associated with a 30% reduction in mortality (hazard ratio = 0.703, p = 0.001).Present guidelines are inconsistent with regard to indications for using RAI for HCC. This could explain why nearly 40% of HCC patients did not receive RAI. RAI is associated with improved survival, suggesting that it should be advocated for HCC patients with tumors >2 cm and those with nodal and distant metastatic disease.

Authors
Jillard, CL; Youngwirth, L; Scheri, RP; Roman, S; Sosa, JA
MLA Citation
Jillard, CL, Youngwirth, L, Scheri, RP, Roman, S, and Sosa, JA. "Radioactive Iodine Treatment Is Associated with Improved Survival for Patients with Hürthle Cell Carcinoma." Thyroid : official journal of the American Thyroid Association 26.7 (July 2016): 959-964.
PMID
27150319
Source
epmc
Published In
Thyroid
Volume
26
Issue
7
Publish Date
2016
Start Page
959
End Page
964
DOI
10.1089/thy.2016.0246

Lymphovascular invasion is associated with survival for papillary thyroid cancer.

Data are limited regarding the association between tumor lymphovascular invasion and survival for patients with papillary thyroid cancer (PTC). This study sought to examine lymphovascular invasion as an independent prognostic factor for patients with PTC undergoing thyroid resection. The National Cancer Data Base (2010-2011) was queried for patients with PTC who underwent total thyroidectomy or lobectomy. Patients were classified into two groups based on the presence/absence of lymphovascular invasion. Demographic, clinical and pathological features were evaluated for all patients. A Cox proportional hazards model was utilized to identify factors associated with survival. Results show that 45,415 patients met inclusion criteria; 11.6% had lymphovascular invasion. Patients with lymphovascular invasion were more likely to have larger tumors (2.8cm vs 1.5cm, P<0.01), metastatic lymph nodes (74.1% vs 32.5%, P<0.01), and distant metastases (3.0% vs 0.5%, P<0.01). They were also more likely to receive radioactive iodine (69.3% vs 44.9%, P<0.01). Unadjusted overall 5-year survival was lower for patients who had tumors with lymphovascular invasion (86.6% vs 94.5%) (log-rank P<0.01). After adjustment, increasing patient age (HR=1.06, P<0.01), male gender (HR=1.68, P<0.01), presence of metastatic lymph nodes (HR=1.77, P<0.01), distant metastases (HR=3.49, P<0.01), and lymphovascular invasion (HR=1.88, P<0.01) were associated with compromised survival. For patients with lymphovascular invasion, treatment with RAI was associated with reduced mortality (HR=0.43, P<0.01). The presence of lymphovascular invasion among patients with PTC is independently associated with compromised survival. Patients who have PTC with lymphovascular invasion should be considered higher risk, and adjuvant RAI should be more strongly considered.

Authors
Pontius, LN; Youngwirth, LM; Thomas, SM; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Pontius, LN, Youngwirth, LM, Thomas, SM, Scheri, RP, Roman, SA, and Sosa, JA. "Lymphovascular invasion is associated with survival for papillary thyroid cancer." Endocrine-related cancer 23.7 (July 2016): 555-562.
PMID
27317633
Source
epmc
Published In
Endocrine-Related Cancer
Volume
23
Issue
7
Publish Date
2016
Start Page
555
End Page
562
DOI
10.1530/erc-16-0123

Knowledge of pathologically versus clinically negative lymph nodes is associated with reduced use of radioactive iodine post-thyroidectomy for low-risk papillary thyroid cancer.

Cervical lymph node metastases are common in papillary thyroid cancer (PTC). Clinically negative lymph nodes confer uncertainty about true lymph node status, potentially prompting empiric postoperative radioactive iodine (RAI) administration even in low-risk patients. We examined the association of clinically (cN0) versus pathologically negative (pN0) lymph nodes with utilization of RAI for low-risk PTC. Using the National Cancer Database 1998-2011, adults with PTC who underwent total thyroidectomy for Stage I/II tumors 1-4 cm were evaluated for receipt of RAI based on cN0 versus pN0 status. Cut-point analysis was conducted to determine the number of pN0 nodes associated with the greatest decrease in the odds of receipt of RAI. Survival models and multivariate analyses predicting RAI use were conducted separately for all patients and patients <45 years. 64,980 patients met study criteria; 39,778 (61.2 %) were cN0 versus 25,202 (38.8 %) pN0. Patients with pN0 nodes were more likely to have negative surgical margins and multifocal disease (all p < 0.001). The mean negative nodes reported in surgical pathology specimens was 4; ≥5 pathologically negative lymph nodes provided the best cut-point associated with reduced RAI administration (OR 0.91, CI 0.85-0.97). After multivariable adjustment, pN0 patients with ≥5 nodes examined were less likely to receive RAI compared to cN0 patients across all ages (OR 0.89, p < 0.001) and for patients aged <45 years (0R 0.86, p = 0.001). Patients with <5 pN0 nodes did not differ in RAI use compared to cN0 controls. Unadjusted survival was improved for pN0 versus cN0 patients across all ages (p < 0.001), but not for patients <45 years (p = 0.11); adjusted survival for all ages did not differ (p = 0.13). Pathological confirmation of negative lymph nodes in patients with PTC appears to influence the decision to administer postoperative RAI if ≥5 negative lymph nodes are removed. It is possible that fewer excised lymph nodes may be viewed by clinicians as incidentally resected and thus may suboptimally represent the true nodal status of the central neck. Further research is warranted to determine if there is an optimal number of lymph nodes that should be resected to standardize pathological diagnosis.

Authors
Ruel, E; Thomas, S; Dinan, MA; Perkins, JM; Roman, SA; Sosa, JA
MLA Citation
Ruel, E, Thomas, S, Dinan, MA, Perkins, JM, Roman, SA, and Sosa, JA. "Knowledge of pathologically versus clinically negative lymph nodes is associated with reduced use of radioactive iodine post-thyroidectomy for low-risk papillary thyroid cancer." Endocrine 52.3 (June 2016): 579-586.
PMID
26708045
Source
epmc
Published In
Endocrine
Volume
52
Issue
3
Publish Date
2016
Start Page
579
End Page
586
DOI
10.1007/s12020-015-0826-0

Receipt of Care Discordant with Practice Guidelines is Associated with Compromised Overall Survival in Nasopharyngeal Carcinoma.

It is unknown whether receiving treatment that is discordant with practice guidelines is associated with improved survival in patients with nasopharyngeal carcinoma. The objectives of this study were to characterise national treatment patterns, analyse whether treatment outside of practice guidelines is associated with overall survival, and identify variables associated with receiving guidelines-discordant care in the USA.This was a retrospective cohort study of 1741 nasopharyngeal carcinoma patients in the National Cancer Data Base (2003-2006). Treatment regimens were compared with the 2004-2006 National Comprehensive Cancer Network guidelines. Statistical analyses included chi-square, Kaplan-Meier, multivariable logistic, and Cox regression.Nearly 26% of our cohort received care discordant with practice guidelines. In multivariable analysis, patients with stage IVC disease (odds ratio 2.59, 95% confidence interval 1.66-4.04) were more likely to receive guidelines-discordant care when compared with those with stage II-IVB disease. The most common treatment deviation for those with stage I disease was overtreatment with chemoradiation therapy. Receiving guidelines-discordant care was associated with an increased risk of death (hazard ratio 1.46, 95% confidence interval 1.25-1.69).Many patients with stages I and IVC nasopharyngeal carcinoma do not receive care in accordance with practice guidelines. Receiving guidelines-discordant care is associated with compromised overall survival in the USA.

Authors
Schwam, ZG; Sosa, JA; Roman, S; Judson, BL
MLA Citation
Schwam, ZG, Sosa, JA, Roman, S, and Judson, BL. "Receipt of Care Discordant with Practice Guidelines is Associated with Compromised Overall Survival in Nasopharyngeal Carcinoma." Clinical oncology (Royal College of Radiologists (Great Britain)) 28.6 (June 2016): 402-409.
PMID
26868285
Source
epmc
Published In
Clinical Oncology
Volume
28
Issue
6
Publish Date
2016
Start Page
402
End Page
409
DOI
10.1016/j.clon.2016.01.010

Treatment trends and survival effects of chemotherapy for hypopharyngeal cancer: Analysis of the National Cancer Data Base.

The current study was performed to characterize trends and survival outcomes for chemotherapy in the definitive and adjuvant treatment of hypopharyngeal cancer in the United States.A total of 16,248 adult patients diagnosed with primary hypopharyngeal cancer without distant metastases between 1998 and 2011 were identified in the National Cancer Data Base. The association between treatment modality and overall survival was analyzed using Kaplan-Meier survival curves and 5-year survival rates. A multivariate Cox regression analysis was performed on a subset of 3357 cases to determine the treatment modalities that predict improved survival when controlling for demographic and clinical factors.There was a significant increase in the use of chemotherapy with radiotherapy both as definitive treatment (P<.001) and as adjuvant chemoradiotherapy with surgery (P=.001). This was accompanied by a decrease in total laryngectomy/pharyngectomy rates (P<.001). Chemoradiotherapy was associated with improved 5-year survival compared with radiotherapy alone in the definitive setting (31.8% vs 25.2%; log rank P<.001). Similarly, in multivariateanalysis, definitive radiotherapy was found to be associated with compromised survival compared with definitive chemoradiotherapy (hazard ratio, 1.51; P<.001).Survival analysis revealed that overall 5-year survival rates were higher for chemoradiotherapy compared with radiotherapy alone in the definitive setting, but were comparable between surgery with chemoradiotherapy and surgery with radiotherapy. Cancer 2016;122:1853-60. © 2016 American Cancer Society.

Authors
Kuo, P; Sosa, JA; Burtness, BA; Husain, ZA; Mehra, S; Roman, SA; Yarbrough, WG; Judson, BL
MLA Citation
Kuo, P, Sosa, JA, Burtness, BA, Husain, ZA, Mehra, S, Roman, SA, Yarbrough, WG, and Judson, BL. "Treatment trends and survival effects of chemotherapy for hypopharyngeal cancer: Analysis of the National Cancer Data Base." Cancer 122.12 (June 2016): 1853-1860.
PMID
27019213
Source
epmc
Published In
Cancer
Volume
122
Issue
12
Publish Date
2016
Start Page
1853
End Page
1860
DOI
10.1002/cncr.29962

Is lymph node involvement associated with mortality risk in younger patients with papillary thyroid cancer?

Authors
Adam, MA; Stang, MT; Sosa, JA; Roman, SA
MLA Citation
Adam, MA, Stang, MT, Sosa, JA, and Roman, SA. "Is lymph node involvement associated with mortality risk in younger patients with papillary thyroid cancer?." Expert Review of Endocrinology & Metabolism 11.3 (May 3, 2016): 233-234.
Source
crossref
Published In
Expert review of endocrinology & metabolism
Volume
11
Issue
3
Publish Date
2016
Start Page
233
End Page
234
DOI
10.1080/17446651.2016.1174574

Patterns of Use and Short-Term Outcomes of Minimally Invasive Surgery for Malignant Pheochromocytoma: A Population-Level Study: Reply.

Authors
Goffredo, P; Adam, MA; Sosa, JA; Roman, S
MLA Citation
Goffredo, P, Adam, MA, Sosa, JA, and Roman, S. "Patterns of Use and Short-Term Outcomes of Minimally Invasive Surgery for Malignant Pheochromocytoma: A Population-Level Study: Reply." World journal of surgery 40.5 (May 2016): 1280-1281. (Letter)
PMID
26791742
Source
epmc
Published In
World Journal of Surgery
Volume
40
Issue
5
Publish Date
2016
Start Page
1280
End Page
1281
DOI
10.1007/s00268-016-3420-6

Hospital readmission and 30-day mortality after surgery for oral cavity cancer: Analysis of 21,681 cases.

Oral cavity squamous cell cancer (SCC) is treated primarily with surgery. Rates of 30-day hospital readmission and mortality after surgery for oral cavity SCC are unknown.We conducted a retrospective analysis of postoperative 30-day unplanned readmission and mortality in patients with oral cavity SCC in the National Cancer Data Base (NCDB).Among 21,681 cases, the 30-day unplanned readmission rate was 3.2%, and the 30-day mortality rate was 1.0%. Male sex (odds ratio [OR] = 1.23; p = .02), stage T3 (OR = 1.55; p = .007), or T4 (OR = 1.52; p = .002), and neck dissection (OR = 1.37; p = .04) were independently associated with readmission. Age 76 to 85 years (OR = 4.80; p < .001), age >85 years (OR = 10.24; p < .001), comorbidity index ≥1 (OR = 2.31; p < .001), and stage T3 (OR = 3.02; p < .001) or T4 (OR = 3.24; p < .001) were associated with 30-day mortality.Interventions aimed at decreasing hospital readmissions should target high-risk patients identified here. Factors associated with 30-day mortality reflect risk factors for overall mortality. © 2015 Wiley Periodicals, Inc. Head Neck 38: E221-E226, 2016.

Authors
Luryi, AL; Chen, MM; Mehra, S; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Luryi, AL, Chen, MM, Mehra, S, Roman, SA, Sosa, JA, and Judson, BL. "Hospital readmission and 30-day mortality after surgery for oral cavity cancer: Analysis of 21,681 cases." Head & neck 38 Suppl 1 (April 2016): E221-E226.
PMID
25537226
Source
epmc
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
38 Suppl 1
Publish Date
2016
Start Page
E221
End Page
E226
DOI
10.1002/hed.23973

Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes?

: Supplemental Digital Content is available in the text OBJECTIVE:: To determine the number of total thyroidectomies per surgeon per year associated with the lowest risk of complications.The surgeon volume-outcome association has been established for thyroidectomy; however, a threshold number of cases defining a "high-volume" surgeon remains unclear.Adults undergoing total thyroidectomy were identified from the Health Care Utilization Project-National Inpatient Sample (1998-2009). Multivariate logistic regression with restricted cubic splines was utilized to examine the association between the number of annual total thyroidectomies per surgeon and risk of complications.Among 16,954 patients undergoing total thyroidectomy, 47% had thyroid cancer and 53% benign disease. Median annual surgeon volume was 7 cases; 51% of surgeons performed 1 case/y. Overall, 6% of the patients experienced complications. After adjustment, the likelihood of experiencing a complication decreased with increasing surgeon volume up to 26 cases/y (P < 0.01). Among all patients, 81% had surgery by low-volume surgeons (≤25 cases/y). With adjustment, patients undergoing surgery by low-volume surgeons were more likely to experience complications (odds ratio 1.51, P = 0.002) and longer hospital stays (+12%, P = 0.006). Patients had an 87% increase in the odds of having a complication if the surgeon performed 1 case/y, 68% for 2 to 5 cases/y, 42% for 6 to 10 cases/y, 22% for 11 to 15 cases/y, 10% for 16 to 20 cases/y, and 3% for 21 to 25 cases/y.This is the first study to identify a surgeon volume threshold (>25 total thyroidectomies/y) that is associated with improved patient outcomes. Identifying a threshold number of cases defining a high-volume thyroid surgeon is important, as it has implications for quality improvement, criteria for referral and reimbursement, and surgical education.

Authors
Adam, MA; Thomas, S; Youngwirth, L; Hyslop, T; Reed, SD; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Thomas, S, Youngwirth, L, Hyslop, T, Reed, SD, Scheri, RP, Roman, SA, and Sosa, JA. "Is There a Minimum Number of Thyroidectomies a Surgeon Should Perform to Optimize Patient Outcomes?." Annals of surgery (March 8, 2016).
PMID
26967630
Source
epmc
Published In
Annals of Surgery
Publish Date
2016

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

Papillary Thyroid Microcarcinoma: An Over-Treated Malignancy?: Reply.

Authors
Wang, TS; Goffredo, P; Sosa, JA; Roman, SA
MLA Citation
Wang, TS, Goffredo, P, Sosa, JA, and Roman, SA. "Papillary Thyroid Microcarcinoma: An Over-Treated Malignancy?: Reply." World journal of surgery 40.3 (March 2016): 766-767. (Letter)
PMID
26475786
Source
epmc
Published In
World Journal of Surgery
Volume
40
Issue
3
Publish Date
2016
Start Page
766
End Page
767
DOI
10.1007/s00268-015-3290-3

Patients Treated at Low-Volume Centers have Higher Rates of Incomplete Resection and Compromised Outcomes: Analysis of 31,129 Patients with Papillary Thyroid Cancer.

Data on the importance of margin status after total thyroidectomy for papillary thyroid cancer (PTC) remain limited. This study sought to identify factors associated with positive margins and to determine the impact of positive margins on survival for patients with PTC.The National Cancer Data Base (1998-2006) was queried for patients with PTC who had undergone total thyroidectomy. The patients were divided into three groups based on margin status (negative, microscopically positive, and macroscopically positive). Patient demographic, clinical, and pathologic features were evaluated. A binary logistic regression model was developed to identify factors associated with positive margins. A Cox proportional hazards model was developed to identify factors associated with survival.Of the 31,129 patients enrolled in the study, 91.3 % had negative margins, 8.1 % had microscopically positive margins, and 0.6 % had macroscopically positive margins. The patients with negative margins were younger and more likely to be female, white, covered by private insurance, and treated at an academic or high-volume center (p < 0.05). They had smaller tumors and were less likely to have advanced-stage disease. After multivariable adjustment, increasing patient age [odds ratio (OR) = 1.02; p < 0.01], government insurance (OR = 1.20; p < 0.01), and no insurance (OR = 1.34; p = 0.01) were associated with positive margins. Reception of surgery at a high-volume facility (OR = 0.72; p < 0.01) was protective. After multivariable adjustment, both microscopically [hazard ratio (HR), 1.49; p < 0.01] and macroscopically positive margins (HR = 2.38; p < 0.01) were associated with compromised survival.Several vulnerable patient populations have a higher risk of incomplete resection after thyroidectomy for PTC. High-risk thyroid cancer patients should be referred to high-volume centers to optimize outcomes.

Authors
Youngwirth, LM; Adam, MA; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Youngwirth, LM, Adam, MA, Scheri, RP, Roman, SA, and Sosa, JA. "Patients Treated at Low-Volume Centers have Higher Rates of Incomplete Resection and Compromised Outcomes: Analysis of 31,129 Patients with Papillary Thyroid Cancer." Annals of surgical oncology 23.2 (February 2016): 403-409.
PMID
26416710
Source
epmc
Published In
Annals of Surgical Oncology
Volume
23
Issue
2
Publish Date
2016
Start Page
403
End Page
409
DOI
10.1245/s10434-015-4867-7

Minimally invasive follicular carcinoma: predictors of vascular invasion and impact on patterns of care.

Some studies have reported that minimally invasive follicular carcinoma (MIFC) with vascular invasion is associated with compromised prognosis, leading to an ongoing debate regarding extent of surgery for MIFC. Our goal was to identify predictors of vascular invasion and determine its impact on patterns of care. Adult patients with MIFC were culled from the National Cancer Database, 2010-2011, and segregated according to the presence/absence of capsular or vascular invasion. Variables of interest were examined using Chi-square and student's t tests. Multivariate analysis was performed with logistic regression. A total of 617 patients with MIFC were identified: 54% with capsular invasion only and 46% with vascular invasion. Demographic characteristics were similarly distributed between the two groups. Tumor size was larger in patients with vascular invasion (mean = 35.7 vs. 29.2 mm capsular invasion only, p < 0.001); a 2% increase in risk of vascular invasion was observed with each 1 mm increase in size. The rate of total thyroidectomy was similar for MIFCs with vascular invasion compared to capsular invasion only (72.9 vs. 75.1%, p = 0.537). The RAI administration rate was higher in patients with vascular invasion (62.1 vs. 52.6% capsular invasion only, p = 0.017). In multivariate analysis, the presence of vascular invasion was independently associated with increased likelihood of receiving RAI (OR 1.641, p = 0.007). MIFC remains aggressively treated despite current guidelines favoring a more conservative approach. Building consensus around MIFC management is important for standardization of practice patterns and improvement in quality of care.

Authors
Goffredo, P; Jillard, C; Thomas, S; Scheri, RP; Sosa, JA; Roman, S
MLA Citation
Goffredo, P, Jillard, C, Thomas, S, Scheri, RP, Sosa, JA, and Roman, S. "Minimally invasive follicular carcinoma: predictors of vascular invasion and impact on patterns of care." Endocrine 51.1 (January 2016): 123-130.
PMID
26077949
Source
epmc
Published In
Endocrine
Volume
51
Issue
1
Publish Date
2016
Start Page
123
End Page
130
DOI
10.1007/s12020-015-0649-z

Same thyroid cancer, different national practice guidelines: When discordant American Thyroid Association and National Comprehensive Cancer Network surgery recommendations are associated with compromised patient outcome.

The American Thyroid Association (ATA) and National Comprehensive Cancer Network (NCCN) guidelines have discordant recommendations for managing patients with differentiated thyroid cancer (DTC). We hypothesized that physician adherence to either of the 2009 extent of surgery guidelines of the ATA or NCCN was associated with improved survival, and that practice is most standardized nationally when guidelines are concordant.Adult patients undergoing surgery for DTC were included from the National Cancer Database. Multivariable modeling was used to identify factors associated with nonadherence to the 2009 ATA or NCCN guidelines (2010-2011) and hypothetically examine the association of retrospective adherence to guidelines with survival (1998-2006).A total of 39,687 patients with DTC were included; 2,249 were not treated in accordance with ATA or NCCN guidelines. Factors independently associated with nonadherence were discordance between ATA and NCCN recommendations, black race, and treatment at nonacademic centers (P < .01). After adjustment, care not in accordance with either set of guidelines was associated with compromised survival (hazard ratio 1.16, P = .02).A minority of patients received surgery for DTC not aligned with guidelines; nonadherent care was associated with compromised survival. Discordance in recommendations between guidelines is associated with reduction in adherent care, suggesting that standardizing guidelines could decrease confusion, increase adherence, and thereby may improve outcomes.

Authors
Adam, MA; Goffredo, P; Youngwirth, L; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Goffredo, P, Youngwirth, L, Scheri, RP, Roman, SA, and Sosa, JA. "Same thyroid cancer, different national practice guidelines: When discordant American Thyroid Association and National Comprehensive Cancer Network surgery recommendations are associated with compromised patient outcome." Surgery 159.1 (January 2016): 41-50.
PMID
26435426
Source
epmc
Published In
Surgery
Volume
159
Issue
1
Publish Date
2016
Start Page
41
End Page
50
DOI
10.1016/j.surg.2015.04.056

Current management of pediatric thyroid disease and differentiated thyroid cancer.

In this article, we focus on the role of ultrasound and fine needle aspiration, management of benign nodules, extent of thyroid resection, management of regional lymph node disease, and risk stratification in staging for well differentiated thyroid cancer (DTC) in children.The recent guidelines by the American Thyroid Association focused specifically on the management of thyroid nodules and DTC in children and adolescents marks a change from previous versions, which extrapolated adult guidelines to the pediatric population. DTC in children has a distinct presentation and clinical behavior compared with adult disease. The overall excellent outcomes for pediatric patients have led to a risk stratification approach in their management (low, intermediate, and high-risk disease groupings), aiming to minimize the potential morbidity of treatment.In this review, we focus on pediatric thyroid disease, including recent studies and debates regarding the management of thyroid nodules and DTC.

Authors
Tracy, ET; Roman, SA
MLA Citation
Tracy, ET, and Roman, SA. "Current management of pediatric thyroid disease and differentiated thyroid cancer." Current opinion in oncology 28.1 (January 2016): 37-42. (Review)
PMID
26575691
Source
epmc
Published In
Current Opinion in Oncology
Volume
28
Issue
1
Publish Date
2016
Start Page
37
End Page
42
DOI
10.1097/cco.0000000000000250

A Bedside Risk Calculator to Preoperatively Distinguish Follicular Thyroid Carcinoma from Follicular Variant of Papillary Thyroid Carcinoma.

Follicular thyroid carcinoma (FTC) and follicular variant of papillary thyroid carcinoma (FV-PTC) are difficult entities to distinguish based on cytology prior to pathologic evaluation of surgical specimens but may have different treatment algorithms. The current study describes trends in rates of FTC versus FV-PTC in the U.S. and develops a risk assessment tool to aid clinicians in predicting final diagnosis and shaping treatment plans.Relative rates of FTC and FV-PTC in the surveillance, epidemiology, and end results (SEER) database were evaluated for temporal trends from 1988 to 2011. Using multivariable logistic regression, a simplified scoring system was developed to estimate the risk of FTC versus FV-PTC using patient and tumor characteristics. The National Cancer Data Base was used for model validation.Of 115,091 thyroid cancer cases in the SEER database from 1988 to 2011, 23,980 involved FTC (n = 5056; 21 %) or FV-PTC (n = 18,924; 79 %). In 1988, half of follicular cases were FV-PTC; however, FV-PTC accounted for over 85 % of these lesions by 2010. Increasing age >45 years, male gender, black race, increasing tumor size, and distant metastases were strongly associated with increased risk of FTC, while lymph node disease and extrathyroidal extension were associated with FV-PTC. A bedside risk assessment nomogram using these preoperative variables classified patient risk of FTC from 2 to 70 %. FV-PTC has become the dominant malignancy with follicular cytology, accounting for >85 % of these cases. A simple bedside risk assessment tool can risk stratify patients with follicular lesions and inform patient and clinician discussions and decision making.

Authors
Englum, BR; Pura, J; Reed, SD; Roman, SA; Sosa, JA; Scheri, RP
MLA Citation
Englum, BR, Pura, J, Reed, SD, Roman, SA, Sosa, JA, and Scheri, RP. "A Bedside Risk Calculator to Preoperatively Distinguish Follicular Thyroid Carcinoma from Follicular Variant of Papillary Thyroid Carcinoma." World journal of surgery 39.12 (December 2015): 2928-2934.
PMID
26324158
Source
epmc
Published In
World Journal of Surgery
Volume
39
Issue
12
Publish Date
2015
Start Page
2928
End Page
2934
DOI
10.1007/s00268-015-3192-4

Impact of Timeliness of Resection and Thyroidectomy Margin Status on Survival for Patients with Anaplastic Thyroid Cancer: An Analysis of 335 Cases.

Controversies regarding anaplastic thyroid cancer (ATC) surround aggressiveness of tumor resection in the presence of extrathyroidal extension and the impact of delayed surgery on patient survival. Our goal was to analyze the survival implications of complete and timely resections.Adult patients with ATC were culled from the National Cancer Data Base for the years 2003-2006. Kaplan-Meier curves and Cox proportional hazard regression analyses were used for univariate and multivariate survival analyses, respectively.A total of 680 ATC patients were identified. In the surgical cohort (n = 335), the female-to-male ratio was 1.6:1; mean age was 68.6 years. Patients with ATCs were staged as IVA in 42.7 % of cases, IVB in 32.2 %, and IVC in 25.1 %. Median time from diagnosis to surgery was 15 days. Negative margin status was more often achieved in patients diagnosed with stage IVA disease (p < 0.001). Compared to surgical patients, those who did not receive thyroid resections were older and had a more advanced stage of disease (both p < 0.001). In multivariable analyses, positive margin status was associated with increased mortality in stage IVA ATC (p = 0.017) but had no survival impact in stages IVB and IVC (p > 0.05). After adjustment for possible confounders, increasing time from diagnosis to surgery was not found to be associated with compromised survival outcomes for any disease stage.Timely and aggressive surgical management should be pursued in patients with intrathyroidal disease; however, aggressive resections may not be recommended for patients with stage IVB and IVC disease when morbidity and operative risks outweigh the limited benefits of surgery.

Authors
Goffredo, P; Thomas, SM; Adam, MA; Sosa, JA; Roman, SA
MLA Citation
Goffredo, P, Thomas, SM, Adam, MA, Sosa, JA, and Roman, SA. "Impact of Timeliness of Resection and Thyroidectomy Margin Status on Survival for Patients with Anaplastic Thyroid Cancer: An Analysis of 335 Cases." Annals of surgical oncology 22.13 (December 2015): 4166-4174.
PMID
26271394
Source
epmc
Published In
Annals of Surgical Oncology
Volume
22
Issue
13
Publish Date
2015
Start Page
4166
End Page
4174
DOI
10.1245/s10434-015-4742-6

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

Is There a Minimum Case Volume of Thyroidectomies Associated with Superior Outcomes? An Analysis of 37,118 Cases in the US

Authors
Adam, M; Thomas, SM; Roman, SA; Sosa, JA
MLA Citation
Adam, M, Thomas, SM, Roman, SA, and Sosa, JA. "Is There a Minimum Case Volume of Thyroidectomies Associated with Superior Outcomes? An Analysis of 37,118 Cases in the US." October 2015.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
221
Issue
4
Publish Date
2015
Start Page
S60
End Page
S61

Patterns of Use and Short-Term Outcomes of Minimally Invasive Surgery for Malignant Pheochromocytoma: A Population-Level Study.

Malignant pheochromocytoma is rare, and there is a scarcity of data on the use of minimally invasive surgery (MIS) for treatment. The aims of this study were to analyze patterns of use of MIS for malignant pheochromocytoma in the U.S. and compare short-term outcomes to those of open adrenalectomy.Patients with malignant pheochromocytoma undergoing MIS, including laparoscopy, robotic assisted, laparoscopy converted to open, or open adrenalectomy, were culled from the National Cancer Database, from 1998 to 2011. Data were examined using simple summary statistics, Χ2 and student's t tests, Mann-Whitney test, and logistic regression.A total of 36 MIS and 67 open adrenalectomies were identified in 2010-2011. No significant differences were observed between the two treatment groups in demographic characteristics or comorbidities. Preoperative diagnosis of malignancy was made in 52.8% of MIS and 48.5% of open patients (p=NS). MIS and open adrenalectomies did not differ with respect to lymph node metastases, vascular invasion, extra-adrenal-extension, and distant metastases (all p=NS). MIS tended to more often be used to perform partial adrenalectomy (38.9 vs. 20.4% open, p=0.061); surgical margins, 30-day readmission and mortality rates were similar to open adrenalectomy (all p=NS). Tumors removed via MIS were smaller (48.7 vs. 73.3 mm open, p=0.003) and associated with a shorter length of stay.A significant proportion of patients with malignant pheochromocytomas underwent MIS, with short-term outcomes which are comparable to those of open surgery. Further studies focused on long-term survival and recurrence are needed to assess the role of MIS in the management of these rare tumors.

Authors
Goffredo, P; Adam, MA; Thomas, SM; Scheri, RP; Sosa, JA; Roman, SA
MLA Citation
Goffredo, P, Adam, MA, Thomas, SM, Scheri, RP, Sosa, JA, and Roman, SA. "Patterns of Use and Short-Term Outcomes of Minimally Invasive Surgery for Malignant Pheochromocytoma: A Population-Level Study." World journal of surgery 39.8 (August 2015): 1966-1973.
PMID
25821949
Source
epmc
Published In
World Journal of Surgery
Volume
39
Issue
8
Publish Date
2015
Start Page
1966
End Page
1973
DOI
10.1007/s00268-015-3040-6

Complications and mortality following surgery for oral cavity cancer: analysis of 408 cases.

OBJECTIVES: To analyze the postoperative complications and mortality for oral cavity cancers, their time course, and to identify modifiable risk factors associated with their occurrence. STUDY DESIGN: Retrospective cohort study. METHODS: Patients undergoing surgery for oral cavity cancer were identified in the American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File (2005-2010). Overall and disease-specific complication and mortality data were analyzed using chi-square and multivariate regression analysis. RESULTS: There were 408 cases identified. The overall 30-day complication and mortality rates were 20.3% and 1.0%, respectively. The most common adverse events were reoperation (9.6%), infectious (6.6%), and respiratory (5.1%) complications. Twenty patients (4.9%) experienced postdischarge complications. Fifty-two percent of postdischarge wound dehiscences and 67% of postdischarge surgical-site infections occurred by postdischarge day 7, and 91% of all postdischarge complications occurred by postdischarge day 14. Smoking was independently associated with respiratory (odds ratio [OR] 3.59, P = .008) and surgical site complications (OR 5.13, P =.004). Neck dissection was independently associated with respiratory (OR 6.17, P = .001), surgical site (OR 6.30, P = .003), and infectious (OR 3.83, P = .003) complications. CONCLUSION: Current smokers and those undergoing neck dissection are at high risk of postoperative complications after oral cavity cancer surgery. Less than 5% of patients experienced postdischarge complications, nearly all of which occurred by postdischarge day 14. Most early postdischarge complications occurred at the surgical site. In order to mitigate postdischarge complications and their sequelae, early clinical follow-up should be sought for high-risk patients. LEVEL OF EVIDENCE: 4.

Authors
Schwam, ZG; Sosa, JA; Roman, S; Judson, BL
MLA Citation
Schwam, ZG, Sosa, JA, Roman, S, and Judson, BL. "Complications and mortality following surgery for oral cavity cancer: analysis of 408 cases." The Laryngoscope 125.8 (August 2015): 1869-1873.
PMID
26063059
Source
epmc
Published In
The Laryngoscope
Volume
125
Issue
8
Publish Date
2015
Start Page
1869
End Page
1873
DOI
10.1002/lary.25328

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

Treatment Factors Associated With Survival in Early-Stage Oral Cavity Cancer: Analysis of 6830 Cases From the National Cancer Data Base.

IMPORTANCE: Most patients with oral cavity squamous cell cancer (OCSCC) are initially seen at an early stage (I and II). Although patient and tumor prognostic features have been analyzed extensively, population-level data examining how variations in treatment factors impact survival are lacking to date. OBJECTIVE: To analyze associations between treatment variables and survival in stages I and II oral cavity squamous cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS: Retrospective study of cases in the National Cancer Data Base. Patients diagnosed as having stage I or II OCSCC between January 1, 2003, and December 31, 2006, and treated with surgery were identified. Univariate and multivariable analyses of overall survival based on patient, disease, and treatment characteristics were conducted. MAIN OUTCOMES AND MEASURES: Overall survival and survival at 5 years. RESULTS: In total, 6830 patients were included. Survival at 5 years was 69.7% (4760 patients). On univariate analysis, treatment factors associated with improved survival included treatment at academic or research institutions, no radiation therapy, no chemotherapy, and negative margins (P < .001 for all). Neck dissection was associated with improved survival (P = .001), reflecting pathologic restaging and elimination of patients with occult nodal disease. Patients treated at academic or research institutions were more likely to receive neck dissection and less likely to receive radiation therapy or have positive margins. On multivariable analysis, neck dissection (hazard ratio [HR], 0.85; 95% CI, 0.76-0.94; P = .003) and treatment at academic or research institutions (HR, 0.88; 95% CI, 1.01-1.26; P = .03) were associated with improved survival, whereas positive margins (HR, 1.27; 95% CI, 1.08-1.49; P = .005), insurance through Medicare (HR, 1.45; 95% CI, 1.25-1.69; P < .001) or Medicaid (HR, 1.96; 95% CI, 1.60-2.39; P < .001), and adjuvant radiation therapy (HR, 1.31; 95% CI, 1.16-1.49; P < .001) or adjuvant chemotherapy (HR, 1.34; 95% CI, 1.03-1.75; P = .03) were associated with compromised survival. CONCLUSIONS AND RELEVANCE: Prognostic impacts of treatment factors in early OCSCC are presented. Overall survival for early OCSCC varies with demographic and tumor characteristics but also varies with treatment and system factors, which may represent targets for improving outcomes in this disease.

Authors
Luryi, AL; Chen, MM; Mehra, S; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Luryi, AL, Chen, MM, Mehra, S, Roman, SA, Sosa, JA, and Judson, BL. "Treatment Factors Associated With Survival in Early-Stage Oral Cavity Cancer: Analysis of 6830 Cases From the National Cancer Data Base." JAMA otolaryngology-- head & neck surgery 141.7 (July 2015): 593-598.
PMID
25974757
Source
epmc
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
141
Issue
7
Publish Date
2015
Start Page
593
End Page
598
DOI
10.1001/jamaoto.2015.0719

Presence and Number of Lymph Node Metastases Are Associated With Compromised Survival for Patients Younger Than Age 45 Years With Papillary Thyroid Cancer.

PURPOSE: Cervical lymph node metastases are recognized as a prognostic indicator only in patients age 45 years or older with papillary thyroid cancer (PTC); patients younger than age 45 years are perceived to have low-risk disease. The current American Joint Committee on Cancer staging for PTC in patients younger than age 45 years does not include cervical lymph node metastases. Our objective was to test the hypothesis that the presence and number of cervical lymph node metastases have an adverse impact on overall survival (OS) in patients younger than age 45 years with PTC. PATIENTS AND METHODS: Adult patients younger than age 45 years undergoing surgery for stage I PTC (no distant metastases) were identified from the National Cancer Data Base (NCDB; 1998-2006) and from SEER 1988-2006 data. Multivariable models were used to examine the association of OS with the presence of lymph node metastases and number of metastatic nodes. RESULTS: In all, 47,902 patients in NCDB (11,740 with and 36,162 without nodal metastases) and 21,855 in the SEER database (5,188 with and 16,667 without nodal metastases) were included. After adjustment, OS was compromised for patients with nodal metastases compared with patients who did not have them (NCDB: hazard ratio (HR), 1.32; 95% CI, 1.04 to 1.67; P = .021; SEER: HR, 1.29; 95% CI, 1.08 to 1.56; P = .006). After adjustment, increasing number of metastatic lymph nodes was associated with decreasing OS up to six metastatic nodes (HR, 1.12; 95% CI, 1.01 to 1.25; P = .03), after which more positive nodes conferred no additional mortality risk (HR, 0.99; 95% CI, 0.99 to 1.05; P = .75). CONCLUSION: Our results suggest that cervical lymph node metastases are associated with compromised survival in young patients, warranting consideration of revised American Joint Committee on Cancer staging. A change point of six or fewer metastatic lymph nodes seems to carry prognostic significance, thus advocating for rigorous preoperative screening for nodal metastases.

Authors
Adam, MA; Pura, J; Goffredo, P; Dinan, MA; Reed, SD; Scheri, RP; Hyslop, T; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Pura, J, Goffredo, P, Dinan, MA, Reed, SD, Scheri, RP, Hyslop, T, Roman, SA, and Sosa, JA. "Presence and Number of Lymph Node Metastases Are Associated With Compromised Survival for Patients Younger Than Age 45 Years With Papillary Thyroid Cancer." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 33.21 (July 2015): 2370-2375.
PMID
26077238
Source
epmc
Published In
Journal of Clinical Oncology
Volume
33
Issue
21
Publish Date
2015
Start Page
2370
End Page
2375
DOI
10.1200/jco.2014.59.8391

Minimally Invasive Versus Open Pancreaticoduodenectomy for Cancer Is Associated With Increased 30-Day Mortality.

Authors
Adam, MA; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Roman, SA, and Sosa, JA. "Minimally Invasive Versus Open Pancreaticoduodenectomy for Cancer Is Associated With Increased 30-Day Mortality." Annals of surgery (June 23, 2015).
PMID
26106834
Source
epmc
Published In
Annals of Surgery
Publish Date
2015
DOI
10.1097/sla.0000000000001316

Predictors of Survival in Sinonasal Adenocarcinoma.

Objectives To identify factors associated with disease-specific survival (DSS) in intestinal and nonintestinal sinonasal adenocarcinoma. Design Retrospective review. Setting Surveillance Epidemiology and End Results database. Participants Adult patients with sinonasal adenocarcinoma. Main Outcome Measures DSS. Results We identified 325 patients; of these, 300 had the nonintestinal type and 25 had intestinal type histologies. The 5-year DSS rates for patients who had no treatment, radiation (RT), surgery, and surgery and postoperative RT were 42.5, 46.1, 85.6, and 72.6%, respectively (log-rank test; p < 0.001). Black race, age ≥ 75 years, paranasal sinus involvement, and high grade were independently associated with decreased DSS. Compared with RT, surgery (hazard ratio [HR]: 0.34; 95% confidence interval [CI]: 0.15-0.77), and adjuvant RT (HR: 0.47; 95% CI, 0.26-0.86) were associated with improved DSS. Conclusions There is no difference in prognosis between intestinal and nonintestinal subtypes of sinonasal adenocarcinoma. Treatment with surgery alone or adjuvant RT is associated with a more favorable prognosis.

Authors
Chen, MM; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Chen, MM, Roman, SA, Sosa, JA, and Judson, BL. "Predictors of Survival in Sinonasal Adenocarcinoma." Journal of neurological surgery. Part B, Skull base 76.3 (June 2015): 208-213.
PMID
26225303
Source
epmc
Published In
Journal of Neurological Surgery, Part B: Skull Base
Volume
76
Issue
3
Publish Date
2015
Start Page
208
End Page
213
DOI
10.1055/s-0034-1543995

Response to the Letter by Katiman E., et al.

Authors
Ruel, E; Thomas, S; Roman, S; Sosa, JA
MLA Citation
Ruel, E, Thomas, S, Roman, S, and Sosa, JA. "Response to the Letter by Katiman E., et al." The Journal of clinical endocrinology and metabolism 100.6 (June 2015): L43-L44. (Letter)
PMID
26047079
Source
epmc
Published In
Journal of Clinical Endocrinology and Metabolism
Volume
100
Issue
6
Publish Date
2015
Start Page
L43
End Page
L44
DOI
10.1210/jc.2015-2044

Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer.

Papillary thyroid cancer (PTC) is the most common endocrine malignancy. The long-term prognosis is generally excellent. Due to a paucity of data, debate exists regarding the benefit of adjuvant radioactive iodine therapy (RAI) for intermediate-risk patients.The objective of the study was to examine the impact of RAI on overall survival in intermediate-risk PTC patients.Adult patients with intermediate-risk PTC who underwent total thyroidectomy with/without RAI in the National Cancer Database, 1998-2006, participated in the study.Intermediate-risk patients, as defined by American Thyroid Association risk and American Joint Commission on Cancer disease stage T3, N0, M0 or Mx, and T1-3, N1, M0, or Mx were included in the study. Patients with aggressive variants and multiple primaries were excluded.Overall survival (OS) for patients treated with and without RAI using univariate and multivariate regression analyses was measured.A total of 21 870 patients were included; 15 418 (70.5%) received RAI and 6452 (29.5%) did not. Mean follow-up was 6 years, with the longest follow-up of 14 years. In an unadjusted analysis, RAI was associated with improved OS in all patients (P < .001) as well as in a subgroup analysis among patients younger than 45 years (n = 12 612, P = .002) and 65 years old and older (median OS 140 vs 128 mo, n = 2122, P = .008). After a multivariate adjustment for demographic and clinical factors, RAI was associated with a 29% reduction in the risk of death, with a hazard risk 0.71 (95% confidence interval 0.62-0.82, P < .001). For age younger than 45 years, RAI was associated with a 36% reduction in risk of death, with a hazard risk 0.64 (95% confidence interval 0.45- 0.92, P = .016).This is the first nationally representative study of intermediate-risk PTC patients and RAI therapy demonstrating an association of RAI with improved overall survival. We recommend that this patient group should be considered for RAI therapy.

Authors
Ruel, E; Thomas, S; Dinan, M; Perkins, JM; Roman, SA; Sosa, JA
MLA Citation
Ruel, E, Thomas, S, Dinan, M, Perkins, JM, Roman, SA, and Sosa, JA. "Adjuvant radioactive iodine therapy is associated with improved survival for patients with intermediate-risk papillary thyroid cancer." The Journal of clinical endocrinology and metabolism 100.4 (April 2015): 1529-1536.
PMID
25642591
Source
epmc
Published In
Journal of Clinical Endocrinology and Metabolism
Volume
100
Issue
4
Publish Date
2015
Start Page
1529
End Page
1536
DOI
10.1210/jc.2014-4332

Patterns of use and cost for inappropriate radioactive iodine treatment for thyroid cancer in the United States: use and misuse.

Authors
Goffredo, P; Thomas, SM; Dinan, MA; Perkins, JM; Roman, SA; Sosa, JA
MLA Citation
Goffredo, P, Thomas, SM, Dinan, MA, Perkins, JM, Roman, SA, and Sosa, JA. "Patterns of use and cost for inappropriate radioactive iodine treatment for thyroid cancer in the United States: use and misuse." JAMA internal medicine 175.4 (April 2015): 638-640.
PMID
25686394
Source
epmc
Published In
JAMA Internal Medicine
Volume
175
Issue
4
Publish Date
2015
Start Page
638
End Page
640
DOI
10.1001/jamainternmed.2014.8020

Malignant struma ovarii: a population-level analysis of a large series of 68 patients.

Malignant struma ovarii (MSO) is a germ cell tumor of the ovary histologically identical to differentiated thyroid cancers. There is a paucity of data on this neoplasm, with fewer than 200 reported cases. The primary objective of this study was to examine the survival rate of women diagnosed with MSO using data from the Surveillance, Epidemiology, and End RESULTS (SEER) database. Secondary objectives were to describe the demographic, clinical, pathologic, and treatment characteristics of this population.A retrospective analysis was performed of prospectively collected cancer registry data. A total of 68 patients were identified in the SEER database, 1973-2011. The chi-square test, Student's t-test, and Kaplan-Meier curves were employed for data analyses.All 68 patients were females with a mean age at diagnosis of 43.0 years. Nearly 33% underwent unilateral oophorectomy, 28.6% bilateral oophorectomy, and 28.6% oophorectomy and omentectomy, and 4.8% were treated with debulking surgery. Pelvic radiation was administered to 12.3% of patients. The mean tumor size was 52.8 mm; 80% of malignant struma ovarii were SEER staged as local. Overall survival rates at 5, 10, and 20 years were 96.7%, 94.3%, and 84.9% respectively. Among the patients, there were six deaths recorded; only one was attributed to MSO. Six individuals (8.8%) had a concomitant or subsequent diagnosis of thyroid cancer. Four patients underwent total thyroidectomy, three patients had radioactive iodine, and one patient underwent external beam radiation. Two thirds of thyroid cancers extended outside the thyroid gland. All six patients with thyroid cancer were alive at the end of follow-up.It was observed that patients with malignant struma ovarii had an excellent disease-specific survival rate, regardless of the management strategy employed. However, MSO patients had a high risk for developing aggressive thyroid cancers. Therefore, MSO patients may benefit from routine thyroid imaging once the diagnosis of MSO is established.

Authors
Goffredo, P; Sawka, AM; Pura, J; Adam, MA; Roman, SA; Sosa, JA
MLA Citation
Goffredo, P, Sawka, AM, Pura, J, Adam, MA, Roman, SA, and Sosa, JA. "Malignant struma ovarii: a population-level analysis of a large series of 68 patients." Thyroid : official journal of the American Thyroid Association 25.2 (February 2015): 211-215.
PMID
25375817
Source
epmc
Published In
Thyroid
Volume
25
Issue
2
Publish Date
2015
Start Page
211
End Page
215
DOI
10.1089/thy.2014.0328

The role of adjuvant therapy in the management of head and neck merkel cell carcinoma: an analysis of 4815 patients.

Merkel cell carcinoma (MCC) is a rare neuroendocrine malignant neoplasm that most commonly occurs in the head and neck and is rapidly increasing in incidence. The role of adjuvant chemoradiotherapy (CRT) in the management of head and neck MCC remains controversial.To evaluate the association between different adjuvant therapies and survival in head and neck MCC.Retrospective review of adult patients with head and neck MCC who had surgery recorded in the National Cancer Data Base from 1998 to 2011.Surgical excision, adjuvant radiation therapy (RT), or adjuvant CRT.Our main outcome was overall survival (OS). Statistical analysis included χ2, t tests, Kaplan-Meier survival analysis, and Cox proportional hazards regression analysis.We identified 4815 patients; 92.0% underwent standard surgical excision, and 8.0% underwent Mohs surgery. On multivariate analysis, age at least 75 years (hazard ratio [HR], 2.83 [95% CI, 1.82-4.41]), larger tumor size, positive margins (HR, 1.52 [95% CI, 1.25-1.85]), and metastatic lymph nodes (HR, 2.29 [95% CI, 1.84-2.85]) were independently associated with decreased OS. Postoperative CRT (HR, 0.62 [95% CI, 0.47-0.81]) and RT (HR, 0.80 [95% CI, 0.70-0.92]) provided a survival benefit over surgery alone. Adjuvant CRT was associated with improved OS over adjuvant RT in patients with positive margins (HR, 0.48 [95% CI, 0.25-0.93]), tumor size at least 3 cm (HR, 0.52 [95% CI, 0.30-0.90]), and male sex (HR, 0.69 [95% CI, 0.50-0.94]).To our knowledge, this the first study examining the role of adjuvant CRT in head and neck MCC. Results suggest that adjuvant CRT may help improve survival in high-risk patients, such as males and those with positive margins and larger tumors.

Authors
Chen, MM; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Chen, MM, Roman, SA, Sosa, JA, and Judson, BL. "The role of adjuvant therapy in the management of head and neck merkel cell carcinoma: an analysis of 4815 patients." JAMA otolaryngology-- head & neck surgery 141.2 (February 2015): 137-141.
PMID
25474617
Source
epmc
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
141
Issue
2
Publish Date
2015
Start Page
137
End Page
141
DOI
10.1001/jamaoto.2014.3052

Potential risks of excess iodine ingestion and exposure: statement by the american thyroid association public health committee.

Authors
Leung, AM; Avram, AM; Brenner, AV; Duntas, LH; Ehrenkranz, J; Hennessey, JV; Lee, SL; Pearce, EN; Roman, SA; Stagnaro-Green, A; Sturgis, EM; Sundaram, K; Thomas, MJ; Wexler, JA
MLA Citation
Leung, AM, Avram, AM, Brenner, AV, Duntas, LH, Ehrenkranz, J, Hennessey, JV, Lee, SL, Pearce, EN, Roman, SA, Stagnaro-Green, A, Sturgis, EM, Sundaram, K, Thomas, MJ, and Wexler, JA. "Potential risks of excess iodine ingestion and exposure: statement by the american thyroid association public health committee." Thyroid : official journal of the American Thyroid Association 25.2 (February 2015): 145-146. (Letter)
PMID
25275241
Source
epmc
Published In
Thyroid
Volume
25
Issue
2
Publish Date
2015
Start Page
145
End Page
146
DOI
10.1089/thy.2014.0331

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

Response to the letter by Katiman E., et al

Authors
Ruel, E; Thomas, S; Roman, S; Sosa, JA
MLA Citation
Ruel, E, Thomas, S, Roman, S, and Sosa, JA. "Response to the letter by Katiman E., et al." Journal of Clinical Endocrinology and Metabolism 100.6 (January 1, 2015): L47-L48. (Letter)
Source
scopus
Published In
Journal of Clinical Endocrinology and Metabolism
Volume
100
Issue
6
Publish Date
2015
Start Page
L47
End Page
L48
DOI
10.1210/jc.20152044

Prognostic factors for squamous cell cancer of the parotid gland: an analysis of 2104 patients.

BACKGROUND: Parotid gland squamous cell cancer (SCC) occurs as metastasis from cutaneous SCC or primary malignancy. There is limited data on incidence, prognosis, and treatment outcomes. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database (1988-2009) identified 2104 adult patients with parotid SCC. RESULTS: SCC is the second most common parotid malignancy, and its incidence is increasing (annual percentage change 1.7%; ptrend  = .004). Age ≥85 years, tumor size ≥4 cm, extraparenchymal extension, cervical metastases, and distant metastases were independently associated with disease-specific mortality. Compared to no surgery, surgery was associated with improved 5-year disease-specific survival (DSS; 44.4% vs 71.0%; p < .001), whereas radiation alone was similar to no treatment (47.0% vs 41.6%; p = .28). CONCLUSION: Surgery and adjuvant radiation therapy (RT) are associated with improved survival compared to radiation alone and no treatment. Patients ≥85 years of age account for nearly 20% of all patients and have a poor prognosis independent of treatment.

Authors
Chen, MM; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Chen, MM, Roman, SA, Sosa, JA, and Judson, BL. "Prognostic factors for squamous cell cancer of the parotid gland: an analysis of 2104 patients." Head & neck 37.1 (January 2015): 1-7.
PMID
24339135
Source
epmc
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
37
Issue
1
Publish Date
2015
Start Page
1
End Page
7
DOI
10.1002/hed.23566

Impact of extent of surgery on survival for papillary thyroid cancer patients younger than 45 years.

Papillary thyroid cancer (PTC) patients <45 years old are considered to have an excellent prognosis; however, current guidelines recommend total thyroidectomy for PTC tumors >1.0 cm, regardless of age.Our objective was to examine the impact of extent of surgery on overall survival (OS) in patients <45 years old with stage I PTC of 1.1 to 4.0 cm.Adult patients <45 years of age undergoing surgery for stage I PTC were identified from the National Cancer Data Base (NCDB, 1998-2006) and the Surveillance, Epidemiology, and End RESULTS dataset (SEER, 1988-2006).Multivariable modeling was used to compare OS for patients undergoing total thyroidectomy vs lobectomy.In total, 29 522 patients in NCDB (3151 lobectomy, 26 371 total thyroidectomy) and 13 510 in SEER (1379 lobectomy, 12 131 total thyroidectomy) were included. Compared with patients undergoing lobectomy, patients having total thyroidectomy more often had extrathyroidal and lymph node disease. At 14 years, unadjusted OS was equivalent between total thyroidectomy and lobectomy in both databases. After adjustment, OS was similar for total thyroidectomy compared with lobectomy across all patients with tumors of 1.1 to 4.0 cm (NCDB: hazard ratio = 1.45 [confidence interval = 0.88-2.51], P = 0.19; SEER: 0.95 (0.70-1.29), P = 0.75) and when stratified by tumor size: 1.1 to 2.0 cm (NCDB: 1.12 [0.50-2.51], P = 0.78; SEER: 0.95 [0.56-1.62], P = 0.86) and 2.1 to 4.0 cm (NCDB: 1.93 [0.88-4.23], P = 0.10; SEER: 0.94 [0.60-1.49], P = 0.80).After adjusting for patient and clinical characteristics, total thyroidectomy compared with thyroid lobectomy was not associated with improved survival for patients <45 years of age with stage I PTC of 1.1 to 4.0 cm. Additional clinical and pathologic factors should be considered when choosing extent of resection.

Authors
Adam, MA; Pura, J; Goffredo, P; Dinan, MA; Hyslop, T; Reed, SD; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Pura, J, Goffredo, P, Dinan, MA, Hyslop, T, Reed, SD, Scheri, RP, Roman, SA, and Sosa, JA. "Impact of extent of surgery on survival for papillary thyroid cancer patients younger than 45 years." The Journal of clinical endocrinology and metabolism 100.1 (January 2015): 115-121.
PMID
25337927
Source
epmc
Published In
Journal of Clinical Endocrinology and Metabolism
Volume
100
Issue
1
Publish Date
2015
Start Page
115
End Page
121
DOI
10.1210/jc.2014-3039

Prophylactic thyroidectomy: who needs it, when, and why.

The most common hereditary thyroid cancer is medullary thyroid cancer, which can be associated with MEN 2A, MEN 2B, or FMTC. In these patients, prophylactic thyroidectomy is recommended; timing of surgery is dependent on the specific RET mutation. Prophylactic thyroidectomy should include total thyroidectomy and accompanying central compartment neck dissection should be done for patients at high risk for micro-metastatic disease only. Surgery should be performed at tertiary care institutions by high-volume thyroid surgeons.

Authors
Wang, TS; Opoku-Boateng, A; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Opoku-Boateng, A, Roman, SA, and Sosa, JA. "Prophylactic thyroidectomy: who needs it, when, and why." Journal of surgical oncology 111.1 (January 2015): 61-65. (Review)
PMID
24965542
Source
epmc
Published In
Journal of Surgical Oncology
Volume
111
Issue
1
Publish Date
2015
Start Page
61
End Page
65
DOI
10.1002/jso.23697

The significance of atrial fibrillation in patients aged ≥ 55 years undergoing abdominal surgery.

BACKGROUND: The Institute of Medicine has identified atrial fibrillation (AF) among national priorities for research. We examine the incidence of AF and its association with outcomes of patients undergoing abdominal surgery. METHODS: Patients ≥ 55 years who underwent abdominal surgery captured in a State Inpatient Database, 2008-2010. Three patient groups were created: (1) No diagnosis of AF (No-AF), (2) Pre-existing AF (Hx-AF), and (3) New-onset AF (New-AF). Outcomes were analysed using bivariate and multivariate methods. RESULTS: AF incidence among 116,477 patients was 8.6 %; approximately one in four patients aged ≥ 85 years had AF. 26.6 % of patients with AF experienced New-AF; the latter was more likely after pancreas resection (43.0 %) and least common after cholecystectomy (20.2 %). Complications (71.1, 47.3 vs. 26.5 %), mortality (8.0, 5.7 vs. 2.0 %), longer hospital stays (8.8, 5.6 vs. 3.8 days), and higher hospitalization cost ($41,427, $26,312 vs. $18,310) were more likely in patients with AF (New-AF, Hx-AF vs. No-AF respectively) (all p < 0.001). After adjustment, New-AF was among factors independently associated with mortality (OR 2.0, 95 % CI 1.7-2.4, p < 0.001); each case of New-AF increased cost of care by $4,482. Factors independently associated with New-AF included ≥ 1 complication, electrolyte imbalance, and procedure-type. Whereas 2.0 % of patients who developed New-AF were admitted from a long-term care facility, 23.8 % of patients with New-AF were discharged to a long-term care facility. CONCLUSIONS: AF is common among abdominal surgery patients, particularly the elderly; New-AF is a serious, potentially avoidable adverse event that could serve as an important quality of care indicator for abdominal surgery patients.

Authors
Kazaure, HS; Roman, SA; Tyler, D; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, Tyler, D, and Sosa, JA. "The significance of atrial fibrillation in patients aged ≥ 55 years undergoing abdominal surgery." World journal of surgery 39.1 (January 2015): 113-120.
PMID
25223740
Source
epmc
Published In
World Journal of Surgery
Volume
39
Issue
1
Publish Date
2015
Start Page
113
End Page
120
DOI
10.1007/s00268-014-2777-7

Positive surgical margins in early stage oral cavity cancer: an analysis of 20,602 cases.

OBJECTIVE: To report the incidence of positive surgical margins in early oral cavity cancer and identify patient, tumor, and system factors associated with their occurrence. STUDY DESIGN AND SETTING: Retrospective analysis of the National Cancer Database. SUBJECTS AND METHODS: Patients diagnosed with stage I or II oral cavity squamous cell cancer between 1998 and 2011 were identified. Univariate and multivariate analyses of factors associated with positive margins were conducted. RESULTS: In total, 20,602 patients with early oral cancer were identified. Margin status was reported in 94.8% of cases, and positive margins occurred in 7.5% of those cases. Incidence of positive margins by institution varied from 0% to 43.8%, with median incidence of 7.1%. Positive margins were associated with clinical factors including stage II disease (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.55-1.98), intermediate grade (OR, 1.20; 95% CI, 1.04-1.37), high grade (OR, 1.68; 95% CI, 1.39-2.03), and floor of mouth (OR, 1.78; 95% CI, 1.52-2.08), buccal mucosa (OR, 2.06; 95% CI, 1.59-2.68), and retromolar locations (OR, 2.40; 95% CI, 1.85-3.11). Positive margins were also associated with treatment at nonacademic cancer centers (OR, 1.23; 95% CI, 1.04-1.44) and institutions with a low oral cancer case volume (OR, 1.45; 95% CI, 1.23-1.69). CONCLUSION: Positive margins are associated with tumor factors, including stage, grade, and site, reflecting disease aggressiveness and difficulty of resection. Positive margins also are associated with factors such as treatment facility type, hospital case volume, and geographic region, suggesting potential variation in quality of care. Margin status may be a useful quality measure for early oral cavity cancer.

Authors
Luryi, AL; Chen, MM; Mehra, S; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Luryi, AL, Chen, MM, Mehra, S, Roman, SA, Sosa, JA, and Judson, BL. "Positive surgical margins in early stage oral cavity cancer: an analysis of 20,602 cases." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 151.6 (December 2014): 984-990.
PMID
25257901
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
151
Issue
6
Publish Date
2014
Start Page
984
End Page
990
DOI
10.1177/0194599814551718

Robotic thyroidectomy for cancer in the US: patterns of use and short-term outcomes.

We describe nationally representative patterns of utilization and short-term outcomes from robotic versus open thyroidectomy for thyroid cancer.Descriptive statistics and multivariable analysis were used to analyze patterns of use of robotic thyroidectomy from the National Cancer Database (2010-2011). Short-term outcomes were compared between patients undergoing robotic versus open thyroidectomy, while adjusting for confounders.A total of 68,393 patients with thyroid cancer underwent thyroidectomy; 225 had robotic surgery and 57,729 underwent open surgery. Robotic thyroid surgery use increased by 30 % from 2010 to 2011 (p = 0.08). Robotic cases were reported from 93 centers, with 89 centers performing <10 robotic cases. Compared with the open group, the robotic group was younger (51 vs. 47 years; p < 0.01) and included more Asian patients (4 vs. 8 %; p = 0.006) and privately-insured patients (68 vs. 77 %; p = 0.01). Tumor size was similar between patients undergoing robotic versus open surgery. Total thyroidectomy was performed less frequently in the robotic group (67 vs. 84 % open; p < 0.0001). Patients were relatively more likely to undergo robotic surgery if they were female (odds ratio [OR] 1.6; p = 0.04), younger (OR 0.8/10 years; p < 0.0001), or underwent lobectomy (OR 2.4; p < 0.0001). In adjusted multivariable analysis, there were no differences in the number of lymph nodes removed or length of stay between groups; however, there was a non-significant increase in the incidence of positive margins with robotic thyroidectomy.Use of robotic thyroidectomy for thyroid cancer is limited to a few institutions, with short-term outcomes that are comparable to open surgery. Multi-institutional studies should be undertaken to compare thyroidectomy-specific complications and long-term outcomes.

Authors
Adam, MA; Speicher, P; Pura, J; Dinan, MA; Reed, SD; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Speicher, P, Pura, J, Dinan, MA, Reed, SD, Roman, SA, and Sosa, JA. "Robotic thyroidectomy for cancer in the US: patterns of use and short-term outcomes." Annals of surgical oncology 21.12 (November 2014): 3859-3864.
PMID
24934584
Source
epmc
Published In
Annals of Surgical Oncology
Volume
21
Issue
12
Publish Date
2014
Start Page
3859
End Page
3864
DOI
10.1245/s10434-014-3838-8

Trends and variations in the use of adjuvant therapy for patients with head and neck cancer.

BACKGROUND: The National Comprehensive Cancer Network guidelines recommend that patients with surgically resected head and neck cancers that have adverse pathologic features should receive adjuvant therapy in the form of radiotherapy (RT) or chemoradiation (CRT). To the authors' knowledge, the current study is the first analysis of temporal trends and use patterns of adjuvant therapy for these patients. METHODS: Patients with head and neck cancer and adverse pathologic features were identified in the National Cancer Data Base (1998-2011). Data were analyzed using chi-square, Student t, and log-rank tests; multivariate logistic regression; and Cox multivariate regression. RESULTS: A total of 73,088 patients were identified: 41.5% had received adjuvant RT, 33.5% had received adjuvant CRT, and 25.0% did not receive any adjuvant therapy. From 1998 to 2011, the increase in the use of adjuvant CRT was greatest for patients with oral cavity (6-fold) and laryngeal (5-fold) cancers. Multivariate analysis demonstrated that Medicare/Medicaid insurance (odds ratio [OR], 1.05; 95% confidence interval [95% CI], 1.01-1.11), distance ≥34 miles from the cancer center (OR, 1.66; 95% CI, 1.59-1.74), and academic (OR, 1.26; 95% CI, 1.20-1.31) and high-volume (OR, 1.10; 95% CI, 1.05-1.15) centers were independently associated with patients not receiving adjuvant therapy. Receipt of adjuvant therapy was found to be independently associated with improved overall survival (hazard ratio, 0.84; 95% CI, 0.81-0.86). CONCLUSIONS: Approximately 25% of patients are not receiving National Comprehensive Cancer Network guideline-directed adjuvant therapy. Patient-level and hospital-level factors are associated with variations in the receipt of adjuvant therapy. Further evaluation of these differences in practice patterns is needed to standardize practice and potentially improve the quality of care. Cancer 2014;120:3353-3360. © 2014 American Cancer Society.

Authors
Chen, MM; Roman, SA; Yarbrough, WG; Burtness, BA; Sosa, JA; Judson, BL
MLA Citation
Chen, MM, Roman, SA, Yarbrough, WG, Burtness, BA, Sosa, JA, and Judson, BL. "Trends and variations in the use of adjuvant therapy for patients with head and neck cancer." Cancer 120.21 (November 2014): 3353-3360.
PMID
25042524
Source
epmc
Published In
Cancer
Volume
120
Issue
21
Publish Date
2014
Start Page
3353
End Page
3360
DOI
10.1002/cncr.28870

Impact of extent of surgery on survival in patients with small nonfunctional pancreatic neuroendocrine tumors in the United States.

Nonfunctional pancreatic neuroendocrine tumors (PNETs) ≤2 cm have uncertain malignant potential, and optimal treatment remains unclear. Objectives of this study were to better understand their malignant potential, determine whether extent of surgery or lymph node dissection is associated with overall survival (OS), and identify other factors associated with OS.Patients with nonfunctional PNETs ≤2 cm were identified from the National Cancer Data Base (1998 to 2011). Descriptive statistics were used for patient characteristics and surgical resection patterns. Five-year OS was estimated using Kaplan-Meier analyses across extent of surgery and compared using the log-rank test. Cox proportional regression modeling was used to test the association between survival and extent of surgery.A total of 1854 patients with nonfunctional PNETs ≤2 cm were included. From 1998 to 2011, these tumors increased three-fold as a proportion of all PNETs. Among tumors ≤0.5 cm, 33 % presented with regional lymph node metastases and 11 % with distant metastases. Five-year OS for patients not undergoing surgery was 27.6 % vs. 83.0 % for partial pancreatectomy, 72.3 % for pancreaticoduodenectomy, and 86.0 % for total pancreatectomy (p < 0.01). Multivariate analysis demonstrated no difference in OS based on type of surgery or the addition of regional lymphadenectomy (p = 0.16). Younger age and later year of diagnosis were independently associated with improved survival.Small nonfunctional PNETs represent an increasing proportion of all PNETs and have a significant risk of malignancy. Survival is improving over time despite older age at diagnosis. Type of surgical resection and the addition of lymph node resection were not associated with OS.

Authors
Gratian, L; Pura, J; Dinan, M; Roman, S; Reed, S; Sosa, JA
MLA Citation
Gratian, L, Pura, J, Dinan, M, Roman, S, Reed, S, and Sosa, JA. "Impact of extent of surgery on survival in patients with small nonfunctional pancreatic neuroendocrine tumors in the United States." Annals of surgical oncology 21.11 (October 2014): 3515-3521.
PMID
24841347
Source
epmc
Published In
Annals of Surgical Oncology
Volume
21
Issue
11
Publish Date
2014
Start Page
3515
End Page
3521
DOI
10.1245/s10434-014-3769-4

Treatment patterns and outcomes for patients with adrenocortical carcinoma associated with hospital case volume in the United States.

Adrenocortical carcinoma (ACC) is a rare, aggressive disease with no apparent change in treatment or survival in the United States over the past two decades. Our objective was to determine whether treatment patterns or clinical outcomes vary by hospital case volume.Patients with ACC were identified from the National Cancer Database (1998-2011). High-volume centers (HVCs) were defined by a case load of ≥4 cases of primary adrenal malignancy annually, which corresponded to the 90th percentile. All other facilities were considered low-volume centers (LVCs).A total of 2,765 ACC patients were treated across 1,046 facilities. Compared to patients treated at LVCs, patients treated at HVCs were younger (50 vs. 54 years), with larger tumors (11.2 vs. 10.5 cm), and underwent higher rates of surgery (78.8 vs. 73.4 %), radical resection (17.3 vs. 13.9 %), regional lymph node evaluation (23.2 vs. 18.8 %), and chemotherapy including mitotane (43.8 vs. 31.0 %, all p < 0.05).There were no significant differences in median length of stay (5 vs. 5 days), 30-day readmission rates (4.0 % for HVCs vs. 3.9 % for LVCs), or 30-day postoperative mortality rates (1.9 % for HVCs vs. 3.7 % for LVCs). Median overall survival was 2.0 years for HVCs and 1.9 years for LVCs, p = 0.53. After adjusting for patient and tumor characteristics, overall survival did not differ significantly between patients treated at HVCs versus LVCs [HR = 0.89 (95 % confidence interval 0.70, 1.12)].Treatment at HVCs was associated with more aggressive surgical resection and chemotherapy use. Prognosis remained poor despite more aggressive treatment.

Authors
Gratian, L; Pura, J; Dinan, M; Reed, S; Scheri, R; Roman, S; Sosa, JA
MLA Citation
Gratian, L, Pura, J, Dinan, M, Reed, S, Scheri, R, Roman, S, and Sosa, JA. "Treatment patterns and outcomes for patients with adrenocortical carcinoma associated with hospital case volume in the United States." Annals of surgical oncology 21.11 (October 2014): 3509-3514.
PMID
25069860
Source
epmc
Published In
Annals of Surgical Oncology
Volume
21
Issue
11
Publish Date
2014
Start Page
3509
End Page
3514
DOI
10.1245/s10434-014-3931-z

Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients.

To examine the association between the extent of surgery and overall survival in a large contemporary cohort of patients with papillary thyroid cancer (PTC).Guidelines recommend total thyroidectomy for PTC tumors >1 cm, based on older data demonstrating an overall survival advantage for total thyroidectomy over lobectomy.Adult patients with PTC tumors 1.0-4.0 cm undergoing thyroidectomy in the National Cancer Database, 1998-2006, were included. Cox proportional hazards models were applied to measure the association between the extent of surgery and overall survival while adjusting for patient demographic and clinical factors, including comorbidities, extrathyroidal extension, multifocality, nodal and distant metastases, and radioactive iodine treatment.Among 61,775 PTC patients, 54,926 underwent total thyroidectomy and 6849 lobectomy. Compared with lobectomy, patients undergoing total thyroidectomy had more nodal (7% vs 27%), extrathyroidal (5% vs 16%), and multifocal disease (29% vs 44%) (all Ps < 0.001). Median follow-up was 82 months (range, 60-179 months). After multivariable adjustment, overall survival was similar in patients undergoing total thyroidectomy versus lobectomy for tumors 1.0-4.0 cm [hazard ratio (HR) = 0.96; 95% confidence interval (CI), 0.84-1.09); P = 0.54] and when stratified by tumor size: 1.0-2.0 cm [HR = 1.05; 95% CI, 0.88-1.26; P = 0.61] and 2.1-4.0 cm [HR = 0.89; 95% CI, 0.73-1.07; P = 0.21]. Older age, male sex, black race, lower income, tumor size, and presence of nodal or distant metastases were independently associated with compromised survival (P < 0.0001).Current guidelines suggest total thyroidectomy for PTC tumors >1 cm. However, we did not observe a survival advantage associated with total thyroidectomy compared with lobectomy. These findings call into question whether tumor size should be an absolute indication for total thyroidectomy.

Authors
Adam, MA; Pura, J; Gu, L; Dinan, MA; Tyler, DS; Reed, SD; Scheri, R; Roman, SA; Sosa, JA
MLA Citation
Adam, MA, Pura, J, Gu, L, Dinan, MA, Tyler, DS, Reed, SD, Scheri, R, Roman, SA, and Sosa, JA. "Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients." Annals of surgery 260.4 (October 2014): 601-605.
PMID
25203876
Source
epmc
Published In
Annals of Surgery
Volume
260
Issue
4
Publish Date
2014
Start Page
601
End Page
605
DOI
10.1097/sla.0000000000000925

Not all do-not-resuscitate (DNR) orders are the same: outcomes of 4738 elderly surgical patients who instituted a DNR order at hospital admission

Authors
Kazaure, HS; Roman, SA; Sosa, JAA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JAA. "Not all do-not-resuscitate (DNR) orders are the same: outcomes of 4738 elderly surgical patients who instituted a DNR order at hospital admission." October 2014.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
219
Issue
4
Publish Date
2014
Start Page
E104
End Page
E104

Papillary thyroid microcarcinoma: an over-treated malignancy?

The clinical importance of papillary thyroid microcarcinoma (PTMC) remains controversial, with current guidelines suggesting that thyroid lobectomy alone is sufficient. The purpose of this study was to identify population-level treatment patterns in the USA for PTMC.Patients with PTMC in SEER (1998-2010) were included; demographic, clinical (extent of surgery, administration of post-operative radioactive iodine [RAI]), and pathologic characteristics were examined. Outcomes of interest were 5- and 10-year overall survival (OS) and disease-specific survival (DSS).The cohort consisted of 29,512 patients. Mean age at diagnosis was 48.5 years; mean tumor size was 0.53 cm. Overall, 73.4 % of patients underwent total thyroidectomy, and RAI was administered to 31.3 %. In multivariate analysis, total thyroidectomy was more frequently performed in patients with multifocal (odds ratio [OR] 2.55), 'regional', or 'distant' PTMC (OR 2.90 and 2.59). Non-operative management was associated with male patients (OR 4.24) and those aged ≥65 years (OR 6.31). Post-operative RAI was associated with multifocal PTMC (OR 2.57). Overall, 5- and 10-year DSS was 99.6 and 99.3 %, respectively, with no difference in DSS between patients who underwent partial versus total thyroidectomy. OS of patients with PTMC who underwent any thyroid operation was similar to that of the general population of the USA.An increasing number of patients are undergoing total thyroidectomy and RAI for PTMC. While there may be a subset of patients for whom more aggressive therapy is indicated, many patients with PTMC may be over-treated, with no demonstrable benefit to survival.

Authors
Wang, TS; Goffredo, P; Sosa, JA; Roman, SA
MLA Citation
Wang, TS, Goffredo, P, Sosa, JA, and Roman, SA. "Papillary thyroid microcarcinoma: an over-treated malignancy?." World journal of surgery 38.9 (September 2014): 2297-2303.
PMID
24791670
Source
epmc
Published In
World Journal of Surgery
Volume
38
Issue
9
Publish Date
2014
Start Page
2297
End Page
2303
DOI
10.1007/s00268-014-2602-3

Predictors of survival in carcinoma ex pleomorphic adenoma.

BACKGROUND: Carcinoma ex pleomorphic adenoma (Ca ex PA) is a high-grade carcinoma arising from benign pleomorphic adenoma. This is the first population-level analysis of prognosis and prognostic features of parotid Ca ex PA. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database (1988-2009) was used to identify 278 patients with parotid Ca ex PA. RESULTS: Extraparenchymal extension of the primary tumor was associated with cervical metastasis (35.7% vs 2.9%; p < .001). Independent predictors of disease-specific survival (DSS) were race (hazard ratio [HR], 7.12; 95% confidence interval [CI], 2.56-19.82), distant metastases (HR, 18.99; 95% CI, 5.06-71.21), and multiple metastatic lymph nodes (HR, 9.48; 95% CI, 4.14-21.71). Patients with multiple cervical lymph node metastases had decreased 5-year DSS compared with patients with ≤1 positive lymph node (42.7% vs 85.9%; p < .001). CONCLUSION: The presence of 2 or more cervical lymph node metastases identifies patients with Ca ex PA with a poor prognosis.

Authors
Chen, MM; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Chen, MM, Roman, SA, Sosa, JA, and Judson, BL. "Predictors of survival in carcinoma ex pleomorphic adenoma." Head & neck 36.9 (September 2014): 1324-1328.
PMID
23956034
Source
epmc
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
36
Issue
9
Publish Date
2014
Start Page
1324
End Page
1328
DOI
10.1002/hed.23453

Combined hepatocellular-cholangiocarcinoma: a population-level analysis of an uncommon primary liver tumor.

Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary liver cancer. Our aims were to analyze the demographic, clinical, and pathological characteristics of cHCC-CC at a population level and to investigate the effects of these features as well as different management strategies on the prognosis. The Surveillance, Epidemiology, and End Results (SEER) database was analyzed for 1988-2009. Data analyses were performed with chi-square tests, analyses of variance, Kaplan-Meier curves, and Cox proportional hazards regression. Four hundred sixty-five patients with cHCC-CC, 52,825 patients with hepatocellular carcinoma (HCC), and 7181 patients with cholangiocarcinoma (CC) were identified. cHCC-CC was more common in patients who were white, male, and older than 65 years. Treatment was more frequently nonsurgical/interventional. Patients with cHCC-CC, HCC, and CC had 5-year overall survival (OS) and disease-specific survival rates of 10.5%, 11.7%, and 5.7% (P < 0.001) and 17.8%, 21.0%, and 11.9% (P < 0.001), respectively. For cHCC-CC patients, an increasing invasiveness of the therapeutic approach was significantly associated with prolonged survival (P < 0.001). In a multivariate model, black race, a distant SEER stage, and a tumor size of 5.0 to 10.0 cm were independently associated with lower survival for cHCC-CC patients; a year of diagnosis after 1995 and surgical treatment with minor hepatectomy, major hepatectomy (MJH), or liver transplantation (LT) were independently associated with better survival for cHCC-CC patients. Patients diagnosed with cHCC-CC, HCC, and CC and treated with LT had 5-year OS rates of 41.1%, 67.0%, and 29.0%, respectively (P < 0.001). In conclusion, cHCC-CC patients appear to have intermediate demographic, clinical, and survival characteristics in comparison with HCC and CC patients. cHCC-CC patients undergoing LT showed inferior survival in comparison with HCC patients, and the role and indications for LT in cHCC-CC have yet to be defined. At this time, MJH may be considered the best therapeutic approach for such patients.

Authors
Garancini, M; Goffredo, P; Pagni, F; Romano, F; Roman, S; Sosa, JA; Giardini, V
MLA Citation
Garancini, M, Goffredo, P, Pagni, F, Romano, F, Roman, S, Sosa, JA, and Giardini, V. "Combined hepatocellular-cholangiocarcinoma: a population-level analysis of an uncommon primary liver tumor." Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society 20.8 (August 2014): 952-959.
PMID
24777610
Source
epmc
Published In
Liver Transplantation
Volume
20
Issue
8
Publish Date
2014
Start Page
952
End Page
959
DOI
10.1002/lt.23897

Leptin signaling and hyperparathyroidism: clinical and genetic associations.

BACKGROUND: The role of leptin in mediating calcium-related metabolic processes is not well understood. STUDY DESIGN: We enrolled patients with hyperparathyroidism undergoing parathyroidectomy in a prospective study to assess postoperative changes to serum leptin and parathyroid hormone levels and to determine the presence of LEPR (leptin receptor) polymorphisms. Patients undergoing hemithyroidectomy under identical surgical conditions were enrolled as controls. Wilcoxon signed-rank test was used to analyze changes in leptin. Pearson correlations and Bland-Altman methods were used to examine the between-subject and within-subject correlations in changes in leptin and parathyroid hormone levels. Five single-nucleotide polymorphisms in the LEPR gene were genotyped, and linear regression analysis was performed for each polymorphism. RESULTS: Among the 71 patients included in the clinical study, after-surgery leptin levels decreased significantly in the parathyroid adenoma (p < 0.001) and parathyroid hyperplasia subgroups (p = 0.002) and increased in the control group (p = 0.007). On multivariate analysis, parathyroid disease subtype, baseline leptin levels, age, body mass index, and calcium at diagnosis was associated with changes in leptin. Among the 132 patients included in the genotyping analysis, under a recessive model of inheritance, single-nucleotide polymorphism rs1137101 had a significant association with the largest parathyroid gland and total mass of parathyroid tissue removed (p = 0.045 and p = 0.040, respectively). When analyzing obese patients only, rs1137100 and rs1137101 were significantly associated with total parathyroid size (p = 0.0343 and p = 0.0259, respectively). CONCLUSIONS: Our results suggest a role for the parathyroid gland in regulating leptin production. Genetic contributions from the leptin pathway might predispose to hyperparathyroidism.

Authors
Hoang, D; Broer, N; Roman, SA; Yao, X; Abitbol, N; Li, F; Sosa, JA; Sue, GR; DeWan, AT; Wong, M-L; Licinio, J; Simpson, C; Li, AY; Pizzoferrato, N; Narayan, D
MLA Citation
Hoang, D, Broer, N, Roman, SA, Yao, X, Abitbol, N, Li, F, Sosa, JA, Sue, GR, DeWan, AT, Wong, M-L, Licinio, J, Simpson, C, Li, AY, Pizzoferrato, N, and Narayan, D. "Leptin signaling and hyperparathyroidism: clinical and genetic associations." Journal of the American College of Surgeons 218.6 (June 2014): 1239-1250.e4.
PMID
24468228
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
218
Issue
6
Publish Date
2014
Start Page
1239
End Page
1250.e4
DOI
10.1016/j.jamcollsurg.2013.11.013

Transoral Robotic Surgery: A Population-Level Analysis.

(1) To determine baseline demographic, geographic, clinical, and pathologic characteristics of patients who had transoral robotic surgery (TORS) for oropharyngeal cancer. (2) To analyze margin status and unplanned readmission after TORS versus nonrobotic surgery.Retrospective database review.National Cancer Database (2010-2011).Searching the National Cancer Database for adults with oropharyngeal cancer, we identified 877 patients who had TORS and 4269 patients who had nonrobotic surgery. Outcomes of interest included likelihood of adjuvant therapy, margin status, and unplanned readmission. Statistical analysis included chi-square, t tests, and multivariate regression.From 2010 to 2011, there was a 67% increase in the use of TORS for oropharyngeal cancer. Compared with patients who had nonrobotic surgery, TORS patients were more likely to be at academic centers (80.8% vs 49.1%, P < .001), to have private insurance (62.2% vs 57.4%, P < .001), and to have human papilloma virus (HPV)-positive tumors (48.3% vs 27.1%, P < .001). TORS (odds ratio, 0.50; 95% CI, 0.39-0.63) and HPV positivity (odds ratio, 0.73; 95% CI, 0.53-0.99) were independently associated with decreased likelihood of adjuvant chemoradiation versus radiation therapy. TORS patients were less likely to have positive margins than were patients who had nonrobotic surgery (20.2% vs 31.0%, P < .001). High-volume TORS centers had lower rates of positive margins (15.8% vs 26.1%, P < .001) and unplanned readmissions (3.1% vs 6.1%, P < .03) than did low-volume centers.TORS is being rapidly adopted by academic and community cancer centers. TORS is associated with a lower rate of positive margins than nonrobotic surgery, and high-volume centers have the lowest rates of positive margins and unplanned readmissions.

Authors
Chen, MM; Roman, SA; Kraus, DH; Sosa, JA; Judson, BL
MLA Citation
Chen, MM, Roman, SA, Kraus, DH, Sosa, JA, and Judson, BL. "Transoral Robotic Surgery: A Population-Level Analysis." Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 150.6 (June 2014): 968-975.
PMID
24618503
Source
epmc
Published In
Otolaryngology - Head and Neck Surgery
Volume
150
Issue
6
Publish Date
2014
Start Page
968
End Page
975
DOI
10.1177/0194599814525747

Safety of adult tonsillectomy: a population-level analysis of 5968 patients.

IMPORTANCE: Tonsillectomy is one of the most commonly performed otolaryngology procedures. The safety of this procedure in adults is based on small case series. To our knowledge, we report the first population-level analysis of the safety of adult tonsillectomies in the United States. OBJECTIVE: To characterize the mortality, complication, and reoperation rate in adult tonsillectomy. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 5968 adult patients who underwent tonsillectomy with records in the database of the American College of Surgeons National Surgical Quality Improvement Program (2005 to 2011). INTERVENTION: Tonsillectomy. MAIN OUTCOMES AND MEASURES: Outcomes of interest included mortality, complications, and reoperation in the 30-day postoperative period. Statistical analysis included χ² test, t test, and multivariate logistic regression. RESULTS: The 30-day mortality rate was 0.03%, the complication rate was 1.2%, and the reoperation rate was 3.2%. Most patients had a primary diagnosis of chronic tonsillitis and/or adenoiditis (82.9%), and the most common complications were pneumonia (27% of all complications), urinary tract infection (27%), and superficial site infections (16%). Patients who underwent reoperation were more likely to be male (54.0% vs 32.4%; P < .001), white (84.8% vs 75.3%; P = .02), or inpatients (24.3% vs 14.3%; P < .001) and to have postoperative complications (5.3% vs 1.1%; P < .001) than those who did not return to the operating room. On multivariate analysis, male sex (odds ratio [OR], 2.30 [95% CI, 1.67-3.15]), inpatient status (OR, 1.52 [95% CI, 1.04-2.22]), and the presence of a postoperative complication (OR, 4.58 [95% CI, 2.11-9.93]) were independent risk factors for reoperation. CONCLUSIONS AND RELEVANCE: In the United States, adult tonsillectomy is a safe procedure with low rates of mortality and morbidity. The most common posttonsillectomy complications were infectious in etiology, and complications were independently associated with the need for reoperation.

Authors
Chen, MM; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Chen, MM, Roman, SA, Sosa, JA, and Judson, BL. "Safety of adult tonsillectomy: a population-level analysis of 5968 patients." JAMA otolaryngology-- head & neck surgery 140.3 (March 2014): 197-202.
PMID
24481159
Source
epmc
Published In
JAMA Otolaryngology - Head and Neck Surgery
Volume
140
Issue
3
Publish Date
2014
Start Page
197
End Page
202
DOI
10.1001/jamaoto.2013.6215

Have 2006 ATA practice guidelines affected the treatment of differentiated thyroid cancer in the United States?

BACKGROUND: There is wide variability in the degree of adherence to guideline recommendations among caregivers. Our aim was to determine the clinical impact of the 2006 guidelines from the American Thyroid Association (ATA) on the management of differentiated thyroid cancer (DTC) in the United States. METHODS: The Surveillance, Epidemiology and End Results (SEER) database (2004-2009) was employed. Patients were divided into two groups based on receipt of care before (DTC 04-06) and after (DTC 07-09) the release of the 2006 ATA guidelines. Adherence was determined with a chi-square test and binary logistic regression. Survival was analyzed with the Kaplan-Meier method and log-rank test. RESULTS: A total of 12,816 patients with DTC were identified between 2004 and 2006, and 14,514 between 2007 and 2009 (DTC 07-09). Adherence to Recommendation 26 (surgery) tended to increase in DTC 07-09 (82.2% vs. 83.2%, p=0.083). Factors associated with discordant practice among the DTC 07-09 group were older age, treatment in the Northeast, having more than one primary cancer, tumor size >4 cm, and follicular and Hürthle cell histologies. Factors associated with accordance were treatment in the Midwest, level II-VI metastases, having lymph nodes examined, AJCC Stage III, and presenting with distant metastases. Patients treated in accordance with Recommendation 26 showed prolonged disease-specific survival (p<0.001). A trend toward more adherence to Recommendation 27 (lymphadenectomy) was observed over time (68.4% vs. 69.7%, p=0.065). Adherence to Recommendation 27 was not associated with disease-specific survival (p=0.539). Less discordance from guidelines was seen for cancers that were 2.1-4 cm, extrathyroidal, and greater than Stage I. Overall accordance with Recommendation 32 (radioactive iodine [RAI] ablation) increased in DTC 07-09 compared to DTC 04-06 (61.7% vs. 57.5% respectively, p<0.001), and this was associated with improved disease-specific survival in DTC 07-09 (p<0.001). Predictors of care discordant with guidelines were patient age ≥ 65 years, living in the Northeast, and not undergoing total thyroidectomy. Factors associated with RAI use in accordance with guidelines were married status, treatment in the South, and having more than one lymph node examined. CONCLUSIONS: Care in accordance with evidence-based guidelines for DTC is associated with improved patient outcomes. Ongoing efforts should be undertaken to propagate guidelines to reduce variation in care and improve overall quality of care.

Authors
Goffredo, P; Roman, SA; Sosa, JA
MLA Citation
Goffredo, P, Roman, SA, and Sosa, JA. "Have 2006 ATA practice guidelines affected the treatment of differentiated thyroid cancer in the United States?." Thyroid : official journal of the American Thyroid Association 24.3 (March 2014): 463-471.
PMID
23978295
Source
epmc
Published In
Thyroid
Volume
24
Issue
3
Publish Date
2014
Start Page
463
End Page
471
DOI
10.1089/thy.2013.0319

Histologic grade as prognostic indicator for mucoepidermoid carcinoma: a population-level analysis of 2400 patients.

BACKGROUND: Mucoepidermoid carcinoma (MEC) is an uncommon malignancy. To the best of our knowledge, this is the largest study investigating disease-specific survival (DSS) of parotid MEC and the first population-level study of the distribution of nodal metastases. METHODS: Patients with MEC of the parotid gland were identified in the Surveillance, Epidemiology, and End Results (SEER) database (1988-2009). RESULTS: We identified 2400 patients with MEC: 522 low grade, 1137 intermediate grade, and 741 high grade. Five-year DSS rates for low-grade, intermediate-grade, and high-grade MEC were 98.8%, 97.4%, and 67.0%, respectively (p < .001). Negative prognostic factors included high grade, increasing patient age, and tumor size, extraparenchymal extension, nodal metastases, and distant metastases. High-grade MEC was more likely to have lymph node metastases in levels I to III (34.0%) than low-grade (3.3%) and intermediate-grade MEC (8.1%; p < .001). CONCLUSION: Grade influences the prognosis and distribution of nodal metastases. Results indicate that management guidelines should vary based on grade.

Authors
Chen, MM; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Chen, MM, Roman, SA, Sosa, JA, and Judson, BL. "Histologic grade as prognostic indicator for mucoepidermoid carcinoma: a population-level analysis of 2400 patients." Head Neck 36.2 (February 2014): 158-163.
PMID
23765800
Source
pubmed
Published In
Head & Neck: Journal for the Sciences & Specialties of the Head and Neck
Volume
36
Issue
2
Publish Date
2014
Start Page
158
End Page
163
DOI
10.1002/hed.23256

A population-level analysis of 5620 recipients of multiple in-hospital cardiopulmonary resuscitation attempts

BACKGROUND: There is a paucity of data examining the epidemiology of recipients of multiple in-hospital cardiopulmonary resuscitation (CPR) attempts, and their outcomes. METHODS: Data source: Nationwide Inpatient Sample, 2000 to 2009. Patient characteristics, survival to discharge, discharge disposition, and cost of hospitalization of patients who had 1 versus multiple (>1) CPR attempts were compared using bivariate and multivariate methods. RESULTS: Of 166,519 hospitalized CPR recipients, 3.4% had multiple CPR attempts. Compared with 1-time CPR recipients, those undergoing multiple CPR were younger (age <65 years; 37.3% vs 42.5%, respectively), more often nonwhite (34.2% vs 41.4%), and commonly treated in nonteaching hospitals (58.0% vs 64.5%; all P<0.001). Survival to discharge decreased by >40% for each additional CPR attempt (23.4% vs 11.9%, and 6.7% for 1, 2, and ≥3 CPR attempts, respectively; P<0.001). After multivariate adjustment, multiple CPR was independently associated with a lower survival to discharge (odds ratio: 0.41, 95% confidence interval: 0.37-0.44, P<0.001). Recipients of multiple CPR were more likely to be discharged to destinations other than home (80.7% vs 70.1%, P<0.001); 1 in 15 survivors of multiple CPR were discharged to hospice (6.8%), compared with 1 in 23 patients (4.3%) who had 1 CPR (P=0.002). The average cost per day of hospitalization was higher for patients who had multiple CPR versus 1 CPR ($4484.60 vs $3581.40, P<0.001). CONCLUSIONS: Recipients of multiple in-hospital CPR attempts are more likely to be younger, nonwhite, and treated in nonteaching hospitals. Survival to discharge is significantly worse, and the cost of hospitalization is considerably higher for these patients. © 2013 Society of Hospital Medicine.

Authors
Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JA. "A population-level analysis of 5620 recipients of multiple in-hospital cardiopulmonary resuscitation attempts." Journal of Hospital Medicine 9.1 (January 1, 2014): 29-34.
Source
scopus
Published In
Journal of Hospital Medicine
Volume
9
Issue
1
Publish Date
2014
Start Page
29
End Page
34
DOI
10.1002/jhm.2127

Impact of extent of surgery on survival in patients with small nonfunctional pancreatic neuroendocrine tumors in the United States

BACKGROUND: Nonfunctional pancreatic neuroendocrine tumors (PNETs) ≤2 cm have uncertain malignant potential, and optimal treatment remains unclear. Objectives of this study were to better understand their malignant potential, determine whether extent of surgery or lymph node dissection is associated with overall survival (OS), and identify other factors associated with OS.METHODS: Patients with nonfunctional PNETs ≤2 cm were identified from the National Cancer Data Base (1998 to 2011). Descriptive statistics were used for patient characteristics and surgical resection patterns. Five-year OS was estimated using Kaplan-Meier analyses across extent of surgery and compared using the log-rank test. Cox proportional regression modeling was used to test the association between survival and extent of surgery.RESULTS: A total of 1854 patients with nonfunctional PNETs ≤2 cm were included. From 1998 to 2011, these tumors increased three-fold as a proportion of all PNETs. Among tumors ≤0.5 cm, 33 % presented with regional lymph node metastases and 11 % with distant metastases. Five-year OS for patients not undergoing surgery was 27.6 % vs. 83.0 % for partial pancreatectomy, 72.3 % for pancreaticoduodenectomy, and 86.0 % for total pancreatectomy (p < 0.01). Multivariate analysis demonstrated no difference in OS based on type of surgery or the addition of regional lymphadenectomy (p = 0.16). Younger age and later year of diagnosis were independently associated with improved survival.CONCLUSIONS: Small nonfunctional PNETs represent an increasing proportion of all PNETs and have a significant risk of malignancy. Survival is improving over time despite older age at diagnosis. Type of surgical resection and the addition of lymph node resection were not associated with OS.

Authors
Gratian, L; Pura, J; Dinan, M; Roman, S; Reed, S; Sosa, JAN
MLA Citation
Gratian, L, Pura, J, Dinan, M, Roman, S, Reed, S, and Sosa, JAN. "Impact of extent of surgery on survival in patients with small nonfunctional pancreatic neuroendocrine tumors in the United States." Annals of surgical oncology 21.11 (2014): 3515-3521.
Source
scival
Published In
Annals of Surgical Oncology
Volume
21
Issue
11
Publish Date
2014
Start Page
3515
End Page
3521
DOI
10.1245/s10434-014-3769-4

Patients with follicular and Hurthle cell microcarcinomas have compromised survival: a population level study of 22,738 patients.

BACKGROUND: There is a scarcity of evidence regarding outcomes of patients with follicular thyroid microcarcinoma and Hurthle cell microcarcinoma (<1 cm); optimal treatment for these tumors remains unclear. METHODS: Patients with follicular and Hurthle cell microcarcinomas, together (mFHCC), were selected from the Surveillance, Epidemiology, and End Results database (1988-2009) and compared with papillary thyroid microcarcinoma (mPTC). Data were analyzed with Chi-square tests, analysis of variance, the Kaplan-Meier method, log-rank tests, and Cox proportional hazards. RESULTS: We identified 564 cases of mFHCC (371 mFTC and 193 mHCC) and 22,174 cases of mPTC. mFHCC had >8 times the rate of distant (extracervical) metastases compared with mPTC (4.1% vs. 0.5%; P < .001). The 10-year disease-specific survival rate was decreased in mFHCC compared with mPTC (95.4% vs. 99.3%; P < .001), and after adjustment, follicular or Hurthle cell histology remained an independent predictor of increased mortality (hazard ratio, 5.30; P < .001). There was no difference in survival for patients who underwent total thyroidectomy versus thyroid lobectomy. CONCLUSION: In comparison with mPTC, mFHCC is rare, presents more often with distant metastases, and patients have compromised survival. Additional studies are necessary in defining the extent of surgery and role of radioactive iodine for the treatment of mFHCC.

Authors
Kuo, EJ; Roman, SA; Sosa, JA
MLA Citation
Kuo, EJ, Roman, SA, and Sosa, JA. "Patients with follicular and Hurthle cell microcarcinomas have compromised survival: a population level study of 22,738 patients." Surgery 154.6 (December 2013): 1246-1253.
PMID
23993409
Source
pubmed
Published In
Surgery
Volume
154
Issue
6
Publish Date
2013
Start Page
1246
End Page
1253
DOI
10.1016/j.surg.2013.04.033

Tall cell variant of papillary thyroid microcarcinoma: clinicopathologic features with BRAF(V600E) mutational analysis.

BACKGROUND: The tall cell variant of papillary thyroid carcinoma is an aggressive subtype that generally presents as a large tumor in the advanced stage; however, little is known about the tall cell variant of microcarcinoma (tumors measuring <1 cm). In this study, we compare the tall cell variant of microcarcinoma (microTCV) with classic papillary microcarcinomas to examine the hypothesis that, despite the small size, the microTCV may be more aggressive than the classic papillary microcarcinoma. METHODS: We identified 27 microTCV patients and compared their clinicopathologic features and BRAF(V600E) mutational status with classic papillary microcarcinomas matched by age and size. The patients with microTCV included 22 women and 5 men aged 33 to 74 years (median age, 56 years). All patients underwent total thyroidectomy; 20 patients had lymph node dissection. RESULTS: Tumor size in microTCV patients ranged from 2 mm to 10 mm (median, 7 mm). Extrathyroidal extension and lymphovascular invasion were seen in 9 (33%) and 4 (15%) tumors, respectively. Thirteen patients (48%) harbored multifocal papillary carcinomas. Metastasis to central compartment lymph nodes was seen in 8 patients and to lateral cervical nodes in 3 patients. Nine of the 25 patients (36%) presented at an advanced stage (stage III/IVA). The BRAF(V600E) mutation was detected in 25 of 27 tumors (92.6%). In contrast, age- and size-matched classic papillary microcarcinomas (n=26) showed no extrathyroidal extension (p=0.002), lymphovascular invasion in 1, central compartment lymph node metastasis in 2, lateral cervical node metastasis in 1, multifocal tumors in 10 (38.5%), the BRAF(V600E) mutation in 20 (76.9%), and it infrequently presented in stage III/IVA (7.7%, p=0.02). CONCLUSIONS: The microTCV form is associated with aggressive features at presentation, and it should be differentiated from other papillary thyroid microcarcinomas.

Authors
Bernstein, J; Virk, RK; Hui, P; Prasad, A; Westra, WH; Tallini, G; Adeniran, AJ; Udelsman, R; Sasaki, CT; Roman, SA; Sosa, JA; Prasad, ML
MLA Citation
Bernstein, J, Virk, RK, Hui, P, Prasad, A, Westra, WH, Tallini, G, Adeniran, AJ, Udelsman, R, Sasaki, CT, Roman, SA, Sosa, JA, and Prasad, ML. "Tall cell variant of papillary thyroid microcarcinoma: clinicopathologic features with BRAF(V600E) mutational analysis." Thyroid : official journal of the American Thyroid Association 23.12 (December 2013): 1525-1531.
PMID
23682579
Source
epmc
Published In
Thyroid
Volume
23
Issue
12
Publish Date
2013
Start Page
1525
End Page
1531
DOI
10.1089/thy.2013.0154

Postdischarge complications predict reoperation and mortality after otolaryngologic surgery.

OBJECTIVES: (1) Determine procedure-specific rates of postdischarge complications (PDCs) and their risk factors in the first 30 days following inpatient otolaryngologic surgery. (2) Evaluate association between PDCs and risk of reoperation and mortality. STUDY DESIGN: Retrospective cohort study. SETTING: American College of Surgeons National Surgical Quality Improvement Program (2005-2011). SUBJECTS AND METHODS: We identified 48,028 adult patients who underwent inpatient otolaryngologic surgery. Outcomes of interest included complications, reoperation, and mortality in the first 30 days following surgery. Statistical analysis included chi-square, t tests, and multivariate regression. RESULTS: Laryngectomy, lip, and tongue/floor of mouth surgery had the highest PDC rates (8.0%, 7.4%, and 4.1%, respectively). Within the first 48 hours, week, and 2 weeks post discharge, 10%, 44%, and 73% of PDCs occurred, respectively. Common PDCs included surgical site infections (53.6%), other infections (37.4%), and venous thromboembolic events (7.4%). Multivariate analysis demonstrated that increasing age (odds ratio [OR] = 1.01; 95% confidence interval [CI], 1.01-1.02), prolonged operative time (OR = 1.68; 95% CI, 1.39-2.03), hospital stay >1 day (OR = 1.49; 95% CI, 1.18-1.86), and American Society of Anesthesiologists (ASA) class ≥ 3 (OR = 1.45; 95% CI, 1.18-1.78) were independently associated with PDCs. Patients with PDCs were more likely to die (0.9% vs 0.1%, P < .001) or have a reoperation (10.4% vs 1.2%, P < .001). CONCLUSION: This is the first study of overall postdischarge events after otolaryngologic surgery. PDC rates in otolaryngology occur soon after discharge, are procedure specific, and are associated with reoperation and mortality. Targeted procedure-specific triage and follow-up plans for high-risk patients may improve outcomes.

Authors
Chen, MM; Roman, SA; Sosa, JA; Judson, BL
MLA Citation
Chen, MM, Roman, SA, Sosa, JA, and Judson, BL. "Postdischarge complications predict reoperation and mortality after otolaryngologic surgery." Otolaryngol Head Neck Surg 149.6 (December 2013): 865-872.
PMID
24047818
Source
pubmed
Published In
Otolaryngology
Volume
149
Issue
6
Publish Date
2013
Start Page
865
End Page
872
DOI
10.1177/0194599813505078

Effect of a matrigel sandwich on endodermal differentiation of human embryonic stem cells.

Definitive endoderm can be derived from human embryonic stem cells using low serum medium with cytokines involved in the epithelial-to-mesenchymal transition, including Activin A and Wnt3A. The purpose of this study was to develop an improved protocol that permits the induction of definitive endoderm while avoiding the high rate of cell death that often occurs with existing protocols. By including insulin and other nutrients, we demonstrate that cell viability can be preserved throughout differentiation. In addition, modifying a matrigel sandwich method previously reported to induce precardiac mesoderm allows for enhanced endodermal differentiation based on expression of endoderm-associated genes. The morphological and migratory characteristics of cells cultured by the technique, as well as gene expression patterns, indicate that the protocol can emulate key events in gastrulation towards the induction of definitive endoderm.

Authors
Lawton, BR; Sosa, JA; Roman, S; Krause, DS
MLA Citation
Lawton, BR, Sosa, JA, Roman, S, and Krause, DS. "Effect of a matrigel sandwich on endodermal differentiation of human embryonic stem cells." Stem cell reviews 9.5 (October 2013): 578-585.
PMID
23719997
Source
epmc
Published In
Stem Cell Reviews and Reports
Volume
9
Issue
5
Publish Date
2013
Start Page
578
End Page
585
DOI
10.1007/s12015-013-9447-2

Aggressive variants of papillary thyroid microcarcinoma are associated with extrathyroidal spread and lymph-node metastases: a population-level analysis.

BACKGROUND: Tall cell variant (TCV) and diffuse sclerosing variant (DSV) of papillary thyroid cancer are aggressive subtypes, for which tumors ≤1 cm have not been exclusively studied. METHODS: The SEER database (1988-2009) was used to compare characteristics of TCV ≤1 cm (mTCV) and DSV ≤1 cm (mDSV) with classic papillary thyroid microcarcinoma (mPTC). Survival was analyzed with the Kaplan-Meier method and log-rank test, and risk factors for nodal metastases with chi-square analysis and binary logistic regression. RESULTS: There were 97 mTCV, 90 mDSV, and 18,260 mPTC patients. mTCV incidence increased by 79.9% (p=0.153) over the study period, while mDSV incidence decreased by 10.3% (p=0.315). Compared to classic mPTC, mTCV tended to be larger on average (7.1 mm vs. 5.3 mm, p<0.001), with higher rates of multifocality (47.2% vs. 34.0% respectively, p=0.018) and lymph-node examination (63.9% vs. 39.2% respectively, p<0.001), while in mDSV, nodal metastases were more frequent (57.1% vs. 33.1% respectively, p=0.007). Both aggressive variants had higher rates of extrathyroidal extension (27.8% mTCV vs. 13.3% mDSV vs. 6.1% mPTC, p<0.001). Aggressive variants also received radioactive iodine more frequently (39.2% mTCV vs. 40.0% mDSV vs. 29.1% mPTC, p<0.001). However, they were not statistically more likely to receive thyroidectomy over lobectomy compared to classic mPTC. There were no significant differences in overall and disease-specific survival between the histologies. In mTCV, after adjustment, extrathyroidal extension was independently associated with size >7 mm (odds ratio (OR) 4.4 [CI 1.5-13.6]) and nodal metastasis with multifocality (OR 5.4 [CI 1.3-23.4]) and extrathyroidal extension (OR 5.8 [CI 1.3-25.4]). No statistically significant predictors of extrathyroidal extension or nodal metastasis in mDSV were observed. CONCLUSIONS: Aggressive variants of mPTC tend to exhibit more aggressive pathologic characteristics than classic mPTC, but survival appears to be similar. Treatment with total thyroidectomy and central lymphadenectomy may be warranted if the diagnosis can be made pre- or intraoperatively.

Authors
Kuo, EJ; Goffredo, P; Sosa, JA; Roman, SA
MLA Citation
Kuo, EJ, Goffredo, P, Sosa, JA, and Roman, SA. "Aggressive variants of papillary thyroid microcarcinoma are associated with extrathyroidal spread and lymph-node metastases: a population-level analysis." Thyroid 23.10 (October 2013): 1305-1311.
PMID
23600998
Source
pubmed
Published In
Thyroid
Volume
23
Issue
10
Publish Date
2013
Start Page
1305
End Page
1311
DOI
10.1089/thy.2012.0563

A Meta-analysis of the Effect of Prophylactic Central Compartment Neck Dissection on Locoregional Recurrence Rates in Patients with Papillary Thyroid Cancer

Authors
Wang, TS; Cheung, K; Farrokhyar, F; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Cheung, K, Farrokhyar, F, Roman, SA, and Sosa, JA. "A Meta-analysis of the Effect of Prophylactic Central Compartment Neck Dissection on Locoregional Recurrence Rates in Patients with Papillary Thyroid Cancer." ANNALS OF SURGICAL ONCOLOGY 20.11 (October 2013): 3477-3483.
PMID
23846784
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
20
Issue
11
Publish Date
2013
Start Page
3477
End Page
3483
DOI
10.1245/s10434-013-3125-0

The impact of implementing The Bethesda System for reporting of thyroid FNA at an academic center.

Recently, a six-tiered diagnostic risk classification system was created based on the recommendations of the National Cancer Institute (NCI) sponsored NCI Thyroid Needle Aspiration State of the Science Conference at Bethesda, MD in October 2007. The objective of the current study was to compare the frequency distribution of the various diagnostic categories to evaluate its diagnostic performance before and after implementation of The Bethesda System (TBS). A total of 5,897 thyroid Fine needle aspirations (FNAs) were reviewed; 3,207 were from 2008 after TBS implementation, and 2,690 were from 2007 immediately before TBS implementation. Follow-up consisted of reviewing corresponding histologic results. The rates of "Nondiagnostic" specimens and cases with a diagnosis of "Follicular Neoplasm" decreased from 13.1 to 11.1% and 8.6 to 5.5%, respectively, after implementation of TBS, while the rate of negative specimens increased from 68.2 to 73.8%. The other categories remained relatively stable. In addition, there also was a significant decrease in the use of noncommittal descriptive diagnoses. The diagnostic performance of thyroid FNA in identifying a neoplastic process as measured by area under the receiver operating characteristic curve increased from 0.88 to 0.89; the difference was statistically significant (P=0.03). Implementation of TBS showed a significant reduction of: nondiagnostic thyroid FNAs, of FNAs with a diagnosis of "Follicular Neoplasm," as well as cases with descriptive noncommittal diagnoses. TBS results in improved diagnostic performance and therefore more consistent and uniform reporting of thyroid FNA.

Authors
Theoharis, C; Adeniran, AJ; Roman, S; Sosa, JA; Chhieng, D
MLA Citation
Theoharis, C, Adeniran, AJ, Roman, S, Sosa, JA, and Chhieng, D. "The impact of implementing The Bethesda System for reporting of thyroid FNA at an academic center." Diagnostic cytopathology 41.10 (October 2013): 858-863.
PMID
23512999
Source
epmc
Published In
Diagnostic Cytopathology
Volume
41
Issue
10
Publish Date
2013
Start Page
858
End Page
863
DOI
10.1002/dc.22970

Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009

Authors
Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JA. "Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000-2009." RESUSCITATION 84.9 (September 2013): 1255-1260.
PMID
23470471
Source
wos-lite
Published In
Resuscitation
Volume
84
Issue
9
Publish Date
2013
Start Page
1255
End Page
1260
DOI
10.1016/j.resuscitation.2013.02.021

Telementoring: a multi-institutional experience with the introduction of a novel surgical approach for adrenalectomy.

BACKGROUND: Telementoring is a video-conferencing tool which can deliver expert opinion to physicians and their patients in remote locations. We report our experience with the use of telementoring as a technique to instruct in the performance of posterior retroperitoneoscopic adrenalectomy (PRA). Issues regarding utility, regulation, and future directions of telementoring are addressed. METHODS: Two consecutive PRAs conducted at Yale New Haven Hospital, New Haven, Connecticut, with telementored guidance from MD Anderson Cancer Center, Houston, Texas, are presented. Practical points in implementing cross-institutional telementoring are presented. A review of the current literature was done to discuss medicolegal issues, regulations and a proposal for future implementation of this technique. RESULTS: The PRAs were performed after careful preparation of appropriate issues regarding cross-institutional telementoring. The procedures were performed quickly and safely. Loss of transmission occurred once, but was reestablished within seconds and was not disruptive to the surgical procedure. Patients were discharged within 48 hours and without complications. In our experience, telementoring was convenient and effective in helping with the execution of a new surgical technique. CONCLUSIONS: Telementoring is a technical application with utility in remotely helping and guiding another surgeon through the execution of a novel surgical approach. The cyberspace consultation is safe and enhances patient care through a real-time collaborative approach which extends beyond the confines of one institution and one surgeon. Aspects concerning improvement in both implementation and regulation of telementoring mandate further research and creation of nationwide guidelines.

Authors
Treter, S; Perrier, N; Sosa, JA; Roman, S
MLA Citation
Treter, S, Perrier, N, Sosa, JA, and Roman, S. "Telementoring: a multi-institutional experience with the introduction of a novel surgical approach for adrenalectomy." Annals of surgical oncology 20.8 (August 2013): 2754-2758.
PMID
23512076
Source
epmc
Published In
Annals of Surgical Oncology
Volume
20
Issue
8
Publish Date
2013
Start Page
2754
End Page
2758
DOI
10.1245/s10434-013-2894-9

Life events during surgical residency have different effects on women and men over time.

BACKGROUND: Women represent half of medical school graduates in the United States. Our aim was to characterize the effects of marriage and childbirth on the experiences of surgery residents. METHODS: This was a prospective, longitudinal study of categorical general surgery residents between 2008 and 2010. Outcomes included changes in faculty and peer relationships, work-life balance, financial security, and career goals over time. RESULTS: We included 4,028 residents. Compared with men, women in postgraduate years (PGYs) 1 through 5 were less likely to be married (28.2% to 47.3% vs 49.6% to 67.6%) or have children (4.6% to 18.0% vs 19.0% to 45.8%) (P < .001). Women who married during PGY1 to PGY3 became worried about performing in front of senior residents (P = .005); men who married were more likely to be happy at work (P = .005). Women who had a first child during PGY1 to PGY3 were more likely to feel overwhelmed (P = .008) and worry about financial security (P = .03) than other women. Men who had a child were more likely to feel supported by faculty (P = .004), but they experienced more family strain (P = .008) compared to childless men. CONCLUSION: Marriage and childbirth are associated with divergent changes in career experiences for women and men. Women lag behind their male peers in these life events from start to finish of residency.

Authors
Chen, MM; Yeo, HL; Roman, SA; Bell, RH; Sosa, JA
MLA Citation
Chen, MM, Yeo, HL, Roman, SA, Bell, RH, and Sosa, JA. "Life events during surgical residency have different effects on women and men over time." Surgery 154.2 (August 2013): 162-170.
PMID
23889946
Source
pubmed
Published In
Surgery
Volume
154
Issue
2
Publish Date
2013
Start Page
162
End Page
170
DOI
10.1016/j.surg.2013.03.014

Differentiated Thyroid Cancer Presenting with Distant Metastases: A Population Analysis Over Two Decades

Authors
Goffredo, P; Sosa, JA; Roman, SA
MLA Citation
Goffredo, P, Sosa, JA, and Roman, SA. "Differentiated Thyroid Cancer Presenting with Distant Metastases: A Population Analysis Over Two Decades." WORLD JOURNAL OF SURGERY 37.7 (July 2013): 1599-1605.
PMID
23525600
Source
wos-lite
Published In
World Journal of Surgery
Volume
37
Issue
7
Publish Date
2013
Start Page
1599
End Page
1605
DOI
10.1007/s00268-013-2006-9

Central lymph node dissection in patients with papillary thyroid cancer: a population level analysis of 14,257 cases

Authors
Enyioha, C; Roman, SA; Sosa, JA
MLA Citation
Enyioha, C, Roman, SA, and Sosa, JA. "Central lymph node dissection in patients with papillary thyroid cancer: a population level analysis of 14,257 cases." AMERICAN JOURNAL OF SURGERY 205.6 (June 2013): 655-661.
PMID
23414635
Source
wos-lite
Published In
The American Journal of Surgery
Volume
205
Issue
6
Publish Date
2013
Start Page
655
End Page
661
DOI
10.1016/j.amjsurg.2012.06.012

Discrepancies in training satisfaction and program completion among 2662 categorical and preliminary general surgery residents.

OBJECTIVE: To compare training experiences of postgraduate year (PGY)-1 and PGY-2 categorical and nondesignated preliminary (NDP) residents and examine NDP educational outcomes. BACKGROUND: There is a paucity of research describing the professional attitudes of NDP surgical trainees. METHODS: Analysis of the 2009 National Study of Expectations and Attitudes of Residents in Surgery survey and American Board of Surgery 2009 to 2011 Resident Rosters. Chi-square and hierarchical logistic regression modeling were employed. RESULTS: A total of 1428 PGY-1s (528 NDPs) and 1234 PGY-2s (189 NDPs) were included. Among PGY-1s, NDPs reported lower program satisfaction than categorical residents (84.2% vs 89.2%, P = .007), and less collegiality with coresidents (P = 0.001). NDPs were less satisfied with their operative experience (P = 0.002) and less frequently enjoyed operating (P < 0.001). NDPs more frequently reported that "the personal cost of surgical training is not worth it" (11.2% vs 3.7%, P < 0.001) and were less frequently committed to completing their surgical training (P < 0.001). Among PGY-2s, NDPs expressed a lower program fit (P = 0.008) and commitment to program completion (P = 0.037). Of 1102 NDP PGY-1s and PGY-2s on the 2009 American Board of Surgery Resident Roster, 347 achieved categorical status by 2011 (31.5%), including 237 National Study of Expectations and Attitudes of Residents in Surgery respondents (34.3%). Marked response differences were found between NDPs who ultimately did and did not achieve categorical status. In hierarchical logistic regression modeling, older age [30-34 years, odds ratio (OR): 0.54; ≥35 years, OR: 0.28), and race/ethnicity (black, OR: 0.28; Hispanic, OR: 0.50) were negatively associated with an NDP attaining categorical status. CONCLUSIONS: The residency experience for NDPs appears less rewarding than for categorical residents. NDPs report less robust operative experience and overall support. Ultimately, only one third of NDPs become categorical surgery residents.

Authors
Sullivan, MC; Yeo, H; Roman, SA; Jones, AT; Bell, RH; Sosa, JA
MLA Citation
Sullivan, MC, Yeo, H, Roman, SA, Jones, AT, Bell, RH, and Sosa, JA. "Discrepancies in training satisfaction and program completion among 2662 categorical and preliminary general surgery residents." Annals of surgery 257.6 (June 2013): 1174-1180.
PMID
23059505
Source
epmc
Published In
Annals of Surgery
Volume
257
Issue
6
Publish Date
2013
Start Page
1174
End Page
1180
DOI
10.1097/sla.0b013e3182718ef1

Malignant pheochromocytoma and paraganglioma: A population level analysis of long-term survival over two decades

Authors
Goffredo, P; Sosa, JA; Roman, SA
MLA Citation
Goffredo, P, Sosa, JA, and Roman, SA. "Malignant pheochromocytoma and paraganglioma: A population level analysis of long-term survival over two decades." JOURNAL OF SURGICAL ONCOLOGY 107.6 (May 2013): 659-664.
PMID
23233320
Source
wos-lite
Published In
Journal of Surgical Oncology
Volume
107
Issue
6
Publish Date
2013
Start Page
659
End Page
664
DOI
10.1002/jso.23297

Race and surgical residency: results from a national survey of 4339 US general surgery residents.

OBJECTIVE: To determine how race influences US general surgery residents' experiences during residency training. BACKGROUND: Minorities are underrepresented in medicine, particularly surgery, with no large-scale studies investigating their training experiences. METHODS: Cross-sectional national survey administered after the 2008 American Board of Surgery In-Training Examination to all categorical general surgery residents. Demographic characteristics and survey responses with respect to race were evaluated using the χ test and hierarchical logistic regression modeling. RESULTS: A total of 4339 residents were included: 61.9% whites, 18.5% Asians, 8.5% Hispanics, 5.3% Blacks, and 5.8% Others. Minorities differed from whites in sex proportion, marital status, number of children, geographic location, type of residency program, and 24 survey items (all Ps < 0.05). Compared with white residents, Black, Asian, and Other residents were less likely to feel they fit in at their programs (86.2% vs 73.9%, 83.3%, and 81.2%, respectively; P < 0.001). Black and Asian residents were more likely to report that attendings would think worse of them if they asked for help (13.5% vs 20.4% and 18.4%, respectively; P = 0.002), and Black residents were less likely to feel they could count on their peers for help (85.2% vs 77.2%; P = 0.017). On hierarchical logistic regression modeling, Blacks were least likely to fit in at their programs (odds ratio = 0.6; P = 0.004), and all minorities were more likely to feel that there was a need for additional specialty training (odds ratio = 1.4 Blacks and Hispanics, 1.9 Asians, and 2.1 Others; all Ps ≤ 0.05). CONCLUSIONS: Minority residents report less positively on program fit and relationships with faculty and peers. Future studies should focus on examining residency interventions to improve support and integration of minority residents.

Authors
Wong, RL; Sullivan, MC; Yeo, HL; Roman, SA; Bell, RH; Sosa, JA
MLA Citation
Wong, RL, Sullivan, MC, Yeo, HL, Roman, SA, Bell, RH, and Sosa, JA. "Race and surgical residency: results from a national survey of 4339 US general surgery residents." Ann Surg 257.4 (April 2013): 782-787.
PMID
23001076
Source
pubmed
Published In
Annals of Surgery
Volume
257
Issue
4
Publish Date
2013
Start Page
782
End Page
787
DOI
10.1097/SLA.0b013e318269d2d0

Can minimally invasive follicular thyroid cancer be approached as a benign lesion? : A population-level analysis of survival among 1,200 patients

Background: Minimally invasive follicular thyroid cancer (MIFC) is an encapsulated follicular tumor of low malignant potential. To date, histological criteria are still under debate, and there are no population-level data regarding characteristics and outcomes of patients with MIFC. Methods: Patients diagnosed with MIFC in the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2009 were included. Summary statistics were utilized to analyze patient characteristics; Kaplan-Meier analysis, and one-sample log-rank test were performed. Results: A total of 1,200 patients with MIFC and 4,208 with widely invasive follicular thyroid cancer (WIFC) were identified over 10 years of follow-up. MIFC was more common than WIFC in younger patients (mean age 49 vs. 52.3 years; p < 0.001). More patients with MIFC were alive at the end of follow-up (96.8 vs. 86.5 % WIFC; p < 0.001). Patients diagnosed with MIFC were less likely than those with WIFC to have lymph nodes involved and distant metastases (0.9 vs. 3.6 % and 0.5 vs. 8.9 %, respectively; both p < 0.001). Only 2 of 1,200 patients died of disease-specific causes; overall survival was comparable to the general US population (p = 0.16). Total thyroidectomy and RAI ablation were not associated with improvement in patient outcomes (p = 0.2 and 0.443, respectively). Conclusions: MIFC is associated with survival comparable to that of the normative US general population. Thyroid lobectomy alone may be considered adequate treatment in these patients. © 2012 Society of Surgical Oncology.

Authors
Goffredo, P; Cheung, K; Roman, SA; Sosa, JA
MLA Citation
Goffredo, P, Cheung, K, Roman, SA, and Sosa, JA. "Can minimally invasive follicular thyroid cancer be approached as a benign lesion? : A population-level analysis of survival among 1,200 patients." Annals of Surgical Oncology 20.3 (March 1, 2013): 767-772.
Source
scopus
Published In
Annals of Surgical Oncology
Volume
20
Issue
3
Publish Date
2013
Start Page
767
End Page
772
DOI
10.1245/s10434-012-2697-4

Striving for work-life balance: effect of marriage and children on the experience of 4402 US general surgery residents.

OBJECTIVE: To determine how marital status and having children impact US general surgical residents' attitudes toward training and personal life. BACKGROUND: There is a paucity of research describing how family and children affect the experience of general surgery residents. METHODS: Cross-sectional survey involving all US categorical general surgery residents. Responses were evaluated by resident/program characteristics. Statistical analysis included the χ test and hierarchical logistic regression modeling. RESULTS: A total of 4402 residents were included (82.4% response rate) and categorized as married, single, or other (separated/divorced/widowed). Men were more likely to be married (57.8% vs 37.9%, P < 0.001) and have children (31.5% vs 12.0%, P < 0.001). Married residents were most likely to look forward to work (P < 0.001), and report happiness at work (P < 0.001) and a good program fit (P < 0.001). "Other" residents most frequently felt that work hours caused strain on family life (P < 0.001). Residents with children more frequently looked forward to work (P = 0.001), were happy at work (P = 0.001), and reported a good program fit (P = 0.034), but had strain on family life (P < 0.001), and worried about future finances (P = 0.005). On hierarchical logistic regression modeling, having children was predictive of a resident looking forward to work [odds ratio (OR): 1.22, P = 0.035], yet feeling that work caused family strain (OR: 1.66, P < 0.001); being single was associated with less strain (OR: 0.72, P < 0.001). The female gender was negatively associated with looking forward to work (OR: 0.81, P = 0.007). CONCLUSIONS: Residents who were married or parents reported greater satisfaction and work-life conflict. The complex effects of family on surgical residents should inform programs to target support mechanisms for their trainees.

Authors
Sullivan, MC; Yeo, H; Roman, SA; Bell, RH; Sosa, JA
MLA Citation
Sullivan, MC, Yeo, H, Roman, SA, Bell, RH, and Sosa, JA. "Striving for work-life balance: effect of marriage and children on the experience of 4402 US general surgery residents." Ann Surg 257.3 (March 2013): 571-576.
PMID
22964726
Source
pubmed
Published In
Annals of Surgery
Volume
257
Issue
3
Publish Date
2013
Start Page
571
End Page
576
DOI
10.1097/SLA.0b013e318269d05c

Surgical Residency and Attrition: Defining the Individual and Programmatic Factors Predictive of Trainee Losses

Authors
Sullivan, MC; Yeo, H; Roman, SA; Ciarleglio, MM; Cong, X; Jr, BRH; Sosa, JA
MLA Citation
Sullivan, MC, Yeo, H, Roman, SA, Ciarleglio, MM, Cong, X, Jr, BRH, and Sosa, JA. "Surgical Residency and Attrition: Defining the Individual and Programmatic Factors Predictive of Trainee Losses." JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS 216.3 (March 2013): 461-471.
PMID
23266420
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
216
Issue
3
Publish Date
2013
Start Page
461
End Page
471
DOI
10.1016/j.jamcollsurg.2012.11.005

Can minimally invasive follicular thyroid cancer be approached as a benign lesion?: a population-level analysis of survival among 1,200 patients.

BACKGROUND: Minimally invasive follicular thyroid cancer (MIFC) is an encapsulated follicular tumor of low malignant potential. To date, histological criteria are still under debate, and there are no population-level data regarding characteristics and outcomes of patients with MIFC. METHODS: Patients diagnosed with MIFC in the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2009 were included. Summary statistics were utilized to analyze patient characteristics; Kaplan-Meier analysis, and one-sample log-rank test were performed. RESULTS: A total of 1,200 patients with MIFC and 4,208 with widely invasive follicular thyroid cancer (WIFC) were identified over 10 years of follow-up. MIFC was more common than WIFC in younger patients (mean age 49 vs. 52.3 years; p < 0.001). More patients with MIFC were alive at the end of follow-up (96.8 vs. 86.5% WIFC; p < 0.001). Patients diagnosed with MIFC were less likely than those with WIFC to have lymph nodes involved and distant metastases (0.9 vs. 3.6% and 0.5 vs. 8.9%, respectively; both p < 0.001). Only 2 of 1,200 patients died of disease-specific causes; overall survival was comparable to the general US population (p = 0.16). Total thyroidectomy and RAI ablation were not associated with improvement in patient outcomes (p = 0.2 and 0.443, respectively). CONCLUSIONS: MIFC is associated with survival comparable to that of the normative US general population. Thyroid lobectomy alone may be considered adequate treatment in these patients.

Authors
Goffredo, P; Cheung, K; Roman, SA; Sosa, JA
MLA Citation
Goffredo, P, Cheung, K, Roman, SA, and Sosa, JA. "Can minimally invasive follicular thyroid cancer be approached as a benign lesion?: a population-level analysis of survival among 1,200 patients." Annals of surgical oncology 20.3 (March 2013): 767-772.
PMID
23111705
Source
epmc
Published In
Annals of Surgical Oncology
Volume
20
Issue
3
Publish Date
2013
Start Page
767
End Page
772
DOI
10.1245/s10434-012-2697-4

Vanishing thyroid tumors: a diagnostic dilemma after ultrasonography-guided fine-needle aspiration.

BACKGROUND: Fine-needle aspiration (FNA) is the most accurate and cost-effective method for evaluating thyroid nodules. However, FNA-induced secondary changes completely replacing thyroid tumors (vanishing tumors) may create a novel problem. In this study, we highlight the diagnostic and management issues associated with the unintended consequences of ultrasonography (US)-guided FNA. METHODS: Fourteen thyroid glands (11 women and 3 men, ages 33-64 years) with vanishing tumors were prospectively identified between 2009 and 2012 upon surgical resection. Cytology and histopathology slides were reviewed, and second opinions were obtained when necessary. RESULTS: The cytology of the 14 vanishing tumors was suspicious/positive for papillary thyroid carcinoma (PTC) in 5, indeterminate (atypia of unknown significance) in 5, benign in 2, follicular neoplasm in 1, and nondiagnostic in 1 nodule. Upon thyroidectomy, the vanishing tumors ranged in size from 0.4 to 3.5 cm (median 0.7 cm). Microscopically, the nodules showed cystic degeneration, organizing hemorrhage, granulation tissue, fibrosis, and microcalcifications. In seven tumors, a few residual malignant cells (PTC in five) or residual benign follicles (hemorrhagic cyst in two) at the periphery of the vanishing tumors helped with the final diagnosis. The remaining seven tumors were completely replaced by FNA-induced secondary changes, and had the cytology diagnosis of benign in one, follicular neoplasm in one, and suspicious/positive for PTC in five. Of the latter five, two showed additional separate foci of PTC, while three vanishing tumors (0.5, 1.2, and 1.6 cm) had no residual malignant cells and no additional carcinoma leading to a final diagnosis of negative for malignancy. CONCLUSIONS: US-guided FNA may lead to complete obliteration of thyroid nodules, rendering final diagnosis upon thyroidectomy difficult or impossible. In these unusual circumstances, the possibility that the surgical pathology may be nonrepresentative should be considered if the cytologic features on FNA are sufficient by themselves to support a definitive diagnosis of PTC.

Authors
Eze, OP; Cai, G; Baloch, ZW; Khan, A; Virk, R; Hammers, LW; Udelsman, R; Roman, SA; Sosa, JA; Carling, T; Chhieng, D; Theoharis, CGA; Prasad, ML
MLA Citation
Eze, OP, Cai, G, Baloch, ZW, Khan, A, Virk, R, Hammers, LW, Udelsman, R, Roman, SA, Sosa, JA, Carling, T, Chhieng, D, Theoharis, CGA, and Prasad, ML. "Vanishing thyroid tumors: a diagnostic dilemma after ultrasonography-guided fine-needle aspiration." Thyroid : official journal of the American Thyroid Association 23.2 (February 2013): 194-200.
PMID
22928739
Source
epmc
Published In
Thyroid
Volume
23
Issue
2
Publish Date
2013
Start Page
194
End Page
200
DOI
10.1089/thy.2012.0157

Hurthle cell carcinoma: a population-level analysis of 3311 patients.

Hurthle cell carcinoma (HCC) is an uncommon and more aggressive thyroid cancer. To date, there is a paucity of data at a population level. In this study, demographic, clinical, and pathologic characteristics of HCC were investigated and compared with other types of differentiated thyroid cancers (ODTCs). The authors also evaluated disease-specific survival and compliance with American Thyroid Association (ATA) management guidelines from 2009.The Surveillance, Epidemiology, and End Results (SEER) database from 1988 to 2009 was used to obtain data on patients with thyroid cancer. Data analyses were performed using chi-square tests, analysis of variance, Kaplan-Meier analysis, binary logistic regression, and Cox proportional hazards regression.In total, 3311 patients with HCC and 59,585 patients with ODTC were identified. Compared with ODTC, HCC was more common among men (31.1% vs 23.0% for ODTC; P < .001) and among older patients (mean age, 57.6 years vs 48.9 years for ODTC; P < .001). Patients with HCC presented with higher SEER disease stage (P < .001), and their tumors were larger (36.1 mm vs 20.2 mm for ODTC; P < .001). Fewer patients underwent total thyroidectomy (P = .028). Both overall and disease-specific survival were lower for patients with HCC (P < .001), and neither improved over the last 2 decades (P = .689). After adjustment, age ≥45 years, not undergoing surgery, and metastatic disease were strongly associated with a worse prognosis (hazard ratio >3.0). Compliance with recommended surgical treatment according to ATA guidelines was lower among patients with HCC aged ≥65 years (odds ratio [OR], 1.43; P = .002) and among unmarried patients (OR, 1.29; P = .004). Predictors of noncompliance with ATA guidelines for treatment with radioactive implants or radioisotopes were age ≥65 years (OR, 1.31; P = .017), diagnosis between 1988 and 1997, no surgery, and partial thyroidectomy (OR, 1.81, 19.48, and 4.02, respectively; P < .001).HCC has more aggressive behavior and compromised survival compared with ODTC. The current results indicated that it may be important to consider a different staging system or separate practice guidelines.

Authors
Goffredo, P; Roman, SA; Sosa, JA
MLA Citation
Goffredo, P, Roman, SA, and Sosa, JA. "Hurthle cell carcinoma: a population-level analysis of 3311 patients." Cancer 119.3 (February 2013): 504-511.
PMID
22893587
Source
epmc
Published In
Cancer
Volume
119
Issue
3
Publish Date
2013
Start Page
504
End Page
511
DOI
10.1002/cncr.27770

Aggressive variants of papillary thyroid cancer.

PURPOSE OF REVIEW: Aggressive variants of papillary thyroid cancer (PTC) have been recognized with increasing frequency. The most common of these include the diffuse sclerosing variant, tall cell variant, and insular thyroid cancer. These tumors may represent a spectrum of dedifferentiation from classic PTC to anaplastic thyroid cancers. RECENT FINDINGS: Pathologists are reaching consensus in the diagnosis of these variants, recognizing their important distinction in clinical behavior. Preoperative studies such as ultrasonography, fine-needle aspiration, and better molecular and genetic markers help raise the suspicion of a thyroid nodule possibly harboring an aggressive cancer; this in turn allows the surgeons and endocrinologists to formulate a more complete operative plan, including thyroidectomy, possible lymphadenectomy, and postoperative radioactive iodine administration. In the past, most studies on these variants have relied on single institution and small clinical series; however, recent population-level analyses using national databases such as Surveillance, Epidemiology and End Result have included larger numbers of cases collected over many years. SUMMARY: These studies have allowed for the identification of temporal trends in tumor incidence, and long-term analyses of the clinical, pathological, and survival outcomes of patients with these aggressive variants.

Authors
Roman, S; Sosa, JA
MLA Citation
Roman, S, and Sosa, JA. "Aggressive variants of papillary thyroid cancer." Current opinion in oncology 25.1 (January 2013): 33-38. (Review)
PMID
23197194
Source
epmc
Published In
Current Opinion in Oncology
Volume
25
Issue
1
Publish Date
2013
Start Page
33
End Page
38
DOI
10.1097/cco.0b013e32835b7c6b

New targeted therapies and other advances in the management of anaplastic thyroid cancer.

Anaplastic thyroid cancer is the most aggressive solid tumor known to humans. Even when found in a localized form, the prognosis is grave. For metastatic disease, there has been little effect on survival using traditional chemotherapy.Over a five-decade interval, there has been little progress in the treatment of this malignancy. However, targeted agents represent a new mode of treatment, and some studies have shown encouraging preclinical results. Combretastatin has shown activity in phase 1 and phase II trials; although the registration phase III study failed to meet its accrual goals, it did appear to show some benefit, especially in younger patients.Combinations of this compound and other targeted agents may prove to be a breakthrough in an otherwise untreatable cancer.

Authors
Deshpande, HA; Roman, S; Sosa, JA
MLA Citation
Deshpande, HA, Roman, S, and Sosa, JA. "New targeted therapies and other advances in the management of anaplastic thyroid cancer." Current opinion in oncology 25.1 (January 2013): 44-49. (Review)
PMID
23159847
Source
epmc
Published In
Current Opinion in Oncology
Volume
25
Issue
1
Publish Date
2013
Start Page
44
End Page
49
DOI
10.1097/cco.0b013e32835a448c

BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype-phenotype correlation.

BRAF(V600E) mutation has emerged as a marker of aggressive behavior in papillary thyroid carcinoma but its significance in microcarcinoma is not entirely clear. One-hundred and twenty-nine papillary thyroid microcarcinomas were tested for BRAF(V600E) mutation by single-strand conformation polymorphism, and their clinicopathologic features (age, sex, tumor size, multifocality, nodal metastases, histologic subtype, tumor cell morphology, architecture, tumor-associated stromal reaction, tumor interface to non-neoplastic thyroid (well circumscribed vs infiltrative), extrathyroidal extension, lymphovascular invasion, intratumoral multinucleated giant cells, and adjacent non-neoplastic thyroid pathology) were examined. Compared with tumors without the mutation (39/129, 30%), the mutated microcarcinomas (90/129, 70%) showed significantly higher prevalence of infiltrative tumor borders (78/90 vs 23/39, P=0.001), tumor-associated stromal desmoplasia/fibrosis and/or sclerosis (80/90 vs 25/39, P=0.002), classic nuclear features of papillary thyroid carcinoma (90/90 vs 35/39, P=0.008) and cystic change (43/90 vs 11/39, P=0.05). BRAF(V600E) mutation was more frequent in classic (75%), tall cell (91%), and other variants (>70%) than in follicular variant (21%) of papillary thyroid microcarcinoma. Tumors without the mutation were significantly more likely to be solid, well circumscribed, and lacked desmoplasia/fibrosis or sclerosis. However, on multivariate analysis, only the follicular variant of papillary microcarcinoma was significantly associated with the absence of mutation (odds ratio (95% confidence interval): 0.09 (0.01-0.54)). Lymph node metastases (n=24) were more frequent in microcarcinomas with mutation than without (21/24 vs 3/24, P=0.02). All patients with lateral cervical node metastasis (n=9), and all but one tumor with extrathyroidal extension (n=17/18) showed BRAF(V600E) mutation. No significant differences were noted in age, sex, tumor size, multifocality, lymphovascular invasion, psammoma bodies, stromal calcification, intratumoral multinucleated osteoclastic-type giant cells, and lymphocytic infiltration between the two groups of tumors. BRAF(V600E) mutation is an early event in thyroid carcinogenesis, and is associated with distinctive morphology and aggressive features even in papillary thyroid microcarcinomas.

Authors
Virk, RK; Van Dyke, AL; Finkelstein, A; Prasad, A; Gibson, J; Hui, P; Theoharis, CG; Carling, T; Roman, SA; Sosa, JA; Udelsman, R; Prasad, ML
MLA Citation
Virk, RK, Van Dyke, AL, Finkelstein, A, Prasad, A, Gibson, J, Hui, P, Theoharis, CG, Carling, T, Roman, SA, Sosa, JA, Udelsman, R, and Prasad, ML. "BRAFV600E mutation in papillary thyroid microcarcinoma: a genotype-phenotype correlation." Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 26.1 (January 2013): 62-70.
PMID
22918165
Source
epmc
Published In
Modern Pathology
Volume
26
Issue
1
Publish Date
2013
Start Page
62
End Page
70
DOI
10.1038/modpathol.2012.152

Cardiac arrest among surgical patients: an analysis of incidence, patient characteristics, and outcomes in ACS-NSQIP.

OBJECTIVES: To describe the incidence, characteristics, and outcomes of surgical patients who experience cardiac arrest requiring cardiopulmonary resuscitation (CPR). DESIGN: Retrospective cohort study. SETTING: American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP), 2005-2010. MAIN OUTCOME MEASURES: Incidence of CPR, complications, mortality, and survival to hospital discharge at 30 days or less after surgery. RESULTS: A total of 6382 nontrauma patients (mean age, 68 years) underwent CPR; 85.9% of events occurred postoperatively, of which 49.8% occurred within 5 days after surgery. Overall incidence of CPR was 1 in 203 surgical cases but varied by specialty (1 in 33 for cardiac surgery vs 1 in 258 for general surgery). The mortality rates varied by specialty (45.0%-74.5%) and were associated with comorbidity burden (58.7% for no comorbidity, 63.1% for 1 comorbidity, and 72.8% for ≥2 comorbidities; P < .001). A total of 77.6% of CPR patients experienced a complication; approximately 75.0% occurred before or on the day of CPR, and septicemia (26.7%), ventilator dependence (22.1%), significant bleeding (13.9%), and renal impairment (11.9%) were the most common. The overall 30-day mortality was 71.6%. Survival to discharge in 30 postoperative days or less was 19.2%; 9.2% of CPR patients were alive but hospitalized at postoperative day 30. Older age, a preexisting do-not-resuscitate order, renal impairment, disseminated cancer, preoperative sepsis, and postoperative arrest were among the factors independently associated with worse survival. CONCLUSIONS: One in 203 surgical patients undergoes CPR, and more than 70.0% of patients die in 30 postoperative days or less. Complications commonly precede arrest; prevention or aggressive treatment of these complications may potentially prevent CPR and improve outcomes. These data could aid discussions regarding advance directives among surgical patients.

Authors
Kazaure, HS; Roman, SA; Rosenthal, RA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, Rosenthal, RA, and Sosa, JA. "Cardiac arrest among surgical patients: an analysis of incidence, patient characteristics, and outcomes in ACS-NSQIP." JAMA surgery 148.1 (January 2013): 14-21.
PMID
23324834
Source
epmc
Published In
JAMA Surgery
Volume
148
Issue
1
Publish Date
2013
Start Page
14
End Page
21
DOI
10.1001/jamasurg.2013.671

Detection and management of cervical lymph nodes in papillary thyroid cancer

Lymph node metastases in papillary thyroid cancer are a common occurrence; however, the management of clinically negative cervical lymph nodes remains controversial. Preoperative neck ultrasound mapping is crucial, and complete dissection of a nodal compartment is recommended for any metastatic lymph nodes. The role of prophylactic central neck dissection remains controversial. The BRAF V600E mutation is a common mutation in papillary thyroid cancer, and has been associated with more aggressive tumor behavior. Evaluating the BRAF status of tumors may have implications for treatment and surveillance. New areas of research continue to focus on risk stratification and identifying which patients benefit from a more aggressive treatment, such as prophylactic central lymphadenectomy and radioiodine ablation and more intense surveillance strategies. © 2013 2013 Informa UK Ltd.

Authors
Elfenbein, DM; Scheri, RP; Roman, S; Sosa, JA
MLA Citation
Elfenbein, DM, Scheri, RP, Roman, S, and Sosa, JA. "Detection and management of cervical lymph nodes in papillary thyroid cancer." Expert Review of Endocrinology and Metabolism 8.4 (2013): 365-378.
Source
scival
Published In
Expert review of endocrinology & metabolism
Volume
8
Issue
4
Publish Date
2013
Start Page
365
End Page
378
DOI
10.1586/17446651.2013.811839

A cost-effectiveness analysis of adrenalectomy for nonfunctional adrenal incidentalomas: is there a size threshold for resection?

BACKGROUND: Adrenocortical carcinoma (ACC) is a rare, but aggressive, malignancy. Current American Association of Clinical Endocrinologists (AACE)/American Association of Endocrine Surgeons (AAES) guidelines recommend resection of nonfunctional adrenal neoplasms ≥ 4 cm. This study evaluates the cost-effectiveness of this approach. METHODS: A decision tree was constructed for patients with a nonfunctional, 4-cm adrenal incidentaloma with no radiographic suspicion for ACC. Patients were randomized to adrenalectomy, surveillance per AACE/AAES guidelines, or no follow-up ("sign-off"). Incremental cost-effectiveness ratio (ICER) includes health care costs, including missed ACC. ICER (dollar/life-year-saved [LYS]) was determined from the societal perspective. Sensitivity analyses were performed. RESULTS: In the base-case analysis, assuming a 2.0% probability of ACC for a 4-cm tumor, surgery was more cost-effective than surveillance (ICER $25,843/LYS). Both surgery and surveillance were incrementally more cost-effective than sign-off ($35/LYS and $8/LYS, respectively). Sensitivity analysis demonstrated that the model was sensitive to patient age, tumor size, probability of ACC, mortality of ACC, and cost of hospitalization. The results of the model were stable across different cost and complications related to adrenalectomy, regardless of operative approach. CONCLUSION: In our model, adrenalectomy was cost-effective for neoplasms >4 cm and in patients <65 years, primarily owing to the aggressiveness of ACC. Current AACE/AAES guideline recommendations for the resection of adrenal incidentalomas ≥ 4 cm seem to be cost-effective.

Authors
Wang, TS; Cheung, K; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Cheung, K, Roman, SA, and Sosa, JA. "A cost-effectiveness analysis of adrenalectomy for nonfunctional adrenal incidentalomas: is there a size threshold for resection?." Surgery 152.6 (December 2012): 1125-1132.
PMID
22989893
Source
epmc
Published In
Surgery
Volume
152
Issue
6
Publish Date
2012
Start Page
1125
End Page
1132
DOI
10.1016/j.surg.2012.08.011

The resident as surgeon: an analysis of ACS-NSQIP.

BACKGROUND: Data on the characteristics and outcomes of patients operated on by surgical residents are limited. METHODS: Using ACS-NSQIP (2005-2008), characteristics and outcomes of patients who underwent cholecystectomy, appendectomy, or inguinal hernia repair by a resident (R) without an attending scrubbed in the operating room, a scrubbed attending with resident (AR), or an attending without resident (A) were pooled and compared. Data analyses involved χ(2), ANOVA, and multivariate regression. RESULTS: The R group performed <1% of ACS-NSQIP cases; the 10 most common procedures represented 69.1% of cases. There were 912 cases of cholecystectomy, appendectomy, or inguinal hernia repair performed by R. Compared with A/AR patients, R patients were more likely to have inpatient (42.6%, 48.9% versus 64.8%), emergent (28.6%, 30.8% versus 35.5%) , and open procedures (27.0%, 29.4% versus 28.9%) (all P < 0.001). In unadjusted analyses, R patients had higher complication rates (4.8% versus 4.4%, 3.4%, P < 0.001) and longer operating time (64.4 min versus 62.2 min, 44.7 min, P < 0.001) than AR/A patients respectively. After risk adjustment, a resident operating without an attending scrubbed in the operating room was not independently associated with increased complications risk (odds ratio 1.2, 95% CI: 0.8-1.8, P = 0.2). Compared with A/AR patients, there was a 1-min difference in adjusted operating time for patients who underwent surgery by R (P < 0.001). CONCLUSIONS: In ACS-NSQIP, a resident rarely performs surgery without an attending scrubbed in the operating room; surgical attendings appear to exercise good judgment in determining the appropriate extent of resident supervision in the operating room without compromising patient outcomes.

Authors
Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JA. "The resident as surgeon: an analysis of ACS-NSQIP." The Journal of surgical research 178.1 (November 2012): 126-132.
PMID
22445454
Source
epmc
Published In
Journal of Surgical Research
Volume
178
Issue
1
Publish Date
2012
Start Page
126
End Page
132
DOI
10.1016/j.jss.2011.12.033

Association of postdischarge complications with reoperation and mortality in general surgery.

OBJECTIVES: To describe procedure-specific types, rates, and risk factors for postdischarge (PD) complications occurring within 30 days after 21 groups of inpatient general surgery procedures. DESIGN: Retrospective cohort study. SETTING: American College of Surgeons National Surgical Quality Improvement Program 2005 through 2010 Participant Use Data Files. PATIENTS: A total of 551,510 adult patients who underwent one of 21 groups of general surgery procedures in the inpatient setting. MAIN OUTCOME MEASURES: Postdischarge complications, reoperation, and mortality. RESULTS: Of 551,510 patients (mean age, 54.6 years), 16.7% experienced a complication; 41.5% occurred PD. Of the PD complications, 75.0% occurred within 14 days PD. Proctectomy (14.5%), enteric fistula repair (12.6%), and pancreatic procedures (11.4%) had the highest PD complication rates. Breast, bariatric, and ventral hernia repair procedures had the highest proportions of complications that occurred PD (78.7%, 69.4%, and 62.0%, respectively). For all procedures, surgical site complications, infections, and thromboembolic events were the most common. Occurrence of an inpatient complication increased the likelihood of a PD complication (12.5% vs 6.2% without an inpatient complication; P < .001). Compared with patients without a PD complication, those with a PD complication had higher rates of reoperation (4.6% vs 17.9%, respectively; P < .001) and death (2.0% vs 6.9%, respectively; P < .001) within 30 days after surgery; those whose PD complication was preceded by an inpatient complication had the highest rates of reoperation (33.7%) and death (24.7%) (all P < .001). After adjustment, PD complications were associated with procedure type, American Society of Anesthesiologists class higher than 3, and steroid use. CONCLUSIONS: The PD complication rates vary by procedure, are commonly surgical site related, and are associated with mortality. Fastidious, procedure-specific patient triage at discharge as well as expedited patient follow-up could improve PD outcomes.

Authors
Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JA. "Association of postdischarge complications with reoperation and mortality in general surgery." Archives of surgery (Chicago, Ill. : 1960) 147.11 (November 2012): 1000-1007.
PMID
23165614
Source
epmc
Published In
Archives of Surgery
Volume
147
Issue
11
Publish Date
2012
Start Page
1000
End Page
1007
DOI
10.1001/2013.jamasurg.114

Surgical approach and outcomes in patients with lithium-associated hyperparathyroidism.

BACKGROUND: Patients receiving lithium therapy are at elevated risk of developing hyperparathyroidism. In lithium-associated hyperparathyroidism (LAH), the incidence of multiglandular disease (MGD) is unclear, and the need for routine bilateral cervical exploration remains controversial. Therefore, in LAH patients, surgical approaches, pathologic findings, cure rates, and factors associated with persistent or recurrent disease were investigated. METHODS: Retrospective analysis of 27 patients with LAH undergoing parathyroidectomy with the intraoperative parathyroid hormone (PTH) assay. RESULTS: The median postoperative follow-up was 7 months; 17 patients had >6 months follow-up. Cervical exploration was unilateral in 9, bilateral in 18 (3 were converted from unilateral). Sixteen patients (62%) had MGD, 12 with four-gland hyperplasia and 4 with double adenomas. Ten patients (38%) had a single adenoma. Twenty-five (93%) of 27 patients had initially successful surgery. Of the 17 patients with >6 months follow-up, two had persistent disease and two experienced recurrent disease. All patients with a single adenoma remain free of disease. Three (75%) of four patients with persistent/recurrent disease had MGD and were receiving lithium at the time of surgery. Patients with persistent/recurrent disease were older (p = 0.01) and had experienced a longer duration of hypercalcemia (p = 0.04). CONCLUSIONS: LAH patients have a high incidence of MGD, and bilateral exploration is frequently necessary. With access to the intraoperative PTH assay, it is reasonable to initiate a unilateral approach because many patients will harbor single adenomas and can be reliably rendered normocalcemic. Patients with MGD remain at higher risk of persistent/recurrent disease.

Authors
Marti, JL; Yang, CS; Carling, T; Roman, SA; Sosa, JA; Donovan, P; Guoth, MS; Heller, KS; Udelsman, R
MLA Citation
Marti, JL, Yang, CS, Carling, T, Roman, SA, Sosa, JA, Donovan, P, Guoth, MS, Heller, KS, and Udelsman, R. "Surgical approach and outcomes in patients with lithium-associated hyperparathyroidism." Annals of surgical oncology 19.11 (October 2012): 3465-3471.
PMID
22669448
Source
epmc
Published In
Annals of Surgical Oncology
Volume
19
Issue
11
Publish Date
2012
Start Page
3465
End Page
3471
DOI
10.1245/s10434-012-2367-6

A fluorodeoxyglucose avid mediastinal parathyroid adenoma masquerading as metastatic bladder cancer.

A 64-year old male with a prior medical history of bladder transitional cell carcinoma treated with a cystoprostatectomy and adjuvant platinum-based chemotherapy 10 years earlier underwent a surveillance positron emission tomography (PET) scan that revealed a metabolically active 2-cm nodule in the superior mediastinum, anterior to the origin of the innominate artery. The lesion was removed due to concerns of metastatic disease using a cervical mediastinoscope. Final pathology revealed an ectopic mediastinal parathyroid adenoma. The combination of the rare presentation, uncommon surgical approach and pathology makes this case unique.

Authors
Adewole, AD; Roman, SA; Kraev, AI; Kim, AW
MLA Citation
Adewole, AD, Roman, SA, Kraev, AI, and Kim, AW. "A fluorodeoxyglucose avid mediastinal parathyroid adenoma masquerading as metastatic bladder cancer." Interactive cardiovascular and thoracic surgery 15.3 (September 2012): 514-515.
PMID
22645294
Source
epmc
Published In
Interactive Cardiovascular and Thoracic Surgery
Volume
15
Issue
3
Publish Date
2012
Start Page
514
End Page
515
DOI
10.1093/icvts/ivs232

Simultaneous medullary and differentiated thyroid cancer: a population-level analysis of an increasingly common entity.

BACKGROUND: Simultaneous medullary thyroid carcinoma (MTC) and differentiated thyroid carcinoma (DTC) is a rare entity. This is the first population-level analysis of the characteristics and outcomes of simultaneous MTC/DTC. METHODS: In the Surveillance, Epidemiology, and End Results (SEER) database (1988-2008), patients with simultaneous MTC/DTC were retrospectively compared with those with MTC alone using χ(2), ANOVA, log-rank tests, Cox multivariate regression, and Kaplan-Meier analyses. RESULTS: A total of 162 patients had simultaneous MTC/DTC; 1,699 had MTC alone. MTC was diagnosed first in 67.9 % of simultaneous MTC/DTC cases. Simultaneous MTC/DTC increased from 2.7 % of all MTCs in 1988-1997 to 12.3 % in 2003-2008. Compared with MTC alone, simultaneous MTC/DTC had smaller mean MTC tumor size (2.9 vs. 2.2 cm; p = 0.005) and lower rates of MTC extrathyroidal extension (25.4 vs. 16.8 %; p = 0.015) and distant metastases (15.7 vs. 9.3 %; p = 0.032). Patients diagnosed with DTC first had smaller mean MTC tumor sizes (p = 0.01), whereas patients diagnosed with MTC first had tumor sizes similar to those of MTC alone. Compared with MTC alone, patients with simultaneous MTC/DTC were more likely to receive thyroidectomy (84.7 vs. 93.2 %; p = 0.003) and radioisotopes (4.4 vs. 25 %; p < 0.001). On Kaplan-Meier analysis, disease-specific survival rates were higher for simultaneous MTC/DTC than for MTC alone (10-year survival rates 87 vs. 81 %; p = 0.056). CONCLUSIONS: Simultaneous MTC/DTC is diagnosed earlier in tumor development than MTC alone, with a trend toward better prognosis. This entity likely represents a primary tumor with an incidental pathologic finding of a second malignancy. Each malignancy should be treated according to its respective stage and current guidelines.

Authors
Wong, RL; Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Wong, RL, Kazaure, HS, Roman, SA, and Sosa, JA. "Simultaneous medullary and differentiated thyroid cancer: a population-level analysis of an increasingly common entity." Annals of surgical oncology 19.8 (August 2012): 2635-2642.
PMID
22526904
Source
epmc
Published In
Annals of Surgical Oncology
Volume
19
Issue
8
Publish Date
2012
Start Page
2635
End Page
2642
DOI
10.1245/s10434-012-2357-8

Insular thyroid cancer: a population-level analysis of patient characteristics and predictors of survival.

BACKGROUND: Insular thyroid cancer (ITC) is an uncommon, poorly differentiated thyroid malignancy. To date, there have been no population-level studies of the characteristics and outcomes of patients with ITC. METHODS: The authors used the Surveillance, Epidemiology, and End Results (SEER) database from 1999 to 2007 to compare the characteristics and prognosis of patients who had ITC with those of patients who had well differentiated thyroid cancer (WDTC) and anaplastic thyroid cancer (ATC). Data analyses were performed using chi-square tests, analyses of variance, log-rank tests, and multivariate regression. RESULTS: There were 114 patients with ITC, 497 patients with ATC, and 34,021 patients with WDTC. The mean age of patients with ITC was 62.1 years versus 48.1 years for patients with WDTC and 69.5 years for patients with ATC (P < .001). The mean ITC tumor size was 5.9 cm versus 2.0 cm for WDTC and 6.4 cm for ATC (P < .001). Distant metastasis occurred in 31% of patients with ITC versus 4.5% of patients with WDTC and 59.1% of patients with ATC (P < .001). Insular histology was associated independently with compromised survival in the overall study sample (hazard ratio [HR], 2.1; P = .001). The 5-year disease-specific survival rate was 72.6%, 97.2%, and 9.1% for patients with ITC, WDTC, and ATC, respectively (P < .001). After adjustment, radioiodine therapy (HR, 0.15; 95% confidence interval, 0.04-0.5) and distant metastasis (HR, 15.3; 95% confidence interval, 3.7-62.2) were associated independently with ITC survival. The mortality rate was 7.1%, 12%, and 54.3% for patients with localized, regional, and distant stage ITC, respectively (P < .001). For patients who had ITC with distant metastasis, thyroidectomy and radioiodine therapy independently improved survival. CONCLUSIONS: ITC is rare and aggressive. The current results indicated that its treatment should include total thyroidectomy and high-dose radioiodine for all patients and neck dissections for patients with lymph node disease. Early diagnosis and close surveillance are essential in the management of patients with ITC.

Authors
Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JA. "Insular thyroid cancer: a population-level analysis of patient characteristics and predictors of survival." Cancer 118.13 (July 2012): 3260-3267.
PMID
22252610
Source
epmc
Published In
Cancer
Volume
118
Issue
13
Publish Date
2012
Start Page
3260
End Page
3267
DOI
10.1002/cncr.26638

Papillary thyroid carcinomas with and without BRAF V600E mutations are morphologically distinct.

AIMS:   The BRAF V600E mutation resulting in the production of an abnormal BRAF protein has emerged as the most frequent genetic alteration in papillary thyroid carcinomas (PTCs). This study was aimed at identifying distinctive features in tumours with and without the mutation. METHODS AND RESULTS:   Thirty-four mutation-positive and 22 mutation-negative tumours were identified by single-strand conformation polymorphism of the amplified BRAF V600E region in the tumour DNA. Mutation-positive tumours were more common in patients older than 45 years (24/33, P = 0.05), in classic (23/30, P = 0.01), tall cell (4/5) and oncocytic/Warthin-like (2/2) variants of PTC, and in subcapsular sclerosing microcarcinomas (4/4). In contrast, all 12 follicular variants (P < 0.0001) and two diffuse sclerosing variants were negative for the mutation. Mutation-positive tumours displayed infiltrative growth (32/34, P = 0.02), stromal fibrosis (33/34, P < 0.001), psammoma bodies (17/34, P = 0.05), plump eosinophilic tumour cells (22/34, P = 0.01), and classic fully developed nuclear features of PTC (33/34, P = 0.0001). Encapsulation was significantly associated with mutation-negative tumours (15/22, P = 0.02). CONCLUSIONS:   BRAF V600E mutation-positive and negative PTCs are morphologically different. Recognition of their morphology may help in the selection of appropriate tumours for genetic testing.

Authors
Finkelstein, A; Levy, GH; Hui, P; Prasad, A; Virk, R; Chhieng, DC; Carling, T; Roman, SA; Sosa, JA; Udelsman, R; Theoharis, CG; Prasad, ML
MLA Citation
Finkelstein, A, Levy, GH, Hui, P, Prasad, A, Virk, R, Chhieng, DC, Carling, T, Roman, SA, Sosa, JA, Udelsman, R, Theoharis, CG, and Prasad, ML. "Papillary thyroid carcinomas with and without BRAF V600E mutations are morphologically distinct." Histopathology 60.7 (June 2012): 1052-1059.
PMID
22335197
Source
epmc
Published In
Histopathology
Volume
60
Issue
7
Publish Date
2012
Start Page
1052
End Page
1059
DOI
10.1111/j.1365-2559.2011.04149.x

Aggressive variants of papillary thyroid cancer: incidence, characteristics and predictors of survival among 43,738 patients.

BACKGROUND: The diffuse sclerosing (DSV) and tall cell (TCV) variants are considered aggressive subtypes of papillary thyroid cancer (PTC) for which data are limited. METHODS: The Surveillance, Epidemiology, and End Results (SEER) database (1988-2008) was used to compare the incidence and clinical/pathologic characteristics of DSV and TCV with classic PTC. Prognostic factors associated with survival were analyzed by chi-square test, analysis of variance, log rank test, and Cox multivariate regression. RESULTS: There were 261 DSV, 573 TCV, and 42,904 PTC patients. Compared to a 60.8% increase in classic PTC incidence, DSV and TCV incidence increased by 126% (P (trend) = 0.052) and 158% (P (trend) = 0.002), respectively. Aggressive variants were associated with higher rates of extrathyroidal extension, multifocality, and nodal and distant metastasis (all P < 0.001) compared to classic PTC. Nodal metastasis was more likely with DSV (72.2% vs. 66.8% TCV vs. 56.3% PTC, P < 0.001); distant metastasis was most common with TCV (11.1% vs. 7.3% DSV vs. 4.3% PTC, P < 0.001). After adjustment, DSV [hazard ratio (HR) 1.8, P = 0.007] and TCV (HR 1.9, P < 0.001) histologies were associated with significantly reduced survival (5-year overall: 87.5% DSV, 80.6% TCV vs. 93.5% PTC, P < 0.001). Tumor size independently predicted worse prognosis for TCV (HR 1.29, P < 0.001) but not DSV patients. Thyroid surgery and radioiodine improved survival of DSV and TCV patients (all P < 0.05). Patients with aggressive variants who received external-beam radiotherapy did not experience improved survival. CONCLUSIONS: DSV and TCV are rare, increasing in incidence, and have a worse prognosis than classic PTC. Patients with these variants should be treated aggressively with thyroidectomy and radioiodine, regardless of tumor size.

Authors
Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JA. "Aggressive variants of papillary thyroid cancer: incidence, characteristics and predictors of survival among 43,738 patients." Annals of surgical oncology 19.6 (June 2012): 1874-1880.
PMID
22065195
Source
epmc
Published In
Annals of Surgical Oncology
Volume
19
Issue
6
Publish Date
2012
Start Page
1874
End Page
1880
DOI
10.1245/s10434-011-2129-x

"Join the club": effect of resident and attending social interactions on overall satisfaction among 4390 general surgery residents.

OBJECTIVES: To investigate which residents develop successful collegial relationships with attending physicians and to determine how social interactions affect residency satisfaction. DESIGN: Cross-sectional National Study of Expectations and Attitudes of Residents in Surgery survey. Demographics and level of agreement regarding training experiences were collected from the survey responses and related to overall satisfaction with the residency program. We performed χ2 testing and hierarchical logistic regression modeling. SETTING: Two hundred forty-eight residency programs. PARTICIPANTS: All US categorical general surgery residents. MAIN OUTCOME MEASURES: Answers to "How often do you do things with your attendings socially?" and "I can turn to members of the faculty when I have difficulties." RESULTS: Of 4402 returned surveys (response rate, 82.4%), we included 4390. Residents who were older (P = .01), in a higher postgraduate year (PGY) (P < .001), men (P = .003), married (P = .02), and parents (P = .001) were most likely to socialize with attendings. In hierarchical logistic regression modeling, PGY-5 status was independently associated with socializing; PGY-1 and PGY-2 status and female sex were negatively associated. Residents who were men (P < .001), married (P < .001), and parents (P = .001) were most likely to feel they could turn to attendings with problems. In hierarchical logistic regression modeling, PGY-1, PGY-4, and PGY-5 status and being married were positively associated with this statement; female sex was negatively correlated. Residents not socializing with attendings expressed 3 times more program dissatisfaction (18.9% vs 6.2% [P < .001]); those unable to turn to attendings expressed 5 times more dissatisfaction (34.7% vs 7.0% [P < .001]). CONCLUSIONS: Collegial interactions between residents and attendings are important because they are associated with residency satisfaction. Efforts should be made to expand such interactions to junior and female residents.

Authors
Sullivan, MC; Bucholz, EM; Yeo, H; Roman, SA; Bell, RH; Sosa, JA
MLA Citation
Sullivan, MC, Bucholz, EM, Yeo, H, Roman, SA, Bell, RH, and Sosa, JA. ""Join the club": effect of resident and attending social interactions on overall satisfaction among 4390 general surgery residents." Archives of surgery (Chicago, Ill. : 1960) 147.5 (May 2012): 408-414.
PMID
22785631
Source
epmc
Published In
Archives of Surgery
Volume
147
Issue
5
Publish Date
2012
Start Page
408
End Page
414
DOI
10.1001/archsurg.2012.27

Optimal surgical management of well-differentiated thyroid cancer arising in struma ovarii: a series of 4 patients and a review of 53 reported cases.

BACKGROUND: Well-differentiated thyroid cancer arising in struma ovarii is rare. The optimal management of this entity remains undefined. Unilateral cystectomy, unilateral salpingo-oophorectomy (USO), or total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO), in addition to total thyroidectomy and radioactive iodine (RAI) ablation, have been employed by various groups. We hypothesized that in patients with thyroid cancer arising within struma ovarii, pelvic surgery alone would be sufficient, provided there is no evidence of gross extra-ovarian extension. METHODS: We review a series of four patients from a single institution and 53 cases from the literature, comparing the extent of treatment and outcomes. Our literature review focused on low-risk patients with struma ovarii confined to the ovary, without evidence of gross extra-ovarian spread or distant metastases. Cumulative recurrence rate was determined by using the Kaplan-Meier method. RESULTS: We report the treatment of four patients with well-differentiated thyroid cancer arising within struma ovarii. Patients underwent USO, BSO, or TAH/BSO. One patient underwent prophylactic total thyroidectomy in anticipation of RAI treatment, and was found to have a synchronous papillary thyroid carcinoma. All patients clinically remain without evidence of disease at a median follow-up of 9 (range 0.8-13) years. Treatment strategies in 53 cases from a review of the literature varied. The pooled cumulative recurrence rate of 57 cases with struma ovarii confined to the ovary was 7.5% at 25 years. CONCLUSIONS: Thyroid cancer arising in struma ovarii is rare. Controversy exists regarding the extent of pelvic resection and management of the thyroid gland. In our series of four patients, all patients are alive without evidence of disease, and the 25-year recurrence rate of 57 cases was low (7.5%), despite a variety of approaches to surgical resection and adjuvant treatment. Extensive pelvic surgery and prophylactic total thyroidectomy to facilitate RAI therapy may be reserved for patients with gross extra-ovarian extension or distant metastases.

Authors
Marti, JL; Clark, VE; Harper, H; Chhieng, DC; Sosa, JA; Roman, SA
MLA Citation
Marti, JL, Clark, VE, Harper, H, Chhieng, DC, Sosa, JA, and Roman, SA. "Optimal surgical management of well-differentiated thyroid cancer arising in struma ovarii: a series of 4 patients and a review of 53 reported cases." Thyroid : official journal of the American Thyroid Association 22.4 (April 2012): 400-406.
PMID
22181336
Source
epmc
Published In
Thyroid
Volume
22
Issue
4
Publish Date
2012
Start Page
400
End Page
406
DOI
10.1089/thy.2011.0162

American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma.

BACKGROUND: The role of prophylactic central lymph node dissection in papillary thyroid cancer (PTC) is controversial in patients who have no pre- or intraoperative evidence of nodal metastasis (clinically N0; cN0). The controversy relates to its unproven role in reducing recurrence rates while possibly increasing morbidity (permanent hypoparathyroidism and unintentional recurrent laryngeal nerve injury). METHODS AND RESULTS: We examined the design and feasibility of a multi-institutional prospective randomized controlled trial of prophylactic central lymph node dissection in cN0 PTC. Assuming a 7-year study with 4 years of enrollment, 5 years of average follow-up, a recurrence rate of 10% after 7 years, a 25% relative reduction in the rate of the primary endpoint (newly identified structural disease; i.e., persistent, recurrent, or distant metastatic disease) with central lymph node dissection and an annual dropout rate of 3%, a total of 5840 patients would have to be included in the study to achieve at least 80% statistical power. Similarly, given the low rates of morbidity, several thousands of patients would need to be included to identify a significant difference in rates of permanent hypoparathyroidism and unintentional recurrent laryngeal nerve injury. CONCLUSION: Given the low rates of both newly identified structural disease and morbidity after surgery for cN0 PTC, prohibitively large sample sizes would be required for sufficient statistical power to demonstrate significant differences in outcomes. Thus, a prospective randomized controlled trial of prophylactic central lymph node dissection in cN0 PTC is not readily feasible.

Authors
Carling, T; Carty, SE; Ciarleglio, MM; Cooper, DS; Doherty, GM; Kim, LT; Kloos, RT; Mazzaferri, EL; Peduzzi, PN; Roman, SA; Sippel, RS; Sosa, JA; Stack, BC; Steward, DL; Tufano, RP; Tuttle, RM; Udelsman, R
MLA Citation
Carling, T, Carty, SE, Ciarleglio, MM, Cooper, DS, Doherty, GM, Kim, LT, Kloos, RT, Mazzaferri, EL, Peduzzi, PN, Roman, SA, Sippel, RS, Sosa, JA, Stack, BC, Steward, DL, Tufano, RP, Tuttle, RM, and Udelsman, R. "American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma." Thyroid : official journal of the American Thyroid Association 22.3 (March 2012): 237-244.
PMID
22313454
Source
epmc
Published In
Thyroid
Volume
22
Issue
3
Publish Date
2012
Start Page
237
End Page
244
DOI
10.1089/thy.2011.0317

Medullary thyroid microcarcinoma: a population-level analysis of 310 patients.

BACKGROUND: Medullary thyroid microcarcinomas (microMTCs) are medullary thyroid carcinomas (MTCs) that measure ≤1 cm in size for which there is a paucity of data on incidence, characteristics, and clinical significance. METHODS: Patients who had a diagnosis of microMTC were abstracted from the Surveillance, Epidemiology, and End Results database (1988-2007). The data were analyzed using chi-square tests, t tests, and log-rank tests; multivariate logistic regression was used to identify factors that were associated independently with lymph node metastases. Tests for diagnostic accuracy, including likelihood ratio tests and post-test probability tests, were computed to evaluate the size-specific likelihood of developing lymph node metastases among patients with microMTC. RESULTS: In total, 310 patients had microMTC; its incidence increased during the study period (P(trend) = .033), and microMTC as a proportion of all MTCs increased by 39%. The mean tumor size was 5.7 mm. Thirty-one percent of tumors were multifocal, and 7.8% had extrathyroid extension. Lymph node metastases occurred in nearly 37% of patients who had any lymph nodes removed (65 of 176 patients). Nearly 20% of patients had regional disease, and 5% had distant metastases. The overall 10-year survival rates for patients with localized, regional, and distant disease stages were 96%, 87%, and 50%, respectively (P < .001). After adjustment, extrathyroid extension (odds ratio [OR], 41.9; P < .001) and tumor size (OR, 1.2; P = .008) retained an independent association with lymph node metastases. MTCs that measured ≤5 mm were associated with a probability of lymph node metastases of approximately 23%, and the probability increased for patients who had tumors >5 mm. CONCLUSIONS: The current results indicated that microMTCs have significant rates of poor prognostic features known to impact the survival of patients with MTC. These microcarcinomas are an important clinical entity that requires comprehensive evaluation and surgical management.

Authors
Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JA. "Medullary thyroid microcarcinoma: a population-level analysis of 310 patients." Cancer 118.3 (February 2012): 620-627.
PMID
21717441
Source
epmc
Published In
Cancer
Volume
118
Issue
3
Publish Date
2012
Start Page
620
End Page
627
DOI
10.1002/cncr.26283

A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism.

BACKGROUND: Reported accuracy of preoperative localization imaging for primary hyperparathyroidism (pHPT) varies. The purpose of this study is to determine the accuracy of ultrasound, sestamibi-single photon emission computed tomography (SPECT), and four-dimensional computed tomography (4D-CT) as preoperative localization strategies. METHODS: A meta-analysis was performed of studies investigating the accuracy of ultrasound, sestamibi-SPECT, and 4D-CT for preoperative localization in pHPT. Electronic databases were systematically searched, and two independent reviewers reviewed results using specific criteria. Study quality was assessed using a validated measure for diagnostic imaging studies. Study heterogeneity and pooled results were calculated. RESULTS: 43 studies met criteria for inclusion, and data were available for extraction in 19 ultrasound, 9 sestamibi-SPECT, and 4 4D-CT studies. Ultrasound had pooled sensitivity and positive predictive value (PPV) of 76.1% (95% CI 70.4-81.4%) and 93.2% (90.7-95.3%), respectively. Sestamibi-SPECT had pooled sensitivity and PPV of 78.9% (64-90.6%) and 90.7% (83.5-96.0%), respectively. Only two 4D-CT studies investigated patients undergoing initial parathyroidectomy. Results suggested sensitivity and PPV of 89.4% and 93.5%, respectively. CONCLUSIONS: Ultrasound and sestamibi-SPECT are similar in ability to preoperatively localize abnormal parathyroid glands in pHPT. Accuracy may be improved with 4D-CT; however, further investigation is required. Choice of preoperative imaging strategy depends on numerous patient, institutional, and economic factors of which the surgeon must be aware.

Authors
Cheung, K; Wang, TS; Farrokhyar, F; Roman, SA; Sosa, JA
MLA Citation
Cheung, K, Wang, TS, Farrokhyar, F, Roman, SA, and Sosa, JA. "A meta-analysis of preoperative localization techniques for patients with primary hyperparathyroidism." Annals of surgical oncology 19.2 (February 2012): 577-583.
PMID
21710322
Source
epmc
Published In
Annals of Surgical Oncology
Volume
19
Issue
2
Publish Date
2012
Start Page
577
End Page
583
DOI
10.1245/s10434-011-1870-5

Efficacy and tolerability of pharmacotherapy options for the treatment of medullary thyroid cancer.

Metastatic and unresectable medullary thyroid carcinoma (MTC) is often difficult to treat as it is relatively unresponsive to radiation and conventional chemotherapy. This emphasizes the importance of the development of targeted therapies for advanced MTC. Vandetanib was approved by the US Food and Drug Administration for the treatment of symptomatic or progressive MTC in patients with advanced disease in April 2011. This therapy proved to be a breakthrough in the management of MTC. We review the efficacy and safety of this novel treatment and other treatments that are being evaluated in this disease.

Authors
Deshpande, HA; Sheth, K; Sosa, JA; Roman, S
MLA Citation
Deshpande, HA, Sheth, K, Sosa, JA, and Roman, S. "Efficacy and tolerability of pharmacotherapy options for the treatment of medullary thyroid cancer." Clinical Medicine Insights. Oncology 6 (January 2012): 355-362.
PMID
23133319
Source
epmc
Published In
Clinical Medicine Insights: Oncology
Volume
6
Publish Date
2012
Start Page
355
End Page
362
DOI
10.4137/cmo.s8305

Clinical and economic outcomes of thyroid surgery in elderly patients: a systematic review.

The U.S. population is undergoing a dramatic shift in demographics, with a rise in the proportion of elderly Americans. Given an increased prevalence of thyroid disease and malignancy with age, understanding the safety of thyroid surgery in this age group is increasingly pertinent. There remains disagreement regarding the clinical outcomes of elderly patients after thyroidectomy and the applicability of single-institution cohorts to the population at large. This paper reviews the epidemiology of thyroid disease in the elderly, current surgical indications and practice patterns, and the clinical and economic outcomes of elderly patients with thyroid disease after surgical intervention.

Authors
Sullivan, MC; Roman, SA; Sosa, JA
MLA Citation
Sullivan, MC, Roman, SA, and Sosa, JA. "Clinical and economic outcomes of thyroid surgery in elderly patients: a systematic review." Journal of thyroid research 2012 (January 2012): 615846-.
PMID
22779035
Source
epmc
Published In
Journal of Thyroid Research
Volume
2012
Publish Date
2012
Start Page
615846
DOI
10.1155/2012/615846

The molecular diagnosis and management of thyroid neoplasms.

PURPOSE OF REVIEW: The molecular work-up of thyroid nodules on fine needle aspiration (FNA) cytology samples has given clinicians a new level of diagnostic information. We focus this review on the molecular techniques used in the diagnosis of thyroid cancer, especially BRAF, and the resulting management considerations that are raised. RECENT FINDINGS: BRAF testing offers both diagnostic and prognostic information; it has been used along with the Bethesda Thyroid FNA Classification System to offer preoperative guidance in the management of thyroid nodules. Various authors have successfully utilized molecular panels on cytologic specimens including mutations and rearrangements such as RAS and RET/PTC. Preoperative mutation detection allows initial management decisions to be made with a greater clinical confidence. SUMMARY: BRAF molecular testing holds promise as a possible diagnostic tool for indeterminate FNAs, and as a determinant for planning initial clinical management of thyroid nodules. Further developments in the molecular approach to thyroid cancer are expected to allow greater individualization of patient care.

Authors
Theoharis, C; Roman, S; Sosa, JA
MLA Citation
Theoharis, C, Roman, S, and Sosa, JA. "The molecular diagnosis and management of thyroid neoplasms." Current opinion in oncology 24.1 (January 2012): 35-41. (Review)
PMID
22123232
Source
epmc
Published In
Current Opinion in Oncology
Volume
24
Issue
1
Publish Date
2012
Start Page
35
End Page
41
DOI
10.1097/cco.0b013e32834dcfca

Emergency surgery in patients who have undergone recent radiotherapy is associated with increased complications and mortality: review of 536 patients.

BACKGROUND: There is a paucity of data regarding patients undergoing emergency surgery following radiotherapy. This study examines the morbidity and mortality of patients having emergent surgery ≤90 days after irradiation. METHODS: We identified patients ≥18 years of age in the American College of Surgeons National Surgical Quality Improvement Program (Radiation group) who underwent irradiation ≤90 days before emergency surgery. Patients receiving concomitant chemotherapy were excluded. Subjects were compared to a Control group that did not have preoperative irradiation but underwent similar emergent procedures (matched 1:1 on age and procedure). Demographic and clinical characteristics, including patient co-morbidities, functional status, and preoperative laboratory values, were assessed. Primary outcomes included 30-day postoperative morbidity and mortality. Log-transformed data, bivariate and multivariate linear and conditional logistic regression were used. RESULTS: A total of 536 patients were included, 268 per group. Patient demographics and preoperative co-morbidities were similar between groups. The Radiation group had more mortality [23.9% vs. 11.6%, P < 0.001; odds ratio (OR) 2.4], major complications (45.1% vs. 34.7%, P = 0.014; OR 1.55), and a greater likelihood of sustaining a complication (48.1% vs. 38.1%, P = 0.019; OR 1.51). Days from admission to operation, operating time, likelihood of reoperation, days from operation to death, and length of hospital stay were not statistically different. By conditional logistic regression, death was independently associated with irradiation, chronic obstructive pulmonary disease (COPD), impaired preoperative functional status, and thrombocytopenia; and a major complication was associated with COPD, hypoalbuminemia, and preoperative wound infection. CONCLUSIONS: Patients who require emergent surgery ≤90 days after irradiation sustain increased morbidity and mortality. Optimizing the nutritional and functional status of these patients may improve surgical outcomes.

Authors
Sullivan, MC; Roman, SA; Sosa, JA
MLA Citation
Sullivan, MC, Roman, SA, and Sosa, JA. "Emergency surgery in patients who have undergone recent radiotherapy is associated with increased complications and mortality: review of 536 patients." World journal of surgery 36.1 (January 2012): 31-38.
PMID
22083433
Source
epmc
Published In
World Journal of Surgery
Volume
36
Issue
1
Publish Date
2012
Start Page
31
End Page
38
DOI
10.1007/s00268-011-1230-4

Effect of program type on the training experiences of 248 university, community, and US military-based general surgery residencies.

BACKGROUND: There is a paucity of research comparing resident training experiences of university, community, and military-affiliated surgical programs. STUDY DESIGN: We reviewed a cross-sectional national survey (NEARS) involving all US categorical general surgery residents (248 programs). Demographics and level of agreement regarding training experiences were collected. Statistical analysis included chi-square, ANOVA, and hierarchical logistic regression modeling (HLRM). RESULTS: There were 4,282 residents included (82.4% response rate). The majority (69%) trained in university programs. Types of programs differed by sex mix (p < 0.001), racial makeup (p = 0.005), marital status profile (p = 0.002), and parental status profile (p < 0.001). Community residents were most satisfied with their operative experience (community 84.5%, university 73.4%, military 62.4%; p < 0.001), most likely to feel their opinions are important (76.0% vs 69.4% vs 67.9%, respectively; p < 0.001), and least likely to believe attendings will think worse of them if residents asked for help with patient management (12.6% vs 15.9% vs 14.7%, respectively; p = 0.025). Military residents were least likely to report that surgical training is too long (military 7.4%, community 14.0%, university 23.8%; p < 0.001). On HLRM, community programs were independently associated with residents feeling their opinions are important (odds ratio [OR] 1.91; p < 0.001), and reporting satisfactory operative experience (OR 4.73; p < 0.001). Residents training at military programs (OR 0.23; p = 0.002) or community programs (OR 0.31; p < 0.001) were less likely to feel that surgical training is too long, or that attendings will think worse of them if asked for help with patient care (community OR 0.19; p < 0.001; military OR 0.27; p = 0.004). CONCLUSIONS: Residents at university, community, and military programs report distinct training experiences. These findings may inform programs of potential targeted strategies for enhanced support.

Authors
Sullivan, MC; Sue, G; Bucholz, E; Yeo, H; Bell, RH; Roman, SA; Sosa, JA
MLA Citation
Sullivan, MC, Sue, G, Bucholz, E, Yeo, H, Bell, RH, Roman, SA, and Sosa, JA. "Effect of program type on the training experiences of 248 university, community, and US military-based general surgery residencies." Journal of the American College of Surgeons 214.1 (January 2012): 53-60.
PMID
22075109
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
214
Issue
1
Publish Date
2012
Start Page
53
End Page
60
DOI
10.1016/j.jamcollsurg.2011.09.021

Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases.

BACKGROUND: Spontaneous adrenal hemorrhage associated with a mass is uncommon and treatment strategies are not standardized. Current treatment modalities range from supportive management and blood transfusion to embolization or immediate operative extirpation. Our objectives were to describe six cases from a single institution and to perform a literature review of the etiology of the condition and recommended management of patients with hemorrhagic adrenal masses. METHODS: Records from six patients diagnosed with adrenal hemorrhage and an associated mass at a single institution were reviewed. Clinical records and outcomes were analyzed. A comprehensive review of 133 reported cases in the literature was performed. RESULTS: Six patients presented with spontaneous adrenal hemorrhage that appeared to be associated with a mass, with tumor sizes ranging from 3.7 to 15 cm. Three patients underwent adrenalectomy for pheochromocytoma or adrenocortical cancer. Three patients did not undergo adrenalectomy: one had a metastasis from lung cancer, one underwent embolization, and one had resolution of the mass on interval imaging. A comprehensive review of the literature identified 133 cases, with pheochromocytoma the most commonly reported lesion (48%). CONCLUSIONS: Spontaneous adrenal hemorrhage is rare. When it does occur, a high level of suspicion for malignant disease or pheochromocytoma should be maintained. The possibility of a hematoma masquerading as a neoplasm should also be considered. In cases of ongoing hemorrhage, embolization may be a lifesaving temporizing measure. Acute surgical intervention should be considered in selected patients, and surgery may not be required in all patients. A cautious approach with a comprehensive biochemical and imaging work-up is advised prior to operation.

Authors
Marti, JL; Millet, J; Sosa, JA; Roman, SA; Carling, T; Udelsman, R
MLA Citation
Marti, JL, Millet, J, Sosa, JA, Roman, SA, Carling, T, and Udelsman, R. "Spontaneous adrenal hemorrhage with associated masses: etiology and management in 6 cases and a review of 133 reported cases." World journal of surgery 36.1 (January 2012): 75-82. (Review)
PMID
22057755
Source
epmc
Published In
World Journal of Surgery
Volume
36
Issue
1
Publish Date
2012
Start Page
75
End Page
82
DOI
10.1007/s00268-011-1338-6

Does chemotherapy prior to emergency surgery affect patient outcomes? Examination of 1912 patients.

BACKGROUND: Data regarding preoperative chemotherapy as a risk to surgical outcomes are limited. This study examines morbidity and mortality among patients necessitating emergent surgical procedures ≤30 days after chemotherapy. METHODS: We identified patients ≥18 years that received chemotherapy ≤30 days before emergency surgery (Chemo) in ACS NSQIP, 2005-2008. Subjects were compared with a control group who underwent similar emergent procedures (matched 1:1 on age and procedure/CPT code). Primary outcomes included 30-day postoperative morbidity and mortality. Log-transformed data, bivariate and multivariate linear and conditional logistic regression were used. RESULTS: A total of 1912 patients were identified (956/group). Patient demographics were similar. The Chemo group had lower BMI (26.3 vs 28.3, P < .001) and more frequent preoperative lab abnormalities. The number of days from admission to operation was greater in the chemo group (3.6 vs 2.6, P < .001). There was no difference in total operative time, days from operation to death, and total length of inpatient stay. Chemo patients were more likely to receive intraoperative transfusions (26.8 vs 18.7, P < .001; odds ratio [OR]: 1.59). Postoperatively, chemo patients had more major complications (44.0% vs 39.2%, P = .033; OR: 1.2), a greater risk of having ≥1 complication (45.0% vs 40.5%, P = .047; OR: 1.2), and higher mortality (22.4% vs 10.3%, P < .001; OR: 2.53). Multivariate analysis identified 3 variables predictive of mortality (chemotherapy, dyspnea, leukopenia), and 2 associated with a major complication (COPD, prolonged PTT). CONCLUSIONS: Patients having emergent surgery after chemotherapy have more comorbidities and severe disease, which are associated with higher complication rates and mortality. Identifying modifiable parameters prior to surgery may improve postoperative outcomes.

Authors
Sullivan, MC; Roman, SA; Sosa, JA
MLA Citation
Sullivan, MC, Roman, SA, and Sosa, JA. "Does chemotherapy prior to emergency surgery affect patient outcomes? Examination of 1912 patients." Annals of surgical oncology 19.1 (January 2012): 11-18.
PMID
21761105
Source
epmc
Published In
Annals of Surgical Oncology
Volume
19
Issue
1
Publish Date
2012
Start Page
11
End Page
18
DOI
10.1245/s10434-011-1844-7

Postoperative calcium supplementation in patients undergoing thyroidectomy.

PURPOSE OF REVIEW: Postoperative hypocalcemia is one of the most common complications following thyroidectomy. This review examines recent literature on predictive factors for hypocalcemia, measurement of serum calcium and parathyroid hormone (PTH) levels, and algorithms for supplementation with calcium and/or vitamin D. RECENT FINDINGS: Risk factors for developing postthyroidectomy hypocalcemia include hyperthyroidism, vitamin D deficiency, female sex, substernal thyroid disease, and thyroid cancer, necessitating central neck lymphadenectomy. Several studies have shown that routine postoperative oral calcium and calcitriol supplementation results in lower rates of tetany. Recent studies have focused on the predictive value of intraoperative and postoperative serum PTH levels for the development of symptomatic hypocalcemia. Although the exact timing and serum levels of PTH have been variable, studies have confirmed that patients with very low postoperative PTH levels require oral calcitriol and calcium supplementation. A societal-level cost-utility analysis examining the use of routine vs. selective oral calcium and calcitriol supplementation found that routine supplementation is more cost-effective, and is associated with improved quality of life, irrespective of the surgeons' specific rates of hypocalcemia. SUMMARY: Although some clinicians favor routine supplementation postoperatively, others advocate selective supplementation, guided by postoperative PTH levels. The optimal algorithm is unknown, although a recent cost-analysis study suggests that routine supplementation may be favored at the societal level.

Authors
Wang, TS; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Roman, SA, and Sosa, JA. "Postoperative calcium supplementation in patients undergoing thyroidectomy." Current opinion in oncology 24.1 (January 2012): 22-28.
PMID
22080941
Source
epmc
Published In
Current Opinion in Oncology
Volume
24
Issue
1
Publish Date
2012
Start Page
22
End Page
28
DOI
10.1097/cco.0b013e32834c4980

Cognitive Improvement After Parathyroidectomy

Authors
Roman, S
MLA Citation
Roman, S. "Cognitive Improvement After Parathyroidectomy." Annals of Surgery 254.6 (December 2011): 1079-1079.
Source
crossref
Published In
Annals of Surgery
Volume
254
Issue
6
Publish Date
2011
Start Page
1079
End Page
1079
DOI
10.1097/SLA.0b013e31823acefb

Would scan, but which scan? A cost-utility analysis to optimize preoperative imaging for primary hyperparathyroidism.

BACKGROUND: Minimally invasive parathyroidectomy for primary hyperparathyroidism depends on accurate preoperative localization. This study examines the cost-utility of sestamibi in combination with single photon emission computed tomography (sestamibi-SPECT); ultrasound; and 4-dimensional computed tomography (4D-CT). METHODS: A decision tree was constructed for patients undergoing initial parathyroidectomy. Patients were randomized to 1 of 5 preoperative localization protocols: (1) ultrasound; (2) sestamibi-SPECT; (3) 4D-CT; (4) sestamibi-SPECT and ultrasound; and (5) sestamibi-SPECT and ultrasound and 4D-CT, if discordant (sestamibi-SPECT and ultrasound ± 4D-CT). From a societal perspective, all relevant costs were included. Input data were obtained from literature and Medicare. The incremental cost-utility ratio was determined in dollars per quality-adjusted life years ($/QALY). Sensitivity analyses were performed. RESULTS: In the base-case, ultrasound was least expensive, with a cost of $6666, compared to $6773 (4-D CT); $7214 (sestamibi-SPECT and ultrasound ± 4D-CT); $7330 (sestamibi-SPECT); and $7371(sestamibi-SPECT and ultrasound). Sestamibi-SPECT and ultrasound ± 4D-CT were most cost-effective because improved localization resulted in fewer bilateral explorations. QALY were comparable across modalities. Compared to sestamibi-SPECT, ultrasound, 4D- CT, and sestamibi-SPECT and ultrasound ± 4D-CT resulted a win-win situation-costing less and accruing more utility. Sensitivity analyses demonstrated that the model was sensitive to surgery cost and diagnostic accuracy of imaging. CONCLUSION: In our model, sestamibi-SPECT and ultrasound ± 4D-CT were the most cost-effective methods, followed by 4D-CT and ultrasound. Sestamibi-SPECT alone was least cost-effective. Cost-utilities were dependent on the sensitivities of ultrasound and 4D-CT and may vary by institution.

Authors
Wang, TS; Cheung, K; Farrokhyar, F; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Cheung, K, Farrokhyar, F, Roman, SA, and Sosa, JA. "Would scan, but which scan? A cost-utility analysis to optimize preoperative imaging for primary hyperparathyroidism." Surgery 150.6 (December 2011): 1286-1294.
PMID
22136852
Source
epmc
Published In
Surgery
Volume
150
Issue
6
Publish Date
2011
Start Page
1286
End Page
1294
DOI
10.1016/j.surg.2011.09.016

Thyroidectomy and parathyroidectomy in patients with high body mass index are safe overall: analysis of 26,864 patients.

BACKGROUND: Obesity is a national epidemic. Prior studies of the impact of body mass index (BMI) on surgical outcomes from cervical endocrine procedures have come from high-volume, single institutions. Our study characterizes the 30-day clinical and economic outcomes in patients with high BMI from a multi-institutional database. METHODS: Patients undergoing thyroidectomy or parathyroidectomy in the American College of Surgeons National Surgery Quality Improvement Program, 2005-2008 were categorized into 4 groups BMI based on: normal, overweight, obese, and morbidly obese. Overweight, obese, and morbidly obese patients were compared with patients with normal BMI using a χ(2) test and an analysis of variance. Multivariable linear/logistic regression models were used to adjust for preoperative risk factors. RESULTS: In all, 18,825 patients underwent thyroidectomy. Overweight, obese, and morbidly obese patients were more likely to have total thyroidectomy, substernal thyroids, general anesthesia, operations of greater duration, and an overall or wound complication (all P < .01). On a multivariable analysis, morbidly obese patients had an increased risk for urinary complications (P < .05); obese and morbidly obese patients had an increased risk for overall or wound complications (P < .01); overweight, obese, and morbidly obese patients had operations of greater duration (P < .05). In all, 8,039 patients underwent parathyroidectomy. Overweight, obese, and morbidly obese patients were more likely to have general anesthesia and operations of greater duration (all P < .01). On multivariable analysis, morbidly obese patients had operations of greater duration (P < .05) and more wound complications (P = .05). CONCLUSION: Patients with high BMI seem to require operations of greater duration and sustain more morbidity after cervical endocrine procedures than patients with normal BMI, but these differences may not be clinically significant. Thyroidectomy and parathyroidectomy can be performed safely, with appropriate surgical decision making.

Authors
Buerba, R; Roman, SA; Sosa, JA
MLA Citation
Buerba, R, Roman, SA, and Sosa, JA. "Thyroidectomy and parathyroidectomy in patients with high body mass index are safe overall: analysis of 26,864 patients." Surgery 150.5 (November 2011): 950-958.
PMID
21621238
Source
epmc
Published In
Surgery
Volume
150
Issue
5
Publish Date
2011
Start Page
950
End Page
958
DOI
10.1016/j.surg.2011.02.017

Adrenalectomy in older Americans has increased morbidity and mortality: an analysis of 6,416 patients.

BACKGROUND: The incidence of adrenal tumors increases with age. We examined the impact of older age (>60 years) on clinical and economic outcomes after adrenalectomy. METHODS: Adult patients who underwent adrenalectomy in the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) from 2003-2008 were categorized into age groups: ≤60 years, 61-70 years, and >70 years. Outcomes were compared using χ(2) and ANOVA; multivariate regression was used to assess the independent effect of older age on adrenalectomy outcomes. RESULTS: There were 6,416 patients: 21.9% were 61-70 years, and 12.9% were >70 years. Compared with patients ≤60 years, patients 61-70 and >70 years had more complications (14.1% vs. 19.9 and 22.6%; p < 0.001) and mortality (0.4% vs. 1.3 and 2.3%; p < 0.001), longer mean length of stay (LOS) (3.3 vs. 4.0 and 4.9 days; p < 0.001), and higher mean costs ($12,307 vs. $13,226 and $14,649; p < 0.001). After adjustment, older age remained independently associated with sustaining one or more complications after adrenalectomy (odds ratio (OR) 1.4, 95% confidence interval (CI) 1.1-1.7, for patients 61-70 years; OR 1.7, 95% CI 1.3-2.2 for patients >70 years) and longer adjusted LOS (1-day difference, p < 0.01). Age >70 years was independently associated with increased mortality after adrenalectomy (OR 2.8; 95% CI 1.4-5.6). Complications, LOS, and costs were reduced if patients underwent surgery by high-volume compared with low-volume surgeons. CONCLUSIONS: Older age seems to be independently associated with adverse short-term clinical and economic outcomes after adrenalectomy. Enhanced access to high-volume surgeons is a potentially modifiable factor of particular importance in these patients.

Authors
Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JA. "Adrenalectomy in older Americans has increased morbidity and mortality: an analysis of 6,416 patients." Annals of surgical oncology 18.10 (October 2011): 2714-2721.
PMID
21544656
Source
epmc
Published In
Annals of Surgical Oncology
Volume
18
Issue
10
Publish Date
2011
Start Page
2714
End Page
2721
DOI
10.1245/s10434-011-1757-5

Parathyroidectomy in the elderly: analysis of 7313 patients.

BACKGROUND: The elderly are the fastest growing subset of the U.S. population, and suffer most from primary hyperparathyroidism. This is the first multi-institutional study to characterize 30-d outcomes in elderly patients undergoing parathyroidectomy. MATERIALS AND METHODS: Patients who underwent parathyroidectomy for primary hyperparathyroidism in ACS-NSQIP, 2005-8, were stratified into age groups: 45-64, 65-79, and ≥80 y. Independent patient variables included gender, race, inpatient/outpatient type, anesthesia, ASA classification, functional status, and presence/absence of >30 conditions. Outcomes included overall/system-specific complications, return to the OR, operating times, LOS, 30-d mortality. Patients 65-79 and ≥80 y were compared with younger ones using multivariable linear and logistic regression. RESULTS: A total of 7313 patients were identified: 77.8% women, 77.2% White, and 95.6% underwent first-time parathyroidectomy. Patients 65-79 and ≥ 80 y were more likely to have inpatient parathyroidectomies compared with younger patients (42.4%, 46.8% versus 36.0%) and higher ASA classification (42.4%, 59.8% versus 24.2%, all P < 0.01). Patients ≥ 80 y were less likely than those 45-64 y to receive general anesthesia (84.9% versus 89.8%, P < 0.01). Patients ≥ 65 y were more likely to have ≥1 complication (2.2% versus 1.3%, P < 0.01) and respiratory-specific complications compared with younger patients (0.9% versus 0.3%, P < 0.01). Patients 65-79 and ≥80 y were more likely to have extended hospital stays (7.7%, 12.2% versus 6.5%, P < 0.01); mortality rate for patients ≥ 80 y was higher (0.8% versus <0.1%, P < 0.01). On multivariable analysis, patients ≥ 65 y had increased risks for overall/respiratory complications and extended hospital stays, (all P < 0.01). CONCLUSIONS: Elderly patients sustain more morbidity following parathyroidectomy. Advanced age may be an independent risk factor worth considering in surgical decision-making.

Authors
Thomas, DC; Roman, SA; Sosa, JA
MLA Citation
Thomas, DC, Roman, SA, and Sosa, JA. "Parathyroidectomy in the elderly: analysis of 7313 patients." The Journal of surgical research 170.2 (October 2011): 240-246.
PMID
21571309
Source
epmc
Published In
Journal of Surgical Research
Volume
170
Issue
2
Publish Date
2011
Start Page
240
End Page
246
DOI
10.1016/j.jss.2011.03.014

Our trainees' confidence: results from a national survey of 4136 US general surgery residents.

OBJECTIVES: To characterize factors shaping surgery resident confidence and determine whether confidence is associated with future specialty training. DESIGN: Cross-sectional study. SETTING: Survey administered at the 2008 American Board of Surgery In-Service Training Examination. PARTICIPANTS: All categorical general surgery residents. INTERVENTIONS: National Study of Expectations and Attitudes of Residents in Surgery survey. PARTICIPANTS: reported demographics and level of agreement for 46 items regarding confidence, training, and professional plans. MAIN OUTCOMES MEASURES: Survey items "My operating skill level is appropriate" and "I may not feel confident enough to perform procedures independently before training completion." We compared demographics and responses among residents who did/not feel confident. RESULTS: Response rate was 77.4%. Residents who were female, single, or without children and at a lower postgraduate year had less confidence in their operating skill, as did residents at larger, university-based programs, in the northeastern United States. Residents worried about competence were more likely to believe specialty training was needed (71.2% vs 60.2%; P < .001). After adjustment, residents dissatisfied with training were less likely to believe their skills were level appropriate (odds ratio, 0.13; P < .001) as were residents not comfortable asking for help (odds ratio, 0.48; P < .001). After adjustment, women were twice more likely than men to worry about competence after training; single residents were 1.36 times more likely than married residents to believe their skills were not level appropriate. Program location, type, and size remained associated with confidence, as did satisfaction and comfort asking for help. Residents worried about skills were more likely to plan for fellowship. CONCLUSIONS: Sex, marital status, children, and postgraduate year are predictors of confidence, as are program location, type, and size. Residency programs may target modifiable factors contributing to low surgical confidence.

Authors
Bucholz, EM; Sue, GR; Yeo, H; Roman, SA; Bell, RH; Sosa, JA
MLA Citation
Bucholz, EM, Sue, GR, Yeo, H, Roman, SA, Bell, RH, and Sosa, JA. "Our trainees' confidence: results from a national survey of 4136 US general surgery residents." Archives of surgery (Chicago, Ill. : 1960) 146.8 (August 2011): 907-914.
PMID
21844434
Source
epmc
Published In
Archives of Surgery
Volume
146
Issue
8
Publish Date
2011
Start Page
907
End Page
914
DOI
10.1001/archsurg.2011.178

High mortality in surgical patients with do-not-resuscitate orders: analysis of 8256 patients.

OBJECTIVE: To evaluate outcomes of patients who undergo surgery with a do-not-resuscitate (DNR) order. DESIGN: Retrospective cohort study. SETTING: More than 120 hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program from 2005 to 2008. PATIENTS: There were 4128 adult DNR patients and 4128 age-matched and procedure-matched non-DNR patients. MAIN OUTCOME MEASURES: Outcomes were occurrence of 1 or more postoperative complications, reoperation, death within 30 days of surgery, total time in the operating room, and length of stay. The χ(2) test was used for categorical variables and t and Wilcoxon tests were used for continuous variables. Multivariate logistic regression was done to determine independent risk factors associated with mortality in DNR patients. RESULTS: Most DNR patients were white (81.5%), female (58.2%), and elderly (mean age, 79 years). Compared with non-DNR patients, DNR patients experienced longer length of stay (36% increase; P < .001) and higher complication (26.4% vs 31%; P < .001) and mortality (8.4% vs 23.1%; P < .001) rates. Nearly 63% of DNR patients underwent nonemergent procedures; they sustained a 16.6% mortality rate. After risk adjustment, DNR status remained an independent predictor of mortality (odds ratio, 2.2; 95% confidence interval, 1.8-2.8). American Society of Anesthesiologists class 3 to 5, age older than 65 years, and preoperative sepsis were among independent risk factors associated with mortality in DNR patients. CONCLUSIONS: Surgical patients with DNR orders have significant comorbidities; many sustain postoperative complications, and nearly 1 in 4 die within 30 days of surgery. Do-not-resuscitate status appears to be an independent risk factor for poor surgical outcome.

Authors
Kazaure, H; Roman, S; Sosa, JA
MLA Citation
Kazaure, H, Roman, S, and Sosa, JA. "High mortality in surgical patients with do-not-resuscitate orders: analysis of 8256 patients." Archives of surgery (Chicago, Ill. : 1960) 146.8 (August 2011): 922-928.
PMID
21502441
Source
epmc
Published In
Archives of Surgery
Volume
146
Issue
8
Publish Date
2011
Start Page
922
End Page
928
DOI
10.1001/archsurg.2011.69

Conventional surgical management of primary hyperparathyroidism

© 2012 Springer-Verlag Berlin Heidelberg. All rights are reserved.Primary hyperparathyroidism is the most common form of hyperparathyroidism (HPTH) and is the most frequent explanation for hypercalcemia in the outpatient setting. Population-based estimates reveal an overall incidence of approximately 25 per 100,000 in the general population, with 50,000 new annual cases. The peak incidence is in the fifth and sixth decades of life, with a female to male ratio of 3:1. Some studies have estimated the overall prevalence of HPTH in the elderly at 2-3%, with approximately 200 cases/100,000 population. Parathyroidectomy with bilateral neck exploration (BNE) has been the treatment of choice for primary HPTH for many decades. With the advent of new preoperative and intraoperative parathyroid localization modalities, the concept of focused or minimally invasive parathyroidectomy has become commonplace. Nonetheless, an understanding of the conventional surgical management remains paramount for the successful treatment of primary HPTH. This time-tested dissection by an experienced endocrine surgeon continues to be the gold standard to which all other procedures are compared.

Authors
Wu, LS; Roman, S
MLA Citation
Wu, LS, and Roman, S. "Conventional surgical management of primary hyperparathyroidism." Surgery of the Thyroid and Parathyroid Glands. July 1, 2011. 463-473.
Source
scopus
Publish Date
2011
Start Page
463
End Page
473
DOI
10.1007/978-3-642-23459-0_32

Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans.

BACKGROUND: Gallstone disease increases with age. The aims of this study were to measure short-term outcomes from cholecystectomy in hospitalized elderly patients, assess the effect of age, and identify predictors of outcomes. METHODS: This was a cross-sectional analysis, using the Health Care Utilization Project Nationwide Inpatient Sample (1999-2006), of elderly patients (aged 65-79 and ≥80 years) and a comparison group (aged 50-64 years) hospitalized for cholecystectomy. Linear and logistic regression models were used to evaluate age and outcome relationships. Main outcomes were in-hospital mortality, complications, discharge disposition, mean length of stay, and cost. RESULTS: A total of 149,855 patients aged 65 to 79 years, 62,561 patients aged ≥ 80 years, and 145,675 subjects aged 50 to 64 years were included. Elderly patients had multiple biliary diagnoses and longer times to surgery from admission and underwent more open procedures. Patients aged 65 to 79 years and those aged ≥80 years had higher adjusted odds of mortality (odds ratios [ORs], 2.36 and 5.91, respectively), complications (ORs, 1.57 and 2.39), nonroutine discharge (ORs, 3.02 and 10.76), longer length of stay (ORs, 1.11 and 1.31), and higher cost (ORs, 1.09 and 1.22) than younger patients. CONCLUSIONS: Elderly patients undergoing inpatient cholecystectomy have complex disease, with worse outcomes. Longer time from admission to surgery predicts poor outcome.

Authors
Kuy, S; Sosa, JA; Roman, SA; Desai, R; Rosenthal, RA
MLA Citation
Kuy, S, Sosa, JA, Roman, SA, Desai, R, and Rosenthal, RA. "Age matters: a study of clinical and economic outcomes following cholecystectomy in elderly Americans." American journal of surgery 201.6 (June 2011): 789-796.
PMID
21741511
Source
epmc
Published In
The American Journal of Surgery
Volume
201
Issue
6
Publish Date
2011
Start Page
789
End Page
796
DOI
10.1016/j.amjsurg.2010.04.018

Obesity is a predictor of morbidity in 1,629 patients who underwent adrenalectomy.

BACKGROUND: We examined the impact of obesity on 30-day outcomes of adrenalectomy using a multi-institutional database. METHODS: Patients who underwent adrenalectomy in 2005-2008 according to the American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) data set were grouped by body mass index (BMI): normal weight (BMI=18.5-24.9 kg/m2), overweight (BMI=25.0-29.9 kg/m2), obese (BMI=30.0-34.9 kg/m2), and morbidly obese (BMI≥35 kg/m2). Outcomes of the higher BMI groups were compared to those of the normal BMI group using χ2, analysis of variance (ANOVA), and multivariate regression. RESULTS: There were 1,629 patients in the study: 22% were normal weight, 31% overweight, 22.2% obese, and 24.7% morbidly obese. Compared to normal-weight patients, obese and morbidly obese patients had a 12.5 and 16.7% increase in operation times (129 vs. 145 and 150 min, respectively, p≤0.01) and sustained more wound complications (0.2 vs. 0.4 and 1.2%, p<0.001), including superficial and deep wound infections (p<0.001 and p<0.01, respectively). Morbid obesity independently predicted overall complications (odds ratio [OR] 2.9, 95% confidence interval [CI]: 1.7-5.7), wound complications (OR 6.1, 95% CI: 2.0-18.9), and septic complications (OR 3.1, 95% CI: 1.1-8.8). Obesity independently predicted longer total time in the operating room (p<0.006). There were no differences in rates of reoperation and length of hospital stay by BMI category. CONCLUSION: Obesity is an independent risk factor that needs to be considered in surgical decisions regarding adrenalectomy. Morbidly obese adrenalectomy patients are particularly at risk for wound and septic complications.

Authors
Kazaure, HS; Roman, SA; Sosa, JA
MLA Citation
Kazaure, HS, Roman, SA, and Sosa, JA. "Obesity is a predictor of morbidity in 1,629 patients who underwent adrenalectomy." World journal of surgery 35.6 (June 2011): 1287-1295.
PMID
21455782
Source
epmc
Published In
World Journal of Surgery
Volume
35
Issue
6
Publish Date
2011
Start Page
1287
End Page
1295
DOI
10.1007/s00268-011-1070-2

The vulnerable stage of dedicated research years of general surgery residency: results of a national survey.

OBJECTIVE: To characterize the demographics and attitudes of US general surgery residents performing full-time research. DESIGN: Cross-sectional national survey administered after the 2008 American Board of Surgery In-Service Training Examination. SETTING: Two hundred forty-eight residency programs. PARTICIPANTS: General surgery residents. INTERVENTION: Survey administration. MAIN OUTCOMES MEASURES: A third of categorical general surgery residents interrupt residency to pursue full-time research. To our knowledge, there exist no comprehensive reports on the attitudes of such residents. RESULTS: Four hundred fifty residents performing full-time research and 864 postgraduate year 3 (PGY-3) clinical residents completed the survey. Thirty-eight percent of research residents were female, 53% were married, 30% had children, and their mean age was 31 years. Residency programs that were academic, large, and affiliated with fellowships had proportionally more research residents compared with other programs. Research and PGY-3 residents differed (P < .05) on 10 survey items. Compared with PGY-3 residents, research residents were less likely to feel they fit well in their program (86% vs 79%, respectively), that their program had support structures if they struggled (72% vs 64%), or that they could turn to faculty (71% vs 65%). They were more likely to feel training was too long (21% vs 30%) and that surgeons must be specialty trained (55% vs 63%). In multivariate analyses, research residents believed surgical training was too long (odds ratio, 1.36) and they fit in less well at their programs (odds ratio, 0.71) (P < .05). CONCLUSIONS: Compared with PGY-3 residents, research residents report less satisfaction with important aspects of training, suggesting this is a vulnerable stage. Interventions could be targeted to facilitate support and better integration into the mainstream of surgical education.

Authors
Sue, GR; Bucholz, EM; Yeo, H; Roman, SA; Jones, A; Bell, RH; Sosa, JA
MLA Citation
Sue, GR, Bucholz, EM, Yeo, H, Roman, SA, Jones, A, Bell, RH, and Sosa, JA. "The vulnerable stage of dedicated research years of general surgery residency: results of a national survey." Archives of surgery (Chicago, Ill. : 1960) 146.6 (June 2011): 653-658.
PMID
21339415
Source
epmc
Published In
Archives of Surgery
Volume
146
Issue
6
Publish Date
2011
Start Page
653
End Page
658
DOI
10.1001/archsurg.2011.12

To supplement or not to supplement: a cost-utility analysis of calcium and vitamin D repletion in patients after thyroidectomy.

BACKGROUND: Postoperative hypocalcemia is the most common complication after thyroidectomy; prevention and treatment remain areas of ongoing debate. The purpose of this study was to determine the incremental cost utility of routine versus selective calcium and vitamin D supplementation after total or completion thyroidectomy. METHODS: A cost-utility analysis using a Markov decision model was performed for a hypothetical cohort of adult patients after thyroidectomy. Routine or selective supplementation of oral calcium carbonate, vitamin D (calcitriol), and intravenous calcium gluconate, when required, was used. Selective supplementation was determined by serum intact parathyroid hormone levels. The incremental cost utility, measured in U.S. dollars per quality-adjusted life-year (QALY), was calculated. RESULTS: In the base-case analysis, the cost of routine supplementation was $102 versus $164 for selective supplementation. Patients in the routine arm gained 0.002 QALYs compared to patients in the selective arm (0.95936 QALYs vs. 0.95725 QALYs). At the population level, this translates into a savings of $29,365/QALY (95% confidence interval, -$66,650 to -$1,772) for routine supplementation. Sensitivity analyses demonstrated that the model was most sensitive to the utility of the hypocalcemic state, postoperative rates of hypocalcemia, and cost of serum parathyroid hormone testing. CONCLUSIONS: Routine oral calcium and calcitriol supplementation in patients after thyroidectomy seems to be less expensive and results in higher patient utility than selective supplementation. Surgeons who have very low rates of hypocalcemia in their patients may benefit less from routine supplementation.

Authors
Wang, TS; Cheung, K; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Cheung, K, Roman, SA, and Sosa, JA. "To supplement or not to supplement: a cost-utility analysis of calcium and vitamin D repletion in patients after thyroidectomy." Annals of surgical oncology 18.5 (May 2011): 1293-1299.
PMID
21088914
Source
epmc
Published In
Annals of Surgical Oncology
Volume
18
Issue
5
Publish Date
2011
Start Page
1293
End Page
1299
DOI
10.1245/s10434-010-1437-x

Same-day thyroidectomy: a review of practice patterns and outcomes for 1,168 procedures in New York State.

BACKGROUND: There has been a shift of procedures from the inpatient to the outpatient setting. Same-day thyroidectomy (SDT) has been reported in high-volume single-institution series, but few studies have evaluated its widespread use. METHODS: Patients undergoing thyroidectomy for benign and malignant thyroid disease were abstracted from the 2004 New York State inpatient (SID) and ambulatory surgery (SASD) databases. SDTs were discharged on the same day as their surgery. Patient and provider (surgeon and hospital volume) characteristics were associated with outcomes, including probability of SDT versus hospital admission and 30-day rehospitalization, by bivariate and multivariate analyses. RESULTS: A total of 6,762 thyroidectomies were identified; 17% (1,168) were SDTs. Patients undergoing SDT compared to thyroidectomy with admission were more often white (80 vs. 65%, P < 0.001), with private insurance (80 vs. 70%, P < 0.001) and fewer comorbidities (96 vs. 89% with Charlson scores of none/low, P < 0.001). SDT was performed more often by high-volume surgeons (48 vs. 31%, P < 0.001) and at high-volume hospitals (61 vs. 35%, P < 0.001). Rehospitalization rates of 1.4 and 2.4% were observed for SDT and inpatient thyroidectomy, respectively (P = NS). In multivariate analysis, thyroidectomy by a high-volume surgeon was associated with a higher chance of same-day discharge (odds ratio = 2.3, P < 0.001). CONCLUSION: Nearly 20% of thyroidectomy patients undergo SDT in New York State. They have different demographic and clinical characteristics than patients undergoing thyroidectomy who are admitted. There seem to be a few high-volume surgeons and centers with extensive SDT experience. More research is needed to explore optimized patient triage and patterns of referral to centers of excellence.

Authors
Tuggle, CT; Roman, S; Udelsman, R; Sosa, JA
MLA Citation
Tuggle, CT, Roman, S, Udelsman, R, and Sosa, JA. "Same-day thyroidectomy: a review of practice patterns and outcomes for 1,168 procedures in New York State." Annals of surgical oncology 18.4 (April 2011): 1035-1040.
PMID
21086054
Source
epmc
Published In
Annals of Surgical Oncology
Volume
18
Issue
4
Publish Date
2011
Start Page
1035
End Page
1040
DOI
10.1245/s10434-010-1398-0

The effects of serum calcium and parathyroid hormone changes on psychological and cognitive function in patients undergoing parathyroidectomy for primary hyperparathyroidism.

OBJECTIVE: This study had 2 aims: (1) to assess the timing and magnitude of psychological and neurocognitive changes before and after parathyroidectomy and (2) to examine correlations between changes in serum biomarkers and psychological symptoms and neurocognitive performance. BACKGROUND: Psychological and neurocognitive changes are common in patients with primary hyperparathyroidism (pHPT), but the associations of serum biomarkers and these changes have not been established. METHODS: This prospective cohort study carried out at a large tertiary care referral center from 2004 to 2008 screened all adult patients with the biochemical diagnosis of pHPT who underwent first-time parathyroidectomy. Laboratory results, psychological symptom reports, and results of neurocognitive testing using validated instruments were obtained preoperatively and at 1, 3, and 6 months postoperatively. Outcomes measures included serum calcium, intact parathyroid hormone (iPTH), and thyroid stimulating hormone; psychological symptom inventories (Beck Depression Inventory-II, Brief Symptom Inventory-18, and Spielberger State-Trait Anxiety Inventory); and neurocognitive test scores (Rey Auditory Verbal Learning Test and Groton Maze Learning Test). RESULTS: Two hundred twelve patients were enrolled; mean age was 60 years; 78% were female and had low comorbidity; 78% had parathyroidectomy under ambulatory, minimally invasive techniques; cure rate was 99%. Improvements in psychological and neurocognitive measures were observed at all postoperative follow-up visits. The most pronounced improvements were noted in depressive and anxiety symptoms, and visuospatial and verbal memory. Examination of change scores revealed that postoperative reduction in iPTH was associated with a decrease in state anxiety, which was also associated with improvement in visuospatial working memory. CONCLUSIONS: Reduction in mood and anxiety symptoms is associated with reductions in both iPTH and spatial working memory in patients with pHPT who undergo successful parathyroidectomy.

Authors
Roman, SA; Sosa, JA; Pietrzak, RH; Snyder, PJ; Thomas, DC; Udelsman, R; Mayes, L
MLA Citation
Roman, SA, Sosa, JA, Pietrzak, RH, Snyder, PJ, Thomas, DC, Udelsman, R, and Mayes, L. "The effects of serum calcium and parathyroid hormone changes on psychological and cognitive function in patients undergoing parathyroidectomy for primary hyperparathyroidism." Annals of surgery 253.1 (January 2011): 131-137.
PMID
21233611
Source
epmc
Published In
Annals of Surgery
Volume
253
Issue
1
Publish Date
2011
Start Page
131
End Page
137
DOI
10.1097/sla.0b013e3181f66720

Medullary thyroid cancer: an update of new guidelines and recent developments.

PURPOSE OF REVIEW: Medullary thyroid cancer (MTC) is an uncommon malignancy. Its low incidence has limited both widespread clinical expertise and definitive large randomized clinical trials. Variation in practice patterns exist in the United States with regard to diagnosis, treatment, and long-term management. We review the most recent guidelines on management of this challenging neuroendocrine malignancy. RECENT FINDINGS: Newly identified re-arranged during transfection point mutations have added to clinicians' disease prognostic accuracy, which have been incorporated in the new MTC treatment guidelines. The study of tumor marker doubling times has guided the extent of surgery and lymphadenectomy for MTC. Although data are limited, standard chemotherapy and radiation therapy have not been shown to be effective in the treatment of MTC. Newer targeted drug therapies are promising and are being examined in therapeutic clinical trials. SUMMARY: There have been several recent advances in the molecular biology, diagnosis, imaging, and treatment options for MTC. Downstaging and treating metastatic disease more effectively may improve overall survival of MTC patients. Dissemination of standardized guidelines is important for optimal treatment with less variation in quality of care.

Authors
Wu, LS; Roman, SA; Sosa, JA
MLA Citation
Wu, LS, Roman, SA, and Sosa, JA. "Medullary thyroid cancer: an update of new guidelines and recent developments." Current opinion in oncology 23.1 (January 2011): 22-27. (Review)
PMID
21045688
Source
epmc
Published In
Current Opinion in Oncology
Volume
23
Issue
1
Publish Date
2011
Start Page
22
End Page
27
DOI
10.1097/cco.0b013e328340b527

Differentiated thyroid cancer: an update.

PURPOSE OF REVIEW: The incidence of differentiated thyroid cancer (DTC) is increasing. There remains controversy regarding several aspects of its management, including the need for prophylactic central compartment neck dissection and use of recombinant human thyroid stimulating hormone (rhTSH) for ¹³¹I radioactive iodine remnant ablation in patients with low-risk disease. RECENT FINDINGS: Central compartment neck dissection entails removal of the prelaryngeal, pretracheal, and paratracheal lymph nodes. Description of the dissection should include the indication (prophylactic vs. therapeutic) and extent of dissection (unilateral vs. bilateral). After 3.7 years, patients who underwent rhTSH-assisted ablation appeared to have similar rates of ablation as patients who underwent thyroid hormone withdrawal using criteria of negative whole body scans (84% of euthyroid and 94% of hypothyroid patients) and stimulated thyroglobulin less than 2 ng/ml (95%, euthyroid; 96%, hypothyroid). In the United States, rhTSH would cost $15,994 per patient, with an incremental societal cost of $1365 per patient and incremental cost-effectiveness ratio of $52,554/quality-adjusted-life-year. SUMMARY: The use of rhTSH in patients with low-risk DTC undergoing thyroid remnant ablation appears to have similar efficacy in remnant ablation and tumoricidal effects and is associated with improved patient quality of life. Cost-effectiveness appears to be above the conventional threshold for cost-effectiveness, but is dependent on cost of rhTSH, patient utility, days off work, and rates of remnant ablation.

Authors
Wang, TS; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Roman, SA, and Sosa, JA. "Differentiated thyroid cancer: an update." Current opinion in oncology 23.1 (January 2011): 7-12. (Review)
PMID
20861795
Source
epmc
Published In
Current Opinion in Oncology
Volume
23
Issue
1
Publish Date
2011
Start Page
7
End Page
12
DOI
10.1097/cco.0b013e32833fc9d9

Surgery for solitary thyroid nodule including differentiated thyroid cancer

© 2012 Springer-Verlag Berlin Heidelberg. All rights are reserved.Thyroid nodules are common in the United States, with a prevalence of 4-7% for palpable nodules. However, nonpalpable nodules discovered incidentally on ultrasound or at autopsy suggest an overall prevalence of 19-67%. The incidence of thyroid cancer has increased from 3.6 per 100,000 in 1973 to 8.7 per 100,000 in 2002-a 2.4-fold increase-with 87% of the increase due to the diagnosis of small differentiated thyroid cancers. The association between increasing age and incidence of thyroid nodules makes their diagnosis and treatment an important public health issue. The majority of thyroid nodules are benign. Colloid nodules, cysts, and thyroiditis account for approximately 80%, and benign follicular and Hürthle cell adenomas account for 10-15% of all thyroid nodules. Overall, only 5% of thyroid nodules are malignant. The challenge for a clinician is to distinguish patients with malignancy, who are treated surgically, from patients with benign disease, who often are followed clinically.

Authors
Wu, LS; Roman, S
MLA Citation
Wu, LS, and Roman, S. "Surgery for solitary thyroid nodule including differentiated thyroid cancer." 2011. 207-214.
Source
scival
Publish Date
2011
Start Page
207
End Page
214
DOI
10.1007/978-3-642-23459-0_15

Rehospitalization among elderly patients with thyroid cancer after thyroidectomy are prevalent and costly.

BACKGROUND: Thyroid cancer increases in incidence and aggressiveness with age. The elderly are the fastest growing segment of the U.S. population. Reducing rates of rehospitalization would lower cost and improve quality of care. This is the first study to report population-level information characterizing rehospitalization after thyroidectomy among the elderly. METHODS: The Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database was used to identify patients older than aged 65 years with thyroid cancer who underwent thyroidectomy from 1997-2002. Patient and hospital characteristics were studied to predict the risk of rehospitalization. Outcomes were 30-day unplanned rehospitalization rate, cost, and length of stay (LOS) of readmission. RESULTS: Of 2,127 patients identified, 69% were women, 84% had differentiated thyroid cancer, and 52% underwent total thyroidectomy. Mean age was 74 years. A total of 171 patients (8%) underwent 30-day unplanned rehospitalization. Rehospitalization was associated with increased comorbidity, advanced stage, number of lymph nodes examined, increased LOS of index admission, and small hospital size (all P < 0.05). Patients with a complication during index hospital stay were more likely to be readmitted (P < 0.001), whereas patients who saw an outpatient medical provider after index discharge returned less frequently (P < 0.001). Forty-seven percent of readmissions were for endocrine-related causes. Mean LOS and cost of rehospitalization were 3.5 days and $5,921, respectively. Unplanned rehospitalization was associated with death at 1 year compared with nonrehospitalized patients (18% vs. 6%; P < 0.001). DISCUSSION: Rehospitalization among Medicare beneficiaries with thyroid cancer after thyroidectomy is prevalent and costly. Further study of predictors could identify high-risk patients for whom enhanced preoperative triage, improved discharge planning, and increased outpatient support might prove cost-effective.

Authors
Tuggle, CT; Park, LS; Roman, S; Udelsman, R; Sosa, JA
MLA Citation
Tuggle, CT, Park, LS, Roman, S, Udelsman, R, and Sosa, JA. "Rehospitalization among elderly patients with thyroid cancer after thyroidectomy are prevalent and costly." Annals of surgical oncology 17.11 (November 2010): 2816-2823.
PMID
20552406
Source
epmc
Published In
Annals of Surgical Oncology
Volume
17
Issue
11
Publish Date
2010
Start Page
2816
End Page
2823
DOI
10.1245/s10434-010-1144-7

Medullary thyroid cancer: are practice patterns in the United States discordant from American Thyroid Association guidelines?

BACKGROUND: Surgery is the mainstay of treatment for medullary thyroid cancer (MTC), with long-term patient outcomes associated with adequacy of resection. This study benchmarked national practice patterns against 2009 American Thyroid Association (ATA) guidelines for MTC regarding use of thyroidectomy, lymphadenectomy, radioactive iodine (RAI), and external-beam radiotherapy (EBRT). METHODS: This is a cross-sectional, retrospective cohort study of MTC patients in the Surveillance, Epidemiology, and End Results Program database, 1973 to 2006. ATA recommendations 61 to 66 (extent of surgery), 85 (RAI), and 93 (EBRT) were analyzed. Outcome of interest was practice accordance with these recommendations. Predictors of accordance were determined and Kaplan-Meier survival analyses were performed. RESULTS: A total of 2033 patients with MTC were identified. Fifty-nine percent were women; 78% were white. Forty-one percent of patients did not receive appropriate surgical therapy (recommendations 61 to 63). Most patients with distant metastatic disease had less aggressive surgery and more EBRT (P < 0.001) (recommendations 64 to 66). Four percent of patients received inappropriate RAI (recommendation 85). Two hundred nine patients had gross incomplete resections, with 33% receiving postoperative EBRT (recommendation 93). Statistically significant predictors of receiving surgery discordant with ATA recommendations in multivariate analysis were patient age >65, female sex, earlier year of diagnosis (1988 to 1997), geographic region, intrathyroidal tumor extent, and tumor size of

Authors
Panigrahi, B; Roman, SA; Sosa, JA
MLA Citation
Panigrahi, B, Roman, SA, and Sosa, JA. "Medullary thyroid cancer: are practice patterns in the United States discordant from American Thyroid Association guidelines?." Annals of surgical oncology 17.6 (June 2010): 1490-1498.
PMID
20224861
Source
epmc
Published In
Annals of Surgical Oncology
Volume
17
Issue
6
Publish Date
2010
Start Page
1490
End Page
1498
DOI
10.1245/s10434-010-1017-0

Reply

Authors
Boudourakis, LD; Roman, SA; Sosa, JA; Wang, TS; Desai, R
MLA Citation
Boudourakis, LD, Roman, SA, Sosa, JA, Wang, TS, and Desai, R. "Reply." Annals of Surgery 251.5 (May 1, 2010): 992-. (Letter)
Source
scopus
Published In
Annals of Surgery
Volume
251
Issue
5
Publish Date
2010
Start Page
992
DOI
10.1097/SLA.0b013e3181db33c7

Early clinical and economic outcomes of patients undergoing living donor nephrectomy in the United States.

BACKGROUND: Efforts to maximize kidney transplantation are tempered by concern for the live donor's safety. Case series and center surveys exist, but national aggregate data are lacking. We sought to determine predictors of early clinical and economic outcomes following living donor nephrectomy. DESIGN: A retrospective cross-sectional analysis using 1999-2005 discharge data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample was performed. Cases were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses. SETTING: Healthcare Cost and Utilization Project Nationwide Inpatient Sample. PATIENTS: Patients undergoing living donor nephrectomy, identified by the ICD-9 codes. INTERVENTIONS: Clinical and economic outcomes were analyzed with regard to patient and provider characteristics using bivariate and multivariate regression analyses. MAIN OUTCOME MEASURES: In-hospital complications, mortality, mean length of stay (LOS), and mean total hospital costs. RESULTS: A total of 6320 cases were identified with 0% mortality and a complication rate of 18.4%. The mean (SD) LOS was 3.3 (0.3) days, and the mean inpatient cost was $10 708 ($505). Independent predictors of donor complications included older age (odds ratio [OR], 1.01), male sex (OR, 1.19), Charlson Comorbidity Index of at least 1 (OR, 1.49), obesity (OR, 1.76), medium-size hospitals (OR, 1.88), and low-volume hospitals (OR, 1.37). Predictors of longer LOS included older age, female sex, Charlson score of at least 1, lower household income, low-volume and urban hospitals, and low-volume surgeons. CONCLUSIONS: Kidney donation is associated with a low mortality rate but an 18% complication rate. Donation by those with advanced age or obesity is associated with higher risks. Informed consent should include discussion of these risks.

Authors
Friedman, AL; Cheung, K; Roman, SA; Sosa, JA
MLA Citation
Friedman, AL, Cheung, K, Roman, SA, and Sosa, JA. "Early clinical and economic outcomes of patients undergoing living donor nephrectomy in the United States." Archives of surgery (Chicago, Ill. : 1960) 145.4 (April 2010): 356-362.
PMID
20404286
Source
epmc
Published In
Archives of Surgery
Volume
145
Issue
4
Publish Date
2010
Start Page
356
End Page
362
DOI
10.1001/archsurg.2010.17

To stimulate or withdraw? A cost-utility analysis of recombinant human thyrotropin versus thyroxine withdrawal for radioiodine ablation in patients with low-risk differentiated thyroid cancer in the United States.

CONTEXT: Use of recombinant human TSH (rhTSH) prior to radioactive iodine remnant ablation for patients with differentiated thyroid cancer avoids the hypothyroid state and improves quality of life. European studies have shown that use of rhTSH vs. thyroid hormone withdrawal is a cost-effective method for preparing patients for ablation. OBJECTIVE: The objective of the study was to determine the cost-utility of rhTSH prior to ablation in the United States. DESIGN/SETTING/SUBJECTS: A Markov decision model was developed for a hypothetical group of adult patients with low-risk differentiated thyroid cancer who were prepared for ablation by either rhTSH or thyroid hormone withdrawal. Patients entered the model after initial thyroidectomy; follow-up was in accordance with current American Thyroid Association guidelines. Input data were obtained from the literature, Medicare reimbursement schedule, and U.S. Bureau of Labor Statistics. Sensitivity analyses were performed for all clinically relevant inputs. MAIN OUTCOME MEASURES: Cost-utility, measured in U.S. dollars per quality-adjusted life-year ($/QALY), was measured. RESULTS: Use of rhTSH yielded an incremental cost-utility of $52,554/QALY (95% confidence interval $52,058-53,050/QALY) (incremental societal cost of $1,365/patient; incremental benefit of 0.026 QALY/patient). The majority of cost and benefit occurs during the preablation, ablation, and postablation period; differences in cost are due to cost of rhTSH and differences in productivity loss (days off work). The model was most sensitive to changes in time off work, cost of rhTSH, and differences in utilities of health states. CONCLUSIONS: In the United States, the cost-effectiveness of rhTSH for ablation in patients with low-risk differentiated thyroid cancer is highly dependent on potential variations in cost of rhTSH, rates of remnant ablation, time off work, and quality of life.

Authors
Wang, TS; Cheung, K; Mehta, P; Roman, SA; Walker, HD; Sosa, JA
MLA Citation
Wang, TS, Cheung, K, Mehta, P, Roman, SA, Walker, HD, and Sosa, JA. "To stimulate or withdraw? A cost-utility analysis of recombinant human thyrotropin versus thyroxine withdrawal for radioiodine ablation in patients with low-risk differentiated thyroid cancer in the United States." The Journal of clinical endocrinology and metabolism 95.4 (April 2010): 1672-1680.
PMID
20139234
Source
epmc
Published In
Journal of Clinical Endocrinology and Metabolism
Volume
95
Issue
4
Publish Date
2010
Start Page
1672
End Page
1680
DOI
10.1210/jc.2009-1803

Endocrine surgery: where are we today? A national survey of young endocrine surgeons.

BACKGROUND: In recent years, there has been a growing interest in endocrine surgery. Educational objectives have been published by the American Association of Endocrine Surgeons (AAES), but data have not been collected describing the recruitment pool, fellowship, or postfellowship experiences. METHODS: A survey was distributed to endocrine surgeons in practice <7 years and endocrine surgery fellows. Demographic, training, and practice data were collected. RESULTS: The survey response rate was 69% (46/67); 85% were practicing endocrine surgeons and 15% were fellows. In all, 72% of respondents completed an endocrine surgery fellowship, 17% completed surgical oncology, and the remaining individuals completed no fellowship. The mean age was 38 (32-49) years; 39% were women, 67% were white, 26% were Asian, 11% were Hispanic, and 2% were black. A total of 89% completed residency at academic centers. Endocrine surgery fellows performed significantly more endocrine surgery cases in residency than the average graduating chief resident. Mentorship was a critical factor in fellows' decisions to pursue endocrine surgery. Fellows graduated with a median (range) of 150 (50-300) thyroid, 80 (35-200) parathyroid, 10 (2-50) neck dissection, 13 (0-60) laparoscopic adrenal, and 3 (0-35) endocrine-pancreas. Fellows felt the least prepared in neck dissection and pancreas. Of the respondents, 76% of endocrine surgeons in practice are at academic centers, and 75% have practices where most cases are endocrine based. CONCLUSION: Exposure to endocrine surgery and mentorship are powerful factors that influence residents to pursue careers in endocrine surgery. Significant variation is found in the case distribution of fellowships with a relative paucity in neck dissection, pancreas procedures, and research. Recruitment to endocrine surgery should begin in residency, and the standardization of training should be a goal.

Authors
Solorzano, CC; Sosa, JA; Lechner, SC; Lew, JI; Roman, SA
MLA Citation
Solorzano, CC, Sosa, JA, Lechner, SC, Lew, JI, and Roman, SA. "Endocrine surgery: where are we today? A national survey of young endocrine surgeons." Surgery 147.4 (April 2010): 536-541.
PMID
19939426
Source
epmc
Published In
Surgery
Volume
147
Issue
4
Publish Date
2010
Start Page
536
End Page
541
DOI
10.1016/j.surg.2009.10.041

Current management of medullary thyroid cancer.

Medullary thyroid carcinoma (MTC) is an uncommon malignancy of the parafollicular C cells of the thyroid, with a propensity for early lymph node spread and distant metastasis. It is hereditary in approximately 25% of cases, involving specific point mutations of the RET proto-oncogene inherited in an autosomal dominant fashion. While European professional organizations have put forth calcitonin screening guidelines for earlier detection of MTC, the American Thyroid Association, which has published recent guidelines for MTC treatment, have not had a position on routine screening in the USA. Surgical extirpation of the primary tumor and involved lymph node metastases is the mainstay of treatment and the only chance for cure. Conventional systemic chemotherapies for metastatic MTC have been disappointing; however, newer agents which affect specific RET proteins and tyrosine kinase growth factor receptors show promise in phase 1 and 2 clinical trials.

Authors
Milan, SA; Sosa, JA; Roman, SA
MLA Citation
Milan, SA, Sosa, JA, and Roman, SA. "Current management of medullary thyroid cancer." Minerva chirurgica 65.1 (February 2010): 27-37. (Review)
PMID
20212415
Source
epmc
Published In
Minerva chirurgica
Volume
65
Issue
1
Publish Date
2010
Start Page
27
End Page
37

ATA practice guidelines for the treatment of differentiated thyroid cancer: were they followed in the United States?

BACKGROUND: The aim of this study was to benchmark national practice patterns against American Thyroid Association guidelines for thyroidectomy, lymphadenectomy, and radioactive iodine (RAI) for differentiated thyroid cancer (DTC). METHODS: A cross-sectional analysis of patients with DTC in Surveillance, Epidemiology, and End Results was performed. Outcomes were practice accordance with guidelines for extent of surgery and RAI treatment. Predictors of accordance were identified. RESULTS: A total of 52,964 patients with DTC were included. Seventy-six percent were women, and 83% white. There was 71% accordance with surgery recommendations; among these, 15% underwent central lymphadenectomy, 31% had RAI but no lymphadenectomy, and 25% had RAI and lymphadenectomy. The highest accordance with guidelines was for patients aged <45 years with stage II disease (80%); the lowest accordance was for patients aged > or = 45 years with stage II disease (52%). Patients aged >65 years and of black race had the lowest accordance (P < .001). CONCLUSIONS: Variation in practice suggests variation in the quality of care for DTC. Greater dissemination of evidence-based recommendations is needed for elderly and minority patients.

Authors
Famakinwa, OM; Roman, SA; Wang, TS; Sosa, JA
MLA Citation
Famakinwa, OM, Roman, SA, Wang, TS, and Sosa, JA. "ATA practice guidelines for the treatment of differentiated thyroid cancer: were they followed in the United States?." American journal of surgery 199.2 (February 2010): 189-198.
PMID
20113699
Source
epmc
Published In
The American Journal of Surgery
Volume
199
Issue
2
Publish Date
2010
Start Page
189
End Page
198
DOI
10.1016/j.amjsurg.2009.04.022

Treatment patterns of aging Americans with differentiated thyroid cancer.

BACKGROUND: The incidence of differentiated thyroid cancer (DTC) increases with age. Total thyroidectomy, often followed by radioactive iodine (RAI), is recommended for patients who have tumors that measure > or =1 cm in greatest dimension. In the current study, the authors assessed the use of thyroidectomy and RAI among elderly patients with DTC and the effects on survival. METHODS: Adults aged > or =45 years with DTC > or =1 cm in the Surveillance, Epidemiology, and End Results database from 1988 to 2003 were included. Bivariate and multivariate analyses were used to measure associations between demographic, clinical, and pathologic characteristics and the likelihood of receiving treatment according to current practice guidelines. RESULTS: Of 8899 patients who were identified, 26% were ages 65 years to 79 years, and 5% were aged > or =80 years. Compared with younger patients, patients aged > or = 65 years were more likely to have larger tumors, stage IV disease, extrathyroid extension, and nonpapillary histology. Elderly patients were less likely to undergo total thyroidectomy (74% vs 80%; P < .001) or to receive RAI (47% vs 54%; P < .001). These trends were most pronounced among those aged > or =80 years. Among the patients who did not undergo surgery, elderly patients did not report higher rates of contraindications to surgery. In multivariate analysis, the groups ages 65 years to 79 years and aged > or =80 years were associated with lower rates of total thyroidectomy (odds ratio, 0.77 and 0.43, respectively; P < .001) and RAI (odds ratio, 0.85 [P < .01] and 0.39 [P < .001], respectively). Among elderly patients, predictors of worse survival included no surgery (hazard ratio, 5.51; P < .001) and no RAI (hazard ratio, 1.36; P < .001). CONCLUSIONS: Elderly patients with DTC received less aggressive surgical and RAI treatment than younger patients despite having more advanced disease and the improved survival associated with these treatments among elderly patients. Long-term outcomes should be measured to determine the impact of this apparent discrepancy in care.

Authors
Park, HS; Roman, SA; Sosa, JA
MLA Citation
Park, HS, Roman, SA, and Sosa, JA. "Treatment patterns of aging Americans with differentiated thyroid cancer." Cancer 116.1 (January 2010): 20-30.
PMID
19908255
Source
epmc
Published In
Cancer
Volume
116
Issue
1
Publish Date
2010
Start Page
20
End Page
30
DOI
10.1002/cncr.24717

Primary thyroid lymphoma: a review of recent developments in diagnosis and histology-driven treatment.

PURPOSE OF REVIEW: Primary thyroid lymphoma (PTL) is a rare but clinically important malignancy of the thyroid. This article reviews the diagnosis, histologic subtypes, pathogenesis, and treatment of PTL, with the objective of optimizing diagnosis and management of the disease. RECENT FINDINGS: Recent studies have shed light on the clinicopathologic features of the histologic subtypes of PTL. Analysis of the pathogenesis of PTL indicates that both antigenic stimulation in the setting of Hashimoto's thyroiditis and aberrant somatic hypermutation may play a role. The first large, population-based study of PTL indicated that age, stage, histologic subtype, and treatment modality have prognostic implications. The U.S. Food and Drug Administration approval of rituximab for non-Hodgkin's lymphoma has improved standard chemotherapeutic options, as data on efficacy in nodal and other extranodal lymphomas have been extrapolated to PTL. SUMMARY: Advances in the understanding of the histologic subtypes of PTL have led to more accurate diagnosis and tailored treatments. The introduction of a new chemotherapeutic agent has expanded the treatment paradigm for PTL. Important prognostic indicators of survival for patients with PTL have been confirmed in the first population-based study. This article emphasizes current diagnostic and treatment approaches and discusses the potential for future developments.

Authors
Graff-Baker, A; Sosa, JA; Roman, SA
MLA Citation
Graff-Baker, A, Sosa, JA, and Roman, SA. "Primary thyroid lymphoma: a review of recent developments in diagnosis and histology-driven treatment." Current opinion in oncology 22.1 (January 2010): 17-22. (Review)
PMID
19844180
Source
epmc
Published In
Current Opinion in Oncology
Volume
22
Issue
1
Publish Date
2010
Start Page
17
End Page
22
DOI
10.1097/cco.0b013e3283330848

Prognosis of primary thyroid lymphoma: demographic, clinical, and pathologic predictors of survival in 1,408 cases.

BACKGROUND: There is a paucity of data regarding prognosis of primary thyroid lymphoma (PTL), with only case reports and institutional series reported. This is the first population-based study of PTL in the United States. METHODS: PTL patients were identified in the SEER database. Bivariate (chi(2), Kaplan-Meier, and log rank) and multivariate (Cox proportional hazards) analyses were used to assess the associations between patient characteristics and survival. RESULTS: A total of 1,408 patients were identified over 32 years of follow-up (median, 3.75 years). Mean age was 66 years; 75% were female and 93% white. Overall, 98% had non-Hodgkin's lymphoma; 68% had diffuse large B-cell, 10% follicular, 10% marginal zone, and 3% small lymphocytic. A total of 88% had stage I-II disease. Median survival was 9.3 years. On bivariate analysis, older age, single marital status, stage II-IV disease, histology (large B-cell, follicular, or other non-Hodgkin's), earlier year of diagnosis, lack of prior malignancies, and no radiation/surgery predicted worse survival. Age >or=80 years, advanced stage, no radiation/surgery, and large B-cell or follicular histology predicted worse prognosis in multivariate analysis. CONCLUSION: Older age, advanced stage, histologic subtype, and lack of radiation/surgical treatment are associated with worse survival. Thyroid resection offers benefit only for patients with stage I disease. Management of PTL requires multidisciplinary collaboration.

Authors
Graff-Baker, A; Roman, SA; Thomas, DC; Udelsman, R; Sosa, JA
MLA Citation
Graff-Baker, A, Roman, SA, Thomas, DC, Udelsman, R, and Sosa, JA. "Prognosis of primary thyroid lymphoma: demographic, clinical, and pathologic predictors of survival in 1,408 cases." Surgery 146.6 (December 2009): 1105-1115.
PMID
19958938
Source
epmc
Published In
Surgery
Volume
146
Issue
6
Publish Date
2009
Start Page
1105
End Page
1115
DOI
10.1016/j.surg.2009.09.020

Outcomes from 3144 adrenalectomies in the United States: which matters more, surgeon volume or specialty?

OBJECTIVE: To assess the effect of surgeon volume and specialty on clinical and economic outcomes after adrenalectomy. DESIGN: Population-based retrospective cohort analysis. SETTING: Healthcare Cost and Utilization Project Nationwide Inpatient Sample. PARTICIPANTS: Adults (>or=18 years) undergoing adrenalectomy in the United States (1999-2005). Patient demographic and clinical characteristics, surgeon specialty (general vs urologist), surgeon adrenalectomy volume, and hospital factors were assessed. MAIN OUTCOME MEASURES: The chi(2) test, analysis of variance, and multivariate linear and logistic regression were used to assess in-hospital complications, mean hospital length of stay (LOS), and total inpatient hospital costs. RESULTS: A total of 3144 adrenalectomies were included. Mean patient age was 53.7 years; 58.8% were women and 77.4% white. A higher proportion of general surgeons were high-volume surgeons compared with urologists (34.1% vs 18.2%, P < .001). Low-volume surgeons had more complications (18.2% vs 11.3%, P < .001) and their patients had longer LOS (5.5 vs 3.9 days, P < .001) than did high-volume surgeons; urologists had more complications (18.4% vs 15.2%, P = .03) and higher costs ($13,168 vs $11,732, P = .02) than did general surgeons. After adjustment for patient and provider characteristics in multivariate analyses, surgeon volume, but not specialty, was an independent predictor of complications (odds ratio = 1.5, P < .002) and LOS (1.0-day difference, P < .001). Hospital volume was associated only with LOS (0.8-day difference, P < .007). Surgeon volume, specialty, and hospital volume were not predictors of costs. CONCLUSION: To optimize outcomes, patients with adrenal disease should be referred to surgeons based on adrenal volume and laparoscopic expertise irrespective of specialty practice.

Authors
Park, HS; Roman, SA; Sosa, JA
MLA Citation
Park, HS, Roman, SA, and Sosa, JA. "Outcomes from 3144 adrenalectomies in the United States: which matters more, surgeon volume or specialty?." Archives of surgery (Chicago, Ill. : 1960) 144.11 (November 2009): 1060-1067.
PMID
19917944
Source
epmc
Published In
Archives of Surgery
Volume
144
Issue
11
Publish Date
2009
Start Page
1060
End Page
1067
DOI
10.1001/archsurg.2009.191

Diagnosis of ectopic middle mediastinal parathyroid adenoma using endoscopic ultrasonography-guided fine-needle aspiration with real-time rapid parathyroid hormone assay.

Authors
Graff-Baker, A; Roman, SA; Boffa, D; Aslanian, H; Sosa, JA
MLA Citation
Graff-Baker, A, Roman, SA, Boffa, D, Aslanian, H, and Sosa, JA. "Diagnosis of ectopic middle mediastinal parathyroid adenoma using endoscopic ultrasonography-guided fine-needle aspiration with real-time rapid parathyroid hormone assay." Journal of the American College of Surgeons 209.3 (September 2009): e1-e4.
PMID
19717031
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
209
Issue
3
Publish Date
2009
Start Page
e1
End Page
e4
DOI
10.1016/j.jamcollsurg.2009.05.023

Outcomes following cholecystectomy in pregnant and nonpregnant women.

BACKGROUND: This study is the first population-based measurement of outcomes after cholecystectomy during pregnancy. METHODS: We identified all pregnant women who underwent cholecystectomy in the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 1996-2006. Outcomes were fetal, maternal, and surgical complications, length of stay (LOS), and hospital cost. Pregnant and nonpregnant women were compared to examine the effects of pregnancy on laparoscopic cholecystectomy outcomes. RESULTS: A total of 9,714 pregnant women underwent cholecystectomy (laparoscopic, 89%). Maternal and fetal complication rates were 4.3% and 5.8%, respectively. Pregnant women who underwent laparoscopic cholecystectomy compared to pregnant women who underwent open procedures had higher rates of surgical (19% vs 10%), maternal (9% vs 4%), and fetal (11% vs 5%) complications; longer LOS (6 vs 4 days); and higher cost ($13,198 vs $9,229), all P < .0001. High-volume surgeons were associated with lower rates of surgical (10% vs 13%; P < .05), maternal (1% vs 14%), and fetal (4% vs 10%) complications; shorter LOS (4 vs 5 days); and lower cost ($8,365 vs $10,350), all P < .0001. Patients with Medicaid coverage were associated with higher rates of surgical complications (13% vs 9%), longer LOS (4.3 vs 3.7 days), and higher cost ($10,403 vs $9,037), all P < .0001. On multivariable analysis, these factors remained independent predictors of outcome. Pregnancy was associated with longer LOS and higher cost. CONCLUSION: Complications of cholecystectomy during pregnancy are significant, with disparities based on modifiable variables.

Authors
Kuy, S; Roman, SA; Desai, R; Sosa, JA
MLA Citation
Kuy, S, Roman, SA, Desai, R, and Sosa, JA. "Outcomes following cholecystectomy in pregnant and nonpregnant women." Surgery 146.2 (August 2009): 358-366.
PMID
19628096
Source
epmc
Published In
Surgery
Volume
146
Issue
2
Publish Date
2009
Start Page
358
End Page
366
DOI
10.1016/j.surg.2009.03.033

Evaluating the surgery literature: can standardizing peer-review today predict manuscript impact tomorrow?

OBJECTIVE: Evidence-based surgery is predicated on the quality of published literature. We measured the quality of surgery manuscripts selected by peer review and identified predictors of excellence. METHODS: One hundred twenty clinical surgery manuscripts were randomly selected from 1998 in 5 eminent peer-reviewed surgery and medical journals. Manuscripts were blinded for author, institution, and journal of origin. Four surgeons and 4 methodologists evaluated the quality using novel instruments based on subject selection, study protocol, statistical analysis/inference, intervention description, outcome assessments, and results presentation. Predictors of quality and impact factor were identified using bivariate and multivariate regression. RESULTS: Oncology was the most common subject (26%), followed by general surgery/gastrointestinal (24%). The average number of study subjects was 417; the majority of manuscripts were American (53%), from a single institution (59%). Eighteen percent had a statistician author. Mean number of citations was 128. Surgery manuscripts from medical, compared with surgery journals, had better total quality scores (3.8 vs. 5.2, P < 0.001). They had more subjects and were more likely to have a statistician as coauthor (43% vs. 10%, P < 0.001), multi-institutional, international collaboration (30% vs. 8%, P < 0.001), and higher citation index (mean: 350 vs. 54, P < 0.001). They were more often foreign (70% vs. 40%, P < 0.001). Independent predictors of quality were having a statistician coauthor, study funding, European origin, and more study subjects. Quality assessment using our instruments predicted the number of citations after 10 years (P < 0.01), along with having a statistician coauthor, international multi-institutional collaboration, and more subjects. CONCLUSION: The quality of surgery manuscripts can be improved by including a statistician as coauthor, with efforts directed toward implementing multi-institutional/interdisciplinary trials. Peer-review across journals can be standardized through the use of instruments measuring methodologic and clinical quality.

Authors
Sosa, JA; Mehta, P; Thomas, DC; Berland, G; Gross, C; McNamara, RL; Rosenthal, R; Udelsman, R; Bravata, DM; Roman, SA
MLA Citation
Sosa, JA, Mehta, P, Thomas, DC, Berland, G, Gross, C, McNamara, RL, Rosenthal, R, Udelsman, R, Bravata, DM, and Roman, SA. "Evaluating the surgery literature: can standardizing peer-review today predict manuscript impact tomorrow?." Annals of surgery 250.1 (July 2009): 152-158.
PMID
19561471
Source
epmc
Published In
Annals of Surgery
Volume
250
Issue
1
Publish Date
2009
Start Page
152
End Page
158
DOI
10.1097/sla.0b013e3181ad8905

Evolution of the surgeon-volume, patient-outcome relationship.

OBJECTIVE: Higher surgeon volume is associated with improved patient outcomes. This finding has prompted recommendations for increasing specialization and referrals to high-volume surgeons, yet their implementation in clinical practice has not been measured. METHODS: We performed cross-sectional analyses using 1999 and 2005 discharge information from the Health Care Utilization Project National Inpatient Sample to measure whether the number of procedures performed by high-volume surgeons increased over time. Procedures included those demonstrated to have strong surgeon volume-outcome associations in the literature. International Classification of Diseases, Ninth Revision codes were employed for colorectal procedures, esophagectomy, gastrectomy, pancreatectomy, thyroidectomy, coronary artery bypass graft surgery, and carotid endarterectomy. Bivariate analyses and hierarchical generalized linear models were employed to measure association between surgeon volume and length of stay (LOS) and mortality or complications. RESULTS: There was a significant increase in the proportion of procedures performed by high-volume surgeons over time, with the most dramatic increases seen for gastrectomy (54%), pancreatectomy (31%), and thyroidectomy (23%). Having a procedure performed by a high-volume surgeon was associated with patient race and insurance status. Overall, unadjusted mortality and LOS were significantly lower for high-volume surgeons compared with low-volume surgeons in 1999 and 2005. In multivariable hierarchical generalized linear models, only differences in LOS by surgeon volume remained significant in both years. CONCLUSIONS: The proportion of procedures performed by high-volume surgeons increased over a 6-year period, as evidence mounted in support of a surgeon volume-outcome association. Efforts are still needed to improve access among underserved subsets of the population and eliminate apparent disparities based on patient race and insurance status.

Authors
Boudourakis, LD; Wang, TS; Roman, SA; Desai, R; Sosa, JA
MLA Citation
Boudourakis, LD, Wang, TS, Roman, SA, Desai, R, and Sosa, JA. "Evolution of the surgeon-volume, patient-outcome relationship." Annals of surgery 250.1 (July 2009): 159-165.
PMID
19561457
Source
epmc
Published In
Annals of Surgery
Volume
250
Issue
1
Publish Date
2009
Start Page
159
End Page
165
DOI
10.1097/sla.0b013e3181a77cb3

The management of thyroid nodules in patients with primary hyperparathyroidism.

BACKGROUND: Thyroid nodules are found in 12-52% of patients with primary hyperparathyroidism (pHPT). With the increasing use of minimally invasive parathyroidectomy (MIP), there is no standard approach for the management of incidental thyroid nodules in pHPT patients. METHODS: A survey was conducted of the American Association of Endocrine Surgeons. Information was obtained regarding parathyroidectomy practice patterns, including surgical technique, preoperative localization procedures, and algorithms used in the diagnosis/treatment of incidental thyroid nodules. RESULTS: The survey response rate was 74%. Sixty-seven percent were high-volume parathyroid surgeons (>5/mo); the majority performed MIP. High-volume surgeons were more likely to use Sestamibi/single photon emitted computed tomography for preoperative localization (40% versus 24%; P = 0.011) and to disregard incidentally discovered thyroid nodules <1 cm (41% versus 22%; P = 0.023). They were less likely to evaluate nodules discovered intraoperatively by frozen section (28% versus 41%; P = 0.081), fine-needle aspiration (13% versus 24%; P = 0.078), or thyroidectomy (24% versus 40%; P = 0.03). Surgeons performing open parathyroidectomy were more likely than those who use MIP to biopsy nodules intraoperatively (32% versus 20%; P < 0.05) and perform simultaneous thyroidectomy (30% versus 10%; P < 0.001). CONCLUSIONS: Experienced endocrine surgeons disagree about the optimal management of incidental thyroid nodules encountered during parathyroidectomy. Our data suggest that high-volume parathyroid surgeons are less aggressive in their evaluation of thyroid pathology in patients with pHPT. Variation in practice among this experienced group implies even greater variation in the broader surgical community, and in the quality and cost of care for patients with pHPT.

Authors
Wang, TS; Roman, SA; Cox, H; Air, M; Sosa, JA
MLA Citation
Wang, TS, Roman, SA, Cox, H, Air, M, and Sosa, JA. "The management of thyroid nodules in patients with primary hyperparathyroidism." The Journal of surgical research 154.2 (June 2009): 317-323.
PMID
19201427
Source
epmc
Published In
Journal of Surgical Research
Volume
154
Issue
2
Publish Date
2009
Start Page
317
End Page
323
DOI
10.1016/j.jss.2008.06.013

Outcomes following thyroid and parathyroid surgery in pregnant women.

OBJECTIVES: To perform the first population-based measurement of clinical and economic outcomes after thyroid and parathyroid surgery in pregnant women and identify the characteristics of this population and the predictors of outcome. DESIGN: Retrospective cross-sectional study. SETTING: Health Care Utilization Project Nationwide Inpatient Sample (HCUP-NIS), a 20% sample of nonfederal US hospitals. PATIENTS: All pregnant women, compared with age-matched nonpregnant women, who underwent thyroid and parathyroid procedures from 1999 to 2005. MAIN OUTCOME MEASURES: Fetal, maternal, and surgical complications, in-hospital mortality, median length of stay, and hospital costs. RESULTS: A total of 201 pregnant women underwent thyroid (n = 165) and parathyroid (n = 36) procedures and were examined together. The mean age was 29 years, 60% were white, 25% were emergent or urgent admissions, and 46% had thyroid cancer. Compared with nonpregnant women (n = 31 155), pregnant patients had a higher rate of endocrine (15.9 vs 8.1%; P < .001) and general complications (11.4 vs 3.6%; P < .001), longer unadjusted lengths of stay (2 days vs 1 day; P < .001), and higher unadjusted hospital costs ($6873 vs $5963; P = .007). The fetal and maternal complication rates were 5.5% and 4.5%, respectively. On multivariate regression analysis, pregnancy was an independent predictor of higher combined surgical complications (odds ratio, 2; P < .001), longer adjusted length of stay (0.3 days longer; P < .001), and higher adjusted hospital costs ($300; P < .001). Other independent predictors of outcome were surgeon volume, patient race or ethnicity, and insurance status. CONCLUSIONS: Pregnant women have worse clinical and economic outcomes following thyroid and parathyroid surgery than nonpregnant women, with disparities in outcomes based on race, insurance, and access to high-volume surgeons.

Authors
Kuy, S; Roman, SA; Desai, R; Sosa, JA
MLA Citation
Kuy, S, Roman, SA, Desai, R, and Sosa, JA. "Outcomes following thyroid and parathyroid surgery in pregnant women." Archives of surgery (Chicago, Ill. : 1960) 144.5 (May 2009): 399-406.
PMID
19451480
Source
epmc
Published In
Archives of Surgery
Volume
144
Issue
5
Publish Date
2009
Start Page
399
End Page
406
DOI
10.1001/archsurg.2009.48

Medullary thyroid cancer: early detection and novel treatments.

PURPOSE OF REVIEW: Medullary thyroid cancer (MTC) is derived from the parafollicular cells of the thyroid. Understanding the molecular biology behind specific mutations of the RET gene and their prognostic implications have led to the establishment of tailored treatment modalities for certain patients. We review the most recent studies on the molecular biology, calcitonin screening, diagnosis, imaging, and treatment of MTC. RECENT FINDINGS: Newly identified rearranged during transfection point mutations have helped with MTC prognosis and have resulted in the establishment of new treatment guidelines. Screening for MTC in the United States with basal serum calcitonin for patients with thyroid nodules would cost $11,793 per life-year saved (LYS), compared with colonoscopy and mammography screening. For metastatic or recurrent disease, neck ultrasound, chest computed tomography scan, liver MRI, bone scintigraphy, and axial skeleton MRI have been proven superior to 18F-FDG PET/computed tomography. For patients with nonoperable metastatic disease, novel chemotherapeutic agents, such as vandetanib, targeting rearranged during transfection, vascular endothelial growth factor receptor and epidermal growth factor receptor, are showing promise. Such agents are currently in phase II trials. SUMMARY: There have been several recent advances in the diagnosis, molecular biology, imaging, and treatment options of MTC. By potentially downstaging of disease, and treating metastatic disease more effectively, overall survival and outcomes of patients may improve.

Authors
Roman, S; Mehta, P; Sosa, JA
MLA Citation
Roman, S, Mehta, P, and Sosa, JA. "Medullary thyroid cancer: early detection and novel treatments." Current opinion in oncology 21.1 (January 2009): 5-10. (Review)
PMID
19125012
Source
epmc
Published In
Current Opinion in Oncology
Volume
21
Issue
1
Publish Date
2009
Start Page
5
End Page
10
DOI
10.1097/cco.0b013e32831ba0b3

Predictors of outcomes following pediatric thyroid and parathyroid surgery.

PURPOSE OF REVIEW: Recent studies have demonstrated racial/ethnic and socioeconomic disparities in adults undergoing thyroidectomy and parathyroidectomy. To date, few studies have examined outcomes in children undergoing cervical endocrine surgery. RECENT FINDINGS: Children undergoing thyroidectomy and parathyroidectomy have higher complication rates than adults undergoing similar procedures. Complication rates appear to be lower when procedures are performed by high-volume surgeons. Access to high-volume surgeons continues to be limited for children of racial/ethnic minorities and in families of a lower socioeconomic status. SUMMARY: Complications following thyroidectomy and parathyroidectomy in children can have profound, life-long effects on development and quality of life. Outcomes are optimized when surgery is performed by high-volume surgeons. Obtaining access to high-volume surgeons requires a multidisciplinary approach by parents, pediatricians, pediatric endocrinologists, and third-party payers.

Authors
Wang, TS; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Roman, SA, and Sosa, JA. "Predictors of outcomes following pediatric thyroid and parathyroid surgery." Current opinion in oncology 21.1 (January 2009): 23-28. (Review)
PMID
19125014
Source
epmc
Published In
Current Opinion in Oncology
Volume
21
Issue
1
Publish Date
2009
Start Page
23
End Page
28
DOI
10.1097/cco.0b013e32831897b6

Pediatric endocrine surgery: who is operating on our children?

BACKGROUND: High surgeon volume is associated with improved outcomes in adult endocrine surgery. This is the first population-based outcomes study for thyroidectomy/parathyroidectomy in children. METHODS: Cross-sectional analyses were performed using 1999 to 2005 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Outcomes included complications, length of stay (LOS), and costs. High-volume surgeons performed >30 cervical endocrine procedures per year in adults and children; pediatric surgeons restricted >90% of their practices to patients

Authors
Tuggle, CT; Roman, SA; Wang, TS; Boudourakis, L; Thomas, DC; Udelsman, R; Ann Sosa, J
MLA Citation
Tuggle, CT, Roman, SA, Wang, TS, Boudourakis, L, Thomas, DC, Udelsman, R, and Ann Sosa, J. "Pediatric endocrine surgery: who is operating on our children?." Surgery 144.6 (December 2008): 869-877.
PMID
19040991
Source
epmc
Published In
Surgery
Volume
144
Issue
6
Publish Date
2008
Start Page
869
End Page
877
DOI
10.1016/j.surg.2008.08.033

Clinical and economic outcomes of thyroid and parathyroid surgery in children.

CONTEXT: Clinical and economic outcomes after thyroidectomy/parathyroidectomy in adults have demonstrated disparities based on patient age and race/ethnicity; there is a paucity of literature on pediatric endocrine outcomes. OBJECTIVE: The objective was to examine the clinical and demographic predictors of outcomes after pediatric thyroidectomy/parathyroidectomy. DESIGN: This study is a cross-sectional analysis of Healthcare Cost and Utilization Project-National Inpatient Sample hospital discharge information from 1999-2005. All patients who underwent thyroidectomy/parathyroidectomy were included. Bivariate and multivariate analyses were performed to identify independent predictors of patient outcomes. SUBJECTS: Subjects included 1199 patients 17 yr old or younger undergoing thyroidectomy/parathyroidectomy. MAIN OUTCOME MEASURES: Outcome measures included in-hospital patient complications, length of stay (LOS), and inpatient hospital costs. RESULTS: The majority of patients were female (76%), aged 13-17 yr (71%), and White (69%). Whites were more often in the highest income group (80% vs. 8% for Hispanic and 6% for Black; P < 0.01) and had private/HMO insurance (76% vs. 10% for Hispanic and 5% for Black; P < 0.001) rather than Medicaid (13% vs. 32% for Hispanic and 41% for Black; P < 0.001). Ninety-one percent of procedures were thyroidectomies and 9% parathyroidectomies. Children aged 0-6 yr had higher complication rates (22% vs. 15% for 7-12 yr and 11% for 13-17 yr; P < 0.01), LOS (3.3 d vs. 2.3 for 7-12 yr and 1.8 for 13-17 yr; P < 0.01), and higher costs. Compared with children from higher-income families, those from lower-income families had higher complication rates (11.5 vs. 7.7%; P < 0.05), longer LOS (2.7 vs. 1.7 d; P < 0.01), and higher costs. Children had higher endocrine-specific complication rates than adults after parathyroidectomy (15.2 vs. 6.2%; P < 0.01) and thyroidectomy (9.1 vs. 6.3%; P < 0.01). CONCLUSIONS: Children undergoing thyroidectomy/parathyroidectomy have higher complication rates than adult patients. Outcomes were optimized when surgeries were performed by high-volume surgeons. There appears to be disparity in access to high-volume surgeons for children from low-income families, Blacks, and Hispanics.

Authors
Sosa, JA; Tuggle, CT; Wang, TS; Thomas, DC; Boudourakis, L; Rivkees, S; Roman, SA
MLA Citation
Sosa, JA, Tuggle, CT, Wang, TS, Thomas, DC, Boudourakis, L, Rivkees, S, and Roman, SA. "Clinical and economic outcomes of thyroid and parathyroid surgery in children." The Journal of clinical endocrinology and metabolism 93.8 (August 2008): 3058-3065.
PMID
18522977
Source
epmc
Published In
Journal of Clinical Endocrinology and Metabolism
Volume
93
Issue
8
Publish Date
2008
Start Page
3058
End Page
3065
DOI
10.1210/jc.2008-0660

Medullary thyroid carcinoma without marked elevation of calcitonin: a diagnostic and surveillance dilemma.

Calcitonin is a sensitive tumor marker for medullary thyroid cancer (MTC) and is useful in preoperative diagnosis and postoperative surveillance for recurrent disease. Calcitonin-negative MTC is a rare occurrence. We present the case of a 68-year-old man with a 6.5 cm sporadic MTC with a 5-cm metastasis in the neck, but only minimally elevated serum calcitonin levels. He underwent total thyroidectomy, resection of internal jugular vein, and limited ipsilateral lymph node dissection. He remains disease-free 12 months after surgery. We review the literature on calcitonin-negative MTC and discuss methods of postoperative surveillance in this subset of patients.

Authors
Wang, TS; Ocal, IT; Sosa, JA; Cox, H; Roman, S
MLA Citation
Wang, TS, Ocal, IT, Sosa, JA, Cox, H, and Roman, S. "Medullary thyroid carcinoma without marked elevation of calcitonin: a diagnostic and surveillance dilemma." Thyroid : official journal of the American Thyroid Association 18.8 (August 2008): 889-894.
PMID
18651827
Source
epmc
Published In
Thyroid
Volume
18
Issue
8
Publish Date
2008
Start Page
889
End Page
894
DOI
10.1089/thy.2007.0413

An examination of the construct validity and factor structure of the Groton Maze Learning Test, a new measure of spatial working memory, learning efficiency, and error monitoring.

This study examined the construct validity of the Groton Maze Learning Test (GMLT) in assessing processing speed, working memory, and aspects of executive function in healthy adults. Performance on GMLT outcome measures was compared to performance on tests of psychomotor speed, working memory, and learning from the CogState computerized cognitive test battery (CGS; http://www.cogstate.com/). The factor structure of the GMLT was evaluated using exploratory factor analysis. The stability of this factor structure was examined in a large sample of patients undergoing parathyroidectomy or thyroidectomy. Results of this study suggest that the GMLT measures of spatial learning efficiency and error monitoring correlate with CogState measures of attention, working memory, and learning. Exploratory factor analysis yielded a two-factor solution of error monitoring and learning efficiency, which was stable across repeated assessments.

Authors
Pietrzak, RH; Maruff, P; Mayes, LC; Roman, SA; Sosa, JA; Snyder, PJ
MLA Citation
Pietrzak, RH, Maruff, P, Mayes, LC, Roman, SA, Sosa, JA, and Snyder, PJ. "An examination of the construct validity and factor structure of the Groton Maze Learning Test, a new measure of spatial working memory, learning efficiency, and error monitoring." Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists 23.4 (July 2008): 433-445.
PMID
18448309
Source
epmc
Published In
Archives of Clinical Neuropsychology (OUP)
Volume
23
Issue
4
Publish Date
2008
Start Page
433
End Page
445
DOI
10.1016/j.acn.2008.03.002

Detection of medullary thyroid cancer: a focus on serum calcitonin levels

Authors
Wang, TS; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Roman, SA, and Sosa, JA. "Detection of medullary thyroid cancer: a focus on serum calcitonin levels." Expert Review of Endocrinology & Metabolism 3.4 (July 2008): 493-501.
Source
crossref
Published In
Expert review of endocrinology & metabolism
Volume
3
Issue
4
Publish Date
2008
Start Page
493
End Page
501
DOI
10.1586/17446651.3.4.493

A population-based study of outcomes from thyroidectomy in aging Americans: at what cost?

We wanted to evaluate clinical and economic outcomes after thyroidectomy in patients 65 years of age and older, with special analyses of those aged 80 years and older, in the US.This was a population-based study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2003-2004, a national administrative database of all patients undergoing thyroidectomy and their surgeon providers. Independent variables included patient demographic and clinical characteristics and surgeon descriptors, including case volume. Clinical and economic outcomes included mean total costs and length of stay (LOS), in-hospital mortality, discharge status, and complications.There were 22,848 patients who underwent thyroidectomies, including 4,092 (18%) aged 65 to 79 years and 744 (3%) 80 years of age or older. On a population level, patient age is an independent predictor of clinical and economic outcomes. Average LOS for patients 80 years and older is 60% longer than for similar patients 65 to 79 years of age (2.9 versus 2.2 days; p < 0.001), complication rates are 34% higher (5.6% versus 2.1%; p < 0.001), and total costs are 28% greater ($7,084 versus $5,917; p < 0.001). High-volume surgeons have shorter LOS and fewer complications but perform fewer thyroidectomies for aging Americans; although they do nearly 29% of these procedures in patients younger than 65 years, they do just 15% of thyroidectomies in patients 80 years and older and 23% in patients 65 to 79 years.On a population level, clinical and economic outcomes for patients 65 years and older undergoing thyroidectomies are considerably worse than for similar, younger patients. The majority of thyroidectomies in aging Americans is performed by low-volume surgeons. More data are needed about longterm outcomes, but increased referrals to high-volume surgeons for aging Americans are necessary.

Authors
Sosa, JA; Mehta, PJ; Wang, TS; Boudourakis, L; Roman, SA
MLA Citation
Sosa, JA, Mehta, PJ, Wang, TS, Boudourakis, L, and Roman, SA. "A population-based study of outcomes from thyroidectomy in aging Americans: at what cost?." Journal of the American College of Surgeons 206.6 (June 2008): 1097-1105.
PMID
18501806
Source
epmc
Published In
Journal of The American College of Surgeons
Volume
206
Issue
6
Publish Date
2008
Start Page
1097
End Page
1105
DOI
10.1016/j.jamcollsurg.2007.11.023

Calcitonin measurement in the evaluation of thyroid nodules in the United States: a cost-effectiveness and decision analysis.

CONTEXT: European studies have shown that the use of routine calcitonin screening for detection of medullary thyroid cancer (MTC) in patients with thyroid nodules increases the detection of occult MTC and may improve patient outcomes. Calcitonin screening for MTC has not been recommended in recent U.S. practice guidelines. OBJECTIVE: Our objective was to determine the cost-effectiveness (C/E) of routine calcitonin screening in adult patients with thyroid nodules in the United States. SETTINGS/SUBJECTS: A decision model was developed for a hypothetical group of adult patients presenting for evaluation of thyroid nodules in the United States. Patients were screened using current American Thyroid Association guidelines only, or American Thyroid Association guidelines with routine serum calcitonin screening. Input data were obtained from the literature, the Surveillance Epidemiology and End Results and Healthcare Cost and Utilization Project's Nationwide Inpatient Sample databases, and the Medicare Reimbursement Schedule. Sensitivity analyses were performed for a number of input variables. MAIN OUTCOME MEASURES: C/E, measured in dollars per life years saved (LYS), was calculated. RESULTS: Addition of calcitonin screening to current American Thyroid Association guidelines for the evaluation of thyroid nodules would cost $11,793 per LYS ($10,941-$12,646). When extrapolated to the national level, calcitonin screening for MTC in the United States would yield an additional 113,000 life years at a cost increase of 5.3%. Calcitonin screening C/E is sensitive to patient age and gender, and to changes in disease prevalence, specificity of fine needle aspiration and calcitonin testing, calcitonin screening level, costs of testing, and length of follow-up. CONCLUSION: Routine serum calcitonin screening in patients undergoing evaluation for thyroid nodules appears to be cost effective in the United States, with C/E comparable to the measurement of thyroid stimulating hormone, colonoscopy, and mammography screening.

Authors
Cheung, K; Roman, SA; Wang, TS; Walker, HD; Sosa, JA
MLA Citation
Cheung, K, Roman, SA, Wang, TS, Walker, HD, and Sosa, JA. "Calcitonin measurement in the evaluation of thyroid nodules in the United States: a cost-effectiveness and decision analysis." The Journal of clinical endocrinology and metabolism 93.6 (June 2008): 2173-2180.
PMID
18364376
Source
epmc
Published In
Journal of Clinical Endocrinology and Metabolism
Volume
93
Issue
6
Publish Date
2008
Start Page
2173
End Page
2180
DOI
10.1210/jc.2007-2496

Health services research in endocrine surgery.

PURPOSE OF REVIEW: We review recent health services research studies examining clinical and economic outcomes in endocrine surgery. RECENT FINDINGS: Recent studies have focused on such important issues as the use of the Internet in medicine, patient quality of life, cost-effectiveness of emerging surgical technologies, and labor-force modeling. There is a need for accurate and informative websites dedicated to thyroid disease, given the large number of patients who use the Internet for healthcare information. Debate continues about the relative merits of medical and surgical therapy for primary hyperparathyroidism; based on measurements of quality of life and cost-effectiveness, parathyroidectomy appears to be favored. Surgical outcomes studies have shown parathyroidectomy to be safe in octogenarian and nonagenarian patients with primary hyperparathyroidism. Sophisticated work-force projections suggest that the supply of endocrine surgeons will grow over the next 15 years, but will be outpaced by the anticipated demand. SUMMARY: Health services research is a burgeoning field of investigation in endocrine surgery. It needs to be developed to improve the quality of care of patients with thyroid, parathyroid, adrenal and endocrine pancreatic diseases.

Authors
Roman, S; Boudourakis, L; Sosa, JA
MLA Citation
Roman, S, Boudourakis, L, and Sosa, JA. "Health services research in endocrine surgery." Current opinion in oncology 20.1 (January 2008): 47-51. (Review)
PMID
18043255
Source
epmc
Published In
Current Opinion in Oncology
Volume
20
Issue
1
Publish Date
2008
Start Page
47
End Page
51
DOI
10.1097/cco.0b013e3282f46d4b

Conventional surgical management of primary hyperparathyroidism

21.8 Conclusions: The incidence of primary HPTH is increasing. While new technologies are enabling preoperative localization of parathyroid gland pathology and the removal of solitary adenomas with minimally invasive approaches, the success of parathyroidectomy remains dependent upon a thorough understanding of the embryology and anatomy of the neck. This is achievable only by the surgeons' experience and intimate knowledge of the traditional bilateral neck exploration. © 2007 Springer-Verlag Berlin Heidelberg. © 2007 Springer-Verlag Berlin Heidelberg.

Authors
Yeo, H; Uranga, P; Roman, S
MLA Citation
Yeo, H, Uranga, P, and Roman, S. "Conventional surgical management of primary hyperparathyroidism." Surgery of the Thyroid and Parathyroid Glands. December 1, 2007. 261-267.
Source
scopus
Publish Date
2007
Start Page
261
End Page
267
DOI
10.1007/978-3-540-68043-7_21

The maturation of a specialty: Workforce projections for endocrine surgery.

BACKGROUND: There has been an increase in the incidence of endocrine diseases and the number of endocrine procedures in the United States. Higher surgeon volume is associated with improved patient outcomes. Fellowship programs will lead to more specialty-trained endocrine surgeons. We make projections for the supply of endocrine surgeons and demand for endocrine procedures over the next 15 years. METHODS: Supply projections are based on data from the Accreditation Council for Graduate Medical Education, a survey of American Association of Endocrine Surgery fellowship program graduates, and Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS). Demand is estimated using HCUP-NIS, U.S. Census Bureau projections, and a literature review. RESULTS: There were 64,275 endocrine procedures performed in 2000 and 80,505 in 2004. Using age-adjusted population projections and increasing incidence of endocrine diseases, 103,704 endocrine procedures are anticipated in 2020. High-volume endocrine surgeons are few in number, but perform 24% of endocrine procedures. Surgeon supply is projected to increase to 938 by 2020; this is based on fellowship graduation rates, retirement trends, and increasing annual endocrine case volume among high-volume surgeons. Alternative projections of supply and demand are generated to test the sensitivity of our analyses to different assumptions. CONCLUSION: Labor force planning in endocrine surgery is essential if the demand for more high-volume endocrine specialists is to be met.

Authors
Sosa, JA; Wang, TS; Yeo, HL; Mehta, PJ; Boudourakis, L; Udelsman, R; Roman, SA
MLA Citation
Sosa, JA, Wang, TS, Yeo, HL, Mehta, PJ, Boudourakis, L, Udelsman, R, and Roman, SA. "The maturation of a specialty: Workforce projections for endocrine surgery." Surgery 142.6 (December 2007): 876-883.
PMID
18063071
Source
epmc
Published In
Surgery
Volume
142
Issue
6
Publish Date
2007
Start Page
876
End Page
883
DOI
10.1016/j.surg.2007.09.005

Racial disparities in clinical and economic outcomes from thyroidectomy.

CONTEXT: Thyroid disease is common, and thyroidectomy is a mainstay of treatment for many benign and malignant thyroid conditions. Overall, thyroidectomy is associated with favorable outcomes, particularly if experienced surgeons perform it. OBJECTIVE: To examine racial differences in clinical and economic outcomes of patients undergoing thyroidectomy in the United States. DESIGN, SETTING, PATIENTS: The nationwide inpatient sample was used to identify thyroidectomy admissions from 1999 to 2004, using ICD-9 procedure codes. Race and other clinical and demographic characteristics of patients were collected along with surgeon volume and hospital characteristics to predict outcomes. MAIN OUTCOME MEASURES: Inpatient mortality, complication rates, length of stay (LOS), discharge status, and mean total costs by racial group. RESULTS: In 2003-2004, 16,878 patients underwent thyroid procedures; 71% were white, 14% black, 9% Hispanic, and 6% other. Mean LOS was longer for blacks (2.5 days) than for whites (1.8 days, P < 0.001); Hispanics had an intermediate LOS (2.2 days). Although rare, in-hospital mortality was higher for blacks (0.4%) compared with that for other races (0.1%, P < 0.001). Blacks trended toward higher overall complication rates (4.9%) compared with whites (3.8%) and Hispanics (3.6%, P = 0.056). Mean total costs were significantly lower for whites ($5447/patient) compared with those for blacks ($6587) and Hispanics ($6294). The majority of Hispanics (55%) and blacks (52%) had surgery by the lowest-volume surgeons (1-9 cases per year), compared with only 44% of whites. Highest-volume surgeons (>100 cases per year) performed 5% of thyroidectomies, but 90% of their patients were white (P < 0.001). Racial disparities in outcomes persist after adjustment for surgeon volume group. CONCLUSIONS: These findings suggest that, although thyroidectomy is considered safe, significant racial disparities exist in clinical and economic outcomes. In part, inequalities result from racial differences in access to experienced surgeons; more data are needed with regard to racial differences in thyroid biology and surveillance to explain the balance of observed disparities.

Authors
Sosa, JA; Mehta, PJ; Wang, TS; Yeo, HL; Roman, SA
MLA Citation
Sosa, JA, Mehta, PJ, Wang, TS, Yeo, HL, and Roman, SA. "Racial disparities in clinical and economic outcomes from thyroidectomy." Annals of surgery 246.6 (December 2007): 1083-1091.
PMID
18043114
Source
epmc
Published In
Annals of Surgery
Volume
246
Issue
6
Publish Date
2007
Start Page
1083
End Page
1091
DOI
10.1097/sla.0b013e31812eecc4

Management of follicular tumors of the thyroid.

The incidence of well-differentiated thyroid cancers is rising. Follicular cancer represents 10-20% of these lesions. While the vast majority of thyroid nodules of follicular origin are benign, fine needle aspiration cannot provide cytologic evidence of capsular and/or vascular invasion; therefore, patients should undergo surgical excision. Frozen section is not recommended for intraoperative evaluation of follicular neoplasia. Patients deemed to have follicular cancer require near-total or total thyroidectomy and postoperative (131)I ablation. The optimal management of minimally invasive follicular cancer remains an area of controversy, but long-term prognosis for these patients is excellent. Areas of research should focus on identification of molecular markers of malignancy and aggressiveness of follicular neoplasia.

Authors
Wang, TS; Roman, SA; Sosa, JA
MLA Citation
Wang, TS, Roman, SA, and Sosa, JA. "Management of follicular tumors of the thyroid." Minerva chirurgica 62.5 (October 2007): 373-382. (Review)
PMID
17947948
Source
epmc
Published In
Minerva chirurgica
Volume
62
Issue
5
Publish Date
2007
Start Page
373
End Page
382

Filling a void: thyroid cancer surgery information on the internet.

BACKGROUND: Thyroid cancer incidence is increasing, making it an important public health issue. Many patients use the Internet for health-related decisions. Our purposes were to measure the quality of thyroid cancer surgery information on the Internet, and to identify quality predictors. METHODS: The 50 most popular thyroid cancer websites from Google, Yahoo, and MSN were identified. A novel 55-point instrument based on current clinical practice guidelines was designed and used by a Delphi panel of 5 "blinded" endocrine surgeons to assess website information. Each website was independently evaluated by two surgeons. Quality was related to website demographic data using the Student's t-test, chi-square, and ANOVA analyses. RESULTS: Inter-rater reliability for quality scores was excellent (kappa = 0.81). Mean (% of overall quality) score was 21 (38%), and mean score for surgical content was low at 3.5 (29%). Only 50% of sites discussed indications for surgery; 8% length of surgery/anesthesia; 42% the role of lymphadenectomy; 44% recurrent laryngeal nerve injury/hoarseness and 42% hypoparathyroidism as potential complications; 16% recovery; and 20% recommendations for choosing a thyroid surgeon. Only 38% were updated within 2 years. On univariate analysis, no significant associations were found between surgical quality score and website country of origin, currency, sponsorship, authorship, oversight, or references. CONCLUSIONS: Thyroid cancer surgery websites on the Internet are incomplete and outdated. No predictors of quality were identified. Significant improvement is needed in regulating information about thyroid cancer surgery on the Internet, and surgeons may contribute to this effort.

Authors
Yeo, H; Roman, S; Air, M; Maser, C; Trapasso, T; Kinder, B; Sosa, JA
MLA Citation
Yeo, H, Roman, S, Air, M, Maser, C, Trapasso, T, Kinder, B, and Sosa, JA. "Filling a void: thyroid cancer surgery information on the internet." World journal of surgery 31.6 (June 2007): 1185-1191.
PMID
17446991
Source
epmc
Published In
World Journal of Surgery
Volume
31
Issue
6
Publish Date
2007
Start Page
1185
End Page
1191
DOI
10.1007/s00268-007-9010-x

Outdated and incomplete: a review of thyroid cancer on the World Wide Web.

OBJECTIVE: To evaluate the most frequently searched thyroid cancer websites for completeness, accuracy, and consumer friendliness. DESIGN: The 50 most popular thyroid cancer websites were evaluated using a novel instrument developed by a Delphi panel of endocrine experts and based on practice guidelines. Each website received independent scores for disease-specific information and a final quality score. Quality was related to website demographics using the Student t test, chi-square, and ANOVA analyses. MAIN OUTCOMES: Interrater reliability was excellent (kappa = 0.81). Most websites were not specific to thyroid cancer alone (72%), contained advertisements (72%), lacked references (66%), and were privately sponsored (50%). Only 38% had been updated within 2 years. "Government" and "Non-Profit" websites were the most consumer friendly. Mean quality score of medical content was 38%, with websites receiving the highest score in "Anatomy/Physiology" (55%) and lowest in "Surgery" (29%). Low quality score was attributed to information deficiency rather than inaccuracy. On univariate analysis, no significant associations were found between quality score and country of origin, currency, sponsorship, authorship, administration, advertisements, or references. CONCLUSIONS: Thyroid cancer websites are out of date and incomplete, lacking important information sought by patients, particularly surgical information. An accurate, comprehensive, easily available, and patient-oriented thyroid cancer Internet resource is needed for patients.

Authors
Air, M; Roman, SA; Yeo, H; Maser, C; Trapasso, T; Kinder, B; Sosa, JA
MLA Citation
Air, M, Roman, SA, Yeo, H, Maser, C, Trapasso, T, Kinder, B, and Sosa, JA. "Outdated and incomplete: a review of thyroid cancer on the World Wide Web." Thyroid : official journal of the American Thyroid Association 17.3 (March 2007): 259-265.
PMID
17381360
Source
epmc
Published In
Thyroid
Volume
17
Issue
3
Publish Date
2007
Start Page
259
End Page
265
DOI
10.1089/thy.2006.0300

Functional paragangliomas presenting as primary liver tumors.

Authors
Roman, SA; Sosa, JA
MLA Citation
Roman, SA, and Sosa, JA. "Functional paragangliomas presenting as primary liver tumors." Southern medical journal 100.2 (February 2007): 195-196. (Review)
PMID
17330690
Source
epmc
Published In
Southern Medical Journal
Volume
100
Issue
2
Publish Date
2007
Start Page
195
End Page
196
DOI
10.1097/01.smj.0000224128.49196.68

Psychiatric and cognitive aspects of primary hyperparathyroidism.

PURPOSE OF REVIEW: Clinical guidelines for the treatment of primary hyperparathyroidism have been established by the 2002 NIH workshop on asymptomatic primary hyperparathyroidism. The panel called for further study of the ill-defined psychiatric and cognitive changes often seen in patients with primary hyperparathyroidism. The present paper provides a rigorous, updated review of the most recent advances and studies that have measured health-related quality of life, neurocognitive and psychiatric changes, as well as neurophysiologic imaging in patients with primary hyperparathyroidism undergoing parathyroidectomy. RECENT FINDINGS: In studies conducted pre and postparathyroidectomy, six recent articles have described improvements in health-related quality of life. Five studies included evaluations with validated psychiatric and cognitive tests in prospective case-control trials, and showed varied improvements in depression, memory and concentration after parathyroidectomy. Two studies evaluated in a preliminary fashion the brains of patients with primary hyperparathyroidism with functional imaging studies, showing regional cerebral blood flow changes and prefrontal cortical activation with sleep improvement in postsurgical patients. SUMMARY: The studies described in this paper underline the benefits of surgical treatment on nontraditional symptoms in patients with primary hyperparathyroidism, and open the door to the continued study of the endocrine effects of primary hyperparathyroidism on brain function.

Authors
Roman, S; Sosa, JA
MLA Citation
Roman, S, and Sosa, JA. "Psychiatric and cognitive aspects of primary hyperparathyroidism." Current opinion in oncology 19.1 (January 2007): 1-5. (Review)
PMID
17133104
Source
epmc
Published In
Current Opinion in Oncology
Volume
19
Issue
1
Publish Date
2007
Start Page
1
End Page
5
DOI
10.1097/cco.0b013e32801173fb

Prognosis of medullary thyroid carcinoma: demographic, clinical, and pathologic predictors of survival in 1252 cases.

BACKGROUND: Medullary thyroid cancer (MTC) is a rare cancer. There is a relative paucity of data over the last decade with regard to the prognosis of these patients. Therefore, the authors used the population-based Surveillance, Epidemiology, and End Results (SEER) registry to update what to their knowledge is one of the largest series of patients with MTC reported to date. METHODS: All patients with a diagnosis of MTC with active follow-up in the SEER database from 1973 to 2002 were included. Univariate and multivariate regression analyses were used to assess the associations between demographic, clinical, and pathologic characteristics of patients and survival. RESULTS: A total of 1252 patients with MTC were identified over 29 years of follow-up. In all, 87% of patients were white and 60% were female, with a mean age of 50 years. Although many variables were significant on univariate analysis, SEER stage and age at diagnosis were found to be the strongest predictors of survival in the multivariate analysis. Prognosis was poor in patients with advanced disease (hazards ratio [HR], 4.47), or those age >65 years (HR, 6.55). Patients who underwent surgery fared better than those who did not. Overall, 51% of patients had less than the currently recommended treatment guidelines for MTC. Adjuvant radiation therapy was found to be independently associated with a decreased survival (HR, 1.65). CONCLUSIONS: Stage of disease and age at diagnosis were found to be the strongest predictors of survival for patients with MTC. To the authors' knowledge there has been no change in stage at diagnosis or a significant improvement in survival noted over the last 30 years. Many patients underwent surgery that was deemed less than optimal for stage of disease.

Authors
Roman, S; Lin, R; Sosa, JA
MLA Citation
Roman, S, Lin, R, and Sosa, JA. "Prognosis of medullary thyroid carcinoma: demographic, clinical, and pathologic predictors of survival in 1252 cases." Cancer 107.9 (November 2006): 2134-2142.
PMID
17019736
Source
epmc
Published In
Cancer
Volume
107
Issue
9
Publish Date
2006
Start Page
2134
End Page
2142
DOI
10.1002/cncr.22244

Black thyroid syndrome.

Authors
Yusim, A; Ghofrani, M; Ocal, IT; Roman, S
MLA Citation
Yusim, A, Ghofrani, M, Ocal, IT, and Roman, S. "Black thyroid syndrome." Thyroid : official journal of the American Thyroid Association 16.8 (August 2006): 811-812.
PMID
16910886
Source
epmc
Published In
Thyroid
Volume
16
Issue
8
Publish Date
2006
Start Page
811
End Page
812
DOI
10.1089/thy.2006.16.811

Gastrointestinal manifestations of endocrine disease.

The hormonal interactions among the systems throughout the body are not fully understood; many vague clinical symptoms may in fact be manifestations of underlying endocrine diseases. The aim of the following review is to discuss gastrointestinal manifestations of surgically correctable endocrine diseases, focusing on abnormalities of thyroid function, cancer and finally autoimmune diseases. We also review manifestations of pancreatic endocrine tumors, and multiple endocrine neoplasia.

Authors
Maser, C; Toset, A; Roman, S
MLA Citation
Maser, C, Toset, A, and Roman, S. "Gastrointestinal manifestations of endocrine disease." World journal of gastroenterology 12.20 (May 2006): 3174-3179. (Review)
PMID
16718836
Source
epmc
Published In
World journal of gastroenterology : WJG
Volume
12
Issue
20
Publish Date
2006
Start Page
3174
End Page
3179

Adrenocortical carcinoma.

PURPOSE OF REVIEW: Adrenocortical carcinoma is a rare malignancy, accounting for 0.02% of all annual cancers reported. Given the generally advanced stage at diagnosis, the overall 5-year survival remains poor, varying between 20 and 45%. While older studies purported an improved outcome for functional tumors in adult patients, this has not been borne out in more recent studies. In the pediatric population, though, virilizing tumors carry a better survival than non-functional or cortisol-secreting tumors. RECENT FINDINGS: Recent studies focusing on the tumorigenesis of adrenocortical carcinoma have focused on onco-developmental genes present in the fetal adrenal cortex, as well as local adrenal paracrine and autocrine effects of cellular peptides. SUMMARY: Pre-operative diagnostic advances in positron emission scanning are emerging as promising modalities for confirmation of malignancy of indeterminate adrenal masses. No significant advances in the treatment of adrenocortical carcinoma have been developed. Surgery remains the mainstay for primary and recurrent disease, including select patients with isolated liver metastases. Mitotane has remained the preferred adjuvant treatment agent, showing modest effect in patients with unresectable, residual or metastatic disease. Multi-institutional registries and trials need to be established, with multidisciplinary efforts focused on the development of new therapeutic strategies.

Authors
Roman, S
MLA Citation
Roman, S. "Adrenocortical carcinoma." Current opinion in oncology 18.1 (January 2006): 36-42. (Review)
PMID
16357562
Source
epmc
Published In
Current Opinion in Oncology
Volume
18
Issue
1
Publish Date
2006
Start Page
36
End Page
42
DOI
10.1097/01.cco.0000198976.43992.14

Laparoscopic lateral transabdominal adrenalectomy

Authors
Roman, S; Udelsman, R
MLA Citation
Roman, S, and Udelsman, R. "Laparoscopic lateral transabdominal adrenalectomy." Adrenal Glands: Diagnostic Aspects and Surgical Therapy. December 1, 2005. 325-332.
Source
scopus
Publish Date
2005
Start Page
325
End Page
332
DOI
10.1007/3-540-26861-8_34

Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism.

BACKGROUND: Clinical guidelines for the treatment of primary hyperparathyroidism (pHPT) often suggest parathyroidectomy, but generally fail to consider neurocognitive and psychiatric symptoms because of the relative paucity of evidence. METHODS: In this prospective study, patients with pHPT (PTX) and benign euthyroid thyroid disease (THY) referred for operation were evaluated pre- and postoperatively with validated psychometric and neurocognitive instruments to determine whether learning, memory, or concentration improved with after parathyroidectomy. Statistical comparisons between groups were performed with univariate analysis and repeated measures of analysis of variance. RESULTS: Fifty-five subjects, mean age of 54 years, were evaluated preoperatively; 41 returned postoperatively. There were no significant differences between groups by age and gender. PTXs reported more depression symptoms preoperatively (P = .04) that improved postoperatively. There were no differences between the 2 groups on verbal memory and trait anxiety. For PTXs, average preoperative serum calcium concentration (11.3 mg/dL) and serum PTH level (100 pg/mL) normalized postoperatively. Preoperatively PTXs showed greater delays in their spatial learning (P = .03). All subjects learned across the 5 trials, but PTXs were more delayed (P = .03). After operation, PTXs improved and functioned at a level equivalent to the THYs. There was an interaction between trial (neurocognitive testing), visit (pre- vs postoperative), status (PTX vs THY), and change in PTH level (P = .06), suggesting that individuals with greater change in PTH were more likely to improve in their learning efficiency postparathyroidectomy. CONCLUSIONS: PHPT may be associated with a spatial learning deficit and processing that improves after parathyroidectomy. While longer-term follow-up is necessary, neurocognitive symptoms perhaps should be considered as criteria for parathyroidectomy.

Authors
Roman, SA; Sosa, JA; Mayes, L; Desmond, E; Boudourakis, L; Lin, R; Snyder, PJ; Holt, E; Udelsman, R
MLA Citation
Roman, SA, Sosa, JA, Mayes, L, Desmond, E, Boudourakis, L, Lin, R, Snyder, PJ, Holt, E, and Udelsman, R. "Parathyroidectomy improves neurocognitive deficits in patients with primary hyperparathyroidism." Surgery 138.6 (December 2005): 1121-1128.
PMID
16360399
Source
epmc
Published In
Surgery
Volume
138
Issue
6
Publish Date
2005
Start Page
1121
End Page
1128
DOI
10.1016/j.surg.2005.08.033

Pheochromocytoma and functional paraganglioma.

PURPOSE OF REVIEW: Pheochromocytoma is a rare, but clinically important tumor of chromaffin cells. Advances in our understanding of the genetic alterations causing hereditary forms and the increasing sensitivity of biochemical assays allow for early identification of high risk individuals and families. Surgical intervention remains the treatment of choice for patients with pheochromocytoma. This article reviews recent developments in the diagnosis, treatment, and pathophysiology of pheochromocytoma, with the objective of developing new guidelines in the identification and management of the disease. It emphasizes current diagnostic and surgical approaches and discusses the potential for future developments in the field. SUMMARY: Advances in the molecular basis of pheochromocytoma have introduced new diagnostic modalities. Refinements in imaging techniques have improved the rate of detection of metastatic disease. Innovations in surgical techniques and trials of adrenal sparing surgery may find a niche in the surgical armamentarium.

Authors
Yeo, H; Roman, S
MLA Citation
Yeo, H, and Roman, S. "Pheochromocytoma and functional paraganglioma." Current opinion in oncology 17.1 (January 2005): 13-18. (Review)
PMID
15608506
Source
epmc
Published In
Current Opinion in Oncology
Volume
17
Issue
1
Publish Date
2005
Start Page
13
End Page
18
DOI
10.1097/01.cco.0000147900.12325.d9

Analysis of errors in laparoscopic surgical procedures.

BACKGROUND: The determination of laparoscopic surgeon ability is essential to training error avoidance. The present study describes a practical method of surgical error analysis. METHODS: After review of practice videotapes of the excisional phase of laparoscopic cholecystectomy, consensus on the identification of eight errors was achieved. Interrater agreement at the end of this phase was 84-96%. Fourteen study videotapes of gallbladder excision were then observed independently by expert reviewers blinded to surgical team identity. Procedures were assessed using a scoring matrix of 1-min segments with each error reported each minute. RESULTS: Interrater agreement was 84-100% for all error categories. CONCLUSIONS: The present study demonstrates that excellent interrater agreement of procedural errors can be achieved by carefully defining and training recognition of targeted events. Extension of this simple and reliable analysis tool to other procedures should be feasible to define behaviors leading to adverse clinical outcomes.

Authors
Seymour, NE; Gallagher, AG; Roman, SA; O'Brien, MK; Andersen, DK; Satava, RM
MLA Citation
Seymour, NE, Gallagher, AG, Roman, SA, O'Brien, MK, Andersen, DK, and Satava, RM. "Analysis of errors in laparoscopic surgical procedures." Surgical endoscopy 18.4 (April 2004): 592-595.
PMID
15026914
Source
epmc
Published In
Surgical Endoscopy
Volume
18
Issue
4
Publish Date
2004
Start Page
592
End Page
595
DOI
10.1007/s00464-002-8927-2

Pheochromocytoma and functional paraganglioma.

PURPOSE: Pheochromocytomas and paragangliomas are rare tumors of chromaffin cell origin. Their identification is likely increasing owing to the increased use of radiographic images detecting incidental adrenal masses. RECENT FINDINGS: The pathophysiology of hypertension induced by the release of catecholamines and newly discovered peptides has been shown to be more complex than the concept of episodic catecholamine release. SUMMARY: This review looks at the most recent advances in the physiology and molecular basis of these tumors.

Authors
Roman, S
MLA Citation
Roman, S. "Pheochromocytoma and functional paraganglioma." Current opinion in oncology 16.1 (January 2004): 8-12. (Review)
PMID
14685086
Source
epmc
Published In
Current Opinion in Oncology
Volume
16
Issue
1
Publish Date
2004
Start Page
8
End Page
12
DOI
10.1097/00001622-200401000-00003

Endocrine tumors: evaluation of the thyroid nodule.

Thyroid nodules are found in 4 to 7% of the population, and with the increased use of radiographic methods, incidental nodules are becoming more prevalent. Only 5% of all nodules will be malignant, and thyroid cancer accounts for only 0.4% of all cancer deaths. The preferred diagnostic approach is early referral, avoidance of numerous radiologic evaluations, and early performance fine-needle aspiration. This article reviews the literature of the last 12 months and discusses some of the new molecular, genetic, and immunostaining techniques in the evaluation of thyroid nodules.

Authors
Roman, SA
MLA Citation
Roman, SA. "Endocrine tumors: evaluation of the thyroid nodule." Current opinion in oncology 15.1 (January 2003): 66-70. (Review)
PMID
12490764
Source
epmc
Published In
Current Opinion in Oncology
Volume
15
Issue
1
Publish Date
2003
Start Page
66
End Page
70
DOI
10.1097/00001622-200301000-00010

Virtual reality training improves operating room performance: results of a randomized, double-blinded study.

OBJECTIVE: To demonstrate that virtual reality (VR) training transfers technical skills to the operating room (OR) environment. SUMMARY BACKGROUND DATA: The use of VR surgical simulation to train skills and reduce error risk in the OR has never been demonstrated in a prospective, randomized, blinded study. METHODS: Sixteen surgical residents (PGY 1-4) had baseline psychomotor abilities assessed, then were randomized to either VR training (MIST VR simulator diathermy task) until expert criterion levels established by experienced laparoscopists were achieved (n = 8), or control non-VR-trained (n = 8). All subjects performed laparoscopic cholecystectomy with an attending surgeon blinded to training status. Videotapes of gallbladder dissection were reviewed independently by two investigators blinded to subject identity and training, and scored for eight predefined errors for each procedure minute (interrater reliability of error assessment r > 0.80). RESULTS: No differences in baseline assessments were found between groups. Gallbladder dissection was 29% faster for VR-trained residents. Non-VR-trained residents were nine times more likely to transiently fail to make progress (P <.007, Mann-Whitney test) and five times more likely to injure the gallbladder or burn nontarget tissue (chi-square = 4.27, P <.04). Mean errors were six times less likely to occur in the VR-trained group (1.19 vs. 7.38 errors per case; P <.008, Mann-Whitney test). CONCLUSIONS: The use of VR surgical simulation to reach specific target criteria significantly improved the OR performance of residents during laparoscopic cholecystectomy. This validation of transfer of training skills from VR to OR sets the stage for more sophisticated uses of VR in assessment, training, error reduction, and certification of surgeons.

Authors
Seymour, NE; Gallagher, AG; Roman, SA; O'Brien, MK; Bansal, VK; Andersen, DK; Satava, RM
MLA Citation
Seymour, NE, Gallagher, AG, Roman, SA, O'Brien, MK, Bansal, VK, Andersen, DK, and Satava, RM. "Virtual reality training improves operating room performance: results of a randomized, double-blinded study." Annals of surgery 236.4 (October 2002): 458-463.
PMID
12368674
Source
epmc
Published In
Annals of Surgery
Volume
236
Issue
4
Publish Date
2002
Start Page
458
End Page
463
DOI
10.1097/00000658-200210000-00008

Vandetanib for the Treatment of Metastatic Medullary Thyroid Cancer

Authors
Deshpande, ; Degrauwe, Nils, ; Deshpande, ; Roman, ; Julie Ann Sosa MD, ; Degrauwe, Nils, ; Julie Ann Sosa MD, ; Roman, ; Deshpande,
MLA Citation
Deshpande, , Degrauwe, Nils, , Deshpande, , Roman, , Julie Ann Sosa MD, , Degrauwe, Nils, , Julie Ann Sosa MD, , Roman, , and Deshpande, . "Vandetanib for the Treatment of Metastatic Medullary Thyroid Cancer (Published online)." Clinical Medicine Insights: Oncology: 243-243.
Source
crossref
Published In
Clinical Medicine Insights: Oncology
Start Page
243
End Page
243
DOI
10.4137/CMO.S7999

Vandetanib (ZD6474) in the Treatment of Medullary Thyroid Cancer

Authors
Deshpande, ; Roman, ; Jaykumar Thumar MD, ; Julie Ann Sosa MD,
MLA Citation
Deshpande, , Roman, , Jaykumar Thumar MD, , and Julie Ann Sosa MD, . "Vandetanib (ZD6474) in the Treatment of Medullary Thyroid Cancer (Published online)." Clinical Medicine Insights: Oncology: 213-213.
Source
crossref
Published In
Clinical Medicine Insights: Oncology
Start Page
213
End Page
213
DOI
10.4137/CMO.S6197
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