Randall Scheri

Positions:

Associate Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1996

University of Virginia

Grants:

Phase III Multicenter Randomized Trial of Sentinel Lymphadenectomy and Complete Lymph Node Dissection vs. Sentinel Lymphadenectomy Alone in Cutaneous Melanoma Patients with Molecular or Histopathological Evidence of Metastases in the Sentinel Node

Administered By
Surgical Oncology
Awarded By
John Wayne Cancer Institute
Role
Principal Investigator
Start Date
End Date

Publications:

Patient-Reported Outcomes Following Total Thyroidectomy for Graves' Disease.

BACKGROUND: Graves' disease accounts for ~80% of all cases of hyperthyroidism and is associated with significant morbidity and decreased quality-of-life. Understanding the association of total thyroidectomy with patient-reported quality-of-life and thyroid-specific symptoms is critical to shared decision-making and high-quality care. We estimate the change in patient-reported outcomes (PROs) before and after surgery for patients with Graves' disease to inform the expectations of patients and their physicians. METHODS: PROs using the MD Anderson Symptom Inventory (MDASI) validated questionnaire were collected prospectively from adult patients with Graves' disease from January 1, 2015 to November 20, 2020 on a longitudinal basis. Survey responses were categorized as Before Surgery (≤120 days), Short-Term After Surgery (<30 days) (ST), and Long-Term After Surgery (≥30 days) (LT). Negative binomial regression was used to estimate the association of select covariates with PROs. RESULTS: 85 patients with Graves' disease were included. The majority were female (83.5%); 47.1% were Non-Hispanic White and 35.3% were Non-Hispanic Black. The median TSH value prior to surgery was 0.05, which increased to 0.82 in ST and 1.57 in LT. In bivariate analysis, the Total Symptom Burden Score, a composite of all patient-reported burden, significantly reduced shortly after surgery (Before Surgery mean 56.88 vs ST 39.60, p<0.001), demonstrating improvement in PROs. Further, both the Thyroid Symptoms Score, including patient-reported thermoregulation, palpitations, and dysphagia, and the Quality-of-Life Symptom Score improved in ST and LT (Thyroid Symptoms, Before Surgery 13.88 vs. ST 8.62 and LT 7.29; Quality-of-Life, Before Surgery 16.16 vs. ST 9.14 and LT 10.04, all p<0.05). After multivariate adjustment, the patient-reported burden in the Thyroid Symptom Score and the Quality-of-Life Symptom Score exhibited reduction in ST (Thyroid Symptoms, Rate Ratio [RR] 0.55, 95% Confidence Interval [CI]: 0.42-0.72) (Quality-of-Life, RR 0.57, 95% CI: 0.40-0.81) and LT (Thyroid Symptoms, RR 0.59, 95% CI: 0.44-0.79) (Quality-of-Life, RR 0.43, 95% CI: 0.28-0.65). CONCLUSIONS: Quality-of-life and thyroid-specific symptoms of Graves' patients improved significantly from their baseline prior to surgery to both shortly after and longer after surgery. This work can be used to guide clinicians and patients with Graves' disease on the expected outcomes following total thyroidectomy.
Authors
Gunn, AH; Frisco, N; Thomas, S; Stang, M; Scheri, RP; Kazaure, HS
MLA Citation
Gunn, Alexander H., et al. “Patient-Reported Outcomes Following Total Thyroidectomy for Graves' Disease.Thyroid, Oct. 2021. Pubmed, doi:10.1089/thy.2021.0285.
URI
https://scholars.duke.edu/individual/pub1499300
PMID
34663089
Source
pubmed
Published In
Thyroid : Official Journal of the American Thyroid Association
Published Date
DOI
10.1089/thy.2021.0285

Perioperative neurocognitive and functional neuroimaging trajectories in older APOE4 carriers compared with non-carriers: secondary analysis of a prospective cohort study.

BACKGROUND: Cognitive dysfunction after surgery is a major issue in older adults. Here, we determined the effect of APOE4 on perioperative neurocognitive function in older patients. METHODS: We enrolled 140 English-speaking patients ≥60 yr old scheduled for noncardiac surgery under general anaesthesia in an observational cohort study, of whom 52 underwent neuroimaging. We measured cognition; Aβ, tau, p-tau levels in CSF; and resting-state intrinsic functional connectivity in six Alzheimer's disease-risk regions before and 6 weeks after surgery. RESULTS: There were no significant APOE4-related differences in cognition or CSF biomarkers, except APOE4 carriers had lower CSF Aβ levels than non-carriers (preoperative median CSF Aβ [median absolute deviation], APOE4 305 pg ml-1 [65] vs 378 pg ml-1 [38], respectively; P=0.001). Controlling for age, APOE4 carriers had significantly greater preoperative functional connectivity than non-carriers between several brain regions implicated in Alzheimer's disease, including between the left posterior cingulate cortex and left angular gyrus (β [95% confidence interval, CI], 0.218 [0.137-0.230]; PFWE=0.016). APOE4 carriers, but not non-carriers, experienced significant connectivity decreases from before to 6 weeks after surgery between several brain regions including between the left posterior cingulate cortex and left angular gyrus (β [95% CI], -0.196 [-0.256 to -0.136]; PFWE=0.001). Most preoperative and postoperative functional connectivity differences did not change after controlling for preoperative CSF Aβ levels. CONCLUSIONS: Postoperative change trajectories for cognition and CSF Aβ, tau or p-tau levels did not differ between community dwelling older APOE4 carriers and non-carriers. APOE4 carriers showed greater preoperative functional connectivity and greater postoperative decreases in functional connectivity in key Alzheimer's disease-risk regions, which occur via Aβ-independent mechanisms.
Authors
Browndyke, JN; Wright, MC; Yang, R; Syed, A; Park, J; Hall, A; Martucci, K; Devinney, MJ; Moretti, EW; Whitson, HE; Cohen, HJ; Mathew, JP; Berger, M; MADCO-PC Investigators,
MLA Citation
URI
https://scholars.duke.edu/individual/pub1496919
PMID
34535274
Source
pubmed
Published In
Bja: British Journal of Anaesthesia
Published Date
DOI
10.1016/j.bja.2021.08.012

Do Ultrasound Patterns and Clinical Parameters Inform the Probability of Thyroid Cancer Predicted by Molecular Testing in Nodules with Indeterminate Cytology?

Background: Molecular testing (MT) is commonly used to refine cancer probability in thyroid nodules with indeterminate cytology. Whether or not ultrasound (US) patterns and clinical parameters can further inform the risk of thyroid cancer in nodules predicted to be positive or negative by MT remains unknown. The aim of this study was to test if clinical parameters, including patient age, sex, nodule size (by US), Bethesda category (III, IV, V), US pattern (American Thyroid Association [ATA] vs. American College of Radiology Thyroid Image Reporting and Data System [TI-RADS] systems), radiation exposure, or family history of thyroid cancer can modify the probability of thyroid cancer or noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) predicted by MT. Methods: We studied 257 thyroid nodules in 232 patients from 10 study centers with indeterminate fine needle aspiration cytology and informative MT results using the ThyroSeq v3 genomic classifier (TSv3). Univariate and multivariate logistic regression was used for data analysis. Results: The presence of cancer/NIFTP was associated with positive TSv3 results (odds ratio 61.39, p < 0.0001). On univariate regression, patient sex, age, and Bethesda category were associated with cancer/NIFTP probability (p < 0.05 for each). Although ATA (p = 0.1211) and TI-RADS (p = 0.1359) US categories demonstrated positive trends, neither was significantly associated with cancer/NIFTP probability. A multivariate regression model incorporating the four most informative non-MT covariates (sex, age, Bethesda category, and ATA US pattern; Model No. 1) yielded a C index of 0.653; R2 = 0.108. When TSv3 was added to Model number 1, the C index increased to 0.888; R2 = 0.572. However, age (p = 0.341), Bethesda category (p = 0.272), and ATA US pattern (p = 0.264) were nonsignificant, and other than TSv3 (p < 0.0001), male sex was the only non-MT parameter that potentially contributed to cancer/NIFTP risk (p = 0.095). The simplest and most efficient clinical model (No. 3) incorporated TSv3 and sex (C index = 0.889; R2 = 0.588). Conclusions: In this multicenter study of thyroid nodules with indeterminate cytology and MT, neither the ATA nor TI-RADS US scoring systems further informed the risk of cancer/NIFTP beyond that predicted by TSv3. Although age and Bethesda category were associated with cancer/NIFTP probability on univariate analysis, in sequential nomograms they provided limited incremental value above the high predictive ability of TSv3. Patient sex may contribute to cancer/NIFTP risk in thyroid nodules with indeterminate cytology.
Authors
Figge, JJ; Gooding, WE; Steward, DL; Yip, L; Sippel, RS; Yang, SP; Scheri, RP; Sipos, JA; Mandel, SJ; Mayson, SE; Burman, KD; Folek, JM; Haugen, BR; Sosa, JA; Parameswaran, R; Tan, WB; Nikiforov, YE; Carty, SE
URI
https://scholars.duke.edu/individual/pub1493452
PMID
34340592
Source
pubmed
Published In
Thyroid : Official Journal of the American Thyroid Association
Published Date
DOI
10.1089/thy.2021.0119

Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

<h4>Background</h4>Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery.<h4>Methods</h4>This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models.<h4>Results</h4>Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas.<h4>Conclusion</h4>Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas.
Authors
COVIDSurg Collaborative,
MLA Citation
COVIDSurg Collaborative, Christopher S. “Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.The British Journal of Surgery, vol. 108, no. 1, Jan. 2021, pp. 88–96. Epmc, doi:10.1093/bjs/znaa051.
URI
https://scholars.duke.edu/individual/pub1481716
PMID
33640908
Source
epmc
Published In
British Journal of Surgery
Volume
108
Published Date
Start Page
88
End Page
96
DOI
10.1093/bjs/znaa051

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.
Authors
Glasbey, JC; Nepogodiev, D; Simoes, JFF; Omar, O; Li, E; Venn, ML; Pgdme,; Abou Chaar, MK; Capizzi, V; Chaudhry, D; Desai, A; Edwards, JG; Evans, JP; Fiore, M; Videria, JF; Ford, SJ; Ganly, I; Griffiths, EA; Gujjuri, RR; Kolias, AG; Kaafarani, HMA; Minaya-Bravo, A; McKay, SC; Mohan, HM; Roberts, KJ; San Miguel-Méndez, C; Pockney, P; Shaw, R; Smart, NJ; Stewart, GD; Sundar Mrcog, S; Vidya, R; Bhangu, AA; COVIDSurg Collaborative,
MLA Citation
Glasbey, James C., et al. “Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.J Clin Oncol, vol. 39, no. 1, Jan. 2021, pp. 66–78. Pubmed, doi:10.1200/JCO.20.01933.
URI
https://scholars.duke.edu/individual/pub1482458
PMID
33021869
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
39
Published Date
Start Page
66
End Page
78
DOI
10.1200/JCO.20.01933