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Scheri, Randall Paul

Positions:

Associate Professor of Surgery

Surgery, Advanced Oncologic and Gastrointestinal Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1996

M.D. — University of Virginia

Grants:

Lymphadenectomy & Complete Lymph Node Dissection vs Lymphadenecty

Administered By
Surgery, Advanced Oncologic and Gastrointestinal Surgery
AwardedBy
John Wayne Cancer Institute
Role
Principal Investigator
Start Date
September 23, 2014
End Date
August 31, 2017

Publications:

Each procedure matters: threshold for surgeon volume to minimize complications and decrease cost associated with adrenalectomy.

An association has been suggested between increasing surgeon volume and improved patient outcomes, but a threshold has not been defined for what constitutes a "high-volume" adrenal surgeon.Adult patients who underwent adrenalectomy by an identifiable surgeon between 1998-2009 were selected from the Healthcare Cost and Utilization Project National Inpatient Sample. Logistic regression modeling with restricted cubic splines was utilized to estimate the association between annual surgeon volume and complication rates in order to identify a volume threshold.A total of 3,496 surgeons performed adrenalectomies on 6,712 patients; median annual surgeon volume was 1 case. After adjustment, the likelihood of experiencing a complication decreased with increasing annual surgeon volume up to 5.6 cases (95% confidence interval, 3.27-5.96). After adjustment, patients undergoing resection by low-volume surgeons (<6 cases/year) were more likely to experience complications (odds ratio 1.71, 95% confidence interval, 1.27-2.31, P = .005), have a greater hospital stay (relative risk 1.46, 95% confidence interval, 1.25-1.70, P = .003), and at increased cost (+26.2%, 95% confidence interval, 12.6-39.9, P = .02).This study suggests that an annual threshold of surgeon volume (≥6 cases/year) that is associated with improved patient outcomes and decreased hospital cost. This volume threshold has implications for quality improvement, surgical referral and reimbursement, and surgical training. (Surgery 2017;160:XXX-XXX.).

Authors
Anderson, KL; Thomas, SM; Adam, MA; Pontius, LN; Stang, MT; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Anderson, KL, Thomas, SM, Adam, MA, Pontius, LN, Stang, MT, Scheri, RP, Roman, SA, and Sosa, JA. "Each procedure matters: threshold for surgeon volume to minimize complications and decrease cost associated with adrenalectomy." Surgery (November 6, 2017).
PMID
29122321
Source
epmc
Published In
Surgery
Publish Date
2017
DOI
10.1016/j.surg.2017.04.028

Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes.

The optimal surgery for patients with renal hyperparathyroidism has been controversial, as either subtotal parathyroidectomy (subtotal PTX) or total parathyroidectomy with auto-transplantation (total PTX-AT) may be employed.Adult patients having subtotal PTX or total PTX-AT for secondary hyperparathyroidism were identified from the American College of Surgeons National Surgical Quality Improvement Program, 2005-2013.Of 1130 patients, the majority (n = 765, 68%) underwent subtotal PTX. Total PTX-AT was associated with longer operative time (median 150 vs. 120 min, p < 0.001). Rates of complications, reoperation, readmission, and 30-day mortality were not significantly different. After adjustment, the odds of having a complication [OR 0.97, p = 0.88] and being readmitted within 30 days [OR 0.86 p = 0.62] were similar between the two procedures. Total PTX-AT was associated with prolonged hospital stay [Adjusted mean 5.0 vs. 4.1 days; (RR) 1.22, p < 0.001] compared to subtotal PTX.Subtotal PTX and total PTX-AT have similar rates of complications, readmission, and 30-day mortality, but subtotal PTX is less likely to have extended hospital stay. These findings have important cost implications for patients, payers, and hospitals.

Authors
Anderson, K; Ruel, E; Adam, MA; Thomas, S; Youngwirth, L; Stang, MT; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Anderson, K, Ruel, E, Adam, MA, Thomas, S, Youngwirth, L, Stang, MT, Scheri, RP, Roman, SA, and Sosa, JA. "Subtotal vs. total parathyroidectomy with autotransplantation for patients with renal hyperparathyroidism have similar outcomes." American journal of surgery 214.5 (November 2017): 914-919.
PMID
28736060
Source
epmc
Published In
The American Journal of Surgery
Volume
214
Issue
5
Publish Date
2017
Start Page
914
End Page
919
DOI
10.1016/j.amjsurg.2017.07.018

Projecting Survival in Papillary Thyroid Cancer: A Comparison of the Seventh and Eighth Editions of the American Joint Commission on Cancer/Union for International Cancer Control Staging Systems in Two Contemporary National Patient Cohorts.

This study aims to compare the seventh and eighth editions of the American Joint Commission on Cancer/Union for International Cancer Control (AJCC/UICC) tumor, node, metastasis staging system for patients with papillary thyroid cancer (PTC) in two national patient cohorts.Adult PTC patients undergoing surgery were selected from the Surveillance, Epidemiology and End Results (SEER) program (2004-2012) and the National Cancer Database (2004-2012). Staging criteria for the seventh and eighth AJCC/UICC editions were applied separately to each cohort. Survival probabilities were estimated using the Kaplan-Meier method. Multivariable Cox proportional hazards models were used to estimate the association of stage with survival in both settings. The Akaike information criterion was used to assess model performance.About 23% of patients were downstaged from the seventh to the eighth edition in SEER, while 24% were downstaged in the National Cancer Database. Disease-specific survival (DSS) and overall survival (OS) were significantly related to stage at diagnosis when using both the seventh and eighth editions of the AJCC/UICC staging system (p < 0.001). Patients classified into higher stages (III and IV) in the eighth edition showed a worse prognosis than those classified into similar stages in the seventh edition. After adjustment, PTC stages as defined by both editions were significantly associated with DSS and OS. With respect to both DSS and OS, the eighth edition PTC model appeared to be a better fit to the data (smaller Akaike information criterion values) compared to the seventh edition.Based on these large contemporary national cohorts, the eighth edition AJCC/UICC tumor, node, metastasis classification for PTC is superior to the seventh edition for predicting survival.

Authors
Pontius, LN; Oyekunle, TO; Thomas, SM; Stang, MT; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Pontius, LN, Oyekunle, TO, Thomas, SM, Stang, MT, Scheri, RP, Roman, SA, and Sosa, JA. "Projecting Survival in Papillary Thyroid Cancer: A Comparison of the Seventh and Eighth Editions of the American Joint Commission on Cancer/Union for International Cancer Control Staging Systems in Two Contemporary National Patient Cohorts." Thyroid : official journal of the American Thyroid Association 27.11 (November 2017): 1408-1416.
PMID
28891405
Source
epmc
Published In
Thyroid
Volume
27
Issue
11
Publish Date
2017
Start Page
1408
End Page
1416
DOI
10.1089/thy.2017.0306

Exposure to flame retardant chemicals and occurrence and severity of papillary thyroid cancer: A case-control study.

Thyroid cancer is the fastest increasing cancer in the U.S., and papillary thyroid cancer (PTC) accounts for >80% of incident cases. Increasing exposure to flame retardant chemicals (FRs) has raised concerns about their possible role in this 'epidemic'. The current study was designed to test the hypothesis that higher exposure to FRs is associated with increased odds of PTC.PTC patients at the Duke Cancer Institute were approached and invited to participate. Age- and gender-matched controls were recruited from the Duke Health System and surrounding communities. Because suitable biomarkers of long-term exposure do not exist for many common FRs, and levels of FRs in dust are significantly correlated with exposure, relationships between FRs in household dust and PTC were evaluated in addition to available biomarkers. PTC status, measures of aggressiveness (e.g. tumor size) and BRAF V600E mutation were included as outcomes.Higher levels of some FRs, particularly decabromodiphenyl ether (BDE-209) and tris(2-chloroethyl) phosphate in dust, were associated with increased odds of PTC. Participants with dust BDE-209 concentrations above the median level were 2.29 times as likely to have PTC [95% confidence interval: 1.03, 5.08] compared to those with low BDE-209 concentrations. Associations varied based on tumor aggressiveness and mutation status; TCEP was more strongly associated with larger, more aggressive tumors and BDE-209 was associated with smaller, less aggressive tumors.Taken together, these results suggest exposure to FRs in the home, particularly BDE-209 and TCEP, may be associated with PTC occurrence and severity, and warrant further study.

Authors
Hoffman, K; Lorenzo, A; Butt, CM; Hammel, SC; Henderson, BB; Roman, SA; Scheri, RP; Stapleton, HM; Sosa, JA
MLA Citation
Hoffman, K, Lorenzo, A, Butt, CM, Hammel, SC, Henderson, BB, Roman, SA, Scheri, RP, Stapleton, HM, and Sosa, JA. "Exposure to flame retardant chemicals and occurrence and severity of papillary thyroid cancer: A case-control study." Environment international 107 (October 2017): 235-242.
Website
http://hdl.handle.net/10161/15444
PMID
28772138
Source
epmc
Published In
Environment International
Volume
107
Publish Date
2017
Start Page
235
End Page
242
DOI
10.1016/j.envint.2017.06.021

Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study.

Sentinel lymph node biopsy (SLNB) is routinely performed for primary cutaneous melanomas; however, limited data exist for SLNB after locally recurrent (LR) or in-transit (IT) melanoma.Data from three centers performing SLNB for LR/IT melanoma (1997 to the present) were reviewed, with the aim of assessing (1) success rate; (2) SLNB positivity; and (3) prognostic value of SLNB in this population.The study cohort included 107 patients. Management of the primary melanoma included prior SLNB for 56 patients (52%), of whom 10 (18%) were positive and 12 had complete lymph node dissections (CLNDs). In the present study, SLNB was performed for IT disease (48/107, 45%) or LR melanoma (59/107, 55%). A sentinel lymph node (SLN) was removed in 96% (103/107) of cases. Nodes were not removed for four patients due to lymphoscintigraphy failures (2) or nodes not found during surgery (2). SLNB was positive in 41 patients (40%, 95% confidence interval (CI) 31.5-50.5), of whom 35 (88%) had CLND, with 13 (37%) having positive nonsentinel nodes. Median time to disease progression after LR/IT metastasis was 1.4 years (95% CI 0.75-2.0) for patients with a positive SLNB, and 5.9 years (95% CI 1.7-10.2) in SLNB-negative patients (p = 0.18). There was a trend towards improved overall survival for patients with a negative SLNB (p = 0.06).SLNB can be successful in patients with LR/IT melanoma, even if prior SLNB was performed. In this population, the rates of SLNB positivity and nonsentinel node metastases were 40% and 37%, respectively. SLNB may guide management and prognosis after LR/IT disease.

Authors
Beasley, GM; Hu, Y; Youngwirth, L; Scheri, RP; Salama, AK; Rossfeld, K; Gardezi, S; Agnese, DM; Howard, JH; Tyler, DS; Slingluff, CL; Terando, AM
MLA Citation
Beasley, GM, Hu, Y, Youngwirth, L, Scheri, RP, Salama, AK, Rossfeld, K, Gardezi, S, Agnese, DM, Howard, JH, Tyler, DS, Slingluff, CL, and Terando, AM. "Sentinel Lymph Node Biopsy for Recurrent Melanoma: A Multicenter Study." Annals of surgical oncology 24.9 (September 2017): 2728-2733.
PMID
28508145
Source
epmc
Published In
Annals of Surgical Oncology
Volume
24
Issue
9
Publish Date
2017
Start Page
2728
End Page
2733
DOI
10.1245/s10434-017-5883-6

Impaired calcium sensing distinguishes primary hyperparathyroidism (PHPT) patients with low bone mineral density.

A subset of PHPT patients exhibit a more severe disease phenotype characterized by bone loss, fractures, recurrent nephrolithiasis, and other dysfunctions, but the underlying reasons for this disparity in clinical presentation remain unknown.We sought to identify new mechanistic indices that could inform more personalized management of PHPT.Pre-, peri-, and postoperative data and demographic, clinical, and pathological information from patients undergoing parathyroidectomy for PHPT were collected. Univariate and partial Spearman correlation was used to estimate the association of parathyroid tumor calcium sensing capacity with select variables.An unselected series of 237 patients aged >18years and undergoing parathyroidectomy for PHPT were enrolled.Calcium sensing capacity, expressed as the concentration required for half-maximal biochemical response (EC50), was evaluated in parathyroid tumors from an unselected series of 74 patients and assessed for association with clinical parameters. The hypothesis was that greater disease severity would be associated with attenuated calcium sensitivity and biochemically autonomous parathyroid tumor behavior.Parathyroid tumors segregated into two distinct groups of calcium responsiveness (EC50<3.0 and ≥3.0mM). The low EC50 group (n=27) demonstrated a mean calcium EC50 value of 2.49mM [95% confidence interval (CI): 2.43-2.54mM], consistent with reference normal activity. In contrast, the high EC50 group (n=47) displayed attenuated calcium sensitivity with a mean EC50 value of 3.48mM [95% CI: 3.41-3.55mM]. Retrospective analysis of the clinical registry data suggested that high calcium EC50 patients presented with a more significant preoperative bone mineral density (BMD) deficit with a t-score of -2.7, (95% CI: -3.4 to -1.9) versus 0.9, (95% CI: -2.1 to -0.4) in low EC50 patients (p<0.001). After adjusting for gender, age, BMI, 25 OH vitamin D level and preoperative iPTH, lowest t-score and calcium EC50 were inversely correlated, with a partial Spearman correlation coefficient of -0.35 (p=0.02).Impaired calcium sensing in parathyroid tumors is selectively observed in a subset of patients with more severe bone mineral density deficit. Assessment of parathyroid tumor biochemical behavior may be a useful predictor of disease severity as measured by bone mineral density in patients with PHPT.

Authors
Weber, TJ; Koh, J; Thomas, SM; Hogue, JA; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Weber, TJ, Koh, J, Thomas, SM, Hogue, JA, Scheri, RP, Roman, SA, and Sosa, JA. "Impaired calcium sensing distinguishes primary hyperparathyroidism (PHPT) patients with low bone mineral density." Metabolism: clinical and experimental 74 (September 2017): 22-31.
PMID
28764845
Source
epmc
Published In
Metabolism
Volume
74
Publish Date
2017
Start Page
22
End Page
31
DOI
10.1016/j.metabol.2017.06.004

Racial Disparities in Differentiated Thyroid Cancer: Have We Bridged the Gap?

Racial disparities in the management of differentiated thyroid cancer (DTC) exist in the United States. There is a paucity of data examining their temporal trends. It was hypothesized that racial disparities in care provided to patients with DTC have improved over the past 15 years.Adult patients undergoing surgery for DTC were included from the National Cancer Data Base (1998-2012). Temporal trends in appropriate extent of thyroidectomy and radioactive iodine therapy (RAI) were described for different racial groups. Multivariable logistic regression models were employed to estimate the adjusted association of receipt of appropriate extent of surgery and RAI, specifically under- and over-treatment, among different racial groups.Among 282,043 DTC patients, 80.3% were non-Hispanic white (white), 8.1% Hispanic, 7.2% non-Hispanic black (black), and 4.4% Asian. Black versus white race/ethnicity was associated with lower odds of receiving appropriate surgery (odds ratio [OR] = 0.78 [confidence interval (CI) 0.71-0.87]; p < 0.001). Appropriate RAI treatment was higher in blacks (OR = 1.07 [CI 1.02-1.12]; p = 0.01) and lower for Hispanics (OR = 0.90 [CI 0.86-0.95]; p < 0.001) compared with whites. There was a higher likelihood of RAI under-treatment in minority groups (Hispanic OR = 1.27, black OR = 1.26, Asian OR = 1.25; p < 0.001), and a lower likelihood of RAI over-treatment (Hispanic OR = 0.89, black OR = 0.83, Asian OR = 0.79; p < 0.001) compared with whites. Over time, an increasing proportion of black and white patients underwent appropriate extent of thyroidectomy (1998 vs. 2012: 78% vs. 88% and 81% vs. 91%, respectively). Compared with 1998, fewer patients in 2012 were under-treated with RAI: whites (48% vs. 29%, respectively), blacks (51% vs. 33%), Hispanics (51% vs. 37%), and Asians (55% vs. 39%). The extent of RAI over-treatment increased (1998 vs. 2012): whites (1% vs. 4%), blacks (2% vs. 4%), Hispanics (2% vs. 4%), and Asians (2% vs. 3%), respectively.Appropriate utilization of surgery and RAI for DTC has improved over time. However, the proportion of patients receiving appropriate thyroid surgery is consistently lower for blacks compared with whites. RAI over-treatment increased for all races over the study period. Efforts are needed to standardize DTC care among minority patients.

Authors
Shah, SA; Adam, MA; Thomas, SM; Scheri, RP; Stang, MT; Sosa, JA; Roman, SA
MLA Citation
Shah, SA, Adam, MA, Thomas, SM, Scheri, RP, Stang, MT, Sosa, JA, and Roman, SA. "Racial Disparities in Differentiated Thyroid Cancer: Have We Bridged the Gap?." Thyroid : official journal of the American Thyroid Association 27.6 (June 2017): 762-772.
PMID
28294040
Source
epmc
Published In
Thyroid
Volume
27
Issue
6
Publish Date
2017
Start Page
762
End Page
772
DOI
10.1089/thy.2016.0626

Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma.

Sentinel-lymph-node biopsy is associated with increased melanoma-specific survival (i.e., survival until death from melanoma) among patients with node-positive intermediate-thickness melanomas (1.2 to 3.5 mm). The value of completion lymph-node dissection for patients with sentinel-node metastases is not clear.In an international trial, we randomly assigned patients with sentinel-node metastases detected by means of standard pathological assessment or a multimarker molecular assay to immediate completion lymph-node dissection (dissection group) or nodal observation with ultrasonography (observation group). The primary end point was melanoma-specific survival. Secondary end points included disease-free survival and the cumulative rate of nonsentinel-node metastasis.Immediate completion lymph-node dissection was not associated with increased melanoma-specific survival among 1934 patients with data that could be evaluated in an intention-to-treat analysis or among 1755 patients in the per-protocol analysis. In the per-protocol analysis, the mean (±SE) 3-year rate of melanoma-specific survival was similar in the dissection group and the observation group (86±1.3% and 86±1.2%, respectively; P=0.42 by the log-rank test) at a median follow-up of 43 months. The rate of disease-free survival was slightly higher in the dissection group than in the observation group (68±1.7% and 63±1.7%, respectively; P=0.05 by the log-rank test) at 3 years, based on an increased rate of disease control in the regional nodes at 3 years (92±1.0% vs. 77±1.5%; P<0.001 by the log-rank test); these results must be interpreted with caution. Nonsentinel-node metastases, identified in 11.5% of the patients in the dissection group, were a strong, independent prognostic factor for recurrence (hazard ratio, 1.78; P=0.005). Lymphedema was observed in 24.1% of the patients in the dissection group and in 6.3% of those in the observation group.Immediate completion lymph-node dissection increased the rate of regional disease control and provided prognostic information but did not increase melanoma-specific survival among patients with melanoma and sentinel-node metastases. (Funded by the National Cancer Institute and others; MSLT-II ClinicalTrials.gov number, NCT00297895 .).

Authors
Faries, MB; Thompson, JF; Cochran, AJ; Andtbacka, RH; Mozzillo, N; Zager, JS; Jahkola, T; Bowles, TL; Testori, A; Beitsch, PD; Hoekstra, HJ; Moncrieff, M; Ingvar, C; Wouters, MWJM; Sabel, MS; Levine, EA; Agnese, D; Henderson, M; Dummer, R; Rossi, CR; Neves, RI; Trocha, SD; Wright, F; Byrd, DR; Matter, M; Hsueh, E; MacKenzie-Ross, A; Johnson, DB; Terheyden, P; Berger, AC; Huston, TL; Wayne, JD; Smithers, BM; Neuman, HB; Schneebaum, S; Gershenwald, JE; Ariyan, CE; Desai, DC; Jacobs, L et al.
MLA Citation
Faries, MB, Thompson, JF, Cochran, AJ, Andtbacka, RH, Mozzillo, N, Zager, JS, Jahkola, T, Bowles, TL, Testori, A, Beitsch, PD, Hoekstra, HJ, Moncrieff, M, Ingvar, C, Wouters, MWJM, Sabel, MS, Levine, EA, Agnese, D, Henderson, M, Dummer, R, Rossi, CR, Neves, RI, Trocha, SD, Wright, F, Byrd, DR, Matter, M, Hsueh, E, MacKenzie-Ross, A, Johnson, DB, Terheyden, P, Berger, AC, Huston, TL, Wayne, JD, Smithers, BM, Neuman, HB, Schneebaum, S, Gershenwald, JE, Ariyan, CE, Desai, DC, and Jacobs, L et al. "Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma." The New England journal of medicine 376.23 (June 2017): 2211-2222.
PMID
28591523
Source
epmc
Published In
The New England journal of medicine
Volume
376
Issue
23
Publish Date
2017
Start Page
2211
End Page
2222
DOI
10.1056/nejmoa1613210

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

Patients with thyroid cancer who 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.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.In total, 241,118 patients with differentiated thyroid cancer met the inclusion criteria; 86.9% had no ETE, 9.1% minimal ETE, and 4.0% extensive ETE. Compared with 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%, respectively), positive margins after thyroidectomy (6.1% vs. 35.2% and 45.9%, respectively), and regional lymph node metastases (32.5% vs. 67.0% and 74.6%, respectively; all p < 0.01). After adjustment, minimal ETE (hazard ratio [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, 3415 patients with medullary thyroid cancer met the inclusion criteria; 87.9% had no ETE, 7.1% minimal ETE, and 5.0% extensive ETE. Compared with 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%, respectively), positive margins after thyroidectomy (5.8% vs. 44.1% and 51.9%, respectively), and regional lymph node metastases (39.0% vs. 90.5% and 94.4%, respectively; all p < 0.01). After adjustment, extensive ETE (HR = 1.63; p = 0.01) was associated with compromised survival for patients with medullary thyroid cancer.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, LM; Adam, MA; Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Youngwirth, LM, Adam, MA, Scheri, RP, Roman, SA, and Sosa, JA. "Extrathyroidal Extension Is Associated with Compromised Survival in Patients with Thyroid Cancer." Thyroid : official journal of the American Thyroid Association 27.5 (May 2017): 626-631.
PMID
27597378
Source
epmc
Published In
Thyroid
Volume
27
Issue
5
Publish Date
2017
Start Page
626
End Page
631
DOI
10.1089/thy.2016.0132

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

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 265.2 (February 2017): 402-407.
PMID
28059969
Source
epmc
Published In
Annals of Surgery
Volume
265
Issue
2
Publish Date
2017
Start Page
402
End Page
407
DOI
10.1097/sla.0000000000001688

Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults.

Each year over 16 million older Americans undergo general anesthesia for surgery, and up to 40% develop postoperative delirium and/or cognitive dysfunction (POCD). Delirium and POCD are each associated with decreased quality of life, early retirement, increased 1-year mortality, and long-term cognitive decline. Multiple investigators have thus suggested that anesthesia and surgery place severe stress on the aging brain, and that patients with less ability to withstand this stress will be at increased risk for developing postoperative delirium and POCD. Delirium and POCD risk are increased in patients with lower preoperative cognitive function, yet preoperative cognitive function is not routinely assessed, and no intraoperative physiological predictors have been found that correlate with lower preoperative cognitive function. Since general anesthesia causes alpha-band (8-12 Hz) electroencephalogram (EEG) power to decrease occipitally and increase frontally (known as "anteriorization"), and anesthetic-induced frontal alpha power is reduced in older adults, we hypothesized that lower intraoperative frontal alpha power might correlate with lower preoperative cognitive function. Here, we provide evidence that such a correlation exists, suggesting that lower intraoperative frontal alpha power could be used as a physiological marker to identify older adults with lower preoperative cognitive function. Lower intraoperative frontal alpha power could thus be used to target these at-risk patients for possible therapeutic interventions to help prevent postoperative delirium and POCD, or for increased postoperative monitoring and follow-up. More generally, these results suggest that understanding interindividual differences in how the brain responds to anesthetic drugs can be used as a probe of neurocognitive function (and dysfunction), and might be a useful measure of neurocognitive function in older adults.

Authors
Giattino, CM; Gardner, JE; Sbahi, FM; Roberts, KC; Cooter, M; Moretti, E; Browndyke, JN; Mathew, JP; Woldorff, MG; Berger, M; MADCO-PC Investigators,
MLA Citation
Giattino, CM, Gardner, JE, Sbahi, FM, Roberts, KC, Cooter, M, Moretti, E, Browndyke, JN, Mathew, JP, Woldorff, MG, Berger, M, and MADCO-PC Investigators, . "Intraoperative Frontal Alpha-Band Power Correlates with Preoperative Neurocognitive Function in Older Adults." Frontiers in systems neuroscience 11 (January 2017): 24-.
Website
http://hdl.handle.net/10161/14971
PMID
28533746
Source
epmc
Published In
Frontiers in Systems Neuroscience
Volume
11
Publish Date
2017
Start Page
24
DOI
10.3389/fnsys.2017.00024

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
DOI
10.1200/jco.2016.68.9372

Vanishing Thyroid Tumors: What Are They, and What Do They Mean for Patients?

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. "Vanishing Thyroid Tumors: What Are They, and What Do They Mean for Patients?." October 2016.
Source
wos-lite
Published In
Journal of The American College of Surgeons
Volume
223
Issue
4
Publish Date
2016
Start Page
E99
End Page
E100

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

Surgical management of sporadic medullary thyroid cancer (extent of thyroid resection and the role of central and lateral neck dissection)

Authors
Scheri, RP; Roman, SA; Sosa, JA
MLA Citation
Scheri, RP, Roman, SA, and Sosa, JA. "Surgical management of sporadic medullary thyroid cancer (extent of thyroid resection and the role of central and lateral neck dissection)." Medullary Thyroid Cancer. July 20, 2016. 115-126.
Source
scopus
Publish Date
2016
Start Page
115
End Page
126
DOI
10.1007/978-3-319-39412-1_11

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

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

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

Critical appraisal

Authors
Scheri, RP; Sosa, JA
MLA Citation
Scheri, RP, and Sosa, JA. "Critical appraisal." Minimally Invasive Therapies for Endocrine Neck Diseases. January 1, 2016. 261-272.
Source
scopus
Publish Date
2016
Start Page
261
End Page
272
DOI
10.1007/978-3-319-20065-1_21

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

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

Anaplastic Thyroid Carcinoma, Version 2.2015.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Thyroid Carcinoma focuses on anaplastic carcinoma because substantial changes were made to the systemic therapy recommendations for the 2015 update. Dosages and frequency of administration are now provided, docetaxel/doxorubicin regimens were added, and single-agent cisplatin was deleted because it is not recommended for patients with advanced or metastatic anaplastic thyroid cancer.

Authors
Haddad, RI; Lydiatt, WM; Ball, DW; Busaidy, NL; Byrd, D; Callender, G; Dickson, P; Duh, Q-Y; Ehya, H; Haymart, M; Hoh, C; Hunt, JP; Iagaru, A; Kandeel, F; Kopp, P; Lamonica, DM; McCaffrey, JC; Moley, JF; Parks, L; Raeburn, CD; Ridge, JA; Ringel, MD; Scheri, RP; Shah, JP; Smallridge, RC; Sturgeon, C; Wang, TN; Wirth, LJ; Hoffmann, KG; Hughes, M
MLA Citation
Haddad, RI, Lydiatt, WM, Ball, DW, Busaidy, NL, Byrd, D, Callender, G, Dickson, P, Duh, Q-Y, Ehya, H, Haymart, M, Hoh, C, Hunt, JP, Iagaru, A, Kandeel, F, Kopp, P, Lamonica, DM, McCaffrey, JC, Moley, JF, Parks, L, Raeburn, CD, Ridge, JA, Ringel, MD, Scheri, RP, Shah, JP, Smallridge, RC, Sturgeon, C, Wang, TN, Wirth, LJ, Hoffmann, KG, and Hughes, M. "Anaplastic Thyroid Carcinoma, Version 2.2015." Journal of the National Comprehensive Cancer Network : JNCCN 13.9 (September 2015): 1140-1150.
PMID
26358798
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
13
Issue
9
Publish Date
2015
Start Page
1140
End Page
1150
DOI
10.6004/jnccn.2015.0139

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

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

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

Impact of delayed lymphoscintigraphy for sentinel lymphnode biopsy for breast cancer.

BACKGROUND: Despite universal adoption of sentinel lymph node biopsy (SLNB) for breast cancer, there remains no standardized protocol for preoperative lymphoscintographic assessment of sentinel nodes. Both immediate and delayed lymphoscintigraphy are currently utilized, although it is unclear how delayed imaging impacts SLN identification. METHODS: Among patients diagnosed with breast cancer who underwent SLNB at Duke from 2011 to 2012, two protocols for preoperative lymphoscintigraphy were used: protocol A included both immediate and delayed lymphoscintigraphy (n = 152), while protocol B involved immediate lymphoscintigraphy only (n = 103). RESULTS: The overall intraoperative SLN identification rate was 98.4% and did not differ between groups. A lower number of SLN were visualized on the immediate scan using protocol A compared to protocol B (P < 0.001). Although a greater total number of nodes was excised using protocol A, this result was not statistically significant (P = 0.08). Moreover, there was no significant difference in the number of negative SLN between groups (P = 0.51). CONCLUSIONS: We found no significant impact on identification rate or number of SLN excised with the use of delayed versus immediate imaging. These findings support abandoning delayed lymphoscintographic imaging, except in those cases where aberrant drainage is suspected.

Authors
Wang, H; Heck, K; Pruitt, SK; Wong, TZ; Scheri, RP; Georgiade, GS; Ichite, I; Hwang, ES
MLA Citation
Wang, H, Heck, K, Pruitt, SK, Wong, TZ, Scheri, RP, Georgiade, GS, Ichite, I, and Hwang, ES. "Impact of delayed lymphoscintigraphy for sentinel lymphnode biopsy for breast cancer." Journal of surgical oncology 111.8 (June 2015): 931-934.
PMID
25953313
Source
epmc
Published In
Journal of Surgical Oncology
Volume
111
Issue
8
Publish Date
2015
Start Page
931
End Page
934
DOI
10.1002/jso.23915

Advances in thyroid and parathyroid care

Authors
Scheri, RP; Sosa, JA; Roman, SA
MLA Citation
Scheri, RP, Sosa, JA, and Roman, SA. "Advances in thyroid and parathyroid care." Technological Advances in Surgery, Trauma and Critical Care. January 1, 2015. 209-219.
Source
scopus
Publish Date
2015
Start Page
209
End Page
219
DOI
10.1007/978-1-4939-2671-8_20

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

What Is the Optimal Treatment of Papillary Thyroid Cancer?

Authors
Jillard, CL; Scheri, RP; Sosa, JA
MLA Citation
Jillard, CL, Scheri, RP, and Sosa, JA. "What Is the Optimal Treatment of Papillary Thyroid Cancer?." Advances in surgery 49 (January 2015): 79-93. (Review)
PMID
26299491
Source
epmc
Published In
Advances in Surgery(R)
Volume
49
Publish Date
2015
Start Page
79
End Page
93
DOI
10.1016/j.yasu.2015.03.007

Thyroid carcinoma, version 2.2014.

These NCCN Guidelines Insights focus on some of the major updates to the 2014 NCCN Guidelines for Thyroid Carcinoma. Kinase inhibitor therapy may be used to treat thyroid carcinoma that is symptomatic and/or progressive and not amenable to treatment with radioactive iodine. Sorafenib may be considered for select patients with metastatic differentiated thyroid carcinoma, whereas vandetanib or cabozantinib may be recommended for select patients with metastatic medullary thyroid carcinoma. Other kinase inhibitors may be considered for select patients with either type of thyroid carcinoma. A new section on "Principles of Kinase Inhibitor Therapy in Advanced Thyroid Cancer" was added to the NCCN Guidelines to assist with using these novel targeted agents.

Authors
Tuttle, RM; Haddad, RI; Ball, DW; Byrd, D; Dickson, P; Duh, Q-Y; Ehya, H; Haymart, M; Hoh, C; Hunt, JP; Iagaru, A; Kandeel, F; Kopp, P; Lamonica, DM; Lydiatt, WM; McCaffrey, J; Moley, JF; Parks, L; Raeburn, CD; Ridge, JA; Ringel, MD; Scheri, RP; Shah, JP; Sherman, SI; Sturgeon, C; Waguespack, SG; Wang, TN; Wirth, LJ; Hoffmann, KG; Hughes, M
MLA Citation
Tuttle, RM, Haddad, RI, Ball, DW, Byrd, D, Dickson, P, Duh, Q-Y, Ehya, H, Haymart, M, Hoh, C, Hunt, JP, Iagaru, A, Kandeel, F, Kopp, P, Lamonica, DM, Lydiatt, WM, McCaffrey, J, Moley, JF, Parks, L, Raeburn, CD, Ridge, JA, Ringel, MD, Scheri, RP, Shah, JP, Sherman, SI, Sturgeon, C, Waguespack, SG, Wang, TN, Wirth, LJ, Hoffmann, KG, and Hughes, M. "Thyroid carcinoma, version 2.2014." Journal of the National Comprehensive Cancer Network : JNCCN 12.12 (December 2014): 1671-1680.
PMID
25505208
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
12
Issue
12
Publish Date
2014
Start Page
1671
End Page
1680
DOI
10.6004/jnccn.2014.0169

Hyperparathyroid crisis due to asymmetric parathyroid hyperplasia with a massive ectopic parathyroid gland.

To report a rare case of primary hyperparathyroidism presenting with hyperparathyroid crisis due to parathyroid hyperplasia with ectopic glands.We present the initial clinical manifestations, laboratory results, radiologic and surgical findings, and management in a patient who had hyperparathyroid crisis. The pertinent literature and management options are also reviewed.A 60-year-old female presented with hyperparathyroid crisis requiring preoperative stabilization with rehydration, diuresis, bisphosphonate therapy, and ultimately hemodialysis. Parathyroidectomy revealed asymmetric 4-gland hyperplasia, with a massive ectopic parathyroid gland in the tracheoesophageal groove extending into the mediastinum. Her postoperative course was complicated by hungry bone syndrome and hypocalcemia.This case illustrates the rare occurrence of hyperparathyroid crises due to asymmetric parathyroid hyperplasia with a massive ectopic parathyroid gland.

Authors
Gratian, LF; Hyland, KA; Scheri, RP
MLA Citation
Gratian, LF, Hyland, KA, and Scheri, RP. "Hyperparathyroid crisis due to asymmetric parathyroid hyperplasia with a massive ectopic parathyroid gland." Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 20.10 (October 2014): e180-e182.
PMID
24936566
Source
epmc
Published In
Endocrine Practice
Volume
20
Issue
10
Publish Date
2014
Start Page
e180
End Page
e182
DOI
10.4158/ep14136.cr

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

Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project.

BACKGROUND: Although the existing literature suggests that laparoscopic adrenalectomy may be associated with less postoperative morbidity than open adrenalectomy, a comparison of the two approaches has not been published using American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data. The objective of our analysis was to compare the 30-d outcomes after laparoscopic versus open adrenalectomy using this data source. METHODS: The ACS-NSQIP Participant User Files for 2005-2010 were used for this retrospective analysis, which included all patients with (1) a primary Current Procedural Terminology code for open or laparoscopic adrenalectomy and (2) a postoperative International Classification of Diseases, Ninth Revision (ICD-9) code for adrenal gland pathology. Primary outcomes were 30-d postoperative mortality, overall complication rate, and length of postoperative hospitalization. The association between surgical approach and primary outcomes were determined after adjusting for a comprehensive array of patient- and procedure-related factors. RESULTS: A total of 3100 patients were included for analysis (644 undergoing open versus 2456 undergoing laparoscopic adrenalectomy). Patients undergoing a laparoscopic procedure had significantly lower postoperative morbidity and shorter length of stay than patients undergoing an open procedure after adjustment for patient- and procedure-related factors. Similar findings were demonstrated for all indications, including malignancy. CONCLUSIONS: To our knowledge, the present study represents the largest comparison to date of laparoscopic versus open adrenalectomy. Our findings suggest that the laparoscopic approach is associated with sizeable reductions in postoperative morbidity and length of postoperative hospitalization.

Authors
Elfenbein, DM; Scarborough, JE; Speicher, PJ; Scheri, RP
MLA Citation
Elfenbein, DM, Scarborough, JE, Speicher, PJ, and Scheri, RP. "Comparison of laparoscopic versus open adrenalectomy: results from American College of Surgeons-National Surgery Quality Improvement Project." J Surg Res 184.1 (September 2013): 216-220.
PMID
23664532
Source
pubmed
Published In
Journal of Surgical Research
Volume
184
Issue
1
Publish Date
2013
Start Page
216
End Page
220
DOI
10.1016/j.jss.2013.04.014

Detection and management of cervical lymph nodes in papillary thyroid cancer

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 & Metabolism 8.4 (July 2013): 365-378.
Source
crossref
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

Multidisciplinary care of patients with early-stage breast cancer.

There is a compelling need for close coordination and integration of multiple specialties in the management of patients with early-stage breast cancer. Optimal patient care and outcomes depend on the sequential and often simultaneous participation and dialogue between specialists in imaging, pathologic and molecular diagnostic and prognostic stratification, and the therapeutic specialties of surgery, radiation oncology, and medical oncology. These are but a few of the various disciplines needed to provide modern, sophisticated management. The essential role for coordinated involvement of the entire health care team in optimal management of patients with early-stage breast cancer is likely to increase further.

Authors
Lyman, GH; Baker, J; Geradts, J; Horton, J; Kimmick, G; Peppercorn, J; Pruitt, S; Scheri, RP; Hwang, ES
MLA Citation
Lyman, GH, Baker, J, Geradts, J, Horton, J, Kimmick, G, Peppercorn, J, Pruitt, S, Scheri, RP, and Hwang, ES. "Multidisciplinary care of patients with early-stage breast cancer." Surg Oncol Clin N Am 22.2 (April 2013): 299-317. (Review)
PMID
23453336
Source
pubmed
Published In
Surgical Oncology Clinics of North America
Volume
22
Issue
2
Publish Date
2013
Start Page
299
End Page
317
DOI
10.1016/j.soc.2012.12.005

Hazard-rate analysis and patterns of recurrence in early stage melanoma: moving towards a rationally designed surveillance strategy.

BACKGROUND: While curable at early stages, few treatment options exist for advanced melanoma. Currently, no consensus exists regarding the optimal surveillance strategy for patients after resection. The objectives of this study were to identify patterns of metastatic recurrence, to determine the influence of metastatic site on survival, and to identify high-risk periods for recurrence. METHODS: A retrospective review of the Duke Melanoma Database from 1970 to 2004 was conducted that focused on patients who were initially diagnosed without metastatic disease. The time to first recurrence was computed from the date of diagnosis, and the associated hazard function was examined to determine the peak risk period of recurrence. Metastatic sites were coded by the American Joint Committee on Cancer (AJCC) system including local skin, distant skin and nodes (M1a), lung (M1b), and other distant (M1c). RESULTS: Of 11,615 patients initially diagnosed without metastatic disease, 4616 (40%) had at least one recurrence. Overall the risk of initial recurrence peaked at 12 months. The risk of initial recurrence at the local skin, distant skin, and nodes peaked at 8 months, and the risk at lung and other distant sites peaked at 24 months. Patients with a cutaneous or nodal recurrence had improved survival compared to other recurrence types. CONCLUSIONS: The risk of developing recurrent melanoma peaked at one year, and the site of first recurrence had a significant impact on survival. Defining the timing and expected patterns of recurrence will be important in creating an optimized surveillance strategy for this patient population.

Authors
Salama, AKS; de Rosa, N; Scheri, RP; Pruitt, SK; Herndon, JE; Marcello, J; Tyler, DS; Abernethy, AP
MLA Citation
Salama, AKS, de Rosa, N, Scheri, RP, Pruitt, SK, Herndon, JE, Marcello, J, Tyler, DS, and Abernethy, AP. "Hazard-rate analysis and patterns of recurrence in early stage melanoma: moving towards a rationally designed surveillance strategy." PLoS One 8.3 (2013): e57665-.
PMID
23516415
Source
pubmed
Published In
PloS one
Volume
8
Issue
3
Publish Date
2013
Start Page
e57665
DOI
10.1371/journal.pone.0057665

Tumor-induced osteomalacia masking primary hyperparathyroidism.

Authors
Elfenbein, DM; Weber, TJ; Scheri, RP
MLA Citation
Elfenbein, DM, Weber, TJ, and Scheri, RP. "Tumor-induced osteomalacia masking primary hyperparathyroidism." Surgery 152.6 (December 2012): 1256-1258.
PMID
23158192
Source
pubmed
Published In
Surgery
Volume
152
Issue
6
Publish Date
2012
Start Page
1256
End Page
1258
DOI
10.1016/j.surg.2012.08.062

The effect of metastatic site and decade of diagnosis on the individual burden of metastatic melanoma: contemporary estimates of average years of life lost.

OBJECTIVES: Metastatic melanoma (MM) is a leading cause of years of life lost due to malignancy. This study aimed to identify the average years of life lost (AYLL) in MM patients. METHODS: MM patients were identified from a prospectively maintained database, and a linear model predicting AYLL was developed. RESULTS: Between 1970 and 1999, 4,774 patients diagnosed with MM died. The AYLL was 23.2 years. AYLL remained stable across three decades. CONCLUSIONS: AYLL for MM is greater than 20 years, and has not improved. This burden underscores the need for continued research and access to funding for this disease.

Authors
Salama, AKS; Rosa, ND; Scheri, RP; Herndon, JE; Tyler, DS; Marcello, J; Pruitt, SK; Abernethy, AP
MLA Citation
Salama, AKS, Rosa, ND, Scheri, RP, Herndon, JE, Tyler, DS, Marcello, J, Pruitt, SK, and Abernethy, AP. "The effect of metastatic site and decade of diagnosis on the individual burden of metastatic melanoma: contemporary estimates of average years of life lost." Cancer Invest 30.9 (November 2012): 637-641.
PMID
23020583
Source
pubmed
Published In
Cancer Investigation (Informa)
Volume
30
Issue
9
Publish Date
2012
Start Page
637
End Page
641
DOI
10.3109/07357907.2012.726387

Tumor proximity to the recurrent laryngeal nerve in patients with primary hyperparathyroidism undergoing parathyroidectomy.

BACKGROUND: Recurrent laryngeal nerve (RLN) injury is a rare complication for patients undergoing neck exploration for primary hyperparathyroidism (pHPT). Distances between RLNs and parathyroid adenomas have not been previously published. In this study we used a RLN monitor to identify the RLN and to measure the proximity to parathyroid tumors. METHODS: Patients with pHPT (n = 136) underwent neck exploration and had the clinical data recorded prospectively. Adenomas were recorded in 1 of 4 locations (right upper, right lower, left upper, left lower). Measurement of RLN to adenoma distances were recorded intraoperatively with the gland in situ. The RLN location was confirmed with a RLN monitor. RESULTS: The average RLN to adenoma distance was 0.52 ± 0.52 cm. Adenomas in the right upper position were significantly closer to the nerve (0.25 ± 0.39 cm) compared with adenomas in the left upper (0.48 ± 0.61 cm, p = .03), left lower (0.70 ± 0.53 cm, p < .001), and right lower position (1.02 ± 0.56 cm, p < .001). Left upper adenomas were also significantly closer to the nerve compared with right lower adenomas (p < .001). Adenomas in the right upper position abutted the nerve more often (47 %) compared with adenomas in other positions (p = .001). There were no perioperative characteristics that predicted tumor abutment. There were no permanent RLN injuries. CONCLUSION: In patients with sporadic pHPT, parathyroid adenomas in the right upper location have, on average, greater proximity to the RLN and are more often directly abutting compared with adenomas in other locations.

Authors
Untch, BR; Adam, MA; Danko, ME; Barfield, ME; Dixit, D; Scheri, RP; Olson, JA
MLA Citation
Untch, BR, Adam, MA, Danko, ME, Barfield, ME, Dixit, D, Scheri, RP, and Olson, JA. "Tumor proximity to the recurrent laryngeal nerve in patients with primary hyperparathyroidism undergoing parathyroidectomy." Ann Surg Oncol 19.12 (November 2012): 3823-3826.
PMID
22847120
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
19
Issue
12
Publish Date
2012
Start Page
3823
End Page
3826
DOI
10.1245/s10434-012-2495-z

Adrenal gland

Authors
Olson, JA; Scheri, RP
MLA Citation
Olson, JA, and Scheri, RP. "Adrenal gland." Greenfield's Surgery: Scientific Principles and Practice: Fifth Edition. September 11, 2012. 1325-1345.
Source
scopus
Publish Date
2012
Start Page
1325
End Page
1345

An acrochordon-like melanoma metastasis.

Authors
Kollitz, KM; Tcheung, WJ; Scheri, RP; Selim, MA; Nelson, KC
MLA Citation
Kollitz, KM, Tcheung, WJ, Scheri, RP, Selim, MA, and Nelson, KC. "An acrochordon-like melanoma metastasis." Arch Dermatol 148.1 (January 2012): 136-137. (Letter)
PMID
22250257
Source
pubmed
Published In
Archives of Dermatology
Volume
148
Issue
1
Publish Date
2012
Start Page
136
End Page
137
DOI
10.1001/archdermatol.2011.1105

Surgeon-performed ultrasound is superior to 99Tc-sestamibi scanning to localize parathyroid adenomas in patients with primary hyperparathyroidism: results in 516 patients over 10 years.

BACKGROUND: Surgeon-performed cervical ultrasound (SUS) and 99Tc-sestamibi scanning (MIBI) are both useful in patients with primary hyperparathyroidism (PHPT). We sought to determine the relative contributions of SUS and MIBI to accurately predict adenoma location. STUDY DESIGN: We performed a database review of 516 patients undergoing surgery for PHPT between 2001 and 2010. SUS was performed by 1 of 3 endocrine surgeons. MIBI used 2-hour delayed anterior planar and single-photon emission computerized tomography images. Directed parathyroidectomy was performed with extent of surgery governed by intraoperative parathyroid hormone decline of 50%. RESULTS: SUS accurately localized adenomas in 87% of patients (342/392), and MIBI correctly identified their locations in 76%, 383/503 (p < 0.001). In patients who underwent SUS first, MIBI provided no additional information in 92% (144/156). In patients who underwent MIBI first, 82% of the time (176/214) SUS was unnecessary (p = 0.015). In 32 patients SUS was falsely negative. The reason for these included gland location in either the deep tracheoesophageal groove (n = 9) or the thyrothymic ligament below the clavicle (n = 5), concurrent thyroid goiter (n = 4), or thyroid cancer (n = 1). In 13 cases, the adenoma was located in a normal ultrasound-accessible location but was missed by the preoperative exam. In the 32 ultrasound false-negative cases, MIBI scans were positive in 21 (66%). Of the 516 patients, 7.6% had multigland disease. Persistent disease occurred in 4 patients (1%) and recurrent disease occurred in 6 (1.2%). CONCLUSIONS: When performed by experienced surgeons, SUS is more accurate than MIBI for predicting the location of abnormal parathyroids in PHPT patients. For patients facing first-time surgery for PHPT, we now reserve MIBI for patients with unclear or negative SUS.

Authors
Untch, BR; Adam, MA; Scheri, RP; Bennett, KM; Dixit, D; Webb, C; Leight, GS; Olson, JA
MLA Citation
Untch, BR, Adam, MA, Scheri, RP, Bennett, KM, Dixit, D, Webb, C, Leight, GS, and Olson, JA. "Surgeon-performed ultrasound is superior to 99Tc-sestamibi scanning to localize parathyroid adenomas in patients with primary hyperparathyroidism: results in 516 patients over 10 years." J Am Coll Surg 212.4 (April 2011): 522-529.
PMID
21463783
Source
pubmed
Published In
Journal of the American College of Surgeons
Volume
212
Issue
4
Publish Date
2011
Start Page
522
End Page
529
DOI
10.1016/j.jamcollsurg.2010.12.038

Patterns of Recurrence in Melanoma and the Impact on Survival

Authors
De Rosa, N; II, HJE; Marcello, J; Tyler, DS; Scheri, RP; Pruitt, SK; Wheeler, JL; Abernethy, AP
MLA Citation
De Rosa, N, II, HJE, Marcello, J, Tyler, DS, Scheri, RP, Pruitt, SK, Wheeler, JL, and Abernethy, AP. "Patterns of Recurrence in Melanoma and the Impact on Survival." February 2010.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
17
Publish Date
2010
Start Page
S104
End Page
S105

Sonography in the identification of calciphylaxis of the breast.

Authors
Bukhman, R; Scheri, RP; Selim, MA; Baker, JA
MLA Citation
Bukhman, R, Scheri, RP, Selim, MA, and Baker, JA. "Sonography in the identification of calciphylaxis of the breast." J Ultrasound Med 29.1 (January 2010): 129-133.
PMID
20040786
Source
pubmed
Published In
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
Volume
29
Issue
1
Publish Date
2010
Start Page
129
End Page
133

Importance of sentinel lymph node biopsy in patients with thin melanoma.

HYPOTHESIS: The status of the sentinel node (SN) confers important prognostic information for patients with thin melanoma. DESIGN, SETTING, AND PATIENTS: We queried our melanoma database to identify patients undergoing sentinel lymph node biopsy for thin (< or =1.00-mm) cutaneous melanoma at a tertiary care cancer institute. Slides of tumor-positive SNs were reviewed by a melanoma pathologist to confirm nodal status and intranodal tumor burden, defined as isolated tumor cells, micrometastasis, or macrometastasis (< or =0.20, 0.21-2.00, or >2.00 mm, respectively). Nodal status was correlated with patient age and primary tumor depth (< or = 0.25, 0.26-0.50, 0.51-0.75, or 0.76-1.00 mm). Survival was determined by log-rank test. MAIN OUTCOME MEASURES: Disease-free and melanoma-specific survival. RESULTS: Of 1592 patients who underwent sentinel lymph node biopsy from 1991 to 2004, 631 (40%) had thin melanomas; 31 of the 631 patients (5%) had a tumor-positive SN. At a median follow-up of 57 months for the 631 patients, the mean (SD) 10-year rate of disease-free survival was 96% (1%) vs 54% (10%) for patients with tumor-negative vs tumor-positive SNs, respectively (P < .001); the mean (SD) 10-year rate of melanoma-specific survival was 98% (1%) vs 83% (8%), respectively (P < .001). Tumor-positive SNs were more common in patients aged 50 years and younger (P = .04). The SN status maintained importance on multivariate analysis for both disease-free survival (P < .001) and melanoma-specific survival (P < .001). CONCLUSIONS: The status of the SN is significantly linked to survival in patients with thin melanoma. Therefore, sentinel lymph node biopsy should be considered to obtain complete prognostic information.

Authors
Wright, BE; Scheri, RP; Ye, X; Faries, MB; Turner, RR; Essner, R; Morton, DL
MLA Citation
Wright, BE, Scheri, RP, Ye, X, Faries, MB, Turner, RR, Essner, R, and Morton, DL. "Importance of sentinel lymph node biopsy in patients with thin melanoma." Arch Surg 143.9 (September 2008): 892-899.
PMID
18794428
Source
pubmed
Published In
Archives of Surgery
Volume
143
Issue
9
Publish Date
2008
Start Page
892
End Page
899
DOI
10.1001/archsurg.143.9.892

Targeted suppression of beta-catenin blocks intestinal adenoma formation in APC Min mice.

INTRODUCTION: Mutations involving the adenomatous polyposis coli (APC) tumor suppressor gene leading to activation of beta-catenin have been identified in the majority of sporadic colonic adenocarcinomas and in essentially all colonic tumors from patients with Familial Adenomatous Polyposis. The C57BL/6J-APC(min) (Min) mouse, which carries a germ line mutation in the murine homolog of the APC gene is a useful model for intestinal adenoma formation linked to loss of APC activity. One of the critical downstream molecules regulated by APC is beta-catenin; molecular targeting of beta-catenin is, thus, an attractive chemopreventative strategy in colon cancer. Antisense oligodeoxynucleotides (AODNs) capable of downregulating murine beta-catenin have been identified. ANALYSIS OF beta-CATENIN PROTEIN EXPRESSION IN LIVER TISSUE AND INTESTINAL ADENOMAS: Adenomas harvested from mice treated for 7 days with beta-catenin AODNs demonstrated clear downregulation of beta-catenin expression, which was accompanied by a significant reduction in proliferation. There was no effect on proliferation in normal intestinal epithelium. Min mice treated systemically with beta-catenin AODNs over a 6-week period had a statistically significant reduction in the number of intestinal adenomas. These studies provide direct evidence that targeted suppression of beta-catenin inhibits the formation of intestinal adenomas in APC-mutant mice. Furthermore, these studies suggest that molecular targeting of beta-catenin holds significant promise as a chemopreventative strategy in colon cancer.

Authors
Foley, PJ; Scheri, RP; Smolock, CJ; Pippin, J; Green, DW; Drebin, JA
MLA Citation
Foley, PJ, Scheri, RP, Smolock, CJ, Pippin, J, Green, DW, and Drebin, JA. "Targeted suppression of beta-catenin blocks intestinal adenoma formation in APC Min mice." J Gastrointest Surg 12.8 (August 2008): 1452-1458.
PMID
18521697
Source
pubmed
Published In
Journal of Gastrointestinal Surgery
Volume
12
Issue
8
Publish Date
2008
Start Page
1452
End Page
1458
DOI
10.1007/s11605-008-0519-6

Mortality burden of melanoma: Metastatic site-specific and temporal trends.

9076 Background: Metastatic melanoma has high disease-specific mortality burden, as measured by Years of Life Lost (YLL). Has mortality burden shifted over time? METHODS: This was a retrospective analysis of a prospective database of 14,029 melanoma cases treated at Duke between 1970-2004. Metastatic analyses focused on cases that developed recurrences after initial diagnosis. YLL was calculated by subtracting the survival since diagnosis from the individual's life expectancy without cancer at an equivalent time of diagnosis, based on U.S. Life Tables, 2003. Average YLL (AYLL) was calculated by group. Survival was calculated by Kaplan Meier method. RESULTS: Of 14,029 cases, 6,810 (49%) had metastases, and of metastatic cases 4,636 (68%) developed recurrences after initial diagnosis; metastatic cases were mean age 49 (SD 15), 60% male, and 99% white. First metastatic sites were lymph nodes 55%, skin 23%, lung 10%, brain 5%, liver 3%, bone 2%, and other 3%. Lymph nodes as first site of metastasis increased in frequency over time (1970s: 51%, 1980s: 54%, and 1990s: 61%). Among metastatic cases, AYLL increased by decade of diagnosis and differed by site of first metastasis ( Table ). CONCLUSIONS: Although a retrospective analysis of a US referral melanoma population, this large-scale analysis suggests that the mortality burden of metastatic melanoma may be increasing over time. This could be due to several factors, including later diagnosis, higher risk of death with initial recurrence in lymph nodes and brain, and lack of available treatments that extend survival. This analysis highlights the continued unmet need to improve survival outcomes in metastatic melanoma. [Table: see text] [Table: see text].

Authors
Scheri, RP; Herndon, JE; Marcello, J; Wheeler, J; Tyler, DS; Abernethy, AP
MLA Citation
Scheri, RP, Herndon, JE, Marcello, J, Wheeler, J, Tyler, DS, and Abernethy, AP. "Mortality burden of melanoma: Metastatic site-specific and temporal trends." J Clin Oncol 26.15_suppl (May 20, 2008): 9076-.
PMID
27950873
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
26
Issue
15_suppl
Publish Date
2008
Start Page
9076

Mortality burden of melanoma: Metastatic site-specific and temporal trends

Authors
Scheri, RP; II, HJE; Marcello, J; Wheeler, J; Tyler, DS; Abernethy, AP
MLA Citation
Scheri, RP, II, HJE, Marcello, J, Wheeler, J, Tyler, DS, and Abernethy, AP. "Mortality burden of melanoma: Metastatic site-specific and temporal trends." May 20, 2008.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
26
Issue
15
Publish Date
2008

Isolated tumor cells in the sentinel node affect long-term prognosis of patients with melanoma.

BACKGROUND: The clinical significance of isolated tumor cells (ITCs) in the melanoma-draining sentinel nodes (SNs) is unclear. METHODS: Records of patients who underwent SN biopsy (SNB) for stage I/II melanoma at our institute between 1991 and 2003 were reviewed to identify patients whose SNs were tumor-free or contained only ITC (

Authors
Scheri, RP; Essner, R; Turner, RR; Ye, X; Morton, DL
MLA Citation
Scheri, RP, Essner, R, Turner, RR, Ye, X, and Morton, DL. "Isolated tumor cells in the sentinel node affect long-term prognosis of patients with melanoma." Ann Surg Oncol 14.10 (October 2007): 2861-2866.
PMID
17882497
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
14
Issue
10
Publish Date
2007
Start Page
2861
End Page
2866
DOI
10.1245/s10434-007-9472-y

Can completion lymph node dissection be avoided for a positive sentinel node in melanoma?

Authors
Morton, DL; Scheri, RP; Balch, CM
MLA Citation
Morton, DL, Scheri, RP, and Balch, CM. "Can completion lymph node dissection be avoided for a positive sentinel node in melanoma?." Ann Surg Oncol 14.9 (September 2007): 2437-2439.
PMID
17574500
Source
pubmed
Published In
Annals of Surgical Oncology
Volume
14
Issue
9
Publish Date
2007
Start Page
2437
End Page
2439
DOI
10.1245/s10434-007-9474-9

Molecular characterization of inflammatory genes in sentinel and nonsentinel nodes in melanoma.

PURPOSE: Identification of regional node metastasis is important for accurate staging and optimal treatment of early melanoma. We hypothesize that the nodal profile of immunoregulatory cytokines can confirm the identity of the first tumor-draining regional node, i.e., the sentinel node (SN) and indicate its tumor status. EXPERIMENTAL DESIGN: RNA was extracted from freshly dissected and preserved nodal tissue of 13 tumor-negative SNs, 10 tumor-positive SNs (micrometastases <2 mm), and 11 tumor-negative non-SNs (NSN). RNA was converted into cDNA and then amplified by PCR. Expression of 96 cytokines and chemokines was assessed using cDNA microarray and compared by using hierarchical clustering. RESULTS: Fifty-seven genes were expressed at significantly (P < 0.05) different levels in SNs and NSNs (4 genes had higher expression, and 53 genes had lower expression in SNs). Expression levels of interleukin-13 (IL-13), leptin, lymphotoxin beta receptor (LTbR), and macrophage inflammatory protein 1b (MIP1b) were significantly higher (P < 0.04, P < 0.01, P < 0.05, and P < 0.01, respectively), and expression level of IL-11Ra was lower (P < 0.03) for tumor-positive as compared with tumor-negative SN. Receiver-operator characteristics curve analyses showed that the area under the curve (AUC) for IL-13, leptin, LTbR, MIP1b, and IL-11Ra was 0.79, 0.83, 0.75, 0.81, and 0.77, respectively. The AUC for the five genes in combination was 0.973, suggesting high concordance of gene-expression profiles with SN staging. CONCLUSIONS: SNs have a different immunoregulatory cytokine profile than NSNs. The cytokine profile of tumor-positive SNs; increased expression of IL-13, leptin, LTbR, and MIP1b and decreased expression of IL-11Ra, may provide clues to the local tumor lymph node interaction seen in the earliest steps of melanoma metastasis.

Authors
Torisu-Itakura, H; Lee, JH; Scheri, RP; Huynh, Y; Ye, X; Essner, R; Morton, DL
MLA Citation
Torisu-Itakura, H, Lee, JH, Scheri, RP, Huynh, Y, Ye, X, Essner, R, and Morton, DL. "Molecular characterization of inflammatory genes in sentinel and nonsentinel nodes in melanoma." Clin Cancer Res 13.11 (June 1, 2007): 3125-3132.
PMID
17545514
Source
pubmed
Published In
Clinical cancer research : an official journal of the American Association for Cancer Research
Volume
13
Issue
11
Publish Date
2007
Start Page
3125
End Page
3132
DOI
10.1158/1078-0432.CCR-06-2645

Do isolated tumor cells in the sentinel node in melanoma affect long-term prognosis?

Authors
Scheri, RP; Essner, R; Turner, RR; Ye, X; Wanek, L; Morton, DL
MLA Citation
Scheri, RP, Essner, R, Turner, RR, Ye, X, Wanek, L, and Morton, DL. "Do isolated tumor cells in the sentinel node in melanoma affect long-term prognosis?." February 2007.
Source
wos-lite
Published In
Annals of Surgical Oncology
Volume
14
Issue
2
Publish Date
2007
Start Page
11
End Page
11

Lymphatic mapping and sentinel node analysis: current concepts and applications.

Since the introduction of sentinel node biopsy in 1990 as a minimally invasive surgical technique for the diagnosis of melanoma lymphatic metastases, the number of applications has expanded. We review applications and the current status of sentinel node biopsy in melanoma, breast, colon, gastric, esophageal, head and neck, thyroid, and lung cancer. Variations on techniques specific to each organ are explained, and the current role of sentinel node biopsy in diagnosis and treatment is discussed.

Authors
Chen, SL; Iddings, DM; Scheri, RP; Bilchik, AJ
MLA Citation
Chen, SL, Iddings, DM, Scheri, RP, and Bilchik, AJ. "Lymphatic mapping and sentinel node analysis: current concepts and applications." CA Cancer J Clin 56.5 (September 2006): 292-309. (Review)
PMID
17005598
Source
pubmed
Published In
Ca: A Cancer Journal for Clinicians
Volume
56
Issue
5
Publish Date
2006
Start Page
292
End Page
309

Lymphatic mapping and sentinel lymphadenectomy in primary cutaneous melanoma.

The management of clinically normal regional lymph nodes in early-stage melanoma has been controversial for over 100 years. Lymphatic mapping and sentinel lymphadenectomy has been developed as a minimally invasive surgical technique to stage regional lymph nodes without the associated morbidity of complete lymph node dissection. Multiple retrospective studies have validated the accuracy of lymphatic mapping and sentinel lymphadenectomy and the importance of the sentinel lymph node as a prognostic tool for melanoma. Several multicenter, prospective, randomized trials are underway to validate the data of the Phase II studies and determine the therapeutic benefit of lymphatic mapping and sentinel lymphadenectomy.

Authors
Scheri, RP; Essner, R
MLA Citation
Scheri, RP, and Essner, R. "Lymphatic mapping and sentinel lymphadenectomy in primary cutaneous melanoma." Expert Rev Anticancer Ther 6.7 (July 2006): 1105-1110. (Review)
PMID
16831081
Source
pubmed
Published In
Expert Review of Anticancer Therapy
Volume
6
Issue
7
Publish Date
2006
Start Page
1105
End Page
1110
DOI
10.1586/14737140.6.7.1105

Lessons learned from two decades of sentinel node biopsies for melanoma.

Authors
Scheri, RP; Kavanagh, M; Wanek, L; Essner, R; Morton, D
MLA Citation
Scheri, RP, Kavanagh, M, Wanek, L, Essner, R, and Morton, D. "Lessons learned from two decades of sentinel node biopsies for melanoma." June 20, 2006.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
24
Issue
18
Publish Date
2006
Start Page
466S
End Page
466S

Prognostic significance of children with cutaneous melanoma: Implications for treatment.

Authors
Kavanagh, MA; Essner, R; Chen, SL; Wanek, LA; Scheri, RP; Morton, DL
MLA Citation
Kavanagh, MA, Essner, R, Chen, SL, Wanek, LA, Scheri, RP, and Morton, DL. "Prognostic significance of children with cutaneous melanoma: Implications for treatment." June 20, 2006.
Source
wos-lite
Published In
Journal of Clinical Oncology
Volume
24
Issue
18
Publish Date
2006
Start Page
458S
End Page
458S

Prognostic significance of children with cutaneous melanoma: Implications for treatment.

8021 Background: The incidence of melanoma in pediatric patients, particularly teenagers, is increasing. Treatment strategies employed for adult patients with melanoma have been applied to pediatric populations with minimal data to support similar efficacy. We performed a matched-paired analysis to compare the prognosis of pediatric (≤19 yrs old) and adult melanoma patients.Single institution, prospectively obtained melanoma database containing >14,000 records was queried for children ages 1-19 years treated for cutaneous melanoma. We identified 197 pediatric patients seen at our institute over the last 35 years. After excluding patients not seen within 4 months of initial diagnosis, 115 pediatric patients were matched to adults (age 20-70 years) chosen from the database by gender, stage, primary site and tumor characteristics (Clark level, Breslow thickness, and ulceration). Overall survival was compared between cohorts by the Kaplan-Meier method.For the pediatric patients, median age at diagnosis was 17.7 years (range 7-19 years). Patients were almost equally distributed between girls (47%) and boys. AJCC stage I and II disease at presentation was most common (73%), with stage III and IV occurring much less frequently (25% and 2%). Most pediatric patients had Clark level IV (37%) lesions; Clark level II (25%), III (25%), V (4%), and I (2%) lesions were less common. Breslow thickness ranged between <1.0mm (38%), 1.1-2.0mm (20%), 2.1-4.0mm (17%), and >4.1mm (12%). The two predominant histologic types were superficial spreading (52%) and nodular (22%) melanoma. 14% of the primary lesions were ulcerated. Rates of disease-free and overall survival were 75%± 4% and 84%± 4% at 5 years and 74%± 4% and 77%± 5% at 10 years, respectively, with a median follow up of 5.1 years (range 1-30 years). Matched pediatric and adult patients showed no difference in survival from time of initial diagnosis and stage of presentation (log rank p=0.24).Stage-specific survival in pediatric and adult melanoma patients is similar. In the absence of specific pediatric trials, standard treatment for children with melanoma should be consistent with that for adults. No significant financial relationships to disclose.

Authors
Kavanagh, MA; Essner, R; Chen, SL; Wanek, LA; Scheri, RP; Morton, DL
MLA Citation
Kavanagh, MA, Essner, R, Chen, SL, Wanek, LA, Scheri, RP, and Morton, DL. "Prognostic significance of children with cutaneous melanoma: Implications for treatment." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24.18_suppl (June 2006): 8021-.
PMID
27955530
Source
epmc
Published In
Journal of Clinical Oncology
Volume
24
Issue
18_suppl
Publish Date
2006
Start Page
8021

Lessons learned from two decades of sentinel node biopsies for melanoma.

8055 Background: The long term prognosis for patients with melanoma staged by sentinel node biopsy (SNB) remains unclear, largely due to limited follow-up from a variety of small single institution studies. We evaluated our extensive 20-year experience to evaluate the long term prognostic significance of SNB.We retrospectively reviewed the records of 2001 successive patients who underwent LM/SNB at our center from 1985 until 2004. After preoperative lymphoscintigraphy, blue dye and a hand-held gamma probe were used for intraoperative identification of sentinel nodes (SN). SN were evaluated for metastases by hemotoxylin and eosin and immunohistochemical staining with HMB45, S-100, and more recently with antibodies to melanA. Patients with tumor-positive SN underwent completion dissection (SCLND). Clinicopathological features of the patients, primaries and SN status were evaluated for their influence on survival using multivariate Cox regression analysis.After median follow-up of 49 months (range 1-237). Median age for our patients was 51 years (range 10-91). Of the 2,001 patients, 1584 (79%) had tumor-negative and 417 (21%) had tumor-positive SN. Survival rates were higher in patients with tumor-negative vs. tumor-positive SN (91 + 2% vs. 72 + 5% at 5 years, log-rank p<0.0001; and 84 + 3% vs. 64 + 7% at 10 years, log-rank p<0.0001). Of the 417 patients with SN metastases, 293 (70%) had a single tumor-positive node, 101 (24%) had 2-3 positive nodes, and 25 (6%) had at least 4 positive nodes (sentinel plus nonsentinel). Overall survival was significantly better when metastases were confined to single vs. multiple nodes (77 + 3% vs. 63 + 5%; p=0.0017). Multivariate analysis with Cox regression identified SN status (p<0.0001) as the most important prognostic factor, Hazard Ratio 3.44 (2.47-4.79). Breslow thickness (p<0.0001) and ulceration (p=0.0001) are also independently significant for survival. Gender and primary site were not significant.Our results demonstrate the long term prognostic significance of SN status. LM/SNB should become standard of care for primary melanoma because it is the most accurate factor for the quantification of the risk for recurrence and death available. No significant financial relationships to disclose.

Authors
Scheri, RP; Kavanagh, M; Wanek, L; Essner, R; Morton, D
MLA Citation
Scheri, RP, Kavanagh, M, Wanek, L, Essner, R, and Morton, D. "Lessons learned from two decades of sentinel node biopsies for melanoma." Journal of clinical oncology : official journal of the American Society of Clinical Oncology 24.18_suppl (June 2006): 8055-.
PMID
27955510
Source
epmc
Published In
Journal of Clinical Oncology
Volume
24
Issue
18_suppl
Publish Date
2006
Start Page
8055

Surgical management of the groin lymph nodes in melanoma in the era of sentinel lymph node dissection

Hypothesis: Intraoperative lymphatic mapping and sentinel lymphadenectomy (LM/SL) has become an increasingly popular surgical technique for staging the regional lymph nodes in early-stage melanoma. The technique of LM/SL has potentially great advantage for the groin, where the morbidity of superficial groin dissection or iliac dissection can be high. The surgical management of these basins is unknown for patients with tumor-positive sentinel lymph nodes (SNs). Design: Cohort of successive patients undergoing LM/SL over 18 years. Those patients found to have tumor-positive SNs underwent sentinel complete lymph node dissection. Postoperatively, patients were followed up on a routine basis with serial examinations and chest radiography. The median follow-up was 50 months. Setting: Tertiary cancer center. Patients: The technique of LM/SL was performed for 431 consecutive patients. Sentinal lymph nodes were identified in each case. Patients with tumor-positive SNs underwent sentinel complete lymph node dissection. Intervention: Cutaneous lymphoscintigraphy and blue dye with or without use of the gamma probe-directed LM/SL. Sentinel lymph nodes were examined by hematoxylineosin staining and immunohistochemistry staining with HMB-45 and S100 protein. Only patients with tumor-positive SNs had sentinel complete lymph node dissection. Main Outcome Measure: Computer-assisted database with statistical analyses using log-rank tests and Cox regression models. Results: Of the 431 patients, 264 (61%) were women and the median age was 50 years (age range, 15-89 years). A majority (86%) of the primary tumors were on the lower extremities, 54% were of Clark level IV or V, and there was a mean ± SD thickness of 1.89 ± 1.59 mm (range, 0.30-14.00 mm). Ninety-three patients (21%) were found to have tumor-positive SNs. After LM/SL and sentinel complete lymph node dissection, 62 patients (67%) were found to have a single tumor-positive lymph node, 25 (27%) had 2 tumor-positive lymph nodes, and 6 (6%) had 3 or more tumor-positive lymph nodes. Only 12 patients (4%) with tumor-negative SNs have had recurrence in the dissected basin. The 5-year overall survival was significantly better for patients with tumor-negative lymph nodes (mean ± SD 5-year overall survival, 94% ± 5%) than for patients with tumor-positive lymph nodes (mean ± SD 5-year overall survival, 75% ± 4%) (P<.01). The tumor status of the Cloquet lymph node was predictive of the tumor status of the iliac lymph nodes. Multivariate analyses with a Cox regression model identified tumor-positive SN (P = .001), primary tumor thickness (P = .03), and ulceration (P = .001) as being predictive of survival. Sex, age, Clark level, and primary site were not significant (P>.05). Conclusions: Our results demonstrate the prognostic significance of LM/SL for early-stage melanoma draining to the groin basin. The accuracy of LM/SL measured by the rare recurrences suggests that this surgical procedure should become standard for patients with early-stage melanoma of the lower extremities and trunk. Sampling of the Cloquet node should be used to determine the need for iliac dissection when a tumor-positive SN is identified in the groin. ©2006 American Medical Association. All rights reserved.

Authors
Essner, R; Scheri, R; Kavanagh, M; Torisu-Itakura, H; Wanek, LA; Morton, DL
MLA Citation
Essner, R, Scheri, R, Kavanagh, M, Torisu-Itakura, H, Wanek, LA, and Morton, DL. "Surgical management of the groin lymph nodes in melanoma in the era of sentinel lymph node dissection." Archives of Surgery 141.9 (2006): 877-882.
PMID
16983031
Source
scival
Published In
Archives of Surgery
Volume
141
Issue
9
Publish Date
2006
Start Page
877
End Page
882
DOI
10.1001/archsurg.141.9.877

A prospective evaluation of positron emission tomography scanning, sentinel lymph node biopsy, and standard axillary dissection for axillary staging in patients with early stage breast cancer

Authors
Scheri, R; Giuliano, AE
MLA Citation
Scheri, R, and Giuliano, AE. "A prospective evaluation of positron emission tomography scanning, sentinel lymph node biopsy, and standard axillary dissection for axillary staging in patients with early stage breast cancer." Breast Diseases 16.3 (2005): 263--.
Source
scival
Published In
Breast Diseases: A Year Book Quarterly
Volume
16
Issue
3
Publish Date
2005
Start Page
263-
DOI
10.1016/S1043-321X(05)80209-7

Noninvasive, quantitative assessment of left ventricular function in ischemic cardiomyopathy.

BACKGROUND: Coronary artery disease characteristically impacts left ventricular (LV) function on a regional basis, although ultimately global function may be affected as well. Echocardiography is commonly clinically used for the assessment of regional function; however, it is only semiquantitative and in its current iteration is only two-dimensional in nature. Magnetic resonance imaging (MRI) with tissue tagging offers the possibility for noninvasive, three-dimensional (3D) assessment of transmural and segmental left ventricular strain and, thereby, function. Accordingly, we have explored methodologies to accurately and quantitatively characterize regional systolic function in three dimensions in patients with ischemic heart disease using MRI. MATERIALS AND METHODS: MRI radiofrequency tissue tagging was performed at rest and during dobutamine administration (10 mg/kg/min) on 10 normal volunteers (age: 26 +/- 6) and 8 patients with severe ischemic cardiomyopathy (age: 60 +/- 5, EF 26 +/- 11%). Three-dimensional global and regional systolic strain calculations were made based on 3D myocardial point displacements and compared with conventional measures. RESULTS: Global left ventricular strains were significantly decreased in ischemic patients at rest (0.14 +/- 0.04 versus 0.25 +/- 0.02, P < 0.001) and with dobutamine (0.14 +/- 0.03 versus 0.29 +/- 0.03, P < 0.001). In the regional analysis (216 LV wall segments) this methodology accurately differentiated normal from abnormally contracting regions. CONCLUSIONS: Noninvasive dobutamine MRI tissue tagging with calculation of 3D regional strains has significant promise as a clinical tool which is capable of the identification, quantification, and display of regionally varying ventricular function.

Authors
Moustakidis, P; Cupps, BP; Pomerantz, BJ; Scheri, RP; Maniar, HS; Kates, AM; Gropler, RJ; Pasque, MK; Sundt, TM
MLA Citation
Moustakidis, P, Cupps, BP, Pomerantz, BJ, Scheri, RP, Maniar, HS, Kates, AM, Gropler, RJ, Pasque, MK, and Sundt, TM. "Noninvasive, quantitative assessment of left ventricular function in ischemic cardiomyopathy." J Surg Res 116.2 (February 2004): 187-196.
PMID
15013355
Source
pubmed
Published In
Journal of Surgical Research
Volume
116
Issue
2
Publish Date
2004
Start Page
187
End Page
196
DOI
10.1016/j.jss.2003.10.013

Severe aortic insufficiency and normal systolic function: determining regional left ventricular wall stress by finite-element analysis.

BACKGROUND: Because severe aortic insufficiency in the setting of preserved left ventricular function is often associated with a long asymptomatic period and unpredictable course on medical therapy, sensitive indices of left ventricular systolic performance are necessary for the optimal direction of therapeutic intervention. Because myocardial wall stress is closely related to both pathologic cardiac remodeling and ultimately to left ventricular decompensation, an accurate description of regional wall stress distribution may improve our ability to clinically manage these patients appropriately. The objectives of this study were (1) to define sensitive, noninvasive indices of left ventricular systolic performance to assist the clinician in the serial evaluation and early detection of increased left ventricular wall stress and, therefore, inadequate left ventricular remodeling and subsequent myocardial decompensation of patients with aortic insufficiency, and (2) to quantify differences in instantaneous global and regional end-systolic wall stress between normal subjects and patients. METHODS: Magnetic resonance imaging was performed on 23 normal volunteers and 19 patients with aortic insufficiency and normal systolic function (ejection fraction, 57% +/- 6%). Finite-element analysis was used to estimate global and regional end-systolic stress. RESULTS: End-systolic stress was significantly higher in the patient group globally (154,700 +/- 31,711 versus 96,781 +/- 23,185 dyne/cm(2); p < 0.001) and regionally (p < 0.001 in all segments) despite normal systolic function and similar end-systolic pressures. CONCLUSIONS: End-systolic stress as determined by magnetic resonance imaging and finite-element analysis may have considerable potential as a noninvasive, clinically applicable index of regional left ventricular function that may help in the serial evaluation, optimal management, and early identification of left ventricular decompensation in patients with aortic insufficiency.

Authors
Cupps, BP; Moustakidis, P; Pomerantz, BJ; Vedala, G; Scheri, RP; Kouchoukos, NT; Davila-Roman, VG; Pasque, MK
MLA Citation
Cupps, BP, Moustakidis, P, Pomerantz, BJ, Vedala, G, Scheri, RP, Kouchoukos, NT, Davila-Roman, VG, and Pasque, MK. "Severe aortic insufficiency and normal systolic function: determining regional left ventricular wall stress by finite-element analysis." Ann Thorac Surg 76.3 (September 2003): 668-675.
PMID
12963173
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
76
Issue
3
Publish Date
2003
Start Page
668
End Page
675

Decreased contractile reserve in severe aortic insufficiency using MRI-derived stress and strain relationships

Authors
Vedala, G; Moustakidis, P; Scheri, RP; Cupps, BP; Gropler, RJ; Nickerson, NJ; Kouchoukos, NT; Pasque, MK; Davila-Roman, VG
MLA Citation
Vedala, G, Moustakidis, P, Scheri, RP, Cupps, BP, Gropler, RJ, Nickerson, NJ, Kouchoukos, NT, Pasque, MK, and Davila-Roman, VG. "Decreased contractile reserve in severe aortic insufficiency using MRI-derived stress and strain relationships." February 2001.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
37
Issue
2
Publish Date
2001
Start Page
486A
End Page
486A

Noninvasive, quantitative identification of left ventricular dysfunction in ischemic cardiomyopathy

Authors
Scheri, RP; Moustakidis, P; Cupps, BP; Kates, AM; Gropler, RJ; Pasque, MK; Sundt, TM
MLA Citation
Scheri, RP, Moustakidis, P, Cupps, BP, Kates, AM, Gropler, RJ, Pasque, MK, and Sundt, TM. "Noninvasive, quantitative identification of left ventricular dysfunction in ischemic cardiomyopathy." October 31, 2000.
Source
wos-lite
Published In
Circulation
Volume
102
Issue
18
Publish Date
2000
Start Page
647
End Page
648

Noninvasive, quantitative detection of left ventricular wall dysfunctional areas in patients with ischemic cardiomyopathy using magnetic resonance imaging with tissue tagging and finite element modeling

Authors
Moustakidis, P; Scheri, RP; Vedala, G; Cupps, BP; Kates, AM; Sundt, TM; Gropler, RJ; Davila-Roman, VG; Pasque, MK
MLA Citation
Moustakidis, P, Scheri, RP, Vedala, G, Cupps, BP, Kates, AM, Sundt, TM, Gropler, RJ, Davila-Roman, VG, and Pasque, MK. "Noninvasive, quantitative detection of left ventricular wall dysfunctional areas in patients with ischemic cardiomyopathy using magnetic resonance imaging with tissue tagging and finite element modeling." February 2000.
Source
wos-lite
Published In
JACC - Journal of the American College of Cardiology
Volume
35
Issue
2
Publish Date
2000
Start Page
193A
End Page
194A

An inverse material identification algorithm for determining in vivo myocardial material properties in patients with aortic insufficiency

Authors
Moustakidis, P; Scheri, RP; Cupps, BP; Vedala, G; Moulton, MJ; Sundt, TM; Kouchoukos, NT; Davila-Roman, VG; Pasque, MK
MLA Citation
Moustakidis, P, Scheri, RP, Cupps, BP, Vedala, G, Moulton, MJ, Sundt, TM, Kouchoukos, NT, Davila-Roman, VG, and Pasque, MK. "An inverse material identification algorithm for determining in vivo myocardial material properties in patients with aortic insufficiency." November 2, 1999.
Source
wos-lite
Published In
Circulation
Volume
100
Issue
18
Publish Date
1999
Start Page
760
End Page
760

Stress distribution analysis of an experimental model of left ventricular aneurysm using magnetic resonance imaging and finite element modeling

Authors
Moustakidis, P; Pyo, R; Scheri, RP; Moulton, MJ; Cupps, BP; Sundt, TM; Guccione, JM; Pasque, MK
MLA Citation
Moustakidis, P, Pyo, R, Scheri, RP, Moulton, MJ, Cupps, BP, Sundt, TM, Guccione, JM, and Pasque, MK. "Stress distribution analysis of an experimental model of left ventricular aneurysm using magnetic resonance imaging and finite element modeling." November 2, 1999.
Source
wos-lite
Published In
Circulation
Volume
100
Issue
18
Publish Date
1999
Start Page
124
End Page
125

Predicting survival after coronary revascularization for ischemic cardiomyopathy.

BACKGROUND: The success of coronary revascularization for ischemic cardiomyopathy (left ventricular ejection fraction of 0.25 or less) has been unpredictable. We and others have demonstrated that the hospital operative mortality rate for these operations has been surprisingly low, particularly if evidence of ischemia is present. We subsequently liberalized our selection criteria based on our hypothesis that coronary artery bypass grafting is safe in this subset of patients regardless of the status of their distal coronary vasculature. METHODS: To examine this hypothesis, we studied retrospectively our patients undergoing coronary artery bypass grafting from 1983 to 1993. Ninety-six patients with ejection fractions of 0.25 or lower underwent this operation, with 88 hospital survivors (mortality 8%). All of the patients had clinical symptoms of heart failure. The male to female ratio was 4.6:1. The average age was 63.1 +/- 0.9 years (mean +/- standard error of the mean). Patients were excluded if they had valvular heart disease other than mild to moderate mitral regurgitation, required resection of a ventricular aneurysm, or required an emergency operation for acute coronary occlusion. Possible predictors of death were examined retrospectively. The catheterization films were reviewed retrospectively by a cardiovascular surgeon who was blinded to patient outcome and was never involved in the clinical management of any of the patients. Vessel quality was described as good, fair, or poor. RESULTS: Increased age and poor vessel quality were the only significant predictors of poor outcome. Sex, presence or absence of angina, preoperative angina, preoperative ejection fraction, preoperative arrhythmia disorder, aortic cross-clamp time, and the number of bypass grafts had no significant effect on outcome in the perioperative period. CONCLUSION: These results demonstrate that poor vessel quality and older age are predictors of poor outcome in patients with low ejection fractions undergoing myocardial revascularization. We conclude that poor distal coronary vasculature is a contraindication to coronary artery bypass grafting in patients with an ejection fraction of 0.25 or less, even if angina is present.

Authors
Langenburg, SE; Buchanan, SA; Blackbourne, LH; Scheri, RP; Sinclair, KN; Martinez, J; Spotnitz, WD; Tribble, CG; Kron, IL
MLA Citation
Langenburg, SE, Buchanan, SA, Blackbourne, LH, Scheri, RP, Sinclair, KN, Martinez, J, Spotnitz, WD, Tribble, CG, and Kron, IL. "Predicting survival after coronary revascularization for ischemic cardiomyopathy." Ann Thorac Surg 60.5 (November 1995): 1193-1196.
PMID
8526598
Source
pubmed
Published In
The Annals of Thoracic Surgery
Volume
60
Issue
5
Publish Date
1995
Start Page
1193
End Page
1196
DOI
10.1016/0003-4975(95)00755-A
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