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Association of perioperative transfusion with survival and recurrence after resection of gallbladder cancer: A 10‐institution study from the US Extrahepatic Biliary Malignancy Consortium 下载免费PDF全文
Alexandra G. Lopez‐Aguiar MD Cecilia G. Ethun MD Mia R. McInnis BA Timothy M. Pawlik MD MPH PhD George Poultsides MD Thuy Tran MD Kamran Idrees MD Chelsea A. Isom MD Ryan C. Fields MD Bradley A. Krasnick MD Sharon M. Weber MD Ahmed Salem MD Robert C. G. Martin MD Charles R. Scoggins MD Perry Shen MD Harveshp D. Mogal MD Carl Schmidt MD Eliza W. Beal MD Ioannis Hatzaras MD Rivfka Shenoy MD Kenneth Cardona MD Shishir K. Maithel MD 《Journal of surgical oncology》2018,117(8):1638-1647
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George A Poultsides Richard D Schulick Timothy M Pawlik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2010,12(1):43-49
An R0 margin width of 1 cm has traditionally been considered a prerequisite to minimize local recurrence and optimize survival following hepatic resection for metastatic colorectal cancer. However, recent data have called into question the prognostic importance of the ‘1-cm rule’. Specifically, several studies have noted that, although an R0 resection is important, the actual margin width may not be as critical. We provide a brief overview of the impact of an R1 vs. an R0 resection on local recurrence and overall survival. In addition, we specifically review the impact of margin width in patients who have undergone an R0 resection. Finally, we highlight those factors most associated with an increased likelihood of an R1 resection and provide recommendations for avoiding and dealing with microscopic carcinoma discovered intraoperatively at the cut parenchymal transection margin. 相似文献
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Alexandra?W.?Acher Malcolm?H.?Squires Ryan?C.?Fields George?A.?Poultsides Carl?Schmidt Konstantinos?I.?Votanopoulos Timothy?M.?Pawlik Linda?X.?Jin Aslam?Ejaz David?A.?Kooby Mark?Bloomston David?Worhunsky Edward?A.?Levine Neil?Saunders Emily?Winslow Clifford?S.?Cho Glen?Leverson Shishir?K.?Maithel Sharon?M.?WeberEmail author 《Journal of gastrointestinal surgery》2016,20(7):1284-1294
Background
This study utilized a multi-institutional database to evaluate risk factors for readmission in patients undergoing curative gastrectomy for gastric adenocarcinoma with the intent of describing both perioperative risk factors and the relationship of readmission to survival.Methods
Patients who underwent curative resection of gastric adenocarcinoma from 2000 to 2012 from seven academic institutions of the US Gastric Cancer Collaborative were analyzed. In-hospital deaths and palliative surgeries were excluded, and readmission was defined as within 30 days of discharge. Univariate and multivariable logistic regression analyses were employed and survival analysis conducted.Results
Of the 855 patients, 121 patients (14.2 %) were readmitted. Univariate analysis identified advanced age (p?<?0.0128), American Society of Anesthesiology status ≥3 (p?=?0.0045), preexisting cardiac disease (p?<?0.0001), hypertension (p?=?0.0142), history of smoking (p?=?0.0254), increased preoperative blood urea nitrogen (BUN; p?=?0.0426), concomitant pancreatectomy (p?=?0.0056), increased operation time (p?=?0.0384), estimated blood loss (p?=?0.0196), 25th percentile length of stay (<7 days, p?=?0.0166), 75th percentile length of stay (>12 days, p?=?0.0256), postoperative complication (p?<?0.0001), and total gastrectomy (p?=?0.0167) as risk factors for readmission. Multivariable analysis identified cardiac disease (odds ratio (OR) 2.4, 95 % confidence interval (CI) 1.6–3.3, p?<?0.0001), postoperative complication (OR 2.3, 95 % CI 1.6–5.4, p?<?0.0001), and pancreatectomy (OR 2.2, 95 % CI 1.1–4.1, p?=?0.0202) as independent risk factors for readmission. There was an association of decreased overall median survival in readmitted patients (39 months for readmitted vs. 103 months for non-readmitted). This was due to decreased survival in readmitted stage 1 (p?=?0.0039), while there was no difference in survival for other stages. Stage I readmitted patients had a higher incidence of cardiac disease than stage I non-readmitted patients (58 vs. 24 %, respectively, p?=?0.0002).Conclusions
Within this multi-institutional study investigating readmission in patients undergoing curative resection for gastric cancer, cardiac disease, postoperative complication, and concomitant pancreatectomy were identified as significant risk factors for readmission. Readmission was associated with decreased overall median survival, but on further analysis, this was driven by differences in survival for stage I disease only.5.
D. I. Tsilimigras D. Moris J. M. Hyer F. Bagante K. Sahara A. Moro A. Z. Paredes R. Mehta F. Ratti H. P. Marques S. Silva O. Soubrane V. Lam G. A. Poultsides I. Popescu S. Alexandrescu G. Martel A. Workneh A. Guglielmi T. Hugh L. Aldrighetti I. Endo K. Sasaki A. I. Rodarte F. N. Aucejo T. M. Pawlik 《The British journal of surgery》2020,107(7):854-864
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Charlotte M. Heidsma Diamantis I. Tsilimigras Susan van Dieren Flavio Rocha Daniel E. Abbott Ryan Fields Paula M. Smith George A. Poultsides Cliff Cho Mary Dillhoff Alexandra G. Lopez-Aguiar Zaheer Kanji Alexander Fisher Bradley A. Krasnick Kamran Idrees Eleftherios Makris Megan Beems Casper H.J. van Eijck Timothy M. Pawlik 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2021,23(3):413-421
BackgroundPancreatoduodenectomy (PD) or distal pancreatectomy (DP) are common procedures for patients with a pancreatic neuroendocrine tumor (pNET). Nevertheless, certain patients may benefit from a pancreas-preserving resection such as enucleation (EN). The aim of this study was to define the indications and differences in long-term outcomes among patients undergoing EN and PD/DP.MethodsPatients undergoing resection of a pNET between 1992 and 2016 were identified. Indications and outcomes were evaluated, and propensity score matching (PSM) analysis was performed to compare long-term outcomes between patients who underwent EN versus PD/DP.ResultsAmong 1034 patients, 143 (13.8%) underwent EN, 304 (29.4%) PD, and 587 (56.8%) DP. Indications for EN were small size (1.5 cm, IQR:1.0–1.9), functional tumors (58.0%) that were mainly insulinomas (51.7%). After PSM (n = 109 per group), incidence of postoperative pancreatic fistula (POPF) grade B/C was higher after EN (24.5%) compared with PD/DP (14.0%) (p = 0.049). Median recurrence-free survival (RFS) was comparable among patients who underwent EN (47 months, 95% CI:23–71) versus PD/DP (37 months, 95% CI: 33–47, p = 0.480).ConclusionComparable long-term outcomes were noted among patients who underwent EN versus PD/DP for pNET. The incidence of clinically significant POPF was higher after EN. 相似文献
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Amy Y. Li John R. Bergquist Auriel T. August Monica M. Dua George A. Poultsides Brendan C. Visser 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2021,23(1):56-62
BackgroundLaparoscopic fenestration has largely replaced open fenestration of liver cysts. However, most hepatectomies for polycystic liver disease (PCLD) are performed open. Outcomes data on laparoscopic hepatectomy for PCLD are lacking.MethodsPatients who underwent surgery for PCLD at a single institution between 2010 and 2019 were reviewed and grouped by operative approach. Pre- and post-operative volumes were calculated for patients who underwent resection. Primary outcomes were: volume reduction, re-admission and postoperative complications.ResultsTwenty-six patients were treated for PCLD: 13 laparoscopic fenestration, nine laparoscopic hepatectomy, three open hepatectomy and one liver transplantation. Median length of stay for patients after laparoscopic resection was 3 days (IQR 2–3). The only complication was post-operative atrial fibrillation in one patient. There were no readmissions. Overall volume reduction was 51% (range 22–69) for all resections, 32% (range 22–46) after open resection and 56% (range 39–69) after laparoscopic resection.ConclusionVolume reduction achieved through laparoscopic approach exceeded open volume reduction at this institution and is comparable to volume reduction in previously published open resection series. Adequate volume reduction can be accomplished by laparoscopic means with acceptable postoperative morbidity. 相似文献
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James R. Barrett MD Victoria Rendell MD Courtney Pokrzywa MD Alexandra G. Lopez-Aguiar MD John Cannon BA George A. Poultsides MD MS Flavio Rocha MD Angelena Crown MD Eliza Beal MD Timothy Michael Pawlik MD MPH PhD Ryan Fields MD Roheena Z. Panni MD MPHS Paula Smith MD Kamran Idrees MD Clifford Cho MD Megan Beems MD Shishir Maithel MD Sharon Weber MD Daniel Erik Abbott MD 《Journal of surgical oncology》2020,121(7):1067-1073