111 results on '"Larson, David W."'
Search Results
2. Effect of previous abdominal surgery on robotic-assisted rectal cancer surgery
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Ferrari, Davide, Violante, Tommaso, Bhatt, Himani, Gomaa, Ibrahim A., D’Angelo, Anne-Lise D., Mathis, Kellie L., and Larson, David W.
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The effect of previous abdominal surgery (PAS) in laparoscopic surgery is well known and significantly adds to longer hospital length of stay (LOS), postoperative ileus, and inadvertent enterotomies. However, little evidence exists in patients with PAS undergoing robotic-assisted (RA) rectal surgery.
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- 2024
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3. Evolution of laparoscopic ileal pouch-anal anastomosis: impact of enhanced recovery program, medication changes, and staged approaches on outcomes
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Violante, Tommaso, Ferrari, Davide, Gomaa, Ibrahim A., Rumer, Kristen K., D’Angelo, Anne-Lise D., Behm, Kevin T., Shawki, Sherief F., Perry, William R.G., Kelley, Scott R., Mathis, Kellie L., Dozois, Eric J., Cima, Robert R., and Larson, David W.
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Although laparoscopic Ileal pouch-anal anastomosis (IPAA) has become the gold standard in restorative proctocolectomy, surgical techniques have experienced minimal changes. In contrast, substantial shifts in perioperative care, marked by the enhanced recovery program (ERP), modifications in steroid use, and a shift to a 3-staged approach, have taken center stage.
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- 2024
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4. Robotic-assisted surgery conversion: the sooner, the better? Insights from a single-center study
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Violante, Tommaso, Ferrari, Davide, Mathis, Kellie L., D'Angelo, Anne-Lise D., Dozois, Eric J., Merchea, Amit, and Larson, David W.
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- 2024
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5. The death of laparoscopy
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Ferrari, Davide, Violante, Tommaso, Novelli, Marco, Starlinger, Patrick P., Smoot, Rory L., Reisenauer, Janani S., and Larson, David W.
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Background: The introduction of laparoscopy in 1989 revolutionized surgical practices, reducing post-operative complications, and enhancing outcomes. Despite its benefits, limitations in laparoscopic tools have led to continued use of open surgery. Robotic-assisted surgery emerged to address these limitations, but its adoption trends and potential impact on open and laparoscopic surgery require analysis. Methods: A retrospective analysis used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) databases from 2012 to 2021. The study encompassed various abdominal procedures, employing Vector Autoregressive (VAR) models to analyze the dynamic relationships between surgical techniques. The models predicted future trends in open, laparoscopic, and robotic surgery until Q2 of 2025. Results: The analysis included 360,171 patients across diverse procedures. In urology, robotic surgery dominated prostatectomies (83.1% in 2021) and nephrectomies (55.1% in 2021), while the open approach remained the predominant surgical technique for cystectomies (72.5% in 2021). In general surgery, robotic colectomies were forecasted to surpass laparoscopy, becoming the primary approach by 2024 (45.7% in 2025). Proctectomies also showed a shift towards robotic surgery, predicted to surpass laparoscopy and open surgery by 2025 (32.3%). Pancreatectomies witnessed a steady growth in robotic surgery, surpassing laparoscopy in 2021, with forecasts indicating further increase. While hepatectomies remained predominantly open (70.0% in 2025), esophagectomies saw a rise in robotic surgery, predicted to become the primary approach by 2025 (52.3%). Conclusions: The study suggests a transformative shift towards robotic-assisted surgery, poised to dominate various minimally invasive procedures. The forecasts indicate that robotic surgery may surpass laparoscopy and open surgery in colectomies, proctectomies, pancreatectomies, and esophagectomies by 2025. This anticipated change emphasizes the need for proactive adjustments in surgical training programs to align with evolving surgical practices. The findings have substantial implications for future healthcare practices, necessitating a balance between traditional laparoscopy and the burgeoning role of robotic-assisted surgery.
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- 2024
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6. Robotic Redo Ileocolonic Resection for Crohn’s Disease: A Preliminary Report From a Tertiary Care Center
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Abd El Aziz, Mohamed A., Abdalla, Solafah, Calini, Giacomo, Saeed, Hamadelneel, D’Angelo, Anne-Lise, Behm, Kevin T., Shawki, Sherief, Mathis, Kellie L., and Larson, David W.
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- 2023
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7. Open approach for ileocolic resection in Crohn’s disease in the era of minimally invasive surgery: indications and perioperative outcomes in a referral center
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Calini, Giacomo, Abdalla, Solafah, Abd El Aziz, Mohamed A., Benammi, Sarah, Merchea, Amit, Behm, Kevin T., Mathis, Kellie L., and Larson, David W.
- Abstract
Minimally invasive surgery (MIS) is the first-line approach for ileocolic resection in Crohn’s disease (CD), and it is safe and feasible, even with severe penetrating CD or redo surgery. While MIS indications are continually broadening, challenging CD cases might still require an open approach. This study aimed to report rate and indications for an upfront open approach in ileocolic resection for CD. Comprehensive perioperative data for all consecutive patients undergoing ileocolic resection for CD between 2014 and 2021 in a high-volume referral center for CD and MIS, were collected retrospectively. Indications for an upfront open approach were reviewed separately by two authors according to the preoperative visit. Among 319 ileocolic resections for CD, 45 (14%) were open and 274 (86%) MIS. Two or more of the below indications were present in 40 patients (89%) in the open group, while only in 6 patients (2%) in the MIS group (p< 0.0001). Indications for upfront open approach were severe penetrating disease (58%), adhesions at previous surgery (47%), history of abdominal sepsis (33%), multifocal and extensive disease (24%), abdominal wall involvement (22%), concomitant open procedures (9%), small bowel dilatation (9%), and anesthesiologic contraindications (4%). MIS was never performed in a patient with abdominal wall involvement, concomitant open procedure, and anesthesiologic contraindication to MIS. This study can help guide patients, physicians, and surgeons. An abdominal wall involvement or the presence of two of the above indications predicts a high surgical complexity and may be considered as a no-go for the MIS approach. These criteria should prompt surgeons to strongly consider an upfront open approach to optimize the perioperative planning and care of these complex patients.
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- 2023
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8. Challenging surgical dogma: are routine postoperative day 1 laboratory tests necessary after bariatric operations?
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McKenna, Nicholas P., Glasgow, Amy E., Shariq, Omair A., Larson, David W., Ghanem, Omar M., McKenzie, Travis J., and Habermann, Elizabeth B.
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Postoperative day (POD) 1 laboratory tests are routinely ordered after bariatric operations. Determine how often these laboratory tests are abnormal and whether they represent value-added care. Academic medical center, United States. Patients undergoing bariatric operations for obesity and complications from prior bariatric surgery from 1 January 2011 to 12 December 2020 at a single institution were identified. Patients with POD 1 hemoglobin, potassium, creatinine, or glucose serum laboratory tests obtained before 08:00 on POD 1 were reviewed. Laboratory-specific exclusion criteria were applied. Abnormal laboratory test results were a hemoglobin < 8.0 g/dL or a hemoglobin drop of > 3.0 g/dL; a potassium < 3.5 mmol/L (hypokalemia), 5.5–5.9 mmol/L (mild hyperkalemia), or ≥ 6.0 mmol/L (severe hyperkalemia); a creatinine increase of 0.3 g/dL or 1.5X the preoperative value (acute kidney injury); and a glucose > 180 mg/dL (hyperglycemia). Intervention for abnormal hemoglobin, potassium, and glucose was also assessed. Of 2090 patients who underwent bariatric operations, 1969 met inclusion criteria for hemoglobin analysis, 1223 for potassium analysis, 1446 for creatinine analysis, and 563 for glucose analysis. Only 0.2% (n = 4) of patients had a hemoglobin < 8.0 g/dL< and only 3.1% (n = 62) had a > 3.0 g/dL hemoglobin drop. Potassium was abnormal in 2.8% of patients (n = 34 total). An acute kidney injury was diagnosed in 1.8% (n = 26) of patients. Hyperglycemia was identified in 2.1% (n = 12) of patients. Of 5227 laboratory test values, only 1.5% were abnormal. Further, of laboratory tests analyzed for intervention (n = 3781), only 14 (0.4%) were actively acted upon. Routine POD 1 laboratory tests after bariatric operations seem to be a continuation of a surgical tradition rather than a clinically valuable tool. POD 1 laboratory tests should be ordered based on specific patient co-morbidities and clinical criteria. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2022
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9. Perioperative outcomes of minimally invasive ileocolic resection for complicated Crohn disease: Results from a referral center retrospective cohort.
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Abdalla, Solafah, Abd El Aziz, Mohamed A., Calini, Giacomo, Saeed, Hamedelneel, Merchea, Amit, Shawki, Sherief, Behm, Kevin T., and Larson, David W.
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Minimally invasive ileocolic resection for complicated Crohn disease, defined as penetrating Crohn disease associated with intra-abdominal fistula, abscess, or phlegmon, is challenging. In addition, the impact of the minimally invasive approach on postoperative outcomes is still debated. This study aimed to compare the intraoperative and postoperative outcomes of minimally invasive ileocolic resection for complicated versus uncomplicated Crohn disease. A retrospective analysis of all consecutive adult patients with Crohn disease undergoing minimally invasive ileocolic resection from 2014 to 2021 was performed. Perioperative outcomes were compared between patients with complicated Crohn disease (complicated group) and patients without these lesions (uncomplicated group). Among the 274 patients undergoing minimally invasive ileocolic resection for Crohn disease, 101 (36.9%) had a robotic approach, and 84 (30.7%) had complicated Crohn disease. Complicated patients were more frequently malnourished (32.1% vs 16.1%, P =.004) and had more frequent previous bowel resections for Crohn disease (22.1% vs 9.5%, P =.002). There were no differences between both groups regarding intraoperative complications (1.1% uncomplicated group vs 2.4% complicated group, P =.463), conversion rate (2.6% uncomplicated group vs 4.8% complicated group, P =.463), postoperative morbidity (27.4% uncomplicated group vs 34.5% complicated group, P =.231), intra-abdominal septic complications (4.2% uncomplicated group vs 7.1% complicated group, P =.309), and length of stay (3.8 ± 2.0 days uncomplicated group vs 4.2 ± 3.0 complicated group, P =.188). Minimally invasive ileocolic resection for complicated Crohn disease is safe and feasible. Future prospective studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]
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- 2022
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10. Postoperative Safety Profile of Minimally Invasive Ileocolonic Resections for Crohn's Disease in the Era of Biologic Therapy.
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Aziz, Mohamed A Abd El, Abdalla, Solafah, Calini, Giacomo, Saeed, Hamadelneel, Stocchi, Luca, Merchea, Amit, Colibaseanu, Dorin T, Shawki, Sherief, and Larson, David W
- Abstract
Background There is controversy regarding the postoperative outcomes in Crohn's disease [CD] patients exposed to vedolizumab [VDZ] or ustekinumab [UST]. We aimed to describe our surgical outcomes in patients who underwent minimally invasive ileocolonic resection [MIS-ICR] for CD who had preoperative biologic therapy. Methods All consecutive adult patients who had MIS-ICR for CD between 2014 and 2021 at our institution were included. Patients were divided into four groups: VDZ, UST, anti-tumour necrosis factor [anti-TNF], and no biologic group. Timing between the last dose of biologics and surgery was per surgeon's discretion. The primary outcome was intra-abdominal septic complications. Secondary outcomes included all 30-day complications. Results A total of 274 patients were identified. Of these, 113 [41.2%] patients had received anti-TNF, 52 [19%] had received UST, and 19 [7%] had received VDZ. There was no difference between the four groups regarding baseline risk factors. There was no difference between the four groups regarding intra-abdominal septic complications [4.4% for no biologic, 5.3% for anti-TNF, 5.8% for UST, and 5.3% for VDZ; p = 0.987], surgical site infection rate, overall 30-day morbidity, overall 30-day readmission, overall surgical and medical complications, urinary tract infection, pulmonary infections, or length of stay. Those results were consistent after a subgroup analysis based on complexity of the disease. Conclusions This retrospective analysis demonstrates an equivalent postoperative safety profile for patients treated with preoperative anti-TNF, VDZ, or UST versus no biologic therapy within 3 months of MIS-ICR for Crohn's disease. Preoperative biologic therapy may not increase complications after minimally invasive ileocolonic resection in Crohn's disease. Further studies with larger sample sizes are needed to confirm results. [ABSTRACT FROM AUTHOR]
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- 2022
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11. Intraoperative Fluid Management a Modifiable Risk Factor for Surgical Quality – Improving Standardized Practice.
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Abd El Aziz, Mohamed A., Grass, Fabian, Calini, Giacomo, Lovely, Jenna K., Jacob, Adam K., Behm, Kevin T., D'Angelo, Anne-Lise D., Shawki, Sherief F., Mathis, Kellie L., and Larson, David W.
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Objective: We aimed to determine a safe zone of intraoperative fluid management associated with the lowest postoperative complication rates without increased acute kidney injury (AKi) risk for elective colorectal surgery patients. Background: To date, standard practice within institutions, let alone national expectations related to fluid administration, are limited. This fact has perpetuated a quality gap. Methods: Elective colorectal surgeries between 2018 and 2020 were included. Unadjusted odds ratios (ORs) for postoperative ileus, prolonged LOS, and AKi were plotted against the rate of intraoperative RL infusion (mL/ kg/h) and total intraoperative volume. Binary logistic regression analysis, including fluid volumes as a confounder, was used to identify risk factors for postoperative complications. Results: A total of 2900 patients were identified. Of them, 503 (17.3%) patients had ileus, 772 (26.6%) patients had prolonged LOS, and 240 (8.3%) patients had AKI. The intraoperative fluid resuscitation rate (mg/kg/h) was less impactful on postoperative ileus, LOS, and AKI than the total amount of intraoperative fluid. A total fluid administration range between 300 mL and 2.7 L was associated with the lowest complication rate. Total intraoperative RL ≥2.7 L was independently associated with a higher risk of ileus (adjusted OR 1.465; 95% confidence interval 1.154–1.858) and prolonged LOS (adjusted OR 1.300; 95% confidence interval 1.047–1.613), but not AKI. Intraoperative RL ≤300 mL was not associated with an increased risk of AKI. Conclusion: Total intraoperative RL ≥2.7 L was independently associated with postoperative ileus and prolonged LOS in elective colorectal surgery patients. A new potential standard for intraoperative fluids will require anesthesia case planning (complexity and duration) to ensure total fluid volume meets this new opportunity to improve care. [ABSTRACT FROM AUTHOR]
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- 2022
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12. Re-resection of Microscopically Positive Margins Found on Intraoperative Frozen Section Analysis Does Not Result in a Survival Benefit in Patients Undergoing Surgery and Intraoperative Radiation Therapy for Locally Recurrent Rectal Cancer
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Ansell, James, Perry, William R.G., Mathis, Kellie L., Grass, Fabian, Yonkus, Jennifer A., Hallemeier, Christopher L., Haddock, Michael G., Graham, Rondell P., Merchea, Amit, Colibaseanu, Dorin T., Mishra, Nitin, Kelley, Scott R., Larson, David W., and Dozois, Eric J.
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- 2022
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13. Oral Antibiotics Bowel Preparation Without Mechanical Preparation for Minimally Invasive Colorectal Surgeries: Current Practice and Future Prospects
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Abd El Aziz, Mohamed A., Grass, Fabian, Calini, Giacomo, Behm, Kevin T., D’Angelo, Anne-Lise, Kelley, Scott R., Mathis, Kellie L., and Larson, David W.
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- 2022
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14. Emergent and Urgent Surgery for Ulcerative Colitis in the United States in the Minimally Invasive and Biologic Era
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Abd El Aziz, Mohamed A., Larson, David W., Grass, Fabian, D’Angelo, Anne-Lise D., Kelley, Scott R., Raffals, Laura E., Mathis, Kellie L., and Shawki, Sherief
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- 2022
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15. Development and validation of a prediction score for safe outpatient colorectal resections.
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Grass, Fabian, Hübner, Martin, Behm, Kevin T., Mathis, Kellie L., Hahnloser, Dieter, Day, Courtney N., Harmsen, William S., Demartines, Nicolas, and Larson, David W.
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Avoiding unnecessary inpatient stay may decrease hospital-acquired complications and costs while increasing patient satisfaction. This study aimed to develop and validate a score to identify patients eligible for safe same-day discharge after colorectal resections. This bi-institutional retrospective cohort study included consecutive patients undergoing elective colon and rectal resections (2011–2018) for benign and malignant indications. Two multivariable logistic models were developed based on demographic and surgical risk factors to predict a combined endpoint (ileus, anastomotic leak, intra-abdominal abscess, and readmission). Development and validation datasets were randomly sampled from the entire cohort. Areas under the receiver operating characteristic curves (AUC) were evaluated, and Hosmer-Lemeshow goodness-of-fit tests were used to assess validation model fit. Of 5,389 patients, 1,182 (21.9%) experienced at least one complication of the combined endpoint. Male gender, open surgery, ASA ≥3, wound class ≥3, ileostomy, surgical duration >3 hours, and perioperative IV fluids >3 L all had significantly greater odds of the combined endpoint in the parsimonious multivariable model (all P <.05). The reduced model considering only the 4 variables with the highest OR (>1.5) contained open surgery, ASA ≥3, wound class ≥3, and surgical duration ≥3 hours as predictors (all P <.05, AUC of 0.65; 95% CI 0.63, 0.68). Both the parsimonious model and the reduced model demonstrated no lack of fit in the validation cohort. The suggested score composed of preand intraoperative items may help physicians decide on patients' same-day discharge after colorectal resection. [ABSTRACT FROM AUTHOR]
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- 2022
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16. Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach: Results From a Large Retrospective Cohort.
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Crippa, Jacopo, Grass, Fabian, Dozois, Eric J., Mathis, Kellie L., Merchea, Amit, Colibaseanu, Dorin T., Kelley, Scott R., and Larson, David W.
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Objective: To compare short term outcomes of patients undergoing laparoscopic or robotic rectal cancer surgery. Background: Significant benefits of robotic rectal cancer surgery over laparoscopy have yet to be demonstrated. Operative time and direct institutional cost seem in favor of the laparoscopic approach. Methods: We performed a retrospective review of consecutive patients operated on for rectal cancer with a mini-invasive approach at Mayo Clinic from 2005 to 2018. The primary aim of this study was to investigate the difference in postoperative morbidity between the laparoscopic and robotic approach. Multivariable models for odds to complications and prolonged (≥6 days) length of stay were built. Results: A total of 600 patients were included in the analysis. The number of patients undergoing robotic surgery was 317 (52.8%). The 2 groups were similar in respect to age, sex, and body mass index. Laparoscopic surgery was correlated to shorter operative time (214 vs 324 minutes; P < 0.001). Patients undergoing robotic surgery had a lower overall complications rate (37.2% vs 51.2%; P < 0.001). Robotic surgery was found to be the most protective factor [odds ratio (OR) 0.485; P = 0.006] for odds to complications. The event of a complication (OR 9.33; P < 0.001) and conversion to open surgery (OR 3.095; P = 0.002) were identified as risk factors for prolonged length of stay whereas robotic surgery (OR 0.62; P = 0.027) was the only independent protective factor. Conclusions: Robotic rectal cancer surgery is strongly associated with better short-term outcomes over laparoscopic surgery. [ABSTRACT FROM AUTHOR]
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- 2021
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17. Intraoperative Fluid Management a Modifiable Risk Factor for Surgical Quality – Improving Standardized Practice
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Abd El Aziz, Mohamed A., Grass, Fabian, Calini, Giacomo, Lovely, Jenna K., Jacob, Adam K., Behm, Kevin T., D’Angelo, Anne-Lise D., Shawki, Sherief F., Mathis, Kellie L., and Larson, David W.
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- 2022
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18. Patient colon and rectal operative outcomes when treated with immune checkpoint inhibitors.
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Calini, Giacomo, Abd El Aziz, Mohamed A., Abdalla, Solafah, Saeed, Hamedelneel A., Lovely, Jenna K., D'Angelo, Anne-Lise D., Behm, Kevin T., Colibaseanu, Dorin T., Mathis, Kellie L., and Larson, David W.
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IMMUNE checkpoint inhibitors ,ELECTIVE surgery ,ONCOLOGIC surgery ,PROCTOLOGY ,TREATMENT effectiveness ,COLON (Anatomy) ,SEPTIC shock - Abstract
There is limited data about the safety of colorectal surgery after immune checkpoint inhibitors (ICI). We aimed to share our experience about postoperative outcomes of colorectal surgery for patients treated with ICI. Overall, 31 patients were identified, 22 (71%) underwent elective and nine (29%) underwent emergent/urgent surgery. The 30-day Clavien Dindo class ≥ III complication rates were 27.3% (n = 6) for elective and 55.5% (n = 5) for emergent/urgent cases. Four patients underwent emergency surgery for immune-related colonic perforation and developed postoperative septic shock; two died. Considering patients' comorbidities, cancer stage, and surgical complexity, elective colorectal surgery after ICI seems relatively safe. However, emergent/urgent colorectal surgery was associated with high postoperative morbidity. Indeed, colonic perforation in the setting of ICI treatment has a significant risk of postoperative mortality. Therefore, for patients on ICI with any acute abdominal symptoms, surgical consult should be involved, and colon perforation should be ruled out. [ABSTRACT FROM AUTHOR]
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- 2021
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19. Trends and consequences of surgical conversion in the United States
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Abd El Aziz, Mohamed A., Grass, Fabian, Behm, Kevin T., D’Angelo, Anne-Lise, Mathis, Kellie L., Dozois, Eric J., and Larson, David W.
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Background: The aim of this study was to identify national utilization trends of robotic surgery for elective colectomy, conversion rates over time, and the specific impact of conversion on postoperative morbidity. Conversion to open represents a hard endpoint for minimally invasive surgery (MIS) and is associated with worse outcomes when compared to MIS or even traditional open procedures. Methods: All adult patients who underwent either laparoscopic or robotic elective colectomy from 2013 to 2018 as reported in the American College of Surgeons Quality Improvement Program (ACS-NSQIP) database were included. National trends of both robotic utilization and conversion rates were analyzed, overall and according to underlying disease (benign disease, inflammatory bowel disease (IBD), cancer), or the presence of obesity (body mass index (BMI) ≥ 30 kg/m
2 ). Demographic and surgical risk factors for surgical conversion to open were identified through multivariable regression analysis. Further assessed were overall and specific postoperative 30-day complications, which were risk adjusted and compared between converted patients and the remaining cohort. Results: Of 66,652 included procedures, 5353 (8.0%) were converted to open. Conversion rates were 8.5% for laparoscopic and 4.9% for robotic surgery (p< 0.0001). A decline in conversion rates over the 6-year inclusion period was observed overall and for patients with obesity. This trend paralleled an increased utilization of the robotic platform. Several surrogates for advanced disease stages for cancer, diverticulitis, and IBD and prolonged surgical duration were identified as independent risk factors for unplanned conversion, while robotic approach was an independent protective factor (OR 0.44, p< 0.0001). Patients who had unplanned conversion were more likely to experience postoperative complications (OR 2.36; 95% CI [2.21–2.51]), length of hospital stay ≥ 6 days (OR 2.86; 95% CI [2.67–3.05], and 30-day mortality (OR 2.28; 95% CI [1.72–3.02]). Conclusion: This nationwide study identified a decreasing trend in conversion rates over the 6-year inclusion period, both overall and in patients with obesity, paralleling increased utilization of the robotic platform. Unplanned conversion to open was associated with a higher risk of postoperative complications.- Published
- 2022
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20. Robotic Surgery for Rectal Cancer Provides Advantageous Outcomes Over Laparoscopic Approach
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Crippa, Jacopo, Grass, Fabian, Dozois, Eric J., Mathis, Kellie L., Merchea, Amit, Colibaseanu, Dorin T., Kelley, Scott R., and Larson, David W.
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- 2021
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21. Completely intracorporeal anastomosis in robotic left colonic and rectal surgery: technique and 30-day outcomes
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Achilli, Pietro, Perry, William, Grass, Fabian, Abd El Aziz, Mohamed A., Kelley, Scott R., Larson, David W., and Behm, Kevin T.
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As robotic surgery continues to disseminate into the field of colon and rectal surgery, there is a growing interest in the utilization of intracorporeal anastomosis to potentially improve surgical outcomes. The purpoe of this study was to compare feasibility, safety, and short-term outcomes of robotic sigmoid and low anterior resections performed with completely intracorporeal anastomosis (CICA) technique to the traditional extracorporeal assisted anastomosis (ECAA) technique. Consecutive series of patients who underwent elective robotic sigmoid or low anterior resections for benign or malignant disease utilizes either CICA or ECAA between August 2017 and November 2019. Surgical complications were assessed until 30 postoperative days and compared between the two groups. A total of 160 patients were identified; 73 (45.6%) in the CICA group and 87 (54.4%) in the ECAA group. Most of the procedures were performed for malignancy (76%). Estimated blood loss was lower in the CICA group (80.7 mL vs. 110.2 mL; p= 0.048), while operative times were longer (5.9 ± SD hours vs. 4.9 ± SD hours; p= < 0.001). Overall conversion rate was 1.9%, with no conversions in the CICA group. Overall complications occurred in 54 patients (33.8%) with 13 (8.3%) representing major complications. There were no significant differences in 30 day outcomes between the two groups. This study demonstrates the feasibility and safety of robotic sigmoid and low anterior resections with CICA. Outcomes for robotic sigmoid and low anterior resections are encouraging regardless of anastomotic technique (CICA vs ECAA).
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- 2021
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22. Preoperative predictive risk to cancer quality in robotic rectal cancer surgery.
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Achilli, Pietro, Radtke, Tyler S., Lovely, Jenna K., Behm, Kevin T., Mathis, Kellie L., Kelley, Scott R., Merchea, Amit, Colibaseanu, Dorin T., and Larson, David W.
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RECTAL surgery ,ABDOMINOPERINEAL resection ,ONCOLOGIC surgery ,RECTAL cancer ,MAGNETIC resonance imaging ,ROBOTICS ,UNIVARIATE analysis - Abstract
Circumferential resection margin (CRM) involvement is widely considered the strongest predictor of local recurrence after TME. This study aimed to determine preoperative factors associated with a higher risk of pathological CRM involvement in robotic rectal cancer surgery. This was a retrospective review of a prospectively maintained database of consecutive adult patients who underwent elective, curative robotic low anterior or abdominoperineal resection with curative intent for primary rectal adenocarcinoma in a tertiary referral cancer center from March 2012 to September 2019. Pretreatment magnetic resonance imaging (MRI) reports were reviewed for all the patients. Risk factors for pathological CRM involvement were investigated using Firth's logistic regression and a predictive model based on preoperative radiological features was formulated. A total of 305 patients were included, and 14 (4.6%) had CRM involvement. Multivariable logistic regression found both T3 >5 mm (OR 6.12, CI 1.35–36.44) and threatened or involved mesorectal fascia (OR 4.54, CI 1.33–17.55) on baseline MRI to be preoperative predictors of pathologic CRM positivity, while anterior location (OR 3.44, CI 0.72–33.13) was significant only on univariate analysis. The predictive model showed good discrimination (area under the receiver-operating characteristic curve >0.80) and predicted a 32% risk of positive CRM if all risk factors were present. Patients with pre-operatively assessed threatened radiological margin, T3 tumors with greater than 5 mm extension and anterior location are at risk for a positive CRM. The predictive model can preoperatively estimate the CRM positivity risk for each patient, allowing surgeons to tailor management to improve oncological outcomes. [ABSTRACT FROM AUTHOR]
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- 2021
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23. Colectomy for patients with super obesity: current practice and surgical morbidity in the United States.
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Abd El Aziz, Mohamed A., Grass, Fabian, Perry, William, Behm, Kevin T., Shawki, Sherief F., Larson, David W., and Mathis, Kellie L.
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While minimally invasive surgery contributed to improved outcomes in bariatric surgery, less is known about current utilization trends and outcomes related to surgical technique for colorectal resections in super-obese patients (body mass index ≥50 kg/m
2 ). The aim of this study was to compare surgical modalities and short-term outcomes of patients with super obesity who underwent elective colectomy in the United States. A retrospective review was performed of patients with super obesity who underwent elective colectomy between 2012 to 2018 using the American College of Surgeons National Quality Improvement Program data pool. Patients were categorized into an open, laparoscopic, or robotic group. Baseline characteristics and perioperative outcomes including 30-day complications and length of stay were compared between the 3 groups. Furthermore, utilization trends of surgical modalities were assessed. Of 1199 patients, 338 (28.2%) had open, 735 (61.3%) laparoscopic, and 126 (10.5%) robotic colectomy during the study period, primarily for colon cancer (50.8%). Patients in the open group tended to have more baseline co-morbidities. Laparoscopic approach showed better risk-adjusted outcomes compared with open for postoperative ileus (adjusted odds ratio [aOR]:.6, 95% confidence interval [CI;.383–.965]), overall medical complications (aOR:.4, 95%CI [.3–.8]), and length of stay (OR.6, 95% CI [.394–.968]). Trend utilization showed increasing utilization of the robotic platform over the study period, which was associated with less unplanned conversion to open (aOR.417, 95%CI [.199–.872]). Laparoscopic colectomy provides advantageous outcomes over open surgery for colectomy in super-obese patients. The robotic platform has been increasingly used over time, and potential benefits need to be further studied. [ABSTRACT FROM AUTHOR]- Published
- 2020
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24. Challenges to accomplish stringent fluid management standards 7 years after enhanced recovery after surgery implementation—The surgeon's perspective.
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Grass, Fabian, Hübner, Martin, Mathis, Kellie L., Hahnloser, Dieter, Dozois, Eric J., Kelley, Scott R., Demartines, Nicolas, and Larson, David W.
- Abstract
This study aimed to analyze fluid management standards in 2 high-volume, enhanced recovery after surgery institutions 7 years after implementation. Retrospective analysis of consecutive patients undergoing elective, segmental colonic and extensive colorectal resections for benign and malignant pathology (2011–2017). Administration and composition of intravenous fluids, postoperative weight gain, and factors impeding compliance to preidentified fluid thresholds (3L fluid administration, 2.5 kg weight gain) were assessed. Multivariable logistic regression was performed to identify risk factors for postoperative adverse events. A total of 5,155 patients were included. Among them, 2,320 patients (45.1%) received >3 L intravenous fluids at postoperative day 0. Fluid totals remained unchanged over the 7-year observation period. Fluid overload was independently associated with postoperative weight gain ≥2.5 kg at postoperative day 2 (odds ratio 1.34, P <.001). Patients with high American Society of Anesthesiologists score (≥3) undergoing open and longer (≥180 minutes) procedures were more likely to exceed both thresholds according to multivariable analysis (all P <.001). Other than open surgery, American Society of Anesthesiologists score ≥3, contamination class ≥3, and malignancy, both thresholds (≥3 L: odds ratio 1.76, 95% confidence interval 1.44–2.15, ≥ 2.5 kg: odds ratio 1.62, 95% confidence interval 1.33–1.97) were independent risk factors for postoperative adverse outcomes (occurring in 28.1% of patients). Compliance with fluid thresholds appears to be challenging in patients with comorbidities undergoing open and long procedures. Efforts are encouraged because both thresholds are linked to adverse outcomes and appear to be potentially modifiable in selected patients. [ABSTRACT FROM AUTHOR]
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- 2020
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25. NASA-Task Load Index Differentiates Surgical Approach: Opportunities for Improvement in Colon and Rectal Surgery.
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Law, Katherine E., Lowndes, Bethany R., Kelley, Scott R., Blocker, Renaldo C., Larson, David W., Hallbeck, M. Susan, and Nelson, Heidi
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Objective: Surgeon workload, or human ''cost'' of performing a procedure, is not well understood in light of emerging surgical technologies. This pilot study quantified surgeon workload for colorectal procedures and identified patient, surgeon, and procedural factors impacting workload. Summary Background Data: Innovative technologies and procedures in surgery have generally been promoted for the advancement of patient care. The resulting surgeon workload is poorly studied with little knowledge of the contributing factors impacting workload. Methods: Surgeons completed NASA-Task Load Index (NASA-TLX) questionnaires to self-assess workload following abdominopelvic colon and rectal procedures. Corresponding patient data were retrieved from the medical record. Descriptive statistics, correlations, and ANOVA were performed to compare surgeon and patient factors, procedure type, and surgical approach on workload overall and by subscales. Results: Seven attending surgeons rated 238 surgeries, of which 218 (92%) had corresponding patient data. Surgeon experience and patient demographics had inconsistent effects on workload. A statistically significant 3-way interaction was identified among disease process, procedure type, and surgical approach on workload (F(9, 146) = 2.17, P = 0.027), but was limited to open procedures for neoplasia and inflammatory bowel disease patients. Proctectomy and colectomy procedures compared across open, laparoscopic, and robotic approaches showed significant differences in overall workload and subscales, where the robotic procedures required significantly less mental demand, physical demand, and effort, than open or laparoscopic (P < 0.05). Conclusions: Patient characteristics, disease process, and surgical experience had inconsistent effects on surgeon workload. Major differences in workload were identified for procedure type and surgical approach, where robotic procedures required less mental demand, physical demand, and effort. [ABSTRACT FROM AUTHOR]
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- 2020
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26. Impact of delay to surgery on survival in stage I-III colon cancer.
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Grass, Fabian, Behm, Kevin T., Duchalais, Emilie, Crippa, Jacopo, Spears, Grant M., Harmsen, William S., Hübner, Martin, Mathis, Kellie L., Kelley, Scott R., Pemberton, John H., Dozois, Eric J., and Larson, David W.
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COLON cancer ,TUMOR classification ,TREATMENT delay (Medicine) ,ELECTIVE surgery ,COMORBIDITY ,SURGICAL diagnosis - Abstract
To assess the impact of delay from diagnosis to curative surgery on survival in patients with non-metastatic colon cancer. National Cancer database (NCDB) analysis (2004–2013) including all consecutive patients diagnosed with stage I-III colon cancer and treated with primary elective curative surgery. Short and long delays were defined as lower and upper quartiles of time from diagnosis to treatment, respectively. Age-, sex-, race-, tumor stage and location-, adjuvant treatment-, comorbidity- and socioeconomic factors-adjusted overall survival (OS) was compared between the two groups (short vs. long delay). A multivariable Cox regression model was used to identify the independent impact of each factor on OS. Time to treatment was <16 days in the short delay group (31,171 patients) and ≥37 days in the long delay group (29,617 patients). OS was 75.4 vs. 71.9% at 5 years and 56.6 vs. 49.7% at 10 years in short and long delay groups, respectively (both p < 0.0001). Besides demographic (comorbidities, advanced age) and pathological factors (transverse and right-vs. left-sided location, advanced tumor stage, poor differentiation, positive microscopic margins), treatment delay had a significant impact on OS (HR 1.06, 95% CI 1.05–1.07 per 14 day-delay) upon multivariable analysis. The adjusted hazard ratio for death increased continuously with delay times of longer than 30 days, to become significant after a delay of 40 days. This analysis using a national cancer database revealed a significant impact on OS when surgeries for resectable colon cancer were delayed beyond 40 days from time of diagnosis. [ABSTRACT FROM AUTHOR]
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- 2020
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27. Clinical–Pathologic Characteristics and Long-term Outcomes of Left Flexure Colonic Cancer: A Retrospective Analysis of an International Multicenter Cohort
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Pedrazzani, Corrado, Turri, Giulia, Park, Soo Yeun, Hida, Koya, Fukui, Yudai, Crippa, Jacopo, Ferrari, Giovanni, Origi, Matteo, Spolverato, Gaya, Zuin, Matteo, Bae, Sung Uk, Baek, Seong Kyu, Costanzi, Andrea, Maggioni, Dario, Son, Gyung Mo, Scala, Andrea, Rockall, Timothy, Guglielmi, Alfredo, Choi, Gyu Seog, and Larson, David W.
- Abstract
Supplemental Digital Content is available in the text.
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- 2020
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28. Is Same-Day and Next-Day Discharge After Laparoscopic Colectomy Reasonable in Select Patients?
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McKenna, Nicholas P., Bews, Katherine A., Shariq, Omair A., Habermann, Elizabeth B., Behm, Kevin T., Kelley, Scott R., and Larson, David W.
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- 2020
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29. Readmissions Within 48 Hours of Discharge: Reasons, Risk Factors, and Potential Improvements
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Grass, Fabian, Crippa, Jacopo, Lovely, Jenna K., Ansell, James, Behm, Kevin T., Achilli, Pietro, Hübner, Martin, Kelley, Scott R., Mathis, Kellie L., Dozois, Eric J., and Larson, David W.
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- 2020
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30. Long-term Oncological Outcomes Following Anastomotic Leak in Rectal Cancer Surgery
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Crippa, Jacopo, Duchalais, Emilie, Machairas, Nikolaos, Merchea, Amit, Kelley, Scott R., and Larson, David W.
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- 2020
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31. Potential Association Between Perioperative Fluid Management and Occurrence of Postoperative Ileus
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Grass, Fabian, Lovely, Jenna K., Crippa, Jacopo, Hübner, Martin, Mathis, Kellie L., and Larson, David W.
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- 2020
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32. Feasibility and safety of robotic resection of complicated diverticular disease
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Grass, Fabian, Crippa, Jacopo, Mathis, Kellie L., Kelley, Scott R., and Larson, David W.
- Abstract
This study aimed to assess intra- and postoperative outcomes of robotic resection of left-sided complicated diverticular disease. Retrospective analysis of a prospectively maintained institutional database on consecutive patients undergoing elective robotic resection for diverticular disease (2014–2018). All procedures were performed within an enhanced recovery pathway (ERP). Demographic, surgical and ERP-related items were compared between patients with simple and complicated diverticular disease according to intra-operative presentation. Postoperative complications and length of stay were compared between the two groups. Out of 150 patients, 78 (52%) presented with complicated and the remaining 72 (48%) with uncomplicated disease. Both groups were comparable regarding demographic baseline characteristics and overall ERP compliance. Surgery for complicated disease was longer (288 ± 96 vs. 258 ± 72 min, p= 0.04) and more contaminated (≥ class 3: 57.7 vs. 23.6%, p< 0.001) with a trend to higher conversion rates (10.3 vs. 2.8%, p= 0.1). While postoperative overall complications tended to occur more often after resections for complicated disease (28.2 vs. 15.3%, p= 0.075), major, surgical and medical complications did not differ between the two groups, and median length of stay was 3 days in both settings (p= 0.19). Robotic resection of diverticular disease was feasible and safe regardless of disease presentation by the time of surgery.
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- 2019
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33. The Practice of Overlapping Colorectal Operations in a Tertiary Care Center Is Safe: A Model for Advancing Team-based Care.
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Shogan, Benjamin D., Harmsen, William S., Dozois, Eric J., Nelson, Heidi, and Larson, David W.
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Objective: Determine the safety of overlapping surgery in a tertiary care colorectal surgery practice. Summary: Although overlapping surgery is common in academic centers, reports on outcomes of this practice are limited. The primary aim of this study was to investigate the safety of overlapping surgery in a dedicated tertiary care academic colorectal practice by comparing groups of patients who did or did not have their surgery performed in an overlapping fashion. Methods: Retrospective review of 1270 colorectal patients undergoing inpatient colorectal surgery at our institution. Eligible participants were all patients undergoing elective inpatient colorectal surgery by one of the colorectal surgeons at the Mayo Clinic Rochester between January 1, 2012 and December 31, 2015. Patients under the age of 18 or who underwent an emergent procedure were excluded. Data were abstracted using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database. Additionally, each subject's chart was reviewed and further abstracted. The safety of overlapping surgery on outcomes was assessed using multiple multivariable models. Results: One thousand two hundred seventy patients were included in the study cohort of whom 50.7% were female and the average age was 55.4 years. Overlapping surgery occurred in 576 patients (45%). There were no significant differences in demographic, surgical indications, procedures, or operative complexity between patients undergoing overlapping surgery and those who did not. Overall adverse events were significantly less likely in patients undergoing overlapping surgery compared with those who did not (18.4% vs 23.6%, P = 0.02). We found that overlapping surgery was associated with significantly less adverse events compared with patients not undergoing overlapping surgery using a model that controlled for the effect of the individual surgeon (OR 0.7, 95% CI 0.6 – 0.96; P = .02) and a multivariable propensity score (OR 0.7, 95% CI 0.5– 0.9; P = 01). Conclusions: Overlapping surgery in a tertiary care colorectal practice is safe and not associated with adverse patient outcomes. [ABSTRACT FROM AUTHOR]
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- 2019
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34. Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial.
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Fleshman, James, Branda, Megan E., Sargent, Daniel J., Boller, Anne Marie, George, Virgilio V., Abbas, Maher A., Peters, Walter R., Maun, Dipen C., Chang, George J., Herline, Alan, Fichera, Alessandro, Mutch, Matthew G., Wexner, Steven D., Whiteford, Mark H., Marks, John, Birnbaum, Elisa, Margolin, David A., Larson, David W., Marcello, Peter W., and Posner, Mitchell C.
- Abstract
Supplemental Digital Content is available in the text Objective: To determine the disease-free survival (DFS) and recurrence after the treatment of patients with rectal cancer with open (OPEN) or laparoscopic (LAP) resection. Background: This randomized clinical trial (ACOSOG [Alliance] Z6051), performed between 2008 and 2013, compared LAP and OPEN resection of stage II/III rectal cancer, within 12 cm of the anal verge (T1-3, N0-2, M0) in patients who received neoadjuvant chemoradiotherapy. The rectum and mesorectum were resected using open instruments for rectal dissection (included hybrid hand-assisted laparoscopic) or with laparoscopic instruments under pneumoperitoneum. The 2-year DFS and recurrence were secondary endpoints of Z6051. Methods: The DFS and recurrence were not powered, and are being assessed for superiority. Recurrence was determined at 3, 6, 9, 12, and every 6 months thereafter, using carcinoembryonic antigen, physical examination, computed tomography, and colonoscopy. In all, 486 patients were randomized to LAP (243) or OPEN (243), with 462 eligible for analysis (LAP = 240 and OPEN = 222). Median follow-up is 47.9 months. Results: The 2-year DFS was LAP 79.5% (95% confidence interval [CI] 74.4–84.9) and OPEN 83.2% (95% CI 78.3–88.3). Local and regional recurrence was 4.6% LAP and 4.5% OPEN. Distant recurrence was 14.6% LAP and 16.7% OPEN. Disease-free survival was impacted by unsuccessful resection (hazard ratio [HR] 1.87, 95% CI 1.21–2.91): composite of incomplete specimen (HR 1.65, 95% CI 0.85–3.18); positive circumferential resection margins (HR 2.31, 95% CI 1.40–3.79); positive distal margin (HR 2.53, 95% CI 1.30–3.77). Conclusion: Laparoscopic assisted resection of rectal cancer was not found to be significantly different to OPEN resection of rectal cancer based on the outcomes of DFS and recurrence. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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35. Postoperative bleeding risk prediction for patients undergoing colorectal surgery.
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Chen, David, Afzal, Naveed, Sohn, Sunghwan, Habermann, Elizabeth B., Naessens, James M., Larson, David W., and Liu, Hongfang
- Abstract
Abstract Background There is limited consensus regarding risk factors for postoperative bleeding. The objective of this work was to investigate the capability of machine learning techniques in combination with practice-based longitudinal electronic medical record data for identifying potential new risk factors for postoperative bleeding and predicting patients at high risk of postoperative bleeding. Methods A retrospective study was conducted for patients who underwent colorectal surgery 1998–2015 at a single tertiary referral center. Various predictors were extracted from electronic medical record. The outcome of interest was the occurrence of postoperative bleeding within 7 days of surgery. Logistic regression and gradient boosting machine models were trained. Area under the receiver operating curve and area under the precision recall curve were used to evaluate the performance to different models. Results Of 13,399 cases undergoing colorectal resection, 1,680 (12.5%) experienced postoperative bleeding. A total of 299 variables were evaluated. Logistic regression and gradient boosting machine models returned an area under the receiver operating curve of 0.735 and 0.822 and area under the precision recall curve of 0.287 and 0.423, respectively. In addition to well-known risk factors for postoperative bleeding, nutrition (ranked third), weakness (ranked fifth), patient mobility (ranked sixth), and activity level (ranked eighth) were found to be novel predictors in the gradient boosting machine model based on permutation importance. Conclusion The study identified measures of functional capacity of patient as novel predictors of postoperative bleeding. The study found that risk of postoperative bleeding can be assessed, allowing for better use of human resources in addressing this important adverse event after surgery. [ABSTRACT FROM AUTHOR]
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- 2018
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36. A Collaborative for Implementation of an Evidence-Based Clinical Pathway for Enhanced Recovery in Colon and Rectal Surgery in an Affiliated Network of Healthcare Organizations.
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Larson, David W., Lovely, Jenna K., Welsh, Jesse, Annaberdyev, Sho, Coffey, Chris, Corning, Cybil, Murray, Bret, Rose, Douglas, Prabhakar, Lawrence, Torgenson, Marcus, Dankbar, Eugene, and Larson, Mark V.
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- 2018
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37. Enhanced Recovery After Surgery and Future Directions
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Merchea, Amit and Larson, David W.
- Abstract
Although the utilization of enhanced recovery after surgery (ERAS) pathways has become more prevalent, issues of compliance and implementation remain. Limiting the complexity of new ERAS protocols by maintaining the core elements of ERAS, along with the development of complementary protocols (prehabilitation, the perioperative surgical home, and telemedicine) may improve overall uptake and subsequent patient outcomes. The future directions of ERAS should be centered on improving the dissemination of the practice and ongoing expansion of patient care outside the immediate hospital period.
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- 2018
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38. Short-Term Outcomes with Robotic Right Colectomy
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Kelley, Scott R., Duchalais, Emilie, and Larson, David W.
- Abstract
Few series have reported on the impact of robotic right colectomy compared with conventional laparoscopy. Even fewer have reported on the outcomes of intracorporeal anastomoses. The aim of our study was to determine the impact of robotic surgery on short-term operative outcomes in patients undergoing right colectomy with intracorporeal anastomosis. One hundred and fourteen consecutive patients who underwent a right colectomy by two colorectal surgeons between 2012 and 2017 were included. Patients were separated into two groups: laparoscopic technique with extracorporeal anastomosis (n = 87) and robotic technique with intracorporeal anastomosis (n = 27). Univariate analysis was performed to determine differences in outcomes. Differences between cohorts were only identified with regard to gender (62 vs37%, P= 0.022) and year of surgery. In comparison with laparoscopy, robotic colectomy resulted in a shorter time of GI recovery (1.3 ± 0.6 vs3 ± 1.1, P< 0.0001), lower rates of postoperative ileus (4 vs28%, P= 0.007), lower overall morbidity (26 vs52%, P= 0.019), less blood loss (P= 0.001), 50 per cent lower narcotic use, and longer operative time (255 ± 66 vs139 ± 49, P< 0.001). Despite longer operative time, robotic surgery improved GI recovery, significantly lowered oral morphine equivalent usage, and decreased short-term complications.
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- 2018
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39. Early Diuresis After Colon and Rectal Surgery Does Not Reduce Length of Hospital Stay: Results of a Randomized Trial
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Danelich, Ilya M., Bergquist, John R., Bergquist, Whitney J., Osborn, Jennifer L., Wright, Sampaguita S., Tefft, Brittany J., Sturm, Ashley W., Langworthy, Diana R., Mandrekar, Jay, Devine, Richard M., Kelley, Scott R., Mathis, Kellie L., Pemberton, John H., Jacob, Adam K., and Larson, David W.
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- 2018
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40. The surgical management of inflammatory bowel disease.
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Lightner, Amy L., Pemberton, John H., Dozois, Eric J., Larson, David W., Cima, Robert R., Mathis, Kellie L., Pardi, Darrell S., Andrew, Rachel E., Koltun, Walter A., Sagar, Peter, and Hahnloser, Dieter
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- 2017
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41. In Brief.
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Lightner, Amy L., Pemberton, John H., Dozois, Eric J., Larson, David W., Cima, Robert R., Mathis, Kellie L., Pardi, Darrell S., Andrew, Rachel E., Koltun, Walter A., Sagar, Peter, and Hahnloser, Dieter
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- 2017
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42. Coordinating clinic and surgery appointments to meet access service levels for elective surgery.
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Kazemian, Pooyan, Sir, Mustafa Y., Pasupathy, Kalyan S., Van Oyen, Mark P., Lovely, Jenna K., and Larson, David W.
- Abstract
Providing timely access to surgery is crucial for patients with high acuity diseases like cancer. We present a methodological framework to make efficient use of scarce resources including surgeons, operating rooms, and clinic appointment slots with a goal of coordinating clinic and surgery appointments so that patients with different acuity levels can see a surgeon in the clinic and schedule their surgery within a maximum wait time target that is clinically safe for them. We propose six heuristic scheduling policies with two underlying ideas behind them: (1) proactively book a tentative surgery day along with the clinic appointment at the time an appointment request is received, and (2) intelligently space out clinic and surgery appointments such that if the patient does not need his/her surgery appointment there is sufficient time to offer it to another patient. A 2-stage stochastic discrete-event simulation approach is employed to evaluate the six scheduling policies. In the first stage of the simulation, the heuristic policies are compared in terms of the average operating room (OR) overtime per day. The second stage involves fine-tuning the most-effective policy. A case study of the division of colorectal surgery (CRS) at the Mayo Clinic confirms that all six policies outperform the current scheduling protocol by a large margin. Numerical results demonstrate that the final policy, which we refer to as Coordinated Appointment Scheduling Policy considering Indication and Resources (CASPIR), performs 52% better than the current scheduling policy in terms of the average OR overtime per day under the same access service level. In conclusion, surgical divisions desiring stratified patient urgency classes should consider using scheduling policies that take the surgical availability of surgeons, patients' demographics and indication of disease into consideration when scheduling a clinic consultation appointment. [ABSTRACT FROM AUTHOR]
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- 2017
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43. How Many Lives Will Delay of Colon Cancer Surgery Cost During the COVID-19 Pandemic? An Analysis Based on the US National Cancer Database
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Larson, David W., Abd El Aziz, Mohamed A., and Mandrekar, Jay N.
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- 2020
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44. Revisional and Reconstructive Surgery for Failing IPAA is Associated with Good Function and Pouch Salvage in Highly Selected Patients
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Lightner, Amy L., Shogan, Benjamin D., Mathis, Kellie L., Larson, David W., Duchalais, Emilie, Pemberton, John H., and Dozois, Eric J.
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- 2018
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45. Robotic Platform for an IPAA
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Lightner, Amy L., Kelley, Scott R., and Larson, David W.
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- 2018
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46. Malignancy and Meckel’s diverticulum: A systematic literature review and 14-year experience at a tertiary referral center
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van Malderen, Kathleen, Vijayvargiya, Priya, Camilleri, Michael, Larson, David W, and Cima, Robert
- Abstract
Background Meckel’s diverticulum is present in about 2% of the population. The literature reports 3.2% incidence of tumors within Meckel’s diverticulum; the tumors are predominantly benign.Objective and methods The purpose of this study was to evaluate malignant tumors in Meckel’s diverticulum through systematic review of the literature and review of electronic medical records including pathology reports over 14 years at the Mayo Clinic, Rochester, USA.Results A literature review over the last 10 years identified 37 citations with 402 patients (median age: 58 years; 68.9% males). The predominant malignancy reported was neuroendocrine tumor 84.6%, followed by gastrointestinal stromal tumor 8.2%, and adenocarcinoma 6%. At the time of diagnosis, 29.5% of patients had metastases. In the Mayo Clinic electronic medical records review, there were 19 patients (5.1% of them surgically removed Meckel’s diverticulum) who had a malignancy associated with Meckel’s diverticulum: 63.2% neuroendocrine tumor, 10.5% gastrointestinal stromal tumor, 5.3% adenocarcinoma, 5.3% pancreatic epithelial neoplasia, and 15.8% metastases from secondary location. Median size of the malignancy was 7 mm, and 17/19 malignancies were coincidental findings. Most neuroendocrine tumors infiltrated the submucosa, while gastrointestinal stromal tumor and adenocarcinoma invaded the serosa. At the time of diagnosis, 33.3% of patients had metastases.Conclusion About 5% of Meckel’s diverticulums resected were associated with malignant tumors, most commonly neuroendocrine tumor, and a significant portion of Meckel’s diverticulum malignancy was metastatic at the time of discovery.
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- 2018
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47. Malignancy and Meckel's diverticulum: A systematic literature review and 14-year experience at a tertiary referral center
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Malderen, Kathleen, Vijayvargiya, Priya, Camilleri, Michael, Larson, David W, and Cima, Robert
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Meckel's diverticulum is present in about 2% of the population. The literature reports 3.2% incidence of tumors within Meckel's diverticulum; the tumors are predominantly benign. The purpose of this study was to evaluate malignant tumors in Meckel's diverticulum through systematic review of the literature and review of electronic medical records including pathology reports over 14 years at the Mayo Clinic, Rochester, USA. A literature review over the last 10 years identified 37 citations with 402 patients (median age: 58 years; 68.9% males). The predominant malignancy reported was neuroendocrine tumor 84.6%, followed by gastrointestinal stromal tumor 8.2%, and adenocarcinoma 6%. At the time of diagnosis, 29.5% of patients had metastases. In the Mayo Clinic electronic medical records review, there were 19 patients (5.1% of them surgically removed Meckel's diverticulum) who had a malignancy associated with Meckel's diverticulum: 63.2% neuroendocrine tumor, 10.5% gastrointestinal stromal tumor, 5.3% adenocarcinoma, 5.3% pancreatic epithelial neoplasia, and 15.8% metastases from secondary location. Median size of the malignancy was 7?mm, and 17/19 malignancies were coincidental findings. Most neuroendocrine tumors infiltrated the submucosa, while gastrointestinal stromal tumor and adenocarcinoma invaded the serosa. At the time of diagnosis, 33.3% of patients had metastases. About 5% of Meckel's diverticulums resected were associated with malignant tumors, most commonly neuroendocrine tumor, and a significant portion of Meckel's diverticulum malignancy was metastatic at the time of discovery.
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- 2018
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48. A Collaborative for Implementation of an Evidence-Based Clinical Pathway for Enhanced Recovery in Colon and Rectal Surgery in an Affiliated Network of Healthcare Organizations
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Larson, David W., Lovely, Jenna K., Welsh, Jesse, Annaberdyev, Sho, Coffey, Chris, Corning, Cybil, Murray, Bret, Rose, Douglas, Prabhakar, Lawrence, Torgenson, Marcus, Dankbar, Eugene, and Larson, Mark V.
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In 2015 the Mayo Clinic Care Network (MCCN), in an effort to extend medical knowledge and share these best practices, embarked on an education mission to diffuse the clinical practice redesign involving the practice of colon and rectal surgery at Mayo Clinic (Rochester, Minnesota) to members of the MCCN. They elected to use a collaborative framework in an attempt to transfer knowledge to multiple teams in an efficient and supportive manner.
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- 2018
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49. Participation of Colon and Rectal Fellows in Robotic Rectal Cancer Surgery: Effect on Surgical Outcomes
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Collins, Danielle, Machairas, Nikolaos, Duchalais, Emilie, Landmann, Ron G., Merchea, Amit, Colibaseanu, Dorin T., Kelley, Scott R., Mathis, Kellie L., Dozois, Eric J., and Larson, David W.
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To determine whether involvement of colon and rectal fellows has an effect on short-term surgical and oncological outcomes in robotic rectal cancer surgery.
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- 2018
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50. Author Reply
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Crippa, Jacopo and Larson, David W.
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- 2023
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