30 results on '"Ryan M. Levy"'
Search Results
2. Comparison of robotic-assisted minimally invasive esophagectomy versus minimally invasive esophagectomy: A propensity-matched study from a single high-volume institution
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Chigozirim N. Ekeke, Gino M. Kuiper, James D. Luketich, Kristine M. Ruppert, Susan J. Copelli, Nicholas Baker, Ryan M. Levy, Omar Awais, Neil A. Christie, Rajeev Dhupar, Arjun Pennathur, and Inderpal S. Sarkaria
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Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2022
3. Robotic assisted minimally invasive thymectomy with simultaneous bilateral thoracoscopy and contralateral phrenic nerve visualization
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Ryan M. Levy, James D. Luketich, Nicholas Baker, Inderpal S. Sarkaria, Nicholas R. Hess, Arjun Pennathur, and Neil A. Christie
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Thymoma ,medicine.diagnostic_test ,business.industry ,Pleural effusion ,medicine.medical_treatment ,Mediastinum ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,Thymectomy ,03 medical and health sciences ,Dissection ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Thoracoscopy ,Medicine ,Original Article ,Robotic surgery ,business ,Phrenic nerve - Abstract
Background: Thoracoscopic approaches to thymectomy and anterior mediastinal mass resection has become increasingly common due to the potential for decreased blood loss and hospital length of stay. However, contralateral mediastinal and phrenic nerve visualization if often difficult from these unilateral approaches, which may affect the ability to achieve a full phrenic to phrenic dissection Herein, we present our early experience of robotic assisted minimally invasive thymectomy (RAMIT) with simultaneous bilateral thoracoscopy and contralateral phrenic nerve visualization. Methods: This was a retrospective review of all sequential patients undergoing RAMIT with simultaneous bilateral thoracoscopy from January 2015 to May 2016. This study was approved by our Institutional Review Board (PRO15080367). Individual patient consent was waived. Results: Twenty-six patients [median age 58 (range, 29–76) years] were included in this study. Sixteen operations were performed for anterior mediastinal mass, 7 for non-thymomatous myasthenia gravis, and 3 for concurrent myasthenia gravis and thymoma. Median blood loss and hospital stay were 25 mL (range, 3–150 mL) and 3 days (range, 2–8 days), respectively. Twenty-one (80.8%) patients experienced an uncomplicated hospital course. The highest graded complication by Clavien Dindo Classification was a grade III due to pleural effusion requiring drainage via pleural catheter. One patient experienced asymptomatic hemidiaphram palsy postoperatively. There were no 90-day postoperative deaths. Conclusions: RAMIT with simultaneous bilateral thoracoscopy is a feasible approach that may allow for enhanced visualization and more complete thymic resection compared to existing unilateral minimally invasive operations. Comparative studies and long-term follow up are needed to adequately assess the potential benefits of RAMIT.
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- 2020
4. Transoral Stapling Technique for Zenker's Diverticulum
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Ernest G. Chan, James D. Luketich, Ryan M. Levy, and Nicholas Baker
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,Reflux ,030204 cardiovascular system & hematology ,Aspiration pneumonia ,medicine.disease ,Surgery ,03 medical and health sciences ,Zenker's diverticulum ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Submucosa ,medicine ,Etiology ,Cricopharyngeal myotomy ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Diverticulum ,Oropharyngeal dysphagia - Abstract
Zenker's diverticulum (ZD) is a rare disorder that has a reported annual incidence of about 2 cases per 100,000. It is a pulsion (false) diverticulum that develops in an area of natural anatomic weakness called Killian's triangle. This is located between the inferior pharyngeal constrictor and the cricopharyngeus muscles. The exact etiology and pathophysiology of ZD is not known. Cricopharyngeal discoordination, spasm, or hypertension have all been implicated as underlying mechanisms leading to herniation of the hypopharyngeal mucosa and submucosa and consequently the formation of a ZD. Gastroesophageal reflux has also been implicated as a potential underlying mechanism in the development of ZD. Patients typically will present with symptoms of oropharyngeal dysphagia, food regurgitation, and in severe cases aspiration pneumonia. Cricopharyngeal myotomy is the mainstay of surgical treatment of symptomatic ZD. The traditional surgical approach to ZD includes an open cervical cricopharyngeal myotomy. However, starting with Collard's initial report of endoscopic stapling in 1993, the endoscopic approach to ZD treatment has been popularized. Since then, increasing reports have described utilizing a variety of endoscopic techniques for management of ZD. Herein we present our current preferred endoscopic approach to treatment of ZD.
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- 2020
5. Commentary: Establishing poetic devices in the crafting of a per-oral endoscopic myotomy masterpiece
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Evan T. Alicuben and Ryan M. Levy
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Poetry ,General surgery ,media_common.quotation_subject ,Per-oral endoscopic myotomy ,medicine ,Commentary ,Surgery ,Art ,media_common - Published
- 2021
6. Pulmonary pathologic alterations associated with biopsy inserted hydrogel plugs
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Samuel A. Yousem, Nicholas Baker, Ryan M. Levy, Paul C. Lee, and Rajnikant M. Amin
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Image-Guided Biopsy ,Lung Diseases ,Male ,0301 basic medicine ,Foreign-body giant cell ,Pathology ,medicine.medical_specialty ,Percutaneous ,Lung biopsy ,Pathology and Forensic Medicine ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Humans ,Eosinophilia ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,Pneumothorax ,Hydrogels ,Middle Aged ,respiratory system ,medicine.disease ,respiratory tract diseases ,Basophilic ,030104 developmental biology ,030220 oncology & carcinogenesis ,Female ,medicine.symptom ,Tomography, X-Ray Computed ,business ,Complication - Abstract
Summary The prevention of pneumothorax after percutaneous lung biopsy is a major patient safety concern. The insertion of hydrogel plugs into biopsy sites to mitigate this complication is a new intervention. The histology of the plug has not been previously reported, and in this study the histologic reaction is reported in 13 cases. The hydrogel plug forms a spherical basophilic matrix pool with an adjacent foreign body giant cell reaction and patchy eosinophilia. No extension to the pleural surface is present. The potential diagnostic errors related to the presence of the plug are discussed.
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- 2019
7. Transoral endoscopic repair of Zenker diverticulum by a thoracic surgical service
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Omar Awais, James D. Luketich, Peter F. Ferson, Chinenyenwa Mpamaugo, Arjun Pennathur, William E. Gooding, Manisha Shende, Ryan M. Levy, Inderpal S. Sarkaria, Manuel Villa Sanchez, Matthew J. Schuchert, and Daniel Brynien
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Male ,Pulmonary and Respiratory Medicine ,Zenker Diverticulum ,medicine.medical_specialty ,Pulsion diverticulum ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Surgical Stapling ,medicine ,Humans ,Esophagus ,Aged ,Retrospective Studies ,business.industry ,Perioperative ,medicine.disease ,Dysphagia ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,030228 respiratory system ,Cardiothoracic surgery ,GERD ,Female ,Esophagoscopy ,medicine.symptom ,Deglutition Disorders ,Cardiology and Cardiovascular Medicine ,business - Abstract
Zenker diverticulum (ZD), a pulsion diverticulum of the esophagus, has been traditionally managed with an open surgical approach, but endoscopic transoral stapling has been reported with increasing frequency. The objective of this study was to evaluate the results of endoscopic repair of ZD by a thoracic surgery service.We conducted a retrospective review of patients who underwent transoral stapling repair of ZD at our institution by the thoracic surgery service. We evaluated perioperative outcomes including dysphagia (1, no dysphagia to 5, unable to swallow saliva) and failure of repair requiring surgical intervention.A total of 151 patients (median age, 78 years; 75 men, 76 women) underwent evaluation for endoscopic repair of ZD. Endoscopic stapled repair of the ZD was completed in 135. Sixteen patients underwent conversion to open repair. The perioperative mortality was 0.6% (1 patient). The median hospital stay was 2 days (range, 0-18 days). Complications occurred in 5 patients who underwent endoscopic repair. The mean preoperative dysphagia score was 2.8 and improved to 1.2 during follow-up (median, 16 months; P .001). During further follow-up (median, 52 months), 8 patients (5.3%) had failure of the endoscopic repair requiring open surgery (n = 5) or redo transoral stapling (n = 3).Endoscopic stapling repair of ZD can be performed safely with good results in experienced centers by thoracic surgeons with significant esophageal experience. Long-term follow-up is required to evaluate the durability of endoscopic repair of ZD.
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- 2022
8. Laparoscopic repair of giant paraesophageal hernia
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Ryan M. Levy, Evan T. Alicuben, and James D. Luketich
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Paraesophageal ,business.industry ,medicine ,Special Issue of Invited Presentations: Thoracic: Esophagus: Invited Video Atlas ,Surgery ,Hernia ,medicine.disease ,business - Abstract
Video Video 1 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 2 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 3 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 4 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 5 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 6 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 7 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 8 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 9 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 10 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext. Video 11 Video available at: https://www.jtcvs.org/article/S2666-2507(21)00514-9/fulltext.
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- 2021
9. Activity-Based Cost Analysis of Robotic Anatomic Lung Resection During Program Implementation
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Garrett N. Coyan, Michael Lu, James D. Luketich, Matthew J. Schuchert, Inderpal S. Sarkaria, Nicholas Baker, Ryan M. Levy, and Kristine Ruppert
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,MEDLINE ,Context (language use) ,Robotic Surgical Procedures ,medicine ,Humans ,Activity-based costing ,Pneumonectomy ,Aged ,Retrospective Studies ,business.industry ,Perioperative ,Middle Aged ,Surgery ,Treatment Outcome ,Cardiothoracic surgery ,Propensity score matching ,Cost analysis ,Costs and Cost Analysis ,Female ,Lung resection ,Cardiology and Cardiovascular Medicine ,business ,Program Evaluation - Abstract
While robotic-assisted lung resection has seen a significant rise in adoption, concerns remain regarding initial programmatic outcomes and potential increased costs. We present our initial outcomes and cost analysis since initiation of a robotic lung resection program.Patients undergoing either video-assisted thoracoscopic lobectomy or segmentectomy (VATS) or robotic-assisted lobectomy or segmentectomy (RALS) between August of 2014 and January of 2017 underwent retrospective review. Patients underwent 1:1 propensity matching based on preoperative characteristics. Perioperative and 30-day outcomes were compared between groups. Detailed activity-based costing analysis was performed on individual patient encounters taking into effect direct and indirect controllable costs, including robotic operative supplies.There were no differences in 30-day mortality between RALS (n = 74) and VATS (n = 74) groups (0% vs 1.4%; P = 1). RALS patients had a decreased median length of stay (4 days vs 7 days; P.001) and decreased median chest tube duration (3 days vs 5 days, P.001). Total direct costs, including direct supply costs, were not significantly different between RALS and VATS ($6621 vs $6483; P = .784). Median total operating costs and total unit support costs, which are closely correlated to length of stay, were lower in the RALS group. Overall median controllable costs were significantly different between RALS and VATS ($16,352 vs $21,154; P = .025).A potentially cost-advantageous robotic-assisted pulmonary resection program can be initiated within the context of an existing minimally invasive thoracic surgery program while maintaining good clinical outcomes when compared with traditional VATS. Process-of-care changes associated with RALS may account for decreased costs in this setting.
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- 2020
10. The association of robotic lobectomy volume and nodal upstaging in non-small cell lung cancer
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Nalyn Siripong, Ryan M. Levy, James D. Luketich, Rajeev Dhupar, Deirdre Martinez-Meehan, Nicholas Baker, Inderpal S. Sarkaria, Waseem Lutfi, Neil A. Christie, and Olugbenga T. Okusanya
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Male ,medicine.medical_specialty ,Lung Neoplasms ,030232 urology & nephrology ,Health Informatics ,03 medical and health sciences ,0302 clinical medicine ,Robotic Surgical Procedures ,Carcinoma, Non-Small-Cell Lung ,medicine ,Humans ,Robotic surgery ,Stage (cooking) ,Lung cancer ,Pneumonectomy ,Aged ,Neoplasm Staging ,business.industry ,Middle Aged ,medicine.disease ,Cancer data ,Hospitals ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Lymph Node Excision ,Female ,Non small cell ,Lymph Nodes ,Lung resection ,business ,Volume (compression) - Abstract
Robotic lung resection for lung cancer has gained popularity over the last 10 years. As with many surgical techniques, there are improvements in outcomes associated with increased operative volume. We sought to investigate lymph-node harvest and upstaging rates for robotic lobectomies performed at hospitals with varying robotic experience. The National Cancer Data Base was queried for patients with early stage non-small cell lung cancer who received lobectomy between 2010 and 2015. Hospitals were stratified into volume categories based on the number of robotic resections performed, as a proxy for robotic experience: low at ≤ 12, low–middle 13–26, middle–high 27–52, and high volume at greater than or equal to 53. Lymph-node counts and nodal upstaging were compared among these volume categories. 8360 robotic lobectomies were performed. Mean lymph-node counts were for low, low–middle, middle–high, and high-volume robotic lobectomies were 9.8, 11.4, 12.9, and 12.6, respectively (P
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- 2019
11. Laparoscopic Approach to Paraesophageal Hernia Repair
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Inderpal S. Sarkaria, Ernest G. Chan, Ryan M. Levy, and James D. Luketich
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Paraesophageal ,Gastroplasty ,medicine.medical_treatment ,Fundoplication ,Gastropexy ,Severity of Illness Index ,Hiatal hernia ,03 medical and health sciences ,0302 clinical medicine ,Blood loss ,medicine ,Humans ,In patient ,Hernia ,Laparoscopy ,Herniorrhaphy ,Surgical approach ,medicine.diagnostic_test ,business.industry ,medicine.disease ,Hernia repair ,Surgery ,Hernia, Hiatal ,Treatment Outcome ,030228 respiratory system ,030220 oncology & carcinogenesis ,business - Abstract
The introduction of minimally invasive techniques to the field of foregut surgery has revolutionized the surgical approach to giant paraesophageal hernia repair. Laparoscopy has become the standard approach in patients with giant paraesophageal hernia because it has been shown to be safe and is associated with lower morbidity and mortality when compared with various open approaches. Specifically, it has been associated with decreased intraoperative blood loss, decreased complications, and reduced hospital length of stay. This is despite a rise in comorbid conditions associated with this patient population. This article describes our operative approach to laparoscopic giant paraesophageal hernia repair.
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- 2019
12. Mesh cruroplasty in laparoscopic repair of paraesophageal hernias is not associated with better long-term outcomes compared to primary repair
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Neil A. Christie, James D. Luketich, Omar Awais, Katie S. Nason, Ryan M. Levy, Manisha Shende, and Vernissia Tam
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Male ,medicine.medical_specialty ,Paraesophageal ,030230 surgery ,Epigastric pain ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Bloating ,Recurrence ,Risk Factors ,medicine ,Humans ,Hernia ,Laparoscopy ,Herniorrhaphy ,Aged ,Retrospective Studies ,Aged, 80 and over ,medicine.diagnostic_test ,business.industry ,Heartburn ,Retrospective cohort study ,General Medicine ,Middle Aged ,Surgical Mesh ,medicine.disease ,Surgery ,Hernia, Hiatal ,Treatment Outcome ,Surgical mesh ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Quality of Life ,Female ,medicine.symptom ,business - Abstract
Background Equipoise still exists regarding routine mesh cruroplasty during laparoscopic paraesophageal hernia (PEH). We aimed to determine whether selective mesh cruroplasty is associated with differences in recurrence and patient-reported outcomes. Methods We compared symptom outcomes (n = 688) and radiographic recurrences (n = 101; at least 10% [or 2 cm] of stomach above hiatus) for 795 non-emergent PEH repair with fundoplication (n = 106 with mesh). Results Heartburn, regurgitation, epigastric pain, and anti-reflux medication use decreased significantly in both groups while postoperative dysphagia (mesh; p = 0.14), and bloating (non-mesh; p = 0.32), were unchanged. Radiographic recurrence rates were similar (15 mesh [22%] versus 86 non-mesh [17%]; p = 0.32; median 27 [IQR 14, 53] months), but was associated with surgical dissatisfaction (13% vs 4%; p = 0.007). Conclusions Selective mesh cruroplasty was not associated with differences in symptom outcomes or radiographic recurrence rates during laparoscopic PEH repair. Radiographic recurrence was associated with dissatisfaction, emphasizing the need for continued focus on reducing recurrences.
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- 2017
13. Robotic assisted minimally invasive esophagectomy (RAMIE): the University of Pittsburgh Medical Center initial experience
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Arjun Pennathur, Inderpal S. Sarkaria, Manuel Villa Sanchez, Katie S. Nason, Ryan M. Levy, James D. Luketich, Olugbenga T. Okusanya, and Nicholas R. Hess
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medicine.medical_specialty ,business.industry ,Robotic assisted ,Masters of Cardiothoracic Surgery ,General surgery ,MEDLINE ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Invasive esophagectomy ,Materials Chemistry ,Medicine ,030211 gastroenterology & hepatology ,Center (algebra and category theory) ,Cardiology and Cardiovascular Medicine ,business - Published
- 2017
14. Cancer Recurrence After Esophagectomy: Impact of Postoperative Infection in Propensity-Matched Cohorts
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Inderpal S. Sarkaria, James D. Luketich, Katie S. Nason, Daniel G. Winger, Neil A. Christie, Manisha Shende, Ryan M. Levy, Vernissia Tam, and Omar Awais
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Proportional hazards model ,business.industry ,medicine.medical_treatment ,Hazard ratio ,Retrospective cohort study ,030230 surgery ,medicine.disease ,Gastroenterology ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Esophagectomy ,030220 oncology & carcinogenesis ,Internal medicine ,Propensity score matching ,medicine ,Adenocarcinoma ,Cardiology and Cardiovascular Medicine ,business ,Survival rate ,Neoadjuvant therapy - Abstract
Background Postoperative infection increases cancer recurrence and worsens survival in colorectal cancer, but the relationship for esophagogastric adenocarcinoma after esophagectomy is not well defined. We aimed to determine whether recurrence and survival after minimally invasive esophagectomy for esophagogastric adenocarcinoma were influenced by postoperative infection using propensity-matched analysis. Methods We abstracted data for 810 patients (1997–2010) and defined exposure as at least 1 in-hospital or 30-day infectious complication (n = 206 [25%]). Using 29 pretreatment/intraoperative variables, patients were propensity-score matched (caliper = 0.05). Time to cancer recurrence and survival (Kaplan-Meier curves and the Breslow test), and associated factors (Cox regression with shared frailty) were assessed. Results After propensity matching (n = 167 pairs), median bias across propensity-score variables was reduced from 12.9% ( p p = 1.000). Postoperative infection was not associated with rate (n = 60 versus 63; McNemar p = 0.736) or time to recurrence in those in whom disease recurred (median, 10.7 versus 11.1 months; Wilcoxon signed-rank p = 0.455) but was associated with shorter overall survival (n = 124 versus 102 deaths; median, 26 versus 41 months; Breslow p = 0.002). After adjusting for age, body mass index, neoadjuvant therapy, sex, comorbidity score, positive resection margins, pathologic stage, R0 resection, and recurrence, postoperative infection was associated with a 44% greater hazard for death (hazard ratio, 1.44; 95% confidence interval, 1.10–1.89). Conclusions In patients with esophagogastric adenocarcinoma, infections after esophagectomy were not associated with an increased rate or earlier time to recurrence when baseline characteristics associated with infection risk were balanced using propensity-score matching. Despite this, overall survival was shorter in patients with infectious complications. After adjusting for other important survival predictors, infections after esophagectomy continued to be independently associated with worse survival.
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- 2016
15. Thoracic Esophageal Diverticula: A 15-Year Experience of Minimally Invasive Surgical Management
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Valentino Bianco, William E. Gooding, Omar Awais, Ryan M. Levy, Arjun Pennathur, Ryan A. Macke, James D. Luketich, Katie S. Nason, Neil A. Christie, and Matthew J. Schuchert
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Pulmonary and Respiratory Medicine ,Thorax ,Myotomy ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Retrospective cohort study ,Dysphagia ,Surgery ,Quality of life ,Cardiothoracic surgery ,medicine ,Clinical endpoint ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Laparoscopy ,business - Abstract
Background Thoracic esophageal diverticula are uncommon, and controversies exist regarding their management. The objective of this study was to evaluate the outcomes of a relatively large cohort of patients with thoracic esophageal diverticula treated with minimally invasive surgical techniques. Methods We conducted a retrospective review of patients who underwent minimally invasive surgical treatment for symptomatic esophageal diverticula during a 15-year period. The primary end point was 30-day mortality. In addition, we evaluated the morbidity, improvement in dysphagia (score: 1, best to 5, worst), and quality of life (Gastroesophageal Reflux Disease–Health-Related Quality of Life score: 0, best to 50, most symptoms). Results Fifty-seven patients underwent minimally invasive surgical treatment of symptomatic thoracic esophageal diverticula. The most common symptom was dysphagia (45 of 57; 79%). A motility disorder or distal mechanical obstruction was identified in 49 patients (86%). Approaches used included video-assisted thoracoscopic surgery (n = 33), laparoscopy (n = 18), and combined video-assisted thoracoscopic surgery and laparoscopy (n = 6). The most common procedure performed was diverticulectomy and myotomy (47 of 57 patients; 82.5%). The 30-day mortality was 0%. There were 4 patients (7%) with postoperative leaks requiring reoperation. During follow-up, the median dysphagia score improved from 3 to 1 ( p Conclusions A minimally invasive surgical approach for the management of thoracic esophageal diverticula is safe and effective during intermediate-term follow-up when performed by surgeons experienced in esophageal surgery and minimally invasive techniques. Further follow-up is required to assess the durability of these results. The optimal approach and procedures performed should be determined on an individualized basis after a thorough investigation.
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- 2015
16. Mo2002 NO CLINICAL DIFFERENCE IN OPTIMISM AND SELF-EFFICACY BETWEEN CASES WITH ESOPHAGEAL ADENOCARCINOMA AND POPULATION CONTROLS
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Inderpal Sarkari, Katie S. Nason, Galen E. Switzer, James D. Luketich, Ryan M. Levy, Paul Visintainer, and Kathryn Norman
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Oncology ,Self-efficacy ,education.field_of_study ,medicine.medical_specialty ,Hepatology ,business.industry ,media_common.quotation_subject ,Population ,Gastroenterology ,Esophageal adenocarcinoma ,Optimism ,Internal medicine ,Medicine ,education ,business ,media_common - Published
- 2020
17. Mo1177 INDIVIDUALS REPORTING FREQUENT (WEEKLY OR MORE) GERD SYMPTOMS IN EARLY TO MID-ADULTHOOD (AGE 18 TO 50) ARE MORE THAN TWICE AS LIKELY TO HAVE ESOPHAGEAL CANCER
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James D. Luketich, Thomas L. Vaughan, Inderpal S. Sarkaria, Galen E. Switzer, Kathryn Norman, Ryan M. Levy, and Katie S. Nason
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medicine.medical_specialty ,business.industry ,Internal medicine ,Gastroenterology ,GERD ,Medicine ,Radiology, Nuclear Medicine and imaging ,Esophageal cancer ,business ,medicine.disease - Published
- 2019
18. Undifferentiated carcinoma of the esophagus: a clinicopathological study of 16 cases
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Jon M. Davison, Kevin McGrath, Raja R. Seethala, James D. Luketich, Ryan M. Levy, Robyn L. Roche, Katie S. Nason, Aatur D. Singhi, and Tyler Foxwell
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Adult ,Male ,Pathology ,medicine.medical_specialty ,Alcohol Drinking ,Esophageal Neoplasms ,Lymphovascular invasion ,Perineural invasion ,Comorbidity ,Biology ,Neuroendocrine differentiation ,Article ,Pathology and Forensic Medicine ,Barrett Esophagus ,Cytokeratin ,Biomarkers, Tumor ,medicine ,Carcinoma ,Humans ,Neoplasm Invasiveness ,Esophagus ,Lymph node ,In Situ Hybridization ,Aged ,Neoplasm Staging ,Aged, 80 and over ,Smoking ,Anemia ,Neoplasms, Second Primary ,Middle Aged ,Prognosis ,medicine.disease ,Immunohistochemistry ,Survival Rate ,Treatment Outcome ,medicine.anatomical_structure ,Giant cell ,Lymphatic Metastasis ,Carcinoma, Squamous Cell ,Gastroesophageal Reflux ,Keratins ,Female ,Esophageal Squamous Cell Carcinoma ,Neoplasm Recurrence, Local ,Deglutition Disorders ,Follow-Up Studies ,Transcription Factors - Abstract
Undifferentiated carcinoma of the esophagus is a rare histologic variant of esophageal carcinoma. Using criteria based on studies of undifferentiated carcinomas arising at other sites, we have collected 16 cases of resected esophageal undifferentiated carcinomas. Patients ranged in age from 39 to 84 years (mean, 65.5 years) and were predominantly male (94%). The tumors were characterized by an expansile growth pattern of neoplastic cells organized in solid sheets and without significant glandular, squamous, or neuroendocrine differentiation. The neoplastic cells had a syncytial-like appearance, little intervening stroma, and patchy tumor necrosis. In a subset of cases, the tumor cells adopted a sarcomatoid (n = 2), rhabdoid (n = 1), or minor component (
- Published
- 2015
19. A propensity-matched analysis comparing survival after primary minimally invasive esophagectomy followed by adjuvant therapy to neoadjuvant therapy for esophagogastric adenocarcinoma
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Ryan M. Levy, James D. Luketich, Daniel G. Winger, Omar Awais, Katie S. Nason, Haris Zahoor, and Michael K. Gibson
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Oncology ,Diagnostic Imaging ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Adenocarcinoma ,law.invention ,Randomized controlled trial ,law ,Risk Factors ,Stomach Neoplasms ,Internal medicine ,medicine ,Adjuvant therapy ,Humans ,Minimally Invasive Surgical Procedures ,Stage (cooking) ,Propensity Score ,Survival rate ,Neoadjuvant therapy ,Aged ,Neoplasm Staging ,business.industry ,Hazard ratio ,Middle Aged ,medicine.disease ,Prognosis ,Neoadjuvant Therapy ,Surgery ,Esophagectomy ,Survival Rate ,Lymph Node Excision ,Female ,business ,Cardiology and Cardiovascular Medicine - Abstract
Objectives Prognosis for patients with locally advanced esophagogastric adenocarcinoma (EAC) is poor with surgery alone, and adjuvant therapy after open esophagectomy is frequently not tolerated. After minimally invasive esophagectomy (MIE); however, earlier return to normal function may render patients better able to receive adjuvant therapy. We examined whether primary MIE followed by adjuvant chemotherapy influenced survival compared with propensity-matched patients treated with neoadjuvant therapy. Methods Patients with stage II or higher EAC treated with MIE (N = 375) were identified. Using 30 pretreatment covariates, propensity for assignment to either neoadjuvant followed by MIE (n = 183; 54%) or MIE as primary therapy (n = 156; 46%) was calculated, generating 97 closely matched pairs. Hazard ratios were adjusted for age, sex, body mass index, smoking, comorbidity, and final pathologic stage. Results In propensity-matched pairs, adjusted hazard ratio for death did not differ significantly for primary MIE compared with neoadjuvant (hazard ratio, 0.83; 95% confidence interval, 0.60-1.16). Recurrence patterns were similar between groups and 65% of patients with IIb or greater pathologic stage received adjuvant therapy. Clinical staging was inaccurate in 37 out of 105 patients (35%) who underwent primary MIE (n = 18 upstaged and n = 19 downstaged). Conclusions Primary MIE followed by adjuvant chemotherapy guided by pathologic findings did not negatively influence survival and allowed for accurate staging compared with clinical staging. Our data suggest that primary MIE in patients with resectable EAC may be a reasonable approach, improving stage-based prognostication and potentially minimizing overtreatment in patients with early stage disease through accurate stage assignments. A randomized controlled trial testing this hypothesis is needed.
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- 2015
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20. Anastomotic complications after esophagectomy: Influence of omentoplasty in propensity-weighted cohorts
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James D. Luketich, Inderpal S. Sarkaria, Michael Lu, Katie S. Nason, Omar Awais, Ryan M. Levy, and Paul Visintainer
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Leak ,Esophageal Neoplasms ,medicine.medical_treatment ,Anastomotic Leak ,030204 cardiovascular system & hematology ,Anastomosis ,Dehiscence ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Humans ,Prospective Studies ,Propensity Score ,Neoadjuvant therapy ,Aged ,business.industry ,Incidence (epidemiology) ,Chemoradiotherapy ,Middle Aged ,Plastic Surgery Procedures ,Neoadjuvant Therapy ,Surgery ,Esophagectomy ,030228 respiratory system ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Omentum - Abstract
Objective A recent meta-analysis of 3 randomized controlled trials reported reduced incidence and severity of postesophagectomy anastomotic dehiscence with anastomotic omentoplasty. Unfortunately, these trials excluded neoadjuvant patients who received chemoradiation. We aimed to determine whether anastomotic omentoplasty was associated with differential postesophagectomy anastomotic complications after neoadjuvant chemoradiotherapy. Methods Data for patients who underwent minimally invasive esophagectomy following neoadjuvant chemoradiotherapy were abstracted (n = 245; 2001-2016; omentoplasty = 147 [60%]). Propensity for omentoplasty was estimated on 21 pretreatment variables, using augmented inverse probability of treatment weights, and used to determine the adjusted proportion of adverse anastomotic outcomes, major morbidity, and 30-day/in-hospital mortality. Results Overall, anastomotic leak rate was 15%; leak-associated mortality was 13% (n = 5 out of 37). Leak rates (omentoplasty n = 24 [16%] vs no omentoplasty n = 13 [13%]; P = .512) and incidence of any major complications (48% vs 48%; P = .958) were similar. Leaks requiring surgical intervention occurred in 12 patients (5% vs 5%; P = .904). Propensity weighting achieved excellent balance across all 21 pretreatment variables (before weighting, standardized differences ranged from –0.23 to 0.35; postweighting standardized differences ranged from –0.09 to 0.07). In propensity-weighted data, omentoplasty was not associated with differential adjusted risk of anastomotic leak (13.2% vs 14.3%; P = .83), major morbidity (27.9% vs 32.6%; P = .44), or mortality (6.7% vs 4.8%; P = .61). Conclusions Within the limits of our sample size and statistical approach, our study failed to find evidence that anastomotic omentoplasty during esophagectomy after neoadjuvant chemoradiation reduced anastomotic leak rate or need for leak-related reoperation.
- Published
- 2017
21. Non-Elective Paraesophageal Hernia Repair Portends Worse Outcomes in Comparable Patients: a Propensity-Adjusted Analysis
- Author
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Vernissia Tam, Manisha Shende, James D. Luketich, Katie S. Nason, Omar Awais, Neil A. Christie, Inderpal S. Sarkaria, Daniel G. Winger, and Ryan M. Levy
- Subjects
Male ,medicine.medical_specialty ,Paraesophageal ,genetic structures ,health care facilities, manpower, and services ,medicine.medical_treatment ,Comorbidity ,030230 surgery ,Article ,Hiatal hernia ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,medicine ,Humans ,Hospital Mortality ,Propensity Score ,health care economics and organizations ,Herniorrhaphy ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,General surgery ,Gastroenterology ,Age Factors ,Retrospective cohort study ,Perioperative ,Middle Aged ,medicine.disease ,Hernia repair ,Surgery ,Hernia, Hiatal ,Treatment Outcome ,030220 oncology & carcinogenesis ,Propensity score matching ,Female ,business ,Elective Surgical Procedure - Abstract
Patients undergoing non-elective paraesophageal hernia repair (PEHR) have worse perioperative outcomes. Because they are usually older and sicker, however, these patients may be more prone to adverse events, independent of surgical urgency. Our study aimed to determine whether non-elective PEHR is associated with differential postoperative outcome compared to elective repair, using propensity-score weighting.We abstracted data for patients undergoing PEHR (n = 924; non-elective n = 171 (19 %); 1997-2010). Using boosted regression, we generated a propensity-weighted dataset. Odds of 30-day/in-hospital mortality and major complications after non-elective surgery were determined.Patients undergoing non-elective repair were significantly older, had more adverse prognostic factors, and significantly more major complications (38 versus 18 %; p 0.001) and death (8 versus 1 %; p 0.001). After propensity weighting, median absolute percentage bias across 28 propensity-score variables improved from 19 % (significant imbalance) to 5.6 % (well-balanced). After adjusting propensity-weighted data for age and comorbidity score, odds of major complications were still nearly two times greater (OR 1.67, CI 1.07-2.61) and mortality nearly three times greater (OR 2.74, CI 0.93-8.1) than for elective repair.Even after balancing significant differences in baseline characteristics, non-elective PEHR was associated with worse outcomes than elective repair. Symptomatic patients should be referred for elective repair by experienced surgeons.
- Published
- 2016
22. Minimally invasive versus open thymectomy: a systematic review of surgical techniques, patient demographics, and perioperative outcomes
- Author
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Nicholas R, Hess, Inderpal S, Sarkaria, Arjun, Pennathur, Ryan M, Levy, Neil A, Christie, and James D, Luketich
- Subjects
Systematic Review - Abstract
Thymectomy is the mainstay of treatment for thymoma and other anterior mediastinal tumors, and is often utilized in the management of patients with myasthenia gravis (MG). While traditionally approached through a median sternotomy, minimally invasive approaches to thymectomy have increasingly emerged. The present systematic review was conducted to compare perioperative and clinical outcomes following minimally invasive thymectomy (MIT) and open thymectomy (OT).Articles were obtained through a PubMed literature search. Comparative studies reporting clinical outcomes following MIT and OT were eligible for inclusion. We selected studies with full text availability, written in the English language, published after 2005 and with at least 15 patients in each arm. A descriptive analysis was performed.Twenty studies were included, involving a total of 2,068 patients undergoing either MIT (n=838) or OT (n=1,230). Within individual studies, MIT and OT cohorts were well matched with regards to patient age and gender, but there was considerable variation across studies. Resected thymomas were consistently larger in OT groups, with mean diameter significantly larger in five studies (MIT, 29-52 mm; OT, 31-77 mm). MIT was consistently associated with a lower estimated blood loss (MIT, 20-200 mL; OT, 86-466 mL), chest tube duration (MIT, 1.3-4.1 days; OT, 2.4-5.3 days), and hospital length of stay (MIT, 1-10.6 days; OT, 4-14.6 days). There were no consistent differences in rates of perioperative complications, thymoma recurrence, MG complete stable remission, or 5-year survival.In appropriately selected patients, MIT may reduce blood loss, chest tube duration, and hospital length of stay, with comparable clinical outcomes compared to OT via median sternotomy.
- Published
- 2016
23. Segmentectomy vs Lobectomy for Pathological N1 Non-Small Cell Lung Cancer
- Author
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Ryan M. Levy, Summer Mazur, James D. Luketich, Katie S. Nason, Ernest G. Chan, Matthew J. Schuchert, Omar Awais, Arjun Pennathur, and Patrick G. Chan
- Subjects
Pulmonary and Respiratory Medicine ,Pathology ,medicine.medical_specialty ,business.industry ,medicine ,Non small cell ,Cardiology and Cardiovascular Medicine ,Critical Care and Intensive Care Medicine ,Lung cancer ,medicine.disease ,business ,Pathological - Published
- 2017
24. Minimally Invasive Esophagectomy
- Author
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Jonathan D’Cunha, David D. Odell, Ryan M. Levy, and James D. Luketich
- Published
- 2015
25. Smad4 Loss in Esophageal Adenocarcinoma Is Associated With an Increased Propensity for Disease Recurrence and Poor Survival
- Author
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Ryan M. Levy, Kristi L. Cressman, Weijing Sun, James D. Luketich, Tyler Foxwell, Aatur D. Singhi, Nathan Bahary, Katie S. Nason, Kevin McGrath, Herbert J. Zeh, and Jon M. Davison
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,animal structures ,Time Factors ,Esophageal Neoplasms ,Lymphovascular invasion ,Perineural invasion ,Down-Regulation ,Kaplan-Meier Estimate ,Adenocarcinoma ,Article ,Disease-Free Survival ,Pathology and Forensic Medicine ,Metastasis ,Young Adult ,Risk Factors ,Internal medicine ,Biomarkers, Tumor ,Medicine ,Humans ,Lymph node ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Smad4 Protein ,Aged, 80 and over ,Chi-Square Distribution ,Proportional hazards model ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Immunohistochemistry ,digestive system diseases ,medicine.anatomical_structure ,Treatment Outcome ,Tissue Array Analysis ,embryonic structures ,Multivariate Analysis ,Surgery ,Female ,Anatomy ,Neoplasm Recurrence, Local ,business - Abstract
Previously regarded as a rare neoplasm, the incidence of esophageal adenocarcinoma has risen rapidly in recent decades. It is often discovered late in the disease process and has a dismal prognosis. Current prognostic markers including clinical, radiographic, and histopathologic findings have limited utility and do not consider the biology of this deadly disease. Genome-wide analyses have identified SMAD4 inactivation in a subset of tumors. Although Smad4 has been extensively studied in other gastrointestinal malignancies, its role in esophageal adenocarcinoma remains to be defined. Herein, we show, in a large cohort of esophageal adenocarcinomas, Smad4 loss by immunohistochemistry in 21 of 205 (10%) tumors and that Smad4 loss correlated with increased postoperative recurrence (P=0.040). Further, patients whose tumors lacked Smad4 had shorter time to recurrence (TTR) (P=0.007) and poor overall survival (OS) (P=0.011). The median TTR and OS of patients with Smad4-negative tumors was 13 and 16 months, respectively, as compared with 23 and 22 months, respectively, among patients with Smad4-positive tumors. In multivariate analyses, Smad4 loss was a prognostic factor for both TTR and OS, independent of histologic grade, lymphovascular invasion, perineural invasion, tumor stage, and lymph node status. Considering Smad4 loss correlated with postoperative locoregional and/or distant metastases, Smad4 was also assessed in a separate cohort of 5 locoregional recurrences and 43 metastatic esophageal adenocarcinomas. In contrast to primary tumors, a higher prevalence of Smad4 loss was observed in metastatic disease (44% vs. 10%). In summary, loss of Smad4 protein expression is an independent prognostic factor for TTR and OS that correlates with increased propensity for disease recurrence and poor survival in patients with esophageal adenocarcinoma after surgical resection.
- Published
- 2015
26. The revised American Joint Committee on Cancer staging system (7th edition) improves prognostic stratification after minimally invasive esophagectomy for esophagogastric adenocarcinoma
- Author
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Katie S. Nason, James D. Luketich, Benny Weksler, Haris Zahoor, Ryan M. Levy, Neil A. Christie, Daniel G. Winger, Jon M. Davison, and Michael K. Gibson
- Subjects
Male ,medicine.medical_specialty ,Esophageal Neoplasms ,medicine.medical_treatment ,Adenocarcinoma ,Prognostic stratification ,Article ,Cohort Studies ,Predictive Value of Tests ,Invasive esophagectomy ,medicine ,Humans ,Stage (cooking) ,Neoadjuvant therapy ,Cancer staging ,Aged ,Neoplasm Staging ,Proportional hazards model ,business.industry ,General surgery ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Neoadjuvant Therapy ,United States ,Esophagectomy ,Survival Rate ,Surgery ,Female ,Laparoscopy ,Radiology ,Esophagogastric Junction ,business - Abstract
Staging for esophagogastric adenocarcinoma lacked sufficient prognostic accuracy and was revised. We compared survival prognostication between American Joint Committee on Cancer (AJCC) 6th and 7th editions.We abstracted data for 836 patients who underwent minimally invasive esophagectomy for esophagogastric adenocarcinoma (n = 256 neoadjuvant). Monotonicity and strength of survival trends, by stage, were assessed (log-rank test of trend chi-square statistic) and compared using permutation testing. Overall survival (Cox regression) and model fit (Akaike Information Criterion) were determined.A greater log-rank test of trend statistic indicated stronger survival trends by stage in AJCC 7th (152.872 vs 167.623; permutation test P.001) edition. Greater Cox likelihood chi-square value (162.957 vs 173.951) and lower Akaike Information Criterion (4,831.011 vs 4,820.016) indicated better model fit. Superior performance was also shown after neoadjuvant therapy.AJCC 7th edition staging for esophagogastric adenocarcinoma provides superior prognostic stratification after minimally invasive esophagectomy, overall and after neoadjuvant therapy compared with AJCC 6th edition.
- Published
- 2015
27. Reply
- Author
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Ryan A, Macke, James D, Luketich, Arjun, Pennathur, and Ryan M, Levy
- Subjects
Pulmonary and Respiratory Medicine ,Surgery ,Cardiology and Cardiovascular Medicine - Published
- 2016
28. Current Screening Recommendations for Barrett's Esophagus Do not Differentiate Esophageal Cancer Patients from Population Controls
- Author
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Inderpal S. Sarkaria, James D. Luketich, Katie S. Nason, Galen E. Switzer, Ryan M. Levy, and Thomas L. Vaughan
- Subjects
medicine.medical_specialty ,education.field_of_study ,Hepatology ,business.industry ,General surgery ,Population ,Gastroenterology ,Esophageal cancer ,medicine.disease ,Internal medicine ,Barrett's esophagus ,medicine ,education ,business - Published
- 2017
29. 1013 Even in Comparable Patients, Non-Elective Paraesophageal Hernia Repair Portends Worse Outcomes: A Propensity-Adjusted Analysis
- Author
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Inderpal S. Sarkaria, James D. Luketich, Katie S. Nason, Manisha Shende, Vernissia Tam, Omar Awais, Ryan M. Levy, Neil A. Christie, and Daniel G. Winger
- Subjects
medicine.medical_specialty ,Paraesophageal ,Hepatology ,business.industry ,medicine.medical_treatment ,Gastroenterology ,medicine ,Hernia repair ,business ,Surgery - Published
- 2016
30. Su1754 Overall Survival but Not Recurrence Is Impacted by Post-Operative Infection After Minimally Invasive Esophagectomy for Esophagogastric Adenocarcinoma
- Author
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Omar Awais, Inderpal S. Sarkaria, Katie S. Nason, Ryan M. Levy, Vernissia Tam, Manisha Shende, James D. Luketich, and Neil A. Christie
- Subjects
medicine.medical_specialty ,Hepatology ,Post operative infection ,business.industry ,General surgery ,Invasive esophagectomy ,Gastroenterology ,medicine ,Overall survival ,Adenocarcinoma ,medicine.disease ,business - Published
- 2015
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