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1. The role of bariatric surgery in liver transplantation: timing and type

Author: Danial Safavi, Ben Creavin, Tom K. Gallagher, and Michael E. Kelly
Subjects: Treatment Outcome, Non-alcoholic Fatty Liver Disease, Gastrectomy, Humans, Bariatric Surgery, Female, Surgery, Obesity, Liver Transplantation, Obesity, Morbid, Retrospective Studies
Abstract: Introduction The rise in obesity worldwide has shifted the indications for liver transplantation (LT), with non-alcoholic steatohepatitis (NASH) being the second most common indication for transplantation. There remains an underestimation of cirrhosis being attributed to NASH. Bariatric surgery (BS) is a reliable solution to overcome obesity and its associated comorbidities. The role of BS in LT has been investigated by different studies; however, the type of BS and timing of LT need further investigation. Methods A systemic review examining the role of BS in LT patients was performed. After selection of the studies based on inclusion and exclusion criteria, data extraction was performed by two independent reviewers. Primary outcomes included patient and graft survival. Results From a total of 2374 articles, five met the prefined criteria. One hundred sixty-two patients had both BS + LT and 1426 underwent LT alone. The percentage of female patients in the BS + LT and LT cohorts was 75% and 35% respectively. The average age in BS + LT and LT cohorts was 43.05 vs. 56.22 years respectively. Patients undergoing BS had comparable outcomes in terms of overall patient survival, graft survival and post-operative morbidity compared to LT alone. When comparing BMI change in patients with prior versus simultaneous BS + LT, no significant difference was found. Conclusion BS and LT patients achieve comparable outcomes to general LT populations. Further studies examining simultaneous BS + LT are needed to answer questions concerning patient selection and timing of surgery.
Published: 2022

2. Are we choosing wisely? Drivers of preoperative MRI use in breast cancer patients

Author: Eric Brown, Amanda Mendiola, Melissa Lazar, Naveenraj L. Solomon, David W. Ollila, Marissa Howard-McNatt, Edward A. Levine, Anees B. Chagpar, Sonali V Pandya, Elisabeth Dupont, Carlos Garcia-Cantu, Mary Murray, Kristalyn K. Gallagher, Andrew Fenton, Jennifer Gass, Sharon S. Lum, Akiko Chiba, Laura Walters, and Jukes P. Namm
Subjects: Male, medicine.medical_specialty, Multivariate analysis, medicine.medical_treatment, Breast Neoplasms, Mastectomy, Segmental, law.invention, Breast cancer, Randomized controlled trial, Patient age, law, Preoperative Care, medicine, Breast-conserving surgery, Humans, Breast, Stage (cooking), Neoadjuvant therapy, Tumor histology, business.industry, General Medicine, medicine.disease, Magnetic Resonance Imaging, Neoadjuvant Therapy, Female, Surgery, Radiology, business
Abstract: Factors contributing to the use of preoperative MRI remain poorly understood.Data from a randomized controlled trial of stage 0-3 breast cancer patients undergoing breast conserving surgery between 2016 and 2018 were analyzed.Of the 396 patients in this trial, 32.6% had a preoperative MRI. Patient age, race, ethnicity, tumor histology, and use of neoadjuvant therapy were significant predictors of MRI use. On multivariate analysis, younger patients with invasive lobular tumors were more likely to have a preoperative MRI. Rates also varied significantly by individual surgeon (p 0.001); in particular, female surgeons (39.9% vs. 24.0% for male surgeons, p = 0.001) and those in community practice (58.9% vs. 14.2% for academic, p 0.001) were more likely to order preoperative MRI. Rates declined over the two years of the study, particularly among female surgeons.Preoperative MRI varies with patient age and tumor histology; however, there remains variability by individual surgeon.
Published: 2022

3. Prospective Evaluation of Radar-Localized Reflector–Directed Targeted Axillary Dissection in Node-Positive Breast Cancer Patients after Neoadjuvant Systemic Therapy

Author: Kristalyn K, Gallagher, Kathleen, Iles, Cherie, Kuzmiak, Raphael, Louie, Kandace P, McGuire, and David W, Ollila
Subjects: Radar, Sentinel Lymph Node Biopsy, Axilla, Humans, Lymph Node Excision, Breast Neoplasms, Female, Surgery, Lymph Nodes, Neoadjuvant Therapy, Neoplasm Staging
Abstract: This is a prospective, single-institution study to evaluate feasibility and accuracy of radar-localized reflector (RLR)-targeted axillary dissection (TAD) in node-positive breast cancer patients after neoadjuvant systemic therapy (NST).Patients with biopsy-proven T1-2, N1-3 disease were eligible. Before NST, a marker clip and/or RLR was placed into the positive node. After NST, RLR was inserted if not placed previously. All patients underwent RLR TAD followed by axillary lymph node dissection (ALND). Primary end points of the trial were feasibility of RLR TAD and false negative rate (FNR).Between 2017 and 2021, 101 patients with N1-3 disease underwent NST. Five patients withdrew from the study, 1 was ineligible, and there were 9 technical failures, thus our final study cohort comprised 86 patients. RLR TAD was performed with probe guidance and confirmed with intraoperative specimen radiograph. After RLR TAD, ALND was performed. Median number of RLR TAD nodes removed was 2 (range 1-10), and the RLR TAD nodes remained positive in 56 patients. Median number of ALND nodes removed was 18 (range 4-46). Accounting for 9 technical failures, feasibility was 90%. All technical failures occurred with attempted placement of RLR after NST. Feasibility rate was 100% when RLR placement occurred at diagnosis. Of the evaluable 86 patients, RLR TAD accurately predicted axillary status in 83 patients, with FNR of 5.1%.We demonstrate high accuracy of RLR TAD, especially when RLR is placed before NST. For patients who present with N1-3 disease, this is another step towards axillary surgery de-escalation strategies.
Published: 2022

4. Sociodemographic and Clinical Predictors of Neoadjuvant Chemotherapy in cT1-T2/N0 HER2-Amplified Breast Cancer

Author: Emilie D. Duchesneau, Selena J. An, Paula D. Strassle, Katherine E. Reeder-Hayes, Kristalyn K. Gallagher, David W. Ollila, Stephanie M. Downs-Canner, and Philip M. Spanheimer
Subjects: Adult, Sentinel Lymph Node Biopsy, Breast Neoplasms, Article, Neoadjuvant Therapy, Oncology, Chemotherapy, Adjuvant, Axilla, Humans, Lymph Node Excision, Female, Surgery, Lymph Nodes, Mastectomy
Abstract: The optimal treatment strategy for small node-negative human epidermal growth factor receptor 2-positive (HER2+) breast cancer remains controversial. Neoadjuvant chemotherapy may risk overtreatment, whereas surgery first fails to identify patients with residual disease in need of escalated adjuvant systemic therapy. We investigated patient characteristics associated with receipt of neoadjuvant chemotherapy.Adult women with cT1-T2/N0, HER2+ breast cancer between 2013 and 2017 in the National Cancer Database who underwent surgery within 8 months of diagnosis were included. Patients were classified as receiving neoadjuvant chemotherapy versus a surgery-first approach. We assessed the sociodemographic and clinical predictors of neoadjuvant chemotherapy versus surgery first and associations between neoadjuvant chemotherapy and breast cancer treatments using multivariable regression models.We identified 56,784 women, of whom 12,758 (22%) received neoadjuvant chemotherapy, 29,139 (53%) received adjuvant chemotherapy, 12,907 (24%) received no chemotherapy, and 1980 were missing chemotherapy information. After adjustment, cT2 stage was the strongest predictor of neoadjuvant chemotherapy compared with surgery first. Younger age and later diagnosis year were positively associated with receipt of neoadjuvant chemotherapy. In contrast, hormone receptor positivity, Black race, rural county, and government-funded or no health insurance were inversely associated with neoadjuvant chemotherapy. In multivariable analyses, patients who received neoadjuvant chemotherapy were more likely to have a mastectomy (vs. lumpectomy) and sentinel lymph node biopsy or no nodal surgery (vs. axillary lymph node dissection). Patients who received neoadjuvant chemotherapy were more likely to receive multi-agent (vs. single-agent) chemotherapy than those who received adjuvant chemotherapy.Substantial differences in the utilization of neoadjuvant chemotherapy exist in women with HER2+ breast cancer, which reflect both clinical parameters and disparities. Optimal treatment strategies should be implemented equitably across sociodemographic groups.
Published: 2022

5. Safety and immunogenicity of the two-dose heterologous Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen in children in Sierra Leone: a randomised, double-blind, controlled trial

Author: Muhammed O Afolabi, David Ishola, Daniela Manno, Babajide Keshinro, Viki Bockstal, Baimba Rogers, Kwabena Owusu-Kyei, Alimamy Serry-Bangura, Ibrahim Swaray, Brett Lowe, Dickens Kowuor, Frank Baiden, Thomas Mooney, Elizabeth Smout, Brian Köhn, Godfrey T Otieno, Morrison Jusu, Julie Foster, Mohamed Samai, Gibrilla Fadlu Deen, Heidi Larson, Shelley Lees, Neil Goldstein, Katherine E Gallagher, Auguste Gaddah, Dirk Heerwegh, Benoit Callendret, Kerstin Luhn, Cynthia Robinson, Brian Greenwood, Maarten Leyssen, Macaya Douoguih, Bailah Leigh, Deborah Watson-Jones, M Kargbo, E Bockarie, N L James, A Kabbah, A Kamara, K H Koroma, S O Langley, N William, R Kessebeh, T Mooney, L Conteh, E Smout, K Allieu, K Bangura, M S Bangura, M A Bangura, H Jalloh, A B Jalloh, I Kamara, M Kamara, A Konteh, S Koroma, C Marrah, M Sesay, M T Sesay, A T Deen, A Jalloh, R M Kaimbay, D Kain, E L Kamara, M P Kamara, O J Kamara, S L M Kamara, M Kanneh, A H Koroma, D Lahai, I S Mansaray, W S Marah, M J Massaquoi, A Nabie, N S Saidu, I Samai, J N Tengheh, A S Turay, A Fornah, F Sesay, A Sow, E Swaray, F Mansaray, T Ade-Cole, L M Bangura, M L Conteh, A M Koroma, M Koroma, A Sam, T Scott, T Sessie, J-H C Sunders, S I-S Turay, J Weekes, M Sheku, L Gibson, D Kowuor, I Ahamed, W Allieu, D U Kabba, F J Kamara, M S Kebbie, M Pessima, A Wurie, F Bah, A I Bangura, R A S Bangura, L Blango, S Boima, M Conteh, Y Conteh, M L Daramy, O Fofanah, E George, T F Hanson, M I Jalloh, M Kalawa, A M Kamara, F E Kamara, G M Kamara, H M Kamara, P B D Kamara, R T Kamara, R Kamara, D P Kanneh, I Komeh, M Kuyateh, F F Mansaray, M M Mansaray, A B Sillah, M A Tarawally, O S Turya, J B Yawmah, B Leigh, D Watson-Jones, B Greenwood, M H Samai, G F Deen, D Marke, T Sesay, P Piot, P Smith, J Edmunds, S Lees, H Larson, H Weiss, P Wilson, R Phillips, C Maxwell, D Ishola, M Afolabi, F Baiden, P Akoo, K Owusu-Kyei, D Tindanbil, H Bower, J Stuart, O M Bah, B T Rogers, A Serry-Bangura, I B Swaray, A Bangura, I J David, D G M Davies, J A Kallon, A B Kamara, I F Kamara, M M Kamara, F E Morovia, F B Suma, F Thompson, M Murray, O Kakay, F Suma, I Sesay, J Foster, D Manno, K Gallagher, S Cox, N Howard, M Cesay, P Torrani, S Sharma, E Snowden, T Banks, T Harber, J Brown, K Howard, N Melton, S Malcolm, S Welsh, R Eggo, M Jendrossek, C Pearson, K Offergeld, C Ferrault, M Van Alst, N Mahajan, M Van Looveren, S Van Ballaert, T De Cnodder, N Grobler, L Roza, T Liberi, L Armishaw, C Verkleij, T Henrick, A Banaszkiewicz, B Lowe, K Awuondo, H Hafezi, E Hancox, B Kohn, G O Tuda, G Bangura, M T Kroma, L Fofanah, A Pessima, M Rogers, O Sheriff, T W Ajala, J Fangawa, S Foday Jr, I S F Koroma, B Mansaray, H A Mansaray, K Sesay, M K Charles, P C Heroe, M Lamin Karbo, I S Yansaneh, S Gogo Egoeh, A Trye, M Amponsah, L Donelson, T Sylvester, V Owira, G Onyuka, L Nambuchi, A Oburu, D Apollo, L Vandi, N D Alghali, A Bah, I J Bangura, A C Cole, S Fofanah, H U Jalloh, K F N Jalloh, N Jalloh, H U Kabba, J N Kabba, M Kabba, J S Kamara, F Kanjie, A P Kanu, I Kargbo, G Kassa-Koroma, S B Koroma, A Sankoh, T Sankoh, O D Sesay, H Wilhem, C T Williams, I Bangura, Y Ben-Rogers, F J Jamboria, N Kamara, I Kanawah, A T Kargbo, I Swaray, L Amara, I Bundu, H B Jakema, K Kamara, M F Sheku, Q Adeleye, I Akhigbe, R Bakalemwa, N P Chami, L Altmann, B Kamara, K van Roey, P Conteh, M Samura, V Gandie, M Marrah, E Moinina, J Kalokoh, S Bosompem, T Hilton, M O Jusu, P Borboh, A S Brima, A F Y Caulker, A Kallon, B Koroma, R C Macauley, T M D Saquee, H I Williams, A R Bangura, J Fornah, B Idriss, M Sillah, W Mackay, B Aleghen, T Murray, J Edem-Hotah, T Fatorma, F Amara, S Bangura, E Bonnie, M Sannoh, A Donaldson, S Ndingi, D Nyaberi, M Pereira, A Rothwell, V Vy, L Nyallay, A Fombah, S Saidu, T P Dambo, P J Fakaba, M M E Fatorma, R H Freeman, C L Johnson, D B Kogba, A Lahai, W Vincent, N Yambasu, M Bangura, A Tengbeh, R Kabia, A M Nyakoi, M Callaghan, L Enria, and S Lee
Subjects: Male, Modified vaccinia Ankara, Pediatrics, medicine.medical_specialty, Adolescent, Antibodies, Viral, medicine.disease_cause, Injections, Intramuscular, Drug Administration Schedule, Sierra Leone, Sierra leone, Immunogenicity, Vaccine, Vaccines, DNA, Humans, Medicine, Ebola Vaccines, Child, Reactogenicity, Heterologous vaccine, Ebola virus, Ebola vaccine, business.industry, Infant, Viral Vaccines, Ebolavirus, Vaccination, Regimen, Infectious Diseases, Child, Preschool, Female, business
Abstract: Summary Background Children account for a substantial proportion of cases and deaths from Ebola virus disease. We aimed to assess the safety and immunogenicity of a two-dose heterologous vaccine regimen, comprising the adenovirus type 26 vector-based vaccine encoding the Ebola virus glycoprotein (Ad26.ZEBOV) and the modified vaccinia Ankara vector-based vaccine, encoding glycoproteins from the Ebola virus, Sudan virus, and Marburg virus, and the nucleoprotein from the Tai Forest virus (MVA-BN-Filo), in a paediatric population in Sierra Leone. Methods This randomised, double-blind, controlled trial was done at three clinics in Kambia district, Sierra Leone. Healthy children and adolescents aged 1–17 years were enrolled in three age cohorts (12–17 years, 4–11 years, and 1–3 years) and randomly assigned (3:1), via computer-generated block randomisation (block size of eight), to receive an intramuscular injection of either Ad26.ZEBOV (5 × 1010 viral particles; first dose) followed by MVA-BN-Filo (1 × 108 infectious units; second dose) on day 57 (Ebola vaccine group), or a single dose of meningococcal quadrivalent (serogroups A, C, W135, and Y) conjugate vaccine (MenACWY; first dose) followed by placebo (second dose) on day 57 (control group). Study team personnel (except for those with primary responsibility for study vaccine preparation), participants, and their parents or guardians were masked to study vaccine allocation. The primary outcome was safety, measured as the occurrence of solicited local and systemic adverse symptoms during 7 days after each vaccination, unsolicited systemic adverse events during 28 days after each vaccination, abnormal laboratory results during the study period, and serious adverse events or immediate reportable events throughout the study period. The secondary outcome was immunogenicity (humoral immune response), measured as the concentration of Ebola virus glycoprotein-specific binding antibodies at 21 days after the second dose. The primary outcome was assessed in all participants who had received at least one dose of study vaccine and had available reactogenicity data, and immunogenicity was assessed in all participants who had received both vaccinations within the protocol-defined time window, had at least one evaluable post-vaccination sample, and had no major protocol deviations that could have influenced the immune response. This study is registered at ClinicalTrials.gov , NCT02509494 . Findings From April 4, 2017, to July 5, 2018, 576 eligible children or adolescents (192 in each of the three age cohorts) were enrolled and randomly assigned. The most common solicited local adverse event during the 7 days after the first and second dose was injection-site pain in all age groups, with frequencies ranging from 0% (none of 48) of children aged 1–3 years after placebo injection to 21% (30 of 144) of children aged 4–11 years after Ad26.ZEBOV vaccination. The most frequently observed solicited systemic adverse event during the 7 days was headache in the 12–17 years and 4–11 years age cohorts after the first and second dose, and pyrexia in the 1–3 years age cohort after the first and second dose. The most frequent unsolicited adverse event after the first and second dose vaccinations was malaria in all age cohorts, irrespective of the vaccine types. Following vaccination with MenACWY, severe thrombocytopaenia was observed in one participant aged 3 years. No other clinically significant laboratory abnormalities were observed in other study participants, and no serious adverse events related to the Ebola vaccine regimen were reported. There were no treatment-related deaths. Ebola virus glycoprotein-specific binding antibody responses at 21 days after the second dose of the Ebola virus vaccine regimen were observed in 131 (98%) of 134 children aged 12–17 years (9929 ELISA units [EU]/mL [95% CI 8172–12 064]), in 119 (99%) of 120 aged 4–11 years (10 212 EU/mL [8419–12 388]), and in 118 (98%) of 121 aged 1–3 years (22 568 EU/mL [18 426–27 642]). Interpretation The Ad26.ZEBOV and MVA-BN-Filo Ebola vaccine regimen was well tolerated with no safety concerns in children aged 1–17 years, and induced robust humoral immune responses, suggesting suitability of this regimen for Ebola virus disease prophylaxis in children. Funding Innovative Medicines Initiative 2 Joint Undertaking and Janssen Vaccines & Prevention BV.
Published: 2022

6. Bridging Endocrine Therapy for HR+/HER2- Resectable Breast Cancer: Is it Safe?

Author: Philip M Spanheimer, David W. Ollila, Kathleen Iles, Madeline Thornton, Kristalyn K. Gallagher, Mya L. Roberson, and Jihye Park
Subjects: Adult, Oncology, 2019-20 coronavirus outbreak, medicine.medical_specialty, Bridging (networking), Antineoplastic Agents, Hormonal, Coronavirus disease 2019 (COVID-19), Receptor, ErbB-2, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Breast Neoplasms, Breast cancer, Surgical oncology, Internal medicine, Pandemic, North Carolina, Humans, Medicine, Pandemics, Aged, Neoplasm Staging, Probability, Aged, 80 and over, business.industry, Endocrine therapy, COVID-19, General Medicine, Middle Aged, medicine.disease, Neoadjuvant Therapy, Carcinoma, Intraductal, Noninfiltrating, Treatment Outcome, Receptors, Estrogen, Female, Receptors, Progesterone, business
Abstract: Background The COVID-19 pandemic has required new treatment paradigms to limit exposures and optimize hospital resources, including the use of neoadjuvant endocrine therapy (NAET) as bridging therapy for HR+/HER2-invasive tumors and DCIS. While this approach has been used in locally advanced disease, it is unclear how it may affect outcomes in resectable HR+/HER2- tumors. Methods Women ≥18 years diagnosed with in situ (Tis) or non-metastatic HR+/HER2- breast cancer from March-May 2019 and 2020 were included. Fisher’s exact test and two-sample t test were used to compare baseline characteristics and surgical outcomes between strata. Sub-analysis was performed between patients who received primary surgery vs a bridging NAET approach. Results Despite similar clinical characteristics, patients in 2019 were more likely to have a surgery-first approach (75% vs 42%, P-value = .0007), receive surgery sooner (22 vs 29 days, P-value < .001), and within 60 days from diagnosis date (100% vs 85%, P-value = .0301). Neoadjuvant endocrine therapy was a more prevalent approach in 2020 (48% vs 7%, P-value < .0001). Rates of clinical to pathologic up-staging remained consistent across primary surgery vs bridging NAET subgroups ( P-value = .9253). Discussion Pandemic-driven treatment protocols provide a unique opportunity to assess the utility of bridging endocrine therapy for resectable HR+/HER2- tumors. Differences in clinical and pathologic staging were similar across groups and did not appear to be affected by receipt of NAET. Our limited cohort demonstrates this strategic therapeutic avenue can optimize health care utilization and may be a reasonable approach when delaying surgery is preferred.
Published: 2021

7. Suboptimal therapy following breast conserving surgery in triple-negative and HER2-positive breast cancer patients

Author: Stephanie Downs-Canner, Paula D Strassle, Hyman B. Muss, Jeffrey E. Johnson, Kristalyn K. Gallagher, Guilherme C de Oliveira, David W. Ollila, Chris B. Agala, and Philip M Spanheimer
Subjects: Adult, 0301 basic medicine, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Breast Neoplasms, Mastectomy, Segmental, Systemic therapy, Article, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Internal medicine, HER2 Positive Breast Cancer, medicine, Breast-conserving surgery, Humans, Triple negative, Triple-negative breast cancer, Neoplasm Staging, business.industry, Cancer, medicine.disease, Combined Modality Therapy, Treatment Outcome, 030104 developmental biology, Oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Female, business, Adjuvant
Abstract: PURPOSE: To assess potential disparities in guideline-concordant care delivery among women with early-stage triple-negative and HER2-positive breast cancer treated with breast conserving therapy. METHODS: Women ≥ 40 years old diagnosed with pT2N0M0 triple-negative or HER2-positive breast cancer treated with primary surgery and axillary staging between 2012 and 2017 were identified using the National Cancer Database (NCDB). The primary outcome was receipt of adjuvant systemic therapy and radiation concordant with current guidelines. Multivariable log-binomial regression was used to assess the prevalence of optimal therapy use across patient and cancer characteristics. Kaplan–Meier curves were used to assess 5-year overall survival. Multivariable Cox proportional hazards regression was used to compare the impact of optimal therapy on 5-year mortality. RESULTS: 11,785 women were included with 7,843 receiving optimal therapy. Receipt of optimal therapy decreased with age even after adjusting for comorbidities and cancer characteristics; other sociodemographic factors were not associated with differences in receipt of optimal therapy. Among patients who did not receive adjuvant systemic therapy, most were not offered the treatment (49%) or refused (40%). Overall 5-year survival was higher among women who received optimal therapy (89% [95% CI 88.0–89.3] vs. 66% [95% CI 62.9–68.5]). Patients who received suboptimal therapy were over twice as likely to die within 5 years of their diagnosis (adjusted HR 2.44, 95% CI 2.12–2.82). CONCLUSION: Age is the primary determinant of the likelihood of a woman to receive optimal adjuvant therapies in high-risk early-stage breast cancer. Patients who did not receive optimal therapy had significantly diminished survival.
Published: 2021

8. Delivery of hepato-pancreato-biliary surgery during the COVID-19 pandemic

Author: Frederik Berrevoet, Stefan Heinrich, Susanne G. Warner, A. Balakrishnan, Andrea Laurenzi, Martin Smith, Kevin C. Conlon, Mert Erkan, Mickael Lesurtel, René Adam, Bodil Andersson, José Manuel Ramia, Tom K. Gallagher, Isabella Frigerio, Ajith K. Siriwardena, Wojciech G. Polak, Shailesh V. Shrikhande, Stefan W.M. Olde Damink, Marc G. Besselink, A. Serrablo, Erkan, Murat Mert (ORCID 0000-0002-2753-0234 & YÖK ID 214689), Balakrishnan, A., Lesurtel, M., Siriwardena, A.K., Heinrich, S., Serrablo, A., Besselink, M.G.H., Andersson, B., Polak, W.G., Laurenzi, A., Olde Damink, S.W.M., Berrevoet, F., Frigerio, I., Ramia, J.M., Gallagher, T.K., Warner, S., Shrikhande, S.V., Adam, R., Smith, M.D., Conlon, K.C., E-AHPBA Scientific and Research Committee, School of Medicine, RS: NUTRIM - R2 - Liver and digestive health, Surgery, MUMC+: MA Heelkunde (9), and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
Subjects: Male, medicine.medical_specialty, Cross-sectional study, Service delivery framework, Pneumonia, Viral, MEDLINE, Article, 03 medical and health sciences, Betacoronavirus, 0302 clinical medicine, Pancreatic cancer, Pandemic, Medicine, Humans, Personal protective equipment, Pandemics, Digestive System Surgical Procedures, Societies, Medical, Hepatology, business.industry, SARS-CoV-2, Liver Neoplasms, Gastroenterology, Cancer, COVID-19, medicine.disease, Surgery, Europe, Pancreatic Neoplasms, Biliary Tract Neoplasms, Cross-Sectional Studies, Surgical oncology, General surgery, Trainee, 030220 oncology & carcinogenesis, Hepatocellular carcinoma, Africa, 030211 gastroenterology & hepatology, Female, business, Coronavirus Infections, Delivery of Health Care
Abstract: Background: the extent of the COVID-19 pandemic and the resulting response has varied globally. The European and African Hepato-Pancreato-Biliary Association (E-AHPBA), the premier representative body for practicing HPB surgeons in Europe and Africa, conducted this survey to assess the impact of COVID-19 on HPB surgery. Methods: an online survey was disseminated to all E-AHPBA members to assess the effects of the pandemic on unit capacity, management of HPB cancers, use of COVID-19 screening and other aspects of service delivery. Results: overall, 145 (25%) members responded. Most units, particularly in COVID-high countries (>100,000 cases) reported insufficient critical care capacity and reduced HPB operating sessions compared to COVID-low countries. Delayed access to cancer surgery necessitated alternatives including increased neoadjuvant chemotherapy for pancreatic cancer and colorectal liver metastases, and locoregional treatments for hepatocellular carcinoma. Other aspects of service delivery including COVID-19 screening and personal protective equipment varied between units and countries. Conclusion: this study demonstrates that the COVID-19 pandemic has had a profound adverse impact on the delivery of HPB cancer care across the continents of Europe and Africa. The findings illustrate the need for safe resumption of cancer surgery in a “new” normal world with screening of patients and staff for COVID-19., NA
Published: 2020

9. Trends in Surgical Axillary Management in Early Stage Breast Cancer in Elderly Women: Continued Over-Treatment

Author: Paula D. Strassle, Charles Gaber, Stephanie Downs-Canner, Raphael J. Louie, Kristalyn K. Gallagher, and David W. Ollila
Subjects: medicine.medical_specialty, medicine.medical_treatment, Breast surgery, Population, Breast Neoplasms, Medical Overuse, Article, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Surgical oncology, Internal medicine, medicine, Humans, Registries, Total Mastectomy, education, Mastectomy, Aged, Neoplasm Staging, Retrospective Studies, Aged, 80 and over, education.field_of_study, Sentinel Lymph Node Biopsy, business.industry, Carcinoma, Ductal, Breast, Cancer, Retrospective cohort study, medicine.disease, United States, Oncology, 030220 oncology & carcinogenesis, Axilla, Lymph Node Excision, Female, 030211 gastroenterology & hepatology, Surgery, business
Abstract: In the past two decades, three prospective randomized trials demonstrated that elderly women with early stage hormone positive breast cancer had equivalent disease-specific mortality regardless of axillary surgery. In 2016, the Choosing Wisely campaign encouraged patients and providers to reconsider the role of axillary surgery in this population. We sought to identify factors that contribute to adopting non-operative management of the axilla in these patients. We performed a retrospective analysis of women ≥ 70 years old with cT1/T2, hormone positive invasive ductal carcinoma who underwent partial or total mastectomy, with/without axillary surgery, and did not receive adjuvant chemotherapy from the National Cancer Database from 2004 to 2015. We used multivariable log-binomial regression to model the risk of undergoing axillary surgery across region, care setting, and Charlson–Deyo scores, and analyzed temporal trends using Poisson regression. From 2004 to 2015, 87,342 of 99,940 women who met inclusion criteria (83%) had axillary surgery. Over time, axillary surgery increased from 78% to 88% (p
Published: 2020

10. Nodal positivity decreases with age in women with early‐stage, hormone receptor–positive breast cancer

Author: Stephanie Downs-Canner, Hyman B. Muss, Kristalyn K. Gallagher, David W. Ollila, Paula D. Strassle, Charles Gaber, and Raphael J. Louie
Subjects: Adult, Cancer Research, medicine.medical_specialty, Adolescent, Receptor, ErbB-2, Breast Neoplasms, Comorbidity, Mastectomy, Segmental, Article, Cohort Studies, Young Adult, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Breast cancer, Internal medicine, medicine, Adjuvant therapy, Humans, Poisson Distribution, 030212 general & internal medicine, Poisson regression, Stage (cooking), Pathological, Aged, Neoplasm Staging, Aged, 80 and over, business.industry, Incidence (epidemiology), Carcinoma, Ductal, Breast, Age Factors, Middle Aged, medicine.disease, Carcinoma, Lobular, Receptors, Estrogen, Socioeconomic Factors, Oncology, Geriatric oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Cohort, symbols, Lymph Node Excision, Regression Analysis, Female, Radiotherapy, Adjuvant, Lymph Nodes, business
Abstract: Background Despite data demonstrating the safety of omitting axillary surgery in older women with early-stage breast cancer, the incidence of axillary surgery remains high. It was hypothesized that the prevalence of nodal positivity would decrease with advancing age. Methods The National Cancer Data Base was used to construct a cohort of adult women with early-stage, clinically node-negative, estrogen receptor-positive (ER+), human epidermal growth factor receptor 2-negative breast cancer treated between 2013 and 2015. Multivariable logistic regression was used to assess the relationship between age and nodal positivity, and this was stratified by the axillary surgery category. Modified Poisson regression was used to estimate the proportion of women receiving adjuvant therapy according to age and nodal status. Results The incidence of axillary surgery among women aged 70 and older (n = 51,917) remained high nationwide (86%). There was a significant decrease in nodal positivity with advancing age in women with early-stage, ER+, clinically node-negative breast cancer from the youngest cohort up to patients aged 70 to 89 years, and this was independent of histologic subtype (ductal vs lobular), race, comorbidities, and socioeconomic factors. Overall, less than 10% of women aged 70 or older who underwent surgery had node-positive disease, regardless of axillary surgery type, and almost 95% of node-positive patients aged 70 or older were at pathological stage N1mi or N1. Conclusions Axillary surgery may be safely omitted for many older women with ER+, clinically node-negative, early-stage breast cancer. Nodal positivity declines with advancing age, and this suggests varied biology in older patients versus younger patients.
Published: 2019

11. The Impact of Neoadjuvant Treatment on Survival in Patients Undergoing Pancreatoduodenectomy With Concomitant Portomesenteric Venous Resection: An International Multicenter Analysis

Author: Bas Groot Koerkamp, Laurent Sulpice, Ho-Seong Han, Nikolaos Machairas, Eduardo de Santibañes, Motaz Qadan, Pierre-Alain Clavien, Casper H.J. van Eijck, Eduardo Barroso, Giuseppe Malleo, Patricia S. nchez Velázquez, Joon Seong Park, Mizelle D'Silva, Sarah Powell-Brett, Fabien Robin, David A. Kooby, Marco Del Chiaro, Nassiba Beghdadi, Ugo Boggi, R. Ravikumar, Dong Sup Yoon, Mohammed Abu Hilal, Alain Sauvanet, David Moskal, Kevin C. Conlon, Richard D. Schulick, Emanuel Vigia, H.K. Hwang, Martin de Santibañes, Mahmoud Abuawwad, Olivier R. Busch, Fernando Burdío, Keith D. Lillemoe, Fabio Casciani, Cristina R. Ferrone, Alexandra Rueda de Leon, Hermien Hartog, Claudio Bassi, Tara M. Mackay, Atsushi Oba, Paolo Muiesan, Ismael Dominguez-Rosado, Hugo Marques, Keith J. Roberts, Brendan P. Lovasik, Philip C. Müller, G. Belfiori, Marc G. Besselink, Syed Hussain Abbas, Harish Lavu, Emanuele Federico Kauffmann, Dimitri A. Raptis, Michael Silva, Tom K. Gallagher, Oscar Mazza, Charles J. Yeo, Massimo Falconi, Ignasi Poves, Domenico Tamburrino, Naomi M. Sell, Giuseppe Fusai, Thomas F. Stoop, Carlos Chan, Niccolò Napoli, Surgery, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, and Graduate School
Subjects: Male, Neoadjuvant treatment, medicine.medical_specialty, Time Factors, Survival, Lymphovascular invasion, medicine.medical_treatment, Resectable, Gastroenterology, Borderline resectable, Chemotherapy, Pancreatic cancer, Pancreaticoduodenectomy, Portal vein resection, Portomesenteric vein invasion, Radiotherapy, Aged, Europe, Female, Follow-Up Studies, Humans, Mesenteric Veins, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Pancreas, Pancreatic Neoplasms, Portal Vein, Retrospective Studies, Survival Rate, Vascular Surgical Procedures, SDG 3 - Good Health and Well-being, Interquartile range, Internal medicine, Diabetes mellitus, medicine, In patient, Vein, Neoadjuvant therapy, business.industry, medicine.disease, medicine.anatomical_structure, Editorial, Concomitant, Surgery, business
Abstract: OBJECTIVE: The aim of this study was to evaluate whether neoadjuvant therapy (NAT) critically influenced microscopically complete resection (R0) rates and long-term outcomes for patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy (PD) with portomesenteric vein resection (PVR) from a diverse, world-wide group of high-volume centers. SUMMARY OF BACKGROUND DATA: Limited size studies suggest that NAT improves R0 rates and overall survival compared to upfront surgery in R/BR-PDAC patients. METHODS: This multicenter study analyzed consecutive patients with R/BR-PDAC who underwent PD with PVR in 23 high-volume centers from 2009 to 2018. RESULTS: Data from 1192 patients with PD and PVR were collected and analyzed. The median age was 68 [interquartile range (IQR) 60-73] years and 52% were males. Some 186 (15.6%) and 131 (10.9%) patients received neoadjuvant chemotherapy (NAC) alone and neoadjuvant chemoradiotherapy, respectively. The R0/R1/R2 rates were 57%, 39.3%, and 3.2% in patients who received NAT compared to 46.6%, 49.9%, and 3.5% in patients who did not, respectively (P =0.004). The 1-, 3-, and 5-year OS in patients receiving NAT was 79%, 41%, and 29%, while for those that did not it was 73%, 29%, and 18%, respectively (P
Published: 2021

12. Variations in the utilization of immediate post-mastectomy breast reconstruction

Author: Cara G. Moses, Michelle C. Roughton, Karishma G. Reddy, Kandace P. McGuire, Apoorve Nayyar, Danielle I. Jameison, Kristalyn K. Gallagher, and Paula D. Strassle
Subjects: Adult, medicine.medical_specialty, Mammaplasty, medicine.medical_treatment, Breast Neoplasms, 030230 surgery, Logistic regression, White People, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Post mastectomy, medicine, Humans, Mastectomy, Aged, Marital Status, business.industry, Obstetrics, Age Factors, Cancer, General Medicine, Middle Aged, Patient Acceptance of Health Care, medicine.disease, United States, Black or African American, 030220 oncology & carcinogenesis, Marital status, Female, Surgery, business, Breast reconstruction, Psychosocial, Procedures and Techniques Utilization
Abstract: For female breast cancer (BC) patients undergoing mastectomy, post-mastectomy breast reconstruction (PMBR) confers significant psychosocial benefits and improved cosmetic outcomes. The objective of this study is to explore whether the utilization of PMBR varies by race, marital status, and geographical location of the patient.Women ≥18 years old who underwent mastectomy for breast cancer diagnosed between 2000 and 2014 were eligible. Women with inflammatory BC, Stage IV BC diagnoses, and bilateral BC were excluded. Multivariable logistic regression, adjusting for patient and cancer characteristics, were used to assess the association between of race, marital status, and region on immediate PMBR utilization.321,206 women were included and 24% underwent immediate PMBR (4 months after mastectomy). Compared to white women, black and other non-white women (OR 0.67, 95% CI 0.65, 0.70 and OR 0.52, 95% CI 0.50, 0.53, respectively) were significantly less likely to receive PMBR. Additionally, women who were single (OR 0.72, 95% CI 0.70, 0.75) or no longer married (OR 0.84, 95% CI 0.82, 0.86) were significantly less likely to undergo breast reconstruction, compared to married women. Regional differences were also seen, with women in the Northeast (OR 2.11, 95% CI 2.05,2.17), Midwest (OR 1.53, 95% CI 1.48, 1.58) and South (OR 1.20, 95%CI 1.17, 1.23) all being more likely to undergo breast reconstruction compared to the West.Significant variations exist in the utilization of post-mastectomy breast reconstruction across race, marital status or geographical location of the patient. Further research is needed to elucidate these differences and identify areas for intervention to increase awareness, and access to reconstruction for all breast cancer patients.
Published: 2019

13. Sexual harassment and women in surgery: Changing the lived experience

Author: Kristalyn K. Gallagher and Apoorve Nayyar
Subjects: medicine.medical_specialty, business.industry, Lived experience, MEDLINE, Internship and Residency, Physicians, Women, Sexual Harassment, Family medicine, General Surgery, Harassment, Medicine, Humans, Surgery, Female, business
Published: 2021

14. BJS commission on surgery and perioperative care post-COVID-19

Author: E. Abahuje, A. Abbas, M. Abd El Aziz Abd El Maksoud, A. Abdelhady, S. Abdelhamid, H. Abdelkarem Ahmed Faraj, B. Abdelqader, T. Abdelrahman, H. Abdou, A. Abdullah, M. Abedua Harrison, E. Abem Owusu, A. Aboalazayem, R. Aboulhosn, S. Abu Oda, A. Abubakar, A. Abutaka, D. Acevedo Fontalvo, S. Acuna, A. Adefemi, S. Adegbola, T. Adenuga, A. Adeyeye, A. Adil Hilmi, A. Adisa, K. Aditya, T. Adjeso, R. Aftab, A. Afzal, V. Aggarwal, A. Aggarwal, R. Aguilera, M. -L. Aguilera-Are´valo, E. J. Aguirre Salamanca, I. Aguirre-Allende, D. Ahari, H. Ahmad, F. Ahmad Rauf, A. Ahmad Zartasht Khan, S. Ahmed, N. Ahmed Fieturi, S. Ahmed Mohamed, Z. Ahmed-Bakhsh, M. Ahsan Javed, L. Akano, A. Akbar, M. Akhbari, P. Akhmedov, G. Aksit, Y. Akula, A. S. Alagaratnam, S. Al Majid, O. Al Mukhtar, H. Al Omran, N. AlAsali, M. Al-Azzawi, R. Al-Habsi, H. Al-Iraqi, H. Al-Naggar, E. Alameer, H. Albirnawi, D. Alderson, F. Aldulaijan, R. Alejandro Miranda Ojeda, A. AlHasan, S. Ali, A. Ali, M. Ali Khan, Y. Alimova, F. Aljanadi, R. Aljubure, N. Allopi, H. Almedbal, M. Almubarak, Z. Alqaidoom, N. Alselaim, M. Alshaar, R. Alshammari, K. Altaf, S. Altıner, B. Altunpak, L. A. Alvarez Lozada, E. Amal Nahal, A. Amer, K. Amin, U. Aminu, N. Amisi Numbi, T. Amjad, R. Amoah, Y. An, N. -A. Anastasopoulos, J. Andre´s Urrutia, F. Angarita, K. -L. Angarita, M. A´ ngel FreirI´a Eiras, A. Antypas, M. A. Anwar, H. Anwar, T. O. Apampa, K. Apostolou, C. Aquina, R. Arachchige Adithi Himika Randeni, M. I. Archila Godı´nez, O. Arez, A. A. Arezzo, P. Armonis, S. Arshad, M. Arshad Salman, A. Arshid, P. C. Arteaga Asensio, T. Arthur, A. Arumuga Jothi, F. Aryo Damara, L. Asensio Gomez, J. Ashcroft, S. Ashraf, A. Asif, M. Atif, M. Attaullah Khan, N. Avellaneda, S. Awad, M. Awadh, A. Axiaq, A. Ayad Mohammed Shuwayyah, D. Ayalew, E. Aytac, F. Azam, J. Azevedo, B. Azhar, J. Aziz, A. Aziz, A. Azzam, A. Baba Ndajiwo, M. Baig, D. Baker, F. Bakko, R. Balachandran, G. Balachandran, J. Balagizi Mudekereza, E. Balai, B. Balci, A. Balduzzi, A. Balhareth, S. Bandyopadhyay, D. Banerjee, D. Bangalore Mahalinga, B. Bankhead-Kendall, N. D. A. Bankole, V. Banwell, F. Baris Bengur, B. Baris Ozmen, M. Barnard, R. Barnett, J. A. Barreras Espinoza, A. Barrios, G. Bass, M. Bass, A. Bausys, A. Bavikatte, J. Bayram, M. Belousov, A. G. Berardi, A. Beamish, C. Beattie, F. Belia, V. Bellato, S. Bellikatti, S. Benjamens, C. Benlice, S. Bennedsgaard, S. Bennett, Z. Bentounsi, H. Bergenfeldt, A. Bergenfelz, M. Besselink, G. Bhandoria, E. Bhangu, M. Bhatia, M. T. Bhatti, Z. Bilgili, G. Bislenghi, C. Bisset, S. Biswas, J. Blake, R. Blanco, L. Boccalatte, R. Boden, C. Bojanic, M. Boland, P. Boland, E. Bollen, E. -A. Bonci, L. Boni, A. Booth, R. Booth, A. Borakati, G. E. Borunda Escudero, S. J. Bosco, P. Bostro¨ m, P. Botelho de Alencar Ferreira Cruz, K. Bouchagier, A. Bouhuwaish, M. Boutros, K. Boyce, C. Boyle, L. Bradshaw, A. Brandl, A. Brar, G. Brat, H. Brenkman, C. Brennan, C. Brines, A. Brookmyre, C. Brosnan, L. Brouwers, A. Brown, L. Brown, C. Brown, J. Brown, V. BS, M. Buksh, M. Bunani Emmanuel, D. Burbano, A. Burelli, A. Burke, J. Burke, N. Burlov, A. Burns, O. Burton, A. Butt, B. Buzra Ozkan, L. Cabrera Silva, E. Y. Caicedo, T. Calderbank, W. Cambridge, G. Campelo, O. Can Tatar, F. Carbone, F. Carrano, D. Casallas, D. Casanova Portoles, F. Casciani, I. Cassimjee, O. A. Castaneda Ramı´rez, V. Catala´ n, J. Caviedes, L. Cayetano, M. ~ Ceresoli, M. Chan, V. Chan, P. Chandrasinghe, S. Chapman, A. Chaturvedi, D. Chaudhry, H. Chaudry, H. W. Chen, A. Cheng, M. Chernykh, A. M. Cherrie, I. Cheruiyot, J. Cheung, C. Chia, J. Chica, N. Chinai, A. Chirwa, J. Chiwaligo, A. Choi, J. Choi, M. R. Chowdhury, E. Christopher, N. Christou, T. Chu, D. Chua, H. W. Chua, C. Chung, A. Cihat Yildirim, M. Cillo, S. Cioffi, H. Claireaux, S. Clermonts, R. Clifford, M. Climent, A. Clynch, R. -J. Coelen, E. Cola´ s-Ruiz, A. Collar, M. Collard, K. C. Conlon, T. Connelly, K. Connor, J. A. Cook, T. Correia de Sa´, N. Cos¸gun Acar, T. Costa, D. Couch, S. Cowper, B. Creavin, B. Crook, A. Curell, R. D’alessio, J. Dale, J. Damgaard Eriksen, I. Dario Martin Gonzalez, A. Darwish, M. Das, R. Das, K. Das, R. Dave, S. O. David, T. Davies, C. Davis, S. Davison, V. Davletshina, A. Dawidziuk, A. Dawson, M. de Andres Crespo, H. de Berker, P. de Dieu Ngo, E. Dekker, R. de la Caridad Espinosa Luis, B. de Lacy, N. Demartines, A. de Montserrat Medina Sifuentes, S. De Silva, C. del Rio, V. Delaune, A. Dell, I. Demirbas¸, S. Demirli Atici, M. Deniz Tepe, M. Derebey, G. Desai, M. Desai, S. Devarakonda, N. Deveras, G. Di Franco, M. Di Martino, F. Di Marzo, A´ . Dı´az, G. Diaz del Gobbo, C. DiazCastrillon, L. Dick, K. Dickinson, E. Diego, I. Dimasi, A. Ding, S. Dingemans, L. Dixon, B. Dixon, W. Doherty, D. Dooreemeah, C. Donohue, M. Dornseifer, F. Dossa, W. Dossou, T. Drake, I. Drami, G. Drevin, M. C. du Plessis, N. Dudi-Venkata, R. Dudley, S. Duffy, D. Duklas, B. -D. Dumbrava, F. Duygu Avlar, A. Dworzynska, W. Ebrahim, A. Ebrahim, E. Efre´n Lozada Herna´ ndez, N. Ehigie, M. El Boghdady, C. El Hasnaoui, M. El Sheikh, A. El-Hussuna, O. Eldurssi, H. Elfeki, M. Elhadi, M. Elhassan, A. Elhissi, B. Elliot, C. Elsenbroek, B. Elsolh, N. Elson, H. Eltyeb, H. Emerson, S. H. Emile, G. Endalle, W. English, C. Ercisli, G. Espinosa, M. Essam Abdelraheem, H. Essangri, P. Etienne, M. D. Evans, T. Evans, C. Ezeme, F. Ezzahraa, T. Fadalla, J. Fagan, M. Fahmy, C. Fairfield, O. Falade, S. Famularo, F. Faqar-Uz-Zaman, Y. Farid, A. Farooq, H. Farooq, F. Farooqui, B. Farquharson, A. Faruqi, R. Faulder, M. Faut, K. Fechner, T. Feenstra, M. Fehervari, L. Fernandez, J. Ferna´ ndez Alberti, L. Ferrario, D. Field, L. Fiore, S. Fingerhut, S. Finlayson, N. Fleming, C. Fleming, E. Florial, M. Fok, D. Fokin, M. Foley, M. P. Forero, T. Forgan, M. Fornasiero, H. Fowler, G. Fowler, E. Franchi, L. Franklin, A˚ . Fredriksson, P. Fruhling, G. Fuentes Navarrette, A. Fu¨ lo¨ p, M. Furtado, T. Gaarder, N. Galbraith, I. T. K. Gallagher, G. Gallo, T. Gana, E. Gaskin, M. Gasparini, R. G. Gatan, E. Geary, K. Gelaye Wudineh, G. Gemenetzis, M. Georgi, H. Ghalige, W. Ghareeb, T. Ghatwary Tantawy, C. Ghomsi, A. Ghuman, P. Giannakis, F. Giron, K. Gjengedal, E. Gkotsis, J. Glasbey, S. Godahewa, D. Godula, P. Goffredo, S. Goh, M. Golriz, L. Gomez, D. Gomez Gomez, R. Gonzalez, D. Gonzalez, E. Gonzalez Gutierrez, D. Gopar, L. Gordini, A. Gori, S. Gorta´ zar, N. Gousy, R. Gowda, M. Gowda, J. Gqada, M. Grechenig, J. Greer, L. Grego´ rio, A. Grigorova, H. Grimes, V. Groot, R. C. Grossman, R. Gruber, A. Gru¨ ter, R. Guest, R. Gujjuri, E. Gu¨ lc¸ek, B. Gulcu, K. Gull, M. Gulmez, V. Gupta, A. Gutlic, T. Guven, T. Gwatirisa, G. Gwini, P. Gwodog, S. Gysling, M. Habib, A. B. Hafeez Bhatti, J. Hallesmith, S. Halloran, M. Hamza Sadiq, C. Haney, N. Hanna, L. Hanna, M. Hannington, J. Harbjerg, D. Haribaskaran, N. Harran, B. Harrington, E. Harrison, R. Hasan, S. Hashmi, M. Hassan, A. Hassan, L. Haverkamp, S. Hazen, B. Heer, J. Heil, J. Helliwell, N. Henriksen, D. Henshall, M. Hermanson, S. Hermena, D. Hettiarachchi, C. Hextall, M. Hidalgo, H. Hidayat, A. Hider, P. Higgins, R. Hinchliffe, D. Hirani, D. Hirpara, I. Hisham, M. Hite, S. M. Hoh, C. Holmberg, E. Ho¨ lmich, F. Holst, A. Hossam, A. Hossam Elfallal, P. Howard, E. Huaman, Y. Huang, L. Huang, D. Huang, T. Huber, J. Hugh, J. Hughes, F. Hu¨ ttner, R. Huynh, A. Hylands, J. Iannuzzi, B. Ielpo, A. Iftikhar Talib, J. Ignacio, P. Ignatavicius, S. Ike, C. Ikwu, M. Inama, A. Ing, A. Ingels, A. Isik, N. Islam, I. J. Ives, A. J. M. S. AlHasan, C. J. Perez Rivera, F. Ja´ come, T. Jaffer, O. Jagiella-Lodise, M. Jain, K. Jain, M. Jakubauskas, M. Jalal, H. James, Y. Jang, B. Janssen, H. Jansson, U´ . Jariod-Ferrer, H. Javanmard, S. Javed, U. Jayarajah, I. Jayasuriya, J. Je, Z. Jessop, E. Jia Lin Tang, H. Jiang, Y. Jiayan, T. Jih Huei, R. Jimenez-Rodriguez, D. Joh, A. Johnson, N. Jones, C. Jones, C. Jordan, J. Jose´ Nu´ nez Ju, ~ M. Jose´ Pizarro, C. Jose Salazar J. Joseph, C. Justiniano, T. Kabir, M. Kadhum, C. Kalfountzos, E. Kalogiannaki, K. Kalyanasundaram, S. Kamarajah, M. Kamil Quraishi, Y. Kanemitsu, A. Kapila, V. Kapila, G. Karagiannidis, M. Kashif, S. Kathiravelupillai, A. Kathiravelupillai, E. Katsogridakis, K. Kaur, H. Kaur Sekhon Inderjit Singh, N. Kausur, M. Kawka, G. Keehan, S. Kehlet Watt, M. Kelly, M. E. Kelly, I. Kelvin Egbuchulem, G. Kembuan, E. Khajeh, A. Khaled Elfaitur, M. F. Khan, S. Khan, M. Khan, D. Khan, H. Khan, H. Khatkar, E. Khatkov, R. Khaw, B. Kim, K. Kishore Siddiraju, D. Kitua, B. Kırımtay, S. Kmezic, S. Knight, T. Koe¨ter, A. Koh, F. Koh Hong Xiang, T. Kojo Anyomih, A. I. N. Kok, R. Kokelaar, I. Koliarakis, S. Kolli, J. Kong, D. Ko¨ nig, M. otze, A. Kourdouli, M. Kowal, A. Kraima, F. Kramer, M. Kryzauskas, I. Kuchynskyi, C. Kuemmerli, S. Kuiper, S. Kumar, A. Kumar, L. Kumar, H. Kumar, N. Kumar, S. Kumar Bandyopadhyay, P. Kumar Garg, S. Kumar Venkatappa, J. Kung, S. Kural, A. Kushairi, E. Kuuzie, M. Kvietkauskas, I. Kwek, J. La, L. Lai, S. Lakpriya, K. Lam, M. Lami, I. Lansdorp-Vogelaar, P. Lapolla, H. Larsen, J. Latif, U. Laudari, A. Laurnezi, A. Lawal, S. Lawday, H. Lederhuber, A. Lednev, R. Lee, M. E. van Leerdam, G. Lefevbre, M. Lesmus, F. A. Leyva Moraga, E. Leyva Moraga, F. Leyva Moraga, H. L. Li, A. Li, Z. Li, E. Licardie, A. Light, A. L. Lightner, A. Lin, E. Lincango, F. Litta, H. Liu, B. Lofthouse, M. A. Londono, R. Lopes, R. Lopes de Freitas, L. Lopez, A. I. Lo´ pez, J. ~ Lopez-Gomez, G. Lopez-Pena, R. Lowe, D. Lowe, M. Lowey, G. Loy, V. Lozanovski, J. Luzon, P. Lynn, T. Maccabe, A. Machielsen, C. A. Mafla Herrerı´a, L. Maggino, K. Mahawar, D. Mahmood, M. Mahmoud, K. Mahtani, I. Maitra, S. Maji, I. Majiet, L. Mal, J. Malherbe, K. Malhotra, P. Malkomes, E. Man, A. Manan Sheikh, S. Manjunath, R. Manzano Nunez, S. Manzoor, R. Maqsood, G. ~ Marchegiani, F. Marchegiani, D. Marı´n, A. Marin, I. Marks, E. Marson, A. Martensen, D. Martin, G. Martı´n Martı´n, B. Martin-Perez, P. Martinez, P. Marwaha, C. Mashauri, H. Mashbari, Ł. Masior, R. Masri, L. Masud, S. Masudi, G. Mateu Calabuig, S. Math, A. Matrachisia, J. Mayol, D. Mazingi, A. Mazzotta, J. McAlinden, G. McCabe, L. McColm, H. McElvaney, K. McGivern, J. McGovern, E. McGuinness, N. McInerney, S. Mckay, C. McKee, M. McKenna, N. McKenna, K. McLean, S. Mediratta, Y. Medkova, O. Medzhidov, A. Mehraj, M. Mekhael, O. Mekinde, C. Mellenthin, A. Melucci, K. Mentor, J. Merchant, H. Messias, M. Messeha, C. Meza, P. Mhango, M. Miladinov, M. Milagros Niquen Jimenez, P. Miller, E. Mills, A. Milton, O. A. Minayeva, Z. MinHua Zheng, H. Mischlinger, B. Mo¨ ckli, R. Modi, H. M. Mohamed, M. Mohamed, T. Mohamed Abulghasm, S. A. Mohammad, T. O. Mohammed, A. Mohammed, H. Mohan, M. Mohan, I. Moin, V. Mok, G. Molina, J. Moloney, J. Moneim, M. Monfort Mira, B. Montcusı´ Ventura, M. Montouri, M. Moossdorff, I. Mora-Guzma´ n, B. Moran, R. A. R. Mora´ n, S. Moreno-Ordaz, A´ . Morera, R. Morgan, R. Morley, D. Moro-Valdezate, S. Moros, J. -L. Moss, A. 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Subjects: Adult, Male, medicine.medical_specialty, Biomedical Research, Coronavirus disease 2019 (COVID-19), International Cooperation, Practice Patterns, Commission, Global Health, Health Services Accessibility, Perioperative Care, Education, Surgeon, COVID-19, surgery, perioperative care, Medical, Pandemic, Humans, Medicine, Practice Patterns, Physicians', Graduate, Pandemics, Surgeons, Health Resource, Infection Control, Physicians', Surgical Procedures, business.industry, General surgery, Middle Aged, Operative, Education, Medical, Graduate, Surgical Procedures, Operative, Perioperative care, Health Resources, Surgery, Female, business, Human
Abstract: Background Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues’ experiences and published evidence. Methods In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.
Published: 2021

15. Elective cancer surgery in COVID-19–Free surgical pathways during the SARS-cov-2 pandemic: An international, multicenter, comparative cohort study

Author: James C Glasbey, Dmitri Nepogodiev, Joana Ff Simoes, Omar Omar, Elizabeth Li, Mary L Venn, Mohammad Abou Chaar, Vita Capizzi, Daoud Chaudhry, Anant Desai, Jonathan G Edwards, Jonathan P Evans, Marco Fiore, Jose Flavio Videria, Samuel J Ford, Ian Ganyli, Ewen A Griffiths, Rohan R Gujjuri, Angelos G Kolias, Haytham Ma Kaafarani, Ana Minaya-Bravo, Siobhan C McKay, Helen M Mohan, Keith Roberts, Carlos San Miguel-Méndez, Peter Pockney, Richard Shaw, Neil J Smart, Grant D Stewart, Sudha Sundar, Raghavan Vidya, Aneel A Bhangu, James C Glasbey, Omar Omar, Aneel A Bhangu, Kwabena Siaw-Acheampong, Ruth A Benson, Edward Bywater, Daoud Chaudhry, Brett E Dawson, Jonathan P Evans, James C Glasbey, Rohan R Gujjuri, Emily Heritage, Conor S Jones, Sivesh K Kamarajah, Chetan Khatri, Rachel A Khaw, James M Keatley, Andrew Knight, Samuel Lawday, Elizabeth Li, Harvinder S Mann, Ella J Marson, Kenneth A McLean, Siobhan C McKay, Emily C Mills, Dmitri Nepogodiev, Gianluca Pellino, Maria Picciochi, Elliott H Taylor, Abhinav Tiwari, Joana Ff Simoes, Isobel M Trout, Mary L Venn, Richard Jw Wilkin, Aneel A Bhangu, James C Glasbey, Neil J Smart, Ana Minaya-Bravo, Jonathan P Evans, Gaetano Gallo, Susan Moug, Francesco Pata, Peter Pockney, Salomone Di Saverio, Abigail Vallance, Dale Vimalchandran, Ewen A Griffiths, Sivesh K Kamarajah, Richard Pt Evans, Philip Townend, Keith Roberts, Siobhan McKay, John Isaac, Sohei Satoi, John Edwards, Aman S Coonar, Adrian Marchbank, Edward J Caruana, Georgia R Layton, Akshay Patel, Alessandro Brunelli, Samuel Ford, Anant Desai, Alessandro Gronchi, Marco Fiore, Max Almond, Fabio Tirotta, Sinziana Dumitra, Angelos Kolias, Stephen J Price, Daniel M Fountain, Michael D Jenkinson, Peter Hutchinson, Hani J Marcus, Rory J Piper, Laura Lippa, Franco Servadei, Ignatius Esene, Christian Freyschlag, Iuri Neville, Gail Rosseau, Karl Schaller, Andreas K Demetriades, Faith Robertson, Alex Alamri, Richard Shaw, Andrew G Schache, Stuart C Winter, Michael Ho, Paul 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McNaught, R Alam, A Budacan, J Cahill, M Kalkat, S Karandikar, L Kenyon, D Naumann, A Patel, J Ayorinde, T Chase, T Cuming, A Ghanbari, L Humphreys, S Tayeh, A Aboelkassem Ibrahim, R Bichoo, H Cao, Akw Chai, J Choudhury, C Evans, H Fitzjohn, H Ikram, M Langstroth, M Loubani, A McMillan, S Nazir, Ssa Qadri, A Robinson, E Ross, T Sehgal, A Wilkins, J Dixon, J Dunning, K Freystaetter, M Jha, S Lester, A Madhavan, S V Thulasiraman, Y Viswanath, T Curl-Roper, C Delimpalta, Ccl Liao, V Velchuru, E Westwood, E Belcher, G Bond-Smith, S Chidambaram, F Di Chiara, K Fasanmade, L Fraser, H Fu, M Ganau, S Gore, J Graystone, D Jeyaretna, H Khatkar, M Lami, M Maher, S Mastoridis, R Mihai, R Piper, S Prabhu, Obf Risk, U Selbong, K Shah, R Smillie, H Soleymani Majd, S Sravanam, D Stavroulias, G D Tebala, M Vatish, C Verberne, K Wallwork, S Winter, M I Bhatti, H Boyd-Carson, E Elsey, E Gemmill, P Herrod, M Jibreel, E Lenzi, T Saafan, D Sapre, T Sian, N Watson, A Athanasiou, G Bourke, L Bradshaw, A Brunelli, J Burke, P Coe, F Costigan, H Elkadi, M Ho, J Johnstone, A Kanatas, V Kantola, A Kaufmann, A Laios, S Lam, E MacInnes, S Munot, C Nahm, M Otify, C Pompili, I Smith, G Theophilou, G Toogood, R Wade, D Ward, C West, S Annamalai, C Ashmore, A Boddy, T Hossain, A Kourdouli, A Gvaramadze, A Jibril, L Prusty, D Thekkinkattil, A Harky, M Shackcloth, A Askari, C Chan, N Cirocchi, S Kudchadkar, K Patel, J Sagar, S Shaw, R Talwar, M Abdalla, R Edmondson, O Ismail, D Jones, K Newton, N Stylianides, A Aderombi, U Andaleeb, O Bajomo, K Beatson, W Garrett, M Mehmood, V Ng, R Al-Habsi, G S Divya, B Keeler, B Al-Sarireh, R Egan, R Harries, A Henry, M Kittur, Z Li, K Parkins, F Soliman, N Spencer, D Thompson, C Burgess, C Gemmell, C Grieco, M Hollyman, L Hunt, J Morrison, S Ojha, N Ryan, F Abbadessa, S Barnard, C Chan, N Dawe, J Hammond, Ali F Mahmoud, I McPherson, C Mellor, J Moir, S Pandanaboyana, J Powell, B Rai, A Rogers, C Roy, A Sachdeva, C Saleh, S Tingle, T Williams, J Manickavasagam, C McDonald, N McGrath, N McSorley, K Ragupathy, L Ramsay, A Solth, O Kakisi, K Seebah, I Shaikh, L Sreedharan, M Youssef, J Shah, P Ameerally, N McLarty, S Mills, A Shenfine, K Sahnan, J Abu, E Addae-Boateng, D Bratt, L Brock, N Burnside, S Cadwell-Sneath, K Gajjar, C Gan, C Grundy, K Hallam, K Hassell, M Hawari, A Joshi, H Khout, K Konstantinidi, Rxn Lee, D Nunns, R Schiemer, T Walton, H Weaver, L Whisker, K Williamson, J McVeigh, R Myatt, M A Williams, R Kaur, E Leung, S Sundar, M Michel, S Patil, S Ravindran, J Sarveswaran, L Scott, M Edmond, E King, M Almond, A Bhangu, O Breik, L D Cato, A Desai, S Ford, E Griffiths, M Idle, M Kamal, A Kisiel, R Kulkarni, Jkc Mak, T Martin, P Nankivell, A Parente, S Parmar, A M Pathanki, L Phelan, P Praveen, S Saeed, N Sharma, J Singh, F Tirotta, D Vijayan, A Geddes, J McCaul, J McMahon, A H Khan, F Khan, A Mansuri, S Mukherjee, M Patel, M Sarigul, S Singh, K L Tan, A Woodham, A Adiamah, H Brewer, A Chowdhury, J Evans, D Humes, J Jackman, A Koh, C Lewis-Lloyd, O Oyende, J Reilly, D Worku, P Cool, G Cribb, K Shepherd, C Bisset, S Moug, N Elson, G Faulkner, P Saleh, C Underwood, G Brixton, L Findlay, T Klatte, A Majkowska, J Manson, R Potter, A Bhalla, Z Chia, P Daliya, A Goyal, E Grimley, A Hamad, A Kumar, F L Malcolm, E Theophilidou, J Bowden, N Campain, I Daniels, C Evans, G Fowler, J John, L Massey, F McDermott, J McGrath, A McLennan, M Ng, J Pascoe, N Rajaretnam, S Bulathsinhala, B Davidson, G Fusai, C Hidalgo Salinas, N Machairas, T Pissanou, J M Pollok, D A Raptis, F Soggiu, H Tzerbinis, S E Xyda, A Beamish, E Davies, R Foulkes, D Magowan, H Nassa, R Ooi, C Price, L Smith, F Solari, A Tang, G Williams, Y Al-Tamimi, A Bacon, N Beasley, D Chew, M Crank, N Ilenkovan, M Macdonald, B Narice, O Rominiyi, A Thompson, I Varley, T Drake, E Harrison, G Linder, J Mayes, R McGregor, R Skipworth, V Zamvar, E Davies, P Hawkin, T Raymond, O Ryska, R Baron, D Dunne, S Gahunia, C Halloran, N Howes, R McKinney, F McNicol, J Russ, P Szatmary, J R Tan, A Thomas, P Whelan, A Anzak, A Banerjee, O Fuwa, F Hughes, J D Jayasinghe, C Knowles, H Kocher, I Leal Silva, F S Ledesma, A Minicozzi, L Navaratne, R Rahman, R Ramamoorthy, C Sohrabi, M Thaha, B Thakur, M Venn, V Yip, R Baumber, J Parry, S Evans, L Jeys, G Morris, M Parry, J Stevenson, N Ahmadi, G Aresu, Z M Barrett-Brown, A S Coonar, H Durio Yates, D Gearon, J Hogan, M King, A Peryt, I S Pradeep, C Smith, M Adishesh, R Atherton, K Baxter, M Brocklehurst, M Chaudhury, N Krishnamohan, J McAleer, G Owens, E Parkin, P Patkar, I Phang, A Aladeojebi, M Ali, B Barmayehvar, A Gaunt, M Gowda, E Halliday, M Kitchen, F Mansour, M Thomas, D Zakai, N Abbassi-Ghadi, H Assalaarachchi, A Currie, M Flavin, A Frampton, M Hague, C Hammer, J Hopper, J Horsnell, S Humphries, A Kamocka, T K Madhuri, S Preston, P Singh, J Stebbing, A Tailor, D Walker, F Aljanadi, M Jones, P Mhandu, C O'Donnell, R Turkington, Z Al-Ishaq, S Bhasin, A S Bodla, A Burahee, A Crichton, R Fossett, N Pigadas, S Pickford, E Rahman, D Snee, R Vidya, N Yassin, F Colombo, D Fountain, M T Hasan, K Karabatsou, R Laurente, O Pathmanaban, A Al-Mukhtar, S Brown, J Edwards, A Giblin, C Kelty, M Lee, G Lye, T Newman, A Sharkey, C Steele, N Sureshkumar Shah, E Whitehall, R Athwal, A Baker, L Jones, C Konstantinou, S Ramcharan, S Singh, J Vatish, R Wilkin, M Ethunandan, G K Sekhon, H Shields, R Singh, F Wensley, S Lawday, A Lyons, T Abbott, S Anwar, K Ghufoor, C Sohrabi, E Chung, R Hagger, A Hainsworth, A Karim, H Owen, A Ramwell, K Williams, C Baker, A Davies, J Gossage, M Kelly, W Knight, J Hall, G Harris, G James, C Kang, D J Lin, A D Rajgor, T Royle, R Scurrah, B Steel, L J Watson, D Choi, R Hutchison, A Jain, V Luoma, H Marcus, R May, A Menon, B Pramodana, L Webber, I A Aneke, P Asaad, B Brown, J Collis, S Duff, A Khan, F Moura, B Wadham, H Warburton, T Elmoslemany, M Jenkinson, C Millward, R Zakaria, S Mccluney, C Parmar, S Shah, J Allison, M S Babar, B Collard, S Goodrum, K Lau, A Patel, R Scott, E Thomas, H Whitmore, D Balasubramaniam, B Jayasankar, S Kapoor, A Ramachandran, A Elhamshary, Smb Imam, K Kapriniotis, V Kasivisvanathan, J Lindsay, S Rakhshani-Moghadam, N Beech, M Chand, L Green, N Kalavrezos, H Kiconco, R McEwen, C Schilling, D Sinha, J Pereca, J Singh, S Chopra, D Egbeare, R Thomas, T Combellack, Sef Jones, M Kornaszewska, M Mohammed, A Sharma, G Tahhan, V Valtzoglou, J Williams, P Eskander, K Gash, L Gourbault, M Hanna, T Maccabe, C Newton, J Olivier, S Rozwadowski, E Teh, D West, H Al-Omishy, M Baig, H Bates, G Di Taranto, K Dickson, N Dunne, C Gill, D Howe, D Jeevan, A Khajuria, K Martin-Ucar AMcEvoy, P Naredla, V Ng, S Robertson, M Sait, D R Sarma, S Shanbhag, T Shortland, S Simmonds, J Skillman, N Tewari, G Walton, M A Akhtar, A Brunt, J McIntyre, K Milne, M M Rashid, A Sgro, K E Stewart, A Turnbull, M Aguilar Gonzalez, S Talukder, C Boyle, D Fernando, K Gallagher, A Laird, D Tham, M Bath, P Patki, C Sohrabi, C Tanabalan, T Arif, C Magee, T Nambirajan, S Powell, R Vinayagam, I Flindall, A Hanson, V Mahendran, S Green, M Lim, L MacDonald, V Miu, L Onos, K Sheridan, R Young, F Alam, O Griffiths, C Houlden, R Jones, V S Kolli, A K Lala, S Leeson, R Peevor, Z Seymour, L Chen, E Henderson, A Loehrer, K Brown, D Fleming, A Haynes, C Heron, C Hill, H Kay, E Leede, K McElhinney, K Olson, E C Osterberg, C Riley, P Srikanth, M Thornhill, D Blazer, G DiLalla, E S Hwang, W Lee, M Lidsky, J Plichta, L Rosenberger, R Scheri, K Shah, K Turnage, J Visgauss, S Zani, J Farma, J Clark, D Kwon, E Etchill, H E Gabre-Kidan AJenny, A Kent, M Ladd, C Long, H Malapati, A Margalit, S Rapaport, J Rose, K Stevens, L Tsai, D Vervoort, P Yesantharao, A Dehal, D Klaristenfeld, K Huynh, L Brown, I Ganly, J Mullinax, N Gusani, J Hazelton, J Maines, J S Oh, A Ssentongo, P Ssentongo, M Azam, A Choudhry, W Marx, J Fleming, A Fuson, J Gigliotti, A Ovaitt, Y Ying, M K Abel, V Andaya, K Bigay, M A Boeck, L Chen, H Chern, C Corvera, I El-Sayed, A Glencer, P Ha, Bcs Hamilton, C Heaton, K Hirose, D M Jablons, K Kirkwood, L Z Kornblith, J R Kratz, R Lee, P N Miller, E Nakakura, B Nunez-Garcia, R O'Donnell, D Ozgediz, P Park, B Robinson, A Sarin, B Sheu, M Varma, K Wai, R Wustrack, M J Xu, D Beswick, J Goddard, J Manor, J Song, T Fullmer, C Gaskill, N Gross, K Kiong, C L Roland, S N Zafar, M Abdallah, A Abouassi, M Almasri, G Kulkarni, H Marwan, M Mehdi, S Aoun, V S Ban, H H Batjer, J Caruso, D Abbott, A Acher, T Aiken, J Barrett, E Foley, P Schwartz, S N Zafar, A Hawkins, A Maiga, J Laufer, S Scasso
Subjects: Aged, 80 and over, Male, Critical Care, SARS-CoV-2, International Cooperation, COVID-19, Middle Aged, Cohort Studies, Logistic Models, Postoperative Complications, Elective Surgical Procedures, Neoplasms, Outcome Assessment, Health Care, Humans, Female, Epidemics, Aged
Abstract: PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.
Published: 2021

16. Contemporary Multi-Institutional Cohort of 550 Cases of Phyllodes Tumors (2007-2017) Demonstrates a Need for More Individualized Margin Guidelines

Author: Jasmine Wong, Samantha M. Thomas, Taryn E. Hassinger, Jennifer F. Tseng, Kandice K. Ludwig, Heather B. Neuman, Tari A. King, Laura H. Rosenberger, Kristalyn K. Gallagher, Megan E. Miller, Lisa K. Jacobs, Tina J. Hieken, James W. Jakub, and Suniti Nimbkar
Subjects: Adult, Cancer Research, medicine.medical_specialty, Neoplasm, Residual, Time Factors, Clinical Decision-Making, Clinical Sciences, Oncology and Carcinogenesis, MEDLINE, Breast Neoplasms, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Margin (machine learning), Phyllodes Tumor, Risk Factors, Medicine, Humans, Oncology & Carcinogenesis, Mastectomy, Retrospective Studies, Cancer, business.industry, General surgery, Margins of Excision, ORIGINAL REPORTS, Middle Aged, United States, Tumor Burden, Neoplasm Recurrence, Treatment Outcome, Oncology, Local, 030220 oncology & carcinogenesis, Residual, Cohort, Practice Guidelines as Topic, Neoplasm, 030211 gastroenterology & hepatology, Female, Neoplasm Recurrence, Local, business
Abstract: PURPOSE Phyllodes tumors (PTs) are rare breast neoplasms, which have little granular data on margins. Current guidelines recommend ≥ 1 cm margins; however, recent data suggest narrower margins are sufficient, and for benign PT, a negative margin may not be necessary. METHODS We performed an 11-institution contemporary (2007-2017) review of PT practices. Demographics, surgical, and histopathologic data were captured. Logistic regression was used to estimate the association of select covariates with local recurrence (LR). RESULTS Of 550 PT patients, the majority underwent excisional biopsy (55.3%, n = 302/546) or lumpectomy (wide excision) (38.5%, n = 210/546). Median tumor size was 30 mm, 68.9% (n = 379) were benign, 19.6% (n = 108) borderline, and 10.5% (n = 58) malignant. Surgical margins were positive in 42% (n = 231) and negative in 57.3% (n = 311). A second operation was performed in 38.0% (n = 209) of the total cohort, including 51 patients with an initial negative margin (82.4% with < 2 mm), and 157 with an initial positive margin, with residual disease only found in six (2.9%). Notably, 32.0% (n = 74) of those with an initial positive margin did not undergo a second operation, among whom only 2.7% (n = 2) recurred. Recurrence occurred in 3.3% (n = 18) of the total cohort (n = 15 LR, n = 3 distant), at median follow-up of 36.7 months. LR (all PT grades) was not reduced with wider negative margin width (≥ 2 mm v < 2 mm: odds ratio [OR] = 0.39; 95% CI, 0.07 to 2.10; P = .27) or final margin status (positive v negative: OR = 0.96; 95% CI, 0.26 to 3.52; P = .96). CONCLUSION In current practice, many patients are managed outside of current guidelines. For the entire cohort, a wider margin width was not associated with a reduced risk of LR. We do not recommend re-excision of a negative margin for benign PT, regardless of margin width, as a progressively wider surgical margin is unlikely to reduce LR.
Published: 2021

17. Defining Benchmark Outcomes for Pancreatoduodenectomy With Portomesenteric Venous Resection

Author: Claudio Bassi, Nassiba Beghdadi, Charles J. Yeo, Hermien Hartog, Fernando Burdío, Atsushi Oba, Ignasi Poves, Syed Hussain Abbas, Nikolaos Machairas, David A. Kooby, Mohammed Abu Hilal, Mizelle DʼSilva, Eduardo Barroso, Thomas F. Stoop, Joon Seong Park, Emanuel Vigia, Fabio Casciani, Giuseppe Malleo, Dong Sup Yoon, Brendan P. Lovasik, Kevin C. Conlon, Alexandra Rueda de Leon, Richard D. Schulick, Keith D. Lillemoe, Sarah Powell-Brett, Tara M. Mackay, Laurent Sulpice, Paolo Muiesan, Ho-Seong Han, Keith J. Roberts, Ho Kyuong Hwang, Eduardo de Santibañes, Carlos Chan, Mahmoud Abuawwad, Oscar Mazza, Philip C. Müller, Cristina R. Ferrone, Massimo Falconi, G. Belfiori, Dimitri A. Raptis, Michael Silva, Patricia Sánchez-Velázquez, Harish Lavu, Tom K. Gallagher, Fabien Robin, Ugo Boggi, R. Ravikumar, David Moskal, Giuseppe Fusai, Casper H.J. van Eijck, Domenico Tamburrino, Ismael Domínguez Rosado, Niccolò Napoli, Alain Sauvanet, Naomi M. Sell, Pierre-Alain Clavien, Marco Del Chiaro, Motaz Qadan, Bas Groot Koerkamp, Emanuele Federico Kauffmann, Marc G. Besselink, Martin de Santibañes, Olivier R. Busch, Surgery, CCA - Cancer Treatment and Quality of Life, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Graduate School, Department of Marketing Management, Raptis, D. A., Sanchez-Velazquez, P., Machairas, N., Sauvanet, A., Rueda de Leon, A., Oba, A., Groot Koerkamp, B., Lovasik, B., Chan, C., Yeo, C. J., Bassi, C., Ferrone, C. R., Kooby, D., Moskal, D., Tamburrino, D., Yoon, D. -S., Barroso, E., de Santibanes, E., Kauffmann, E. F., Vigia, E., Robin, F., Casciani, F., Burdio, F., Belfiori, G., Malleo, G., Lavu, H., Hartog, H., Hwang, H. K., Han, H. -S., Poves, I., Rosado, I. D., Park, J. -S., Lillemoe, K. D., Roberts, K. J., Sulpice, L., Besselink, M. G., Abuawwad, M., Del Chiaro, M., de Santibanes, M., Falconi, M., D'Silva, M., Silva, M., Abu Hilal, M., Qadan, M., Sell, N. M., Beghdadi, N., Napoli, N., Busch, O. R. C., Mazza, O., Muiesan, P., Muller, P. C., Ravikumar, R., Schulick, R., Powell-Brett, S., Abbas, S. H., Mackay, T. M., Stoop, T. F., Gallagher, T. K., Boggi, U., van Eijck, C., Clavien, P. -A., Conlon, K. C. P., and Fusai, G. K.
Subjects: Adult, Male, medicine.medical_specialty, Percentile, Population, Outcome and Process Assessment, Pancreaticoduodenectomy, 03 medical and health sciences, 0302 clinical medicine, Mesenteric Veins, Postoperative Complications, Pancreatic cancer, medicine, Humans, Hospital Mortality, education, Aged, education.field_of_study, business.industry, Portal Vein, Mortality rate, Cancer, Middle Aged, medicine.disease, Surgery, Portal vein thrombosis, Health Care, Benchmarking, Outcome and Process Assessment, Health Care, Pancreatic fistula, 030220 oncology & carcinogenesis, Cohort, 030211 gastroenterology & hepatology, Female, business
Abstract: Objective: The aim of this study was to establish clinically relevant outcome benchmark values using criteria for pancreatoduodenectomy (PD) with portomesenteric venous resection (PVR) from a low-risk cohort managed in high-volume centers. Summary Background Data: PD with PVR is regarded as the standard of care in patients with cancer involvement of the portomesenteric venous axis. There are, however, no benchmark outcome indicators for this population which hampers comparisons of patients undergoing PD with and without PVR resection. Methods: This multicenter study analyzed patients undergoing PD with any type of PVR in 23 high-volume centers from 2009 to 2018. Nineteen outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers (NCT04053998). Results: Out of 1462 patients with PD and PVR, 840 (58%) formed the benchmark cohort, with a mean age was 64 (SD11) years, 413 (49%) were females. Benchmark cutoffs, among others, were calculated as follows: Clinically relevant pancreatic fistula rate (International Study Group of Pancreatic Surgery): ≤14%; in-hospital mortality rate: ≤4%; major complication rate Grade≥3 and the CCI up to 6 months postoperatively: ≤36% and ≤26, respectively; portal vein thrombosis rate: ≤14% and 5-year survival for patients with pancreatic ductal adenocarcinoma: ≥9%. Conclusion: These novel benchmark cutoffs targeting surgical performance, morbidity, mortality, and oncological parameters show relatively inferior results in patients undergoing vascular resection because of involvement of the portomesenteric venous axis. These benchmark values however can be used to conclusively assess the results of different centers or surgeons operating on this high-risk group.
Published: 2020

18. Germline Genetic Mutations in a Multi-center Contemporary Cohort of 550 Phyllodes Tumors: An Opportunity for Expanded Multi-gene Panel Testing

Author: Kandice K. Ludwig, Jasmine Wong, Suniti Nimbkar, Jennifer F. Tseng, Taryn E. Hassinger, Heather B. Neuman, Samantha M. Thomas, Megan E. Miller, Lisa K. Jacobs, Laura H. Rosenberger, James W. Jakub, Kristalyn K. Gallagher, and Tina J. Hieken
Subjects: medicine.medical_specialty, Oncology and Carcinogenesis, Breast Neoplasms, Article, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Germline mutation, Phyllodes Tumor, Clinical Research, Internal medicine, medicine, Genetics, Humans, Genetic Predisposition to Disease, Genetic Testing, Oncology & Carcinogenesis, Family history, Germ-Line Mutation, Genetic testing, Cancer, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Prevention, Odds ratio, Confidence interval, Oncology, 030220 oncology & carcinogenesis, Cohort, 030211 gastroenterology & hepatology, Surgery, Female, business, Cohort study
Abstract: BackgroundA paucity of data exists regarding inherited mutations associated with phyllodes tumors (PT); however, some are reported (TP53, BRCA1, and RB1). A PT diagnosis does not meet NCCN criteria for testing, including within Li-Fraumeni Syndrome (TP53). We sought to determine the prevalence of mutations associated with PT.MethodsWe performed an 11-institution review of contemporary (2007-2017) PT practice. We recorded multigenerational family history and personal history of genetic testing. We identified patients meeting NCCN criteria for genetic evaluation. Logistic regression estimated the association of select covariates with likelihood of undergoing genetic testing.ResultsOf 550 PT patients, 59.8% (n = 329) had a close family history of cancer, and 34.0% (n = 112) had ≥ 3 family members affected. Only 6.2% (n = 34) underwent genetic testing, 38.2% (n = 13) of whom had only BRCA1/BRCA2 tested. Of 34 patients tested, 8.8% had a deleterious mutation (1 BRCA1, 2 TP53), and 5.9% had a BRCA2 VUS. Of women who had TP53 testing (N = 21), 9.5% had a mutation. Selection for testing was not associated with age (odds ratio [OR] 1.01, p = 0.55) or PT size (p = 0.12) but was associated with grade (malignant vs. benign: OR 9.17, 95% CI 3.97-21.18) and meeting NCCN criteria (OR 3.43, 95% confidence interval 1.70-6.94). Notably, an additional 86 (15.6%) patients met NCCN criteria but had no genetic testing.ConclusionsVery few women with PT undergo germline testing; however, in those selected for testing, a deleterious mutation was identified in ~ 10%. Multigene testing of a PT cohort would present an opportunity to discover the true incidence of germline mutations in PT patients.
Published: 2020

19. The Prognostic Value of Axillary Staging Following Neoadjuvant Chemotherapy in Inflammatory Breast Cancer

Author: Monica M. Grova, Stephanie Downs-Canner, David W. Ollila, Philip M Spanheimer, Paula D. Strassle, Emma E Navajas, and Kristalyn K. Gallagher
Subjects: Oncology, medicine.medical_specialty, Axillary lymph nodes, Receptor, ErbB-2, Breast Neoplasms, Inflammatory breast cancer, Article, 03 medical and health sciences, 0302 clinical medicine, Surgical oncology, Internal medicine, Antineoplastic Combined Chemotherapy Protocols, Medicine, Humans, Stage (cooking), skin and connective tissue diseases, Survival analysis, Mastectomy, Neoplasm Staging, business.industry, Proportional hazards model, Cancer, medicine.disease, Prognosis, Neoadjuvant Therapy, Axilla, medicine.anatomical_structure, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Surgery, Female, Inflammatory Breast Neoplasms, Neoplasm Recurrence, Local, business
Abstract: BACKGROUND: Inflammatory breast cancer (IBC) has historically been characterized by high rates of recurrence and poor survival, however, there have been significant improvements in systemic therapy. We sought to investigate modern treatment of IBC and define the yield and prognostic significance of axillary lymph nodes after neoadjuvant chemotherapy (NAC). METHODS: Women with clinical stage T4d, N0–N3, M0 IBC from 2012 to 2016 in the National Cancer Database (NCDB) were included. Kaplan Meier survival curves and Cox regression were used to assess mortality by receptor subtype and nodal status. RESULTS: We identified 5,265 patients; 37% hormone receptor (HR)+/HER2−, 19% HR+/HER2+, 18% HR−/HER2+, and 26% triple negative (TN) and five-year overall survival was 51.6%. Only 34% were treated according to guidelines with neoadjuvant chemotherapy (NAC), modified radical mastectomy, and adjuvant radiation. Pathologically positive lymph nodes (ypN+) after NAC varied by subtype and clinical nodal status (cN) ranging from 82% in cN+ HR+/HER2− patients to 19% in cN0 HR−/HER2+ patients. ypN+ strongly correlated with survival in all subtypes with the most pronounced impact in HR+/HER2+ patients, with 90% five year overall survival in ypN0 vs 66% for ypN+ (HR 4.29, 95% CI 1.58–11.70, p=0.03). CONCLUSIONS: Five-year survival in M0 IBC is 51.6%. Positive nodes after NAC varied by subtype and clinical N status but is sufficiently high and provided meaningful prognostication in all subtypes to support continued routine pathologic assessment. Future study is warranted to identify reliable, less morbid, methods of staging the axilla in IBC patients appropriate for de-escalation of axillary surgery.
Published: 2020

20. Survival analysis of early-stage breast cancer patients undergoing axillary lymph node dissection and sentinel lymph node dissection

Author: Paula D. Strassle, Mary R. Shen, Jonathan A. Black, Kristalyn K. Gallagher, Kandace P. McGuire, and Apoorve Nayyar
Subjects: Adult, medicine.medical_specialty, Adolescent, Databases, Factual, medicine.medical_treatment, Sentinel lymph node, Population, Breast Neoplasms, Mastectomy, Segmental, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, medicine, Humans, 030212 general & internal medicine, education, Survival analysis, Aged, Neoplasm Staging, Aged, 80 and over, education.field_of_study, Sentinel Lymph Node Biopsy, business.industry, Carcinoma, Ductal, Breast, Lumpectomy, Axillary Lymph Node Dissection, Cancer, General Medicine, Middle Aged, medicine.disease, Survival Analysis, Carcinoma, Lobular, Dissection, Treatment Outcome, Lymphatic Metastasis, 030220 oncology & carcinogenesis, Axilla, Lymph Node Excision, Female, Surgery, Radiology, business, Follow-Up Studies
Abstract: Background The American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated equivalent survival in early-stage breast cancer (BC) patients receiving either axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. However, institutional studies have called into question the generalization of these findings outside of a clinical trial. Methods Early-stage BC patients diagnosed in 2013, that received lumpectomy with whole-breast irradiation, and underwent either ALND or SLND alone, in National Cancer Database were included. Weighted Kaplan-Meier curves were used to estimate 45-month survival, accounting for demographics, comorbidities, insurance type, cancer and neighborhood characteristics. Results 62,184 patients were included, of which 21,892 (35%) underwent ALND. Patients undergoing ALND, compared to SLND, appeared to have slightly lower survival (91.4% vs 95.1%); moreover, even after weighting, a small difference persisted (92.7% vs 94.7%, RR 0.98, 95% CI 0.97, 0.99). Conclusions SLND is a safe and effective alternative to ALND in BC patients with limited nodal involvement. This study provides additional evidence that the findings of ACOSOG Z0011 are applicable to the larger early-stage BC population.
Published: 2018

21. Incidence and Risk Factors of Intracranial Hemorrhage in Liver Transplant Recipients

Author: Farzaneh A. Sorond, Jonathan P. Fryer, Tom K. Gallagher, Eric M. Liotta, Kathryn Thomas, Shyam Prabhakaran, Daniel Ganger, Michael Abecassis, and Daniela P. Ladner
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Blood Pressure, Liver transplantation, Article, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, medicine, Humans, 030212 general & internal medicine, Intraparenchymal hemorrhage, Aged, Transplantation, Univariate analysis, business.industry, Incidence, Incidence (epidemiology), Odds ratio, Middle Aged, medicine.disease, Liver Transplantation, Surgery, Blood pressure, Female, business, Complication, Intracranial Hemorrhages, 030217 neurology & neurosurgery
Abstract: BACKGROUND Intracranial hemorrhage after liver transplantation is an infrequently reported complication but one which can have devastating consequences. METHODS We performed a retrospective cross-sectional analysis of all liver transplants performed between January 2010 and June 2015 at a single high-volume institution using a prospectively maintained electronic database and query of the electronic medical record. Cases of intracranial hemorrhage were adjudicated as either spontaneous intraparenchymal hemorrhage(IPH) or extra-axial hemorrhage (EAH). Patients with confirmed intracranial hemorrhage were compared with all other liver transplant recipients. Risk factors were identified by univariate analysis and logistic regression models for IPH and EAH. RESULTS Thirty-one (5.2%) of 595 liver transplant recipients developed an intracranial hemorrhage within 12 months of transplantation, 15 IPH and 16 EAH. The majority of intracranial hemorrhages were diagnosed within 1 month of transplantation. Eight (26%) intracranial hemorrhage patients died during hospitalization. Fourteen (45%) intracranial hemorrhage patients died within 1 year of transplantation and 1-year mortality was greater than in patients without intracranial hemorrhage (11.2%, P < 0.01). Female sex (adjusted odds ratio [OR], 3.291; 95% confidence interval [CI], 1.092-9.924; P = 0.034), higher pretransplant bilirubin (adjusted OR, 1.037; 95% CI, 1.006-1.070; P = 0.020), and greater increase in pretransplant to posttransplant systolic blood pressure (adjusted OR, 1.029; 95% CI, 1.006-1.052; P = 0.012) were associated with posttransplant IPH. Lower pretransplant serum fibrinogen level (adjusted OR, 0.988; 95% CI, 0.979-0.998; P = 0.017) was associated with posttransplant EAH. CONCLUSIONS Postoperative blood pressure control and pretransplant fibrinogen levels may be modifiable risk factors for preventing posttransplant intracranial hemorrhage.
Published: 2018

22. Multidisciplinary Management of Breast Cancer During Pregnancy

Author: Hyman B. Muss, Aimee Faso, Raeshell S. Sweeting, Kandace P. McGuire, Timothy M. Zagar, Shlomit S. Shachar, Carey K. Anders, and Kristalyn K. Gallagher
Subjects: 0301 basic medicine, Cancer Research, medicine.medical_specialty, MEDLINE, Breast Neoplasms, Mastectomy, Segmental, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Pregnancy, Multidisciplinary approach, Breast Cancer, medicine, Humans, 030212 general & internal medicine, Dosing, Stage (cooking), Medical diagnosis, skin and connective tissue diseases, Intensive care medicine, Body surface area, business.industry, Published Erratum, General surgery, Disease Management, Gestational age, Prognosis, medicine.disease, 030104 developmental biology, Oncology, 030220 oncology & carcinogenesis, Female, Erratum, business, Pregnancy Complications, Neoplastic
Abstract: Background Although breast cancer during pregnancy (BCDP) is rare (occurring with only 0.4% of all BC diagnoses in female patients aged 16–49 years), management decisions are challenging to both the patient and the multidisciplinary team. Materials and Methods Experts in breast cancer at the University of North Carolina conducted a targeted literature search regarding the multidisciplinary treatment approaches to BCDP: medical, surgical, and radiation oncology. Supportive care, including antiemetic agents, and imaging approaches were also reviewed. Results Review of the literature revealed key points in the management of BCDP. Surgical management is similar to that in nonpregnant patients; pregnant patients may safely undergo breast-conserving surgery. Recommendations should be tailored to the individual according to the clinical stage, tumor biology, genetic status, gestational age, and personal preferences. Anthracycline-based chemotherapy can be safely initiated only in the second and third trimesters. The rate of congenital abnormalities in children exposed to chemotherapy is similar to the national average (approximately 3%). Dosing of chemotherapy should be similar to that in the nonpregnant patient (i.e., actual body surface area). Antihuman epidermal growth factor receptor 2 therapy, radiation, and endocrine treatment are contraindicated in pregnancy and lactation. Care should include partnership with obstetricians. The literature regarding prognosis of BCDP is mixed. Conclusion To maximize benefit and minimize risk to the mother and fetus, an informed discussion with the patient and her medical team should result in an individualized treatment plan, taking into account the timing of the pregnancy and the stage and subtype of the breast cancer. Because BCDP is rare, it is essential to collect patient data in international registries.
Published: 2017

23. Indications for Neoadjuvant Systemic Therapy for Breast Cancer

Author: David W. Ollila and Kristalyn K. Gallagher
Subjects: Oncology, medicine.medical_specialty, Chemotherapy, business.industry, Receptor, ErbB-2, medicine.medical_treatment, MEDLINE, Breast Neoplasms, Triple Negative Breast Neoplasms, medicine.disease, Systemic therapy, Neoadjuvant Therapy, Breast cancer, Chemotherapy, Adjuvant, Internal medicine, medicine, Humans, Surgery, Female, business, Adjuvant, Neoadjuvant therapy
Published: 2019

24. Resection of Cavity Shave Margins in Stage 0-III Breast Cancer Patients Undergoing Breast Conserving Surgery: A Prospective Multicenter Randomized Controlled Trial

Author: Elisabeth Dupont, David W. Ollila, Mary Murray, Melissa Lazar, Theodore N. Tsangaris, Noreen E. McGowan, Tara McPartland, Marissa Howard-McNatt, Naveenraj L. Solomon, Maria E. Herrera, Maheswari Senthil, Yoana P. Avitan, Andrew Fenton, David Edmonson, Fangyong Li, Eric Brown, Kristalyn K. Gallagher, Amanda Mendiola, Meghan Butler, Adam C. Berger, Jukes P. Namm, Carlos Garcia-Cantu, Ricardo D. Martinez, Edward A. Levine, Brian Yoder, Alliric I. Willis, Anees B. Chagpar, Sharon S. Lum, Akiko Chiba, Jennifer Gass, Laura Walters, and Sonali V Pandya
Subjects: Adult, medicine.medical_specialty, Randomization, medicine.medical_treatment, Breast Neoplasms, Mastectomy, Segmental, law.invention, Resection, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Randomized controlled trial, law, medicine, Breast-conserving surgery, Humans, Prospective Studies, Stage (cooking), Prospective cohort study, Aged, Neoplasm Staging, Aged, 80 and over, integumentary system, business.industry, Margins of Excision, Middle Aged, medicine.disease, Surgery, Treatment Outcome, 030220 oncology & carcinogenesis, 030211 gastroenterology & hepatology, Female, business, Mastectomy, Follow-Up Studies
Abstract: OBJECTIVE Single-center studies have demonstrated that resection of cavity shave margins (CSM) halves the rate of positive margins and re-excision in breast cancer patients undergoing partial mastectomy (PM). We sought to determine if these findings were externally generalizable across practice settings. METHODS In this multicenter randomized controlled trial occurring in 9 centers across the United States, stage 0-III breast cancer patients undergoing PM were randomly assigned to either have resection of CSM ("shave" group) or not ("no shave" group). Randomization occurred intraoperatively, after the surgeon had completed their standard PM. Primary outcome measures were positive margin and re-excision rates. RESULTS Between July 28, 2016 and April 13, 2018, 400 patients were enrolled in this trial. Four patients (2 in each arm) did not meet inclusion criteria after randomization, leaving 396 patients for analysis: 196 in the "shave" group and 200 to the "no shave" group. Median patient age was 65 years (range; 29-94). Groups were well matched at baseline for demographic and clinicopathologic factors. Prior to randomization, positive margin rates were similar in the "shave" and "no shave" groups (76/196 (38.8%) vs. 72/200 (36.0%), respectively, P = 0.604). After randomization, those in the "shave" group were significantly less likely than those in the "no shave" group to have positive margins (19/196 (9.7%) vs. 72/200 (36.0%), P < 0.001), and to require re-excision or mastectomy for margin clearance (17/196 (8.7%) vs. 47/200 (23.5%), P < 0.001). CONCLUSION Resection of CSM significantly reduces positive margin and re-excision rates in patients undergoing PM.
Published: 2019

25. Disparities in the Use of Sentinel Lymph Node Dissection for Early Stage Breast Cancer

Author: Jihane Jadi, Jonathan A. Black, Kandace P. McGuire, Cara G. Moses, Francisco Schlottmann, Paula D. Strassle, Kristalyn K. Gallagher, and Apoorve Nayyar
Subjects: Adult, medicine.medical_specialty, Sentinel lymph node, Black People, Breast Neoplasms, White People, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Quality of life, Internal medicine, medicine, Humans, Stage (cooking), Healthcare Disparities, Early Detection of Cancer, Mastectomy, Aged, Neoplasm Staging, Insurance, Health, business.industry, Sentinel Lymph Node Biopsy, Axillary Lymph Node Dissection, Cancer, Odds ratio, Hispanic or Latino, Middle Aged, medicine.disease, Clinical trial, 030220 oncology & carcinogenesis, Axilla, Lymph Node Excision, 030211 gastroenterology & hepatology, Surgery, Female, business
Abstract: Background Clinical trials have long established the long-term safety of omitting axillary lymph node dissection (ALND) after sentinel lymph node dissection (SLND) in patients with clinically node-negative early stage breast cancer. The variations in utilization of SLND and ALND in this patient population, however, are currently unknown. Methods Adult female patients (40 years and older) within the National Cancer Database diagnosed with breast cancer between January 2013 and December 2015, who had clinical T1-T2 and N0 disease, and who underwent either SLND (with or without subsequent ALND) or ALND were included. Differences in utilization across race, ethnicity, insurance type, facility, and residential characteristics were assessed using multivariable logistic regression. Results Overall, 271,689 patients were included, of which 26,527 (10%) received ALND and 245,162 (90%) underwent SLND. After adjusting for demographics and cancer characteristics, black (odds ratio [OR], 1.11; 95% confidence interval [95% CI], 1.06-1.17) and Hispanic women (OR, 1.16; 95% CI, 1.10-1.24) were more likely to receive ALND. Patients without health insurance (OR, 1.33; 95% CI, 1.19-1.47), compared with private health insurance, and those receiving treatment at community cancer centers (OR, 1.60; 95% CI, 1.53-1.67), compared with academic/research centers, were also more likely to receive ALND. Conclusions Although the vast majority of women undergo SLND, significant disparities exist in its utilization for early stage breast cancer, with traditionally underserved patients receiving unwarranted extensive axillary surgery. Increased patient and surgeon education is needed to decrease variations in care that can affect patient's quality of life.
Published: 2018

26. Are You on the Right Platform? A Conjoint Analysis of Social Media Preferences in Aesthetic Surgery Patients

Author: Apoorve Nayyar, Cindy Wu, Kristalyn K. Gallagher, Stephen Tyler Elkins-Williams, Roja Garimella, Loree K. Kalliainen, Jihane Jadi, and Charles Scott Hultman
Subjects: Adult, Male, medicine.medical_specialty, Mammaplasty, Information Seeking Behavior, Video Recording, 030230 surgery, Crowdsourcing, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Interactivity, Information seeking behavior, Surveys and Questionnaires, medicine, Humans, Social media, Prospective Studies, Aged, Aged, 80 and over, Marketing of Health Services, Surgeons, business.industry, Abdominoplasty, Patient Preference, General Medicine, Middle Aged, Preference, Conjoint analysis, Surgery, Outreach, Cross-Sectional Studies, Rhytidoplasty, The Internet, Female, business, Social Media
Abstract: Background Social media has become an indispensable tool for patients to learn about aesthetic surgery. Currently, procedure-specific patient preferences for social media platforms and content are unknown. Objectives The authors sought to evaluate social media preferences of patients seeking aesthetic surgery. Methods We utilized a choice-based conjoint analysis survey to analyze the preferences of patients seeking 3 common aesthetic procedures: breast augmentation (BA), facial rejuvenation (FR), and combined breast/abdominal surgery (BAB). Participants were asked to choose among social media platforms (Facebook, Twitter, Instagram, Snapchat, Pinterest, Tumblr, YouTube), information extent (basic, moderate, comprehensive), delivery mechanism (prerecorded video, live video, photographs, text description), messenger (surgeon, nurse/clinic staff, patient), and option for interactivity (yes/no). The survey was administered using an Internet crowdsourcing service (Amazon Mechanical Turk). Results A total of 647 participants were recruited: 201 in BA, 255 in FR, and 191 in BAB. Among attributes surveyed, participants in all 3 groups (BA, FR, BAB) valued social media platform as the most important (30.9%, 33.1%, 31.4%), followed by information extent (23.1%, 22.9%, 21.6%), delivery mechanism (18.9%, 17.4%, 18%), messenger (16%, 17%, 17.2%), and interactivity (11.1%, 9.8%, 11.8%). Within these attributes, Facebook ranked as the preferred platform, with comprehensive information extent, live video as the delivery mechanism, and surgeon as the messenger as most preferred. Conclusions The choice of social media platform is the most important factor for patients, and they indicated a preference for comprehensive information delivered by the surgeon via live video on Facebook. Our study elucidates social media usage in common aesthetic populations, which can help improve aesthetic patient outreach.
Published: 2018

27. Definition and Management of Positive Margins for Invasive Breast Cancer

Author: Kandace P. McGuire, Kristalyn K. Gallagher, and Apoorve Nayyar
Subjects: Reoperation, medicine.medical_specialty, Standard of care, medicine.medical_treatment, Tumor resection, Breast Neoplasms, 030230 surgery, Mastectomy, Segmental, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, medicine, Positive Margins, Humans, Neoplasm Invasiveness, Stage (cooking), business.industry, Margins of Excision, medicine.disease, Radiation therapy, Additional Surgery, 030220 oncology & carcinogenesis, Surgery, Female, Radiology, Neoplasm Recurrence, Local, business
Abstract: Breast-conserving surgery (BCS) followed by radiation therapy is the current standard of care for early stage breast cancer. Successful BCS necessitates complete tumor resection with clear margins at the pathologic assessment of the specimen ("no ink on tumor"). The presence of positive margins warrants additional surgery to obtain negative final margins, which has significant physical, psychological, and financial implications for the patient. The challenge lies in developing accurate real-time intraoperative margin assessment techniques to minimize the presence of "ink on tumor" and the subsequent need for additional surgery.
Published: 2018

28. Temporal trends in immediate post-mastectomy breast reconstruction

Author: Kandace P. McGuire, Michelle C. Roughton, Cara G. Moses, Apoorve Nayyar, Paula D. Strassle, Karishma G. Reddy, and Kristalyn K. Gallagher
Subjects: medicine.medical_specialty, Time Factors, business.industry, General surgery, medicine.medical_treatment, Mammaplasty, MEDLINE, Middle Aged, medicine.disease, Surgery, Breast cancer, Post mastectomy, Seer program, medicine, Humans, Female, business, Breast reconstruction, Mastectomy, SEER Program
Published: 2018

29. Surgical Intervention for Lymphedema

Author: Stephanie Gray, Kristalyn K. Gallagher, and Kathleen Marulanda
Subjects: Male, medicine.medical_specialty, Secondary lymphedema, Disease, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Quality of life, hemic and lymphatic diseases, Edema, medicine, Humans, Lymphedema, Subclinical infection, business.industry, medicine.disease, humanities, Surgery, body regions, Oncology, 030220 oncology & carcinogenesis, Female, Lymph Nodes, medicine.symptom, business, Progressive disease
Abstract: Lymphedema is a chronic, progressive disease with no curative treatment. Breast cancer therapy is the most common cause of secondary lymphedema in the developed world. Treatment includes nonsurgical and surgical strategies. Conservative measures are reserved for subclinical lymphedema. Surgical options are divided into physiologic (to restore function) and reductive (to remove diseased tissue). Early stage disease is managed with physiologic procedures. Reductive treatment is reserved for moderate to severe staged disease owing to high morbidity. Surgical options effectively decrease edema and improve quality of life. However, further research is necessary to best establish management of lymphedema.
Published: 2017

30. Structural changes of the choroid in sarcoid- and tuberculosis-related granulomatous uveitis

Author: Adnan Tufail, Richard W J Lee, P A Keane, K Gallagher, C. Egan, Carlos Pavesio, Hemal Mehta, Javier Zarranz-Ventura, Mark Westcott, and Da Sim
Subjects: Adult, Male, Pathology, medicine.medical_specialty, Tuberculosis, Sarcoidosis, Visual Acuity, Tuberculosis, Ocular, Granulomatous uveitis, Uveitis, Clinical study, Young Adult, hemic and lymphatic diseases, Ophthalmology, Humans, Medicine, skin and connective tissue diseases, Aged, Retrospective Studies, Aged, 80 and over, Granuloma, Choroid, business.industry, Middle Aged, medicine.disease, eye diseases, Ocular oncology, stomatognathic diseases, Cross-Sectional Studies, medicine.anatomical_structure, Clinical Study, Female, sense organs, business, Tomography, Optical Coherence
Abstract: The aim of this study is to characterise the choroidal features of patients diagnosed with sarcoid- and tuberculosis (TB)-associated granulomatous uveitis using spectral domain optical coherence tomography (OCT).Twenty-seven patients (27 eyes) diagnosed with sarcoid- (13 eyes) and TB (14 eyes)-related uveitis were included in this retrospective, cross-sectional study. Over a six-month period, patients diagnosed with sarcoid and TB granulomatous uveitis were scanned using enhanced depth imaging OCT. Clinical and demographical characteristics were recorded, including the method of diagnosis, disease activity, site of inflammation (anterior or posterior), treatments, and visual acuity (VA). Manual segmentation of the choroidal layers was performed using custom image analysis software.The main outcome measure was OCT-derived thickness measurements of the choroid and choroidal sublayers (Haller's large vessel and Sattler's medium vessel layers) at the macula region. The ratio of Haller's large vessel to Sattler's medium vessel layer was significantly different at the total macula circle in eyes diagnosed with TB uveitis (1.47 (=140.71/95.72 μm)) compared with sarcoid uveitis (1.07 (=137.70/128.69 μm)) (P=0.001). A thinner choroid was observed in eyes with a VA ≥0.3 LogMAR (Snellen 6/12; 198.1 μm (interquartile range (IQR)=147.0-253.4 μm) compared with those with VA0.3 LogMAR (292.4 μm (IQR=240.1-347.6 μm)) at the total macula circle (P=0.004). At the foveal central subfield, the median choroidal thickness was 336.8 μm (IQR=272.3-375.4 μm) in active compared with 239.3 μm (IQR=195.3-330.9 μm) in quiescent disease (P=0.04).A disproportionately enlarged Sattler's layer may indicate a diagnosis of sarcoid-related uveitis, and choroidal thickening may be a feature of active granulomatous uveitis.
Published: 2015

31. The SAVE Review: Sonographic Analysis Versus Excision for Axillary Staging in Breast Cancer

Author: Michael A. Preston, Kent C. Westbrook, V. Suzanne Klimberg, Evan Tummel, Katherine Glover-Collins, Soheila Korourian, Daniela Ochoa, Ronda Henry-Tillman, Kristalyn K. Gallagher, and Yara V. Robertson
Subjects: Adult, Image-Guided Biopsy, Core needle, medicine.medical_specialty, Sentinel lymph node, Breast Neoplasms, Breast cancer, Biopsy, medicine, Humans, health care economics and organizations, Aged, Neoplasm Staging, Retrospective Studies, Aged, 80 and over, medicine.diagnostic_test, Sentinel Lymph Node Biopsy, business.industry, Biopsy, Needle, Reproducibility of Results, Retrospective cohort study, Middle Aged, medicine.disease, Surgery, Axilla, medicine.anatomical_structure, Lymphatic Metastasis, Cohort, Female, Lymph Nodes, Ultrasonography, Mammary, business, Axillary staging, Follow-Up Studies
Abstract: Background Health care reform goals involve more cost-effective methods of delivering health care. The cost-effectiveness of axillary ultrasound-guided core needle biopsy (AUS-CNB) was compared with sentinel lymph node biopsy (SLNB) when evaluating the status of the axilla in operable invasive breast cancer. Study Design We performed an IRB-approved retrospective review of patients undergoing ultrasound of the axilla plus core needle biopsy at our institution from 2007 to 2012. An accuracy of technique and cost analysis (TreeAge Pro 2009) of AUS-CNB vs SLNB was conducted. Results The cohort of 95 patients was divided into 2 groups: clinically positive (CP) (32%) and negative (CN) (68%) axilla. In the CP group, 83% had a suspicious AUS, of which 90% were positive. In the CN group, AUS was suspicious in 70%, with a positive biopsy in 59%. The sensitivity and specificity of AUS-CNB were 90% (95% CI 84.8% to 98.8%) and 100% (95% CI 27% to 59.1%), respectively. Cost estimates comparing AUS-CNB with SLNB demonstrated a cost saving of $236,517 in the CP axilla and $248,490 in the CN axilla, for a total cost savings of $485,007. Conclusions Axillary ultrasound-guided core needle biopsy is a sensitive, diagnostic, surgeon-performed procedure. It is time-saving, cost-efficient, and less invasive, making it a viable option when evaluating the status of the axilla in invasive breast cancer or staging before neoadjuvant chemotherapy.
Published: 2015

32. Enhancer Remodeling during Adaptive Bypass to MEK Inhibition Is Attenuated by Pharmacologic Targeting of the P-TEFb Complex

Author: Gary L. Johnson, Xin Chen, Noah Sciaky, Samantha M. Bevill, Daniel R. Goulet, H. Shelton Earp, Naim U. Rashid, Xiaping He, Jon S. Zawistowski, Martin C. Whittle, Kristalyn K. Gallagher, James S. Duncan, Lee M. Graves, Sara H. Velarde, Brian T. Golitz, Lisa A. Carey, Timothy J. Stuhlmiller, Charles M. Perou, Steven P. Angus, Darshan Singh, Joel S. Parker, Adriana S. Beltran, Charlene M. Santos, David B. Darr, and Jose F. Olivares-Quintero
Subjects: 0301 basic medicine, BRD4, Pyridones, MAP Kinase Kinase 2, MAP Kinase Kinase 1, Antineoplastic Agents, Cell Cycle Proteins, Triple Negative Breast Neoplasms, Mice, SCID, Pyrimidinones, Heterocyclic Compounds, 4 or More Rings, Article, Receptor tyrosine kinase, Epigenesis, Genetic, MED1, 03 medical and health sciences, Discoidin Domain Receptor 1, Downregulation and upregulation, RNA interference, Cell Line, Tumor, Animals, Humans, Positive Transcriptional Elongation Factor B, Molecular Targeted Therapy, Enhancer, Trametinib, Mice, Inbred BALB C, biology, Nuclear Proteins, Drug Synergism, Azepines, DNA Methylation, Triazoles, Xenograft Model Antitumor Assays, Molecular biology, Bromodomain, Enhancer Elements, Genetic, 030104 developmental biology, Oncology, Drug Resistance, Neoplasm, biology.protein, Cancer research, Female, RNA Interference, Transcription Factors
Abstract: Targeting the dysregulated BRAF–MEK–ERK pathway in cancer has increasingly emerged in clinical trial design. Despite clinical responses in specific cancers using inhibitors targeting BRAF and MEK, resistance develops often involving nongenomic adaptive bypass mechanisms. Inhibition of MEK1/2 by trametinib in patients with triple-negative breast cancer (TNBC) induced dramatic transcriptional responses, including upregulation of receptor tyrosine kinases (RTK) comparing tumor samples before and after one week of treatment. In preclinical models, MEK inhibition induced genome-wide enhancer formation involving the seeding of BRD4, MED1, H3K27 acetylation, and p300 that drives transcriptional adaptation. Inhibition of the P-TEFb–associated proteins BRD4 and CBP/p300 arrested enhancer seeding and RTK upregulation. BRD4 bromodomain inhibitors overcame trametinib resistance, producing sustained growth inhibition in cells, xenografts, and syngeneic mouse TNBC models. Pharmacologic targeting of P-TEFb members in conjunction with MEK inhibition by trametinib is an effective strategy to durably inhibit epigenomic remodeling required for adaptive resistance. Significance: Widespread transcriptional adaptation to pharmacologic MEK inhibition was observed in TNBC patient tumors. In preclinical models, MEK inhibition induces dramatic genome-wide modulation of chromatin, in the form of de novo enhancer formation and enhancer remodeling. Pharmacologic targeting of P-TEFb complex members at enhancers is an effective strategy to durably inhibit such adaptation. Cancer Discov; 7(3); 302–21. ©2017 AACR. This article is highlighted in the In This Issue feature, p. 235
Published: 2017
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33. Incidence and risk factors of delirium in patients post pancreaticoduodenectomy

Author: Aimee O'Farrell, Donal Maguire, Sarah McErlean, Oscar Traynor, Justin Geoghegan, Tom K. Gallagher, Kevin C. Conlon, and Emir Hoti
Subjects: Adult, Male, medicine.medical_specialty, Time Factors, Databases, Factual, medicine.medical_treatment, behavioral disciplines and activities, Pancreaticoduodenectomy, Hospitals, University, Risk Factors, mental disorders, medicine, Odds Ratio, Humans, Intensive care medicine, Aged, Retrospective Studies, Aged, 80 and over, Chi-Square Distribution, Hepatology, business.industry, Incidence (epidemiology), Incidence, Age Factors, Gastroenterology, Delirium, Retrospective cohort study, Odds ratio, Original Articles, Length of Stay, Middle Aged, nervous system diseases, Treatment Outcome, Multivariate Analysis, Female, medicine.symptom, business, Complication, Chi-squared distribution, Ireland, Abdominal surgery
Abstract: BackgroundPost-operative delirium is an important and common complication of major abdominal surgery characterized by acute confusion with fluctuating consciousness. The aim of this study was to establish the incidence of post-operative delirium in patients undergoing a pancreaticoduodenectomy and to determine the risk factors for its development.MethodsFrom a prospectively maintained database, a retrospective cohort analysis was performed of 50 consecutive patients who underwent a pancreaticoduodenectomy at the National Surgical Centre for Pancreatic Cancer in St. Vincent's University Hospital, Dublin and whose entire post-operative stay was in this institution, between July 2011 and December 2012. Two independent medical practitioners assessed all data and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder (DSM), fourth edition. Univariate and multivariate analyses were performed.ResultsSeven patients (14%) developed post-operative delirium. The median onset was on the second post-operative day. Older age was predictive of an increased risk of delirium post-operatively. Those who developed delirium had a significantly increased length of stay (LOS) as well as a significantly increased risk of developing at least a grade 3 complication (Clavien-Dindo classification).ConclusionThis study demonstrates that post-operative delirium is associated with a more complicated recovery after a pancreaticoduodenectomy and that older age is independently predictive of its development. Focused screening may allow targeted preventative strategies to be used in the peri-operative period to reduce complications and costs associated with delirium.
Published: 2014
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34. Autologous Chondrocyte Implantation in the Knee

Author: Timothy W. R. Briggs, Baljinder S. Dhinsa, K Gallagher, Richard Carrington, George E. Bentley, S.Z. Nawaz, and John A. Skinner
Subjects: Adult, Cartilage, Articular, Male, medicine.medical_specialty, Adolescent, Knee Joint, Kaplan-Meier Estimate, Osteoarthritis, Young Adult, Chondrocytes, Survivorship curve, medicine, Humans, Orthopedics and Sports Medicine, Autografts, Autologous chondrocyte implantation, Survival analysis, Analysis of Variance, Pain, Postoperative, Proportional hazards model, business.industry, Graft Survival, Hazard ratio, General Medicine, Middle Aged, medicine.disease, Arthralgia, Confidence interval, Surgery, Treatment Outcome, Cohort, Female, Joint Diseases, business, Cartilage Diseases
Abstract: Background: From 1998 to 2008, 1000 skeletally mature patients underwent autologous chondrocyte implantation for an osteochondral defect of the knee. We evaluated the functional outcomes in 827 of 869 patients who had undergone autologous chondrocyte implantation with Chondron or periosteum (ACI-C/ACI-P) or matrix-assisted chondrocyte implantation (MACI) and attempted to identify factors that influenced outcome. Methods: The age of the patient, the size and site of the osteochondral lesion, previous surgery, and the presence of early osteoarthritis were assessed for their influence on outcomes. Each factor was evaluated in a separate Cox proportional hazards model with use of hazard ratios (HRs), with 95% confidence intervals (CIs), describing the likelihood of failure for that particular factor. Outcomes were assessed with use of the modified Cincinnati score, visual analog scale pain score, and Stanmore functional score. Results: The mean duration of follow-up was 6.2 years (range, two to twelve years). The mean age was thirty-four years (range, fourteen to fifty-six years), with 493 males and 334 females. The average size of the defect was 409 mm2 (range, 64 to 2075 mm2). Four hundred and twenty-one procedures (51%) were performed on the medial femoral condyle; 109 (13%), on the lateral femoral condyle; 200 (24%), on the patella; and fifty (6%), on the trochlea. Kaplan-Meier survival analysis revealed that the unadjusted graft survival rate was 78.2% at five years and 50.7% and ten years for the entire cohort. No difference was found between the survival rates of the ACI-C/ACI-P and MACI techniques (HR = 0.948, 95% CI = 0.738 to 1.219, p = 0.678). There was a significant postoperative improvement in the function and pain scores of all three outcome measures (p < 0.002). Survivorship in the group with a previous cartilage regenerative procedure was inferior to that in patients with a previously untreated lesion, with failure five times more likely in the former group (HR = 4.718, standard error [SE] = 0.742, 95% CI = 3.466 to 6.420, p < 0.001). Degenerative change in any compartment had a significant detrimental effect on survivorship, with survivorship worsening as the osteoarthritis grade increased (Grade 1: HR = 2.077, 95% CI = 1.299 to 3.322, p = 0.002; Grade 2: HR = 3.450, 95% CI = 2.646 to 4.498, p < 0.001; and Grade 3: HR = 3.820, 95% CI = 2.185 to 6.677, p < 0.001). Conclusions: Our study demonstrated an overall graft survival of 78% at five years and 51% beyond ten years following both autologous chondrocyte implantation techniques. Despite study limitations, our results demonstrate that autologous chondrocyte implantation for the treatment of osteochondral defects of the knee can achieve good results. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Published: 2014

35. Does Aptitude Influence the Rate at which Proficiency Is Achieved for Laparoscopic Appendectomy?

Author: Tom K. Gallagher, Dara O. Kavanagh, Oscar Traynor, Paul C. Neary, Christina E. Buckley, and Ronan M. Conroy
Subjects: Adult, Male, Models, Educational, medicine.medical_specialty, Students, Medical, Adolescent, media_common.quotation_subject, Aptitude, Young Adult, Appendectomy, Humans, Medicine, Computer Simulation, Single-Blind Method, Medical physics, Technical skills, Competence (human resources), Minimally invasive procedures, media_common, Psychomotor learning, business.industry, Surgical procedures, Surgical training, Surgery, Learning curve, Female, Laparoscopy, Clinical Competence, business, Learning Curve
Abstract: The attainment of technical competence for surgical procedures is fundamental to a proficiency-based surgical training program. We hypothesized that aptitude may directly affect one's ability to successfully complete the learning curve for minimally invasive procedures. The aim was to assess whether aptitude has an impact on ability to achieve proficiency in completing a simulated minimally invasive surgical procedure. The index procedure chosen was a laparoscopic appendectomy.Two groups of medical students with disparate aptitude were selected. Aptitude (visual-spatial, depth perception, and psychomotor ability) was measured by previously validated tests. Indicators of technical proficiency for laparoscopic appendectomy were established by trained surgeons with an individual case volume of more than 150. All subjects were tested consecutively on the ProMIS III (Haptica) until they reached predefined proficiency in this procedure. Simulator metrics, critical error scores, and Objective Structured Assessment of Technical Skills (OSATS) scores were recorded.The mean numbers of attempts to achieve proficiency in performing a laparoscopic appendectomy for group A (high aptitude) and B (low aptitude) were 6 (range 4 to 7) and 14 (range 10 to 18), respectively (p0.0001). Significant differences were found between the 2 groups for path length (p = 0.014), error score (p = 0.021), and OSATS score (p0.0001) at the initial attempt.High aptitude is directly related to a rapid attainment of proficiency. These findings suggest that resource allocation for proficiency-based technical training in surgery may need to be tailored according to a trainee's natural ability.
Published: 2013

36. Does Axillary Reverse Mapping Prevent Lymphedema After Lymphadenectomy?

Author: Maureen McCarthy, Evan Tummel, Richard D. Betzold, Laura Adkins, Kristalyn K. Gallagher, Daniela Ochoa, Vicki Klimberg, Kyle J. Kalkwarf, Jeannette Y. Lee, Stephanie Hung, and Soheila Korourian
Subjects: medicine.medical_specialty, medicine.medical_treatment, Sentinel lymph node, Breast Neoplasms, 030230 surgery, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Breast cancer, Biopsy, medicine, Humans, Lymphedema, Prospective Studies, Mastectomy, Aged, medicine.diagnostic_test, business.industry, Sentinel Lymph Node Biopsy, Biopsy, Needle, Axillary Lymph Node Dissection, Middle Aged, medicine.disease, Prognosis, Immunohistochemistry, humanities, Surgery, body regions, Axilla, medicine.anatomical_structure, Lymphatic system, Treatment Outcome, 030220 oncology & carcinogenesis, Lymph Node Excision, Lymphadenectomy, Female, Lymph Nodes, Sentinel Lymph Node, business
Abstract: We hypothesized that disconcerting lymphedema rates in both sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND) may be because of unrecognized vunerable variations in arm lymphatic drainage within the axilla. Axillary reverse mapping (ARM) facilitates identification and avoidance of arm lymphatics within the axilla and its use may reduce lymphedema.This institutional review board-approved study from June 2007 to December 2013 involved patients undergoing SLNB with or without ALND, or ALND alone. Technetium is injected subareolarly for localization of the breast SLN and isosulfan blue dye (5 mL) is injected in the ipsilateral upper arm for localization of nonbreast lymphatics. Data were collected on identification and preservation of arm lymphatics, crossover rates, blue node metastases, axillary recurrence, and lymphedema as measured by volume displacement.A total of 654 patients prospectively underwent 685 ARM procedures with a SLNB and/or ALND. Objective lymphedema rates for SLNB and ALND were 0.8% and 6.5% respectively, with 26-month median follow up. Blue lymphatics were identified in 29.2% (138/472) of SLNB and 71.8% (153/213) of ALND. Crossover was seen in 3.8% (18/472) of SLNB and 5.6% (12/213) of ALND. Blue node metastases rate was 4.5% (2/44). Axillary recurrence rate was 0.2% and 1.4% for SLNB and ALND, respectively.ARM allows frequent identification of arm lymphatics in the axilla, which would have been transected during routine surgery. Rates of metastases in noncrossover nodes and axillary recurrences are low. Lymphedema rates are dramatically reduced using ARM when compared with accepted standards.
Published: 2016

37. Neutralizing Activity of Saliva against Cytomegalovirus

Author: Mary K. Gallagher, Michael A. McVoy, Frances M. Saccoccio, and Stuart P. Adler
Subjects: Male, Microbiology (medical), Saliva, Cell type, Clinical Biochemistry, Immunology, Congenital cytomegalovirus infection, Cytomegalovirus, Antibodies, Viral, Cytomegalovirus Vaccines, Viral entry, medicine, Humans, Immunology and Allergy, Fibroblast, biology, Epithelial Cells, Child Day Care Centers, Fibroblasts, Vaccine Research, medicine.disease, Antibodies, Neutralizing, Virology, Titer, medicine.anatomical_structure, Child, Preschool, Immunoglobulin G, Cytomegalovirus Infections, biology.protein, Female, Cytomegalovirus vaccine, Antibody, medicine.drug
Abstract: Congenital cytomegalovirus (CMV) disease is the leading cause of permanent disability in neonates in the United States. Neutralizing antibodies in saliva may protect against maternal CMV infection by blocking viral entry into oral epithelial cells, but the antibody response to CMV in the saliva following natural infection is not well characterized. Saliva specimens from naturally infected individuals were tested for CMV-neutralizing activity using epithelial and fibroblast cells. Saliva from seronegative adults had no inherent anti-CMV activity. Neutralizing activity of saliva from naturally infected adults was not detectable using fibroblast cells, and saliva from young children, adolescents, and Towne vaccine recipients did not have activity using either cell type. However, when using epithelial cells, neutralizing activity was present in saliva from 50% of seropositive adults, correlated with serum-neutralizing activity, and was more prevalent in mothers of children in day care than in non-day care-associated adults. Three day care mothers with high salivary neutralizing activities (>1:20) had exceptionally high serum-neutralizing titers (3- to 8-fold higher than typical seropositives) and were immunoblot positive for serum antibodies to the epithelial entry mediator UL130. These results suggest that salivary neutralizing activities are attainable by induction of high serum IgG levels and could be utilized to evaluate candidate cytomegalovirus vaccines.
Published: 2011

38. Gun Shot-101: an 8-year review of gunshot injuries in an Irish teaching hospital from a general surgical perspective

Author: P. N. Keeling, T. K. Gallagher, P. J. Smyth, F. O’Kelly, and K. T. Lim
Subjects: Adult, Male, Firearms, medicine.medical_specialty, Time Factors, Adolescent, Thoracic Injuries, Exploratory laparotomy, medicine.medical_treatment, Poison control, Abdominal Injuries, Suicide prevention, Occupational safety and health, Young Adult, Irish, Risk Factors, Injury prevention, Craniocerebral Trauma, Humans, Medicine, Hospitals, Teaching, Demography, Retrospective Studies, business.industry, General surgery, Human factors and ergonomics, Extremities, Retrospective cohort study, General Medicine, Middle Aged, medicine.disease, Survival Analysis, language.human_language, Unemployment, General Surgery, language, Female, Wounds, Gunshot, Medical emergency, business, Ireland
Abstract: Gun-related crime offences have increased in the Republic of Ireland steadily over the past number of years. Regional trauma units are witnessing unprecedented numbers of injuries in the Republic of Ireland with limited prior experience. Eight-year retrospective study analysing demographic data, management and outcome of firearm-related injuries. Patients who experience gunshot injuries in this region are statistically likely to be young, male and unemployed with a single shotgun injury to an extremity. Post-operative survival rates of 100% for those who undergo an exploratory laparotomy. Ireland has comparable survival outcomes to other international centres with similar patient demographics due to timely and appropriate operative intervention. These results serve to provide a template for further patient management.
Published: 2010

39. Barriers to Reporting Sexual Assault for Women and Men: Perspectives of College Students

Author: Sarah K. Gallagher, Fran S. Danis, Marjorie R. Sable, and Denise Mauzy
Subjects: Adult, Male, medicine.medical_specialty, Adolescent, Universities, Sexual Behavior, media_common.quotation_subject, education, Embarrassment, Poison control, Shame, Human sexuality, Violence, Truth Disclosure, Suicide prevention, Surveys and Questionnaires, Injury prevention, medicine, Humans, Students, Psychiatry, media_common, Public Health, Environmental and Occupational Health, social sciences, United States, Sexual abuse, behavior and behavior mechanisms, Anxiety, Female, medicine.symptom, Psychology, Clinical psychology
Abstract: The authors asked college students to rate the importance of a list of barriers to reporting rape and sexual assault among male and female victims. The authors' findings indicate that barriers prevalent 30 years ago, prior to efforts by the rape reform movement, continue to be considered important among college men and women. The barriers rated as the most important were (1) shame, guilt, embarrassment, not wanting friends and family to know; (2) concerns about confidentiality; and (3) fear of not being believed. Both genders perceived a fear of being judged as gay as an important barrier for male victims of sexual assault or rape and fear of retaliation by the perpetrator to be an important barrier for female victims.
Published: 2006

40. Emerging Ethical Considerations of Donation After Circulatory Death

Author: Anton I. Skaro, Michael Abecassis, and Tom K. Gallagher
Subjects: Male, medicine.medical_specialty, Tissue and Organ Procurement, business.industry, MEDLINE, 030204 cardiovascular system & hematology, 030230 surgery, Circulatory death, Tissue Donors, Surgery, Death, 03 medical and health sciences, 0302 clinical medicine, Donation, medicine, Humans, Female, Intensive care medicine, business
Published: 2016

41. A comparative analysis of the patient characteristics and cost of managing intravenous drug users (IVDU) with soft tissue abscesses with non-IVDU

Author: K Gallagher, D.M. Ricketts, N. Chotai, W.K.M. Kieffer, and Benedict A Rogers
Subjects: Financial costs, Adult, Male, medicine.medical_specialty, Adolescent, Cost-Benefit Analysis, Patient characteristics, Age and sex, 03 medical and health sciences, Young Adult, 0302 clinical medicine, Cost of Illness, Internal medicine, Medicine, Humans, 030212 general & internal medicine, Substance Abuse, Intravenous, Retrospective Studies, Intravenous drug, business.industry, Incidence, Soft tissue, Disease Management, Retrospective cohort study, Hepatitis C, Health Care Costs, medicine.disease, Abscess, United Kingdom, Surgery, Cohort, Female, business, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract: Intravenous drug users (IVDU) often present to hospitals with complex co-morbidities, associated with prolonged in-patient admissions. The aim of this study was to compare a cohort of IVDU patients with soft tissue abscesses with non-IVDUs. We analysed the demographics, comorbidities, location of abscesses, multidisciplinary input and financial costs of managing both groups.A retrospective cohort study was conducted between January 2010 and September 2013. Two age and sex matched cohorts were compared: IVDU and non-IVDU.We identified 44 IVDU patients and 54 non-IVDU patients. The IVDU had higher rates of smoking (89% p 0.001) and unemployment (73% p 0.05). The most common comorbidities in the IVDU cohort were hepatitis C (17%) and HIV (14%), whereas diabetes mellitus (15%) and hypertension (11%) were the most common in the non-IVDUs (p 0.01). The most common location for an abscess in non-IVDU patients was the hand, whereas IVDU patients had abscesses in their groin. Groin injecting led to a referral to multiple specialties. The median length of stay for the IVDU patients was 4 days and for non-IVDU patients 1 day (p 0.01). The average cost of managing IVDU patients in our unit was £1280: for non- IVDU the cost was £530 (p 0.001).IVDU patients with soft tissue abscesses have higher rates of smoking, unemployment, infection with hepatitis C and HIV compared to a control group. We have suggested several recommendations to optimise the management of these patients including the implementation of an additional code to compensate for the complexity of their management.
Published: 2014

42. Diarrhoea, ascites and eosinophilia: An unusual triad

Author: Tom K. Gallagher and Desmond C. Winter
Subjects: Adult, Diarrhea, medicine.medical_specialty, Abdominal pain, Gastroenterology, Enteritis, Diagnosis, Differential, Adrenal Cortex Hormones, Internal medicine, Eosinophilia, Ascites, medicine, Humans, Disease process, Eosinophilic enteritis, Food type, business.industry, medicine.disease, Dermatology, Female, medicine.symptom, business
Abstract: The onset of diarrhoea and cramp-like abdominal pain following consumption of an identified food type is not an uncommon presentation to many practitioners. However, when it fails to settle and is associated with unusual features both on examination and on initial work-up, then a more complex diagnostic and therapeutic conundrum needs to be considered. We report on such a case where the onset of diarrhoea was associated with ascites and peripheral eosinophilia. A variety of causes including parasitic and tuberculous infection were excluded. A diagnosis of eosinophilic enteritis was made based on definite criteria, and appropriate management was instituted. In this report we discuss the diagnostic criteria and some of the proposed pathophysiologic theories in order to explain this unusual disease process.
Published: 2007

43. Iron, Copper, Magnesium and Zinc Status as Predictors of Swimming Performance

Author: B.S. Hoverson, W.A. Siders, Henry C. Lukaski, and S K Gallagher
Subjects: Adult, Male, Anemia, Iron, Nutritional Status, Mineralogy, chemistry.chemical_element, Physical Therapy, Sports Therapy and Rehabilitation, Zinc, Body iron, Animal science, medicine, Humans, Magnesium, Orthopedics and Sports Medicine, Serum ferritin, Swimming, Iron copper, Nutritional status, medicine.disease, Diet, chemistry, Physical performance, Female, Copper
Abstract: The hypothesis that blood biochemical measurements of iron (Fe), copper (Cu), magnesium (Mg) and zinc (Zn) nutritional status and dietary intakes of these minerals are useful predictors of 100-yd free-style swimming performance during actual competition was examined in five female and five male collegiate swimmers. Dietary intakes of Fe, Cu, Mg, and Zn exceeded 70% of daily recommended or estimated safe and adequate intakes. Anemia was not present but body iron stores, assessed with serum ferritin concentration, were reduced in female swimmers who had significantly increased erythrocyte Mg and superoxide dismutase activity which suggest a biochemical adaptation to physical training. Actual 100-yd freestyle times (53.1 +/- 1.4 sec; mean +/- SE) measured during competition were similar to values (52.6 +/- 1.4 sec) predicted with models previously derived from other groups of swimmers. These findings indicate the important role of mineral nutritional status in facilitating the development of peak physical performance and support the hypothesis that mineral element nutritional status is one factor contributing to attainment of optimal human physiological function.
Published: 1996

44. Living with the mentally ill: Effects on the health and functioning of other household members

Author: Sally K. Gallagher and David Mechanic
Subjects: Male, Gerontology, medicine.medical_specialty, Health (social science), Multivariate analysis, Health Status, MEDLINE, Sex Factors, History and Philosophy of Science, medicine, Humans, National Health Interview Survey, Parent-Child Relations, Social Behavior, Psychiatry, Family Health, Family Characteristics, business.industry, Mental Disorders, Mentally ill, Public health, Health Services, Middle Aged, Mental illness, medicine.disease, Health Surveys, Mental health, Social relation, Caregivers, Multivariate Analysis, Female, business
Abstract: Based on data from the National Health Interview Survey Mental Health Supplement, 1989 (NCHS, 1991), this article compares health outcomes for respondents living with someone who is mentally ill (N = 776) with a randomly selected subsample of respondents not living with someone identified as mentally ill (N = 716). When other predictors of health are controlled, sharing a household with a mentally ill person is associated with poorer self-reported physical health, increased risk of reporting some activity limitation, and increased service utilization-both greater risk of hospitalization or visiting a physician, and a greater number of days hospitalized and number of physician visits among those utilizing these services. The severity and duration of mental illness have little effect across health outcome measures. Impaired health and increased utilization of medical care among persons living with someone who is mentally ill suggest hidden costs to individuals, to families of the mentally ill, and to the service system.
Published: 1996

45. Outcomes of central bisectionectomy for hepatocellular carcinoma

Author: Tan To Cheung, Chung Mau Lo, Kenneth S. H. Chok, See Ching Chan, Ronnie T.P. Poon, Albert C. Y. Chan, and Thomas K. Gallagher
Subjects: Adult, Male, medicine.medical_specialty, Carcinoma, Hepatocellular, Time Factors, medicine.medical_treatment, MEDLINE, Kaplan-Meier Estimate, Disease-Free Survival, medicine, Carcinoma, Hepatectomy, Humans, Hospital Mortality, Aged, Retrospective Studies, Chi-Square Distribution, Hepatology, business.industry, Liver Neoplasms, Gastroenterology, Retrospective cohort study, Original Articles, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Surgery, Treatment Outcome, Hepatocellular carcinoma, Cohort, Resection margin, Female, business, Tomography, X-Ray Computed, Chi-squared distribution
Abstract: Background Central bisectionectomy (resection of Couinaud segments IV, V and VIII) for malignant or benign disease poses a technical challenge to the surgeon but if feasible, has significant benefits in terms of conserving liver volume and options for future intervention. This study reviews a cohort of patients who underwent this procedure; outlines the indications, optimal operative technique as well as both short‐ and long‐term outcomes. Methods A retrospective review of a prospectively maintained database was performed. Pre‐operative clinicopathological data, operative details and post‐operative outcomes including overall and disease‐free survival were analysed. Results Between 1989 and 2009, 21 patients underwent a central bisectionectomy. All procedures were performed for hepatocellular carcinoma (HCC). All patients underwent a R0 resection with a median resection margin of 5 mm (1–15 mm). The 1‐, 3‐ and 5‐year disease‐free survivals were 65%, 34.8% and 34.8%, and the corresponding overall survival rates were 90.5%, 66.8% and 66.8%, respectively. Conclusion These data support the use of a central bisectionectomy in selected cases in the management of HCC. With the use of a meticulous operative technique and adherence to surgical oncological principles, satisfactory long‐term outcomes were achievable.
Published: 2012

46. High- versus low-meat diets: effects on zinc absorption, iron status, and calcium, copper, iron, magnesium, manganese, nitrogen, phosphorus, and zinc balance in postmenopausal women

Author: Glenn I. Lykken, Janet R. Hunt, LuAnn K. Johnson, and S K Gallagher
Subjects: Nitrogen balance, medicine.medical_specialty, Meat, Nitrogen, Iron, Nutritional Status, Medicine (miscellaneous), chemistry.chemical_element, Zinc, Calcium, Intestinal absorption, Absorption, Internal medicine, medicine, Humans, Food science, Aged, Minerals, Nutrition and Dietetics, biology, Middle Aged, Urinary calcium, Diet, Ferritin, Human nutrition, Endocrinology, chemistry, biology.protein, Female, Nutrition physiology, Energy Metabolism
Abstract: The effects of three diets-high meat (HM), low meat (LM), or low meat with mineral supplements (LS)-on zinc absorption, elemental balance, and related clinical indexes were investigated in a metabolic study of 14 women aged 51-70 y. The women ate each of the three diets for 7 wk in random order. Lean beef, chicken, ham, and tuna in the HM diet replaced foods with a low mineral content in the LM diet. The LS diet was similar to the HM diet in K, P. Fe, Mg, and Zn contents. Compared with the other diets, the HM diet increased zinc absorption and retention, and slightly increased urinary zinc. Nitrogen and calcium balances and urinary calcium were not different for the HM and LM diets. Iron balance was not different for the HM and LS diets with similar iron content, but the HM diet was unexpectedly associated with lower iron status (higher iron-binding capacity and lower ferritin than LM and LS diets). These results indicate that 0.8 g protein/kg body wt meets protein requirements in older women, and that high meat consumption increases zinc retention without compromising calcium status and may reduce indexes of iron status, in contrast with iron absorption results from studies with radiolabeled test meals. Am J Clin Nutr 1995;62:621-32.
Published: 1995

47. Considerations in the Early Termination of Clinical Trials in Surgery

Author: Ewen M Harrison, Stephen J. Wigmore, Tom K. Gallagher, and O. James Garden
Subjects: Male, Postoperative Care, medicine.medical_specialty, business.industry, General surgery, medicine.medical_treatment, Pancreaticoduodenectomy, Clinical trial, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Text mining, medicine, Drainage, Humans, Female, 030211 gastroenterology & hepatology, Surgery, 030212 general & internal medicine, business
Published: 2016

48. Day-case laparoscopic Nissen fundoplication: a default pathway or is selection the key?

Author: Myles Smith, Kevin C. Conlon, Michael E. Kelly, Paul F. Ridgway, and Tom K. Gallagher
Subjects: Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Fundoplication, Nissen fundoplication, Statistics, Nonparametric, Body Mass Index, Patient Admission, Sex Factors, Ambulatory Care, Medicine, Humans, Laparoscopy, Retrospective Studies, Univariate analysis, medicine.diagnostic_test, business.industry, Incidence (epidemiology), Smoking, Reflux, Retrospective cohort study, Length of Stay, Patient Discharge, Surgery, Logistic Models, Treatment Outcome, Mann–Whitney U test, Gastroesophageal Reflux, Female, business, Body mass index
Abstract: In recent years, day-case laparoscopic Nissen fundoplication (LNF) has became popular. Our study aims to evaluate the effect of patient factors and severity of gastroesophageal reflux disease measured by DeMeester score on the success of day-case LNF.We conducted a retrospective case series review of patient demographics (age, gender, body mass index [BMI], and smoking status) and DeMeester score over a 5-year period. Between 2005 and 2010, 112 patients had day-case LNF. Same-day discharge was achieved in 80.3%. Twenty-two patients (19.7%) required postoperative admission ("failed day-case surgery"), with a resultant mean length of stay of 1.41 days. Univariate analysis showed that female gender had a significantly higher incidence of postsurgical admission (30.76% females versus 13.69% males, P=.03 by Mann-Whitney U test). Compared with the same-day discharge group, the failed day-case group has a higher mean DeMeester score (50.89 versus 36.03, P=.021 by t test) and BMI (28.71±0.778 kg/m(2) versus 26.79±0.3737 kg/m(2), P=.023). Age and smoking status were not significant determining factors in postoperative admission rates. Using multivariable analysis and logistical regression, we derived a model based on gender, BMI, and DeMeester score to predict the probability of admission following day-case LNF.We conclude that day-case LNF is a safe, feasible procedure in the appropriately selected patient population. Our novel finding of higher admission rates in females, high DeMeester score, and high BMI should be used in planning perioperative hospitalization in this cohort.
Published: 2012

49. Mid-term functional outcome after the internal fixation of distal radius fractures

Author: K Gallagher, David S Elliott, Lucy Bradshaw, Alex Trompeter, Joideep Phadnis, Kevin Newman, and Apollo - University of Cambridge Repository
Subjects: Adult, Male, Wrist Joint, medicine.medical_specialty, lcsh:Diseases of the musculoskeletal system, Adolescent, Radiography, medicine.medical_treatment, Palmar Plate, Wrist, Distal Radius, Fixation (surgical), Disability Evaluation, Fracture Fixation, Internal, Young Adult, lcsh:Orthopedic surgery, Dash, Bone plate, medicine, Internal fixation, Humans, Orthopedics and Sports Medicine, Aged, Retrospective Studies, Aged, 80 and over, Fracture Healing, business.industry, Retrospective cohort study, Recovery of Function, Middle Aged, Wrist Injuries, Internal fixation: functional outcome, Surgery, lcsh:RD701-811, medicine.anatomical_structure, Fracture, Treatment Outcome, Orthopedic surgery, Female, lcsh:RC925-935, business, Radius Fractures, Bone Plates, Research Article, Follow-Up Studies
Abstract: Background Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. Methods 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation = 10.4). Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. Results The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74%) had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15%) and in 11 patients were major (6%). Conclusion This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention.
Published: 2012

50. Effect of ascorbic acid on apparent iron absorption by women with low iron stores

Author: Janet R. Hunt, LuAnn K. Johnson, and S K Gallagher
Subjects: Adult, medicine.medical_specialty, Iron, Iron absorption, Thyroid Gland, Biological Availability, Medicine (miscellaneous), Ascorbic Acid, Absorption (skin), Double-Blind Method, Predictive Value of Tests, Internal medicine, Western diet, medicine, Humans, Food science, Nutrition and Dietetics, Chemistry, Iron Deficiencies, Iron deficiency, medicine.disease, Ascorbic acid, Crossover study, Diet, Bioavailability, Endocrinology, Increased serum ferritin, Female, Energy Intake
Abstract: The effect of ascorbic acid supplementation on apparent iron absorption was tested in women with low iron stores. For 10 wk, 25 healthy nonpregnant women, aged 20-45 y with low serum ferritin (3.5-17.7 micrograms/L), consumed either a diet with predicted poorly bioavailable iron or a typical Western diet, classified according to dietary meat and ascorbic acid contents. Meals were supplemented with ascorbic acid (500 mg, three times a day) for 5 of the 10 wk, in a double-blind, crossover design. Ascorbic acid did not affect most biochemical indexes of iron status, the biological half-life of 59Fe, or apparent iron absorption (diet-feces) from either diet, but slightly increased serum ferritin (11.9 vs 10.7 micrograms/L, P < 0.06) when data from both diets were combined. These results support other evidence that ascorbic acid has less effect on iron bioavailability than has been predicted from tests with single meals.
Published: 1994

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