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6. American Society of Colon and Rectal Surgeons 95th Annual Convention Podium and Poster Abstracts June 9–14, 1996 Seattle, Washington

Author

Obrand, D., Gordon, P. H., Rowley, S., Grace, R. H., Rai, S., Moran, M. R., Rai, A. M., Farouk, R., Lee, P. W. R., Edwards, J., Thorne, M., MacDonald, A. W., Duthie, G. S., Monson, J. R. T., Shabahang, M., Brenner, R., Wright, A., Montgomery, E., Trock, B., Buras, R., Schumaker, L., Nolla, J., Buffan, A., Uskokovic, M., Nauta, R., Evans, S., Velázquez, O. C., Zhou, D., Seto, R. W., Choi, J., Jabbar, A., Breen, F., Rombeau, J. L., Casillas, S., Dietz, D. W., Brand, M. I., Vladisavljevic, A., Jones, S. C., Milsom, J. W., Stuntz, M., Wilmoth, G., Ong, J., Stabile, B., Stamos, M. J., Kahn, H., Alexander, A., Rakinic, J., Nagle, D., Fry, R., Simons, A. J., Kerr, R., Toms, C., Groshen, S., Ross, R., Morris, M., Beart, R., Ortega, A., Anthone, G., Lucha, P., Rosen, L., Stasik, J., Olenwine, J., Riether, R., Khubchandani, I., Ogunbivi, O., Birnbaum, E., Fleshman, J., Kodner, I., McLeod, R. S., Geerts, W., Sniderman, K., Greenwood, C., Gregoire, R., Taylor, B., Silverman, R., Atkinson, K., Burnstein, M., Marshall, J., Burul, C., Anderson, D., Ross, T., Wilson, S., Barton, P., Maetani, S., Onodera, H., Morimoto, H., Imamura, M., Hyams, D. M., Mamounas, E., Petrelli, N., Rockette, H., Jones, J., Wolmark, N., Sofo, L., Ratto, C., Valentini, V., Ippoliti, M., Nucera, P., Merico, M., Bellantone, R., Doglietto, G. B., Crucitti, F., Goes, R., Simons, A., Gunderson, L., Grado, G., Streeter, O., Sun, J. H., Decanini-Garza, P., Kim, D. G., Wong, W. D., Rothenberger, D. A., Madoff, R. D., Madlensky, L., Berk, T., Bapat, B., Redston, M., Gallinger, S., Cohen, Z., Winde, G., Schmid, K. W., Brandt, B., Müller, R., Osswald, H., Jang, Y., Steinhagen, R., Heimann, T., Schnitzler, M., Blackstein, M., McLeod, R., Devesa, J. M., Madrid, J. M. Fernandez, Enriquez, J. M., Geerdes, B. P., Heineman, E., Konsten, J., Baeten, C. G. M., Michot, F., Lehur, P. A., Denis, P., Grise, P. H., Leborgne, J., Teniere, P., Buzelin, J. M., Stebbing, J. F., Brading, A. F., Mortensen, N. J. McC, Gunn, J., Gardiner, A., Abdullah, N., Nyam, D. C. N. K., Pemberton, J. H., Ilstrup, D., Lund, J. N., Scholefield, J. H., Stamm, L., Matzel, K. E., Stadelmaier, U., Dünne, A., Hohenberger, W., Sala, C., Garcia-Granero, E., Molina, M. J., Garcia, J. V., Lledo, S., Ternent, C. A., Shashidharan, M., Blatchford, G. J., Christensen, M. A., Thorson, A. G., Sentovich, S. M., Jensen, L. L., Lowry, A. C., Zaheer, S., Reilly, W. T., Tsang, C., Singer, D., Richard, C. S., Stern, H. S., Oliveira, L., Daniel, N., Bernstein, M., DeMarta, D., Weiss, E. G., Nogueras, J. J., Wexner, S. D., Keighley, M. R. B., Korsgen, S., Agachan, F., Kim, D. -S., Goldberg, S. M., Durham, R. M., Pruitt, G., Longo, W. E., Marchesa, P., Oliart, S., Goldblum, J., Fazio, V. W., Rantis, P. C., Daniel, G. L., Vernava, III, A. M., Becker, J. M., Marie, G. St., Ferzoco, S., Franklin, M., Rosenthal, D., Goldstein, E. T., Bass, E. M., DelPino, A., Tan, A., Pearl, R., Orsay, C., Sher, M. E., Sands, L. R., Påhlman, Lars, Hewett, P. J., Thomas, W. M., King, G., Eaton, M., Allendorf, U. D. F., Bessler, M., Whelan, R. L., Trokel, M., Laird, D., Nowygrod, R., Treat, M. R., Vukasin, P., Steele, G., Weston, L., Allendorf, J. D. F., Sellers, G., Joo, J. S., Bruce, C. J., Coller, J. A., Murray, J. J., Schoetz, Jr., D. J., Roberts, P. L., Schoetz, D., Bockler, M., Rosenblatt, M., Malhorta, S., Roberts, P., Murray, J., Coller, J., Rusin, L., Liu, C. D., Newton, T. R., Zinner, M. J., Ashley, S. W., McFadden, D. W., Tusek, D. L., Church, J. M., Strong, S. A., Grass, J., Steinhart, A. H., Greenberg, G. R., Siminovich, K., Blair, J. E., Cruz, C., Prabhakar, L. P., Laramee, C., Nelson, H., Dozois, R. R., Ozuner, G., Hull, T., Fazio, V., Navaro, G., Bauer, J. J., Gorfine, S. R., Gelemt, I. M., Harris, M. T., Kreel, I., Marcello, P. W., Rusin, L. C., Veidenheimer, M. C., Ogunbiyi, O. A., Thibault, C., Sagar, P., Wolff, B. G., Lee, F., Lee, E. C., Pennoyer, W. P., Vignati, P. V., Cohen, J., MacRae, H. M., O'Connor, B., Ton, E., Hain, J. M., Perez-Ramirez, J. J., Spencer, M. P., Gemlo, B. T., Neto, J. A. Reis, Quilici, F. A., Cordeiro, F., Reis, Jr., J. A., Neto, C. I. Reis, Gottesman, L., Tjandra, J., Takano, M., Kuromizu, J., Tsuji, Y., Lee, C. S., Ferrara, A., Levy, J. R., Larach, S. W., Krecker, M., Williamson, P. R., Wong, D. W., Sarmiento, J. M., Burgart, L. J., Frizelle, F. A., Ilstrup, D. M., Salem, R., Smith, L. E., Rooney, P. S., Chapman, M. A. S., Steele, R. J. C., Koren, R., Gal, R., Kyzer, S., Chaimoff, CH., Rodríguez-Bigas, M. A., Mahoney, M. C., Weber, T. K., Petrelli, N. J., Ault, G., Ceron, O., Conti, P., Hadfield, M. B., Turnbull, L. W., Nicholson, A. A., Horsman, A., Shibata, D., Sentovich, S., Hyland, W., Busse, P., Bleday, R., Allendorf, J., Whelan, R., Horvath, K., Treat, M., Wronski, M., Arbit, E., Bilsky, M., Galicich, J. H., Miller, A. S., Lewis, W. G., Williamson, M. E. R., Sagar, P. M., Holdsworth, P. J., Johnston, D., Smith, A. H., Marchetti, F., Thompson-Fawcett, M. W., Warren, B. F., Mortensen, N. J. M., Bouchard, S., Belliveau, P., Trudel, J., Zinsmeister, A. R., Schleck, C. D., McIntyre, P. B., Hanson, R. B., Read, T. E., Dominguez, J. M., Hyman, N. H., Beck, D. E., Dayton, M. T., Stryker, S. J., Wolf, B. G., Young-Fadok, T. M., Meagher, A., Benn, P. L., Takao, Y., Chen, F. C., Wu, J., Milsom, J., Stein, B. L., Vasilevsky, C. A., Hartley, J. E., Cureshi, A., Sellers, G. J., Van, D., Ludwig, K. A., Garcia-Ruiz, A., Espat, N. J., Rao, G. N., Drew, P. J., Pfeifer, J., Park, U. C., Gonzalez, A., Okamoto, T., Konishi, F., Tsukamoto, T., Senba, S., Kashiwagi, H., Kojima, M., Togashi, T., Kanazawa, K., Yoon, W. H., Kang, Y. N., Hong, K. H., Park, H. D., Koo, S. H., Song, K. S., Kim, J. C., Roh, S. A., Park, K. C., Jessup, J. M., Changchien, C. R., Wang, J. Y., Hsu, K. C., Chen, J. S., Tang, R., You, Y. T., Ho, Y. S., Guttman, R., Nelson, R., Sardinha, T. G. S., Gilliland, J., Kroll, M., Lee, E., Wexler, J., Hudzinski, D., Glass, D., Wolff, B. D., King, D. W., Talley, N., Chen, W. S., Lin, W. C., Hsu, H., Wrightson, W. R., Galandiuk, S., LaRocca, R., Myers, S. R., Tada, M., Inoue, H., Tsubaki, M., Endo, M., Sobzcak, S., Welch, J. P., Cohen, J. L., Allen, L. W., Morrow, J. S., Behen, S. L., Smith, K. W., Cali, J. R., Bailey, H. R., Fucini, C., Elbetti, C., Messerini, L., Law, W. L., Butts, D. R., Max, E., Memon, M. A., Devine, J., Feeney, J., Talley, N. J., Stephenson, E. R., Ilahi, O., Koltun, W. A., Spellman, M., Rantis, R. C., Vernava, A. M., Parra, R. O., Breen, E., Hayes, P., Quinn, D., Whitlow, C. B., Opelka, F. G., Gathright, J. B., Golub, R. W., Maccabee, P. J., Combs, A. J., Grose, E. A., Taylor, B. M., Kozell, K., McGannon, E., Krogh, K., Nielsen, J., Djurhuus, J. C., Mosdal, C., Sabroe, S., Laurberg, S., Chen, M. F., Kerner, B. A., Khanduja, K. S., Wise, Jr., W. E., Padmanabhan, A., Meesig, D. M., Yasin, M. T., Aguilar, P. S., Ho, Y. H., Tan, M., Seow-Choen, F., Rustin, R. B., and Harmon, J. M.

Published
1996
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9. American Society of Colon and Rectal Surgeons 91st Annual Convention Podium and Poster abstracts: June 7–12, 1992 San Francisco, CA

Author

Lechner, P., Lind, P., Binter, G., Golub, R. W., Kerner, B. A., Wise, Jr., W. E., Meesig, D. M., Hartmann, R. F., Khanduja, K. S., Sayre, J. W., Aguilar, P. S., Guillem, J. G., Forde, K. A., Treat, M. R., Neugut, A. I., O'Toole, K. M., Diamond, B. E., Kewenter, J., Brevinge, H., Haglind, E., Limberg, B., Elles, C. N., Boggs, W. H., Slagle, G. H., Cole, P. A., Coyle, D. J., Smith, L. E., Orkin, B., Saclarides, T. J., Sheridan, W. G., Lowndes, R. H., Young, H. L., Wong, W. D., Rothenberger, D. A., Bartolo, D. C. C., Wexner, S. D., Ger, G. C., Jorge, J. M. N., Lee, E., Nogueras, J. J., Jagelman, D. G., McKenna, K., Koltun, W. A., Bute, B., Lichliter, W., Le, T., Timmcke, A., Gathright, J. B., Mascagni, D., Hojo, K., Moriya, Y., Sugihara, K., Di, G., Zenni, G. C., Abraham, K., Dobrin, P. B., Harford, F. J., Suzuki, K., Gunderson, L., Devine, R. M., Dozois, R. R., Cavaliere, F., Pemberton, J. H., Fazio, V., Cosimelli, M., Beart, R. W., Giannarelli, D., Moran, M., Ramos, A., Rothenberger, D., Goldberg, S., Antonenko, D., Heymen, S., Gulledge, A. D., Jakate, S., Saclarides, T., Heine, J. A., Williams, J. G., VanBergen, E. H., Buie, W. D., Goldberg, S. M., Davies, N., Yates, J., Jenkins, S. A., Taylor, B. A., Bapat, B., Stern, H., Berk, T., Parker, J., Ray, P. N., McLeod, R., Cohen, Z., Rowe, J. K., Zera, R. T., Madoff, R. D., Bubrick, M. P., Roberts, J. C., Johnston, G. R., Fenney, D. A., Farouk, R., Duthie, G. S., McCue, J. L., Phillips, R. K. S., Viamonte, M., Cole, J., Gottesman, L., Solomon, M. J., McLeod, R. S., Kern, K., Jensen, L. L., Lowry, A. C., Vernava, III, A. M., Longo, W. E., Daniel, G. L., Ehrenpreis, E., Stone, J. M., Cosman, B. C., Wolfe, V. A., Nino-Murcia, M., Perkash, I., Marcello, P. W., Roberts, P. L., Schoetz, Jr., D. J., Murray, J. J., Coller, J. A., Veidenheimer, M. C., Keighley, M. R. B., Grobler, S. P., Hosie, K. B., Schmitt, S. L., James, K., Lucas, F., Peck, Donald A., Ferrara, A., Grotz, R. L., Perry, R. E., Hanson, R. B., Lewis, W. G., Holdsworth, P. J., Sagar, P. M., Johnston, D., Perry, T. G., Strong, S. A., Fazio, V. W., Lavery, I. C., Oakley, J. R., Church, J. M., Milsom, J. W., Fozard, J. B. J., Nelson, H., Schneebaum, S., Arnold, M. W., Young, D., LaValle, G. J., Petty, L., Berens, A., Mojizisik, C., Martin, E. W., Hase, K., Shatney, C. H., Trollope, M., Johnson, D., Vierra, M., Deutsch, A. A., Tulchinsky, H., Nudelman, I., Gutman, H., Reiss, R., Taylor, Brian M., Araujo, A., Bleday, R., Jessurun, J., Heine, J., Rosen, Les, Sipe, Paul, Riether, Robert, Stasik, John, Sheets, James, Khubchandani, Indru, Reiter, W., Friedberg, G., Morey, G., Goldstein, E., Williamson, P., Larach, S., Senagore, A. J., Luchtefeld, M. A., MacKeigen, J. M., Mazier, W. P., Wengert, T., Ott, M. T., Bailey, H. R., Hartendorp, P., Dailey, T. H., Church, J. C., Johansen, O. B., Daniel, N., Korst, M., Kuijpers, H. C., Pena, J. P., Christenson, C. E., Balcos, E. G., Lewis, W., Mitchell, C., MacFie, J., Hildebrandt, U., Ecker, K. W., Kraus, J., Schmid, T., Feifel, G., Tjandra, J. J., Scoggin, Steve, Frazee, Richard C., Ambroze, Jr., W. L., Nezhat, C., Pennington, E., Nezhat, F., Stolfi, V. M., Thorson, A. G., Falk, P. M., Fitzgibbons, Jr, R. J., Luukkonen, P., Järvinen, H. J., James, E., Paty, P. B., Enker, W. E., Cohen, A. M., Lauwers, G. Y., Saad, R., Birnbaum, E., DeVos, W., Fry, R., Kodner, I., Fleshman, J., Cali, R. L., Pitsch, R. M., Blatchford, G. J., Christensen, M. A., Schroeder, T. K., Easley, K. A., Ellis, C. N., Cheape, J. D., Hull, T. L., Salanga, V., Kokoszka, Joseph, Andrianopoulos, Georgia, Nelson, Richard, Abcarian, Herand, Kumar, D., Benson, M. J., Roberts, J., Martin, J. E., Swash, M., Wingate, D. L., Williams, N. S., Orkin, B. A., Emsellem, H., Dent, John, Tissaw, M. A., Shafik, A., Abel, M. E., Chiu, Y. S. Y., Russell, T. R., Volpe, P. A., Casillas, G. L., Mashas, W. E., Eastman, D. A., Grace, R. H., Anderson, J. M., Hacker, K., Heryer, J., Conner, W., Rubin, R., Eisenstat, T., Salvati, E., Oliver, G., Duberman, E., Simmang, C. L., Fry, R. D., Kodner, I. J., Fleshman, J. W., Corman, M. L., Galandiuk, S., Weiner, G. J., Kahn, D., Mitchell, E., Abdel-Nabi, H., Block, G. E., Mannella, E., Tedesco, M., Anza, M., Civalleri, D., Di Tora, P., Capussotti, L., Morandi, G. B., Tirelli, C., Da Pian, P. P., Cortesi, E., Ruggeri, E., Fitzgerald, S. D., Davis, Faith, Bowen, Phyllis, Sutter, Eileen, Kikendall, Walter, McGannon, E., Brantley, P. A., Czyrko, C., Falardeau, C., Trepashko, Don, Skosey, John, Michelassi, F., Staniunas, R. J., Vignati, P. V., Beck, D. E., Karulf, R., Roettger, R., Braidt, J., Ruoff, K., Ackroyd, F., Shellito, P., Goh, H. S., Lin, L. W., Edwards, E., Farmer, J., Walters, C. A., Hyman, N. H., Hebert, J. C., Richman, Irving M., Staren, E. D., Sessions, S. C., Scoma, R. S., Clements, B., Smink, Jr., R. D., Arai, K., Sugita, A., Yamazaki, Y., Harada, H., Fukushima, T., Armstrong, D. N., Ballantyne, G. H., Sillin, L. F., Davie, R. J., Harding, L. K., Birch, N. J., Yamanouchi, T., Bayer, I., Mitmaker, B., Gordon, P. H., Wang, E., Kynaston, H., Edelstein, P. S., Thompson, S. M., Davies, R. J., Farmer, K. C. R., Oliver, S. E., Spigelman, A. D., Bennett, P., O'Kelly, T. J., Brading, A. F., Mortensen, N. J., Paul, P., McGannon, E. M., Huth, P., Hull-Boiner, S., Pezim, M. E., Johnson, H. W., Gillespie, K. D., Willard, P., Owen, D. A., Ramsey, P. S., Leu, S. Y., Hsu, H., Al-Humadi, Adil H., Eisman, E., Tries, J., Gupta, N. C., Frick, M. P., Boman, B. M., Franceschi, D., Eckhauser, M. L., Pritchard, T., Konsten, J., Baeten, C. G. M. I., Havenith, M. G., Soeters, P. B., Lau, P. W. K., Lorentz, T. G., Wong, J., and The III In-CYT-103 Immunoscintigraphy Study Group

Published
1992
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10. 90th Annual Convention Poster Presentations and Abstracts

Author

Ellis, C. N., Coyle, D. J., Boggs, H. W., Slagle, G. W., Cole, P. A., Kuramoto, S., Ihara, O., Oohara, T., Nichols, J., Opelka, F., Gathright, J. B., Green, J. B., Poulard, J. B., Ott, A., Bank, S., Margolis, I. B., Meagher, A., Stuart, M., Heine, J. A., Rothenberger, D. A., Nemer, F. D., Christenson, C. E., Saad, R. C., Church, J. M., Fazio, V. W., Lavery, I. C., Oakley, J. R., Milsom, J. W., Schroeder, T. K., Påhlman, L., Frykholm, G., Glimelius, B., Kashtan, H., Papa, M., Wilson, B., Stern, H., Zelnick, R., Haas, P., Ajlouni, M., Fox, T., Szilagy, E., Cummings, B. J., Fleshman, J. W., Dreznick, Z., Fry, R. D., Kodner, I. J., Perry, R. E., Pemberton, J. H., Litchy, W. L., Ferrara, A., Levin, K. E., Hanson, R. B., Cali, R. L., Blatchford, G. J., Thorson, A. G., Christenson, M. A., Pitsch, R. M., Jensen, L. L., Lowry, A. C., Keighley, M. R. B., Oya, M., Oritz, J., Pinho, M., Asperer, J., Chattaphaday, G., Baeten, C., Konsten, J., Spaans, F., Soeters, P., Habets, A., Schouten, W. R., Ruseler van Embden, J. G. H., Auwerda, J. J. A., Sagar, P. M., Goodwin, P., Holdsworth, P. J., Johnston, D., Bundy, C. A., Jacobs, D. M., Bubrick, M. P., Kashiwagi, H., Konishi, F., Kanazawa, K., Woodland, D. O., Saclarides, T. J., Bapna, M. S., Kubota, Y., Sunouchi, K., Ono, M., Muto, T., Masaki, T., Suzuki, K., Adachi, M., Wong, W. D., Goldberg, S. M., Wexner, S. D., Daniel, N., Jagelman, D. G., Christiansen, J., Rasmussen, O., Zhu, B. -W., Williams, J. G., Schottler, J. L., Heyman, S., Marchetti, F., Timmcke, A. E., Hicks, T. C., Ray, J. E., Bernstein, M. A., Madoff, R. D., Caushaj, P. F., Zarbo, R. J., Ma, C. K., Shida, H., Yamamoto, T., Machida, T., Imanari, T., Wang, J. Y., You, Y. T., Tang, R. P., Chen, J. S., Chang-Chien, C. R., Sugihara, K., Hojo, K., Moriya, Y., Hasegawa, H., Krueger, B., Warren, W., Faber, L. P., Abel, M. E., Chiu, Y. S. Y., Russell, T. R., Volpe, P. A., Frazee, R. C., Roberts, J., Symmonds, S., Snyder, S., Hendricks, J., Smith, R., Merchant, N., Hashmi, H., Scalea, T., Whelan, R., Longo, W. E., Gusberg, B. J., Ballantyne, G. H., Davidson, T., Allen-Mersh, T. G., Gazzard, B., Miles, A. J. G., Wastell, C., Viponde, M., Stotter, A., Miller, R. F., Fieldman, N., Slack, W. W., Tjandra, J., Savoca, P. E., Flannery, J. T., Modlin, I. M., Tsukada, K., Tazawa, K., Lavery, E. C., Voeller, G. R., Bunch, G., Britt, L. G., Neto, J. A. Reis, Quilici, F. A., Cordeiro, F., Reis, Jr, J. A., Wojcik, J. B., Banerjee, S. R., Walters, D. L., Cherry, D. A., Bleday, R., Pena, J. P., Buls, J. G., Pascual, R., Tripodi, G., Padmanabhan, A., Schouter, W. R., Blankensteijn, J. D., Moenning, S., Huber, P., Simonton, C., Odom, C., Kaplan, E., Nightengale, S., Shah, P. C., Hashami, H. F., Kottmeier, P., Velcek, F., Klotz, D., Whelan, R. L., Sher, M. E., Bauer, J. J., Gelernt, I., Launer, D. P., Gerber, A., Nogueras, J. J., Finne, C. O., Sohn, N., Weinstein, M. A., Lugo, R. N., Eisenberg, M. M., Tsao, J., Galandiuk, S., Tuckson, W. B., Strong, S., Oakey, J. R., Ambroze, W. L., Dozois, R. R., Carpenter, H. A., Kartheuser, A. H., LaRusso, N. F., Wiesner, R. H., Ilstrup, D. M., Schleck, C. D., Ambroze, W., Beart, R., Dozois, R., Wolff, B., Pemberton, J., Kelly, K., Devine, R., Nivatvongs, S., Metzger, P., Phillips, S. F., Zinmeister, A. R., Pezim, M. E., Vignati, P., Cohen, J., Stahl, T. J., Roberts, P. L., Schoetz, Jr., D. J., Murray, J. J., Coller, J. A., Veidenheimer, M. C., Yamazaki, Y., Ribeiro, M. B., Sachar, D., Heimann, T. M., Aufses, A. H., Greenstein, A. J., Stryker, S. J., Green, D., McLeod, R. S., Cohen, Z., Cullen, J., Greenberg, G. R., Ho, C. S., Reznick, R., Wolff, B. G., Cangemi, J., Carryer, P., Jeejeebhoy, K. N., MacCarty, R., Weilland, L., Senagore, A. J., MacKeigan, J. M., Guillem, J., Ondrula, D. P., Prasad, M. L., Nelson, R. L., Abcarian, H., Coughlin, R. J., Corman, M. L., Prager, E. D., Borison, D. I., Bloom, A. D., Pritchard, T. J., McGannon, E., Sivak, M. V., van Stolk, R., Hull-Boiner, S., Milson, J. W., Sullivan, M., Rosato, G. O., Jorge, J. M., Durdey, P., Kennedy, M. J., Oster, M., Murray, J., Cirocco, W. C., Rusin, L. C., Brown, A. C., Reilly, J. C., Cataldo, P., Luchtefeld, M. A., Mazier, W. P., Wolkomir, A. F., Ruiz-Moreno, F., Alvarado-Cerna, R., Rodriguez, U., Amaro, J., Kerner, B. A., Oliver, G. C., Eisenstat, T. E., Rubin, R. J., Salvati, E. P., Dominguez, J. M., Coon, J. S., Weinstein, R. S., Kameyama, M., Fukuda, I., Imaoka, S., Iwanga, T., Kyzer, S., Mitmaker, B., Gordon, P. H., Wang, E., Grace, R. H., Gibbons, P., Scott, K. M. W., Berger, A., Mischinger, H. J., Arian-Schad, K., Davis, M., Miller, D., Fielding, L. P., Begin, L. R., Bell, A. M., Shafik, A., Abdel-Moneim, K., Khalid, A., Devine, R. M., Beart, Jr., R. W., Melton, L. J., Ngoi, S. S., Chia, J., Goh, P., Sim, E., Godwin, P., Quirke, P., Barrett, R. C., Koltun, W. A., Smith, R. J., Loehner, D., Roberts, P., Veidenheimer, M., Schoetz, D., Chattopadhyay, G., Kumar, D., Hosie, K., Kmiot, W., Mostaf, A., Tulley, N., Harding, I., Falcone, R. E., Wanamaker, S., Santanello, S. A., Carey, L. C., Rivera, D. E., Durdley, P., Gross, P. T., Sarles, J. C., Arnaud, A., Sielezneff, I., Orsoni, P., Joly, A., Limberg, B., Stolfi, V. M., Lavery, I., Oakley, J., Church, J., Fazio, V., Asbun, H. J., Castellanos, H., Asbun, J., Franko, E. R., Ivatury, R. R., Schwalb, D., Saad, R., Schroeder, T., Reis, Jr., J. A., Dziki, A. J., Duncan, M. D., Harmon, J. W., Saini, N., Malthaner, R. A., Fernicola, M. T., Hakki, F. Z., Trad, K. S., Ugarte, R. M., Ryan, P., Chang, H. R., Chavoshan, B., Barsoum, G., Bonardi, R., Scaramelo, A., Possebon, A., Peres, C., Röhrig, C., Kappas, A. M., Ortiz, J., Fan, H. A., Milsom, J., Lechner, P., Lind, P., Cesnik, H., Venkatesh, K. S., Larson, D. M., Morrison, D. N., Ramanujam, P. J., Rubbini, M., Mascoli, F., Mari, C., Bresadola, V., and Donini, I.

Published
1991
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12. Reduction in adhesive small-bowel obstruction by Seprafilm adhesion barrier after intestinal resection.

Author

Fazio, V.W., Cohen, Z., Fleshman, J.W., Goor, H. van, Bauer, J.J., Wolff, B.G., Corman, M., Beart Jr, R.W., Wexner, S.D., Becker, J.M., Monson, J.R., Kaufman, H.S., Beck, D.E., Bailey, H.R., Ludwig, K.A., Stamos, M.J., Darzi, A., Bleday, R., Dorazio, R., Madoff, R.D., Smith, L.E., Gearhart, S., Lillemoe, K., Gohl, J., Fazio, V.W., Cohen, Z., Fleshman, J.W., Goor, H. van, Bauer, J.J., Wolff, B.G., Corman, M., Beart Jr, R.W., Wexner, S.D., Becker, J.M., Monson, J.R., Kaufman, H.S., Beck, D.E., Bailey, H.R., Ludwig, K.A., Stamos, M.J., Darzi, A., Bleday, R., Dorazio, R., Madoff, R.D., Smith, L.E., Gearhart, S., Lillemoe, K., and Gohl, J.

Abstract

Contains fulltext : 50472.pdf (publisher's version ) (Closed access), INTRODUCTION: Although Seprafilm has been demonstrated to reduce adhesion formation, it is not known whether its usage would translate into a reduction in adhesive small-bowel obstruction. METHODS: This was a prospective, randomized, multicenter, multinational, single-blind, controlled study. This report focuses on those patients who underwent intestinal resection (n = 1,701). Before closure of the abdomen, patients were randomized to receive Seprafilm or no treatment. Seprafilm was applied to adhesiogenic tissues throughout the abdomen. The incidence and type of bowel obstruction was compared between the two groups. Time to first adhesive small-bowel obstruction was compared during the course of the study by using survival analysis methods. The mean follow-up time for the occurrence of adhesive small-bowel obstruction was 3.5 years. RESULTS: There was no difference between the treatment and control group in overall rate of bowel obstruction. The incidence of adhesive small-bowel obstruction requiring reoperation was significantly lower for Seprafilm patients compared with no-treatment patients: 1.8 vs. 3.4 percent (P < 0.05). This finding represents an absolute reduction in adhesive small-bowel obstruction requiring reoperation of 1.6 percent and a relative reduction of 47 percent. In addition, a stepwise multivariate analysis indicated that the use of Seprafilm was the only predictive factor for reducing adhesive small-bowel obstruction requiring reoperation. In both groups, 50 percent of first adhesive small-bowel obstruction episodes occurred within 6 months after the initial surgery with nearly 30 percent occurring within the first 30 days. Additionally no first adhesive small-bowel obstruction events were reported in Years 4 and 5 of follow-up. CONCLUSIONS: The overall bowel obstruction rate was unchanged; however, adhesive small-bowel obstruction requiring reoperation was significantly reduced by the use of Seprafilm, which was the only factor that predicted

Published
2006

19. Instrumented measurement of the posterolateral corner

Author

Bleday, R., Fanelli, G., Giannotti, B., Edson, C., and Barrett, T.

Abstract

A new device called the Lars Rotational Laxiometer (Lars Inc, Dijon, France) is introduced to aid in the diagnosis of posterolateral rotatory instability of the knee. This device assigns a quantitative value for tibial external rotation. Three examiners each evaluated a separate group of 30 different subjects (total 180 knees) to obtain side-to-side differences. The subjects had no history of injury, pain, or instability. An external rotation measurement was performed at 30 degrees and 90 degrees of knee flexion. At 90 degrees, the mean side-to- side difference was 4.4 degrees (range, 3.7 degrees to 5.1 degrees); at 30 degrees it was 5.5 degrees (range, 4.7 degrees to 6.3 degrees). There was no significant difference with gender or age. The purpose of this study is to establish baseline side-to-side values for the posterolateral complex in normal knees. Objective values are obtainable with the Laxiometer. Arthroscopy 1998 Jul-Aug;14(5):489-94

Published
1998
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20. Dequalinium, a topical antimicrobial agent, displays anticarcinoma activity based on selective mitochondrial accumulation.

Author

Weiss, M J, Wong, J R, Ha, C S, Bleday, R, Salem, R R, Steele, G D, and Chen, L B

Abstract

Positively charged lipophilic compounds, such as rhodamine 123, localize in mitochondria and are selectively accumulated and retained by carcinoma cells. It has been suggested that this phenotype may be exploited for selective killing of carcinoma cells by lipophilic cations. Here we report that doubly positively charged dequalinium, which has been used for 30 years as an antimicrobial agent in over-the-counter mouthwashes, lozenges, ointments, and paints, exhibits significant anticarcinoma activity. Dequalinium is more effective than seven of eight established anticancer drugs in prolonging the survival of mice with intraperitoneally implanted mouse bladder carcinoma MB49. Dequalinium also inhibits the growth of subcutaneously implanted human colon carcinoma CX-1 in nude mice and recurrent rat colon carcinoma W163 in rats. Lipophilic cationic compounds, such as dequalinium, could comprise a unique class of anticarcinoma agents.

Published
1987
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21. Clinical and molecular prognostic factors in sphincter-preserving surgery for rectal cancer

Author

Jessup, J.M., Loda, M., and Bleday, R.

Abstract

As many as a third of patients with rectal cancers may be candidates for sphincter preservation surgery. The goal of the conservative management of adenocarcinoma of the distal rectum is to preserve rectal sphincter function without sacrificing local tumor control. To achieve this goal, a combined modality approach is necessary because multimodality therapy for more advanced disease has improved both local control and survival. Candidates for local excision are those with adenocarcinomas with a maximal diameter of less than 4 cm, mobile, and not poorly differentiated or mucinous and within 10 cm of the anal verge-usually within 6 cm. These criteria should be defined objectively by biopsy combined with state-of-the-art endorectal imaging Newer molecular markers that are associated with prognosis and response to therapy may also be important for assessing prognosis, probability of local recurrence, and whether conservative treatment is appropriate. Patients with T0-3 NO lesions meeting these standard clinicopathologic criteria have been treated successfully with wide local excision combined with chemotherapy and radiotherapy. Patients with larger or more advanced lesions may undergo low anterior resection with coloanal anastomosis. After resection, radiotherapy to at least 45 to 50 Ty is delivered to the pelvis and tumor bed often with concomitant chemotherapy. The overall rate of local failure in prospective single-institution trials in which local excision is performed with postoperative chemoradiotherapy has been 5% for T1 lesions, 7% for T2 lesions and 24% for T3 lesions. Although single-institution studies have supported the concept of conservative therapy, the safety and efficacy of this approach must still be confirmed in a multicenter, prospective trial, such as that underway in several of the cooperative oncology groups, before it may be considered a standard of practice.

Published
1998
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25. Long-term outcomes analysis of flap-based perineal reconstruction.

Author

Rinkinen JR, Fruge S, Welten VM, Kinsley S, Bleday R, Irani J, Yoo J, Goldberg JE, Melnitchouk N, and Talbot SG

Subjects
Humans, Surgical Flaps surgery, Postoperative Complications epidemiology, Postoperative Complications etiology, Postoperative Complications surgery, Pelvis, Retrospective Studies, Perineum surgery, Plastic Surgery Procedures adverse effects, Anus Neoplasms surgery, Rectal Neoplasms surgery
Abstract

Background: High-risk patients undergoing abdominoperineal resection and pelvic exenteration may benefit from immediate flap reconstruction. However, there is currently no consensus on the ideal flap choice or patient for whom this is necessary. This study aimed to evaluate the long-term outcomes of using pedicled gracilis flaps for pelvic reconstruction and to analyze predictors of postoperative complications., Methods: This was a retrospective review of a single reconstructive surgeon's cases between January 2012 and June 2021 identifying patients who underwent perineal reconstruction secondary to oncologic resection. Preoperative and outcome variables were collected and analyzed to determine the risk of developing minor and major wound complications., Results: A total of 101 patients were included in the study with most patients (n = 88) undergoing unilateral gracilis flap reconstruction after oncologic resection. The mean follow-up period was 75 months. Of 101 patients, 8 (7.9%) developed early major complications, and an additional 13 (12.9%) developed late major complications. Minor complications developed in 33 patients (32.7%) with most cases being minor wound breakdown requiring local wound care. Most patients (n = 92, 91.1%) did not develop donor site complications. Anal cancer was significantly associated with early major complications, whereas younger age and elevated body mass index were significant predictors of developing minor wound complications., Conclusions: This study builds on our previous work that demonstrated the long-term success rate of gracilis flap reconstruction after large pelvic oncologic resections. A few patients developed donor site complications, and perineal complications were usually easily managed with local wound care, thus making the gracilis flap an attractive alternative to abdominal-based flaps., (Copyright © 2023 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.)

Published
2024
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26. Concordance of MRI With Pathology for Primary Staging of Rectal Cancer in Routine Clinical Practice: A Single Institution Experience.

Author

Kikano EG, Matalon SA, Eskian M, Lee L, Melnitchouk N, Bleday R, and Khorasani R

Subjects
Male, Humans, Adult, Middle Aged, Aged, Retrospective Studies, Rectum diagnostic imaging, Neoadjuvant Therapy, Neoplasm Staging, Magnetic Resonance Imaging methods, Rectal Neoplasms diagnostic imaging, Rectal Neoplasms therapy, Rectal Neoplasms pathology
Abstract

Purpose: MRI is the preferred imaging modality for primary staging of rectal cancer, used to guide treatment. Patients identified with clinical stage I disease receive upfront surgical resection; those with clinical stage II or greater undergo upfront neoadjuvant therapy. Although clinical under-/over-staging may have consequences for patients and presents opportunities for organ preservation, the correlation between clinical and pathologic staging in routine clinical practice within a single institute has not been fully established., Methods: This retrospective, Institutional Review Board-approved study, conducted at a National Cancer Institute-Designated Comprehensive Cancer Center with a multi-disciplinary rectal cancer disease center, included patients undergoing rectal MRI for primary staging January 1, 2018-August 30, 2020. Data collection included patient demographics, initial clinical stage via MRI report, pathologic diagnosis, pathologic stage, and treatment. The primary outcome was concordance of overall clinical and pathologic staging. Secondary outcomes included reasons for mismatched staging., Results: A total 105 rectal adenocarcinoma patients (64 males, mean age 57 ± 12.7 years) had staging MRI followed by surgical resection. A total of 28 patients (27%) had mismatched under-/over- staging. Ten patients (10%) were understaged with mismatched T stage group (clinical stage I, pathologic stage II), five (5%) were understaged with mismatched N stage group (clinical stage I, pathologic stage III), and 13 (12%) were overstaged (clinical stage II-III, pathologic stage 0-I). Treatment matched concordance between clinical and pathologic stages was 86%., Conclusion: MRI for primary rectal cancer staging has high concordance with pathology. Future studies to assess strategies for reducing clinically relevant understaging would be beneficial., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Published
2024
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27. VentX promotes tumor specific immunity and efficacy of immune checkpoint inhibitors.

Author

Le Y, Gao H, Le J, Hornick JL, Bleday R, Wee J, and Zhu Z

Abstract

Immune suppression within tumor microenvironments (TME) have been implicated in limited efficacy of immune check point inhibitors (ICIs) against solid tumors. Down-regulated VentX expression in tumor associated macrophages (TAMs) underlies phagocytotic anergic phenotype of TAMs, which govern immunological state of TME. In this study, using a tumor immune microenvironment enabling model system (TIME-EMS) of non-small cell lung cancer (NSCLC), we found that PD-1 antibody modestly activates cytotoxic T lymphocytes (CTLs) within the NSCLC-TME but not the status of TIME. We showed that the restoration of VentX expression in TAMs reignites the phagocytotic function of TAMs, which in turn, transforms TIME, activates CTLs in a tumor-specific manner and promotes efficacy of PD-1 antibody against NSCLC but not toxicity on normal lung epithelial cells. Supported by in vivo data on NSG-PDX models of primary human NSCLC, our study revealed potential venues to promote the efficacy of ICI against solid tumors through VentX-based mechanisms., Competing Interests: The authors declare no competing interests., (© 2023 The Author(s).)

Published
2023
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29. Evaluation of interdisciplinary care pathway implementation in older elective surgery patients.

Author

Hu FY, Rowe KA, O'Mara LM, Bulger A, Bleday R, Groff MW, Cooper Z, and Bernacki RE

Subjects
Humans, Female, Aged, Male, Critical Pathways, Qualitative Research, Patients, Primary Health Care, Frailty
Abstract

Background: The American College of Surgeons Geriatric Surgery Verification Program outlines best practices for surgical care in older adults. These recommendations have guided institutions to create workflows to better support needs specific to older surgical patients. This qualitative study explored clinician experiences to understand influences on implementation of frailty screening and an interdisciplinary care pathway in older elective colorectal surgery and neurosurgery patients., Study Design: Semi-structured in-person and video-based interviews were conducted from July 2021 to March 2022 with clinicians caring for patients ≥70 years on the colorectal surgery and neurosurgery services. Interviews addressed familiarity with and beliefs about the intervention, intervention alignment with routine workflow and workflow adaptations, and barriers and facilitators to performing the intervention. Interviews were analyzed using the consolidated framework for implementation research (CFIR) to find themes related to ongoing implementation., Results: Thirty-two clinicians participated (56.3% female, 58.8% White). Fifteen relevant CFIR constructs were identified. Key themes to implementation success included strong participant belief in effectiveness of the intervention and its advantage over standard care; the importance of training, reference materials, and champions; and the need for institution-level investment in resources to amplify the impact of the intervention on patients and expand the capacity to address their needs., Conclusion: Systematic evaluation found implementation of frailty screening and an interdisciplinary care pathway in elective colorectal surgery and neurosurgery patients to be supported by participating clinicians, yet sustainability of the intervention and further adoption across surgical services to better meet the needs of older patients would necessitate organizational resource allocation., (© 2023 The American Geriatrics Society.)

Published
2023
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30. NF-κB-regulated VentX expression mediates tumoricidal effects of chemotherapeutics at noncytotoxic concentrations.

Author

Le Y, Gao H, Zhu A, Felt K, Rodig S, Bleday R, and Zhu Z

Abstract

Limited therapeutic efficacy and severe side effects represent the central hurdles facing cancer chemotherapy. Immune suppression within tumor immune microenvironments (TIME) has been implicated in chemoresistance. In this study, using a TIME-enabling model system (TIME-EMS), we demonstrate that the chemotherapeutic agent doxorubicin has cytocidal effects on tumor cells at high dosage but induces changes in the immune landscape of the TIME at low noncytotoxic concentrations via NF-κB-mediated induction of homeobox protein VentX expression in tumor-associated macrophages (TAMs). We demonstrated that VentX-regulated TAMs drastically promote tumor chemosensitivity >10-fold but exert little effect on chemotoxicity to normal cells through activating cytotoxic T lymphocytes in a tumor-specific manner. Supported by the in vivo synergy of VentX-regulated TAMs and low-dosage noncytotoxic doxorubicin, our data suggest a cell-death-independent immune mechanism for improving the therapeutic index of chemotherapeutic agents., Competing Interests: The authors declare no competing interests., (© 2022 The Author(s).)

Published
2022
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31. An international multi-institutional analysis of operative morbidity in patients undergoing elective diverticulitis surgery.

Author

Altinel Y, Cavallaro P, Ricciardi R, Ozben V, Ozturk E, Bleday R, Aytac E, and Bordeianou L

Subjects
Elective Surgical Procedures adverse effects, Humans, Morbidity, Postoperative Complications epidemiology, Retrospective Studies, United States, Diverticulitis complications, Diverticulitis surgery, Malnutrition
Abstract

Objective: We investigated surgical complications of elective surgery for diverticulitis in international multi-institution to identify a prediction model for potential opportunities of quality improvement., Methods: We identified 1225 patients who underwent elective surgery for diverticulitis between January 2010 and January 2018. The data were obtained from the National Surgical Quality Improvement Program and the Turkish Diverticulitis Study Group Collaborative, retrospectively., Results: We observed that the presence of chronic obstructive pulmonary disease (OR: 3.2, 95%CI 1.8-5.9, p<0.001) or abscess at the time of surgery (OR: 1.4, 95%CI 1.2-1.7, p£0.001) is associated with a higher rate of minor complications, while comorbidities such as dyspnea (OR: 2.8, 95%CI 1.6-4.9, p£0.001) and preoperative sepsis (OR: 4.1, 95%CI 2.3-7.3, p£0.001) are associated with major complications. The centers had similar findings in minor and major complications (OR: 0.8, 95%CI 0.5-1.4, p=0.395). The major independent predictors for complications were malnutrition (low albumin) (OR: 0.5, 95%CI 0.4-0.6, p<0.001) and the American Society of Anesthesiology score (OR: 1.7, 95%CI 1.2-2.4, p=0.002)., Conclusion: Regarding the major and minor complications of diverticulitis of elective surgery, the malnutrition and higher American Society of Anesthesiology score showed higher impact among the quality improvement initiatives.

Published
2022
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32. Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals.

Author

Welten VM, Fields AC, Malizia RA, Yoo J, Irani JL, Goldberg JE, Bleday R, and Melnitchouk N

Subjects
Antineoplastic Combined Chemotherapy Protocols, Combined Modality Therapy, Hospitals, Community, Humans, Retrospective Studies, Survival Rate, Hyperthermia, Induced, Mesothelioma drug therapy, Peritoneal Neoplasms drug therapy
Abstract

Background: Malignant peritoneal mesothelioma is a rare disease with poor outcomes. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is the cornerstone of therapy. We aim to compare outcomes of malignant peritoneal mesothelioma treated at academic versus community hospitals., Methods: This was a retrospective cohort study using the National Cancer Database to identify patients with malignant peritoneal mesothelioma from 2004 to 2016. Patients were divided according to treating facility type: academic or community. Outcomes were assessed using log-rank tests, Cox proportional-hazard modeling, and Kaplan-Meier survival statistics., Results: In total, 2682 patients with malignant peritoneal mesothelioma were identified. A total of 1272 (47.4%) were treated at an academic facility and 1410 (52.6%) were treated at a community facility. Five hundred forty-six (42.9%) of patients at academic facilities underwent debulking or radical surgery compared to 286 (20.2%) at community facilities. Three hundred sixty-six (28.8%) of patients at academic facilities received chemotherapy on the same day as surgery compared to 147 (10.4%) of patients at community facilities. Unadjusted 5-year survival was 29.7% (95% CI 26.7-32.7) for academic centers compared to 18.3% (95% CI 16.0-20.7) for community centers. In multivariable analysis, community facility was an independent predictor of increased risk of death (HR: 1.19, 95% CI 1.08-1.32, p = 0.001)., Conclusions: We demonstrate better survival outcomes for malignant peritoneal mesothelioma treated at academic compared to community facilities. Patients at academic centers underwent surgery and received chemotherapy on the same day as surgery more frequently than those at community centers, suggesting that malignant peritoneal mesothelioma patients may be better served at experienced academic centers., (© 2021. The Society for Surgery of the Alimentary Tract.)

Published
2022
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33. The Effect of Facility Volume on Survival Following Proctectomy for Rectal Cancer.

Author

Welten VM, Wanis KN, Madenci AL, Fields AC, Lu PW, Malizia RA, Yoo J, Goldberg JE, Irani JL, Bleday R, and Melnitchouk N

Subjects
Cross-Sectional Studies, Humans, Neoadjuvant Therapy, Neoplasm Staging, Retrospective Studies, Proctectomy, Rectal Neoplasms pathology, Rectal Neoplasms surgery
Abstract

Background: Prior studies assessing colorectal cancer survival have reported better outcomes when operations are performed at high-volume centers. These studies have largely been cross-sectional, making it difficult to interpret their estimates. We aimed to assess the effect of facility volume on survival following proctectomy for rectal cancer., Methods: Using data from the National Cancer Database, we included all patients with complete baseline information who underwent proctectomy for non-metastatic rectal cancer between 2004 and 2016. Facility volume was defined as the number of rectal cancer cases managed at the treating center in the calendar year prior to the patient's surgery. Overall survival estimates were obtained for facility volumes ranging from 10 to 100 cases/year. Follow-up began on the day of surgery and continued until loss to follow-up or death., Results: A total of 52,822 patients were eligible. Patients operated on at hospitals with volumes of 10, 30, and 50 cases/year had similar distributions of grade, clinical stage, and neoadjuvant therapies. 1-, 3-, and 5-year survival all improved with increasing facility volume. One-year survival was 94.0% (95% CI: 93.7, 94.3) for hospitals that performed 10 cases/year, 94.5% (95% CI: 94.2, 94.7) for 30 cases/year, and 94.8% (95% CI: 94.5, 95.0) for 50 cases/year. Five-year survival was 68.9% (95% CI: 68.0, 69.7) for hospitals that performed 10 cases/year, 70.8% (95% CI: 70.1, 71.5) for 30 cases/year, and 72.0% (95% CI: 71.2, 72.8) for 50 cases/year., Conclusions: Treatment at a higher volume facility results in improved survival following proctectomy for rectal cancer, though the small benefits are less profound than previously reported., (© 2021. The Society for Surgery of the Alimentary Tract.)

Published
2022
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35. A Case of Microsatellite Instability-High Colon Cancer in a Young Woman With Familial Adenomatous Polyposis.

Author

Blum SM, Jeck WR, Kipnis L, Bleday R, Nowak JA, and Yurgelun MB

Subjects
Female, Humans, Microsatellite Instability, Microsatellite Repeats, Mutation, Young Adult, Adenomatous Polyposis Coli complications, Adenomatous Polyposis Coli genetics, Adenomatous Polyposis Coli surgery, Colonic Neoplasms genetics, Colonic Neoplasms surgery, Colorectal Neoplasms genetics
Abstract

Two major molecular pathways of colorectal carcinogenesis, chromosomal instability (CIN) and microsatellite instability (MSI), are considered to be mutually exclusive. Distinguishing CIN from MSI-high tumors has considerable therapeutic implications, because patients with MSI-high tumors can derive considerable benefit from immune checkpoint inhibitors, and tumors that evolved through the CIN pathway do not respond to these agents. Familial adenomatous polyposis (FAP) is a genetic syndrome that is defined by a mutation in the APC gene and is thought to lead to carcinogenesis through the CIN pathway. Here, we report a case of a young woman with FAP who was treated for medulloblastoma as a child and developed advanced MSI-high colon cancer as a young adult. Her response to second-line immunotherapy enabled resection of her colon cancer, and she is free of disease >10 months after surgery. This case highlights the potential for overlap between the CIN and MSI carcinogenic pathways and associated therapeutic implications.

Published
2021
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36. The Association Between Sex and Survival for Anal Squamous Cell Carcinoma.

Author

Welten VM, Fields AC, Malizia RA, Yoo J, Irani JL, Bleday R, Goldberg JE, and Melnitchouk N

Subjects
Databases, Factual, Female, Humans, Incidence, Male, Anus Neoplasms epidemiology, Anus Neoplasms pathology, Carcinoma, Squamous Cell epidemiology, Carcinoma, Squamous Cell pathology
Abstract

Background: The incidence of anal squamous cell carcinoma (SCC) is rising, despite the introduction of a vaccine against human papillomavirus (HPV), the most common etiology of anal SCC. The rate of anal SCC is higher among women and sex-based survival differences may exist. We aimed to examine the association between sex and survival for stage I-IV anal SCC., Materials and Methods: The National Cancer Database was used to identify patients with stage I-IV anal SCC from 2004-2016. Outcomes were assessed utilizing log rank tests, Kaplan-Meier statistics, and Cox proportional-hazard modeling. Subgroup analyses by disease stage and by HPV status were performed. Outcomes of interest were median, 1-, and 5-year survival by sex., Results: There were 31,185 patients with stage I-IV anal SCC. 10,714 (34.3%) were male and 20,471 (65.6%) were female. 1- and 5- year survival was 90.2% (95% CI 89.8 - 90.7) and 67.7% (95% CI 66.9 - 68.5) for females compared to 85.8% (95% CI 85.1 - 86.5) and 55.9% (95% CI 54.7 - 57.0) for males. In subgroup analysis, females demonstrated improved unadjusted and adjusted survival for all stages of disease. Female sex was an independent predictor of improved survival (HR 0.68, 95% CI 0.65 - 0.71, P < 0.001)., Conclusions: We demonstrate better overall survival for females compared to males for stage I-IV anal SCC. It is not clear why women have a survival advantage over men, though exposure to prominent risk factors may play a role. High-risk men may warrant routine screening for anal cancer., (Copyright © 2021. Published by Elsevier Inc.)

Published
2021
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37. Spatially organized multicellular immune hubs in human colorectal cancer.

Author

Pelka K, Hofree M, Chen JH, Sarkizova S, Pirl JD, Jorgji V, Bejnood A, Dionne D, Ge WH, Xu KH, Chao SX, Zollinger DR, Lieb DJ, Reeves JW, Fuhrman CA, Hoang ML, Delorey T, Nguyen LT, Waldman J, Klapholz M, Wakiro I, Cohen O, Albers J, Smillie CS, Cuoco MS, Wu J, Su MJ, Yeung J, Vijaykumar B, Magnuson AM, Asinovski N, Moll T, Goder-Reiser MN, Applebaum AS, Brais LK, DelloStritto LK, Denning SL, Phillips ST, Hill EK, Meehan JK, Frederick DT, Sharova T, Kanodia A, Todres EZ, Jané-Valbuena J, Biton M, Izar B, Lambden CD, Clancy TE, Bleday R, Melnitchouk N, Irani J, Kunitake H, Berger DL, Srivastava A, Hornick JL, Ogino S, Rotem A, Vigneau S, Johnson BE, Corcoran RB, Sharpe AH, Kuchroo VK, Ng K, Giannakis M, Nieman LT, Boland GM, Aguirre AJ, Anderson AC, Rozenblatt-Rosen O, Regev A, and Hacohen N

Subjects
Bone Morphogenetic Proteins metabolism, Cancer-Associated Fibroblasts metabolism, Cancer-Associated Fibroblasts pathology, Cell Compartmentation, Cell Line, Tumor, Chemokines metabolism, Cohort Studies, Colorectal Neoplasms genetics, DNA Mismatch Repair genetics, Endothelial Cells metabolism, Gene Expression Regulation, Neoplastic, Humans, Immunity, Inflammation pathology, Monocytes pathology, Myeloid Cells pathology, Neutrophils pathology, Stromal Cells metabolism, T-Lymphocytes metabolism, Transcription, Genetic, Colorectal Neoplasms immunology, Colorectal Neoplasms pathology
Abstract

Immune responses to cancer are highly variable, with mismatch repair-deficient (MMRd) tumors exhibiting more anti-tumor immunity than mismatch repair-proficient (MMRp) tumors. To understand the rules governing these varied responses, we transcriptionally profiled 371,223 cells from colorectal tumors and adjacent normal tissues of 28 MMRp and 34 MMRd individuals. Analysis of 88 cell subsets and their 204 associated gene expression programs revealed extensive transcriptional and spatial remodeling across tumors. To discover hubs of interacting malignant and immune cells, we identified expression programs in different cell types that co-varied across tumors from affected individuals and used spatial profiling to localize coordinated programs. We discovered a myeloid cell-attracting hub at the tumor-luminal interface associated with tissue damage and an MMRd-enriched immune hub within the tumor, with activated T cells together with malignant and myeloid cells expressing T cell-attracting chemokines. By identifying interacting cellular programs, we reveal the logic underlying spatially organized immune-malignant cell networks., Competing Interests: Declaration of interests K.P., M.H., J.H.C., V.K.K., A.J.A., O.R.-R., A. Regev., and N.H. are co-inventors on US Patent Application No. 16/995,425 relating to methods for predicting outcomes and treating colorectal cancer as described in the manuscript. A.J.A. is a Consultant for Oncorus, Arrakis Therapeutics, and Merck and receives research funding from Mirati Therapeutics, Deerfield, and Novo Ventures. R.B.C. receives consulting/speaking fees from Abbvie, Amgen, Array Biopharma/Pfizer, Asana Biosciences, Astex Pharmaceuticals, AstraZeneca, Avidity Biosciences, BMS, C4 Therapeutics, Chugai, Elicio, Fog Pharma, Fount Therapeutics/Kinnate Biopharma, Genentech, Guardant Health, Ipsen, LOXO, Merrimack, Mirati Therapeutics, Natera, N-of-one/QIAGEN, Novartis, nRichDx, Revolution Medicines, Roche, Roivant, Shionogi, Shire, Spectrum Pharmaceuticals, Symphogen, Tango Therapeutics, Taiho, Warp Drive Bio, and Zikani Therapeutics; holds equity in Avidity Biosciences, C4 Therapeutics, Fount Therapeutics/Kinnate Biopharma, nRichDx, and Revolution Medicines; and has received research funding from Asana, AstraZeneca, Lilly, and Sanofi. V.K.K. consults for Pfizer, GSK, Tizona Therapeutics, Celsius Therapeutics, Bicara Therapeutics, Compass Therapeutics, Biocon, and Syngene. G.M.B. has sponsored research agreements with Palleon Pharmaceuticals, Olink Proteomics, and Takeda Oncology; served on SABs for Novartis and Nektar Therapeutics; and received honoraria from Novartis. A.C.A. is a paid consultant for iTeos Therapeutics, and is an SAB member for Tizona Therapeutics, Compass Therapeutics, Zumutor Biologics, and ImmuneOncia, which have interests in cancer immunotherapy. A.C.A.’s interests were reviewed and managed by the BWH and Partners Healthcare in accordance with their conflict of interest policies. M.G. receives research funding from BMS, Merck, and Servier. J.W.R., C.A.F., and M.L.H. are employees of and stockholders for NanoString Technologies Inc. D.R.Z. is a former employee of NanoString Technologies Inc. B.I. is a consultant for Merck and Volastra Therapeutic. R.B. is an UptoDate Author. A. Rotem is an equity holder in Celsius Therapeutics and NucleAI. K.N. has research funding from Janssen, Revolution Medicines, Evergrande Group, Pharmavite; advisory board: Seattle Genetics, BiomX; consulting: X-Biotix Therapeutics; research funding: BMS, Merck, and Servier. B.E.J. is on the SAB for Checkpoint Therapeutics. O.R.-R. is a named inventor on patents and patent applications filed by the Broad Institute in single-cell genomics. From October 2020, O.R.-R. is an employee of Genentech. A. Regev. is a founder of and equity holder in Celsius Therapeutics, an equity holder in Immunitas Therapeutics, and was an SAB member for Thermo Fisher Scientific, Syros Pharmaceuticals, and Neogene Therapeutics until August 1, 2020. From August 1, 2020, A. Regev. is an employee of Genentech. A. Regev. is a named inventor on several patents and patent applications filed by the Broad Institute in single-cell and spatial genomics. N.H. holds equity in BioNTech and is an advisor for Related Sciences/Danger Bio., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2021
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38. Perioperative Code Status Discussions: How Are We Doing?

Author

O'Leary S, Pimentel MP, Ford S, Vacanti JC, Bleday R, Salmasian H, and Mendu ML

Subjects
Humans, Documentation, Resuscitation Orders
Abstract

Approximately 15% of patients with a code status of do-not-resuscitate (DNR) or do-not-intubate (DNI) present for surgery. Despite professional guidelines requiring discussions with patients regarding perioperative resuscitation, it is unclear whether these recommendations are consistently followed. Our review of 158 patient encounters with established DNR/DNI code status found that code status discussions (CSDs) were documented only 70% of the time, and code status orders were inconsistently entered to reflect those discussions. We present solutions to improve CSD documentation, including refining perioperative workflows, simplifying code status choices, optimizing electronic health record order entry, and a supplementary consent form to facilitate code status review., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 International Anesthesia Research Society.)

Published
2021
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39. Lymph Node Positivity in T1/T2 Rectal Cancer: a Word of Caution in an Era of Increased Incidence and Changing Biology for Rectal Cancer.

Author

Fields AC, Lu P, Hu F, Hirji S, Irani J, Bleday R, Melnitchouk N, and Goldberg JE

Subjects
Biology, Humans, Incidence, Lymph Nodes pathology, Neoplasm Invasiveness pathology, Neoplasm Staging, Prognosis, Retrospective Studies, Rectal Neoplasms pathology
Abstract

Background: The evaluation of lymph nodes in rectal cancer dictates treatment. The goals of this study are to characterize the contemporary rate of lymph node metastasis in early stage rectal cancer and to re-investigate histologic factors that predict positive lymph nodes., Materials and Methods: Using the National Cancer Database, we identified patients with clinical stage I rectal adenocarcinoma. Multivariable logistic regression was used to determine risk factors for lymph node positivity., Results: 12.2% of patients with T1 tumors and 18.0% of patients with T2 tumors had positive lymph nodes. For T1 tumors, positive lymph nodes were present in 9.3% with neither poor differentiation nor lymphovascular invasion (LVI), 17.3% with poor differentiation alone, 34.7% with LVI alone, and 45.0% with both poor differentiation and LVI. For T2 tumors, positive lymph nodes were present in 11.7% with neither poor differentiation nor LVI, 25.3% with poor differentiation alone, 47.3% with LVI alone, and 41.5% with both poor differentiation and LVI. LVI was an independent predictor of positive lymph nodes (OR;4.75,95%CI;3.17-7.11,p < 0.001) for T1 and (OR;6.20,95%CI;4.53-8.51,p < 0.001) T2 tumors., Conclusions: T1/T2 tumors have higher rates of positive lymph nodes when poor differentiation and LVI are present. These results should be taken into consideration prior to surgical treatment.

Published
2021
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41. Surgical Management of Small Bowel Lymphoma.

Author

Lu PW, Fields AC, Yoo J, Irani J, Goldberg JE, Bleday R, and Melnitchouk N

Subjects
Humans, Intestine, Small surgery, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Duodenal Neoplasms, Lymphoma surgery
Abstract

Background: Primary small bowel non-Hodgkin's lymphoma is a rare disease representing 2% of small intestine malignancies. There is limited data delineating the optimal treatment for these heterogeneous tumors. We aim to examine relationships between different treatment modalities and surgical outcomes in patients with small bowel lymphoma., Materials and Methods: Patients diagnosed with stage I-III small bowel lymphoma in 2004-2015 who underwent surgery were identified in the National Cancer Database. Two cohorts were created based on systemic chemotherapy treatment status. The primary outcome was overall survival. An adjusted Cox proportional hazards model was used to evaluate the impact of treatment strategy on survival., Results: 2283 patients met inclusion criteria Of these patients, 826 patients (36%) underwent surgical resection alone, and 1457 patients (64%) underwent resection with systemic chemotherapy. Chemotherapy was associated with improved overall survival in unadjusted (5-year overall survival, 55% versus 70%) and adjusted analysis (HR 0.54, 95% CI 0.47-0.63, p < 0.001)., Discussion: Patients with small bowel lymphoma have a low five-year overall survival after surgery. Chemotherapy is associated with improved survival, although one third of patients do not receive this therapy. Several other clinical factors are identified that are also associated with overall survival, including histology subtype, margin status, age, and medical comorbidities. This information can help with prognostication and potentially aid in treatment decision-making.

Published
2021
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42. Surgical resection improves overall survival of patients with small bowel leiomyosarcoma.

Author

Welten VM, Fields AC, Lu PW, Yoo J, Goldberg JE, Irani J, Bleday R, and Melnitchouk N

Subjects
Female, Humans, Male, Middle Aged, Neoplasm Recurrence, Local, Prognosis, Retrospective Studies, Leiomyosarcoma surgery
Abstract

Purpose: Small bowel leiomyosarcoma (SB LMS) is a rare disease with few studies characterizing its outcomes. This study aims to evaluate surgical outcomes for patients with SB LMS., Methods: The National Cancer Database was queried from 2004 to 2016 to identify patients with SB LMS who underwent surgical resection. The primary outcome was overall survival., Results: A total of 288 patients with SB LMS who had undergone surgical resection were identified. The median age was 63, and the majority of patients were female (56%), White (82%), and had a Charlson comorbidity score of zero (76%). Eighty-one percent of patients had negative margins following surgical resection. Fourteen percent of patients had metastatic disease at the time of diagnosis. Nineteen percent of patients received chemotherapy and 3% of patients received radiation. One-year overall survival was 77% (95% CI: 72-82%) and 5-year overall survival was 43% (95% CI: 36-49%). Higher grade (HR: 1.98, 95% CI: 1.10-3.55, p = 0.02) and metastatic disease at diagnosis (HR: 2.57, 95% CI: 1.45-4.55, p = 0.001) were independently associated with higher risk of death., Conclusion: SB LMS is a rare disease entity, with treatment centering on complete surgical resection. Our results demonstrate that overall survival is higher than previously thought. Timely diagnosis to allow for complete surgical resection is key, and investigation into the possible role of chemotherapy or radiation therapy is needed.

Published
2020
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43. The Effect of Surgical Trainee Education on Opioid Prescribing: An International Evaluation.

Author

Prigoff JG, Titan AL, Fields AC, Shwaartz C, Melnitchouk N, Bleday R, Hawn MT, and Wiechmann L

Subjects
Appendectomy, Humans, Pain, Postoperative, Practice Patterns, Physicians', United States, Analgesics, Opioid therapeutic use, Hernia, Inguinal
Abstract

Introduction: Up to 6% of opioid naive patients who undergo surgery become chronic opioid users. The aim of this study was to determine if formal opioid prescribing education of general surgery residents is associated with decreased opioid prescribing postoperatively., Methods: We surveyed surgery residents at 3 general surgery programs in the United States and 1 in Israel. Residents were divided into 2 groups based on whether or not they received formal opioid prescribing education., Results: Of those surveyed, 107 (50%) responded. 45% of residents had formal opioid prescribing education, which included instructional videos, current literature, and hospital guidelines. For the 4 operations analyzed, residents who received no formal teaching prescribed a higher number of opioids (lumpectomy p = 0.001, open inguinal hernia repair p = 0.004, laparoscopic appendectomy p = 0.007, thyroidectomy p = 0.002). The largest difference in opioid prescribing was seen in "high prescribers," defined as residents prescribing 15 or more opioid pills. For thyroidectomy, 24.4% of residents without formal education prescribed 20 or more oxycodone 5mg pills compared to 0% of residents with formal education. The Israeli cohort was less likely to receive a pain focused education and was also less likely to prescribe opioids to their patients for all 4 procedures evaluated., Conclusions: Although a minority of general surgery residents are receiving an opioid prescribing education, a formal educational program was associated with significantly decreased opioid prescribing. There is a need for a generalizable educational opioid program for surgery residents., (Copyright © 2020 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Published
2020
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44. A multi-center analysis of cumulative inpatient opioid use in colorectal surgery patients.

Author

Cavallaro PM, Fields AC, Bleday R, Kaafarani H, Yao Y, Sequist TD, Ahmed KF, Rubin M, Ricciardi R, and Bordeianou LG

Subjects
Age Factors, Aged, Female, Humans, Inflammatory Bowel Diseases epidemiology, Length of Stay, Male, Multivariate Analysis, Patient Readmission, Perioperative Period, Postoperative Complications epidemiology, Postoperative Period, United States epidemiology, Analgesics, Opioid administration & dosage, Colon surgery, Drug Utilization statistics & numerical data, Hospitalization, Rectum surgery
Abstract

Background: There are little data on risk factors for increased inpatient opioid use and its relationship with persistent opioid use after colorectal surgery., Methods: We identified colorectal surgery patients across five collaborating institutions. Patient comorbidities, surgery data, and outcomes were captured in the American College of Surgeons National Surgical Quality Improvement Program. We recorded preoperative opioid exposure, inpatient opioid use, and persistent use 90-180 days after surgery., Results: 1646 patients were analyzed. Patients receiving ≥250 MMEs (top quartile) were included in the high use group. On multivariable analysis, age <65, emergent surgery, inflammatory bowel disease, and postoperative complications, but not prior opioid exposure, were predictive of high opioid use. Patients in the top quartile of use had an increased risk of persistent opioid use (19.8% vs. 9.7%, p < 0.001), which persisted on multivariable analysis (OR 1.48; p = 0.037)., Conclusions: We identified risk factors for high inpatient use that can be used to identify patients that may benefit from opioid sparing strategies. Furthermore, high postoperative inpatient use was associated with an increased risk of persistent opioid use., Competing Interests: Declaration of competing interest The authors have no related conflicts of interest to declare., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Published
2020
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45. Restarting Essential Surgery in the Era of COVID-19: A Cautious Data Driven Approach Based on the Literature and Local Data.

Author

Fields AC, Vacanti JC, Rhee C, Klompas M, Kanjilal S, Maldonado L, Robinson MK, Nguyen LL, Pimentel MPT, Doherty GM, and Bleday R

Subjects
COVID-19 transmission, Humans, Patient Selection, COVID-19 epidemiology, COVID-19 prevention & control, Elective Surgical Procedures, Infection Control organization & administration
Abstract

Competing Interests: The authors declare no conflict of interest.

Published
2020
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46. VentX expression in tumor-associated macrophages promotes phagocytosis and immunity against pancreatic cancers.

Author

Le Y, Gao H, Richards W, Zhao L, Bleday R, Clancy T, and Zhu Z

Subjects
Adenocarcinoma immunology, Adenocarcinoma pathology, Aged, Aged, 80 and over, Carcinogenesis genetics, Carcinogenesis immunology, Cell Differentiation genetics, Cell Line, Tumor, Cell Proliferation genetics, Female, Gene Expression Regulation, Neoplastic genetics, Gene Expression Regulation, Neoplastic immunology, Humans, Lymphocytes, Tumor-Infiltrating immunology, Lymphocytes, Tumor-Infiltrating pathology, Male, Middle Aged, Pancreatic Neoplasms immunology, Pancreatic Neoplasms pathology, Phagocytosis genetics, Signal Transduction genetics, Tumor Microenvironment genetics, Tumor Microenvironment immunology, Tumor-Associated Macrophages immunology, Tumor-Associated Macrophages pathology, Adenocarcinoma genetics, Homeodomain Proteins genetics, Immunity, Innate genetics, Pancreatic Neoplasms genetics
Abstract

Pancreatic ductal adenocarcinoma (PDA) is a lethal malignancy that has no effective treatment. The tumor microenvironment (TME) of PDA employs a multitude of immune derangement strategies to protect PDA from immune elimination. Tumor-associated macrophages (TAMs) have been implicated in the pathogenesis of immune suppression of the PDA TME; however, its underlying mechanisms remained largely unknown. Using primary patient samples, our studies showed that, in comparison with macrophages isolated from normal pancreatic tissues, the phagocytosis activity of the PDA TAMs was significantly reduced. We found that the expression of homeobox protein VentX, a master regulator of macrophage plasticity, was significantly decreased in the PDA TAMs. We demonstrated that VentX was required for phagocytosis and that restoration of VentX expression in PDA TAMs promoted phagocytosis through the regulation of the signaling cascades involved in the process. Using an ex vivo culture model of primary human PDA, we showed that VentX-modulated TAMs transformed the PDA TME from a protumor milieu to an antitumor microenvironment by rectifying differentiation, proliferation, and activation of PDA-infiltrating immune cells. Using NSG-PDX models of primary human PDAs, we showed that VentX-modulated TAMs exerted strong inhibition on PDA tumorigenesis in vivo. Taken together, our data revealed a central mechanism underlying immune evasion of PDA and a potential novel venue to improve PDA prognosis.

Published
2020
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47. The Distribution of Colorectal Surgeons in the United States.

Author

Lu PW, McCarty JC, Fields AC, Azzeh M, Goldberg JE, Irani J, Bleday R, and Melnitchouk N

Subjects
Cross-Sectional Studies, Health Workforce, Humans, United States, Colorectal Surgery, Surgeons statistics & numerical data
Abstract

Background: Surgical resection is a mainstay of colorectal cancer treatment, and prior studies have shown improved outcomes in patients undergoing surgery for colorectal cancer by colorectal surgical specialists compared with nonspecialized surgeons. Here, we examine the geographic distribution of colorectal surgeons in the United States and its relationship with sociodemographic characteristics of the served population., Methods: The Area Health Resource File from 2017 to 2018 was used to identify the number and location of colorectal surgeons practicing throughout the United States and sociodemographic characteristics at the county and hospital referral region (HRR) level. The main outcomes of interest were the density of colorectal surgeons per 100,000 population and associations with sociodemographic characteristics at the county and HRR level based on multivariable linear regression., Results: In multivariable analysis, regions with higher proportion of nonwhite individuals and college-educated individuals had significantly more colorectal surgeons per 100,000 population, whereas regions with higher proportions of uninsured individuals had significantly fewer colorectal surgeons per 100,000 population at both the county and HRR levels., Conclusions: Geographic and sociodemographic variability exists in the distribution of colorectal surgeons in the United States. Such variability may be contributing to disparities in access to specialized colorectal care., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Published
2020
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48. Local versus Radical Excision of Early Distal Rectal Cancers: A National Cancer Database Analysis.

Author

Melnitchouk N, Fields AC, Lu P, Scully RE, Powell AC, Maldonado L, Goldberg JE, and Bleday R

Subjects
Databases, Factual, Humans, Neoplasm Staging, Retrospective Studies, Treatment Outcome, Adenocarcinoma pathology, Adenocarcinoma surgery, Digestive System Surgical Procedures, Rectal Neoplasms pathology, Rectal Neoplasms surgery
Abstract

Background: Local excision (LE) has been proposed as an alternative to radical resection for early distal rectal cancer, for which the optimal oncologic treatment remains unclear., Objective: The goal of this study was to compare the overall survival of rectal cancer patients with early distal tumors who underwent LE versus abdominoperineal resection (APR) using a large contemporary database., Methods: The National Cancer Database (2004-2013) was used to identify patients with early T-stage rectal adenocarcinoma who underwent LE or APR. Patients were split into groups based on T stage and type of surgery (LE vs. APR). The primary outcome measure was overall survival. An adjusted Cox proportional hazards model was used to evaluate the impact of treatment strategy on survival., Results: Overall, there were 2084 patients with T1 tumors and 912 patients with T2 tumors. For patients with T1 disease, after adjusting for age, sex, income level, race, Charlson score, insurance payor, and tumor size, there was no significant difference in survival between the LE and APR groups (hazard ratio [HR] 0.89, 95% confidence interval [CI] 0.65-1.22; P = 0.49). For patients with T2 disease, after adjusting for age, Charlson score, and tumor size, there was no significant difference in survival between patients undergoing LE + chemoradiation therapy (CRT) and APR (HR 1.11, 95% CI 0.84-1.45; P = 0.47)., Conclusions: Patients with early distal rectal adenocarcinoma who underwent LE had similar survival to patients who underwent APR. LE is an acceptable oncologic treatment strategy for patients with T1 rectal cancers, and LE with CRT is an acceptable oncologic treatment for patients with T2 distal rectal cancers.

Published
2020
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49. Differential Index-Hospitalization Cost Center Impact of Enhanced Recovery After Surgery Program Implementation.

Author

Najjar PA, Fields AC, Maldonado LJ, Ward A, and Bleday R

Subjects
Adult, Aged, Anesthesia economics, Anesthesia statistics & numerical data, Case-Control Studies, Colectomy adverse effects, Diagnosis-Related Groups economics, Economics, Nursing statistics & numerical data, Economics, Pharmaceutical statistics & numerical data, Equipment and Supplies economics, Female, Hospitalization statistics & numerical data, Humans, Male, Middle Aged, Non-Randomized Controlled Trials as Topic methods, Operating Rooms economics, Operating Rooms statistics & numerical data, Postoperative Period, Preoperative Period, Retrospective Studies, United States epidemiology, Colectomy economics, Colorectal Surgery economics, Enhanced Recovery After Surgery standards, Health Plan Implementation methods, Hospitalization economics
Abstract

Background: Most hospitals in the United States are reimbursed for colectomy via a bundled payment based on the diagnosis-related group assigned. Enhanced recovery after surgery programs have been shown to improve the value of colorectal surgery, but little is known about the granular financial tradeoffs required at individual hospitals., Objective: The purpose of this study is to analyze the index-hospitalization impact on specific cost centers associated with enhanced recovery after surgery implementation for diagnosis-related groups commonly assigned to patients undergoing colon resections., Design: We performed a single-institution retrospective, nonrandomized, preintervention (2013-2014) and postintervention (2015-2017) analysis of hospital costs., Setting: This study was conducted at an academic medical center., Patients: A total of 1297 patients with diagnosis-related group 330 (colectomy with complications/comorbidities) and 331 (colectomy without complications/comorbidities) were selected., Main Outcome Measures: The primary outcome was total index-hospitalization cost. Secondary outcomes included specific cost center expenses., Results: Total median cost for diagnosis-related group 330 in the pre-enhanced recovery after surgery group was $24,111 ($19,285-$28,658) compared to $21,896 ($17,477-$29,179) in the enhanced recovery after surgery group, p = 0.01. Total median cost for diagnosis-related group 331 in the pre-enhanced recovery after surgery group was $19,268 ($17,286-$21,858) compared to $18,444 ($15,506-$22,847) in the enhanced recovery after surgery group, p = 0.22. When assessing cost changes after enhanced recovery after surgery implementation for diagnosis-related group 330, operating room costs increased (p = 0.90), nursing costs decreased (p = 0.02), anesthesia costs increased (p = 0.20), and pharmacy costs increased (p = 0.08). For diagnosis-related group 331, operating room costs increased (p = 0.001), nursing costs decreased (p < 0.001), anesthesia costs increased (p = 0.03), and pharmacy costs increased (p = 0.001)., Limitations: This is a single-center study with a pre- and postintervention design., Conclusions: The returns on investment at the hospital level for enhanced recovery after surgery implementations in colorectal surgery result largely from cost savings associated with decreased nursing expenses. These savings likely offset increased spending on operating room supplies, anesthesia, and medications. See Video Abstract at http://links.lww.com/DCR/B204. IMPACTO DE LA IMPLEMENTACIÓN DEL PROTOCOLO DE RECUPERACIÓN MEJORADA DESPUÉS DE CIRUGÍA EN EL COSTO DE LA HOSPITALIZACIÓN ÍNDICE EN CENTROS ESPECÍFICOS: La mayoría de los hospitales en los Estados Unidos son reembolsados por la colectomía a través de un paquete de pago basado en el grupo de diagnóstico asignado. Se ha demostrado que los programas de recuperación después de la cirugía mejoran el valor de la cirugía colorrectal, pero se sabe poco sobre las compensaciones financieras granulares que se requieren en los hospitales individuales.El objetivo de este estudio es analizar el impacto del índice de hospitalización en centros de costos específicos asociados con la implementación de RMDC para grupos relacionados con el diagnóstico comúnmente asignados a pacientes que se someten a resecciones de colon.Realizamos un análisis retrospectivo, no aleatorio, previo (2013-2014) y posterior a la intervención (2015-2017) de los costos hospitalarios de una sola institución.Centro médico académico.Un total de 1. 297 pacientes con diagnóstico relacionado con el grupo 330 (colectomía con complicaciones/comorbilidades) y 331 (colectomía sin complicaciones/comorbilidades).El resultado primario fue el índice total de costos de hospitalización. Los resultados secundarios incluyeron gastos específicos del centro de costos.El costo medio total para el grupo relacionado con el diagnóstico de 330 en el grupo de recuperación pre-mejorada después de la cirugía fue de $24,111 ($19,285- $28,658) en comparación con $21,896 ($17,477- $29,179) en el grupo de recuperación mejorada después de la cirugía, p = 0.01. El costo medio total para DRG 331 en el grupo de recuperación pre-mejorada después de la cirugía fue de $19,268 ($17,286- $21,858) en comparación con $18,444 ($15,506-$22,847) en el grupo de recuperación mejorada después de la cirugía, p = 0.22. Al evaluar los cambios en los costos después de una recuperación mejorada después de la implementación de la cirugía para el grupo 330 relacionado con el diagnóstico, los costos de la sala de operaciones aumentaron (p = 0.90), los costos de enfermería disminuyeron (p = 0.02) los costos de anestesia aumentaron (p = 0.20) y los costos de farmacia aumentaron (p = 0.08). Para el grupo 331 relacionado con el diagnóstico, los costos de la sala de operaciones aumentaron (p = 0.001), los costos de enfermería disminuyeron (p < 0.001) los costos de anestesia aumentaron (p = 0.03) y los costos de farmacia aumentaron (p = 0.001).Este es un estudio de un solo centro con un diseño previo y posterior a la intervención.El retorno de la inversión a nivel hospitalario para una recuperación mejorada después de la implementación de la cirugía en la cirugía colorrectal se debe en gran parte al ahorro de costos asociado con la disminución de los gastos de enfermería. Es probable que estos ahorros compensen el aumento de los gastos en suministros de quirófano, anestesia y medicamentos. Consulte Video Resumen en http://links.lww.com/DCR/B204. (Traducción-Dr. Gonzalo Hagerman).

Published
2020
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50. Sociodemographic predictors of surgery refusal in patients with stage I-III colon cancer.

Author

Lu PW, Fields AC, Yoo J, Irani J, Goldberg JE, Bleday R, and Melnitchouk N

Subjects
Adenocarcinoma epidemiology, Adenocarcinoma pathology, Adenocarcinoma surgery, Age Factors, Aged, Aged, 80 and over, Colonic Neoplasms pathology, Databases, Factual, Female, Humans, Insurance, Health statistics & numerical data, Male, Middle Aged, Neoplasm Staging, Propensity Score, Sex Factors, Sociological Factors, Survival Rate, United States, Colonic Neoplasms epidemiology, Colonic Neoplasms surgery, Treatment Refusal statistics & numerical data
Abstract

Background and Objectives: Over 104 000 cases of colon cancer are estimated to be diagnosed in 2020. Surgical resection is a critical part of colon cancer treatment and adequate resection impacts prognosis. However, some patients refuse potentially curative surgery. We aimed to identify the rate and predictors of surgery refusal among patients with colon cancer., Methods: The National Cancer Database (2004-2015) was queried for patients diagnosed with stage I-III colonic adenocarcinoma. Sociodemographic factors, clinical features, and treatment facility characteristics were collected. Patients who underwent surgery with curative intent were compared to those who refused surgery. Multivariable analysis was used to identify factors associated with surgery refusal. Adjusted survival analysis was performed on propensity-matched cohorts., Results: A total of 151 020 patients were included and 1071 (0.71%) refused surgery. In multivariable analysis older age, Black race, higher Charlson comorbidity score, Medicaid, Medicare, or lack of insurance were predictive of refusing surgery. After propensity matching, there was a significant difference in 5-year survival for patients who refused surgery vs those who underwent surgery (P < .001)., Conclusions: There are racial and socioeconomic disparities in the refusal of surgery for colon cancer. Further studies are needed to better understand the drivers behind differences in refusing curative surgery for colon cancer., (© 2020 Wiley Periodicals, Inc.)

Published
2020
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