127 results on '"Melnitchouk N"'
Search Results
2. Evaluation of practice patterns of chemodenervation for anal fissure of the ASCRS young surgeons
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Bhama, A. R., Melnitchouk, N., Mizell, J. S., Sherman, K. L., and Zaghiyan, K.
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- 2020
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3. The Impact of Treatment at Minority-serving Hospitals on Outcomes for Pancreatic Cancer
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Castillo-Angeles, M., primary, Mehtsun, W., additional, Lu, P., additional, Trinh, Q.-D., additional, Melnitchouk, N., additional, Castillo, C. Fernandez-del, additional, Ferrone, C., additional, Lillemoe, K., additional, Callery, M., additional, Qadan, M., additional, and Kent, T., additional
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- 2022
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4. Transanal anorectal stricturoplasty using the Heineke–Mikulicz principle: a novel technique
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Lee, S. W., Niec, R., Melnitchouk, N., and Samdani, T.
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- 2016
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5. PTH-288 Trends in colon and rectal cancer epidemiology in ukraine: incidence, mortality and surgical management in comparison to a us hospital
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Traa, MX, Shabat, G, Lukashenko, A, Shchepotin, I, Bleday, R, and Melnitchouk, N
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- 2015
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6. PTU-240 Comparison of outcomes of abdominal and colorectal surgery in patients with left ventricular assist devices versus heart transplants
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Traa, MX, Asban, A, and Melnitchouk, N
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- 2015
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7. 1732P War and the fragility of anticancer drug supply networks in Ukraine
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Kostenchak-Svystak, O., Kizub, D., Dzhemiliev, A., Huivaniuk, I., Kopetskiy, V., Rieutova, L., Uzlova, H., Matiushenko, I., Kasianchyk, M., Beznosenko, A., and Melnitchouk, N.
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- 2023
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8. 1727P Barriers and facilitators of physician involvement in clinical oncology database management in Ukraine
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Huivaniuk, I., Kizub, D., Dzhemiliev, A., Melnitchouk, N., Beznosenko, A., and Kopetskyi, V.S.
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- 2023
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9. 1695MO Cancer care during armed conflict: Factors associated with adult patient transfer for treatment abroad during the war in Ukraine
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Huivaniuk, I., Kizub, D., Kopetskyi, V.S., Dzhemiliev, A., Kacharian, A., Strilka, V., Beznosenko, A., and Melnitchouk, N.
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- 2023
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10. The impact of treatment at minority-serving hospitals on outcomes for pancreatic cancer
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Castillo-Angeles, M., primary, Mehtsun, W.T., additional, Lu, P.W., additional, Trinh, Q., additional, Melnitchouk, N., additional, Fernandez-del Castillo, C., additional, Ferrone, C.R., additional, Lillemoe, K.D., additional, Callery, M.P., additional, Qadan, M., additional, and Kent, T.S., additional
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- 2021
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11. Enhancing trauma care in Ukraine amid conflict: A successful implementation of the modified advanced trauma life support course in an active war zone.
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Dzhemiliev A, Lienau B, Melnitchouk N, Schmid A, Loevinsohn G, Lopatniuk O, Carton-Rossen N, Sydlowski M, Darnytskyi A, Murray K, Kushner O, Strong J, Martin L, Ali J, Roberts J, Mooney D, Hochman B, Owens M, Sidhwa F, Rudas I, Hvozd V, Aksenkova S, Mazurenko OV, Kliukach K, Kivlehan SM, and Anderson GA
- Abstract
Background: Following the 2022 Russian invasion, Ukraine's healthcare system suffered extensive damage, with over 1000 medical facilities destroyed, exacerbating the trauma care crisis. The absence of standardized trauma training left Ukrainian healthcare providers ill-equipped to manage the surge in trauma cases amid conflict. To bridge this gap, we implemented advanced trauma life support (ATLS) courses in Ukraine amid active warfare, aiming to enhance trauma care expertise among healthcare professionals., Methods: A consortium, including the International Medical Corps, Harvard Humanitarian Initiative, and others, responded to a request from the Ukrainian Ministry of Health. The ATLS curriculum, translated into Ukrainian, guided the training, with US-based instructors sent to Ukraine for teaching. Despite logistical challenges, such as missile attacks and curfews, the courses ran in multiple Ukrainian cities over 3 months. Course effectiveness was evaluated through pre- and post-course knowledge tests, self-efficacy surveys, and satisfaction assessments., Results: Ten ATLS courses trained 213 Ukrainian healthcare providers across five deployments. Significant improvements in knowledge scores (p < 0.05) and enhanced self-reported confidence in trauma management were observed. Notably, no casualties were reported among instructors or students, highlighting program safety despite security challenges., Conclusions: Our study demonstrates successful ATLS course implementation in an active war zone, filling a critical gap in trauma education in Ukraine. Despite challenges, the program significantly enhanced participants' trauma care knowledge and confidence. Collaboration between international and local partners was pivotal. This model can serve as a valuable framework for trauma education globally, improving outcomes in conflict zones and resource-limited settings., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
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- 2024
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12. Building an Effective International Medical Evacuation Program for Ukrainian Patients With Cancer Amid Prolonged Military Conflict.
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Huivaniuk I, Kopetskyi V, Ivanykovych T, Nikiforchin A, Kizub D, Antoniv M, Dzhemiliev A, Powell B, Yaniuta S, Kacharian A, Podolianko A, and Melnitchouk N
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- Humans, Ukraine, Retrospective Studies, Male, Female, Middle Aged, Adult, Armed Conflicts, Military Personnel statistics & numerical data, Neoplasms therapy
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Purpose: During military conflicts, the immediate response to a severely disrupted health care system often overlooks the needs of patients with cancer who require continuous specialized care. The full-scale Russian invasion of Ukraine in February 2022 was no exception, leaving many Ukrainian patients without access to essential care., Materials and Methods: We conducted a retrospective cohort study to assess the impact of the MedEvac program, facilitating the transfer of Ukrainian patients with cancer to European Union (EU) institutions for treatment, and to describe its components. Patient data from the Ministry of Health of Ukraine (MOH) database (April 2022-April 2023) were analyzed., Results: Of 639 applications in the MOH database, 339 (53.1%) had sufficient data for analysis and, of those, 281 (82.9%) were evacuated to EU hospitals. Median age of evacuated patients was 47 (IQR, 38-58) years and most were newly diagnosed (94.0%, n = 264). Predominantly, patients were evacuated for systemic cancer therapy (81.9%, n = 230). Multivariate logistic regression analysis revealed that a good performance status (Eastern Cooperative Oncology Group 0-2) was the most significant factor associated with evacuation (odds ratio [OR], 9.64 [95% CI, 3.08 to 30.23]). Patients with melanoma were more likely to be evacuated, even after adjustment for performance status (OR, 2.56 [95% CI, 1.14 to 5.72]), while patients with head and neck cancer were significantly less so (OR, 0.20 [95% CI, 0.06 to 0.72])., Conclusion: MedEvac program provides a viable model for medical evacuation and management of patients with cancer amid prolonged military conflict, highlighting the importance of international cooperation and setting a precedent for other crisis responses. Continuous evaluation and adaptation are essential to ensure the program's effectiveness and sustainability.
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- 2024
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13. Strengths and opportunities for improvement in surgical education in Ukraine: A qualitative study.
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Dzhemiliev A, Antoniv M, Huivaniuk I, Kizub D, Reich AJ, Kochis M, Prystaia A, Beliechenko S, Danylyshyn M, Ivanykovych T, Semeniv S, Beznosenko A, Shabat G, Kopetskyi V, Zmijewski P, and Melnitchouk N
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- Ukraine, Humans, Female, Male, General Surgery education, Mentors, Quality Improvement, Adult, Interviews as Topic, Qualitative Research, Internship and Residency organization & administration
- Abstract
Background: The full-scale invasion of Ukraine by Russia in 2022 has significantly impacted the country's healthcare system including surgical education. To assess the current state and identify the strengths and opportunities for the improvement of Ukraine's surgical education system during the peri-war period, this study is one of the first to explore the state of surgical education across Ukraine in peri-war, providing essential insights for current and postwar healthcare reconstruction., Methods: This qualitative study involved semi-structured interviews with 24 Ukrainian surgical residents, surgeons, and program leadership from various regions. The study focused on clinical training, didactics, mentorship, autonomy, resident evaluation, the impact of war, and gender disparities in surgical education. Data analysis was conducted using a rapid qualitative analysis technique., Results: Interviews revealed strengths in surgical education such as adaptability to war conditions and international collaborations. However, opportunities for improvement were identified including a lack of structured clinical and didactic experiences, limited autonomy and access to simulators, gender discrimination, and war-time challenges. These issues highlight a need for more comprehensive training and support systems for surgical trainees in Ukraine., Conclusions: The study underscores the resilience and adaptability of Ukrainian surgical education in the face of war while also emphasizing the need for significant improvements. It calls for implementing structured training programs, enhanced mentorship, and attention to gender equality. These findings are crucial for improving surgical education in Ukraine and can be used as an example for other lower-middle-income countries, especially in conflict settings., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)
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- 2024
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14. Factors Affecting Colorectal Cancer Screening in Primary Care Physician Practices in Ukraine.
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Dzhemiliev A, Kizub D, Wanis KN, Allar BG, Vus V, Malovanna A, Huivaniuk I, Kopetskyi V, Beznosenko A, Shabat G, Antoniv M, Suprun U, and Melnitchouk N
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- Humans, Ukraine, Female, Male, Middle Aged, Practice Patterns, Physicians' statistics & numerical data, Surveys and Questionnaires, Adult, Occult Blood, Colonoscopy statistics & numerical data, Mass Screening statistics & numerical data, Primary Health Care statistics & numerical data, Colorectal Neoplasms diagnosis, Early Detection of Cancer statistics & numerical data, Early Detection of Cancer methods, Physicians, Primary Care statistics & numerical data
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Purpose: This study aims to identify the factors influencing colorectal cancer (CRC) screening practices, along with the barriers and facilitators from the perspective of primary care physicians (PCPs) in Ukraine. Considering health care system challenges, including those posed by the ongoing war, this research seeks to inform improvements in CRC screening and outcomes in Ukraine and other low- and middle-income countries (LMICs)., Methods: A survey was designed and distributed electronically to Ukrainian PCPs, focusing on CRC screening practices, beliefs, and barriers. The survey incorporated questions adapted from established cancer screening surveys and frameworks. Complete responses were collected from 740 PCPs. Sample statistics were computed, and population-level perceptions and associations with CRC screening practices were estimated by standardizing responses to national PCP demographics., Results: The majority of respondents were women (91%) and specialized in family medicine (84%). Respondents believed in the effectiveness of colonoscopy for reducing CRC mortality (80%), with 75% of PCPs referring patients for this screening modality. Major barriers identified include inadequate training of PCPs in screening and lack of resources. Respondents reported high utilization of fecal occult blood test and colonoscopy for screening when these tests were said to be available in their practices. Self-reported familiarity with CRC screening guidelines and participation in educational workshops were positively associated with screening referrals., Conclusion: The study highlights the role of access to CRC screening tests and awareness of screening guidelines in enhancing CRC screening practices among Ukrainian PCPs. Addressing training and resource barriers, alongside public health interventions targeting patient-related barriers, is essential. These findings offer valuable insights for LMICs facing similar challenges, emphasizing the need for tailored strategies to improve cancer screening in these health care settings.
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- 2024
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15. Long-term outcomes analysis of flap-based perineal reconstruction.
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Rinkinen JR, Fruge S, Welten VM, Kinsley S, Bleday R, Irani J, Yoo J, Goldberg JE, Melnitchouk N, and Talbot SG
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- 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
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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.)
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- 2024
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16. Concordance of MRI With Pathology for Primary Staging of Rectal Cancer in Routine Clinical Practice: A Single Institution Experience.
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Kikano EG, Matalon SA, Eskian M, Lee L, Melnitchouk N, Bleday R, and Khorasani R
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- 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
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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.)
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- 2024
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17. Patient Values and Goals Regarding Treatment for Rectal Cancer: a Mixed Methods Study.
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Welten VM, Dabekaussen KFAA, Miller MO, Yoo J, Irani JL, Goldberg JE, Bleday R, Reich AJ, Davids JS, and Melnitchouk N
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- Humans, Patient Preference, Goals, Rectal Neoplasms surgery
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- 2023
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18. Patient Care and Surgical Training During Armed Conflict: Experiences and Perspectives of Surgical Residents in Ukraine.
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Dzhemiliev A, Kizub D, Welten VM, Shabat G, Huivaniuk I, Bielichenko S, Semeniv S, Zmijewski P, Voitiv Y, Usenko O, Beznosenko A, Kopetskyi V, Frolov S, and Melnitchouk N
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- Humans, Ukraine, Patient Care, Armed Conflicts, Internship and Residency
- Abstract
Competing Interests: The authors report no conflicts of interest.
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- 2023
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19. Highly Sensitive Circulating Tumor DNA Assay Aids Clinical Management of Radiographically Occult Isolated Peritoneal Metastases in Patients With GI Cancer.
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Singh H, Klempner SJ, Melnitchouk N, Chander DP, Negrea OG, Patel AK, Schlechter BL, Rubinson DA, Huffman BM, Nambiar C, Remland J, Andrews E, Leahy ME, Brais LK, Enzinger PC, Mamon HJ, Giannakis M, Meyerhardt JA, Ng K, Perez KJ, Aguirre AJ, Clark JW, Cleary JM, and Wolpin BM
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- Humans, Female, Aged, Male, Retrospective Studies, Biomarkers, Tumor genetics, DNA, Neoplasm genetics, Circulating Tumor DNA genetics, Appendiceal Neoplasms, Peritoneal Neoplasms diagnosis, Peritoneal Neoplasms genetics, Adenocarcinoma, Stomach Neoplasms
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Purpose: GI cancers commonly spread to the peritoneal cavity, particularly from primary adenocarcinomas of the stomach and appendix. Peritoneal metastases are difficult to visualize on cross-sectional imaging and cause substantial morbidity and mortality. The purpose of this study was to determine whether serial highly sensitive tumor-informed circulating tumor DNA (ctDNA) measurements could longitudinally track changes in disease burden and inform clinical care., Methods: This was a retrospective case series of patients with gastric or appendiceal adenocarcinoma and isolated peritoneal disease that was radiographically occult. Patients underwent quantitative tumor-informed ctDNA testing (Signatera) as part of routine clinical care. No interventions were prespecified based on ctDNA results., Results: Of 13 patients studied, the median age was 65 (range, 45-75) years, with 7 (54%) women, 5 (38%) patients with gastric, and 8 (62%) patients with appendiceal adenocarcinoma. Eight (62%) patients had detectable ctDNA at baseline measurement, with median value 0.13 MTM/mL (range, 0.06-11.68), and assay was technically unsuccessful in two cases with appendiceal cancer because of limited tumor tissue. Five (100%) patients with gastric cancer and 3 (50%) patients with appendiceal cancer had detectable ctDNA at baseline. Although baseline levels of ctDNA were low, longitudinal assessment tracked with changes in disease burden among patients undergoing chemotherapy for metastatic disease. In two patients undergoing surveillance after definitive surgical management of gastric adenocarcinoma, detection of ctDNA prompted diagnosis of isolated peritoneal disease., Conclusion: Quantitative tumor-informed serial ctDNA testing aids clinical management of patients with isolated peritoneal disease. Low levels of baseline ctDNA suggest a role for highly sensitive ctDNA approaches over panel-based testing. Further exploration of this approach should be considered in patients with isolated peritoneal malignant disease.
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- 2023
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20. Long-Term Impact of Medicaid Expansion on Colorectal Cancer Screening in Its Targeted Population.
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Qian Z, Chen X, Pucheril D, Al Khatib K, Lucas M, Nguyen DD, McNabb-Baltar J, Lipsitz SR, Melnitchouk N, Cole AP, and Trinh QD
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- Adult, United States epidemiology, Humans, Patient Protection and Affordable Care Act, Early Detection of Cancer, Poverty, Insurance Coverage, Health Services Accessibility, Medicaid, Colorectal Neoplasms diagnosis, Colorectal Neoplasms epidemiology
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Introduction: Colorectal cancer screening continuously decreased its mortality and incidence. In 2010, the Affordable Care Act extended Medicaid eligibility to low-income and childless adults. Some states elected to adopt Medicaid at different times while others chose not to. Past studies on the effects of Medicaid expansion on colorectal cancer screening showed equivocal results based on short-term data following expansion., Aims: To examine the long-term impact of Medicaid expansion on colorectal cancer screening among its targeted population at its decade mark., Methods: Behavioral Risk Factor Surveillance System data were extracted for childless adults below 138% federal poverty level in states with different Medicaid expansion statuses from 2012 to 2020. States were stratified into very early expansion states, early expansion states, late expansion states, and non-expansion states. Colorectal cancer screening prevalence was determined for eligible respondents. Difference-in-differences analyses were used to examine the effect of Medicaid expansion on colorectal cancer screening in states with different expansion statuses., Results: Colorectal cancer screening prevalence in very early, early, late, and non-expansion states all increased during the study period (40.45% vs. 48.14%, 47.52% vs 61.06%, 46.06% vs 58.92%, and 43.44% vs 56.70%). Difference-in-differences analysis showed significantly increased CRC screening prevalence in very early expansion states during 2016 compared to non-expansion states (Crude difference-in-differences + 16.45%, p = 0.02, Adjusted difference-in-differences + 15.9%, p = 0.03). No statistical significance was observed among other years and groups., Conclusions: Colorectal cancer screening increased between 2012 and 2020 in all states regardless of expansion status. However, Medicaid expansion is not associated with long-term increased colorectal cancer screening prevalence., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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21. Colonoscopy Needs for Implementation of a Colorectal Cancer Screening Program in Ukraine.
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Welten VM, Wanis KN, Semeniv S, Shabat G, Dabekaussen KFAA, Davids JS, Beznosenko A, Suprun U, Soeteman DI, and Melnitchouk N
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- Colonoscopy, Humans, Mass Screening, Occult Blood, Ukraine, Colorectal Neoplasms diagnosis, Early Detection of Cancer
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Background: In Ukraine, there is no established colorectal cancer screening program. We aimed to project the number of screening colonoscopies needed for implementation of various CRC screening strategies in Ukraine., Methods: We modified a previously developed Markov microsimulation model to reflect the natural history of adenoma and CRC progression among average-risk 50-74-year-olds. We simulated colonoscopies needed for the following screening strategies: no screening, fecal occult blood test yearly, FOBT yearly with flexible sigmoidoscopy every 5 years, FS every 5 years, fecal immunohistochemistry test (FIT) yearly, or colonoscopy every 10 years. Assuming 80% screening adherence, we estimated colonoscopies required at 1 and 5 years depending on the implementation rate. In one-way sensitivity analyses, we varied implementation rate, screening adherence, sensitivity, and specificity., Results: Assuming an 80% screening adherence and complete implementation (100%), besides a no screening strategy, the fewest screening colonoscopies are needed with an FOBT program, requiring on average 6,600 and 26,800 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. The most screening colonoscopies are required with a colonoscopy program, requiring on average 76,600 and 101,000 colonoscopies per 100,000 persons at 1 and 5 years post-implementation, respectively. In sensitivity analyses, the biggest driver of number of colonoscopies needed was screening adherence., Conclusions: The number of colonoscopies needed and therefore the potential strain on the healthcare system vary substantially by screening test. These findings can provide valuable information for stakeholders on equipment needs when implementing a national screening program in Ukraine., (© 2022. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)
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- 2022
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22. Stop the Bleed Ⓡ .
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Jacobs L, Keating JJ, Hunt RC, Butler FK, Pons PT, Gestring M, Bulger E, Eastman A, Kerby J, Hashmi Z, Fridling J, Inaba K, Matsushima K, Goralnick E, Melnitchouk N, and Welten V
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- Humans, Hemorrhage therapy, Tourniquets
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- 2022
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23. Global Health 101.
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Welten VM, Dabekaussen KFAA, and Melnitchouk N
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Global health is an evolving field that has been broadly defined as the promotion of health for all through transnational collaboration and research. It centers on the concepts of equity and collaboration. The focus of global health has recently undergone a major shift toward emphasizing the importance of a systems-based approach to healthcare delivery, which considers not only the target disease but also the many contextual factors, influencing the ability to deliver care equitably to a population to reduce the burden of any particular disease. Thus, an important global health delivery framework has been established to outline this inter- and multi-disciplinary systems-based to address major global health issues and improve health for all globally. The practice of global health, whether in research or in active intervention, necessitates guiding principles to ensure ethical conduct in the transnational partnerships and efforts to advance the field. With the introduction of the United Nations' Sustainable Development Goals in 2015, there has been a major shift in response to epidemiologic transition to focus on reducing the burden of noncommunicable diseases, including cancer, which disproportionately impact low-to-middle income countries. This is true for colorectal cancer, with care challenged by significant gaps in screening, early detection, and referral systems., (Thieme. All rights reserved.)
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- 2022
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24. Leadership Styles Among Female Surgical Department Chairs.
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Welten VM, Dabekaussen KFAA, Hill SS, Columbus AB, Lu PW, Fields AC, Reich AJ, Davids JS, and Melnitchouk N
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- Female, Humans, Academic Medical Centers, Leadership
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- 2022
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25. Radiation Therapy Under the Falling Bombs: A Tale of 2 Ukrainian Cancer Centers.
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Kovalchuk N, Zelinskyi R, Hanych A, Severyn Y, Bachynska B, Beznosenko A, Duda O, Kowalchuk R, Iakovenko V, Melnitchouk N, and Suchowerska N
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- 2022
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26. Promoting Female Leadership in Academic Surgery: Disrupting Systemic Gender Bias.
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Welten VM, Dabekaussen KFAA, Davids JS, and Melnitchouk N
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- Faculty, Medical, Female, Humans, Leadership, Male, Mentors, Pregnancy, United States, Physicians, Women, Sexism
- Abstract
Gender bias is a pervasive issue in academic surgery and is characterized by familiar patterns previously described in the business world. In this article, the authors illuminate gender bias patterns in academic surgery identified in prior in-depth interviews with female surgical department chairs across the United States. The 4 main gender bias patterns drawn from the business world and illuminated with data from the interviews are (1) prove-it-again, (2) tightrope or double-blind dilemma, (3) maternity wall or benevolent bias, and (4) tug-of-war. The authors propose steps to disrupt systemic gender bias issues recognized in the academic surgery community. The proposed steps are informed by guidance from surgical diversity task forces, by existing literature, and by the authors' own experiences in the field. The steps are divided into 3 main categories: education, structured mentorship, and transparency. The proposed changes include improving training and recognition of unconscious bias, establishing level-appropriate and deliberate mentorship across all stages of training and practice, standardizing promotional requirements, and eliminating outdated standards that contribute to the gender pay gap. Although this article addresses gender bias in academic surgery, the proposed steps toward change can promote equity across the surgical community as a whole and extend to other underrepresented groups in the field., (Copyright © 2022 by the Association of American Medical Colleges.)
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- 2022
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27. Management of Peritoneal Disease in Colorectal Cancer.
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Welten VM and Melnitchouk N
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- Antineoplastic Combined Chemotherapy Protocols therapeutic use, Combined Modality Therapy, Cytoreduction Surgical Procedures, Humans, Prognosis, Survival Rate, Colorectal Neoplasms drug therapy, Hyperthermia, Induced, Peritoneal Diseases drug therapy, Peritoneal Neoplasms drug therapy, Peritoneal Neoplasms therapy
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Colorectal cancer with peritoneal involvement is traditionally recognized as having a poor prognosis, with treatment initially limited to palliative systemic chemotherapy alone. The introduction of cytoreductive surgery (CRS) in combination with hyperthermic intraperitoneal chemotherapy drastically altered the course of this disease entity and has demonstrated improvements in survival outcomes. Recent evidence has shown benefit of CRS but did not show benefit of HIPEC. Under the guidance of a multidisciplinary team and for appropriately selected patients, CRS is a key component of treatment that can positively alter the course of disease outcomes for patients with peritoneal involvement., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)
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- 2022
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28. Resilience and perseverance under siege: providing cancer care during the invasion of Ukraine.
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Kizub D, Melnitchouk N, Beznosenko A, Shabat G, Semeniv S, Nogueira L, Watson PJ, Berg K, Trapido EJ, Espinel Z, and Shultz JM
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- Humans, Ukraine epidemiology, Neoplasms epidemiology, Neoplasms therapy
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- 2022
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29. Survival Outcomes for Malignant Peritoneal Mesothelioma at Academic Versus Community Hospitals.
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Welten VM, Fields AC, Malizia RA, Yoo J, Irani JL, Goldberg JE, Bleday R, and Melnitchouk N
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- 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.)
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- 2022
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30. The Effect of Facility Volume on Survival Following Proctectomy for Rectal Cancer.
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Welten VM, Wanis KN, Madenci AL, Fields AC, Lu PW, Malizia RA, Yoo J, Goldberg JE, Irani JL, Bleday R, and Melnitchouk N
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- 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.)
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- 2022
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31. Survival Outcomes for Colorectal Cancer with Isolated Liver Metastases at Academic Versus Community Hospitals.
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Welten VM, Fields AC, Yoo J, Irani JL, Goldberg JE, Bleday R, and Melnitchouk N
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- Hepatectomy, Hospitals, Community, Humans, Retrospective Studies, Survival Rate, Colorectal Neoplasms surgery, Liver Neoplasms surgery
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- 2022
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32. The Association Between Sex and Survival for Anal Squamous Cell Carcinoma.
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Welten VM, Fields AC, Malizia RA, Yoo J, Irani JL, Bleday R, Goldberg JE, and Melnitchouk N
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- 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.)
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- 2021
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33. Barriers to Evidence-Based Colorectal Cancer Care in Ukraine.
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Lu PW, Semeniv S, Shabat G, Welten V, Pylypchuk VI, Galyuk V, Fields AC, and Melnitchouk N
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- Humans, Ukraine, Colorectal Neoplasms epidemiology, Colorectal Neoplasms therapy
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Background: The incidence of colorectal cancer (CRC) is increasing in many low- to middle-income countries, including Ukraine. Ukraine reports high mortality rates in CRC patients. To identify potential areas for targeted interventions to improve CRC care in Ukraine, we investigated Ukrainian clinician perspectives on evidence-based CRC treatment guidelines., Methods: An explanatory sequential mixed-methods study design was used. A survey was administered to attendees of a regional surgical conference. Semi-structured interviews were subsequently performed with practicing clinicians in Ukraine. Interviews were coded to identify prominent themes., Results: Quantitative: 105 clinicians completed the survey. 76% of respondents reported using guidelines in daily practice. Lack of English proficiency was cited by 28.6% of respondents as a barrier to guideline use. Improved knowledge and additional financial resources were reported as factors that would be helpful in providing evidence-based care., Quantitative: 15 clinicians were interviewed. Two major themes were identified: limitations in access to the medical literature resources (language barriers and financial barriers), and sense of clinician initiative and willingness to learn despite hardships., Conclusions: Clinicians in Ukraine have positive perspectives on utilization of evidence-based CRC treatment guidelines. However, they face major barriers in accessing resources needed to keep up-to-date on the current literature. Fortunately, there exists both willingness and initiative on the clinician level to pursue continuing education. Efforts should be made on the international society level to improve open-access and foreign language translation availability to support physicians in Ukraine and other low- to middle-income countries., (© 2021. Société Internationale de Chirurgie.)
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- 2021
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34. Spatially organized multicellular immune hubs in human colorectal cancer.
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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.)
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- 2021
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35. Representation of women in speaking roles at annual surgical society meetings.
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Lu PW, Atkinson RB, Rouanet E, Cho NL, Melnitchouk N, and Kuo LE
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- Committee Membership, Confidence Intervals, Congresses as Topic trends, Female, Humans, Logistic Models, Odds Ratio, Sex Ratio, Sexism statistics & numerical data, Specialties, Surgical trends, United States, Congresses as Topic statistics & numerical data, Physicians, Women statistics & numerical data, Societies, Medical statistics & numerical data, Specialties, Surgical statistics & numerical data
- Abstract
Background: Women are disproportionately underrepresented in American academic surgery and surgical society leadership; we investigated the proportion of speaking roles held by women across a wide variety of surgical society meetings., Methods: Publicly-available data on invited speakers, panelists, and moderators at 23 national surgical societies' annual meetings from 2002 to 2019 were collected. Mixed effects logistic regression was used to evaluate the adjusted trend of gender representation over time for each role., Results: 15.9% of invited speakers were women. Adjusted analysis showed an 8% increase in odds of having female speakers per year (OR1.08, p = 0.002, 95%CI 1.03-1.14). 24.4% of moderators and 22.5% of panelists were female; there was increasing trend in adjusted analysis for both moderators (OR1.09, p < 0.001, 95%CI 1.07-1.11) and panelists (OR1.13, p < 0.001, 95%CI 1.11-1.43)., Conclusions: There is a wide range in speaking roles held by women at surgical society meetings, but an encouraging trend towards greater parity was seen overall., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest, and have no funding to disclose., (Copyright © 2020. Published by Elsevier Inc.)
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- 2021
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36. A Multi-institutional Study of Peritoneal Recurrence Following Resection of Low-grade Appendiceal Mucinous Neoplasms.
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Baumgartner JM, Srivastava A, Melnitchouk N, Drage MG, Huber AR, Gonzalez RS, Bell P, Wu E, Resnick M, Turaga K, Poli E, Esquivel J, Deneve J, Kelly KJ, Veerapong J, and Lowy AM
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- Female, Humans, Middle Aged, Neoplasm Recurrence, Local surgery, Retrospective Studies, Adenocarcinoma, Mucinous surgery, Appendiceal Neoplasms surgery, Peritoneal Neoplasms surgery, Pseudomyxoma Peritonei surgery
- Abstract
Background: Peritoneal dissemination of low-grade appendiceal mucinous neoplasms (LAMNs), sometimes referred to as pseudomyxoma peritonei, can result in significant morbidity and mortality. Little is known about the natural history of localized (non-disseminated) LAMNs., Objective: The goal of this study was to evaluate the risk of peritoneal recurrence in patients with localized LAMNs., Methods: We performed a multi-institutional retrospective review of patients with pathologically confirmed localized LAMNs. Baseline characteristics, pathology, and follow-up data were collected. The primary endpoint was the rate of peritoneal recurrence., Results: We identified 217 patients with localized LAMNs. Median age was 59 years (11-95) and 131 (60%) patients were female. Surgical management included appendectomy for 124 (57.1%) patients, appendectomy with partial cecectomy for 26 (12.0%) patients, and colectomy for 67 (30.9%) patients. Pathology revealed perforation in 46 patients (37.7% of 122 patients with perforation status mentioned in the report), extra-appendiceal acellular mucin (EAM) in 49 (22.6%) patients, and extra-appendiceal neoplastic cells (EAC) in 13 (6.0%) patients. Median follow-up was 51.1 months (0-271). Seven (3.2%) patients developed a peritoneal recurrence, with a median time to recurrence of 14.4 months (2.5-47.0). Seven (15.2%) patients with histologic evidence of perforation had recurrence, versus no patients (0%) without perforation (p < 0.001); five (10.2%) patients with EAM versus two (1.2%) patients without EAM (p = 0.007), and one (7.7%) patient with EAC versus six (2.9%) patients without EAC (p = 0.355) had recurrence., Conclusions: This multi-institutional study represents the largest reported series of patients with localized LAMNs. In the absence of perforation or extra-appendiceal mucin or cells, recurrence was extremely rare; however, patients with any of these pathologic findings require careful follow-up.
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- 2021
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37. When not winning means losing: Underrepresentation of women surgeons in recognition awards at a single institution.
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Lyu HG, Smink DS, Doherty GM, Melnitchouk N, and Cho NL
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- Female, Humans, Male, Awards and Prizes, Internship and Residency statistics & numerical data, Physicians, Women statistics & numerical data, Sexism statistics & numerical data, Surgeons statistics & numerical data
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- 2021
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38. Racial Disparities in Treatment for Rectal Cancer at Minority-Serving Hospitals.
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Lu PW, Scully RE, Fields AC, Welten VM, Lipsitz SR, Trinh QD, Haider A, Weissman JS, Freund KM, and Melnitchouk N
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- Hospitals, Humans, Minority Groups, Racial Groups, United States epidemiology, Healthcare Disparities, Rectal Neoplasms therapy
- Abstract
Background: Racial disparities exist in patients with rectal cancer with respect to both treatment and survival. Minority-serving hospitals (MSHs) provide healthcare to a disproportionately large percent of minority patients in the USA. We examined the effects of rectal cancer treatment at MSH to understand drivers of these disparities., Methods: The NCDB was queried (2004-2015), and patients diagnosed with stage II or III rectal adenocarcinoma were identified. Racial case mix distribution was calculated at the institutional level, and MSHs were defined as those within the top decile of Black and Hispanic patients. Logistic regression was used to identify predictors of receipt of standard of care treatment. Survival was assessed using the Kaplan-Meier method, and Cox proportional hazards models were used to evaluate adjusted risk of death. Analyses were clustered by facility., Results: A total of 68,842 patients met the inclusion criteria. Of these patients, 63,242 (91.9%) were treated at non-MSH, and 5600 (8.1%) were treated at MSH. In multivariable analysis, treatment at MSH (OR 0.70 95%CI 0.61-0.80 p < 0.001) and Black race (OR 0.75 95%CI 0.70-0.81 p < 0.001) were associated with significantly lower odds of receiving standard of care. In adjusted analysis, Black patients had a significantly higher risk of mortality (HR 1.20 95%CI 1.14-1.26 p < 0.001)., Conclusions: Treatment at MSH institutions and Black race were associated with significantly decreased odds of receipt of recommended standard therapy for locally advanced rectal adenocarcinoma. Survival was worse for Black patients compared to White patients despite adjustment for receipt of standard of care., (© 2020. The Society for Surgery of the Alimentary Tract.)
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- 2021
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39. Is Medicaid expansion associated with increases in palliative treatments for metastatic cancer?
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Cole AP, Lipsitz SR, Kibel AS, Mahal BA, Melnitchouk N, Cooper Z, and Trinh QD
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- Female, Health Services Accessibility, Humans, Insurance Coverage, Male, Palliative Care, Patient Protection and Affordable Care Act, United States, Medicaid, Neoplasms therapy
- Abstract
Background: Medicaid expansion following the 2010 Affordable Care Act has an unknown impact on palliative treatments. Materials & methods: This registry-based study of individuals with metastatic cancer from 2010 to 2016 identified men and women with metastatic cancer in expansion and non-expansion states who received palliative treatments. A mixed effects logistic regression compared trends in expansion and non-expansion states and generated risk-adjusted probabilities or receiving palliative treatments each year. Results: Despite lower baseline use of palliative treatments, the rate of change was more rapid in expansion states (odds ratio [OR]: 1.02; 95% CI: 1.01-1.03; p < 0.001). The adjusted probability of receiving palliative treatments rose from 21.3 to 26.0% in non-expansion states, and from 19.7 to 26.9% in expansion states. Conclusion: Use of palliative treatments among metastatic cancer patients increased from 2010 to 2016 with a significantly greater increase in Medicaid expansion states, even when adjusting for demographic differences between states.
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- 2021
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40. Lymph Node Positivity in T1/T2 Rectal Cancer: a Word of Caution in an Era of Increased Incidence and Changing Biology for Rectal Cancer.
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Fields AC, Lu P, Hu F, Hirji S, Irani J, Bleday R, Melnitchouk N, and Goldberg JE
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- 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.
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- 2021
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41. Workplace absenteeism amongst patients undergoing open vs. robotic radical prostatectomy, hysterectomy, and partial colectomy.
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Pucheril D, Fletcher SA, Chen X, Friedlander DF, Cole AP, Krimphove MJ, Fields AC, Melnitchouk N, Kibel AS, Dasgupta P, and Trinh QD
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- Adolescent, Adult, Female, Humans, Male, Middle Aged, Retrospective Studies, Young Adult, Absenteeism, Colectomy methods, Hysterectomy methods, Prostatectomy methods, Robotic Surgical Procedures methods, Workplace standards
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Background: There is controversy regarding the widespread uptake of robotic surgery across several surgical disciplines. While it has been shown to confer clinical benefits such as decreased blood loss and shorter hospital stays, some argue that the benefits of this technology do not outweigh its high cost. We performed a retrospective insurance-based analysis to investigate how undergoing robotic surgery, compared to open surgery, may impact the time in which an employed individual returns to work after undergoing major surgery., Methods: We identified a cohort of US adults with employer-sponsored insurance using claims data from the MarketScan database who underwent either open or robotic radical prostatectomy, hysterectomy/myomectomy, and partial colectomy from 2012 to 2016. We performed multiple regression models incorporating propensity scores to assess the effect of robotic vs. open surgery on the number of absent days from work, adjusting for demographic characteristics and baseline absenteeism., Results: In a cohort of 1157 individuals with employer-sponsored insurance, those undergoing open surgery, compared to robotic surgery, had 9.9 more absent workdays for radical prostatectomy (95%CI 5.0 to 14.7, p < 0.001), 25.3 for hysterectomy/myomectomy (95%CI 11.0-39.6, p < 0.001), and 29.8 for partial colectomy (95%CI 14.8-44.8, p < 0.001) CONCLUSION: For the three major procedures studied, robotic surgery was associated with fewer missed days from work compared to open surgery. This information helps payers, patients, and providers better understand some of the indirect benefits of robotic surgery relative to its cost.
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- 2021
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42. Current Management of Appendiceal Neoplasms.
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Hoehn RS, Rieser CJ, Choudry MH, Melnitchouk N, Hechtman J, and Bahary N
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- Humans, Neoplasms, Glandular and Epithelial, Appendiceal Neoplasms diagnosis, Appendiceal Neoplasms epidemiology, Appendiceal Neoplasms therapy
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Appendiceal neoplasms include a heterogeneous group of epithelial and nonepithelial tumors that exhibit varying malignant potential. This review article summarizes current diagnostic criteria, classification systems, and optimal therapeutic strategies for the five main histopathologic subtypes of appendiceal neoplasms. In particular, the management of epithelial appendiceal neoplasms has evolved. Although their treatment has historically been extrapolated from colon cancer, improved understanding of their unique histopathologic and molecular characteristics and a growing body of published clinical data support a more nuanced approach to their management.
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- 2021
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43. Surgical Management of Small Bowel Lymphoma.
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Lu PW, Fields AC, Yoo J, Irani J, Goldberg JE, Bleday R, and Melnitchouk N
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- Humans, Intestine, Small surgery, Neoplasm Staging, Proportional Hazards Models, Retrospective Studies, Duodenal Neoplasms, Lymphoma surgery
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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.
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- 2021
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44. Access denied: The relationship between patient insurance status and access to high-volume hospitals.
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Nabi J, Tully KH, Cole AP, Marchese M, Cone EB, Melnitchouk N, Kibel AS, and Trinh QD
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- Adult, Aged, Breast Neoplasms economics, Breast Neoplasms epidemiology, Breast Neoplasms pathology, Breast Neoplasms therapy, Colorectal Neoplasms economics, Colorectal Neoplasms epidemiology, Colorectal Neoplasms pathology, Colorectal Neoplasms therapy, Databases, Factual, Female, Health Expenditures, Humans, Lung Neoplasms economics, Lung Neoplasms epidemiology, Lung Neoplasms pathology, Lung Neoplasms therapy, Male, Medicaid, Medically Uninsured, Medicare, Middle Aged, Patient Protection and Affordable Care Act, Prostatic Neoplasms economics, Prostatic Neoplasms epidemiology, Prostatic Neoplasms pathology, Prostatic Neoplasms therapy, Quality of Health Care, United States, Health Services Accessibility, Hospitals, High-Volume, Insurance Coverage, Insurance, Health
- Abstract
Background: Underinsured patients face significant barriers in accessing high-quality care. Evidence of whether access to high-volume surgical care is mediated by disparities in health insurance coverage remains wanting., Methods: The authors used the National Cancer Data Base to identify all adult patients who had a confirmed diagnosis of breast, prostate, lung, or colorectal cancer during 2004 through 2016. The odds of receiving surgical care at a high-volume hospital were estimated according to the type of insurance using multivariable logistic regression analyses for each malignancy. Then, the interactions between study period and insurance status were assessed., Results: In total, 1,279,738 patients were included in the study. Of these, patients with breast cancer who were insured by Medicare (odds ratio [OR], 0.75; P < .001), Medicaid (OR, 0.55; P < .001), or uninsured (OR, 0.50; P < .001); patients with prostate cancer who were insured by Medicare (OR, 0.87; P = .003), Medicaid (OR, 0.58; P = .001), or uninsured (OR, 0.36; P < .001); and patients with lung cancer who were insured by Medicare (OR, 0.84; P = .020), Medicaid (OR, 0.74; P = .001), or uninsured (OR, 0.48; P < .001) were less likely to receive surgical care at high-volume hospitals compared with patients who had private insurance. For patients with colorectal cancer, the effect of insurance differed by study period, and improved since 2011. For those on Medicaid, the odds of receiving care at a high-volume hospital were 0.51 during 2004 through 2007 and 0.99 during 2014 through 2016 (P for interaction = .001); for uninsured patients, the odds were 0.45 during 2004 through 2007 and 1.19 during 2014 through 2016 (P for interaction < .001) compared with patients who had private insurance., Conclusions: Uninsured, Medicare-insured, and Medicaid-insured patients are less likely to receive surgical care at high-volume hospitals. For uninsured and Medicaid-insured patients with colorectal cancer, the odds of receiving care at high-volume hospitals have improved since implementation of the Patient Protection and Affordable Care Act of 2010., (© 2020 American Cancer Society.)
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- 2021
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45. The Current Landscape of Staging and Treatment of Colorectal Cancer in a Region of Ukraine: a Mixed Methods Study.
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Lu PW, Shabat G, Semeniv S, Fedorkiv M, Fields AC, Lyu HG, Beznosenko A, Davids JS, and Melnitchouk N
- Subjects
- Chemotherapy, Adjuvant, Humans, Neoplasm Staging, Retrospective Studies, Ukraine, Colorectal Neoplasms pathology, Colorectal Neoplasms therapy
- Abstract
Background: In Ukraine, the 1-year mortality for colorectal cancer is much higher than that seen in high-income countries. We investigated practice patterns of colorectal cancer treatment in a region of Ukraine to account for high mortality rates., Methods: An explanatory sequential mixed methods design was used. Data from patients who underwent surgery for colorectal cancer in Ivano-Frankivsk from 2011 to 2015 were collected via retrospective chart review, and descriptive statistics were calculated. Semi-structured interviews were performed with local practicing surgeons and oncologists until thematic saturation was reached., Results: A total of 960 patients who underwent surgery were identified in the Ivano-Frankivsk region with colon (689) or rectal (271) cancer. 11.7% of patients underwent preoperative CT of the abdomen and pelvis, and only 1.7% underwent CT of the chest. 4.1% of patients underwent a complete preoperative colonoscopy, while 31.0% had incomplete colonoscopies. Postoperatively, 31.1% of patients with stage II colon cancer and 43.9% of patients with stage III colon cancer underwent adjuvant chemotherapy. For patients with stage II and III rectal cancers, 20.9% and 33.3% underwent chemotherapy, while 68.4% and 66.7% underwent radiation therapy, respectively. Fifteen physicians completed interviews. Two major themes emerged regarding physician perceptions on providing colorectal cancer care: lack of resources and systems level issues negatively impacting patient care., Conclusion: In this region in Ukraine, staging practices for colorectal malignancies are inconsistent and inadequate, and adjuvant treatments are varied. This is likely attributable to the lack of resources facing providers and the prohibitively high cost of care to patients.
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- 2021
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46. Surgical resection improves overall survival of patients with small bowel leiomyosarcoma.
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Welten VM, Fields AC, Lu PW, Yoo J, Goldberg JE, Irani J, Bleday R, and Melnitchouk N
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- 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.
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- 2020
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47. Racial and Socioeconomic Disparities After Surgical Resection for Rectal Cancer.
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Ghaffarpasand E, Welten VM, Fields AC, Lu PW, Shabat G, Zerhouni Y, Farooq AO, and Melnitchouk N
- Subjects
- Humans, Proctectomy, Rectal Neoplasms surgery, Survival Rate, Black or African American statistics & numerical data, Health Status Disparities, Rectal Neoplasms mortality, Socioeconomic Factors, White People statistics & numerical data
- Abstract
Background: There are various racial, socioeconomic, and tumor-specific factors that can impact rectal cancer outcomes. The current systematic review and meta-analysis evaluate the effect socioeconomic and racial variables on overall survival of rectal cancer patients after surgical resection., Methods: A literature search was performed via electronic databases according to Systematic Reviews and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology guidelines. All studies were evaluated by three authors and validated for data extraction. Predictive variables and survival profiles (1-, 5-, and 10-y survival and overall survival) reported by the studies were recorded for the systematic review. Hazard ratios, odds ratios, and 95% confidence intervals were extracted for meta-analysis. Forest plots were used to interpret the results. The primary outcome was the effect size of the predictive variables on overall survival after surgical resection., Results: Of the 265 articles collected, 22 met inclusion criteria. Sixteen studies were used for the systematic review, and 17 studies were considered for meta-analysis. Overall, 662,053 subjects with rectal cancer were studied (439,766 with race reported), of which 344,193 (78.3%) were White and 60,283 (13.7%) were Black. The median survival was 56.8% for White patients and 47.9% for Black patients. Meta-analysis revealed that race, socioeconomic variables (education level, income level, and insurance status), and facility characteristics (type and volume) were significantly associated with overall survival in rectal cancer., Conclusions: Racial and socioeconomic disparities are present in outcomes for rectal cancer patients undergoing surgical resection. It is important to consider these disparities in the management of patients with rectal cancer to minimize any consequent disparities in surgical outcomes., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2020
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48. The Effect of Surgical Trainee Education on Opioid Prescribing: An International Evaluation.
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Prigoff JG, Titan AL, Fields AC, Shwaartz C, Melnitchouk N, Bleday R, Hawn MT, and Wiechmann L
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- 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.)
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- 2020
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49. Factors Associated With the Professional Success of Female Surgical Department Chairs: A Qualitative Study.
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Columbus AB, Lu PW, Hill SS, Fields AC, Davids JS, and Melnitchouk N
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- Academic Medical Centers, Cohort Studies, Female, Grounded Theory, Humans, Professional Competence, Qualitative Research, Career Mobility, Faculty, Medical, Gender Equity, General Surgery, Leadership, Professional Autonomy
- Abstract
Importance: Only 7% of US surgical department chairs are occupied by women. While the proportion of women in the surgical workforce continues to increase, women remain significantly underrepresented across leadership roles within surgery., Objective: To identify commonality among female surgical chairs with attention toward moderators that appear to have contributed to their professional success., Design, Setting, and Participants: A grounded theory qualitative study was conducted in academic surgical departments within the US. Participants included current and emeritus female chairs of American academic surgical departments. The study was conducted between December 1, 2018, and March 31, 2019. An eligible cohort of 26 women was identified., Interventions and Exposures: Participants completed semistructured telephone interviews conducted with an interview guide., Main Outcomes and Measures: Common themes associated with career success., Results: Of the eligible cohort of 26 women, 20 individuals (77%) participated. Sixteen participants were serving as active department chairs and 4 were former department chairs. Mean (SD) length of time served in the chair position, either active or former, was calculated at 5.6 (2.6) years. Two major themes were identified. First, internal factors emerged prominently. Personality traits, including confidence, resilience, and selflessness, were shared among participants. Adaptability was described as a major facilitator to career success. Second, participants described 2 subtypes of external factors, overt and subtle, each of which included barriers and bolsters to career development. Overt support from mentors of both sexes was described as contributing to success. Subtle factors, such as gender norms, on institutional and cultural levels, affected behavior by creating environments that supported or detracted from career advancement., Conclusions and Relevance: In this study, participants described both internal and external factors that have been associated with their advancement into leadership roles. Future attention toward encouraging intrinsic strengths, fostering environments that bolster career development, and emphasizing adaptability, along with work-system redesign, may be key components to career success and advancing diversity in surgical leadership roles.
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- 2020
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50. Association of surgical approach and prolonged opioid prescriptions in patients undergoing major pelvic cancer procedures.
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Krimphove MJ, Chen X, Marchese M, Friedlander DF, Fields AC, Roa L, Pucheril D, Kibel AS, Melnitchouk N, Urman RD, Kluth LA, Dasgupta P, and Trinh QD
- Subjects
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Pain, Postoperative, Patients, Prescriptions, Retrospective Studies, Risk Factors, United States, Young Adult, Analgesics, Opioid, Minimally Invasive Surgical Procedures, Pelvic Neoplasms surgery, Practice Patterns, Physicians'
- Abstract
Background: The rise in deaths attributed to opioid drugs has become a major public health problem in the United States and in the world. Minimally invasive surgery (MIS) is associated with a faster postoperative recovery and our aim was to investigate if the use of MIS was associated with lower odds of prolonged opioid prescriptions after major procedures., Methods: Retrospective study using the IBM Watson Health Marketscan® Commerical Claims and Encounters Database investigating opioid-naïve cancer patients aged 18-64 who underwent open versus MIS radical prostatectomy (RP), partial colectomy (PC) or hysterectomy (HYS) from 2012 to 2017. Propensity weighted logistic regression analyses were used to estimate the independent effect of surgical approach on prolonged opioid prescriptions, defined as prescriptions within 91-180 days of surgery., Results: Overall, 6838 patients underwent RP (MIS 85.5%), 4480 patients underwent PC (MIS 61.6%) and 1620 patients underwent HYS (MIS 41.8%). Approximately 70-80% of all patients had perioperative opioid prescriptions. In the weighted model, patients undergoing MIS were significantly less likely to have prolonged opioid prescriptions in all three surgery types (Odds Ratio [OR] 0.737, 95% Confidence Interval [CI] 0.595-0.914, p = 0.006; OR 0.728, 95% CI 0.600-0.882, p = 0.001; OR 0.655, 95% CI 0.466-0.920, p = 0.015, respectively)., Conclusion: The use of the MIS was associated with lower odds of prolonged opioid prescription in all procedures examined. While additional studies such as clinical trials are needed for further confirmation, our findings need to be considered for patient counseling as postoperative differences between approaches do exist.
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- 2020
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