71 results on '"Sutherland FR"'
Search Results
2. Population-based review of the outcomes following hepatic resection in a Canadian health region.
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Dixon E, Bathe OF, McKay A, You I, Dowden S, Sadler D, Burak KW, McKinnon JG, Miller W, Sutherland FR, Dixon, Elijah, Bathe, Oliver F, McKay, Andrew, You, Isabelle, Dowden, Scot, Sadler, David, Burak, Kelly W, McKinnon, J Gregory, Miller, Walter, and Sutherland, Francis R
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Background: Higher hospital and surgeon volumes have been associated with improved outcomes following hepatic resection; however, there appear to be additional factors that also play a role. The objective of our study was to examine the outcomes following hepatic resection over the past 13 years in a large urban Canadian health region.Methods: We used administrative procedure codes to identify all patients from 1991/92 to 2003/04 who underwent a hepatic resection in the Calgary health region, which has a referral base of about 1.5 million people. The primary outcome was operative mortality, defined as death before discharge.Results: There were 424 hepatic resections performed in the stated time period. Annual volume was stable until 2000, when it increased substantially. This corresponded to the formation of a multidisciplinary group that provided care to these patients. There were 25 deaths over the study period for a mean mortality of 5.9%. The mean length of stay in hospital was 14.6 (median 10) days. Over time, however, mortality steadily decreased. This corresponded to a concomitant increase in the volume of hepatic resections performed.Conclusion: Over the past 13 years, the number of hepatic resections performed has increased; there has been a corresponding improvement in mortality rates. The improved rates are likely the result of multiple factors. [ABSTRACT FROM AUTHOR]- Published
- 2009
3. Care plans for acutely deteriorating COPD: a randomized controlled trial.
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Martin, IR, McNamara, D, Sutherland, FR, Tilyard, MW, and Taylor, DR
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OBSTRUCTIVE lung diseases ,PREDNISONE ,QUALITY of life ,PATIENTS ,ASTHMA ,MEDICAL care - Abstract
Introduction: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a frequent reason for admission to hospital and are responsible for the majority of the direct economic costs of treating COPD. Aims: To test whether an individualized care plan for patients experiencing acute exacerbations of COPD result in reduced health care utilization and improved quality of life for patients. Methods: Ninety-two patients with confirmed COPD were selected by general practitioners or district nurses, and randomly assigned to care plan or usual care groups. The care plan was developed in collaboration with general practitioners, secondary care specialists, specialist nurses, ambulance service providers and the after hours clinic. Patients were followed for 12 months, and the primary end-points were frequency of use of primary care services and hospital admissions. Results: There was no significant reduction in hospital admissions or improvement in quality of life in the group of patients who used the care plan compared to controls. The care plan group called out the ambulance service more frequently [2.8 (1.3, 4.3) versus 1.1 (0.7, 1.5) calls per 12 months; P = 0.03], and there was a trend towards greater use of oral prednisone [2.3 (1.4, 3.2) versus 1.3 (0.8, 1.8) courses per 12 months; P = 0.06]. Conclusion: In contrast to asthma, the provision of individualized self-management plans, whose content was enhanced to provide guidance to carers and health care professionals, did not reduce health care utilization or improve overall quality of life during acute exacerbations of COPD. Other strategies are required. [ABSTRACT FROM AUTHOR]
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- 2004
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4. A phase II experience with neoadjuvant irinotecan (CPT-11), 5-fluorouracil (5-FU) and leucovorin (LV) for colorectal liver metastases
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Bigam David, Butts Charles, Dixon Elijah, Sutherland Francis R, Ernst Scott, Bathe Oliver F, Holland David, Porter Geoffrey A, Koppel Jennifer, and Dowden Scot
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Chemotherapy may improve survival in patients undergoing resection of colorectal liver metastases (CLM). Neoadjuvant chemotherapy may help identify patients with occult extrahepatic disease (averting unnecessary metastasectomy), and it provides in vivo chemosensitivity data. Methods A phase II trial was initiated in which patients with resectable CLM received CPT-11, 5-FU and LV for 12 weeks. Metastasectomy was performed unless extrahepatic disease appeared. Postoperatively, patients with stable or responsive disease received the same regimen for 12 weeks. Patients with progressive disease received either second-line chemotherapy or best supportive care. The primary endpoint was disease-free survival (DFS); secondary endpoints included overall survival (OS) and safety. Results 35 patients were accrued. During preoperative chemotherapy, 16 patients (46%) had grade 3/4 toxicities. Resection was not possible in 5 patients. One patient died of arrhythmia following surgery, and 1 patient had transient liver failure. During the postoperative treatment phase, 12 patients (55%) had grade 3/4 toxicities. Deep venous thrombosis (DVT) occurred in 11 patients (34%) at various times during treatment. Of those who underwent resection, median DFS was 23.0 mo. and median OS has not been reached. The overall survival from time of diagnosis of liver metastases was 51.6 mo for the entire cohort. Conclusion A short course of chemotherapy prior to hepatic metastasectomy may serve to select candidates best suited for resection and it may also direct postoperative systemic treatment. Given the significant incidence of DVT, alternative systemic neoadjuvant regimens should be investigated, particularly those that avoid the use of a central venous line. Trial Registration ClinicalTrials.gov NCT00168155.
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- 2009
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5. Phase II study of neoadjuvant 5-FU + leucovorin + CPT-11 in patients with resectable liver metastases from colorectal adenocarcinoma
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Bigam David, Butts Charles, Dixon Elijah, Sutherland Francis, Dowden Scot, Bathe Oliver F, Walley Barb, Ruether Dean, and Ernst Scott
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Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Abstract Background Following resection of liver metastases from colorectal cancer, 5-year survivals are reportedly 30 – 39%. It can be assumed that this clinical situation represents systemic disease. Therefore, it is postulated that systemic chemotherapy would improve outcomes, particularly in those whose disease is sensitive to the agents administered. One potential advantage of neoadjuvant chemotherapy is that it provides in vivo chemosensitivity data. Response to neoadjuvant chemotherapy could therefore guide adjuvant chemotherapy following resection of liver metastases from colorectal cancer. Methods and design This is a prospective Phase II evaluation of outcomes in patients with potentially resectable liver metastases. Patients will receive neoadjuvant chemotherapy and will undergo resection. Postoperative chemotherapy will be directed by the degree of response to preoperative chemotherapy. All patients with Stage IV colorectal adenocarcinoma isolated to the liver that have disease that is amenable to complete ablation by resection, radiofrequency ablation, and/or cryoablation will be candidates for the trial. Patients will receive CPT-11 180 mg/m2 IV (over 90 minutes) on day 1 with 5-FU 400 mg/m2 bolus and 600 mg/m2 by 22 hour infusion and calcium folinate 200 mg/m2 on days 1 and 2, every 2 weeks. Altogether, six cycles of chemotherapy will be administered. Patients will then undergo resection and/or radiofrequency ablation. Patients who had stable disease or a clinical response with preoperative chemotherapy will receive an additional 12 cycles of CPT-11 180 mg/m2 IV (over 90 minutes) on day 1 with 5-FU 400 mg/m2 bolus and 600 mg/m2 by 22 hour infusion and calcium folinate 200 mg/m2 on days 1 and 2 (given every 2 weeks). Patients with resectable disease who had progressive disease during neoadjuvant chemotherapy will receive best supportive care or an alternative agent, at the discretion of the treating physician. Those patients who are not rendered free of disease following the neoadjuvant chemotherapy and surgery will receive best supportive care or an alternative agent, at the discretion of the treating physician. The primary endpoint of the study is disease-free survival. Secondary endpoints include overall survival, safety and feasibility, response to chemotherapy, and quality of life.
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- 2004
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6. Extracorporeal shock wave lithotripsy for pancreatic duct stones in patients with chronic pancreatitis: Are we underutilizing a new technology?
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Hashmi S, Dushinski J, Mohamed R, Sutherland FR, and Ball CG
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- Humans, Canada, Pancreatic Ducts, Technology, Treatment Outcome, Pancreatic Diseases therapy, Pancreatitis, Chronic complications, Pancreatitis, Chronic therapy, Lithotripsy, Calculi therapy, Calculi diagnosis
- Abstract
The progressive inflammatory nature of chronic pancreatitis and its sparse therapeutic toolbox remain obstacles in offering patients durable solutions for their symptoms. Obstruction of the main pancreatic duct by either strictures or stones represents a scenario worthy of therapeutic focus, as nearly all patients with pancreatitis eventually have intraductal stones. A more recent option for removal of main duct stones is extracorporeal shock wave lithotripsy (ESWL). In an effort to explore the role of ESWL in a Canadian setting, we evaluated our initial experience over an 8-year period (2011-2019)., Competing Interests: Competing interests: C.G. Ball is coeditor-in-chief of CJS; he was not involved in the review or decision to accept this manuscript for publication. No other competing interests were declared., (© 2023 CMA Impact Inc. or its licensors.)
- Published
- 2023
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7. Is the Pringle manoeuvre becoming a lost art? Contemporary use for both severe liver trauma with ongoing hemorrhage and elective partial hepatectomy.
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Silverberg J, Clements TW, Hashmi S, Kirkpatrick AW, Sutherland FR, and Ball CG
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- Blood Loss, Surgical, Elective Surgical Procedures, Humans, Liver surgery, Hepatectomy methods, Liver Neoplasms surgery
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The Pringle manoeuvre (vascular inflow occlusion) has been a mainstay technique in trauma surgery and hepato-pancreato-biliary surgery since it was first described in the early 1900s. We sought to determine how frequently the manoeuvre is used today for both elective and emergent cases in these disciplines. To reflect on its evolution, we evaluated the Pringle manoeuvre over a recent 10-year period (2010-2020). We found it is used less frequently owing to more frequent nonoperative management and more advanced elective hepatic resection techniques. Continuing educational collaboration is critical to ensure continued insight into the impact of hepatic vascular inflow occlusion among trainees who observe this procedure less frequently., Competing Interests: Competing interests: C.G. Ball is coeditor in chief of CJS. He was not involved in the review or decision to accept this manuscript for publication. No other competing interests declared., (© 2022 CMA Impact Inc. or its licensors.)
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- 2022
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8. Preoperative Single-dose Methylprednisolone Prevents Surgical Site Infections After Major Liver Resection: A Randomized Controlled Trial.
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Bressan AK, Isherwood S, Bathe OF, Dixon E, Sutherland FR, and Ball CG
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- Double-Blind Method, Female, Humans, Male, Middle Aged, Preoperative Period, Prospective Studies, Glucocorticoids administration & dosage, Hepatectomy methods, Methylprednisolone administration & dosage, Surgical Wound Infection prevention & control
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Objective: The primary aim of this study was to evaluate the efficacy of a single preoperative dose of methylprednisolone for preventing postoperative complications after major liver resections., Summary Background Data: Hepatic resections are associated with a significant acute systemic inflammatory response. This effect subsequently correlates with postoperative morbidity, mortality, and length of recovery. Multiple small trials have proposed that the administration of glucocorticoids may modulate this effect., Methods: This study was a parallel, dual-arm, double-blind randomized controlled trial. Adult patients undergoing elective major hepatic resection (≥3 segments) at a quaternary care institution were included (2013-2019). Patients were randomly assigned to receive a single preoperative 500 mg dose of methylprednisolone versus placebo. The main outcome measure was postoperative complications after liver resection, within 90 days of the index operation. Standard statistical methodology was employed (P < 0.05 = significant)., Results: A total of 151 patients who underwent a major hepatic resection were randomized (mean age = 62.8 years; 57% male; body-mass-index = 27.9). No significant differences were identified between the intervention and control groups (age, sex, body-mass-index, preoperative comorbidities, hepatic function, ASA class, portal vein embolization rate) (P > 0.05). Underlying hepatic diagnoses included colorectal liver metastases (69%), hepatocellular carcinoma (18%), noncolorectal liver metastases (7%), and intrahepatic cholangiocarcinoma (6%). There was a significant reduction in the overall incidence of postoperative complications in the methylprednisolone group (31.2% vs 47.3%; P = 0.042). Patients in the glucocorticoid group also displayed less frequent organ space surgical site infections (6.5% vs 17.6%; P = 0.036), as well as a shorter length of hospital stay (8.9 vs 12.5 days; P = 0.015). Postoperative serum bilirubin and prothrombin timeinternational normalized ratio (PT-INR) levels were also lower in the steroid group (P = 0.03 and 0.04, respectively). Multivariate analysis did not identify any additional significant modifying factor relationships (estimated blood loss, duration of surgery, hepatic vascular occlusion (rate or duration), portal vein embolization, drain use, etc) (P > 0.05)., Conclusions: A single preoperative dose of methylprednisolone significantly reduces the length of hospital stay, postoperative serum bilirubin, and PT-INR, as well as infectious and overall complications following major hepatectomy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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9. Response to the Comment on "Preoperative single-dose Methylprednisolone Prevents Surgical Infections After Major Liver Resection: A randomized controlled trial".
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Ball CG, Bressan AK, Isherwood S, Bathe OF, Dixon E, and Sutherland FR
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- Glucocorticoids, Humans, Liver, Hepatectomy adverse effects, Methylprednisolone therapeutic use
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Competing Interests: The authors report no conflicts of interest.
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- 2021
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10. The art and craft of biliary T-tube Use.
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Padmore G, Sutherland FR, and Ball CG
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- Common Bile Duct surgery, Equipment Design, Humans, Bile, Drainage instrumentation
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Introduction: Since the universal adoption of Hans Kehr's biliary T-tube in the early twentieth century, use has shifted from routine towards highly selective. Improved interventional endoscopy, percutaneous techniques, and hepato-pancreato-biliary (HPB) training have resulted in less T-tube experience within general surgery. The aim of this technical review is to discuss T-tube indications, technical nuances, and management., Methods: Peer-reviewed literature, combined with high volume HPB experience by the authors, was utilized to construct a 10-step conceptual pathway for safe T-tube usage., Results: Essential concepts surrounding T-tube use include: 1. Contemporary indications for T-tube insertion (disease-, patient-, and anatomy-based); 2. Correct instrument availability (open and laparoscopic); 3. T-tube selection and mechanical preparation; 4. Atraumatic T-tube insertion and security; 5. Immediate postoperative management and meticulous T-tube care; 6. Imaging biliary T-tubes; 7. Optimal timing of T-tube removal; 8. Technical aspects of T-tube removal; 9. Management of potential T-tube inpatient complications; and 10. Management of T-tube complications in the outpatient setting., Conclusions: Although their use has decreased substantially, the role of biliary T-tubes in some patients is essential. Given the reality of less frequent experience with T-tube insertion and management, this 10-step pathway will provide an adequate mental and technical framework for safe biliary T-tube use., Level of Evidence: Expert opinion, level V., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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11. Adverse Outcomes After Bile Spillage in Incidental Gallbladder Cancers: A Population-based Study.
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Horkoff MJ, Ahmed Z, Xu Y, Sutherland FR, Dixon E, Ball CG, and Bathe OF
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Neoplasm Seeding, Retrospective Studies, Treatment Outcome, Bile, Cholecystectomy, Gallbladder Neoplasms pathology, Incidental Findings, Postoperative Complications epidemiology
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Objective: To determine the effect of bile spillage during cholecystectomy on oncological outcomes in incidental gallbladder cancers., Background: Gallbladder cancer (GBC) is rare, but lethal. Achieving complete resection offers the best chance of survival. About 30% of GBCs are discovered incidentally after cholecystectomy for benign pathology. There is an anecdotal association between peritoneal dissemination and bile spillage during the index cholecystectomy. However, no population-based studies are available that measure the consequences of bile spillage on patient outcomes., Methods: We conducted a retrospective cohort comparison of patients with incidental GBC. All cholecystectomies and cases of GBC in Alberta, Canada, from 2001 to 2015, were identified. GBCs discovered incidentally were included. Operative events leading to bile spillage were reviewed. Patient outcomes were compared between cases of bile spillage versus no contamination., Results: In all, 115,484 cholecystectomies were performed, and a detailed analysis was possible in 82 incidental GBC cases. In 55 cases (67%), there was bile spillage during the index cholecystectomy. Peritoneal carcinomatosis occurred more frequently in those with bile spillage (24% vs 4%; P = 0.0287). Patients with bile spillage were less likely to undergo a radical re-resection (25% vs 56%; P = 0.0131) and were less likely to achieve an R0 resection margin [odds ratio 0.19, 95% confidence interval (CI) 0.06-0.55]. On Cox regression modeling, bile spillage was an independent predictor of shorter disease-free survival (hazard ratio 1.99, 95% CI 1.07-3.67)., Conclusion: For incidentally discovered GBC, bile spillage at the time of index cholecystectomy has measureable adverse consequences on patient outcomes. Early involvement of a hepatobiliary specialist is recommended where concerning features for GBC exist., Competing Interests: The authors have no conflicts of interest., (Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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12. Surgical Transgastric Necrosectomy for Necrotizing Pancreatitis: A Single-stage Procedure for Walled-off Pancreatic Necrosis.
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Driedger M, Zyromski NJ, Visser BC, Jester A, Sutherland FR, Nakeeb A, Dixon E, Dua MM, House MG, Worhunsky DJ, Munene G, and Ball CG
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- Drainage methods, Female, Follow-Up Studies, Humans, Laparoscopy methods, Male, Middle Aged, Pancreatitis, Acute Necrotizing diagnosis, Retrospective Studies, Treatment Outcome, Ultrasonography, Laparotomy methods, Pancreatectomy methods, Pancreatitis, Acute Necrotizing surgery, Stomach surgery
- Abstract
Objective: The aim of this study was to evaluate the role of surgical transgastric necrosectomy (TGN) for walled-off pancreatic necrosis (WON) in selected patients., Background: WON is a common consequence of severe pancreatitis and typically occurs 3 to 5 weeks after the onset of acute pancreatitis. When symptomatic, it can require intervention., Methods: A retrospective review of patients with WON undergoing surgical management at 3 high-volume pancreatic institutions was performed. Surgical indications, intervention timing, technical methodology, and patient outcomes were evaluated. Patients undergoing intervention <30 days were excluded. Differences across centers were evaluated using a P value of <0.05 as significant., Results: One hundred seventy-eight total patients were analyzed (mean WON diameter = 14 cm, 64% male, mean age = 51 years) across 3 centers. The majority required inpatient admission with a median preoperative length of hospital stay of 29 days (25% required preoperative critical care support). Most (96%) patients underwent a TGN. The median duration of time between the onset of pancreatitis symptoms and operative intervention was 60 days. Thirty-nine percent of the necrosum was infected. Postoperative morbidity and mortality were 38% and 2%, respectively. The median postoperative length of hospital length of stay was 8 days, with the majority of patients discharged home. The median length of follow-up was 21 months, with 91% of patients having complete clinical resolution of symptoms at a median of 6 weeks. Readmission to hospital and/or a repeat intervention was also not infrequent (20%)., Conclusion: Surgical TGN is an excellent 1-stage surgical option for symptomatic WON in a highly selected group of patients. Precise surgical technique and long-term outpatient follow-up are mandatory for optimal patient outcomes.
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- 2020
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13. Effect of proximity to specialty care on outcomes for biliary cancers: a population-based retrospective cohort study.
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Xu Y, Steckle S, Lui A, Dixon E, Ball CG, Sutherland FR, Spratlin J, and Bathe OF
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Background: The management of biliary cancers is complex and requires a multidisciplinary approach. Because it is unknown how access to specialty care affects resource use and survival in patients with biliary cancer, we conducted a population-based study to understand the needs of these patients and the relation of geography to care delivery and clinical outcomes for biliary cancer in Alberta., Methods: All patients with biliary cancer diagnosed in Alberta from Sept. 1, 2001, to Dec. 31, 2015 were included in this population-based retrospective cohort study. Data were extracted from administrative databases and the 2011 Canadian census. Driving time and types of medical services were tracked throughout the patients' clinical course. We categorized proximity to specialty care according to driving time to the nearest specialist. The primary outcome was overall survival. We conducted Cox proportional hazard regression to evaluate the effects of driving time on overall survival and multivariate logistic regression to evaluate the effect of driving time on treatment types and stage at diagnosis., Results: We identified 1610 patients with biliary cancer; they accounted for 117 381 medical encounters. Patients living 120 minutes or more from the nearest hepatobiliary surgeon and from the nearest cancer centre had significantly decreased survival (hazard ratio [and 95% confidence interval (CI)] 1.27 [1.17-1.37]) and 1.27 [1.14-1.41], respectively). Location of residence was not associated with advanced stage or probability of undergoing surgery or a biliary drainage procedure. Patients who lived 120 minutes or more from a cancer centre were less likely than those who lived less than 120 minutes away to receive chemotherapy (odds ratio 0.51, 95% CI 0.29-0.88). Subgroup analysis showed that the effect of travel time was especially pronounced among those who received only best supportive care and those who had biliary drains., Interpretation: Geography and accessibility to specialty care affected survival in patients with biliary cancer. Further study is required to understand how patients with biliary drains and those receiving best supportive care are affected by proximity to specialty care. This will aid in the identification of strategies to provide improved care for this subgroup who are particularly affected by geography., Competing Interests: Competing interests: None declared., (Copyright 2019, Joule Inc. or its licensors.)
- Published
- 2019
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14. Host phenotype is associated with reduced survival independent of tumour biology in patients with colorectal liver metastases.
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van Dijk DPJ, Krill M, Farshidfar F, Li T, Rensen SS, Olde Damink SWM, Dixon E, Sutherland FR, Ball CG, Mazurak VC, Baracos VE, and Bathe OF
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- Aged, Female, Humans, Inflammation diagnostic imaging, Inflammation pathology, Intra-Abdominal Fat diagnostic imaging, Male, Middle Aged, Muscle, Skeletal diagnostic imaging, Phenotype, Prognosis, Subcutaneous Fat diagnostic imaging, Survival Analysis, Tomography, X-Ray Computed, Body Composition, Colorectal Neoplasms diagnostic imaging, Colorectal Neoplasms mortality, Colorectal Neoplasms pathology, Liver Neoplasms diagnostic imaging, Liver Neoplasms mortality, Liver Neoplasms secondary, Liver Neoplasms surgery
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Background: Most prognostic scoring systems for colorectal liver metastases (CRLMs) account for factors related to tumour biology. Little is known about the effects of the host phenotype to the tumour. Our objective was to delineate the relationship of systemic inflammation and body composition features [i.e. low skeletal muscle mass (sarcopenia) and low visceral adipose tissue (VAT)], two well-described host phenotypes in cancer., Methods: Clinical data and pre-operative blood samples were collected from 99 patients who underwent resection of CRLM. Pre-operative computed tomography scans were available for 97 patients; body composition was analysed at the L3 level, stratified for sex and age. Clinicopathological variables, serum C-reactive protein (CRP), and various body composition variables were evaluated. Overall survival was evaluated as a function of these same variables in multivariate Cox regression analysis., Results: Skeletal muscle was significantly correlated with VAT (r = 0.46, P < 0.001). Of patients with sarcopenia, 35 (65%) also had low VAT. C-reactive protein was elevated (≥5 mg/mL) in 42 patients (43.3%). Elevated CRP was more common in patients with sarcopenia (73.8% vs. 51.1%, P = 0.029). The most significant prognostic factors were the coincidence of elevated CRP and adverse body composition features (sarcopenia and/or low VAT; hazard ratio 4.3, 95% confidence interval 1.5-13.0, P = 0.008), as well as Fong clinical prognostic score (hazard ratio 2.9, 95% confidence interval 1.5-5.5, P = 0.002)., Conclusions: Body composition in patients with CRLM is not directly linked to the presence of systemic inflammation. However, when systemic inflammation coincides with sarcopenia and/or low VAT, prognosis is adversely affected, independent of the Fong clinical prognostic score., (© 2018 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.)
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- 2019
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15. Acute kidney injury following resection of hepatocellular carcinoma: prognostic value of the acute kidney injury network criteria
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Bressan AK, James MT, Dixon E, Bathe OF, Sutherland FR, and Ball CG
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- Acute Kidney Injury urine, Aged, Female, Humans, Male, Middle Aged, Postoperative Complications urine, Predictive Value of Tests, Acute Kidney Injury diagnosis, Carcinoma, Hepatocellular surgery, Fibrosis surgery, Hepatectomy, Liver Neoplasms surgery, Postoperative Complications diagnosis, Practice Guidelines as Topic standards
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Background: Acute kidney injury (AKI) is associated with increased morbidity and mortality after liver resection. Patients with hepatocellular carcinoma (HCC) have a higher risk of AKI owing to the underlying association between hepatic and renal dysfunction. Use of the Acute Kidney Injury Network (AKIN) diagnostic criteria is recommended for patients with cirrhosis, but remains poorly studied following liver resection. We compared the prognostic value of the AKIN creatinine and urine output criteria in terms of postoperative outcomes following liver resection for HCC., Methods: All patients who underwent a liver resection for HCC from January 2010 to June 2016 were included. We used AKIN urine output and creatinine criteria to assess for AKI within 48 hours of surgery., Results: Eighty liver resections were performed during the study period. Cirrhosis was confirmed in 80%. Median hospital stay was 9 (interquartile range 7–12) days, and 30-day mortality was 2.5%. The incidence of AKI was higher based on the urine output than on the creatinine criterion (53.8% v. 20%), and was associated with prolonged hospitalization and 30-day postoperative mortality when defined by serum creatinine (hospital stay: 11.2 v. 20.1 d, p = 0.01; mortality: 12.5% v. 0%, p < 0.01), but not urine output (hospital stay: 15.6 v. 10 d, p = 0.05; mortality: 2.3% v. 2.7%, p > 0.99)., Conclusion: The urine output criterion resulted in an overestimation of AKI and compromised the prognostic value of AKIN criteria. Revision may be required to account for the exacerbated physiologic postoperative reduction in urine output in patients with HCC., Competing Interests: None declared.
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- 2018
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16. Efficacy of a Dual-ring Wound Protector for Prevention of Surgical Site Infections After Pancreaticoduodenectomy in Patients With Intrabiliary Stents: A Randomized Clinical Trial.
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Bressan AK, Aubin JM, Martel G, Dixon E, Bathe OF, Sutherland FR, Balaa F, Mimeault R, Edwards JP, Grondin SC, Isherwood S, Lillemoe KD, Saeed S, and Ball CG
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- Adolescent, Adult, Aged, Aged, 80 and over, Double-Blind Method, Female, Humans, Incidence, Intention to Treat Analysis, Male, Middle Aged, Multivariate Analysis, Pancreaticoduodenectomy methods, Prospective Studies, Risk Factors, Surgical Wound Infection epidemiology, Surgical Wound Infection etiology, Treatment Outcome, Young Adult, Pancreaticoduodenectomy instrumentation, Stents, Surgical Wound Infection prevention & control
- Abstract
Objective: To evaluate the efficacy of a dual-ring wound protector for preventing incisional surgical site infection (SSI) among patients with preoperative biliary stents undergoing pancreaticoduodenectomy (PD)., Methods and Analysis: This study was a parallel, dual-arm, double-blind randomized controlled trial. Adult patients with a biliary stent undergoing elective PD at 2 tertiary care institutions were included (February 2013 to May 2016). Patients were randomly assigned to receive a surgical dual-ring wound protector or no wound protector, and also the current standard of care. The main outcome measure was incisional SSI, as defined by the Centers for Disease Control and Prevention criteria, within 30 days of the index operation., Results: A total of 107 patients were recruited (mean age 67.2 years; standard deviation 12.9; 65% male). No significant differences were identified between the intervention and control groups (age, sex, body mass index, preoperative comorbidities, American Society of Anesthesiologists class, prestent cholangitis). There was a significant reduction in the incidence of incisional SSI in the wound protector group (21.1% vs 44.0%; relative risk reduction 52%; P = 0.010). Patients with completed PD also displayed a decrease in incisional SSI with use of the wound protector compared with those palliated surgically (27.3% vs 48.7%; P = 0.04). Multivariate analysis did not identify any significant modifying factor relationships (estimated blood loss, duration of surgery, hospital site, etc.) (P > 0.05)., Conclusion: Among adult patients with intrabiliary stents, the use of a dual-ring wound protector during PD significantly reduces the risk of incisional SSI.
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- 2018
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17. Sarcopenia and myosteatosis are accompanied by distinct biological profiles in patients with pancreatic and periampullary adenocarcinomas.
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Stretch C, Aubin JM, Mickiewicz B, Leugner D, Al-Manasra T, Tobola E, Salazar S, Sutherland FR, Ball CG, Dixon E, Vogel HJ, Damaraju S, Baracos VE, and Bathe OF
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- Adenocarcinoma genetics, Adenocarcinoma metabolism, Adenocarcinoma pathology, Aged, Body Composition, Duodenal Neoplasms genetics, Duodenal Neoplasms metabolism, Duodenal Neoplasms pathology, Female, Gene Expression Profiling, Humans, Male, Metabolomics, Middle Aged, Pancreatic Neoplasms genetics, Pancreatic Neoplasms metabolism, Pancreatic Neoplasms pathology, Adenocarcinoma complications, Adipose Tissue pathology, Ampulla of Vater, Duodenal Neoplasms complications, Muscles pathology, Pancreatic Neoplasms complications, Sarcopenia complications
- Abstract
Introduction: Pancreatic and periampullary adenocarcinomas are associated with abnormal body composition visible on CT scans, including low muscle mass (sarcopenia) and low muscle radiodensity due to fat infiltration in muscle (myosteatosis). The biological and clinical correlates to these features are poorly understood., Methods: Clinical characteristics and outcomes were studied in 123 patients who underwent pancreaticoduodenectomy for pancreatic or non-pancreatic periampullary adenocarcinoma and who had available preoperative CT scans. In a subgroup of patients with pancreatic cancer (n = 29), rectus abdominus muscle mRNA expression was determined by cDNA microarray and in another subgroup (n = 29) 1H-NMR spectroscopy and gas chromatography-mass spectrometry were used to characterize the serum metabolome., Results: Muscle mass and radiodensity were not significantly correlated. Distinct groups were identified: sarcopenia (40.7%), myosteatosis (25.2%), both (11.4%). Fat distribution differed in these groups; sarcopenia associated with lower subcutaneous adipose tissue (P<0.0001) and myosteatosis associated with greater visceral adipose tissue (P<0.0001). Sarcopenia, myosteatosis and their combined presence associated with shorter survival, Log Rank P = 0.005, P = 0.06, and P = 0.002, respectively. In muscle, transcriptomic analysis suggested increased inflammation and decreased growth in sarcopenia and disrupted oxidative phosphorylation and lipid accumulation in myosteatosis. In the circulating metabolome, metabolites consistent with muscle catabolism associated with sarcopenia. Metabolites consistent with disordered carbohydrate metabolism were identified in both sarcopenia and myosteatosis., Discussion: Muscle phenotypes differ clinically and biologically. Because these muscle phenotypes are linked to poor survival, it will be imperative to delineate their pathophysiologic mechanisms, including whether they are driven by variable tumor biology or host response.
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- 2018
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18. Distinguishing Benign from Malignant Pancreatic and Periampullary Lesions Using Combined Use of ¹H-NMR Spectroscopy and Gas Chromatography-Mass Spectrometry.
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McConnell YJ, Farshidfar F, Weljie AM, Kopciuk KA, Dixon E, Ball CG, Sutherland FR, Vogel HJ, and Bathe OF
- Abstract
Previous work demonstrated that serum metabolomics can distinguish pancreatic cancer from benign disease. However, in the clinic, non-pancreatic periampullary cancers are difficult to distinguish from pancreatic cancer. Therefore, to test the clinical utility of this technology, we determined whether any pancreatic and periampullary adenocarcinoma could be distinguished from benign masses and biliary strictures. Sera from 157 patients with malignant and benign pancreatic and periampullary lesions were analyzed using proton nuclear magnetic resonance (¹H-NMR) spectroscopy and gas chromatography-mass spectrometry (GC-MS). Multivariate projection modeling using SIMCA-P+ software in training datasets ( n = 80) was used to generate the best models to differentiate disease states. Models were validated in test datasets ( n = 77). The final ¹H-NMR spectroscopy and GC-MS metabolomic profiles consisted of 14 and 18 compounds, with AUROC values of 0.74 (SE 0.06) and 0.62 (SE 0.08), respectively. The combination of ¹H-NMR spectroscopy and GC-MS metabolites did not substantially improve this performance (AUROC 0.66, SE 0.08). In patients with adenocarcinoma, glutamate levels were consistently higher, while glutamine and alanine levels were consistently lower. Pancreatic and periampullary adenocarcinomas can be distinguished from benign lesions. To further enhance the discriminatory power of metabolomics in this setting, it will be important to identify the metabolomic changes that characterize each of the subclasses of this heterogeneous group of cancers.
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- 2017
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19. Effect of N-acetylcysteine on liver recovery after resection: A randomized clinical trial.
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Grendar J, Ouellet JF, McKay A, Sutherland FR, Bathe OF, Ball CG, and Dixon E
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- Aged, Delirium epidemiology, Female, Humans, Liver Failure epidemiology, Male, Middle Aged, Prospective Studies, Acetylcysteine pharmacology, Hepatectomy adverse effects, Postoperative Complications epidemiology
- Abstract
Background and Objectives: Liver failure following hepatic resection is a multifactorial complication. In experimental studies, infusion of N-acetylcysteine (NAC) can minimize hepatic parenchymal injury., Methods: Patients undergoing liver resection were randomized to postoperative care with or without NAC. No blinding was performed. Overall complication rate was the primary outcome; liver failure, length of stay, and mortality were secondary outcomes. Due to safety concerns, a premature multivariate analysis was performed and included within the model randomization to NAC, preoperative ASA, extent of resection, and intraoperative vascular occlusion as factors., Results: Two hundred and six patients were randomized (110 to conventional therapy; 96 to NAC). No significant differences were noted in overall complications (32.7% and 45.7%, P = 0.06) or hepatic failure (3.6% and 5.4%, P = 0.537) between treatment groups. There was significantly more delirium within the NAC group (2.7% and 9.8%, P < 0.05) that caused early trial termination. In multivariate analysis, only randomization to NAC (OR = 2.21, 95%CI = 1.16-4.19) and extensive resections (OR = 2.28, 95%CI = 1.22-4.29) were predictive of postoperative complications., Conclusions: Patients randomized to postoperative NAC received no benefit. There was a trend toward a higher rate of overall complications and a significantly higher rate of delirium in the NAC group. J. Surg. Oncol. 2016;114:446-450. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)
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- 2016
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20. The diagnostic pathway for solid pancreatic neoplasms: are we applying too many tests?
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Driedger MR, Dixon E, Mohamed R, Sutherland FR, Bathe OF, and Ball CG
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- Adenocarcinoma surgery, Adult, Aged, Aged, 80 and over, Alberta, Female, Humans, Male, Middle Aged, Pancreatic Neoplasms surgery, Retrospective Studies, Tomography, X-Ray Computed statistics & numerical data, Adenocarcinoma diagnosis, Delayed Diagnosis statistics & numerical data, Pancreatic Neoplasms diagnosis, Practice Patterns, Physicians' statistics & numerical data, Referral and Consultation statistics & numerical data, Unnecessary Procedures statistics & numerical data
- Abstract
Background: The single best diagnostic and staging test for pancreatic cancer remains a contrast-enhanced computed tomography scan. It is frequently the only imaging test required before surgical resection for solid pancreatic lesions. Unfortunately, many patients undergo additional testing that often delays definitive care., Materials and Methods: A retrospective review of all patients with solid pancreatic lesions concerning for adenocarcinoma referred to a high volume Hepato-Pancreato-Biliary (HPB) service over 4 y (2008-2012) was completed. The time intervals between the initial imaging test and both consultation with HPB surgery and operative intervention, as well as the number of additional tests, were evaluated. Standard statistical methodology was used (P < 0.05)., Results: Among 130 patients with solid pancreatic lesions, the index imaging modality was ultrasonography and computed tomography for 75 (58%) and 52 (40%), respectively. Patients underwent a mean of 1.3 diagnostic tests after the index study and before consultation with HPB surgery (range: 0-5). There was a significant increase in time to HPB consultation and operative intervention with an increasing number of interval imaging tests. The mean time to surgical consultation and operation if 0 interval diagnostic tests were performed was 15.9 and 45.4 d, respectively. If four interval tests were conducted, the mean was 69.4 and 122.6 d, respectively. Sixty-two patients (48%) were initially referred to a nonsurgical service. The mean time to surgical consultation and operation if an intervening referral occurred was 36.6 and 66.8 d, respectively. This compares to 19.8 and 48.1 d, respectively, in cases of direct referral to an HPB surgeon. The mean number of diagnostic tests performed before HPB consultation if a nonsurgical referral occurred was 2.1 (versus 0.7 if direct HPB surgeon referral)., Conclusions: Despite a relatively simple algorithm for the investigation of solid pancreatic lesions, considerable heterogeneity remains in how these patients are evaluated before referral to HPB surgery. As the number of investigations increases after the index imaging test, there is increasing delay to both surgical consultation and definitive intervention. Education is required to expedite care and mitigate excess diagnostic tests., (Copyright © 2015 Elsevier Inc. All rights reserved.)
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- 2015
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21. Preoperative single-dose methylprednisolone versus placebo after major liver resection in adults: protocol for a randomised controlled trial.
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Bressan AK, Roberts DJ, Bhatti SU, Dixon E, Sutherland FR, Bathe OF, and Ball CG
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- Adolescent, Adult, Dose-Response Relationship, Drug, Female, Glucocorticoids administration & dosage, Humans, Injections, Intravenous, Male, Treatment Outcome, Young Adult, Clinical Protocols, Hepatectomy adverse effects, Methylprednisolone administration & dosage, Postoperative Complications prevention & control, Preoperative Care methods
- Abstract
Introduction: Although randomised controlled trials have demonstrated that preoperative glucocorticoids may improve postoperative surrogate outcomes among patients undergoing major liver resection, evidence supporting improved patient-important outcomes is lacking. This superiority trial aims to evaluate the effect of administration of a bolus of the glucocorticoid methylprednisolone versus placebo during induction of anaesthesia on postoperative morbidity among adults undergoing elective major liver resection., Methods and Analysis: This will be a randomised, dual-arm, parallel-group, superiority trial. All consecutive adults presenting to a large Canadian tertiary care hospital who consent to undergo major liver resection will be included. Patients aged <18 years and those currently receiving systemic corticosteroid therapy will be excluded. We will randomly allocate participants to a preoperative 500 mg intravenous bolus of methylprednisolone versus placebo. Surgical team members and outcome assessors will be blinded to treatment allocation status. The primary outcome measure will be postoperative complications. Secondary outcome measures will include mortality, the incidence of several specific postoperative complications, and blood levels of select proinflammatory cytokines, acute-phase proteins, and laboratory liver enzymes or function tests on postoperative days 0, 1, 2 and 5. The incidence of postoperative complications and mortality will be compared using Fisher's exact test, while the above laboratory measures will be compared using mixed-effects models with a subject-specific random intercept., Ethics and Dissemination: This trial will evaluate the protective effect of a single preoperative dose of methylprednisolone on the hazard of postoperative complications. A report releasing study results will be submitted for publication in an appropriate journal, approximately 3 months after finishing the data collection., Trial Registration Number: NCT01997658; Pre-results., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
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- 2015
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22. In search of the best reconstructive technique after pancreaticoduodenectomy: pancreaticojejunostomy versus pancreaticogastrostomy.
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Grendar J, Ouellet JF, Sutherland FR, Bathe OF, Ball CG, and Dixon E
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- Adolescent, Adult, Aged, Aged, 80 and over, Anastomosis, Surgical, Female, Humans, Intention to Treat Analysis, Logistic Models, Male, Middle Aged, Multivariate Analysis, Pancreatic Fistula epidemiology, Pancreatic Fistula etiology, Postoperative Complications epidemiology, Treatment Outcome, Young Adult, Pancreas surgery, Pancreatic Fistula prevention & control, Pancreaticoduodenectomy, Pancreaticojejunostomy, Postoperative Complications prevention & control, Stomach surgery
- Abstract
Background: It has been suggested that pancreaticogastrostomy (PG) is a safer reconstruction than pancreaticojejunostomy (PJ), resulting in lower morbidity, including lower pancreatic leak rates and decreased postoperative mortality. We compared PJ and PG after pancreaticoduodenectomy (PD)., Methods: A randomized clinical trial was designed. It was stopped with 50% accrual. Patients underwent either PG or PJ reconstruction. The primary outcome was the pancreatic fistula rate, and the secondary outcomes were overall morbidity and mortality. We used the Student t, Mann-Whitney U and χ(2) tests for intention to treat analysis. The effect of randomization, American Society of Anesthesiologists score, soft pancreatic texture and use of pancreatic stent on overall complications and fistula rates was calculated using logistic regression., Results: Our trial included 98 patients. The rate of pancreatic fistula formation was 18% in the PJ and 25% in the PG groups (p = 0.40). Postoperative complications occurred in 48% of patients in the PJ and 58% in the PG groups (p = 0.31). There were no significant predictors of overall complications in the multivariate analysis. Only soft pancreatic gland predicted the occurrence of pancreatic fistula (odds ratio 5.89, p = 0.003)., Conclusion: There was no difference in the rates of pancreatic leak/fistula, overall complications or mortality between patients undergoing PG and and those undergoing PJ after PD.
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- 2015
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23. Efficacy of a dual-ring wound protector for prevention of incisional surgical site infection after Whipple's procedure (pancreaticoduodenectomy) with preoperatively-placed intrabiliary stents: protocol for a randomised controlled trial.
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Bressan AK, Roberts DJ, Edwards JP, Bhatti SU, Dixon E, Sutherland FR, Bathe O, and Ball CG
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- Humans, Pancreaticoduodenectomy instrumentation, Pancreatic Neoplasms surgery, Pancreaticoduodenectomy methods, Preoperative Care, Stents, Surgical Instruments, Surgical Wound Infection prevention & control
- Abstract
Introduction: Among surgical oncology patients, incisional surgical site infection is associated with substantially increased morbidity, mortality and healthcare costs. Moreover, while adults undergoing pancreaticoduodenectomy with preoperative placement of an intrabiliary stent have a high risk of this type of infection, and wound protectors may significantly reduce its risk, no relevant studies of wound protectors yet exist involving this patient population. This study will evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among adults undergoing pancreaticoduodenectomy with preoperatively-placed intrabiliary stents., Methods and Analysis: This study will be a parallel, dual-arm, randomised controlled trial that will utilise a more explanatory than pragmatic attitude. All adults (≥18 years) undergoing a pancreaticoduodenectomy at the Foothills Medical Centre in Calgary, Alberta, Canada with preoperative placement of an intrabiliary stent will be considered eligible. Exclusion criteria will include patient age <18 years and those receiving long-term glucocorticoids. The trial will employ block randomisation to allocate patients to a commercial dual-ring wound protector (the Alexis Wound Protector) or no wound protector and the current standard of care. The main outcome measure will be the rate of surgical site infection as defined by the Centers for Disease Control and Prevention criteria within 30 days of the index operation date as determined by a research assistant blinded to treatment allocation. Outcomes will be analysed by a statistician blinded to allocation status by calculating risk ratios and 95% CIs and compared using Fisher's exact test., Ethics and Dissemination: This will be the first randomised trial to evaluate the efficacy of a dual-ring wound protector for prevention of incisional surgical site infection among patients undergoing pancreaticoduodenectomy. Results of this study are expected to be available in 2016/2017 and will be disseminated using an integrated and end-of-grant knowledge translation strategy., Trial Registration Number: ClinicalTrials.gov identifier NCT01836237., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)
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- 2014
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24. Identification of prognostic inflammatory factors in colorectal liver metastases.
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Hamilton TD, Leugner D, Kopciuk K, Dixon E, Sutherland FR, and Bathe OF
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- Adult, Aged, Aged, 80 and over, C-Reactive Protein metabolism, Colorectal Neoplasms pathology, Female, Humans, Liver Neoplasms pathology, Liver Neoplasms secondary, Male, Middle Aged, Prognosis, Survival Analysis, Colorectal Neoplasms immunology, Inflammation Mediators blood, Liver Neoplasms immunology
- Abstract
Background: The modified Glasgow Prognostic Score (mGPS) has been reported to be an important prognostic indicator in a number of tumor types, including colorectal cancer (CRC). The features of the inflammatory state thought to accompany elevated C-reactive protein (CRP), a key feature of mGPS, were characterized in patients with colorectal liver metastases. Additional inflammatory mediators that contribute to prognosis were explored., Methods: In sera from 69 patients with colorectal liver metastases, a panel of 42 inflammatory mediators were quantified as a function of CRP levels, and as a function of disease-free survival. Multivariate statistical methods were used to determine association of each mediator with elevated CRP and truncated disease-free survival., Results: Elevated CRP was confirmed to be a strong predictor of survival (HR 4.00, p = 0.001) and recurrence (HR 3.30, p = 0.002). The inflammatory state associated with elevated CRP was comprised of raised IL-1β, IL-6, IL-12 and IL-15. In addition, elevated IL-8 and PDGF-AB/BB and decreased eotaxin and IP-10 were associated with worse disease-free and overall survival., Conclusions: Elevated CRP is associated with a proinflammatory state. The inflammatory state is an important prognostic indicator in CRC liver metastases. The individual contributions of tumor biology and the host to this inflammatory response will require further investigation.
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- 2014
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25. Does regional variation impact decision-making in the management and palliation of pancreatic head adenocarcinoma? Results from an international survey.
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Hurdle V, Ouellet JF, Dixon E, Howard TJ, Lillemoe KD, Vollmer CM, Sutherland FR, and Ball CG
- Subjects
- Africa, Canada, Cultural Characteristics, Europe, Health Care Surveys, Humans, Medical Futility legislation & jurisprudence, Pancreaticoduodenectomy, Postoperative Care methods, Practice Guidelines as Topic, Preoperative Care methods, Qualitative Research, Religion and Medicine, United States, Adenocarcinoma therapy, Attitude of Health Personnel, Decision Making, Palliative Care, Pancreatic Neoplasms therapy, Practice Patterns, Physicians' statistics & numerical data, Terminal Care
- Abstract
Background: Management and palliation of pancreatic head adenocarcinoma is challenging. End-of-life decision-making is a variable process involving multiple factors., Methods: We conducted a qualitative, physician-based, 40-question international survey characterizing the impact of medical, religious, social, training and system factors on care., Results: A total of 258 international clinicians completed the survey. Respondents were typically fellowship-trained (78%), with a mean of 16 years' experience in a university-affiliated (93%) hepato-pancreato-biliary group (96%) practice. Most (91%) believed resection is potentially curative. Most patients were discussed preoperatively by multidisciplinary teams (94%) and medical assessment clinics (68%), but rarely critical care (21%). Intraoperative surgical palliation included double bypass or no intervention for locally advanced nonresectable tumours (41% and 49% v. 14% and 85%, respectively, for patients with hepatic metastases). Postoperative admission to the intensive care unit was frequent (58%). Severe postoperative complications were often treated with aggressive cardiopulmonary resuscitation, intubation and critical care (96%), with no defined time points for futility (74%). Admitting surgeons guided most end-of-life decisions (97%). Formal medical futility laws were rarely available (26%). Insurance status did not alter treatment (97%) or palliation (95%) in non-universal care regions. Clinician experience, regional culture and training background impacted treatment (all p < 0.05)., Conclusion: Despite remarkable overall agreement, geographic and training differences are evident in the treatment and palliation of pancreatic head adenocarcinoma.
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- 2014
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26. The impact of an acute care surgery clinical care pathway for suspected appendicitis on the use of CT in the emergency department.
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Ball CG, Dixon E, MacLean AR, Kaplan GG, Nicholson L, and Sutherland FR
- Subjects
- Acute Disease, Adult, Alberta, Appendectomy, Appendicitis surgery, Emergency Service, Hospital statistics & numerical data, Follow-Up Studies, Humans, Outcome and Process Assessment, Health Care, Time Factors, Tomography, X-Ray Computed standards, Triage, Appendicitis diagnostic imaging, Critical Pathways, Emergency Service, Hospital standards, Quality Improvement statistics & numerical data, Tomography, X-Ray Computed statistics & numerical data
- Abstract
Background: The natural evolution of an acute care surgery (ACS) service is to develop disease-specific care pathways aimed at quality improvement. Our primary goal was to evaluate the implementation of an ACS pathway dedicated to suspected appendicitis on patient flow and the use of computed tomography (CT) in the emergency department (ED)., Methods: All adults within a large health care system (3 hospitals) with suspected appendicitis were analyzed during our study period, which included 3 time periods: pre- and postimplementation of the disease-specific pathway and at 12-month follow-up., Results: Of the 1168 consultations for appendicitis that took place during our study period, 349 occurred preimplementation, 392 occurred postimplementation, and 427 were follow-up visits. In all, 877 (75%) patients were admitted to the ACS service. Overall, 83% of patients underwent surgery within 6 hours. The mean wait time from CT request to obtaining the CT scan decreased with pathway implementation at all sites (197 v. 143 min, p < 0.001). This improvement was sustained at 12-month followup (131 min, p < 0.001). The pathway increased the number of CTs completed in under 2 hours from 3% to 42% (p < 0.001). No decrease in the total number of CTs or the pattern of ultrasonography was noted (p = 0.42). Wait times from ED triage to surgery were shortened (665 min preimplementation, 633 min postimplementation, 631 min at the 12-month follow-up, p = 0.040)., Conclusion: A clinical care pathway dedicated to suspected appendicitis can decrease times to both CT scan and surgical intervention.
- Published
- 2014
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27. Severe street and mountain bicycling injuries in adults: a comparison of the incidence, risk factors and injury patterns over 14 years.
- Author
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Roberts DJ, Ouellet JF, Sutherland FR, Kirkpatrick AW, Lall RN, and Ball CG
- Subjects
- Accidents, Traffic statistics & numerical data, Adolescent, Adult, Alberta epidemiology, Child, Child, Preschool, Critical Care, Female, Hospitalization statistics & numerical data, Humans, Incidence, Infant, Injury Severity Score, Male, Middle Aged, Retrospective Studies, Risk Factors, Trauma Centers, Wounds and Injuries diagnosis, Wounds and Injuries therapy, Young Adult, Bicycling injuries, Wounds and Injuries epidemiology
- Abstract
Background: Street and mountain bicycling are popular recreational activities and prevalent modes of transportation with the potential for severe injury. The purpose of this investigation was to compare the incidence, risk factors and injury patterns among adults with severe street versus mountain bicycling injuries., Methods: We conducted a retrospective cohort study using the Southern Alberta Trauma Database of all adults who were severely injured (injury severity score [ISS] ≥ 12) while street or mountain bicycling between Apr. 1, 1995, and Mar. 31, 2009., Results: Among 11 772 severely injured patients, 258 (2.2%) were injured (mean ISS 17, hospital stay 6 d, mortality 7%) while street (n = 209) or mountain bicycling (n = 49). Street cyclists were often injured after being struck by a motor vehicle, whereas mountain bikers were frequently injured after faulty jump attempts, bike tricks and falls (cliffs, roadsides, embankments). Mountain cyclists were admitted more often on weekends than weekdays (61.2% v. 45.0%, p = 0.040). Injury patterns were similar for both cohorts (all p > 0.05), with trauma to the head (67.4%), extremities (38.4%), chest (34.1%), face (26.0%) and abdomen (10.1%) being common. Spinal injuries, however, were more frequent among mountain cyclists (65.3% v. 41.1%, p = 0.003). Surgical intervention was required in 33.3% of patients (9.7% open reduction internal fixation, 7.8% spinal fixation, 7.0% craniotomy, 5.8% facial repair and 2.7% laparotomy)., Conclusion: With the exception of spine injuries, severely injured cyclists display similar patterns of injury and comparable outcomes, regardless of style (street v. mountain). Helmets and thoracic protection should be advocated for injury prevention.
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- 2013
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28. The effect of wait times on oncological outcomes from periampullary adenocarcinomas.
- Author
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McLean SR, Karsanji D, Wilson J, Dixon E, Sutherland FR, Pasieka J, Ball C, and Bathe OF
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma pathology, Adult, Aged, Canada, Common Bile Duct Neoplasms mortality, Common Bile Duct Neoplasms pathology, Female, Humans, Male, Middle Aged, Neoplasm Staging, Pancreatic Neoplasms mortality, Pancreatic Neoplasms pathology, Retrospective Studies, Survival Analysis, Time Factors, Treatment Outcome, Adenocarcinoma surgery, Ampulla of Vater pathology, Ampulla of Vater surgery, Common Bile Duct Neoplasms surgery, Pancreatectomy, Pancreatic Neoplasms surgery, Waiting Lists
- Abstract
Background: Overall few patients presenting with periampullary adenocarcinomas have resectable lesions. We postulated that rapid diagnosis and treatment would enhance the likelihood of successful resection, improving survival., Methods: A retrospective analysis of patients undergoing surgery for resection of a pancreatic or periampullary lesion was conducted. Resection rate, disease stage and survival were evaluated as a function of wait times., Results: Pancreatic resections were booked in 355 patients. Of 193 patients with periampullary adenocarcinomas, 119 patients (61.7%) had resectable disease. There was no difference in median time from initial physician consultation to surgery in patients with resectable and unresectable disease (61 days vs. 64 days, respectively). The likelihood of successful resection was virtually identical in patients with wait times ≤ 30 and > 30 days (from surgical consultation to procedure). There was a trend toward a higher T-stage in patients who waited >30 days for surgery (P = 0.055). However, there was no difference in survival as a function of wait time., Conclusions: This series does not demonstrate an advantage for rapid diagnosis and surgery, in terms of resection rate and survival. However, further study is required in a larger cohort of patients, to confirm these findings., (Copyright © 2013 Wiley Periodicals, Inc.)
- Published
- 2013
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29. Canadian Surgery Forum.
- Author
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Fayez R, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, AlMuntashery A, Fayez R, Demyttenaere S, Christou N, Court O, Bodie G, Bonrath E, Hagen J, Okrainec A, Sullivan P, Grantcharov T, Almamar A, Sharma A, Karmali S, Birch DW, Gill RS, Majumdar SR, Wang X, Tuepah R, Klarenbach SW, Birch DW, Karmali S, Sharma AM, Padwal RJ, Raîche I, Smith C, Haggar F, Moloo H, Poulin EC, Martel G, Yelle JD, Mamazza J, Mueller CL, Jackson TD, Penner T, Pitzul K, Urbach DR, Okrainec A, AlMuntashery A, Villeneuve S, Roy M, Fayez R, Demyttenaere S, Christou N, Court O, Fayez R, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, AlMuntashery A, Fayez R, Demyttenaere S, Court O, Christou N, Moustarah F, Biertho L, Hould FS, Lebel S, Lescelleur O, Marceau S, Marceau P, Biron S, Khokhotva M, Grantcharov T, Anvari M, Sharma A, Yusuf S, Kwong J, Okrainec A, Pitzul KB, Urbach DR, Jackson T, Elkassem S, Lindsay D, Sullivan P, Smith L, Bonrath E, Zevin B, Dedy N, Grantcharov TP, Zevin B, Bonrath EM, Aggarwal R, Grantcharov T, Sockalingam S, Cassin S, Crawford S, Pitzul K, Khan A, Hawa R, Jackson T, Okrainec A, Smith C, Brar B, Mamazza J, Raîche I, Yelle JD, Haggar F, Moloo H, Smith C, Brar B, Haggar F, Dent R, Mamazza J, Raîche I, Moloo H, Whitlock KA, Gill RS, Ali T, Shi X, Birch DW, Karmali S, Gill RS, Whitlock KA, Shi X, Sarkhosh K, Birch DW, Karmali S, Suri M, Turner JM, Nation PN, Wizzard P, Brubaker PL, Gisalet DL, Wales PW, Palter VN, Grantcharov TP, Wakeam E, Tien H, Spencer F, Brenneman F, Khan RSA, Kowal J, Wiseman SM, Martelli V, Fraser SA, Vedel I, Deban M, Holcroft C, Monette M, Monette J, Bergman S, Malik A, Bell C, Stukel T, Urbach DR, Young PY, Mueller TF, Lucykx VA, Lukowski CM, Compston CA, Churchill TA, Khadaroo RG, Daigle C, Grantcharov T, McCreery G, Vogt K, Dubois L, Gray D, Seth R, Ananth A, Tai LH, Lam T, Falls T, Souza C, Bell J, Auer R, Paskar D, Crawford S, Parry N, Leslie K, Sudarshan M, Alhabboubi M, St-Louis E, Deckelbaum D, Razek T, Feldman LS, Khwaja K, Richardson D, Porter G, Johnson P, Haggar F, Boushey R, Moloo H, Raiche I, Mamazza J, Davis VW, Schiller DE, Eurich D, Sawyer MB, Rivard J, Vergis A, Unger B, Hardy K, Andrew C, Gillman L, Park J, Agzarian J, Prodger J, Kelly W, Kelly S, Prodger D, Racz J, Ewara E, Martin J, Sarma S, Chu M, Schlachta C, Zaric G, Winocour J, Al-Ali K, Briggs K, George R, Zilbert NR, Murnaghan ML, Leung A, Regehr G, Moulton CA, Decker C, Neumann K, Mahmud S, Metcalfe J, McKay A, Park J, Hochman D, Gosney JE Jr, Burkle FM Jr, Redmond AD, McQueen K, Wissanji H, Desrosiers E, Gilbert A, Chadi SA, Leslie K, Ott MC, Alhabboubi M, Sudarshan M, Jessula S, Alburakan A, Deckelbaum D, Razek T, Iqbal S, Khwaja K, Partridge E, Aikins C, Alhabboubi M, Sudarshan M, Deckelbaum D, Iqbal S, Khwaja K, Razek T, Olszewski M, Roberts N, Moulton CA, Murnaghan ML, Cil T, Chan R, Marshall J, Pederson K, Erichsen S, White J, Nadler A, Aarts MA, Okrainec A, Victor JC, Pearsall E, McLeod RS, Hameed U, Jackson TD, Okrainec A, Penner TP, Urbach DR, Brotherhood H, Karimuddin A, Hall C, Bawan S, Malik S, Hayashi A, Menezes AS, Gill RS, McAlister C, Zhang N, DesRosiers E, Mills A, Crozier M, Lee L, Maxwell J, Partridge E, Chad S, Steigerwald S, Mapiour D, Roberts D, MacPherson C, Donahoe L, MacDonald B, Mercer D, Hopman W, Rakovich G, Latulippe JF, Hilsden R, Knowles S, Moffat B, Parry N, Leslie K, Merani S, Switzer N, Khadaroo RG, Tul Y, Widder S, Davis P, Molinari M, Levy A, Johnson P, Davis PJB, Bailey J, Molinari M, Hayden J, Johnson P, Cools-Lartigue J, Benlolo S, Marcus V, Ferri L, Ojah J, Finley R, Anderson D, Julien F, Gagné JP, Carter D, Chan S, Wong S, Li J, Michael A, Choi D, Liu E, Hoogenes J, Dath D, Pitt D, Aubin JM, Banks BA, Mew D, McConnell Y, Rudovics A, Classen D, Kanthan S, Ravichandran P, Croome KP, Kovacs MJ, Lazo-Langner A, Hernandez-Alejandro R, Anantha R, Vogt K, Crawford S, Parry N, Leslie K, Aad I, Kholdebarin R, Khoshgoo N, Iwasiow BM, Keijzer R, Aird LNF, Brown CJ, Wong SL, Isa D, Pace D, Payne JRM, Widder S, Tul Y, Primrose M, Hudson D, Khadaroo RG, Hallet J, Lauzier F, Mailloux O, Trottier V, ARchambault P, Zarychanski R, Turgeon AF, Mailloux O, Farries L, Hardy P, Muirhead RM, Raiche I, Masters J, Haggar F, Poulin HMEC, Martel G, Mamazza J, Botkin C, Milbrandt C, Keijzer R, Morency D, Sideris L, Grenier-Vallée P, Latulippe JF, Dubé P, Berger-Richardson D, Kurashima Y, Kaneva P, Feldman LS, Fried GM, Vassiliou MC, Isa AD, Kwan AH, Dupuis I, Fraser SA, Schweigert M, Solymosi N, Rauh N, Dubecz A, Renz M, Ofner D, Stein HJ, Koubi S, Borgaonkar M, Ernjakovic M, Crystal P, Easson A, Escallon J, Reedijk M, Cil T, Leong WL, McCready DR, Grant K, Clifton J, Mayo J, Finley R, Cools-Lartigue J, Noreau-Nguyen M, Mulder DS, Ferri LE, Carrott P, Markar S, Hong J, Low DE, Stafford T, Maslow A, Davignon K, Ng T, Malthaner R, Tan L, Aruranian J, Kosa S, Sudarshan M, Ferri LE, Hanna WC, Murphy G, Allison F, Moshonov H, Darling GE, Waddell TK, De Perrot M, Cypel M, Yasufuku K, Keshavjee S, Paul NS, Pierre AF, Lee L, Darling G, Pedneault C, Marcus V, Mulder DS, Ferri LE, Markar S, Low D, Razzak R, Roa W, Löbenberg R, McEwan S, Bédard EL, Bharadwaj SC, Louie BE, Farivar AS, McHugh SP, Aye RW, Ashrafi AS, Tan-Tam C, De Vera M, Bond RJ, Ong SR, Johal B, Schellenberg D, Po M, Nissar S, Lund C, Ahmadi SY, Ouellette D, Wakil N, Rakovich G, Beauchamps G, Markar S, Preston S, Baker C, Low D, Bottoni DA, Campbell G, Malthaner RA, Knickle C, Bethune D, Henteleff H, Johnston M, Buduhan G, Coughlin S, Coughlin HE, Roth L, Bhandari M, Malthaner R, Gazala S, Johnson J, Kutsogiannis J, Bédard E, Gazala S, Rammohan K, Stewart K, Bédard E, Donahoe L, Buduhan G, Walker K, Gruchy J, Xu Z, Buduhan G, Li C, Ferri LE, Mulder DS, Ncuti A, Neville A, Kaneva P, Watson D, Vassiliou M, Carli F, Feldman LS, Alnasser S, Av R, Mayrand S, Franco E, Ferri LE, Schweigert M, Dubecz A, Renz M, Stadlhuber RJ, Ofner D, Stein HJ, Schweigert M, Renz M, Dubecz A, Solymosi N, Thumfart L, Ofner D, Stein HJ, Zhuruk A, Croome K, Leeper R, Hernandez R, Hanouf A, Livingstone S, Sapp J, Woodhall D, Alwayn I, Vanounou T, Bergman S, Karanicolas P, Lam-McCulloch J, Balaa F, Jayaraman S, Quan D, Wei A, Guyatt G, Aubin JM, Rekman JF, Fairfull-Smith RJ, Mimeault R, Balaa FK, Martel G, Yeung JC, Boehnert MS, Bazerbachi F, Knaak JM, Selzner N, McGilvray ID, Rotstein OD, Adeyi OA, Levy GA, Keshavjee S, Grant DR, Selzner M, Dumitra S, Khalil JA, Jamal M, Chaudhury P, Zogopoulos G, Petrakos P, Tchervenkov J, Barkun J, Simoneau E, Jamal MH, Hassanain M, Chaudhury P, Wong S, Salman A, Tran T, Metrakos P, Vanounou TT, Groeschl RT, Geller DA, Marsh JW, Gamblin TC, Howe B, Croome K, Hawel J, Croome K, Quan D, Hernandez R, Jang JH, Kim PTW, Greig PD, Gallinger S, Moulton CA, Wei AC, Fischer SE, Cleary SP, Bertens K, Vogt KN, Hernandez-Alejandro R, Gray DK, Rekman JF, Aubin JM, Fairfull-Smith JJ, Mimeault R, Balaa FK, Martel G, Wei AC, Devitt KS, Ramjaun A, Gallingher S, Dumitra S, Alabbad S, Constantinos D, Hassanein M, Barkun J, Metrakos P, Paraskevas S, Chaudhury P, Tchervenkov J, Koubi S, Borgaonkar M, Ouellet JF, Tanyingoh D, Dixon E, Kaplan GG, Myers RP, Howard TJ, Sutherland FR, Zyromski NJ, Ball CG, Wei AC, Coburn N, Moulton CA, Cleary SP, Law CH, Greig P, Steven G, Covelli A, Baxter N, Fitch M, Wright F, Maniar R, Hochman DJ, Wirtzfeld DA, McKay A, Yaffe CS, Yip B, Silverman R, Park J, Sun S, McConnell YJ, Temple WJ, Mack LA, Davis VW, Schiller DE, Bathe OF, Sawyer MB, Brackstone M, Scott L, Vandenberg T, Perera F, Potvin K, Chambers A, Boissonneault R, Loungnarath R, DeBroux É, Lavertu S, Donath D, Ayoub JP, Tehfé M, Richard C, Kim SHH, Cornacchi SD, Heller B, Farrokhyar F, Babra M, Lovrics PJ, Baliski C, Liberto C, Gazala S, Ghosh S, McLean R, Schiller D, Hameed U, Jackson TD, Okrainec A, Penner TP, Urbach DR, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Arnaout A, Seely J, Smylie J, Knight K, Robertson S, Watters J, Wedman D, Zhang T, Arneout A, Nostedt M, Hochman D, Wirtzfeld D, McKay A, Yip B, Yaffe CS, Silverman R, Park J, Hebbard P, Baxter N, Yun L, Rakovitch E, Wright F, Warner E, McCready D, Hodgson N, Quan ML, Shetty SJ, Natarajan B, Govindarajan V, Thomas P, Loggie BW, Dixon M, Brar S, Mahar A, Law C, Coburn N, Wei AC, Devitt KS, Wiebe M, Bathe OF, McLeod RS, Baxter NN, Gagliardi AR, Kennedy ED, Urbach DR, Dixon M, Brar S, Mahar A, Law C, Coburn N, Kazazian K, Zih F, Rosario C, Dennis J, Gingras AC, Swallow C, Lemke M, Ko YJ, Rowsell C, Law CHL, Wells B, Saskin R, Quan ML, Musselman RP, Xie M, McLaughlin K, Marginean C, Moyana TN, Moloo H, Boushey RP, Auer RC, Zih FSW, Razik R, Haase E, Mathieson A, Smith AJ, Swallow CJ, Menezes AS, Barnes A, Scheer AS, Moloo H, Boushey RP, Sabri E, Auer RAC, Nassif M, Reidel K, Trabulsi N, Meterissian S, Tamblyn R, Mayo N, Meguerditchian AN, Leon-Carlyle M, Brown JA, Hamm J, Phang PT, Raval MJ, Brown CJ, Wei AC, Devitt KS, Wiebe M, Bathe OF, McLeod RS, Taylor B, Urbach DR, Krotneva S, Reidel K, Mayo N, Tamblyn R, Meguerditchian A, Bradley NL, Hamm JD, Wiseman SM, Trabulsi N, Patakfalvi L, Nassif M, Turcotte R, Nichols A, Meguerditchian A, Trabulsi N, Riedel KE, Winslade NE, Grégoire JP, Meterissian S, Abrahamovicz M, Megueerditchian A, Chin-Lenn L, Pasieka J, Cheng H, McMillan C, Lipa J, Snell L, Petrucci AM, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Meterissian S, Sandhu L, Tomlinson G, Kennedy ED, Wei A, Baxter NN, Urbach DR, Neville A, Liberman AS, Charlebois P, Stein B, Ncuti A, Vassiliou MC, Fried GM, Feldman LS, Lee L, Capretti G, Power A, Liberman AS, Charlebois P, Stein B, Kaneva P, Carli F, Fried GM, Feldman LS, Li C, Carli F, Charlebois P, Stein B, Liberman AS, Kaneva P, Augustin B, Gamsa A, Kim DJ, Vassiliou M, Feldman L, Yang I, Boushey R, Moloo H, Prabhu KL, Vu L, Chan S, Phang PT, Gown A, Jones S, Wiseman S, Melich G, Jeong DH, Hur H, Baik SH, Kim NK, Faria J, Min BS, Knowles S, Lumb K, Colquhoun P, Richardson D, Porter G, Johnson P, Borowiec AM, Baxter NN, Schmocker S, Huang H, Victor JC, Krzyzanowska MK, Brierley J, McLeod RS, Kennedy ED, Hallet J, Milot H, Desrosiers E, Lebrun A, Drolet S, Bouchard A, Grégoire RC, Boissonneault R, Vuong T, Loungnarath R, DeBroux E, Liberman AS, Charlebois P, Stein B, Richard C, Kolozsvari NO, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou MC, Fried GM, Feldman LS, Hallet J, Milot H, Drolet S, Bouchard A, Grégoire RC, Tuttle P, Powell R, Fowler A, Mathieson A, VanHouwelingen L, Martin K, Vogt K, Ott MC, Haggar F, Pereira G, Einarsdottir K, Moloo H, Boushey R, Mamazza J, Boulanger-Gobeil C, Bouchard A, Gagné JP, Grégoire RC, Thibault C, Bouchard P, Chan BP, Gomes T, Musselman RP, Auer RC, Moloo H, Mamdani M, Al-Omran M, Boushey RP, AlObeed O, Chan BP, Armstrong JBP, Fergusson DA, Forster AJ, Boushey RP, Richardson D, Porter G, Johnson P, Musselman RP, Gomes T, Chan BP, Auer RC, Moloo H, Mamdani M, Al-Omran M, Al-Obaid O, Boushey RP, Melich G, Lim DR, Min BS, Baik SH, Gordon PH, Kim NK, Phang PT, Lo A, Pinsk I, Brown C, Raval M, Goldstein LJ, Cheng H, Wen C, Wong C, Johnston N, Farrokhyar F, Stephen W, Kelly S, Lindsay L, Forbes S, Lebrun A, Bouchard A, Chadi SA, Parry NG, Leslie K, and Ott MC
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- 2012
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30. Serum metabolomic profile as a means to distinguish stage of colorectal cancer.
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Farshidfar F, Weljie AM, Kopciuk K, Buie WD, Maclean A, Dixon E, Sutherland FR, Molckovsky A, Vogel HJ, and Bathe OF
- Abstract
Background: Presently, colorectal cancer (CRC) is staged preoperatively by radiographic tests, and postoperatively by pathological evaluation of available surgical specimens. However, present staging methods do not accurately identify occult metastases. This has a direct effect on clinical management. Early identification of metastases isolated to the liver may enable surgical resection, whereas more disseminated disease may be best treated with palliative chemotherapy., Methods: Sera from 103 patients with colorectal adenocarcinoma treated at the same tertiary cancer center were analyzed by proton nuclear magnetic resonance (1H NMR) spectroscopy and gas chromatography-mass spectroscopy (GC-MS). Metabolic profiling was done using both supervised pattern recognition and orthogonal partial least squares-discriminant analysis (O-PLS-DA) of the most significant metabolites, which enables comparison of the whole sample spectrum between groups. The metabolomic profiles generated from each platform were compared between the following groups: locoregional CRC (N = 42); liver-only metastases (N = 45); and extrahepatic metastases (N = 25)., Results: The serum metabolomic profile associated with locoregional CRC was distinct from that associated with liver-only metastases, based on 1H NMR spectroscopy (P = 5.10 × 10-7) and GC-MS (P = 1.79 × 10-7). Similarly, the serum metabolomic profile differed significantly between patients with liver-only metastases and with extrahepatic metastases. The change in metabolomic profile was most markedly demonstrated on GC-MS (P = 4.75 × 10-5)., Conclusions: In CRC, the serum metabolomic profile changes markedly with metastasis, and site of disease also appears to affect the pattern of circulating metabolites. This novel observation may have clinical utility in enhancing staging accuracy and selecting patients for surgical or medical management. Additional studies are required to determine the sensitivity of this approach to detect subtle or occult metastatic disease.
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- 2012
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31. Acute care surgery: the impact of an acute care surgery service on assessment, flow, and disposition in the emergency department.
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Ball CG, MacLean AR, Dixon E, Quan ML, Nicholson L, Kirkpatrick AW, and Sutherland FR
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- Adult, Alberta, Emergency Service, Hospital organization & administration, Humans, Prospective Studies, Critical Care statistics & numerical data, Emergency Service, Hospital statistics & numerical data, Emergency Treatment statistics & numerical data
- Abstract
Background: Acute care surgery (ACS) services are becoming increasingly popular., Methods: Assessment, flow, and disposition of adult ACS patients (acute, nontrauma surgical conditions) through the emergency department (ED) in a large health care system (Calgary) were prospectively analyzed., Results: Among 447 ACS ED consultations over 3 centers (70% admitted to ACS), the median wait time from the consultation request to ACS arrival was 36 minutes, and from ACS arrival to the admission request it was 91 minutes. The total ACS-dependent time was 127 minutes compared with 261 minutes for initial ED activities and 104 minutes for transfer to a hospital ward (P < .05). Forty percent of patients underwent computed tomography (CT) imaging (76% before consultation). The time to ACS consultation was 305 minutes when a CT scan was performed first., Conclusions: An ACS service results in rapid ED assessment of surgical emergencies. Patient waiting is dominated by the time before requesting ACS consultation and/or waiting for transfer to the ward., (Copyright © 2012 Elsevier Inc. All rights reserved.)
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- 2012
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32. Feasibility of identifying pancreatic cancer based on serum metabolomics.
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Bathe OF, Shaykhutdinov R, Kopciuk K, Weljie AM, McKay A, Sutherland FR, Dixon E, Dunse N, Sotiropoulos D, and Vogel HJ
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- Aged, Biliary Tract Diseases blood, Biliary Tract Diseases diagnosis, Feasibility Studies, Humans, Male, Metabolome, Nuclear Magnetic Resonance, Biomolecular methods, Metabolomics methods, Pancreatic Neoplasms blood, Pancreatic Neoplasms diagnosis
- Abstract
Background: We postulated that the abundance of various metabolites in blood would facilitate the diagnosis of pancreatic and biliary lesions, which could potentially prevent unnecessary surgery., Methods: Serum samples from patients with benign hepatobiliary disease (n = 43) and from patients with pancreatic cancer (n = 56) were examined by ¹H NMR spectroscopy to quantify 58 unique metabolites. Data were analyzed by "targeted profiling" followed by supervised pattern recognition and orthogonal partial least-squares discriminant analysis (O-PLS-DA) of the most significant metabolites, which enables comparison of the whole sample spectrum between groups., Results: The metabolomic profile of patients with pancreatic cancer was significantly different from that of patients with benign disease (AUROC, area under the ROC curve, = 0.8372). Overt diabetes mellitus (DM) was identified as a possible confounding factor in the pancreatic cancer group. Thus, diabetics were excluded from further analysis. In this more homogeneous pancreatic cancer group, compared with benign cases, serum concentrations of glutamate and glucose were most elevated on multivariate analysis. In benign cases, creatine and glutamine were most abundant. To examine the usefulness of this test, a comparison was made to age- and gender-matched controls with benign lesions that mimic cancer, controlling also for presence of jaundice and diabetes (n = 14 per group). The metabolic profile in patients with pancreatic cancer remained distinguishable from patients with benign pancreatic lesions (AUROC = 0.8308)., Conclusions: The serum metabolomic profile may be useful for distinguishing benign from malignant pancreatic lesions., Impact: Further studies will be required to study the effects of jaundice and diabetes. A more comprehensive metabolomic profile will be evaluated using mass spectrometry., (©2010 AACR.)
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- 2011
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33. Peri-operative blood transfusion and operative time are quality indicators for pancreatoduodenectomy.
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Ball CG, Pitt HA, Kilbane ME, Dixon E, Sutherland FR, and Lillemoe KD
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- Aged, Humans, Linear Models, Middle Aged, Pancreaticoduodenectomy mortality, Perioperative Care, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, United States, Blood Loss, Surgical prevention & control, Erythrocyte Transfusion, Outcome and Process Assessment, Health Care, Pancreaticoduodenectomy adverse effects, Quality Indicators, Health Care
- Abstract
Background: Minimization of blood loss during pancreatoduodenectomy requires careful surgical technique and specific preventative measures. Therefore, red blood cell (RBC) transfusions and operative time are potential surgical quality indicators. The aim of the present study was to compare peri-operative RBC transfusion and operative time with 30-day morbidity/mortality after pancreatoduodenectomy., Methods: All pancreatoduodenectomies (2005 to 2008) were identified using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP). RBC transfusions and operative time were correlated with 30-day morbidity/mortality., Results: Pancreatoduodenectomy was completed in 4817 patients. RBC transfusions were given to 1559 (32%) patients (1-35 units). Overall morbidity and mortality rates were 37% and 3.0%, respectively. Overall 30-day morbidity increased in a stepwise manner with the number of RBC transfusions (R = 0.69, P < 0.01). Although RBC transfusions and operative times were not statistically linked (P = 0.87), longer operative times were linearly associated with increased 30-day morbidity (R = 0.79, P < 0.001) and mortality (R = 0.65, P < 0.01). Patients who were not transfused also displayed less morbidity (33%) and mortality (1.9%) (P < 0.05)., Discussion: Peri-operative RBC transfusion after pancreatoduodenectomy is linearly associated with 30-day morbidity. Longer operative time also correlates with increased morbidity and mortality. Therefore, blood transfusions and prolonged operative time should be considered quality indicators for pancreatoduodenectomy.
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- 2010
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34. Canadian Surgery Forum.
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Atlas H, Safa N, Denis R, Garneau P, Moustarah F, Marceau S, Lebel S, Biertho L, Hould F, Marceau P, Biron S, Anvari M, Sharma A, Goldsmith CH, Lacobellis G, Cadeddu M, Misra M, Taylor V, Tarride J, Hubert E, Tiboni M, Hong D, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Graham PJ, Kaban GK, Vizhul A, Birch DW, Menezes AC, Shi X, Karmali S, Seth R, MacKenzie L, Kus A, Bell J, Carrier M, Atkins H, Boushey R, Auer R, Croome KP, Yamashita M, Aarts MA, Okrainec A, Glicksman A, Pearsall E, Pitzul K, Huang H, McLeod RS, Sarkhosh K, Robertson M, Boctor D, Lam V, Sigalet D, Johner A, Faulds J, Wiseman SM, Pemberton J, Gordon ML, Prashad C, Rambaran M, Cameron B, Neville A, Sarosi GA Jr, Wei Y, Gibbs JO, Reda DJ, McCarthy M Jr, Fitzgibbons RJ Jr, Barkun JST, Fenech DS, Forbes S, Pearsall E, Chung J, Glickman A, Victor JC, Nathens A, McLeod RS, Fitzmaurice GJ, Mone F, Brown R, Cranley B, Conlon EF, Todd RAJ, O'Donnell ME, Tran TT, Kaneva PA, Finch LE, Fried GM, Mayo NE, Feldman LS, VanHouwellingen L, Vogt KN, Stewart TC, Williamson J, Parry N, DeRose G, Gray D, Harriman S, Rodych N, Hayes P, Moser M, Jamal MH, Doi S, Rousseau M, Snell L, Meterissian S, Zolfaghari S, Friedlich MS, Kurashima Y, Al-Sabah S, Kaneva PA, Feldman LS, Fried GM, Vassiliou MC, Tran TT, Kaneva PA, Mayo NE, Fried GM, Feldman LS, Pearsall E, Sheth U, Fenech D, McKenzie M, Victor JC, McLeod RS, Ghaderi I, Vaillancourt M, Sroka G, Kaneva PA, Vassiliou MC, Seagull FJ, Sutton E, Godinez C, George I, Park A, Choy I, Okrainec A, Brintzenhoff R, Prabhu A, Heniford BT, Stefanidis D, Fried GM, Feldman LS, Igric A, Vogt KN, Girotti M, Parry NG, Vinden C, Kim SHH, Zhang NN, Russo JJ, El-Salfiti IK, Kowalczuk M, Rajaee AN, Bal M, Gill MS, Lysecki PJ, Hoogenes J, Dath D, Nassar AK, Reid S, Mohaisen KN, Winch J, Omar D, Hanna WC, Mulder DS, El-Hilali MM, Khwaja KA, Jamal MH, Rayment J, Doi SA, Megueditchian A, Meterissian S, Tso D, Langer M, Blair G, Butterworth S, Vaillancourt M, Vassiliou MC, Bergman S, Fried GM, Kaneva PA, Feldman LS, Davenport E, Haggar F, Trottier D, Huynh H, Soto C, Shamji FM, Seely A, Sundaresan S, Pagliarello G, Tadros S, Yelle JD, Maziak D, Moloo H, Poulin EC, Mamazza J, Knowlton LM, Chackungal S, MacQueen KA, Anvari M, Allen C, Goldsmith C, Ghaderi I, Madani A, de Gara C, Schlachta CM, Zakrison TL, Tee MC, Chan S, Nguyen V, Yang J, Holmes D, Levine D, Bugis S, Wiseman SM, Sandhu L, Zhai J, Kennedy ED, Baxter NN, Gagliardi AR, Urbach DR, Wei AC, Sabalbal M, McAlister VC, Balayla J, Bergman S, Feldman LS, Ghitulescu G, Fraser SA, Daigle R, Urquart R, Cox M, Grunfeld E, Porter G, Hallet J, Labidi S, Clairoux A, Gagné JP, Gill RS, Manouchehri N, Liu JQ, Lee TF, Bigam DL, Cheung PY, Van Koughnett JA, Colquhoun PH, Gordon ML, Cornacchi S, Farrokhyar F, Hodgson N, Porter G, Quan ML, Wright F, Lovrics P, Datta I, Brar SS, Ball CG, Heine JA, Rothwell B, Crozier M, Ting H, Boone D, O'Regan N, Brown C, Bandrauk N, Hapgood J, Hogan M, McDonald LA, Da'as S, Sorensen PHB, Berman JN, Ameer A, Jamal M, Aljiffry M, Doi S, Hasanain M, Chaudhury P, Metrakos P, Tchervenkov J, Lapierre S, Mohammad W, Balaa N, Akil M, Mimeault R, Fairfull-Smith R, Teague BD, Butler MS, Garneau PY, Sample CB, Kapoor A, Cadeddu MO, Anvari M, Hanna WC, Jamal MH, Nguyen L, Fraser SA, Kwan K, Wallis CJD, Jones S, Fraser T, Masterso J, Blair G, Duffy D, Roberts DJ, Kirkpatrick AW, Datta I, Feliciano DV, Kortbeek JB, Laupland KB, Ball CG, Haggar F, Davenport E, Moloo H, Mamazza J, Manouchehri N, Bigam D, Churchill T, Joynt C, Cheung PY, Al-Sairafi R, Sample CB, Paquette F, Fraser SA, Feldman LS, Fried GM, Weissglas I, Ghitulescu G, Meterissian S, Bergman S, Al-Dohayan A, Al-Naami M, Bamehriz F, Madkhali A, Hallet J, LeBlanc M, Gilbert A, Daigle C, Tien G, Atkins MS, Zheng B, Tanin H, Swindells C, Meneghetti A, Panton ONM, Qayumi AK, Chhiv M, Drolet S, Sirois-Giguère É, Gilbert A, Doyle JD, Sheth U, Huang H, Pearsall E, McLeod RS, Nathens AB, Suri RR, Vora P, Kirby JM, Chan K, Smith S, Ruo L, Faryniuk A, Hochman D, Ball CG, Kirkpatrick AW, Broderick TJ, Williams DR, Kholdebarin R, Helewa R, Bracken J, Zabolotny B, Hochman D, Merchant S, Hameed M, Melck A, McGuire AL, Wilson C, Mercer D, Sharma B, Orzech N, Grantcharov T, Johner A, Taylor DC, Buczkowski AK, Chung SW, Lumb KJ, Trejos AL, Ward CDW, Naish MD, Patel RV, Schlachta CM, Davenport E, Haggar F, Moloo H, Boushey RP, Poulin EC, Mamazza J, Graybiel KM, Fernandes VT, Hoogenes J, Dath D, Mohammad W, Trottier D, Nadolny K, Poulin EC, Mamazza J, Balaa F, Diederichs B, Turner S, de Gara C, Ghitulescu GA, Filip I, Bergman S, Fraser S, Finley RJ, Mayo J, Clifton J, Yee J, Evans K, MacWilliams A, Lam S, English J, Finley C, Jacks L, Darling G, Hanna WC, Sudarshan M, Roberge D, David M, Waschke KA, Mayrand S, Ferri LE, Coughlin S, Emmerton-Coughlin H, Malthaner R, Grover HS, Basi S, Chiasson P, Basi S, Irshad K, Emmerton-Coughlin HMA, Vogt KN, Malthaner RA, Spicer JD, McDonald B, Perera R, Rousseau MC, Chan CHF, Hsu RYC, Giannias B, Ferri LE, Ahmed S, Birnbaum AE, Berz D, Fontaine JP, Dipetrillo TA, Ready NE, Ng T, Alhussaini A, Oberoi M, Threader J, Villeneuve J, Gilbert S, Shamji FM, Sundaresan S, Maziak D, Seely A, Rammohan KS, Hunt I, Chuck A, Gazala S, Valji A, Stewart K, Bedard ELR, Plourde M, Fortin D, Arab A, Inculet RI, Malthaner RA, Bharadwaj SC, Hamin T, Tan LA, Unruh HW, Srinathan SK, McGuire AL, Petsikas D, Reid K, Hopman W, Levine P, Rousseau M, Spicer J, Ferri LE, Ashrafi AS, Bond RJ, Ong SR, Ahmadi SY, Partington SL, Graham AJ, Owen S, Kelly EJ, Gelfand G, Grondin SC, McFadden SD, Paolucci EO, Weeks SG, Davis PJ, Molinari M, Topp T, Walsh MJ, Simoneau E, Hassanain M, Cabrera T, Chaudhury P, Dumitra S, Aljiffry M, Feteih I, Leduc S, Rivera J, Jamal M, Valenti D, Metrakos P, Elgadi K, Cherniak W, Chan D, Wei AC, Gallinger S, Mohammad W, Mimeault R, Fairfull-Smith R, Auer R, Balaa F, Kwan J, Hassanain M, Chaudhury P, Dey C, Gadahadh R, Salman A, Simoneau E, Meti N, Aljiffry M, Jamal M, Cabrera T, Bouganim N, Kavan P, Alcindor T, Valenti D, Metrakos P, Brar B, Sutherland F, Bégin A, Bourdonnais D, Lapointe R, Plasse M, Létourneau R, Roy A, Dagenais M, Vandenbroucke-Menu F, Bégin A, Bourdonnais D, Lapointe R, Plasse M, Létourneau R, Dagenais M, Roy A, Vandenbroucke-Menu F, Bégin A, Ismail S, Vandenbroucke-Menu F, Létourneau R, Plasse M, Roy A, Dagenais M, Lapointe R, Greco EF, Nanji S, Shah SA, Wei AC, Greig PD, Gallinger S, Cleary SP, Al-Adra DP, Anderson C, Nanji S, Ryan P, Guindi M, Selvarajah S, Greig P, McGilvray I, Taylor B, Wei A, Moulton C, Cleary SP, Gallinger S, Sandroussi C, Brace C, Kennedy E, Baxter N, Gallinger S, Wei AC, Yamashita T, Leslie K, McLean SR, Karsanji D, Dixon E, Sutherland FR, Bathe OF, Suri RR, Marcaccio MJ, Ruo L, Jamal MH, Simoneau E, Khalil JA, Hassanain M, Chaudhury P, Tchervenkov J, Metrakos P, Doi SA, Barkun JS, Barnett C, Marcaccio MJ, Hankinson JJ, Ruo L, Alawashez A, Ellsmere J, Neville A, Boutros M, Barkun J, Wiebe ME, Sandhu L, Takata JL, Kennedy ED, Baxter NN, Gagliardi AR, Urbach DR, Wei AC, Chan G, Kocha W, Reid R, Wall W, Quan D, Lovrics P, Hodgson N, Ghola G, Franic S, Goldsmith C, McCready D, Cornacchi S, Garnett A, Reedijk M, Scheer AS, McSparron JI, Schulman AR, Tuorto S, Gonen M, Gonsalves J, Fong Y, Auer RAC, Francescutti V, Coates A, Thabane L, Goldsmith CH, Levine M, Simunovic M, Richardson DP, Porter G, Johnson PM, Leon-Carlyle M, Schmocker S, O'Connor BI, Victor JC, Baxter NN, Smith AJ, McLeod RS, Kennedy ED, Chan CHF, Arabzadeh A, DeMarte L, Spicer JD, Turbide C, Brodt P, Beauchemin N, Ferri LE, Zih F, Panzarella T, Hummel C, Petronis J, McCart A, Swallow C, Mathieson A, Ridgway PF, Ko YJ, Smith AJ, Gieni M, Dickson L, Sne N, Avram R, Farrokhyar F, Smith M, Giacomantonio C, Hoskin D, Doyon C, Martin G, Patocskai E, Brar SS, Wright F, Okrainec A, Smith AJ, Bischof DA, Maier B, Fitch M, Wright FC, Baliski CR, Kluftinger A, MacLeod M, Kwong S, Racz JM, Fortin A, Latosinsky S, Messenger DE, Kirsch R, McLeod RS, Aslani N, Heidary B, Prabhu KL, Raval M, Phang PT, Brow C, Richardson DP, Porter G, Johnson PM, Moloo H, Haggar F, Duhaime S, Hutton B, Grimshaw J, Coyle D, Poulin EC, Mamazza J, Boushey RP, Paun BC, Shaheen AAM, Dixon E, Maclean AR, Buie WD, Moustarah F, Talarico J, Zink J, Gatmaitan P, Schauer P, Chand B, Brethauer S, Martel G, Duhaime S, Ramsay CR, Barkun JS, Ferguson DA, Boushey RP, Palter VN, MacRae HM, Grantcharov TP, Messenger DE, Victor JC, O'Connor BI, MacRae HM, McLeod RS, Al-Sabah S, Feldman LS, Charlebois P, Stein B, Kaneva PA, Fried GM, Liberman AS, Borowiec AM, Karmal S, Apriasz I, Mysliwiec B, Hussain N, Ott M, Reynolds R, Lum A, Williams LJ, Morash R, Shin S, Smylie J, Moloo H, Auer R, Poulin EC, Mamazza J, Watters J, Fung-Kee-Fung M, Boushey RP, Pelletier JS, de Gara CJ, White J, Ghosh S, Schiller D, Drolet S, Paolucci EO, Heine J, Buie WD, Maclean AR, Barnes A, Liang S, Auer R, Moloo H, Mamazza J, Poulin EC, Boushey RP, Klevan AE, Dalvi AA, Ramsay JA, Stephen WJ, Nhan C, Driman DK, Raby M, Smith AJ, Hunter A, Srigley J, McLeod RS, Zolfaghari S, Auer R, Moloo H, Mamazza J, Friedlich M, Poulin EC, Stern HS, Boushey RP, Scheer AS, Boushey RP, Liang S, Doucette S, O'Connor AM, and Moher D
- Published
- 2010
35. A decade of experience with injuries to the gallbladder.
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Ball CG, Dixon E, Kirkpatrick AW, Sutherland FR, Laupland KB, and Feliciano DV
- Abstract
Background: Considering that injuries to the gallbladder are rare, the purpose of this study was to evaluate injury patterns, operative procedures and outcomes in patients with trauma to the gallbladder. A retrospective review of traumatic injuries to the gallbladder at an urban level 1 trauma center from 1996 to 2008 was performed. Injuries were identified via imaging or during operative exploration., Results: Injuries to the gallbladder occurred in 45 patients, 40 (89%) of whom suffered penetrating trauma. Associated injuries were present in 44 (98%) patients, including 10 (22%) pancreatic injuries requiring repair and/or drainage. Patients were severely injured (49% hemodynamically unstable at presentation; mean Injury Severity Score = 20; mean length of stay = 22 days; mortality rate = 24%). Cholecystectomy was performed in 42 patients (93%), while the remaining 3 had drainage only as part of a "damage control" operation related to their critical physiologic status. Injuries to the extrahepatic biliary ducts occurred in 3 patients (7%) as well. Although all patients developed trauma related complications, none were a direct result of their biliary tract injuries., Conclusion: Injuries to the gallbladder are rare even in the busiest urban trauma centers. Almost all patients have associated intra-abdominal injuries, and nearly 50% of patients are hemodynamically unstable on admission. Rapid cholecystectomy is the treatment of choice for all mechanisms of injury, except when the first operative procedure is of the damage control type.
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- 2010
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36. Abstracts of presentations to the Annual Meetings of the Canadian Association of General Surgeons Canadian Association of Thoracic Surgeons Canadian Hepato-Pancreato-Biliary Society Canadian Society of Surgical Oncology Canadian Society of Colon and Rectal Surgeons: Victoria, BC Sept. 10-13, 2009.
- Author
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Nenshi R, Kennedy E, Baxter NN, Saskin R, Sutradhar R, Urbach DR, Sroka G, Feldman LS, Vassiliou MC, Kaneva PA, Fayez R, Fried GM, Krajewski SA, Brown CJ, Hur C, McCrea PH, Mitchell A, Porter G, Grushka J, Razek T, Khwaja K, Fata P, Martel G, Moloo H, Picciano G, Boushey RP, Poulin EC, Mamazza J, Haas B, Xiong W, Brennan-Barnes M, Gomez D, Nathens AB, Yang I, Forbes SS, Stephen WJ, Loeb M, Smith R, Christoffersen EP, McLean RF, Westerholm J, Garcia-Osogobio S, Farrokhyar F, Cadeddu M, Anvari M, Ponton-Carss A, Hutchison C, Violato C, Segedi M, Mittleman M, Fisman D, Kinlin L, Rousseau M, Saleh W, Ferri LE, Feldman LS, Stanbridge DD, Mayrand S, Fried GM, Pandya A, Gagliardi A, Nathens A, Ahmed N, Tran T, Demyttenaere SV, Polyhronopoulos G, Seguin C, Artho GP, Kaneva P, Fried GM, Feldman LS, Demyttenaere SV, Bergman S, Anderson J, Mikami DJ, Melvin WS, Racz JM, Dubois L, Katchky A, Wall WJ, Faryniuk A, Hochman D, Clarkson CA, Rubiano AM, Clarkson CA, Boone D, Ball CG, Dixon E, Kirkpatrick AW, Sutherland FR, Feliciano DV, Wyrzykowski AD, Nicholas JM, Dente CJ, Ball CG, Feliciano DV, Ullah SM, McAlister VC, Malik S, Ramsey D, Pooler S, Teague B, Misra M, Cadeddu M, Anvari M, Kaminsky M, Vergis A, Gillman LM, Gillman LM, Vergis A, Altaf A, Ellsmere J, Bonjer HJ, Klassen D, Orzech N, Palter V, Aggarwal R, Okrainec A, Grantcharov TP, Ghaderi I, Feldman LS, Sroka G, Kaneva PA, Fried GM, Shlomovitz E, Reznick RK, Kucharczyk W, Lee L, Iqbal S, Barayan H, Lu Y, Fata P, Razek T, Khwaja K, Boora PS, White JS, Vogt KN, Charyk-Stewart T, Minuk L, Eckert K, Chin-Yee I, Gray D, Parry N, Humphrey RJ, Bütter A, Schmidt J, Grieci T, Gagnon R, Han V, Duhaime S, Pitt DF, Palter V, Orzech N, Aggarwal R, Okrainec A, Grantcharov TP, Dubois L, Vogt KN, Davies W, Schlachta CM, Shi X, Birch DW, Gu Y, Moser MA, Swanson TW, Schaeffer DF, Tang BQ, Rusnak CH, Amson BJ, Vogt KN, Dubois L, Hobbs A, Etemad-Rezai R, Schlachta CM, Claydon E, McAlister V, Grushka J, Sur W, Laberge JM, Tchervenkov J, Bell L, Flageole H, Labidi S, Gagné JP, Gowing R, Kahnamoui K, McAlister CC, Marble A, Coughlin S, Karanicolas P, Emmerton-Coughlin H, Kanbur B, Kanbur S, Colquhoun P, Trottier DC, Doucette S, Huynh H, Soto CM, Poulin EC, Mamazza J, Boushey RP, Jamal MH, Rousseau M, Meterissian S, Snell L, Racz JM, Davies E, Aminazadeh N, Farrokhyar F, Reid S, Naeeni A, Naeeni M, Kashfi A, Kahnamoui K, Martin K, Weir M, Taylor B, Martin KM, Girotti MJ, Parry NG, Hanna WC, Fraser S, Weissglas I, Ghitulescu G, Bilek A, Marek J, Galatas C, Bergman S, Chiu CG, Nguyen NH, Bloom SW, Wiebe S, Klassen D, Bonjer J, Lawlor D, Plowman J, Ransom T, Vallis M, Ellsmere J, Menezes AC, Karmali S, Birch DW, Forbes SS, Eskicioglu C, Brenneman FD, McLeod RS, Fraser SA, Bergman S, Garzon J, Gomez D, Lawless B, Haas B, Nathens AB, Lumb KJ, Harkness L, Williamson J, Charyk-Stewart T, Gray D, Malthaner RA, Van Koughnett JA, Vogt KN, Gray DK, Parry NG, Teague B, Cadeddu M, Anvari M, Misra M, Pooler S, Malik S, Swain P, Chackungal S, Vogt KN, Yoshy C, Etemad-Rezai R, Cunningham I, Dubois L, Schlachta CM, Scott L, Vinden C, Okrainec A, Henao O, Azzie G, Deen S, Hameed M, Ramirez V, Veillette C, Bray P, Jewett M, Okrainec A, Pagliarello G, Brenneman F, Buczkowski A, Nathens A, Razek T, Widder S, Anderson I, Klassen D, Saadia R, Johner A, Hameed SM, Qureshi AP, Vergis A, Jimenez CM, Green J, Pryor AD, Schlachta CM, Okrainec A, Perri MT, Trejos AL, Naish MD, Patel RV, Malthaner RA, Stanger J, Stewart K, Yasui Y, Cass C, Damaraju S, Graham K, Bharadwaj S, Srinathan S, Tan L, Unruh H, Finley C, Miller L, Ferri LE, Urbach DR, Darling G, Spicer J, Ergun S, McDonald B, Rousseau M, Kaneva P, Ferri LE, Spicer J, Andalib A, Benay C, Rousseau M, Kushner Y, Marcus V, Ferri LE, Hunt I, Gazala S, Razzak R, Chuck A, Valji A, Stewart K, Tsuyuki R, Bédard ELR, Bottoni DA, Campbell G, Malthaner RA, Rousseau M, Guevremont P, Chasen M, Spicer J, Eckert E, Alcindor T, Ades S, Ferri LE, McGory R, Nagpal D, Fortin D, Inculet RI, Malthaner RA, Ko M, Shargall Y, Compeau C, Razzak R, Gazala S, Hunt I, Veenstra J, Valji A, Stewart K, Bédard ELR, Davis PJ, Mancuso M, Mujoomdar AA, Gazala S, Bédard ELR, Lee L, Spicer J, Robineau C, Sirois C, Mulder D, Ferri LE, Cools-Lartigue J, Chang SY, Mayrand S, Marcus V, Fried GM, Ferri LE, Perry T, Hunt I, Allegretto M, Maguire C, Abele J, Williams D, Stewart K, Bédard ELR, Grover HS, Basi S, Chiasson P, Basi S, Gregory W, Irshad K, Schieman C, MacGregor JH, Kelly E, Gelfand G, Graham AJ, McFadden SP, Grondin SC, Croome KP, Chudzinski R, Hanto DW, Jamal MH, Doi SA, Barkun JS, Wong SL, Kwan AHL, Yang S, Law C, Luo Y, Spiers J, Forse A, Taylor W, Apriasz I, Mysliwiec B, Sarin N, Gregor J, Moulton CE, McLeod RS, Barnett H, Nhan C, Gallinger S, Demyttenaere SV, Nau P, Muscarella P, Melvin WS, Ellison EC, Wiseman SM, Melck AL, Davidge KM, Eskicioglu C, Lipa J, Ferguson P, Swallow CJ, Wright FC, Edwards JP, Kelly EJ, Lin Y, Lenders T, Ghali WA, Graham A, Francescutti V, Farrokhyar F, Tozer R, Heller B, Lovrics P, Jansz G, Kahnamoui K, Spiegle G, Schmocker S, Huang H, Victor C, Law C, Kennedy ED, McCart JA, Aslani N, Swanson T, Kennecke H, Woods R, Davis N, Klevan AE, Ramsay JA, Stephen WJ, Smith M, Plourde M, Johnson PM, Yaffe P, Walsh M, Hoskin D, Huynh HP, Trottier DC, Soto C, Auer R, Poulin EC, Mamazza J, Boushey RP, Moloo H, Huynh HP, Trottier DC, Soto C, Moloo H, Poulin EC, Mamazza J, Boushey RP, Nhan C, Driman DK, Smith AJ, Hunter A, McLeod RS, Eskicioglu C, Fenech DS, Victor C, McLeod RS, Trottier DC, Huynh H, Sabri E, Soto C, Scheer A, Zolfaghari S, Moloo H, Mamazza J, Poulin EC, Boushey RP, Hallet J, Guénette-Lemieux M, Bouchard A, Grégoire RC, Thibault C, Dionne G, Côté F, Langis P, Gagné JP, Raval MJ, Phang PT, Brown CJ, Kuzmanovic A, Planting A, Raval MJ, Phang PT, Brown CJ, Huynh HP, Trottier DC, Moloo H, Poulin EC, Mamazza J, Friedlich M, Stern HS, Boushey RP, Tang BQ, Moloo H, Bleier J, Goldberg SM, Alsharif J, Martel G, Bouchard A, Sabri E, Ramsay CR, Mamazza J, Poulin EC, Boushey RP, Richardson D, Porter G, Johnson P, Al-Sukhni E, Ridgway PF, O'Connor B, McLeod RS, Swallow CJ, Forbes SS, Urbach DR, Sutradhar R, Paszat L, Rabeneck L, Baxter NN, Chung W, Ko D, Sun C, Brown CJ, Raval M, Phang PT, Pao JS, Woods R, Raval MJ, Phang PT, Brown CJ, Power A, Francescutti V, Ramsey D, Kelly S, Stephen W, Simunovic M, Coates A, Goldsmith CH, Thabane L, Reeson D, Smith AJ, McLeod RS, DeNardi F, Whelan TJ, Levine MN, Al-Khayal KA, Buie WD, Wallace L, Sigalet D, Eskicioglu C, Gagliardi A, Fenech DS, Victor C, and McLeod RS
- Published
- 2009
37. Blood loss in surgical oncology: neglected quality indicator?
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Dixon E, Datta I, Sutherland FR, and Vauthey JN
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- Humans, Neoplasm Recurrence, Local, Survival Analysis, Blood Loss, Surgical prevention & control, Blood Loss, Surgical statistics & numerical data, Neoplasms surgery, Quality Indicators, Health Care, Transfusion Reaction
- Abstract
Quality indicators can be defined as "specific and measurable elements of practice that can be used to assess the quality of care". Surgical blood loss is one of the most significant perioperative predictors of patient outcome. Blood loss is a modifiable quality indicator for oncologic cancer surgery. Surgical oncologists need to alter their surgical technique to promote bloodless surgery and decrease the variability in reported blood loss and rates of blood transfusion.
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- 2009
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38. A phase II experience with neoadjuvant irinotecan (CPT-11), 5-fluorouracil (5-FU) and leucovorin (LV) for colorectal liver metastases.
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Bathe OF, Ernst S, Sutherland FR, Dixon E, Butts C, Bigam D, Holland D, Porter GA, Koppel J, and Dowden S
- Subjects
- Aged, Antineoplastic Combined Chemotherapy Protocols adverse effects, Camptothecin adverse effects, Camptothecin therapeutic use, Cohort Studies, Colorectal Neoplasms mortality, Colorectal Neoplasms pathology, Female, Fluorouracil adverse effects, Humans, Irinotecan, Leucovorin adverse effects, Liver Neoplasms drug therapy, Liver Neoplasms mortality, Liver Neoplasms surgery, Male, Middle Aged, Neoplasm Metastasis, Treatment Outcome, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Camptothecin analogs & derivatives, Colorectal Neoplasms drug therapy, Fluorouracil therapeutic use, Leucovorin therapeutic use, Liver Neoplasms secondary, Neoadjuvant Therapy
- Abstract
Background: Chemotherapy may improve survival in patients undergoing resection of colorectal liver metastases (CLM). Neoadjuvant chemotherapy may help identify patients with occult extrahepatic disease (averting unnecessary metastasectomy), and it provides in vivo chemosensitivity data., Methods: A phase II trial was initiated in which patients with resectable CLM received CPT-11, 5-FU and LV for 12 weeks. Metastasectomy was performed unless extrahepatic disease appeared. Postoperatively, patients with stable or responsive disease received the same regimen for 12 weeks. Patients with progressive disease received either second-line chemotherapy or best supportive care. The primary endpoint was disease-free survival (DFS); secondary endpoints included overall survival (OS) and safety., Results: 35 patients were accrued. During preoperative chemotherapy, 16 patients (46%) had grade 3/4 toxicities. Resection was not possible in 5 patients. One patient died of arrhythmia following surgery, and 1 patient had transient liver failure. During the postoperative treatment phase, 12 patients (55%) had grade 3/4 toxicities. Deep venous thrombosis (DVT) occurred in 11 patients (34%) at various times during treatment. Of those who underwent resection, median DFS was 23.0 mo. and median OS has not been reached. The overall survival from time of diagnosis of liver metastases was 51.6 mo for the entire cohort., Conclusion: A short course of chemotherapy prior to hepatic metastasectomy may serve to select candidates best suited for resection and it may also direct postoperative systemic treatment. Given the significant incidence of DVT, alternative systemic neoadjuvant regimens should be investigated, particularly those that avoid the use of a central venous line., Trial Registration: ClinicalTrials.gov NCT00168155.
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- 2009
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39. Rupture and intra-peritoneal bleeding of a hepatocellular carcinoma after a transarterial chemoembolization procedure: a case report.
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Reso A, Ball CG, Sutherland FR, Bathe O, and Dixon E
- Abstract
Background: Transarterial chemoembolization (TACE) is a well accepted treatment for inoperable hepatocellular carcinoma (HCC). While minor complications involve 10% of all patients, severe complications are rare., Case Presentation: We describe a case of a 90-year-old male with a large, superficial HCC who underwent TACE. He had a significant intraperitoneal bleed secondary to tumor rupture immediately following the procedure., Conclusion: Tumor size and superficial location must be considered risk factors for tumor rupture and related complications.
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- 2009
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40. Colorectal liver metastases contract centripetally with a response to chemotherapy: a histomorphologic study.
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Ng JK, Urbanski SJ, Mangat N, McKay A, Sutherland FR, Dixon E, Dowden S, Ernst S, and Bathe OF
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- Adult, Aged, Chemotherapy, Adjuvant, Female, Humans, Liver Cirrhosis pathology, Liver Neoplasms pathology, Male, Middle Aged, Colorectal Neoplasms pathology, Liver Neoplasms drug therapy, Liver Neoplasms secondary
- Abstract
Background: Recently, there has been considerable interest in neoadjuvant chemotherapy for colorectal liver metastases. However, there is little information that defines how much liver should be removed after a favorable response., Methods: Liver metastases from 2 groups of patients were analyzed: 25 metastases were evaluated from a group that did not receive chemotherapy and 26 lesions were studied from patients who had received systemic chemotherapy before resection. All patients except for 1 had 5-fluorouracil (5-FU), leucovorin (LV), and irinotecan (CPT-11); 1 had 5-FU and LV alone. The average duration of chemotherapy was 2.9+/-0.7 months. Separate assessments of the histopathologic features of the central and peripheral portions of each tumor were made. The pathologist was blinded to all clinical information., Results: All of the untreated metastases had well-circumscribed borders. Irregular borders were seen in 6 of the postchemotherapy lesions (26%), which was particularly prominent in lesions that had significantly contracted. After chemotherapy, discrete islands of viable tumor cells outside of the main tumor mass were seen in 4 patients, but all were close to the peripheral margin of the tumor mass. Viable tumor cells were more frequent in the periphery of metastases, regardless of chemotherapy exposure. Central necrosis was prominent in untreated metastases, but disappeared after chemotherapy. In lesions treated with chemotherapy, central fibrosis was greater compared with untreated lesions., Conclusions: After a partial response to chemotherapy, liver metastases shrank in a generally concentric fashion. These findings support the practice of removing less liver after downsizing with chemotherapy.
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- 2008
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41. Morbidity and mortality following multivisceral resections in complex hepatic and pancreatic surgery.
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McKay A, Sutherland FR, Bathe OF, and Dixon E
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- Adult, Aged, Aged, 80 and over, Alberta epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Morbidity trends, Prognosis, Retrospective Studies, Risk Factors, Survival Rate trends, Hepatectomy methods, Liver Diseases surgery, Pancreatectomy methods, Pancreatic Diseases surgery, Postoperative Complications epidemiology
- Abstract
Complex multivisceral resections in major hepatic and pancreatic surgery are relatively infrequent, and information regarding the morbidity and mortality associated with such resections is scant. The purpose of this paper is to describe the outcomes following such aggressive surgical treatment. A retrospective review of the outcomes following multiorgan resection in the setting of major liver or pancreatic resection was conducted from 2002 until July 2006. Patients who had a major hepatic or pancreatic resection plus resection of at least one other organ were included. The primary outcome measures analyzed were the postoperative morbidity and mortality. Secondary outcomes included recurrence rates and survival. Twenty-seven patients met the inclusion criteria. There were two postoperative deaths (7%). Complications occurred in 59% of patients. Complications were minor in 26% and severe in 33%. Complications were more frequent in older patients and in patients with pancreatic resections. Mortality was significantly increased in the setting of a pancreaticoduodenectomy. These more aggressive procedures should be considered to carry a higher risk of complications, particularly in patients undergoing pancreaticoduodenectomies. Patients should be selected carefully when undertaking complex multivisceral resections in major hepatic and pancreatic surgery.
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- 2008
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42. Pancreatic fistulae: are we making progress?
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Parr ZE, Sutherland FR, Bathe OF, and Dixon E
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- Humans, Morbidity, Pancreatic Fistula mortality, Postoperative Complications mortality, Risk Factors, Severity of Illness Index, Pancreas surgery, Pancreatic Fistula etiology, Postoperative Complications etiology
- Abstract
Background/purpose: Pancreatic fistulae constitute a morbid outcome of pancreatic surgery. Yet, a definition of a pancreatic fistula does not exist that can be reliably used to report on and study this outcome. We compare reported fistula, morbidity, and mortality rates with fistula parameters in order to identify high-risk fistulae predictive of morbid outcomes., Methods: A systematic literature review was performed; of 1426 articles identified, 43 articles ultimately met inclusion and exclusion criteria and were reviewed. Fistula, morbidity, and mortality rates as well as fistula definitions were extracted and then compared and graphically reported., Results: Thirty-two different definitions of pancreatic fistulae were found in 43 articles; only 24 articles defined fistulae according to all three parameters examined in this study. The data trends suggest that fistula, morbidity, and mortality rates have remained relatively stable since 1980. Further, drainage volumes, amylase levels, and length of drainage do not appear to correlate with reported morbidity or mortality rates., Conclusions: This study suggests that pancreatic fistulae may not correlate with morbidity and mortality. Further, the parameters historically used to define fistulae do not appear to correlate with morbidity and mortality. A different system is needed to identify this outcome and determine its clinical significance.
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- 2008
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43. Meta-analysis of pancreaticojejunostomy versus pancreaticogastrostomy reconstruction after pancreaticoduodenectomy.
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McKay A, Mackenzie S, Sutherland FR, Bathe OF, Doig C, Dort J, Vollmer CM Jr, and Dixon E
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- Ampulla of Vater surgery, Cohort Studies, Humans, Pancreatic Fistula etiology, Prospective Studies, Randomized Controlled Trials as Topic, Risk Factors, Common Bile Duct Neoplasms surgery, Gastrostomy methods, Pancreatectomy methods, Pancreatic Fistula surgery, Pancreaticoduodenectomy adverse effects, Pancreaticojejunostomy methods
- Abstract
Background: Pancreaticoduodenectomy is the primary treatment for periampullary cancer. Associated morbidity is high and often related to pancreatic anastomotic failure. This paper compares rates of pancreatic fistula, morbidity and mortality after pancreaticoduodenectomy in patients having reconstruction by pancreaticogastrostomy with those in patients having reconstruction by pancreaticojejunostomy., Methods: A meta-analysis was performed of all large cohort and randomized controlled trials carried out since 1990., Results: Eleven articles were identified for inclusion: one prospective randomized trial, two non-randomized prospective trials and eight observational cohort studies. The meta-analysis revealed a higher rate of pancreatic fistula associated with pancreaticojejunostomy reconstruction (relative risk (RR) 2.62 (95 per cent confidence interval (c.i.) 1.91 to 3.60)). A higher overall morbidity rate was also demonstrated in this group (RR 1.43 (95 per cent c.i. 1.26 to 1.61)), as was a higher mortality rate (RR 2.51 (95 per cent c.i. 1.61 to 3.91))., Conclusion: Current literature suggests that the safer means of pancreatic reconstruction after pancreaticoduodenectomy is pancreaticogastrostomy, but much of the evidence comes from observational cohort study data.
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- 2006
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44. Management of perforation after endoscopic retrograde cholangiopancreatography (ERCP): a population-based review.
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Wu HM, Dixon E, May GR, and Sutherland FR
- Abstract
Background: Perforation related to endoscopic retrograde cholangiopancreatography (ERCP) is a rare complication associated with significant morbidity and mortality. This study evaluated the management and outcomes of these perforations., Patients and Methods: Between July 1996 and December 2002, a total of 6620 ERCPs were performed at our regional endoscopy unit serving the 1.5 million population of Southern Alberta. Thirty perforations (0.45%) were identified and retrospectively reviewed. Results. Seven of these 30 patients were found to have guidewire perforations of the bile duct, 11 perforations were peri-ampullary, 3 duodenal, 1 esophageal, and 1 patient had a perforation of an afferent limb of a Billroth II anastomosis. In seven patients the location of the perforation could not be determined (unknown). All patients with guidewire perforations were recognized during ERCP, and all were managed medically. Of the 11 peri-ampullary perforations, 7 of these patients had a pre-cut sphincterotomy, 5 underwent surgery and 4 patients died. Delay in diagnosis occurred in all patients that died. Of the three duodenal perforations, all required operation and one patient died. Of the seven 'unknown' retroperitoneal perforations, two patients required surgery and there was no mortality. The patients with esophageal and afferent limb perforations both recovered uneventfully after surgery. Most patients who required surgery had retroperitoneal fluid seen on CT scanning., Conclusions: We found that most guidewire perforations can be managed medically with little morbidity. Pre-cut sphincterotomy is a risk factor for perforation. Peri-ampullary and duodenal perforations have a high morbidity and mortality rate. In particular, retroperitoneal fluid collections on CT scans, delay in diagnosis and failure of medical therapy requiring salvage surgery are associated with poor outcomes. Early aggressive surgery may improve patient care.
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- 2006
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45. Hepatic arterial infusion after curative resection of colorectal cancer metastases: a meta-analysis of prospective clinical trials.
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Clancy TE, Dixon E, Perlis R, Sutherland FR, and Zinner MJ
- Subjects
- Clinical Trials as Topic, Humans, Liver Neoplasms mortality, Liver Neoplasms secondary, Prospective Studies, Survival Analysis, Antineoplastic Agents administration & dosage, Colorectal Neoplasms pathology, Hepatic Artery, Infusions, Intra-Arterial, Liver Neoplasms surgery, Neoplasm, Residual drug therapy
- Abstract
The use of hepatic arterial infusion (HAI) for the delivery of chemotherapeutic agents to treat residual microscopic disease after curative hepatic resection for colorectal cancer metastases remains controversial. In recent years, a number of studies examining adjuvant HAI have shown conflicting results. A meta-analysis of prospective clinical trials was performed to determine if adjuvant HAI confers a survival benefit in this setting. Two reviewers independently performed a literature search of MEDLINE, PubMed, EMBASE, the Cochrane library, and the Cochrane Clinical Trials Registry. Prospective clinical trials comparing hepatic arterial chemotherapy after curative hepatic resection for colorectal cancer metastases against a control arm were included. Non-English-language publications were excluded. The outcome measure was survival difference at 1 and 2 years after surgery. Seven studies met the inclusion criteria, and all except one were randomized trials. The survival difference in months (positive values favoring the treatment arm) was 1.8 at 1 year (95% confidence interval, -4.9, 8.5) and 9.6 at 2 years (95% confidence interval, -2.2, 21.4). Neither was statistically significant (at 2 years, P=0.11). Based on these findings, routine adjuvant HAI after curative resection for colorectal cancer of the liver cannot be recommended. However, given the trend toward a survival benefit at 2 years, further study is recommended.
- Published
- 2005
- Full Text
- View/download PDF
46. Bile duct injury after laparoscopic cholecystectomy: resection of the entire extrahepatic biliary tree.
- Author
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Dixon E, Sutherland FR, Vollmer CM Jr, and Greig PD
- Subjects
- Adult, Anastomosis, Roux-en-Y methods, Cholangiography standards, Cholangiopancreatography, Endoscopic Retrograde, Female, Humans, Intestine, Small surgery, Magnetic Resonance Angiography standards, Predictive Value of Tests, Rupture, Stents, Bile Ducts, Extrahepatic injuries, Bile Ducts, Extrahepatic surgery, Cholecystectomy, Laparoscopic adverse effects
- Published
- 2003
- Full Text
- View/download PDF
47. Gallstone pancreatitis: does discharge and readmission for cholecystectomy affect outcome?
- Author
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McCullough LK, Sutherland FR, Preshaw R, and Kim S
- Abstract
Background: Conventional surgical wisdom is that a patient with gallstone pancreatitis should have the gallbladder removed during their initial hospitalization. However, patients are now often discharged to await operating room availability., Methods: A retrospective review of all cases of gallstone pancreatitis at the Foothills Hospital between 1992 and 1996 was undertaken. Patients with a first attack of mild gallstone pancreatitis were studied., Results: In all, 164 patients were identified: 90 patients were discharged for readmission cholecystectomy (discharged group), and 74 patients had the cholecystectomy before discharge (in-hospital group). Over the 5-year time period the proportion of patients discharged for readmission cholecystectomy increased from 27% to 67% (p<0.01). The total number of days waited for operation was greater in the discharged group versus in-hospital group: 40+/-69 days versus 8+/-10 days respectively (mean+/-SD). There was a trend towards an increased total number of days in hospital in the in-hospital group, 15.5+/-17 days versus 10.7+/-16 days. In the discharged group 20% (18 of 90) of patients experienced an adverse event requiring readmission while awaiting operation. Three had documented recurrent pancreatitis, 10 experienced recurrent pain, and 5 developed acute cholecystitis. There were no deaths in either group., Discussion: Twenty percent of patients with gallstone pancreatitis who are discharged to await operating room time (average wait 40 days) will require readmission for biliary symptoms.
- Published
- 2003
- Full Text
- View/download PDF
48. Cystadenomas of the liver: a spectrum of disease.
- Author
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Dixon E, Sutherland FR, Mitchell P, McKinnon G, and Nayak V
- Subjects
- Adult, CA-19-9 Antigen analysis, Carcinoembryonic Antigen analysis, Diagnosis, Differential, Female, Humans, Male, Middle Aged, Treatment Outcome, Cystadenoma diagnosis, Cystadenoma surgery, Liver Neoplasms diagnosis, Liver Neoplasms surgery
- Abstract
Objectives: To describe the wide variation in presentation of cystadenomas of the liver and to delineate useful tests for diagnosis and effective surgical treatment., Design: A case series., Setting: A university-affiliated hospital., Patients: Four patients (3 women, 1 man) having cystadenoma of the liver, 2 of whom had associated mesenchymal stroma., Main Outcome Measures: Serum and cyst fluid carcinoembryonic antigen (CEA) and CA19-9 levels, type of surgery, morbidity and recurrence rates., Results: Cyst fluid CEA and CA19-9 levels were elevated. One patient had resection, 2 had complete enucleation and 1 had partial enucleation. There were no deaths. Morbidity included 1 wound infection; there were no biliary fistulas. The patient with partial enucleation had a radiologically confirmed recurrence., Conclusions: Analysis of cyst fluid CEA and CA19-9 is useful for diagnosis; besides hepatic resection, complete enucleation should be considered as a reasonable treatment for patients with this disease.
- Published
- 2001
49. Cystadenoma of the liver without mesenchymal stroma in a female following hormonal therapy for acne.
- Author
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Dixon E, Sutherland FR, Burak K, McKinnon G, and May G
- Abstract
Background: Liver cystadenomas are relatively rare tumours that can be difficult to diagnose; treatment entails complete surgical extirpation either by either anatomical resection or enucleation., Case Outline: A 19-year-old woman presented with acute onset of abdominal pain and was found to have a multilocular giant liver cyst.The cyst was percutaneously drained; CEA and CA 19-9 tumour markers were elevated in this cyst fluid: CEA 96 microg/L, CAI9-9 37 550 kU/L. The cyst was completely enucleated and has not recurred. Pathological examination confirmed a cystadenoma without mesenchymal stroma, and tumour oestrogen and progesterone receptors were negative., Discussion: This is the fourth report of a liver cystadenoma without mesenchymal stroma in a female and the first to document elevated cyst fluid tumour markers. This case also illustrates the possible relationship between hormonal therapy and tumour growth.
- Published
- 2001
- Full Text
- View/download PDF
50. Non-heart-beating organ donors as a source of kidneys for transplantation: a chart review.
- Author
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Campbell GM and Sutherland FR
- Subjects
- Adult, Aged, Aged, 80 and over, Alberta, Canada, Female, Humans, Male, Middle Aged, Respiration, Artificial, Heart Arrest, Kidney Transplantation, Tissue Donors, Tissue and Organ Procurement standards
- Abstract
Background: Organ transplantation is the treatment of choice for patients with end-stage organ failure, but the supply of organs has not increased to meet demand. This study was undertaken to determine the potential for kidney donation from patients with irremediable brain injuries who do not meet the criteria for brain death and who experience cardiopulmonary arrest after withdrawal of ventilatory support (controlled non-heart-beating organ donors)., Methods: The charts of 209 patients who died during 1995 in the Emergency Department and the intensive care unit at the Foothills Hospital in Calgary were reviewed. The records of patients who met the criteria for controlled non-heart-beating organ donation were studied in detail. The main outcome measure was the time from discontinuation of ventilation until cardiopulmonary arrest., Results: Seventeen potential controlled non-heart-beating organ donors were identified. Their mean age was 62 (standard deviation 19) years. Twelve of the patients (71%) had had a cerebrovascular accident, and more than half (10 [59%]) did not meet the criteria for brain death because one or more brain stem reflexes were present. At the time of withdrawal of ventilatory support, the mean serum creatinine level was 71 (29) mumol/L, mean urine output was 214 (178) mL/h, and 9 (53%) patients were receiving inotropic agents. The mean time from withdrawal of ventilatory support to cardiac arrest was 2.3 (5.0) hours; 13 of the 17 patients died within 1 hour, and all but one died within 6 hours. For the year for which charts were reviewed, 33 potential conventional donors (people whose hearts were beating) were identified, of whom 21 (64%) became donors. On the assumption that 40% of the potential controlled non-heart-beating donors would not in fact have been donors (25% because of family refusal and 15% because of nonviability of the organs), there might have been 10 additional donors, which would have increased the supply of cadaveric kidneys for transplantation by 48%., Interpretation: A significant number of viable kidneys could be retrieved and transplanted if eligibility for kidney donation was extended to include controlled non-heart-beating organ donors.
- Published
- 1999
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