Publications by authors named "Brian D Badgwell"
Introduction: Prior work has established hyperthermic intraperitoneal chemotherapy (HIPEC) administration as a safe treatment option for select patients with gastric adenocarcinoma and carcinomatosis. However, identifying patients who will maximally benefit from HIPEC remains unclear. This study assessed a single-institution experience with HIPEC for metastatic gastric cancer to identify variables associated with improved survival.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to improve the classification of gastric neuroendocrine tumors (GNETs) and assess their outcomes, as some tumors didn't fit into the existing subtypes.
- Out of 246 patients examined from 1995 to 2021, the majority had type 1 GNETs, with type 3 GNETs showing higher chances of metastatic disease at diagnosis.
- The findings suggest that PPI-associated tumors may be a unique subtype with moderate survival rates, emphasizing the need to consider various factors when evaluating prognosis.
Background: Perioperative chemotherapy has become the standard of care for locally advanced gastric cancer. Total neoadjuvant therapy (TNT), including both chemotherapy and chemoradiation, is utilized in other gastrointestinal malignancies. We determined survival in a contemporary cohort of gastric cancer patients treated with TNT.
View Article and Find Full Text PDFObjective: To determine the magnitude of the perioperative costs associated with robotic gastrectomy (RG).
Background: A robotic surgery platform has a high implementation cost and requires maintenance costs; however, whether the overall cost of RG, including all perioperative costs, is higher than conventional open gastrectomy (OG) remains unknown.
Methods: Patients who underwent a major gastrectomy during February 2018 through December 2021 were retrospectively identified.
Background And Objectives: Patients with pancreatic and gastroesophageal (PGE) cancers experience high symptom burden, but patient experience throughout multimodality treatment remains unclear. We aimed to delineate the experience and symptom burden of patients throughout their perioperative course.
Methods: Qualitative interviews were performed with 17 surgical patients with PGE cancer.
Background: Few studies have focused on palliative surgery in patients with advanced gastroesophageal junction (GEJ) or gastric cancer. We sought to evaluate clinical observational outcomes following palliative surgery in this population.
Patients And Methods: Patients with GEJ or gastric cancer who underwent palliative surgery (1/2010-11/2022) were identified.
Article Synopsis
- Financial toxicity (FT) significantly affects cancer patients' treatment adherence and outcomes, particularly among those undergoing major upper gastrointestinal surgeries, with nearly half of surveyed patients experiencing FT.
- A study involving 627 patients revealed that younger age, non-White race, lower income, and poor credit scores were key factors linked to higher FT risk, alongside longer hospital stays and recovery times.
- Minimally invasive surgery (MIS) was found to reduce the likelihood of FT, highlighting the importance of surgical approaches that promote quicker recovery to mitigate financial challenges faced by these patients.
Purpose: To determine the efficacy and efficiency of laparoscopic transverse abdominis plane block (Lap-TAP) in patients undergoing pancreatoduodenectomy and gastrectomy compared to those of ultrasound-guided TAP (US-TAP).
Methods: We retrospectively analyzed the records of patients who underwent open or minimally invasive (MIS) pancreatoduodenectomy and major gastrectomy with the use of Lap-TAP or US-TAP at our institution between November 1, 2018, and September 30, 2021. We compared the estimated time and cost associated with Lap-TAP and US-TAP.
In gastroesophageal junction (GEJ) adenocarcinoma cases, a prognosis based on ypTNM staging could be affected by preoperative therapy. Patients with esophageal adenocarcinoma and gastric adenocarcinoma who underwent preoperative therapy followed by surgical resection from 2006 through 2017 were identified in the National Cancer Database. To enable stage-by-stage OS comparisons, tumors were classified into four gross ypTNM groups: ypT1/2, N-negative; ypT1/2, N-positive; ypT3/4, N-negative; and ypT3/4, N-positive.
View Article and Find Full Text PDFGastric cancer (GCa) is an aggressive malignancy, representing the third leading cause of cancer mortality worldwide. The poor prognosis of GCa can be associated with the prevalence of peritoneal metastasis (PM). Current international and national GCa treatment guidelines only recommend palliative treatment options for patients with PM.
View Article and Find Full Text PDFArticle Synopsis
- Robotic gastrectomy (RG) usage for gastric cancer treatment has significantly increased in the U.S. from 2010 to 2018, with a notable rise from 37 cases in 2010 to 412 in 2018.
- RG showed better short-term safety outcomes and oncological metrics compared to open and laparoscopic gastrectomy, with improvements over time in the number of lymph nodes examined, R0 resection rates, hospital stay length, readmission rates, and 90-day mortality.
- The indication for RG has broadened to include patients with more advanced cancer stages, high comorbidities, and those receiving preoperative therapy, indicating it is becoming a more common option
Background: Most patients with resectable gastric cancer present with locally advanced disease and warrant neoadjuvant chemotherapy based on level 1 evidence. However, the incremental benefit of adding radiation to chemotherapy as a neoadjuvant treatment strategy for these patients is less clear.
Methods: While awaiting the results of two ongoing randomized clinical trials attempting to specifically address this question (TOPGEAR and CRITICS-II), this article presents the debate between two gastric cancer surgery experts supporting each side of the argument on the use or omission of neoadjuvant radiation in this setting.
Background: There is little data describing symptom burden before or after gastrectomy for patients with cancer. We aimed to examine the perioperative patterns of symptom severity in patients undergoing gastrectomy.
Methods: In this single-institution prospective cohort study, patients scheduled to undergo gastrectomy for cancer completed serial symptom measurement questionnaires preoperatively, at postoperative day (POD) 1-3, and POD 4-7.
Background: The current standard operation for proximal gastric and gastroesophageal junction (P/GEJ) cancers with limited esophageal extension is total gastrectomy (TG). TG is associated with impaired appetite and weight loss due to the loss of gastric functions such as production of ghrelin and with anemia due to intrinsic factor loss and vitamin B malabsorption. Theoretically, proximal gastrectomy (PG) can mitigate these problems by preserving gastric function.
View Article and Find Full Text PDFBackground: Microscopically positive (R1) surgical margins after gastrectomy increase gastric cancer recurrence risk, but optimal management after R1 gastrectomy is controversial. We sought to identify the impact of R1 margins on recurrence patterns and survival in the era of preoperative therapy for gastric cancer.
Methods: Patients who underwent gastrectomy for adenocarcinoma during 1998-2017 at a major cancer center were enrolled.
Background: Whereas current guidelines recommend staging laparoscopy for most patients with potentially resectable gastric cancer, such a recommendation for patients with adenocarcinoma of the gastroesophageal junction (AEG) is lacking. This study sought to identify baseline clinicopathologic characteristics associated with peritoneal metastasis (PM) among patients with Siewert II AEG.
Methods: Trimodality therapy-eligible patients with Siewert II AEG (2000-2015, single institution) were retrospectively identified.
Article Synopsis
- A study was conducted to compare the safety and outcomes of robotic gastrectomy (RG) versus open gastrectomy (OG) for gastric cancer patients, as a RG program was initiated in 2018.
- The research monitored various short-term outcomes, including negative surgical margins, lymph node examination, and postoperative complications, finding that overall metrics of success were similar between the two surgical methods.
- Results showed RG patients experienced longer surgery times but less blood loss and shorter hospital stays compared to OG patients, indicating that RG can be safely implemented without compromising patient safety or oncological results.
Objective: To evaluate whether patients with advanced cancer prefer surgeons to use the best case/worst case (BC/WC) communication framework over the traditional risk/benefit (R/B) framework in the context of palliative surgical scenarios.
Background: Identifying the patient's preferred communication frameworks may improve satisfaction and outcome measures during difficult clinical decision-making.
Methods: In a video-vignette-based randomized, double-blinded study from November 2020 to May 2021, patients with advanced cancer viewed 2 videos depicting a physician-patient encounter in a palliative surgical scenario, in which the surgeon uses either the BC/WC or the R/B framework to discuss treatment options.
Objective: The aim of this study was to assess rates of palliative care (PC) involvement in the care of patients with malignant gastrointestinal obstruction (GIO) and its influence on interdisciplinary team involvement.
Background: Malignant GIO is an advanced oncologic diagnosis with associated poor prognosis. Data regarding PC and interdisciplinary team involvement in these patients is lacking.
Currently available data suggest that gastroesophageal junction (GEJ) cancers with an esophageal extension less than 2 cm can be removed using gastrectomy with a limited esophagectomy via a transhiatal approach and selective lower mediastinal dissection. In this multimedia article, we demonstrate our approach to robotic total gastrectomy with data-driven mediastinal lymph node (LN) dissection and sutured esophagojejunostomy for GEJ cancer.The video shows the case of a 63-year-old man with Siewert type 2 GEJ adenocarcinoma.
View Article and Find Full Text PDFIntroduction: Gastroesophageal adenocarcinoma is relatively common in elderly patients as the incidence increases with age. However, the optimal treatment approach is not well established in this group of patients. The aim of this study is to review our experience for localized gastroesophageal adenocarcinoma in patients aged ≥80 years and to assess association between patient characteristics, clinical factors, and overall survival (OS) in order to optimize the therapeutic approaches for this population.
View Article and Find Full Text PDFIntroduction: There are no approved locoregional therapies for peritoneal carcinomatosis from gastric adenocarcinoma (GA). Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) represents a potential treatment for advanced GA with isolated peritoneal metastasis.
Patients And Methods: Two separate single-institution phase II, single-arm studies evaluating CRS-HIPEC using cisplatin with mitomycin C (NIH: NCT03092518, MDACC: NCT02891447) in patients with GA and confirmed peritoneal metastasis were analyzed.