Publications by authors named "Brock Hewitt"

A number of patients with periampullary carcinoma deemed resectable on preoperative CT have their curative-intent surgery aborted on the basis of intraoperative findings. This study sought to identify imaging and clinical factors associated with aborted curative-intent Whipple procedures for periampullary adenocarcinoma. Ten U.

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Summary Of Background Data: Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic cancer is typically managed like pancreatic intraepithelial neoplasia (PanIN)-derived pancreatic cancer. However, in IPMN-derived pancreatic cancer, the role of chemotherapy remains controversial, particularly in the neoadjuvant setting (NAT).

Objective: To evaluate the role of neoadjuvant chemotherapy in IPMN-derived pancreatic cancer.

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Background: Histotripsy is a novel, noninvasive, nonionizing, and nonthermal approach that uses focused ultrasound waves to treat liver tumors. This technology received a de novo Food and Drug Administration grant in late 2023. This study aimed to provide the first report on post-trial real-world clinical safety data.

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Background: The current evaluation of surgical resident operative autonomy consists primarily of self-report and is prone to bias. Objective performance indicators (OPIs) generated from the da Vinci Surgical System capture objective intraoperative data providing an opportunity to evaluate the intraoperative resident experience more accurately. This study investigates the ability of OPIs to describe resident autonomy during robotic cholecystectomy.

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Background: To improve outcomes for patients with pancreatic ductal adenocarcinoma, a complete resection is crucial. However, evidence regarding the impact of microscopically positive surgical margins (R1) on recurrence is conflicting due to varying definitions and limited populations of patients with borderline-resectable and locally advanced pancreatic cancer. Therefore, we aimed to determine the impact of the resection margin status on recurrence and survival in patients with pancreatic ductal adenocarcinoma stratified by local tumor stage.

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Background: The National Comprehensive Cancer Network guidelines consider pancreatic cancer with celiac axis (CA), proper hepatic artery (PHA), and superior mesenteric artery (SMA) involvement unresectable. Thus, technical reports and video illustrations of these operations are rare. We report the stepwise management of multivascular reconstruction for Mayo Clinic class IIIb CA resections at New York University Langone Health, a dedicated center of excellence in pancreatic surgery.

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Objectives: To evaluate patient preferences for decision-making role in the management of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas and to identify individual characteristics associated with those preferences.

Background: Management of IPMNs is rooted in uncertainty with current guidelines failing to incorporate patients' preferences and values.

Methods: A representative sample of participants aged 40-70 were recruited to evaluate a clinical vignette where they were given the option to undergo surveillance or surgical resection of their IPMN.

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Purpose: Dynamics of carbohydrate antigen 19-9 (CA19-9) often inform treatment decisions during and after neoadjuvant chemotherapy (NAT) of patients with pancreatic ductal adenocarcinoma (PDAC). However, considerable dispute persists regarding the clinical relevance of specific CA19-9 thresholds and dynamics. Therefore, we aimed to define optimal thresholds for CA19-9 values and create a biochemically driven composite score to predict survival in CA19-9-producing patients with PDAC after NAT.

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Introduction: Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic premalignant lesions frequently detected incidentally. Choosing between surgery and surveillance for IPMNs is rooted in uncertainty. We characterized patient preferences in IPMN management, and examined associations with patients' uncertainty profiles (risk perception, risk attitude, and uncertainty tolerance).

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The majority of patients diagnosed with pancreatic cancer already have metastatic disease at the time of presentation, which results in a 5-year survival rate of only 13%. However, multiagent chemotherapy regimens can stabilize the disease in select patients with limited metastatic disease. For such patients, a combination of curative-intent therapy and systemic therapy may potentially enhance outcomes compared to using systemic therapy alone.

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Objective: To determine the interobserver variability for complications of pancreatoduodenectomy as defined by the International Study Group for Pancreatic Surgery (ISGPS) and others.

Background: Good interobserver variability for the definitions of surgical complications is of major importance in comparing surgical outcomes between and within centers. However, data on interobserver variability for pancreatoduodenectomy-specific complications are lacking.

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Background And Aim: Intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC) management is generally extrapolated from pancreatic intraepithelial neoplasia (PanIN)-derived PDAC guidelines. However, these are biologically divergent, and heterogeneity further exists between tubular and colloid subtypes.

Methods: Consecutive upfront surgery patients with PanIN-derived and IPMN-derived PDAC were retrospectively identified from international centers (2000-2019).

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Article Synopsis
  • Researchers studied a classification system called T1 sub-staging for IPMN-derived pancreatic ductal adenocarcinoma (PDAC), aiming to better understand its characteristics compared to other types of PDAC.
  • The study involved 747 surgery patients and found that increased T-stages correlated with worse overall survival, more advanced disease features, and higher recurrence rates.
  • The findings support the validity of T1 sub-staging, indicating that higher sub-stages relate to poorer outcomes and suggesting its importance in clinical assessments.
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Article Synopsis
  • - The study investigates the effects of different surgical procedures (pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy) on outcomes for patients with pancreatic neck tumors, finding similar rates of successful tumor removal (R0-resection) across these methods.
  • - Among 846 patients analyzed, results showed significant differences in lymph node involvement and the number of lymph nodes examined, with total pancreatectomy associated with worse survival rates compared to pancreatoduodenectomy.
  • - The findings suggest that while distal pancreatectomy may lead to inadequate lymph node removal, this did not adversely affect patient survival, indicating that total pancreatectomy does not provide additional survival benefits over partial resections.
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Background Objectives: The aim of this study was to determine the role of site-specific metastatic patterns over time and assess factors associated with extended survival in metastatic PDAC. Half of all patients with pancreatic ductal adenocarcinoma (PDAC) present with metastatic disease. The site of metastasis plays a crucial role in clinical decision making due to its prognostic value.

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Objective: We aimed to better understand patients' treatment preferences and quantify the level of cancer risk at which treatment preferences change (risk threshold) to inform better counseling of patients with intraductal papillary mucinous neoplasms (IPMNs).

Summary Background Data: The complexity of IPMN management provides an opportunity to align treatment with individual preference.

Methods: We surveyed a sample of healthy volunteers simulating a common scenario: undergoing an imaging study that incidentally identifies an IPMN.

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Article Synopsis
  • The study seeks to determine the minimum and optimal number of lymph nodes (LNs) needed for effective staging and determining survival outcomes in patients with intraductal papillary mucinous neoplasm (IPMN)-derived pancreatic ductal adenocarcinoma (PDAC).
  • Current guidelines suggest a minimum of 12-15 LNs based on different cancer types, but this study specifically evaluates the IPMN subtype, showing that at least 10 LNs are necessary for accurate staging.
  • The findings indicate that examining 20 or more LNs is linked to significantly better overall survival rates (80.3 months vs. 37.2 months), with optimal cut-off points varying based on the type of surgical procedure performed.
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Article Synopsis
  • Pancreatic cancer has a low 5-year survival rate of only 12%, despite improvements in treatment methods.
  • The study reviews how deep learning (DL) technology can be applied to enhance diagnosis, management, and monitoring of pancreatic cancer.
  • AI is highlighted as a promising emerging technology that could significantly impact the care of patients with this disease.
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Background: The relationship between surgical delay and outcomes for patients with cutaneous melanoma is understudied. The objectives of this study were to determine the impact of surgical delay on regional nodal involvement and mortality in patients with cutaneous melanoma.

Methods: Retrospective study of patients diagnosed with clinically node-negative invasive cutaneous melanoma from 2004 to 2018.

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Background: Choledochal cysts (CCs) are rare cystic dilatations of the intrahepatic and/or extrahepatic bile ducts. We review the pathophysiology, diagnosis, and management of CCs.

Methods: MEDLINE/PubMed and Web of Science databases were queried for "choledochal cyst", "bile duct cyst", "choledochocele", and "Caroli disease".

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