Publications by authors named "Ejaz Aslam"
Background: A 5 cm margin is advocated for distal gastric adenocarcinoma (GAC). The optimal proximal resection margin (PM) length for proximal GAC is not established.
Methods: Patients who underwent curative-intent resection for proximal GAC from 2000 to 2012 at 7 centers in the US Gastric Cancer Collaborative were included.
Background: Fluid administration among patients undergoing liver resection is a key aspect of perioperative care. We sought to examine practice patterns of crystalloid administration, as well as potential factors associated with receipt of crystalloid fluids.
Method: Patients who underwent liver resection between 2010 and 2014 were identified.
Objectives: To define the incidence of 90-day readmission and characterize the factors associated with 90-day readmission after 10 major surgical procedures.
Background: Most data on readmission focus solely on same hospital readmission (index hospitals) within 30 days of discharge. These studies may underestimate readmission, as patients may be readmitted beyond 30 days of discharge or to other non-index hospitals.
Background: Understanding factors associated with variation in hospital charges may help identify means to increase savings. The aim of the present study was to define potential variation in hospital charges associated with hepatopancreatobiliary(HPB) surgery.
Methods: Patients who underwent an HPB procedure between 2009-2013 were identified.
Background: Jejunostomy feeding tubes (J-tubes) are often placed during resection for gastric adenocarcinoma (GAC). Their effect on postoperative complications and receipt of adjuvant therapy is unclear.
Methods: Patients who underwent curative-intent resection of GAC at seven institutions of the U.
Background: The prognostic effect of perioperative blood transfusion on recurrence and survival in patients undergoing resection of gastric adenocarcinoma (GAC) remains controversial.
Study Design: All patients who underwent resection for GAC from 2000 to 2012 at the 7 institutions of the US Gastric Cancer Collaborative were identified. The effect of transfusion on recurrence-free (RFS) and overall survival (OS) in the context of adverse clinicopathologic variables was examined by univariate and multivariate regression analyses.
Importance: Delta hemoglobin (ΔHb), defined as the difference between the preoperative hemoglobin (Hb) level and the nadir Hb level during a patient's hospitalization, may be associated with adverse outcomes even if the absolute level of Hb remains greater than the transfusion threshold of 7 g/dL.
Objective: To evaluate the association between ΔHb and morbidity in patients who undergo major gastrointestinal surgery as an independent factor or combined with the nadir Hb concentration.
Design, Setting, And Participants: Retrospective review of prospectively collected data on patients who underwent pancreatic, hepatic, or colorectal resection from January 1, 2010, through April 30, 2014, at Johns Hopkins Hospital were included in the study.
Background: Conflicting data exist on the prognostic implication of signet-ring cell (SRC) histology in gastric adenocarcinoma (GAC).
Methods: All patients who underwent curative-intent resection of GAC from the seven institutions of the U.S.
Background: Data on cost-effectiveness and efficacy of hepatic resection (HR) for advanced intrahepatic cholangiocarcinoma (ICC) are lacking. We sought to estimate the cost-effectiveness of upfront HR resulting in an R1 resection (strategy A) relative to initial systemic chemotherapy (sCT) followed by possible curative HR (strategy B) for patients with advanced ICC.
Methods: A Markov model was developed using data from a systematic literature review.
Background: The objective of the current study was to characterize the prevalence of the expectation that surgical resection of lung or colorectal cancer might be curative. The authors sought to assess patient-level, tumor-level, and communication-level factors associated with the perception of cure.
Methods: Between 2003 and 2005, a total of 3954 patients who underwent cancer-directed surgery for lung (30.
Hepatic Resection for Disappearing Liver Metastasis: a Cost-Utility Analysis.
J Gastrointest Surg
September 2015
Background: We sought to estimate the cost-effectiveness of hepatic resection (HR) (strategy A) relative to surveillance plus 6 months of additional systemic chemotherapy (sCT) (strategy B) for patients with colorectal disappearing liver metastases (DLM).
Methods: A Markov model was developed using data from a systematic literature review. Three base cases were evaluated: (1) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT, had normalized carcinoembryonic antigen (CEA), and was diagnosed with DLM through a computed tomography (CT) scan; (2) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT, had normalized CEA, and was diagnosed with DLM through a magnetic resonance imaging (MRI) scan; and (3) a 60-year-old patient with three lesions in the right hemi-liver who underwent 6 months of sCT plus hepatic artery infusion (HAI), had normalized CEA, and was diagnosed with DLM through a MRI scan.
Background: Data on hemoglobin (Hb) threshold levels for "appropriate" packed red blood cell (PRBC) transfusions have not taken into account patient-specific variables such as sex and age. We sought to define differences in perioperative transfusion practices based on patient sex and age among patients undergoing complex gastrointestinal (GI) and cardiothoracic-vascular (CT-V) surgical procedures.
Methods: All patients undergoing any major GI or CT-V procedures between January 2010 and April 2014 at the Johns Hopkins Hospital were identified.
Importance: Currently, one of the most commonly available biomarkers in the treatment of patients with colorectal liver metastases (CRLM) is the Kirsten rat sarcoma viral oncogene homolog (KRAS); however, the prognostic implications of specific mutations of the KRAS gene are still not well defined.
Objective: To investigate the prognostic impact of specific KRAS mutations on patients undergoing liver resection for CRLM.
Design, Setting, And Participants: This retrospective single-center study was conducted from January 1, 2003, to December 31, 2013.
Background: The effect of routine drainage after abdominal surgery with enteric anastomoses is controversial. In particular, the role of peritoneal drain (PD) placement after total gastrectomy for adenocarcinoma is not well established.
Methods: Patients who underwent total gastrectomy for gastric adenocarcinoma (GAC) at seven institutions from the US Gastric Cancer Collaborative, from 2000 to 2012, were identified.
Background: Resident participation during hepatic and pancreatic resections varies. The impact of resident participation on surgical outcomes in hepatic and pancreatic operations is poorly defined.
Methods: We identified 25,511 patients undergoing a hepatic or pancreatic resection between 2006 and 2012 using the American College of Surgeons National Surgical Quality Improvement Program database.
Background: Management of patients with neuroendocrine liver metastasis (NELM) remains controversial. We sought to compare the net health benefit (NHB) of hepatic resection (HR) versus intraarterial therapy (IAT) among patients with NELM.
Methods: A decision analytic Markov model was created to estimate and compare the cost effectiveness associated with different management strategies (HR vs IAT) for a simulated cohort of patients with NELM.
Background: We sought to define the overall utilization of fresh frozen plasma (FFP) and platelets and the impact on perioperative outcomes among patients undergoing hepatopancreaticobiliary and colorectal resections, as well as analyze the utility of laboratory triggers in guiding transfusion practice.
Methods: We identified 3027 patients undergoing pancreatic, hepatic, and colorectal resections between 2010 and 2013 at Johns Hopkins Hospital. Data on international normalized ratio (INR) and platelet counts that triggered the perioperative utilization of these non-RBC (red blood cell) products were obtained and analyzed.
Importance: Transfusion practice among surgeons varies despite several evidence-based recommendations supporting the restrictive use of blood products.
Objective: To define the economic impact of liberal blood transfusions as assessed through an analysis of hemoglobin (Hb) triggers.
Design, Setting, And Participants: Using a prospective database, data on Hb levels that triggered a transfusion and overall blood product use were obtained for patients undergoing pancreas, liver, or colorectal surgery between January 1, 2010, and August 31, 2013, at Johns Hopkins Hospital.
Background: The American College of Surgeons recently added liver-specific variables to the National Surgical Quality Improvement Program (NSQIP). We sought to use these variables to define patterns of care, as well as characterize perioperative outcomes among patients undergoing hepatic resection.
Methods: The American College of Surgeons-NSQIP database was queried for all patients undergoing hepatic resection between January 1, 2013 and December 31, 2013 (n = 2448).
Importance: Whereas conventional actuarial overall survival (OS) estimates rely exclusively on static factors determined around the time of surgery, conditional survival (CS) estimates take into account the years that a patient has already survived.
Objective: To define the CS of patients following liver resection for intrahepatic cholangiocarcinoma (ICC).
Design, Setting, And Participants: Between January 1, 1990, and December 31, 2013, a total of 535 patients who underwent resection of ICC were identified from an international multi-institutional database.
Background: Most studies focus on readmission within 30 d of surgery and may therefore underestimate the true burden of readmission after complex procedures. We therefore sought to explore factors associated with readmission within 90 d of discharge after pancreaticoduodenectomy (PD).
Methods: Patients discharged after PD between 2010 and 2012 were identified from the Truven Health MarketScan database.
Background: The long-term impact of transfusions with packed red blood cells (PRBC) among patients undergoing hepatopancreaticobiliary (HPB) surgery remains ill-defined. We sought to determine the impact of overall blood utilization, as well as a restrictive transfusion strategy, on long-term outcomes among patients undergoing an HPB resection for a malignancy.
Methods: Data on overall blood utilization and hemoglobin (Hb) levels that triggered a transfusion were obtained for patients with cancer undergoing pancreas or liver surgery between 2009 and 2013.
Background: There are no conclusive cost-effectiveness studies measuring the efficacy of salvage LT after liver resection (LR) and radiofrequency ablation (RFA) in patients with early hepatocellular carcinoma (HCC) and compensated cirrhosis. The aim of the present study is to compare liver transplantation (LT) versus locoregional therapy plus salvage LT (to treat tumor recurrence) in patients with early HCC and compensated cirrhosis.
Methods: Reference case: 55-year old male with HCC within Milan criteria and Child-Pugh A cirrhosis.
Background: Metastatic disease to the regional lymph node (LN) is a strong predictor of worse long-term outcome after curative-intent resection of intrahepatic cholangiocarcinoma (ICC). The objectives of this study were to assess the prognostic performance of American Joint Committee on Cancer (AJCC)/International Union Against Cancer, 7th edition, N stage, LN ratio (LNR), and log odds of metastatic LN (LODDS) staging criteria in patients with ICC.
Methods: The surveillance, epidemiology, and end results cancer registry was queried to identify 749 patients who underwent surgical resection of ICC during 1988-2011.