Publications by authors named "Garrett Nash"
Background: The watch-and-wait strategy provides an opportunity to pursue non-operative management in rectal cancer patients with clinical complete response after neoadjuvant therapy. The management of those with near complete response remains controversial.
Objective: We assessed the oncologic outcomes of patients managed by watch-and-wait versus total mesorectal excision according to clinical response to neoadjuvant therapy.
Article Synopsis
- Hemipelvectomy is a complex surgery typically aimed at curing cancer, but its use for palliative care in advanced cancer cases is quite rare and not well understood.
- A retrospective study reviewed outcomes for 10 patients with stage IV cancer who underwent this palliative procedure, revealing significant complications and limited survival benefits.
- While some patients experienced reduced pain, none showed functional improvement post-surgery, indicating that more conservative treatment options should be considered, especially for patients with less severe pelvic tumors.
Background: Appendiceal epithelial tumors are rare and encompass a broad set of adenocarcinoma histologies, including mucinous (mAC), colonic-type (cAC), and goblet cell (GCA) adenocarcinomas. It has previously been reported that nodal disease predicted recurrence in patients with nonmetastatic appendiceal adenocarcinomas, supporting diagnostic laparoscopy with right hemicolectomy for staging and assessment for risk of recurrence. In this update, we sought to identify predictors of nodal disease on initial diagnostic pathology in nonmetastatic adenocarcinomas.
View Article and Find Full Text PDFBackground: Surgical site infections (SSIs) are a major driver of morbidity after combined liver and colorectal surgery for metastatic colorectal cancer. Available literature is inadequate to characterize risk factors and benchmarks for quality improvement.
Methods: Consecutive cases of simultaneous liver and colorectal surgery for colorectal adenocarcinoma from November 2013 through September 2022 were reviewed for SSIs per National Surgical Quality Improvement Program (NSQIP) and National Healthcare Safety Network (NHSN) criteria.
Background And Objectives: Infrequent preoperative goals of care (GOC) documentation leads to challenges in medical decision-making when patients experience postoperative complications. We evaluated the feasibility of enhancing GOC documentation through a patient portal-based values questionnaire.
Methods: A patient values questionnaire (PVQ) was distributed to patients before their Gynecologic Surgical Oncology clinic appointments via an electronic health record (EHR)-based portal from June to October 2023.
Article Synopsis
- Total mesorectal excision with intersphincteric resection and handsewn coloanal anastomosis (ISR-CAA) is considered safe for patients with distal rectal cancer, but the outcomes for those not qualifying for a watch-and-wait strategy have yet to be studied.
- A retrospective analysis compared ISR-CAA with abdominoperineal resection (APR) in patients who received neoadjuvant therapy, showing similar tumor characteristics but differing local recurrence rates.
- Results revealed a lower 5-year local recurrence-free survival rate for ISR-CAA (79%) compared to APR (93%), while disease-free survival rates were similar for both groups.
Purpose: Well-differentiated papillary peritoneal mesothelial tumors (WDPMTs) are understudied and discrete from peritoneal mesotheliomas (PMs). We report clinicopathologic characteristics and outcomes of a large prospective WDPMT cohort.
Methods: Patients with WDPMT identified between August 2007 and December 2020 were followed through January 2023.
Article Synopsis
- Adenosquamous carcinoma (ASC) is a rare and severe form of colon cancer that often presents at more advanced stages compared to common adenocarcinomas, resulting in worse outcomes.
- A study reviewed 13 cases of colonic ASC from 2000 to 2020, revealing that most patients were diagnosed at Stage III or IV, with a median age of 48.7 years and a high recurrence rate (53.8%).
- The overall five-year survival rate for these patients was found to be only 38.5%, highlighting the need for further research to understand and improve management strategies.
Purpose: Outcome for patients with nonmetastatic, microsatellite instability (MSI) colon cancer is favorable: however, high-risk cohorts exist. This study was aimed at developing and validating a nomogram model to predict freedom from recurrence (FFR) for patients with resected MSI colon cancer.
Patients And Methods: Data from patients who underwent curative resection of stage I, II, or III MSI colon cancer in 2014-2021 (model training cohort, 384 patients, 33 events; median follow-up, 38.
Background: Neoadjuvant therapy leads to a clinical complete response in a considerable proportion of patients with locally advanced rectal cancer, allowing for possible nonoperative management. The presence of mucin on magnetic resonance imaging (MRI) after neoadjuvant therapy leads to uncertainty about residual disease and appropriateness of a watch-and-wait strategy in patients with no evidence of disease on proctoscopy (endoscopic clinical complete response).
Methods: MRI reports for locally advanced rectal cancer patients seen between July 2016 and January 2020 at Memorial Sloan Kettering Cancer Center were queried for presence of mucin in the tumor bed on MRI following neoadjuvant therapy.
Article Synopsis
- - A study evaluated the effectiveness of a convolutional neural network (CNN) in interpreting endoscopic images of rectal tumors, specifically focusing on identifying non-complete responses to total neoadjuvant therapy (TNT) and local regrowth during surveillance.
- - The CNN, based on ResNet-50 architecture, was trained on endoscopic images from patients treated between 2012 and 2020, achieving high accuracy (AUC of 0.99) in identifying tumors alongside surgeons and trainees, although it struggled with images indicating local regrowth.
- - Results showed that while the CNN performed comparably to surgeons in some aspects, its accuracy diminished with local regrowth images, highlighting challenges in distinguishing these cases compared to
Abdominoperineal resection (APR) has been advocated for persistent or recurrent disease after failure of chemoradiation (CRT) for anal squamous cell cancer (SCC). Treatment with salvage APR can potentially achieve a cure. This study aimed to analyze oncological outcomes for salvage APR in a recent time period at a comprehensive cancer center.
View Article and Find Full Text PDFObjective: Assess the significance of enlarged lateral lymph nodes (LLN) for disease recurrence, metastasis, and organ preservation in patients with rectal cancer.
Background: Optimal treatment of rectal adenocarcinoma involving LLN is subject to debate.
Methods: A post hoc analysis of the OPRA trial, a multicenter study of patients with rectal cancer treated with total neoadjuvant therapy (TNT) followed by total mesorectal excision or watch-and-wait management.
Background: Goals of care discussions are infrequently documented in the preoperative period. Furthermore, documentation does not consistently address what matters most to patients, although patient values (PV) are central to person-centered care.
Methods: A multidisciplinary working group was formed.
Aim: Tumour deposits are focal aggregates of cancer cells in pericolic fat and mesentery, distinct from vessels, nerves and lymphatics. Their presence upstages lymph node negative patients but is ignored in lymph node positive patients. We investigated the clinicopathological factors associated with tumour deposits and their impact on recurrence in lymph node positive and negative patients.
View Article and Find Full Text PDFBackground: Anal adenocarcinoma bears a treatment strategy unique to other anal cancers.
Objective: This study aimed to describe oncologic outcomes of total neoadjuvant therapy followed by watch-and-wait approach for anal adenocarcinoma.
Design: Retrospective analysis.
Article Synopsis
- The study examines treatment outcomes for asymptomatic patients with unresectable colorectal metastases who have untreated primary tumors, focusing on left-sided versus right-sided colon cancer.
- Out of 523 patients with stage IV colon cancer, 221 started treatment specifically for metastases, revealing that 21% developed complications requiring invasive intervention, with left-sided tumors facing a higher complication rate (29%) compared to right-sided tumors (13%).
- The findings suggest that left-sided primary tumors pose a greater risk for complications, indicating the need for careful monitoring and potential early surgical intervention for these patients.
Article Synopsis
- - The OPRA trial studied the long-term outcomes of different treatment sequences for stage II/III rectal cancer, comparing induction chemotherapy followed by chemoradiation (INCT-CRT) with chemoradiation followed by consolidation chemotherapy (CRT-CNCT) to evaluate organ preservation and oncologic results.
- - After a median follow-up of 5.1 years with 324 patients, the 5-year disease-free survival (DFS) rates were similar for both treatment groups, while TME-free survival was significantly higher in the CRT-CNCT group (54% vs. 39%).
- - The study found that most tumor regrowth occurred within the first 2 years for patients who opted for the watch-and-w
Background: The Memorial Sloan Kettering clinical calculator for estimating the likelihood of freedom from colon cancer recurrence on the basis of clinical and molecular variables was developed at a time when testing for microsatellite instability was performed selectively, based on patient age, family history, and histologic features. Microsatellite stability was assumed if no testing was done.
Objective: This study aimed to validate the calculator in a cohort of patients who had all been tested for microsatellite instability.
Objective: This systematic review aimed to identify key elements of perioperative team-based morbidity and mortality conferences (TBMMs) and their impact on patient safety, education, and quality improvement outcomes.
Background: Patient safety in the perioperative period is influenced by system, team, and individual behaviors. However, despite this recognition, single-discipline morbidity and mortality conferences remain a mainstay of educational and quality improvement efforts.
Background: In contrast to microsatellite stable (MSS) colon cancer, predictors of lymph node metastases and their association with recurrence are not well-defined in microsatellite instability (MSI) colon cancer.
Methods: A cohort of nonmetastatic colon cancer patients undergoing surgery between 2015 and 2021 were evaluated for predictors of lymph node metastases (LNMs) and their association with recurrence-free survival (RFS).
Results: Of 1466 patients included in the analyses, 361 (25 %) had MSI.