Publications by authors named "Iris H Wei"
Background: 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.
ASO Visual Abstract: Outcomes of Distal Rectal Cancer Patients Who Did Not Qualify for Watch-and-Wait-Comparison of Intersphincteric Resection Versus Abdominoperineal Resection.
Ann Surg Oncol
January 2025
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.
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: Weekend surgical time is an underused asset. Concerns over a possible weekend effect (substandard care) may be a barrier.
Methods: This study examined whether a weekend effect applies to elective colorectal surgery via a single-center retrospective analysis comparing outcomes between patients who underwent elective colorectal surgery on a weekend vs a weekday.
Assessing Endoscopic Response in Locally Advanced Rectal Cancer Treated with Total Neoadjuvant Therapy: Development and Validation of a Highly Accurate Convolutional Neural Network.
Ann Surg Oncol
October 2024
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
Objective: 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.
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.
Nonoperative management of the primary tumor in patients with unresectable stage IV colon cancer treated with systemic chemotherapy: Higher complication rates for left-sided colon tumors.
Eur J Surg Oncol
January 2024
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.
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.
Article Synopsis
- * Robotic colectomy resulted in shorter hospital stays (5 vs. 6 days) and fewer cases needing a switch to open surgery (3% vs. 17%) than laparoscopic colectomy.
- * Both surgical methods had similar rates of complications, overall survival, and disease-free survival, showing that robotic colectomy benefits elderly patients without affecting their cancer treatment outcomes.
MRI Assessment of Extramural Venous Invasion Before and After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer and Its Association with Disease-Free and Overall Survival.
Ann Surg Oncol
July 2023
Background: Extramural venous invasion (EMVI) on baseline MRI is associated with poor prognosis in patients with locally advanced rectal cancer. This study investigated the association of persistent EMVI after total neoadjuvant therapy (TNT) (chemoradiotherapy and systemic chemotherapy) with survival.
Methods: Baseline MRI, post-TNT MRI, and surgical pathology data from 175 patients with locally advanced rectal cancer who underwent TNT and total mesorectal excision between 2010 and 2017 were retrospectively analyzed for evidence of EMVI.
Article Synopsis
- The study compares survival rates for robotic, laparoscopic, and open surgical resections in patients with nonmetastatic colon cancer, focusing on outcomes and complications associated with each approach.
- A total of 2398 patients were included, with robotic surgery leading to higher lymph node yields and fewer complications compared to laparoscopic and open surgery; however, there was no significant difference in overall or disease-free survival among the methods.
- The research highlights that while minimally invasive techniques offered benefits like shorter hospital stays and lower complication rates, the findings are limited due to being a retrospective study from a single cancer center.
Despite improvements in surgical techniques, functional outcomes and quality of life after therapy for rectal cancer remain suboptimal. We sought to prospectively evaluate the effect of bowel, bladder, and sexual functional outcomes on health-related quality of life (QOL) in patients with restorative versus non-restorative resections after rectal cancer surgery. A cohort of 211 patients with clinical stage I-III rectal cancer who underwent open surgery between 2006 and 2009 at Memorial Sloan Kettering were included.
View Article and Find Full Text PDFImportance: The risk of recurrence in patients with locally advanced rectal cancer has historically been determined after surgery, relying on pathologic variables. A growing number of patients are being treated without surgery, and their risk of recurrence needs to be calculated differently.
Objective: To develop a dynamic calculator for estimating the probability of recurrence-free survival (RFS) in patients with rectal cancer who undergo total neoadjuvant therapy (TNT) (induction systemic chemotherapy and chemoradiotherapy) and either surgery or watch-and-wait management.
Background: There is limited knowledge on long-term bowel, sexual, and urinary function after combined modality therapy for anal squamous-cell cancer.
Objective: This study aimed to evaluate long-term changes in patients treated with combined modality.
Design: This was a retrospective study of prospectively collected patient-reported outcome surveys.
The incidence of rectal cancer is increasing in patients younger than 50 years. Locally advanced rectal cancer is still treated with neoadjuvant radiation, chemotherapy and surgery, but recent evidence suggests that patients with a complete response can avoid surgery permanently. To define correlates of response to neoadjuvant therapy, we analyzed genomic and transcriptomic profiles of 738 untreated rectal cancers.
View Article and Find Full Text PDFAim: This study evaluates the relationship of tumour and anatomical features with operative difficulty in robotic low anterior resection performed by four experienced surgeons in a high-volume colorectal cancer practice.
Methods: Data from 382 patients who underwent robotic low anterior resection by four expert surgeons between January 2016 and June 2019 were included in the analysis. Operating time was used as a measure of operative difficulty.
Article Synopsis
- A clinical trial was conducted to evaluate the effectiveness of a watch-and-wait strategy in preserving organs for patients with locally advanced rectal cancer after total neoadjuvant therapy, involving 324 patients.
- Both groups receiving different treatment sequences (induction chemotherapy followed by chemoradiotherapy vs. chemoradiotherapy followed by consolidation chemotherapy) showed a similar 3-year disease-free survival (DFS) rate of about 76%.
- Results indicated that approximately half of the patients could avoid total mesorectal excision (TME) while maintaining survival rates comparable to historical data, suggesting organ preservation is a viable option.