Surgical prophylaxis for inheritable malignant diseases: breast cancer and endocrine disease.

Despite advances in modern medicine, cancer remains all too common and deadly. At its core, cancer is a disease of our DNA. As such, many cancers are passed from parents to children, making cancer one of the most commonly inherited diseases.

Nutritional support with endoluminal stenting during neoadjuvant therapy for esophageal malignancy.

Background: Perioperative nutrition remains a significant problem in patients undergoing neoadjuvant treatment for esophageal cancer. The aim of this study was to evaluate the effectiveness of esophageal stenting, feeding tube placement, or observation among esophageal cancer patients receiving neoadjuvant therapy.

Methods And Materials: A review of our prospectively maintained database of esophageal cancer patients identified 58 patients who underwent neoadjuvant chemoradiotherapy.

An evaluation of 2537 gastrointestinal stromal tumors for a proposed clinical staging system.

Hypothesis: A gastrointestinal stromal tumor (GIST) staging system can be created with the Surveillance, Epidemiology and End Results (SEER) database.

Design: A review of records in the SEER database from 2537 patients with GISTs from June 1, 1977, through August 1, 2004.

Patients And Methods: Patients were compared using all available clinicopathologic factors, and a TGM (tumor, grade, metastasis) staging system was created according to these parameters.

Laparoscopic left pancreatectomy: complication risk score correlates with morbidity and risk for pancreatic fistula.

Background: Surgeons are performing laparoscopic left pancreatectomy (LLP) with increasing frequency; however, determinants of perioperative outcome after LLP are not well defined. We evaluated factors contributing to morbidity after LLP.

Methods: Records from patients undergoing LLP from 2000 to 2008 from nine academic medical centers were evaluated to assess risk factors for perioperative complications.

The impact of obesity on outcomes following pancreatectomy for malignancy.

Background: Obesity has previously been shown to correlate with higher stage and decreased survival in pancreatic cancer. The aim of this study was to determine the impact of obesity on operative outcomes, recurrence, and overall survival.

Methods: A review of our 1345 patient prospective hepatopancreaticobiliary database was performed to identify patients undergoing pancreatic resection from January 1991 to August 2008 for adenocarcinoma.

Surgical prophylaxis for inheritable malignant diseases: colorectal and gastric cancer.

Despite advances in modern medicine, cancer remains all too common and deadly. At its core, cancer is a disease of our DNA. As such, many cancers are passed from parents to children, making cancer one of the most commonly inherited diseases.

Simultaneous versus staged resection for synchronous colorectal cancer liver metastases.

Background: The aim of this study was to compare postoperative outcomes of patients with synchronous colorectal liver metastases treated with either simultaneous or staged colectomy and hepatectomy.

Study Design: From July 1997 to June 2008, a review of our 1,344-patient prospective hepato-pancreatico-biliary database identified 230 patients treated surgically for primary adenocarcinoma of the large bowel and synchronous hepatic metastasis. Clinicopathologic, operative, and perioperative data, complications, and grade of complications (grade 1, minor, to grade 5, death) were reviewed to evaluate selection criteria, operative methods, and perioperative outcomes.

Adjuvant chemoradiation therapy for pancreatic adenocarcinoma: who really benefits?

Background: The role of adjuvant chemoradiation therapy (CRT) in pancreatic cancer remains controversial. The primary aim of this study was to determine if CRT improved survival in patients with resected pancreatic cancer in a large, multiinstitutional cohort of patients.

Study Design: Patients undergoing resection for pancreatic adenocarcinoma from seven academic medical institutions were included.

Is selective internal radioembolization safe and effective for patients with inoperable hepatocellular carcinoma and venous thrombosis?

Background: The goal of this study was to examine the safety and efficacy of selective internal radioembolization (SIR) for hepatocellular carcinoma (HCC) with portal vein or caval thrombosis (VT), or both. Recent reports have demonstrated that SIR is safe for patients with HCC, but the impact on efficacy of venous thrombosis is unknown.

Study Design: Prospective single-arm study of the use of Therasphere in patients with unresectable HCC enrolled from January 2004 to June 2007.

Arterial and venous resection for pancreatic adenocarcinoma: operative and long-term outcomes.

Hypothesis: Aggressive preoperative and intraoperative management may improve the resectability rates and outcomes for locally advanced pancreatic adenocarcinoma with venous involvement. The efficacy and use of venous resection and especially arterial resection in the management of pancreatic adenocarcinoma remain controversial.

Design: Retrospective review of patients entered into prospective databases.

Proposed staging system for colon carcinoid tumors based on an analysis of 2,459 patients.

Background: Colon carcinoid remains an uncommon finding during screening endoscopy or operation, with little known about the longterm prognosis. The reason for this uncertainty is that no staging system exists to appropriately risk stratify or follow these patients for overall survival. We sought to investigate prognostic factors associated with colon carcinoid tumors and create a predictive staging system to accurately estimate prognosis.

Liver cell adenoma: a multicenter analysis of risk factors for rupture and malignancy.

Background: Liver cell adenoma (LCA) is a benign hepatic tumor with poorly characterized risk for spontaneous rupture and malignant transformation.

Methods: Records from five tertiary hepatobiliary centers were reviewed for all patients treated for LCA from 1997 to 2006. Clinicopathological data were collected and analyzed, and factors that were associated with rupture and/or malignant transformation were assessed by using multivariable logistic regression.

Preoperative performance status predicts outcome following heated intraperitoneal chemotherapy.

Background: Peritoneal carcinomatosis has a typical natural history of bowel obstruction and death. Significant evidence suggests that cytoreduction with heated intraperitoneal chemotherapy (HIPEC) improves long-term survival for these tumors.

Methods: A retrospective case series of patients who underwent initial HIPEC treatment was performed at 2 moderate-volume centers.

A proposed staging system for small bowel carcinoid tumors based on an analysis of 6,380 patients.

Background: Little is known about the long-term prognosis of small bowel carcinoids because currently no staging system exists.

Methods: A search of the Surveillance, Epidemiology and End Results (SEER) database identified 6,380 patients with small bowel carcinoid tumors from 1977 to 2004. Patients were analyzed according to various clinicopathologic factors and a tumor (T1, T2, T3), lymph node (N0, N1), and metastasis (M0, M1) staging system was created according to these parameters.

Preoperative chemotherapy does not increase morbidity or mortality of hepatic resection for colorectal cancer metastases.

Hepatic metastasis from colorectal cancer (mCRC) is best treated with a multidisciplinary approach. Conflicting data exist regarding the impact of preoperative chemotherapy on morbidity and mortality after hepatectomy. We hypothesized that preoperative chemotherapy does not adversely impact complications or mortality associated with hepatectomy.

Radiofrequency ablation vs. resection for hepatic colorectal metastasis: therapeutically equivalent?

Introduction: The role of ablation for hepatic colorectal metastases (HCM) continues to evolve as ablation technology changes and systemic chemotherapy improves. Our aim was to evaluate the therapeutic efficacy of radiofrequency ablation (RFA) of HCM compared to surgical resection.

Methods: A retrospective review of our 1,105 patient prospective hepatic database from August 1995 to July 2007 identified 192 patients with only hepatic resection or only ablation for HCM.

Diagnosis and management of soft tissue sarcomas.

STS are a heterogeneous group of malignant tumors that pose significant management challenges. The cornerstone of therapy for patients who have primary STS remains margin-negative resection. Adjuvant radiotherapy has been shown to reduce the risk of recurrence for extremity and trunk STS, although its role for retroperitoneal STS remains to be defined.

A proposed staging system for gastric carcinoid tumors based on an analysis of 1,543 patients.

The lack of a clinically relevant staging system for gastric carcinoid tumors creates a persistent challenge for clinicians trying to provide patients with meaningful prognostic information. The purpose of this study was to identify the clinicopathologic factors that affect survival for patients diagnosed with gastric carcinoid, and use this information to create a staging system. A search of 15,983 patients with carcinoid tumors from the Surveillance Epidemiology and End Results (SEER) database identified 1,543 patients with gastric carcinoid tumors from 1973 to 2004.

Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches.

Objectives: To compare perioperative outcomes of laparoscopic left-sided pancreatectomy (LLP) with traditional open left-sided pancreatectomy (OLP) in a multicenter experience.

Summary And Background Data: LLP is being performed more commonly with limited data comparing results with outcomes from OLP.

Methods: Data from 8 centers were combined for all cases performed between 2002-2006.

A proposed staging system for rectal carcinoid tumors based on an analysis of 4701 patients.

Background: The lack of a clinically relevant staging system for carcinoid tumors of the rectum creates a persistent challenge for clinicians trying to provide patients with meaningful prognostic information. The purpose of this study was to identify the clinicopathologic factors that affect survival for patients diagnosed with carcinoid of the rectum, and to use this information to create a staging system.

Methods: A search of 15,983 patients with carcinoid tumors from the National Cancer Institute's SEER (Surveillance Epidemiology and End Results) database identified 4701 patients with rectal carcinoid tumors from 1973 to 2004.

Empiric antibiotics for transarterial embolization in hepatocellular carcinoma: indicated?

Background: Transarterial embolization (TAE) remains a common treatment option in unresectable patients with hepatocellular cancer (HCC); however there are no standard protocols for post procedure care in these patients who often have extensive disease, marginal liver function, and multiple comorbidities. The aim of this study was to examine antibiotics use in HCC undergoing TAE.

Methods: A prospective review of our center's 1109 hepato-pancreatico-biliary patients, from 1/99 to 7/07, was performed to identify all HCC patients.

Analysis of 900 appendiceal carcinoid tumors for a proposed predictive staging system.

Background: Appendiceal carcinoid tumors (ACTs) are rare, and little is known about the long-term prognosis for these tumors because no staging system exists. Therefore, we sought to investigate prognostic factors associated with ACTs and to create a predictive staging system to accurately estimate prognosis.

Hypothesis: In patients with ACTs, TNM staging will accurately predict prognosis.

Effect of multiple-nodal basin drainage on cutaneous melanoma.

Hypothesis: The number of nodal basins draining a primary cutaneous melanoma is not an independent predictor of outcome.

Design: Post hoc analysis of patients entered into a randomized, prospective study.

Setting: Multi-institutional academic and community medical centers.

The use of self-expanding silicone stents in esophagectomy strictures: less cost and more efficiency.

Background: Benign and postoperative anastomotic esophageal strictures remain a common problem in the management of esophageal diseases and cancer. Repeated dilation remains the most common treatment algorithm. Esophageal stenting with a removable plastic stent is another option.