Publications by authors named "Toms Augustin"
Importance: There is sparse literature on whether routine cholangiography (RC) vs selective cholangiography (SC) during cholecystectomy is associated with improved perioperative outcomes, regardless of whether an intraoperative cholangiogram (IOC) is performed.
Objective: To compare perioperative outcomes of cholecystectomy between surgeons who routinely vs selectively perform IOC.
Design, Setting, And Participants: This retrospective cohort study was conducted from January 2015 through June 2023 and took place within the Cleveland Clinic Enterprise, which includes 18 hospitals and 9 ambulatory surgery centers in 2 states (Ohio and Florida).
Introduction: Pancreatic acinar cell carcinoma (pACC) is a rare malignancy with unique clinical and molecular features. The role of chemotherapy in pACC management is not well established.
Methods: The National Cancer Database (NCDB) for pACC was used.
Article Synopsis
- Obesity significantly increases the risk of idiopathic intracranial hypertension (IIH), and this study investigates how bariatric surgery impacts clinical outcomes for patients with both conditions.
- The study analyzed data from 97 predominantly female patients (median age 46.7) who underwent various types of bariatric surgery, leading to a median weight loss of 24% and notable improvements in IIH symptoms, including headaches and visual issues.
- Results showed a significant reduction in mean lumbar opening pressure and a decrease in the usage of medications for IIH post-surgery, indicating that bariatric surgery can effectively alleviate IIH symptoms in obese patients.
Article Synopsis
- Subtotal cholecystectomy is an alternative surgical option for complicated gallbladder cases, and this study compares two types, fenestrating and reconstituting, to assess their long-term outcomes.
- The retrospective analysis, conducted on 218 patients, showed that both surgical techniques had similar rates of complications such as bile duct injury and bile leak, with laparoscopic procedures yielding better results overall.
- The study revealed a high patient-reported quality of life, with few instances of recurrent symptoms; however, 37.2% of patients experienced some dietary restrictions post-surgery.
Objective: Study findings showing an association between nonsteroidal anti-inflammatory drug use and marginal ulcer, a significant cause of morbidity after gastrojejunostomy, have been inconsistent. This study aimed to evaluate this relationship in large cohort.
Methods: This retrospective cohort included adult patients with a history of gastrojejunostomy documented between 2004 and 2023.
Background: Branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) are becoming more prevalent with advanced medical imaging and account for most of pancreatic cystic neoplasms (PCNs). Most incidental lesions should be surveyed, with resection reserved for specific, high-risk cases. Solid organ transplantation candidates may be high risk of resection before transplant and will require systemic immunosuppression after transplant, which has been theorized to alter the natural history of the IPMN.
View Article and Find Full Text PDFBackground: The frequency of minimally invasive distal pancreatectomy is gradually exceeding that of the open approach. Our study aims to compare short-term outcomes of robotic (RDP) and laparoscopic (LDP) distal pancreatectomies for pancreatic ductal adenocarcinoma (PDAC) using a national database.
Methods: The National Cancer Database was utilized to identify patients with PDAC who underwent distal pancreatectomy from 2010-2020.
Article Synopsis
- * Among the 2,596 patients analyzed, those receiving NAST had better results in terms of nodal harvest and lower rates of node positivity, but they did not experience improved overall survival (OS) after surgery compared to those who had immediate surgery.
- * The findings suggest that while NAST may enhance the quality of oncologic resection, it does not provide a survival advantage, with node positivity and positive margins being significant risk factors for reduced OS.
Purpose: Postoperative pancreatic fistula (POPF) remains a devastating complication of pancreatoduodenectomy (PD). Minimally invasive PD (MIPD), including laparoscopic (LPD) and robotic (RPD) approaches, have comparable POPF rates to open PD (OPD). However, we hypothesize that the likelihood of having a more severe POPF, as defined as clinically relevant POPF (CR-POPF), would be higher in an MIPD relative to OPD.
View Article and Find Full Text PDFArticle Synopsis
- The study aimed to measure how quickly side-branch intraductal papillary mucinous neoplasms (SB-IPMNs) progress and identify which factors may delay surgery.
- Out of 1,337 patients identified with SB-IPMN, only 2.7% had immediate surgery, while 75% were monitored over time, revealing that 15.3% showed clinically relevant progression indicating potential for cancer development.
- Patients whose SB-IPMN progressed clinically had a significantly higher risk of invasive cancer and better survival rates if surgically resected, although size alone (≥3 cm) did not predict cancer risk.
Objective: Develop and validate a mortality risk calculator that could be utilized at the time of transfer, leveraging routinely collected variables that could be obtained by trained non-clinical transfer personnel.
Summary Background Data: There are no objective tools to predict mortality at the time of inter-hospital transfer for Emergency General Surgery (EGS) patients that are "unseen" by the accepting system.
Methods: Patients transferred to general or colorectal surgery services from January 2016 through August 2022 were retrospectively identified and randomly divided into training and validation cohorts (3:1 ratio).
Article Synopsis
- Five-year survival rates for pancreatic adenocarcinoma are below 20%, and the role of carbohydrate antigen 19-9 (CA19-9) in predicting outcomes post-surgery is unclear.
- A study of 109 patients analyzed the relationship between CA19-9 levels, tumor size, and survival outcomes after surgery, distinguishing between short (less than 1 year) and prolonged (more than 2 years) survival.
- Results showed that higher CA19-9 levels were linked to shorter survival, particularly for small (≤2 cm) and large (>4 cm) tumors, suggesting that combined CA19-9 levels and tumor size can improve predictions of post-surgery outcomes.
Introduction: Minimally invasive Pancreatoduodenectomy (MIPD), or the Whipple procedure, is increasingly utilized. No study has compared laparoscopic (LPD) and robotic (RPD) approaches, and the impact of the learning curve on oncologic, technical, and post-operative outcomes remains relatively understudied.
Methods: The National Cancer Database was queried for patients undergoing LPD or RPD from 2010 to 2020 with a diagnosis of pancreatic cancer.
Objective: Serous cystic neoplasms (SCN) are benign pancreatic cystic neoplasms that may require resection based on local complications and rate of growth. We aimed to develop a predictive model for the growth curve of SCNs to aid in the clinical decision making of determining need for surgical resection.
Methods: Utilizing a prospectively maintained pancreatic cyst database from a single institution, patients with SCNs were identified.
Background: Gallbladder cancer (GBC) is the most common biliary tract malignancy and has a poor prognosis. The clinical significance of focal vs diffuse GBC remains unclear.
Methods: A retrospective review was conducted on all patients with non-metastatic GBC at a quaternary care center.
Article Synopsis
- Colorectal cancer liver metastasis (CRLM) is common and significantly impacts patient outcomes, with liver resection being the preferred treatment for resectable cases; the safety of intraoperative autotransfusion during this procedure is debated.
- This study analyzed data from 316 patients who underwent liver surgery for CRLM between 1999 and 2016, focusing on demographics, surgical variables, and survival rates, using propensity score matching to mitigate potential biases.
- Results indicated that while the overall survival rates were similar regardless of autotransfusion, patients receiving autotransfusion experienced a significant reduction in recurrence-free survival, leading to concerns about its use in surgical treatment for CRLM.
This position statement is issued by the American Society for Metabolic and Bariatric. Surgery in response to inquiries made to the Society by patients, physicians, Society members, hospitals, health insurance payors, the media, and others regarding the access and outcomes of metabolic and bariatric surgery for beneficiaries of Centers for Medicare and Medicaid Services. This position statement is based on current clinical knowledge, expert opinion, and published peer-reviewed scientific evidence available at this time.
View Article and Find Full Text PDFIntroduction: The Neoadjuvant Rectal score (NAR) was developed as a short-term surrogate for 5-year overall survival (OS) prediction in locally advanced rectal cancer on the basis of response to neoadjuvant therapy. We aim to assess whether this score can be repurposed for locally advanced gastric adenocarcinoma treated with neoadjuvant chemotherapy followed by surgical resection.
Methods: Patients with gastric adenocarcinoma treated with neoadjuvant systemic therapy followed by surgical resection were extracted from the National Cancer Database.
Introduction: Drain amylase on day 1 (DA-D1) after pancreaticoduodendectomy (PD) to predict occurrence of postoperative pancreatic fistula (POPF) is controversial. In this study, we evaluate the optimal DA-D1 level to predict clinically relevant POPF (CR-POPF).
Methods: The 2014-2020 NSQIP pancreatectomy-targeted database was queried for patients who underwent elective PD.
Introduction: Cirrhotic patients with primary liver cancer may undergo curative-intent resection when selected appropriately. Patients with T1 tumors and low-MELD are generally referred for resection. We aim to evaluate whether minimally invasive hepatectomy (MIH) is associated with improved outcomes versus open hepatectomy (OH).
View Article and Find Full Text PDFBackground: In distal pancreatectomy (DP) for pancreatic ductal adenocarcinoma (PDAC), we hypothesize that minimally invasive DP (MIDP) carries short-term benefits over ODP (ODP) in the absence of postoperative pancreatic fistula (POPF).
Methods: NSQIP database was queried to select patients who underwent DP for PDAC with available report on POPF. The population was divided into No-POPF vs.
This literature review is issued by the American Society for Metabolic and Bariatric Surgery regarding limb lengths in Roux-en-Y gastric bypass (RYGB) and their effect on metabolic and bariatric outcomes. Limbs in RYGB consist of the alimentary and biliopancreatic limbs and the common channel. Variation of limb lengths in primary RYGB and as a revisional option for weight recurrence after RYGB are described in this review.
View Article and Find Full Text PDFIntroduction: Idiopathic acute pancreatitis (IAP) is a diagnosis of exclusion; systematic work-up is challenging but essential. Recent advances suggest IAP results from micro-choledocholithiasis, and that laparoscopic cholecystectomy (LC) or endoscopic sphincterotomy (ES) may prevent recurrence.
Methods: Patients diagnosed with IAP from 2015-21 were identified from discharge billing records.
Background: To mitigate the opioid crisis, physicians are reevaluating opioid prescribing patterns.
Objectives: To evaluate outcomes of maximal opioid reduction on top of an existing Enhanced Recovery after Surgery (ERAS) pathway in our The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program-accredited bariatric surgery program.
Setting: Academic tertiary care hospital, United States.