Textbook outcome in liver surgery for intrahepatic cholangiocarcinoma: defining predictors of an optimal postoperative course using machine learning.

Background: We sought to define textbook outcome in liver surgery (TOLS) for intrahepatic cholangiocarcinoma (ICC) by considering the implications of perioperative outcomes on overall survival (OS).

Methods: Using a multi-institutional database, TOLS for ICC was defined by employing novel machine learning (ML) models to identify perioperative factors most strongly predictive of OS ≥ 12 months. Subsequently, clinicopathologic factors associated with achieving TOLS were investigated.

Machine learning based prediction model for bile leak following hepatectomy for liver cancer.

Objective: We sought to develop a machine learning (ML) preoperative model to predict bile leak following hepatectomy for primary and secondary liver cancer.

Methods: An eXtreme Gradient Boosting (XGBoost) model was developed to predict post-hepatectomy bile leak using data from the ACS-NSQIP database. The model was externally validated using data from hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) multi-institutional databases.

Association of mental health assessment with postoperative outcomes following major surgery in older individuals.

Introduction: Individuals with mental illness are at risk for poor surgical outcomes. Notably, the impact of preoperative assessment and optimization for high-risk surgical procedures remains a relatively understudied and evolving field. We sought to investigate the association between mental health assessment and postoperative outcomes.

Perioperative Benzodiazepine Exposure Impacts Risk of New Persistent Benzodiazepine Use Among Patients with Cancer.

Background: Benzodiazepines are the third most misused medication, with many patients having their first exposure during a surgical episode. We sought to characterize factors associated with new persistent benzodiazepine use (NPBU) among patients undergoing cancer surgery.

Patients And Methods: Patients who underwent cancer surgery between 2013 and 2021 were identified using the IBM-MarketScan database.

Perioperative Changes in Serum Transaminases Levels Predicts Long-Term Survival Following Liver Resection of Hepatocellular Carcinoma.

Background: We sought to define whether and how hepatic ischemia/reperfusion (I/R) as manifested by perioperative aspartate aminotransferase (AST) and alanine aminotransaminase (ALT) levels impact long-term outcomes after curative-intent resection of hepatocellular carcinoma (HCC).

Patients And Methods: Intrasplenic injection of HCC cells was used to establish a murine model of HCC recurrence with versus without I/R injury. Patients who underwent curative resection for HCC were identified from a multi-institutional derivative cohort (DC) and separate external validation (VC) cohort.

Variations in medicare reimbursements among surgical oncologists who are US versus international medical graduates.

Introduction: We sought to assess the variations in practice metrics and billing practices among US Medical Graduates (USMGs) and International Medical Graduates (IMGs) in surgical oncology who serve a fee-for-service population.

Methods: Medicaid Services Medicare fee-for-service provider utilization and payment files were used to obtain publicly available data between January 1, 2021, and December 31, 2021. Comparisons were conducted using the t-test for parametric variables and Wilcoxon rank-sum for nonparametric variables.

Association of Socio-Environmental Burden and Inequality With Cancer Screening and Mortality.

Background And Objectives: Social and environmental injustice may influence accessibility and utilization of health resources, affecting outcomes of patients with cancer. We sought to assess the impact of socio-environmental inequalities on cancer screening and mortality rates for breast, colon, and cervical cancer.

Methods: Data on cancer screening and environmental justice index social and environmental ranking (SER) was extracted from the CDC PLACES and ATSDR, respectively.

Prime suspect or collective responsibility: Impact of specific lymph node station dissection on short- and long-term outcomes among locally advanced gastric cancer patients after neoadjuvant chemotherapy.

Background: Lymphatic route is the main pathway for gastric cancer (GC) spread, and lymph node (LN) involvement is a major prognostic factor after curative resection. The aim of this study was to assess the outcomes of specific LN station dissection.

Methods: Patients with locally advanced (cT2-4N0-3M0) GC who underwent multimodal treatment between 2013 and 2023 were included in the study.

Hepato-Pancreato-Biliary Surgery: Analysis of Outcomes Among Graduates of Different Fellowship Pathways.

Objective: To characterize the association between type of fellowship training and patient outcomes following hepatopancreatic (HP) surgery across different surgeon career stages using a national representative cohort of Medicare beneficiaries.

Background: The current state of training in HPB surgery in North America is defined through three main pathways: the Complex General Surgical Oncology (CGSO), the Americas HPB Association fellowship, and the American Society of Transplant surgeons fellowship. Each pathway offers a unique perspective on HPB surgery with different number of training years, yet outcomes of graduates performing HP surgery relative to type of fellowship training have not been defined.

Lymphadenectomy for perihilar cholangiocarcinoma: therapeutic benefit of lymph node number and station.

Background: We sought to characterize the benefit of lymphadenectomy among patients undergoing curative-intent surgery for perihilar cholangiocarcinoma (pCCA) utilizing the therapeutic index.

Methods: Data on patients who underwent curative-intent resection for pCCA were obtained from 8 high-volume international hepatobiliary centers. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with overall survival (OS).

Association of transplant recipient status with clinical and financial outcomes among patients undergoing major surgery.

Background: Transplant recipients undergoing surgery may represent a vulnerable population because of transplant-related comorbidities as well as reliance on immunosuppressive medications. We sought to characterize the association of prior transplant status on postoperative outcomes among patients undergoing major non-transplant-related surgical procedures.

Methods: Data on patients who underwent a major surgical procedure (pneumonectomy, coronary artery bypass graft, abdominal aortic aneurysm repair, Whipple, colectomy) between 2016 and 2020 were obtained from the Nationwide Readmission Database.

Recurrence Timing and Risk Following Curative Resection of Colorectal Liver Metastases: Insights From a Hazard Function Analysis.

Introduction: There is no consensus on the optimal surveillance interval for patients undergoing resection of colorectal liver metastases (CRLM). We sought to assess the timing and intensity of recurrence following curative-intent resection of CRLM utilizing a recurrence-free survival (RFS) hazard function analysis.

Methods: Patients with CRLM who underwent curative-intent resection were identified from a multi-institutional database.

Machine learning prediction of early recurrence after surgery for gallbladder cancer.

Background: Gallbladder cancer is often associated with poor prognosis, especially when patients experience early recurrence after surgery. Machine learning may improve prediction accuracy by analysing complex non-linear relationships. The aim of this study was to develop and evaluate a machine learning model to predict early recurrence risk after resection of gallbladder cancer.

Variation in Cost Centers Following Gastrointestinal Cancer Surgery.

Introduction: Despite cost-standardization efforts, significant variations in hospital costs persist in insurance claims. We sought to identify and quantify factors driving cost variability at hospital and cost center levels following a complex gastrointestinal surgical procedure.

Methods: Individuals who underwent pancreatectomy (PA), colectomy (CO), and proctectomy (PR) were identified from the Surveillance, Epidemiology, and End Results database.

Open versus minimally invasive hepatic and pancreatic surgery: 1-year costs, healthcare utilization and days of work lost.

Background: Utilization of minimally invasive surgery (MIS) has become increasingly popular due to its potential benefits such as earlier recovery and reduced morbidity. We sought to characterize differences in 1-year healthcare costs and missed workdays among patients undergoing MIS and open surgery for a hepatic or pancreatic indication.

Methods: Data on patients who underwent hepatic and pancreatic resection were obtained from the IBM Marketscan database.

Variation in lymph node assessment after pancreatic cancer resection: Patient, surgeon, pathologist, or hospital?

Background: We sought to define individual contributions at the patient, surgeon, pathologist, and hospital levels on lymph node assessment after pancreatic cancer resection.

Methods: SEER-Medicare beneficiaries who underwent pancreatic cancer resection were identified. Multi-level multivariable regression was performed to assess the proportion of variance explained by patient, surgeon, pathologist, and hospitals on lymph node assessment (≥12 versus <12).

Disparities in Next-Generation Genetic Sequencing Among Individuals with Cancer.

Background: We sought to investigate disparities in the utilization of next-generation genetic sequencing (NGS) across demographic groups related to several  common cancer subtypes.

Methods: Data on patients aged 65 years or older with a diagnosis of gastrointestinal, lung, and breast cancer between 2015 and 2020 were obtained from the Medicare Standard Analytic Files. Propensity score matching was employed to reduce selection bias, and logistic regression analysis was performed to investigate racial, ethnic, and sex-based disparities in NGS utilization.

Improving Recurrence Prediction in Intrahepatic Cholangiocarcinoma: The Synergistic Impact of the FIB-4 Index and Tumor Burden Score on Post-hepatectomy Outcomes.

Background: The prognostic role of the fibrosis-4 (FIB-4) index relative to intrahepatic cholangiocarcinoma (ICC) after hepatectomy remains unclear. This study sought to characterize the impact of the FIB-4 index and tumor burden score (TBS) on recurrence and overall survival (OS).

Methods: ICC patients undergoing hepatectomy (2000-2020) were identified using a multi-institutional database.

Metabolic-associated steatotic liver disease and hepatocellular carcinoma.

Introduction: Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has been introduced as a superior term to describe steatosis on a background of metabolic dysregulation and is slated to become the leading cause of HCC worldwide, as the incidence of metabolic comorbidities is increasing. As such, MASLD has evolved into an important public health issue, potentially leading to higher rates of liver mortality and end-stage liver disease. To this end, understanding the association between MASLD and HCC may allow for the identification of better interventions and novel therapeutic strategies.

Surgical opioid prescription and the risk of opioid initiation among opioid-naive households.

Background: We sought to investigate the association between surgical opioid prescriptions and the risk of opioid initiation among opioid-naive spouses.

Methods: Patients who underwent surgery for breast or gastrointestinal cancer were identified from the IBM Marketscan database. Multivariable regression analysis was performed to examine the association between surgical opioid prescription and opioid initiation among opioid-naïve patient spouses.