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The benefit of adding external beam radiation to adjuvant chemotherapy in patients that have undergone a margin positive resection for early stage, pancreatic ductal adenocarcinoma has not been determined definitively. The National Cancer Data Base was queried to evaluate the utility of adjuvant radiation in patients with pathologic stage I–II pancreatic ductal adenocarcinoma who underwent upfront...
Studies evaluating the efficacy of minimally invasive approaches to pancreatoduodenectomy (MIS-PD) compared to open pancreatioduodenectomy (OPD) have been limited by selection bias and mixed outcomes.ACS-NSQIP 2014–2015 pancreas procedure-targeted data were used to identify patients undergoing PD. Intention-to-treat analysis was performed.Of 7907 PD patients, 1277 (16%) underwent MIS-PD: 776 (61%)...
Studies comparing orthotopic liver transplantation to margin negative resection for patients with small unifocal hepatocellular carcinoma have not controlled for degree of cirrhosis.The National Cancer Database was used to identify patients with preserved liver function (Model for End-stage Liver Disease score ≤12) who underwent orthotopic liver transplantation or margin negative resection for American...
Prior studies comparing the efficacy of orthotopic liver transplantation to resection in patients with hepatocellular carcinoma have not controlled for underlying severity of liver disease.Patients with stage I to III hepatocellular carcinoma and preserved liver function (model for end-stage liver disease <12) who underwent resection or orthotopic liver transplantation between 2010 and 2013 were...
The absolute benefit of adjuvant external beam radiation therapy after a margin-negative resection in early stage pancreatic cancer has not been determined.We queried the National Cancer Data Base for patients with pathologic stage I–II pancreatic adenocarcinoma who underwent operative resection between 2004 and 2012. Multivariate Cox regression adjusted for age, race, comorbidities, facility type,...
The value of neoadjuvant chemotherapy in the treatment of early stage pancreatic cancer is not yet clear.We evaluated patients from the National Cancer Data Base who underwent pancreaticoduodenectomy for clinical stage I and II pancreatic adenocarcinoma between 2006 and 2012.In total, 7,881 patients were identified. Of these, 27.5% received no chemotherapy, 57.4% received adjuvant chemotherapy, 10...
This study compares the predictability of 5 tumor markers for distant metastasis and mortality in pancreatic neuroendocrine tumors (PNETs).A total of 128 patients who underwent pancreatectomy for nonfunctioning PNETs between 1998 and 2011 were evaluated. Tumor specimens were stained via immunochemistry for cytoplasmic and nuclear survivin, cytokeratin 19 (CK19), c-KIT, and Ki67. Univariate and multivariate...
The biologic potential of nonfunctioning pancreatic neuroendocrine tumors (PNETs) is highly variable and difficult to predict before resection. This study was conducted to identify clinical and pathologic factors associated with malignant behavior and death in patients diagnosed with PNETs.We used International Classification of Diseases 9th edition codes to identify patients who underwent pancreatectomy...
Laparoscopic distal pancreatectomy (LP) is an emerging modality for managing benign and premalignant neoplasms of the pancreatic body and tail. The efficacy of LP has been examined in single and multi-institutional retrospective reviews but not compared prospectively to open distal pancreatectomy (ODP).We maintain a prospectively accruing database tracking peri-operative clinical parameters for all...
Despite guidelines that recommend total thyroidectomy for papillary thyroid cancer (PTC) greater than or equal to 1 cm, the extent of surgery remains controversial. We examined surgical practice patterns for PTC greater than or equal to 1 cm and identified factors that predict the use of total thyroidectomy.Of 90,382 patients in the National Cancer Center Data Base (NCDB) with PTC from 1985 to 2003,...
This study was performed to develop a management algorithm that accurately predicts the necessity of operative intervention and results in significant cost savings for patients with cystic pancreatic tumors.We reviewed 60 patients treated between 1992 and 2003. Accuracy rates of tests used to differentiate benign from premalignant and malignant cysts were calculated. A management algorithm was generated...
Background. We reviewed 36 patients with liver metastases from islet cell tumors of the pancreas (n = 18) and carcinoid tumors (n = 18) who were treated with surgical resection (n = 16) or hepatic chemoembolization (n = 20). Methods. All resections were complete and included 4 lobectomies, 6 segmental resections, and 6 wedge resections. There were no operative deaths. Results. Median survival has...
Background. This study was done to review the clinical presentation, surgical management, and prognostic factors for primary gastrointestinal sarcomas. Methods. We reviewed medical records of 55 patients who were treated for primary gastrointestinal sarcomas from 1981 through 1996. Mean follow-up time was 32 months. Results. Clinical findings included gastrointestinal bleeding (51%), palpable mass...
Background: Evidence indicates that sentinel node (SN) biopsy can accurately predict axillary nodal status. Debate exists as to the optimal method of SN identification. Methods: Patients with clinical T1 or T2 tumors and negative axillae were randomized to SN localization with blue dye (B) alone (n = 50) or blue dye plus radioactivity (B+R) (n = 42). Patients undergoing needle localization (n = 47)...
Background: Free jejunal transfer has become the standard technique for reconstruction of the proximal pharynx and hypopharynx. Gastric tube interposition is an effective alternative when resection extends below the thoracic inlet. This study was done to determine current indications, review morbidity and mortality rates, and to define clinical and pathologic determinants of survival associated with...
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