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Am J Surg ; 226(6): 873-877, 2023 12.
Article in English | MEDLINE | ID: mdl-37460372

ABSTRACT

BACKGROUND: Neoadjuvant chemoradiation (NACRT) is the standard of care for locally advanced rectal cancers. The purpose of this study was to determine patient and tumor factors associated with a pathologic complete response (pCR). METHODS: The National Surgical Quality Improvement Program proctectomy-targeted database was utilized to identify all patients from 2016 to 2020 who underwent NACRT followed by proctectomy with curative intent for T3-4N0-2 rectal cancers. RESULTS: A total of 1891 patients were included, of which 253 (13.4%) demonstrated a pCR. Pretreatment N0 staging was associated with a higher rate of pCR (18.9%) when compared to N1 (6.7%) and N2 (6.7%) (p < 0.0001). Patients clinically staged at T3N0 had the highest rate of pCR (19.5%). Gender, age, race, weight, smoking status, and tumor height were not associated with pCR. CONCLUSIONS: Patients with cN0 disease were more likely to experience a pCR compared to cN1-2 patients. Tumor height relative to anal verge or patient demographics were not associated with pCR.


Subject(s)
Proctectomy , Rectal Neoplasms , Humans , Neoplasm Staging , Rectum/surgery , Rectum/pathology , Rectal Neoplasms/therapy , Rectal Neoplasms/pathology , Neoadjuvant Therapy , Retrospective Studies , Chemoradiotherapy , Treatment Outcome
5.
Surgery ; 174(3): 733-734, 2023 09.
Article in English | MEDLINE | ID: mdl-37365083

ABSTRACT

Since 2020, all general surgery residency interviews have been mandatorily virtual, elevating the importance of social media and online reputation management for applicants and residency programs. This article highlights how virtual interviews changed the way programs and applicants engage each other online, including some pros and cons of these new interactions.


Subject(s)
Internship and Residency , Social Media , Humans
7.
Oncol Nurs Forum ; 49(6): 571-584, 2022 10 20.
Article in English | MEDLINE | ID: mdl-36413736

ABSTRACT

OBJECTIVES: To examine glycemic variability within one month and one year following surgery and throughout adjuvant chemotherapy among patients with stage II-III colon cancer, with and without type 2 diabetes (T2D). SAMPLE & SETTING: 58 patients with stage II-III colon cancer treated with surgery and chemotherapy. METHODS & VARIABLES: A retrospective analysis of electronic health record data over one year showed glycemic variability, measured as standard deviation and coefficient of variation. Chi-square, Fisher's exact, and Mann-Whitney U tests and Spearman's correlation coefficient were calculated. RESULTS: Patients with T2D had higher glycemic variability throughout chemotherapy and within one year following surgery. A significant increase in glycemic variability throughout chemotherapy was observed in patients without T2D. Significant associations between glycemic variability and demographic and clinical characteristics differed by T2D status, standard deviation, and coefficient of variation. IMPLICATIONS FOR NURSING: Nurses need to assess serial blood glucose levels in patients with and without T2D. Teaching patients how to maintain glycemic control during treatment is a priority. Research should include predictive models to identify risk factors for higher glycemic variability and cancer-related symptoms and outcomes.


Subject(s)
Colonic Neoplasms , Diabetes Mellitus, Type 2 , Hyperglycemia , Humans , Blood Glucose , Diabetes Mellitus, Type 2/drug therapy , Retrospective Studies , Chemotherapy, Adjuvant , Colonic Neoplasms/drug therapy , Colonic Neoplasms/surgery , Adenosine Monophosphate
10.
Surgery ; 172(5): 1300-1301, 2022 11.
Article in English | MEDLINE | ID: mdl-35606182
11.
Am J Surg ; 224(1 Pt A): 18, 2022 07.
Article in English | MEDLINE | ID: mdl-35249729
13.
Surg Clin North Am ; 101(6): xvii-xviii, 2021 12.
Article in English | MEDLINE | ID: mdl-34774279
14.
Surgery ; 170(3): 657-658, 2021 09.
Article in English | MEDLINE | ID: mdl-34274147

Subject(s)
Neuroblastoma , Humans
15.
Clin Colon Rectal Surg ; 34(2): 86-90, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33642947

ABSTRACT

Uncomplicated diverticulitis is common, and its evaluation and treatment have evolved over time. Most patients present in a nontoxic manner with localized pain, leukocytosis, and reliable findings on computed tomography (CT). Healthy and stable patients are typically treated in the outpatient setting with very high rates of success. Recently, the necessity of antibiotic therapy has come into question, and several alternative agents have emerged, with the jury still out on their relative roles in diverticular disease. Currently, colonoscopy is still recommended after the resolution of an index episode of uncomplicated diverticulitis, and recurrence rates remain low. Several diet and lifestyle modifications have been shown to impact the rates of diverticulitis recurrence.

17.
Surg Clin North Am ; 99(6): xvii-xviii, 2019 12.
Article in English | MEDLINE | ID: mdl-31676062
18.
Am J Surg ; 217(6): 1042-1046, 2019 06.
Article in English | MEDLINE | ID: mdl-30709552

ABSTRACT

BACKGROUND: We aim to investigate the effects of delaying surgery on outcomes and cost in patients admitted with severe clostridium difficile infection (CDI). METHODS: The Vizient database was queried for patients with CDI who underwent open total abdominal colectomy (TAC). Patients operated on the day of admission were excluded. Chi-square, Fisher's exact, student T-test, and logistic regression were performed with α = 0.05. RESULTS: Logistic regression analyses using days from admission to surgery (DATO), age, race, and gender demonstrated that increased DATO was associated with higher 30-day mortality (OR 1.022, 95% CI 1.001-1.044, p = 0.040), overall complications (OR 1.034, 95% CI 1.014-1.054, p = 0.001), and infectious complications (OR 1.040, 95% CI 1.018-1.062, p < 0.001) compared to age for all three outcomes. Total length of stay (LOS), intensive care unit LOS, and direct cost increased in conjunction with DATO (p < 0.001). CONCLUSIONS: Early surgical intervention in appropriately selected patients should be considered when there is a high suspicion for prolonged non-operative treatment.


Subject(s)
Clostridioides difficile , Clostridium Infections/therapy , Colectomy/economics , Colitis/therapy , Conservative Treatment/economics , Hospital Costs/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Clostridium Infections/economics , Clostridium Infections/mortality , Colitis/economics , Colitis/mortality , Databases, Factual , Female , Humans , Logistic Models , Male , Middle Aged , Postoperative Complications/economics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Retrospective Studies , Time Factors , Treatment Outcome , Young Adult
19.
Am J Surg ; 217(1): 34-39, 2019 01.
Article in English | MEDLINE | ID: mdl-30266417

ABSTRACT

BACKGROUND: We aim to compare outcomes between loop ileostomy (LI) and total abdominal colectomy (TAC) for clostridium difficile infection (CDI) and hypothesize that LI is associated with fewer complications. METHODS: The 2011-2016 ACS-NSQIP database was queried for patients undergoing LI or TAC for CDI. Patients with high outlying age, LOS, and operative time were excluded. Statistics were performed using IBM-SPSS and NCSS PASS-11. RESULTS: Of 457 patients identified, 47 underwent LI. Predicted morbidity was higher in the TAC cohort (62% vs. 37%, p < 0.001). Patients in the LI cohort experienced fewer complications (72% vs. 87%, p = 0.021); however, mortality did not differ between LI (36%) and TAC (31%). Blood transfusions were more than twice as frequent in the TAC cohort (54% vs. 19%, p < 0.001). Four patients in the LI cohort required reoperation; however, none required colectomy. CONCLUSIONS: No mortality difference was observed between LI and TAC. Prospective studies are required to determine the utility of LI. SUMMARY: An analysis of the ACS-NSQIP database was performed and demonstrates that no survival benefit exists for patients who undergo loop ileostomy for C difficile infection compared to those who undergo total colectomy; however, patients who undergo loop ileostomy are likely to retain their colon with low risk of requiring subsequent colectomy.


Subject(s)
Clostridioides difficile , Clostridium Infections/surgery , Colectomy/adverse effects , Colitis/surgery , Ileostomy/adverse effects , Postoperative Complications/epidemiology , Aged , Clostridium Infections/mortality , Colitis/microbiology , Colitis/mortality , Female , Humans , Length of Stay , Male , Middle Aged , Operative Time , Retrospective Studies , Survival Analysis
20.
Am J Surg ; 218(1): 113-118, 2019 07.
Article in English | MEDLINE | ID: mdl-30201139

ABSTRACT

BACKGROUND: Consensus guidelines recommend a yield of 12 lymph nodes in resections for colon cancer. Factors affecting this yield are not well defined. METHODS: Retrospective study using the colectomy-targeted American College of Surgeons National Surgical Quality Improvement Program for years 2014-2016. Primary outcome was resection of at least 12 nodes. Univariate and multivariate analyses determined factors associated with ≥12 LN yield. RESULTS: 17,612 colectomies for colon cancer were extracted from the NSQIP database. 7.26% of cases did not reach a 12 LN harvest. Harvesting ≥12 LN was 74% more likely (p = 0.001) if the resection was laparoscopic and 72% more likely (p < 0.0001) if hand-assisted. Advanced T and N stage had a higher likelihood of reaching 12 LN harvest. Older age, female gender and smoking history decreased the likelihood of ≥12 LN harvest. CONCLUSIONS: Laparoscopic and robotic colectomies were 1.5-2.5 times more likely to achieve adequate LN harvest compared to open surgery. Several non-modifiable patient and disease related factors may render adequate LN yield challenging.


Subject(s)
Colonic Neoplasms/surgery , Lymph Node Excision/standards , Age Factors , Aged , Colectomy , Colonic Neoplasms/pathology , Female , Humans , Laparoscopy , Male , Middle Aged , Neoplasm Staging , Quality Improvement , Retrospective Studies , Risk Factors , Robotic Surgical Procedures , Sex Factors , Smoking , United States
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