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Resection Margin Distance in Extra-Hepatic Cholangiocarcinoma: How Much Is Enough? [Meeting Abstract]

Rahnemai-Azar, A.; Ronnekleiv-Kelly, S. M.; Abbott, D.; Ethun, C.; Poultsides, G.; Tran, T.; Fields, R.; Krasnick, B. A.; Martin, R.; Scoggins, C. R.; Idrees, K.; Isom, C. A.; Hatzaras, I.; Shenoy, R.; Shen, P.; Perkins, J. D.; Pawlik, T.; Maithel, S.; Weber, S.
ISI:000459144900067
ISSN: 1068-9265
CID: 3705512

Role of Additional Organ Resection in Adrenocortical Carcinoma: Analysis of 167 patients from the US Adrenocortical Carcinoma Database [Meeting Abstract]

Smith, P. Marincola; Kiernan, C. M.; Tran, T. B.; Postlewait, L. M.; Maithel, S. K.; Prescott, J.; Pawlik, T.; Wang, T. S.; Glenn, J.; Hatzaras, I.; Shenoy, R.; Phay, J.; Shirley, L.; Fields, R.; Jin, L.; Weber, S.; Salem, A.; Sicklick, J.; Gad, S.; Yopp, A.; Mansour, J.; Duh, Q.; Seiser, N.; Votanopoulos, K.; Levine, E. A.; Poultsides, G.; Solorzano, C.
ISI:000431188600037
ISSN: 1068-9265
CID: 3113872

Conditional survival after surgical resection of gallbladder carcinoma: A multi-institutional analysis [Meeting Abstract]

Buettner, S; Poultsides, G; Idrees, K; Fields, R; Weber, S; Scoggins, C; Shen, P; Schmidt, C; Hatzaras, I; Maithel, S; Pawlik, T M
Introduction: While survival after malignancies is traditionally reported as actuarial overall survival (OS), conditional survival (CS) may be more clinically relevant. CS gives an estimate of overall survival at a certain time point by accounting for "accrued" survival. We sought to provide CS data after curative-intent surgery for gallbladder carcinoma (GBC). Methods: 312 patients who underwent resection for GBC in 2000-2014 were identified from 10 major HPB centers. CS estimates were calculated as the probability of surviving 3 years at "x" years after surgery using the formula CS3 = S(x+3)/Sx. Results: Median patient age was 66 years (IQR:56-73) and most patients were female (66.7%). At the time of surgery, the majority of patients underwent radical cholecystectomy (90.0%). While OS decreased over time from 51.1% at 2 years to 31.6% at postoperative year 5, the CS3 at 2 years (i.e. the probability of surviving to postoperative year 5) was 61.8%. The CS3 if the patient was alive at 3-, 4- and 5-years was 70.5%, 74.1% and 78.2% respectively. Factors associated with reduced OS included margin status (HR:3.61;95%CI:2.47-5.26), tumor size (HR:1.02;95% CI:1.01-1.02), high tumor grade (HR:2.98;95%CI:1.47- 6.04), residual disease found at re-resection (HR:2.78;95% CI:1.49-3.49), and lymph node metastasis (HR:1.95;95% CI:1.39-2.75) (all p < 0.001). The CS3 exceeded the OS for all high-risk subgroups, e.g. patients with residual disease at re-resection had an OS of 23.1% at 5 years versus 56.3% CS3 at 2 years (DELTA = 33.2%). Discussion: The probability of surviving increased as time elapsed after surgery and patients with the worst initial prognosis, demonstrated the greatest increase in CS over time. CS may help guide provider recommendations for post-operative treatment and surveillance. (Figure Presented)
EMBASE:72257509
ISSN: 1365-182x
CID: 2103482

Surgical management of gallbladder cancer: Routine vs. selective resection of the common bile duct [Meeting Abstract]

Gani, F; Maithel, S; Poultsides, G; Idrees, K; Fields, R; Weber, S; Scoggins, C; Shen, P; Schmidt, C; Hatzaras, I; Pawlik, T
Background: Most gallbladder cancers (GBC) are diagnosed incidentally. Although a radical re-resection has been advocated, the optimal extent of re-resection remains unknown. The current study aimed to assess the impact of extent of resection on survival among patients undergoing surgery for GBC. Methods: Patients undergoing curative-intent surgery for GBC were identified using a multi-institutional cohort of patients. OS was estimated using the Kaplan Meir method and differences assessed using the log-rank test. Results: Among the 217 patients identified, 74.1%(n = 160) of patients had incidental GBC. Among these, 142 (88.8%) also underwent a lymphadenectomy (LND) while 45 (28.7%) underwent a concomitant common bile duct (CBD) resection. The median number of lymph nodes harvested was 4 (IQR,2-8) and did not differ between LND vs. LND+CBD (p = 0.479). Residual disease was noted in 50 patients (31.3%). The most common sites of residual disease were the liver (n = 27,16.9%) and bile duct (n = 13,8.1%). The overall recurrence rate was 33.1%(n = 53). All patients with a positive cystic duct margin developed a recurrence (p = 0.04). Although no differences in OS were noted relative to CBD resection, patients who had residual disease demonstrated a poor prognosis (5-year OS:53.0%[95%CI 38.0-65.9] vs. 31.4%[95%CI 15.8-48.2], p = 0.002). On multivariable analysis, residual disease in the liver was most strongly associated with an increased risk of death (HR 2.74,95%CI 1.32-5.67, p = 0.007). Conclusions: CBD resection was not associated with an increase in LN yield or an improvement in OS. Routine CBD excision may be unwarranted and should only be performed among select patients who have a positive cystic duct margin
EMBASE:72257303
ISSN: 1365-182x
CID: 2103492

Rates and patterns of recurrence after curative intent resection for gallbladder cancer: A multiinstitution analysis from the us extrahepatic biliary malignancy consortium [Meeting Abstract]

Margonis, G A; Poultsides, G; Idrees, K; Fields, R; Weber, S; Scoggins, C; Shen, P; Schmidt, C; Hatzaras, I; Maithel, S; Pawlik, T M
Introduction: Hepato-Pancreato-Biliary Surgery Gallbladder cancer is a relatively rare malignancy. The current study aimed to define the incidence and patterns of recurrence following gallbladder cancer resection. Methods: Using a multi-institutional cohort we identified 217 patients undergoing curative-intent surgery for gallbladder cancer. Patterns and rates of recurrence were determined and classified as locoregional and distant recurrence. Results: Median patient age was 66.1 years (IQR 55.6- 72.8). Most patients underwent a radical cholecystectomy (n = 166, 76.5%) and an R0 resection was achieved in 197 (90.8%) patients; 41.9% of patients received adjuvant chemo/radiation therapy. At last follow-up, 76 (35.0%) patients had experienced recurrence (locoregional only, 15.8%; distant only, 65.8%; locoregional+distant, 18.4%). Median time-to-recurrence was 9.5 months (IQR 4.7-17.6) and was comparable by site of recurrence (all p > 0.05). On multivariable analysis, T3 disease (OR 9.4, 95% CI 1.58- 56.1, p = 0.01) and lympho-vascular invasion (OR 2.86, 95% CI 1.07-7.63, p = 0.036) were associated with an increased odds of recurrence. Patients who recurred demonstrated a worse 1-, 3- and 5-year OS (1-year OS: 91.3% vs. 68.6%; 3-year OS: 79.3% vs. 28.7%; 5-year OS: 75.9% vs. 16.0%; all p <0.001). While receipt of adjuvant therapy was not associated with a decreased time-torecurrence, among these who developed a recurrence, receipt of adjuvant therapy was associated with an improved median OS (11.6 months vs. 18.9 months, p = 0.01). Conclusions: Over one-third of patients experienced a recurrence after gallbladder cancer surgery. While recurrence was associated with a poor prognosis, receipt of adjuvant chemotherapy among pati
EMBASE:72257198
ISSN: 1365-182x
CID: 2103502

Lymphadenectomy for Adrenocortical Carcinoma: Is there a Therapeutic Benefit? [Meeting Abstract]

Gerry, J; Postlewait, LM; Maithel, S; Prescott, J; Wang, T; Glenn, JA; Phay, J; Keplinger, K; Fields, RC; Jin, L; Weber, S; Salem, AI; Sicklick, J; Gad, S; Yopp, A; Mansour, J; Duh, Q; Seiser, N; Solorzano, CC; Kiernan, CM; Votanopoulos, K; Levine, EA; Hatzaras, I; Shenoy, R; Pawlik, TM; Poultsides, G
ISI:000368185000270
ISSN: 1534-4681
CID: 1931002

Adjuvant Radiation Therapy in Patients Undergoing Curative Intent Resection for Adrenocortical Carcinoma: A Multi-Institutional Experience [Meeting Abstract]

Hatzaras, I; Rao, R; Tran, TB; Postlewait, LM; Maithel, SK; Prescott, J; Pawlik, TM; Wang, T; Phay, J; Fields, RC; Jin, L; Weber, S; Salem, AI; Sicklick, J; Gad, S; Yopp, A; Mansour, J; Duh, Q; Seiser, N; Solorzano, CC; Kiernan, CM; Votanopoulos, K; Levine, EA; Newman, E; Poultsides, G; Pachter, H
ISI:000368185000268
ISSN: 1534-4681
CID: 1930812

Significance of Intravenous Thrombus in the Management of Adrenocortical Carcinoma: Prognosis and Surgical Implications [Meeting Abstract]

Ahmed, S; Tran, T; Levine, EA; Weber, S; Salem, AI; Postlewait, LM; Maithel, SK; Wang, T; Hatzaras, I; Shenoy, R; Phay, J; Shirley, L; Fields, RC; Jin, L; Pawlik, TM; Prescott, J; Sicklick, J; Gad, S; Yopp, A; Mansour, J; Duh, Q; Seiser, N; Solorzano, CC; Kiernan, CM; Poultsides, GA; Votanopoulos, K
ISI:000368185000272
ISSN: 1534-4681
CID: 1930822

[A training program for dementia trainers: does this program have practical relevance?]

Schulz, H; Auer, S; Span, E; Adler, C; Donabauer, Y; Weber, S; Wimmer-Elias, J; Meyer, M
BACKGROUND: Specific curricula for professionals working in various settings with persons with dementia have been developed and implemented into practice. In this study, the practical relevance of a teaching program for the M.A.S (Morbus Alzheimer syndrome) dementia trainer was evaluated. The curriculum was developed in 2002 within a scientific project. The goal was that care professionals and noncare professionals learn how to support and train persons with dementia and their caregivers. The task of the trainer is to support the functional and emotional resources of the person with dementia employing stage-specific training according to principles of the theory of retrogenesis. Trainers are also able to support family caregivers in their difficult day-to-day care for the person with dementia. With this training and support program, persons with dementia can train their residual capacities and develop a life perspective which enables them to cope with the long duration of Alzheimer's disease. MATERIALS AND METHODS: The curriculum for the training methodology is based in the theory of retrogenesis. The 1-year training course is held in the form of modules and includes the following topics: (1) stages of dementia and medical aspects, (2) communication with persons with dementia, (3) stage-specific retrogenic training, (4) physical training for the elderly and persons with dementia, (5) coaching family caregivers through the long disease duration, and (6) care issues for persons without education in care. M.A.S trainers were questioned after they had concluded the teaching program successfully and had the chance to apply the content of the teaching program in their practical work. A short questionnaire was sent via e-mail or a telephone interview was performed. RESULTS: A total of 279 trainers graduated and were certified. Of these, 140 persons (53.6% of the population) could be questioned after an average of 2.69 years after completion of the course: 93.6% of trainees were still using the principles of the teaching course successfully; of these, 56% were working in the function of a trainer full time and 44% used the principles within their work environment (mainly in the nursing home environment). CONCLUSION: The study found that the majority of questioned trainers are still using the principles taught in the course successfully with persons with dementia living at home and the content was found to be relevant for practice. The content of the teaching course, applying principles of retrogenesis, which was originally designed for persons with dementia living at home, can also be successfully applied in the nursing home environment. Increasing interest has been shown by institutions employing professionals whose task it is to keep persons with dementia active and interested as well as physically functioning at their best possible level. As a consequence, persons with dementia perceive higher quality of life and exhibit fewer behavior problems which complicate care. More research is needed to accumulate evidence and to support these findings.
PMID: 22538782
ISSN: 1435-1269
CID: 2504022

Intervention to reduce transmission of resistant bacteria in intensive care

Huskins, W Charles; Huckabee, Charmaine M; O'Grady, Naomi P; Murray, Patrick; Kopetskie, Heather; Zimmer, Louise; Walker, Mary Ellen; Sinkowitz-Cochran, Ronda L; Jernigan, John A; Samore, Matthew; Wallace, Dennis; Goldmann, Donald A; Alangaden, G; Baddley, J; Blair, J; Bochicchio, G; Blumberg, H; Chenoweth, C; Frankel, H; Kaplan, L; Glasby, C; Hejal, R; Hellinger, W; Herwaldt, L; Huskins, W; Kett, D; Reboli, A; Schulhof, N; Koll, B; Taplitz, R; Weber, S; Wright, S; Zachary, K
BACKGROUND:Intensive care units (ICUs) are high-risk settings for the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). METHODS:In a cluster-randomized trial, we evaluated the effect of surveillance for MRSA and VRE colonization and of the expanded use of barrier precautions (intervention) as compared with existing practice (control) on the incidence of MRSA or VRE colonization or infection in adult ICUs. Surveillance cultures were obtained from patients in all participating ICUs; the results were reported only to ICUs assigned to the intervention. In intervention ICUs, patients who were colonized or infected with MRSA or VRE were assigned to care with contact precautions; all the other patients were assigned to care with universal gloving until their discharge or until surveillance cultures obtained at admission were reported to be negative. RESULTS:During a 6-month intervention period, there were 5434 admissions to 10 intervention ICUs, and 3705 admissions to 8 control ICUs. Patients who were colonized or infected with MRSA or VRE were assigned to barrier precautions more frequently in intervention ICUs than in control ICUs (a median of 92% of ICU days with either contact precautions or universal gloving [51% with contact precautions and 43% with universal gloving] in intervention ICUs vs. a median of 38% of ICU days with contact precautions in control ICUs, P<0.001). In intervention ICUs, health care providers used clean gloves, gowns, and hand hygiene less frequently than required for contacts with patients assigned to barrier precautions; when contact precautions were specified, gloves were used for a median of 82% of contacts, gowns for 77% of contacts, and hand hygiene after 69% of contacts, and when universal gloving was specified, gloves were used for a median of 72% of contacts and hand hygiene after 62% of contacts. The mean (±SE) ICU-level incidence of events of colonization or infection with MRSA or VRE per 1000 patient-days at risk, adjusted for baseline incidence, did not differ significantly between the intervention and control ICUs (40.4±3.3 and 35.6±3.7 in the two groups, respectively; P=0.35). CONCLUSIONS:The intervention was not effective in reducing the transmission of MRSA or VRE, although the use of barrier precautions by providers was less than what was required. (Funded by the National Institute of Allergy and Infectious Diseases and others; STAR*ICU ClinicalTrials.gov number, NCT00100386.).
PMID: 21488763
ISSN: 1533-4406
CID: 5211472