Surgery 2013 Oct
Authors: Zapf M, Yetasook A, Leung D, Salabat R, Denham W, Barrera E, Butt Z, Carbray J, Du H, Wang CE, Ujiki M,
Our objective was to compare hospital charges and both perioperative and mid-term quality of life between single- (SILC) and multi-incision (MILC) laparoscopic cholecystectomy in a randomized controlled trial.
Patients with acute or chronic biliary disease were invited to participate. Pain scores, quality of life, and perioperative outcomes were measured. Patients were followed for 1 year postoperatively in the clinic with examination to document hernia formation.
One hundred subjects were randomized to SILC (n = 49) or MILC (n = 51). Demographics were similar for both groups except more women underwent SILC (86% vs 67%, P = .026). Operative time was greater for SILC (63.5 ± 21.0 vs 43.8 ± 24.2 minute, P < .0001). Five SILC patients required added ports. One substantial complication occurred in SILC. Pain, the use of analgesics, and duration of hospital stay were equal between groups; however, charges were greater in the SILC group ($17,602 ± $6,089 vs $13,342 ± $8,197, P < .0001). Both groups reported similar quality of life and cosmesis. At an average follow-up of SILC (16.4 ± 12.1 months) and MILC (16.2 ± 10.5 months), no novel umbilical hernias were identified.
SILC results in longer operative time and greater hospital charges with similar pain and quality of life scores compared with a standard laparoscopic approach.
PMID: 24074405 [PubMed - as supplied by publisher]
Surgical endoscopy 2013 Dec
Authors: Zapf M, Denham W, Barrera E, Butt Z, Carbray J, Wang C, Linn J, Ujiki M,
Laparoscopic cholecystectomy (LC) is the second most common general surgical operation performed in the United States, yet little has been reported on patient-centered outcomes.
We prospectively followed 100 patients for 2 years as part of an institutional review board-approved study. The Surgical Outcomes Measurement System (SOMS) was used to quantify quality-of-life (QoL) values at various time points postoperatively.
Maximum pain was reported at 24 h (5.5 ± 2.2), and decreased to preoperative levels at 7 days (1.2 ± 2.3 vs. 2.0 ± 1.6, P = 0.096). Bowel function improved from before the operation to 3 weeks after surgery (10.7 ± 3.8 vs. 12.0 ± 3.2, P < 0.05), but then regressed to preoperative levels. Physical function worsened from before surgery (31.7 ± 6.2) to 1 week (27.5 ± 5.9, P < 0.0001), but surpassed preoperative levels at 3 weeks (33.5 ± 3.4, P < 0.01). Return to the activities of daily living occurred at 6.3 ± 4.7 days and work at 11.1 ± 9.0 days. Fatigue increased from before surgery (15.8 ± 6.2) to week 1 (20.7 ± 6.6, P < 0.0001) before improving at week 3 (14.0 ± 5.8, P < 0.01). Forty-four patients contacted the health care team 61 times before their 3 weeks appointment, most commonly for wound issues (26.2 %), pain (24.6 %), and gastrointestinal issues (24.6 %). Seventy-two percent reported that the procedure had no negative effect on cosmesis at 6 months. Satisfaction with the procedure was high, averaging 9.52 out of 11.
QoL is significantly affected in the 24 h after LC but returns to baseline at week 3. Cosmesis and overall satisfaction are high, and QoL improvements are maintained in the long term except for bowel function, which regresses to preoperative levels of impairment. Analysis of patient-initiated contacts after LC may provide feedback on discharge counseling to increase patient satisfaction.
PMID: 23943114 [PubMed - as supplied by publisher]
CA: a cancer journal for clinicians
Authors: Wender R, Fontham ET, Barrera E,
Findings from the National Cancer Institute's National Lung Screening Trial established that lung cancer mortality in specific high-risk groups can be reduced by annual screening with low-dose computed tomography. These findings indicate that the adoption of lung cancer screening could save many lives. Based on the results of the National Lung Screening Trial, the American Cancer Society is issuing an initial guideline for lung cancer screening. This guideline recommends that clinicians with access to high-volume, high-quality lung cancer screening and treatment centers should initiate a discussion about screening with apparently healthy patients aged 55 years to 74 years who have at least a 30-pack-year smoking history and who currently smoke or have quit within the past 15 years. A process of informed and shared decision-making with a clinician related to the potential benefits, limitations, and harms associated with screening for lung cancer with low-dose computed tomography should occur before any decision is made to initiate lung cancer screening. Smoking cessation counseling remains a high priority for clinical attention in discussions with current smokers, who should be informed of their continuing risk of lung cancer. Screening should not be viewed as an alternative to smoking cessation.
PMID: 23315954 [PubMed - as supplied by publisher]
Surgical endoscopy 2013 Feb
Authors: Zhao JC, Barrera E, Salabat M, Denham W, Leung D, Ujiki M,
Gallstone ileus is an uncommon cause for small bowel obstruction. Less than 3 % of cases are due to a gallstone impacted in the duodenum or pylorus resulting in a gastric outlet obstruction, described by Bouveret in 1896. Most of the successful therapeutic maneuvers described involve open surgical removal of the stone through either a gastrotomy or duodenotomy, and reported morbidity is not insignificant. Endoscopic techniques continue to evolve, allowing for more complex procedures and avoidance of open surgery and its accompanying high morbidity. This video displays a rarely used endoscopic method of relieving gastric outlet obstruction caused by a stone in a patient with Bouveret syndrome.
Video of successful endoscopic retrieval of a gallstone lodged in the pylorus is presented. An endoscopic retrieval basket is used, and key maneuvers highlighted include passage of the closed device distal to the stone, opening of the basket, and withdrawal of the stone under direct vision.
After successful retrieval, endoscopic inspection revealed a normal duodenum and relief of the obstruction. Cholecystectomy was not performed, given that most cholecystoduodenal fistulae are large and will spontaneously close, especially if a patent cystic duct is present. Liver function tests were normal postoperatively, so no further evaluation of the bile duct was necessary.
With new advances in technology, the endoscopic approach should be considered as the first line of treatment for cases of Bouveret syndrome because most patients are elderly with multiple comorbidities.
PMID: 23052513 [PubMed - as supplied by publisher]
Journal of the American College of Surgeons 2012 Nov
Authors: Leung D, Yetasook AK, Carbray J, Butt Z, Hoeger Y, Denham W, Barrera E, Ujiki MB,
Since the development of single-incision surgery, several retrospective studies have demonstrated its feasibility; however, randomized prospective trials are still lacking. We report a prospective randomized single-blinded trial with a cost analysis of single-incision (SI) to multi-incision (MI) laparoscopic cholecystectomy.
After obtaining IRB approval, patients with chronic cholecystitis, acute cholecystitis, or biliary dyskinesia were offered participation in this multihospital, multisurgeon trial. Consenting patients were computer randomized into either a transumbilical SI or standard MI group; patient data were then entered into a prospective database.
We report 79 patients that were prospectively enrolled and analyzed. Total hospital charges were found to be significantly different between SI and MI groups (MI $15,717 ± $14,231 vs SI $17,817 ± $5,358; p < 0.0001). Broken down further, the following subcharges were found to also be significant: operating room charges (MI $4,445 ± $1,078 vs SI $5,358 ± 893; p < 0.0001); medical/surgical supplies (MI $3,312 ± $6,526 vs SI $5,102 ± $1,529; p < 0.0001); and anesthesia costs (MI $579 ± $7,616 vs SI $820 ± $23,957; p < 0.0001). A validated survey (ie, Surgical Outcomes Measurement System) was used to evaluate various patient quality-of-life parameters at set visits after surgery; scores were statistically equivalent for fatigue, physical function, and satisfaction with results. No difference was found between visual analogue scale scores or inpatient and outpatient pain-medication use.
We show SI surgery to have higher costs than MI surgery with equivalent quality-of-life scores, pain analogue scores, and pain-medication use.
PMID: 22819642 [PubMed - as supplied by publisher]
Journal of the American College of Surgeons 2011 Jul
Authors: Spiguel L, Yao K, Winchester DJ, Gorchow A, Du H, Sener SF, Martz B, Turk M, Barrera E, Winchester DP,
Complete node dissection for a tumor-positive sentinel node (SN) is becoming more controversial. We report our institution's 12-year experience with sentinel node biopsy (SNB) alone for a tumor-positive SN.
This was a retrospective review from 1998 to 2009. Of 3,806 patients who underwent SNB, 2,139 underwent SNB alone, of which 1,997 were tumor-negative and 123 were tumor-positive. SNs were staged node-positive (N1mic or N1) according to American Joint Committee on Cancer criteria.
One hundred and twenty-three node-positive patients underwent SNB alone with no completion axillary dissection for invasive breast cancer. Mean age was 57 years (range 32 to 92 years) and stage distribution was as follows: stage IIA: 76 (62%) patients; stage IIB: 40 (33%) patients; and stage III: 4 patients (3%). Mean size of the tumors was 1.9 cm (range 0.1 to 9 cm). Eighty-nine (72%) underwent lumpectomy and 34 (28%) underwent mastectomy. Ninety-three percent of patients underwent some form of adjuvant therapy. Forty-two patients (34%) did not undergo radiation and there were no axillary recurrences in this group. At median follow-up of 95 months, there has been 1 axillary recurrence (0.8%) and 13 deaths, 4 of which were attributed to metastatic breast cancer and the rest to non-breast-related causes.
Axillary recurrence is rare after SN biopsy alone. This might be related to favorable tumor and patient characteristics and frequent use of adjuvant therapy.
PMID: 21530326 [PubMed - as supplied by publisher]
American journal of surgery 2009 Mar
Authors: Sener SF, Winchester DJ, Winchester DP, Du H, Barrera E, Bilimoria M, Krantz S, Rabbitt S,
The goal of this study was to compare the characteristics of breast cancers and survival rates in HRT users versus nonusers.
Data were analyzed for 1055 patients > or = 50 years of age who had definitive therapy for breast cancer from 1994 through 2002.
There were 471 (45%) HRT users. The median age at diagnosis was 61.0 years for HRT users and 68.0 years for HRT nonusers (P < .001). HRT users more often had tumors that were <1 cm (P = .007), node negative (P = .033), and grade I (P = .016). HRT users had a decreased risk of death versus nonusers (hazard ratio = .438, 95% confidence limit = .263 to .729, P = .002).
HRT users developed breast cancer at a younger age than nonusers; HRT use was associated with the development of biologically more favorable cancers than those that developed in nonusers; and overall and disease-free survival rates were higher in HRT users than nonusers.
PMID: 19245923 [PubMed - as supplied by publisher]
Journal of vascular surgery 2008 Aug
Authors: Sedjo RL, Byers T, Barrera E,
In 1998, the American Cancer Society (ACS) set a challenge goal for the nation to reduce cancer incidence by 25% over the period between 1992 and 2015. This report examines the trends in cancer incidence between 1992 and 2004. Trends were calculated using data on incident malignant cancer cases from the Surveillance, Epidemiology, and End Results (SEER) Registry. Delay-adjusted incidence trends for all cancer sites; all cancer sites without prostate cancer included; all cancer sites stratified by gender, age, and race; and for 20 selected cancer sites are presented. Over the first half of the ACS challenge period, overall cancer incidence rates have declined by about 0.6% per year. The greatest overall declines were observed among men and among those aged 65 years and older. The pace of incidence reduction over the first half of the ACS challenge period was only half that necessary to put us on target to achieve the 25% cancer incidence reduction goal in 2015. New understandings of preventable factors are needed, and new efforts are also needed to better act on our current knowledge about how we can prevent cancer, especially by continuing to reduce tobacco use and beginning to reverse the epidemic of obesity.
PMID: 18644493 [PubMed - as supplied by publisher]
Cancer 2006 Jul 15
Authors: Byers T, Barrera E, Fontham ET, Newman LA, Runowicz CD, Sener SF, Thun MJ, Winborn S, Wender RC, American Cancer Society Incidence and Mortality Ends Committee,
The American Cancer Society has challenged the U.S. to reduce cancer mortality rates 50% over the 25 years from 1990 to 2015. The current report is an analysis and commentary on progress toward that goal through 2002, the midpoint of the challenge period.
Cancer mortality rates were examined from 1990 through 2002, and projections to the Year 2015 were made. Cancer deaths that were prevented or deferred by the declining death rates were expressed as the difference between the observed and projected numbers of deaths and the numbers that would have been observed over that period had the 1990 death rates persisted.
Since 1990, cancer mortality rates have been declining in the U.S. by approximately 1% per year. Trends especially have been favorable for cancers of the breast, prostate, and colorectum and for lung cancer among men. Should this rate of decline continue over the coming decade, death rates from cancer will be approximately 23% lower in the Year 2015 than they were in 1990, and approximately 1.8 million deaths from cancer will have been prevented or deferred.
At this midpoint of the 25-year challenge period, it appears that fully reaching the goal will require substantial breakthroughs in cancer early detection and/or in cancer therapy. Between now and 2015, however, many more cancer deaths can be averted by concerted action to control tobacco and obesity, by redoubling efforts in mammography and colorectal screening, and by enacting policies to close gaps in access to cancer detection and treatment services.
PMID: 16770789 [PubMed - as supplied by publisher]