David J. Winchester, M.D.

David J. Winchester, M.D.

David J. Winchester, M.D.

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Conditions & Procedures

Conditions

Abscess, Appendix, Breast Cancer, Cyst, Gallbladder, Gallbladder Disease, Hernia, Lipoma, Melanoma, Parathyroid, Sarcoma, Skin Lesion

Procedures

Abdominal Hernia Repair, Endocrine Surgery, General Surgery, Inguinal Hernia Repair, Minimally Invasive Hernia Surgery, Parathyroid Surgery, Peritoneal Dialysis (PD) Catheter, Port-a-cath, Surgical Oncology, Surgical Oncology in Breast, Temporal Artery Biopsy, Thyroid & Parathyroid Surgery, Thyroid Surgery

General Information

Gender

Male

Affiliation

NorthShore Medical Group

Expertise

General Surgery, Surgical Oncology

Academic Rank

Clinical Professor

Languages

English

Board Certified

Surgery

Clinical Service

Surgical Oncology

Education, Training & Fellowships

Medical School

Northwestern Feinberg School of Medicine, 1986

Internship

Northwestern Feinberg School of Medicine

Residency

Northwestern Feinberg School of Medicine

Fellowship

University of Texas MD Anderson Cancer Center

Locations

A

NorthShore Medical Group

2050 Pfingsten Rd.
Suite 128
Glenview, IL 60026
847.570.1700 847.832.5034 fax This location is wheelchair accessible.
B

NorthShore Medical Group

2050 Pfingsten Rd.
Suite 130
Glenview, IL 60026
847.570.1700 847.832.5034 fax This location is wheelchair accessible.
C

NorthShore Medical Group

1000 Central St.
Suite 800
Evanston, IL 60201
847.570.1000 847.832.5034 fax This location is wheelchair accessible.
D

NorthShore Medical Group

2650 Ridge Ave.
Suite 1155
Evanston, IL 60201
847.570.1700 847.832.5034 fax This location is wheelchair accessible.

Insurance

Every effort has been made to ensure the accuracy of the information in this directory. However, some changes may occur between updates. Please check with your provider to ensure that he or she participates in your health plan.

Aetna HMO/PPO/POS
BCBS HMOI
BCBS PPO *except Blue Choice IL
Beechstreet PPO
CCN PPO
CIGNA Choice Fund
CIGNA EPO
CIGNA POS
First Health PPO
Galaxy PPO
Great West POS
Healthcares Finest Network PPO
Humana Choice Care PPO
Humana IPA--HMO
Humana POS
Humana PPO
Land of Lincoln
Medicare
Multiplan Admar PPO
Multiplan Formost PPO
Multiplan Health Network PPO
NorthShore Employee Network I (EPO Option)
NorthShore Employee Network II (EPO Plus & CDHP)
PHCS PPO
Preferred Plan PPO
Railroad Medicare - Cook County
UHC *except Core & Navigate
Unicare PPO

Publications

  • Impact of Bilateral Versus Unilateral Mastectomy on Short Term Outcomes and Adjuvant Therapy, 2003-2010: A Report from the National Cancer Data Base.

    Annals of surgical oncology 2014 Apr 12

    Authors: Sharpe SM,
    Abstract
    Rates of bilateral mastectomy (BM) have increased, but the impact on length of stay (LOS), readmission rate, 30-day mortality, and time to adjuvant therapy is unknown.
    Using the National Cancer Data Base, we selected 390,712 non-neoadjuvant AJCC stage 0-III breast cancer patients who underwent either unilateral mastectomy (UM) or BM from 2003 to 2010 with and without reconstruction. We used chi-square and logistic regression models for the analysis.
    A total of 315,278 patients (81 %) had UM, and 75,437 (19 %) had BM; 97,031 (25 %) underwent reconstruction. The number of median days from diagnosis to UM increased from 19 days in 2003 to 28 days in 2010, and for BM, increased from 21 to 31 days (p < 0.001). BM was independently associated with a longer time to surgery when adjusting for patient, facility, and tumor factors and reconstruction (OR 1.11; 95 % CI 1.07-1.15; p < 0.001). Reconstructed patients were twice as likely to have a longer time to surgery (OR 2.07; 95 % CI 2.01-2.14; p < 0.001). The median LOS was 1 day (range 0-184 days) for UM versus 2 (range 0-182) for BM (p < 0.001); 30-day mortality and readmission rates were not different between BM and UM. The median number of days from diagnosis to definitive chemotherapy, hormonal therapy, and radiation therapy was significantly greater in the BM group.
    Delays to surgical and adjuvant treatment are significantly longer for BM irrespective of reconstruction, and these delays have increased over the study period. These findings can be used by clinicians to counsel patients on BM.
    PMID: 24728739 [PubMed - as supplied by publisher]
  • Contralateral prophylactic mastectomy and survival: report from the National Cancer Data Base, 1998-2002.

    Breast cancer research and treatment 2013 Dec

    Authors: Yao K,
    Abstract
    The use of contralateral prophylactic mastectomy (CPM) has been increasing despite questionable survival benefit. We examined the effect of CPM on survival using the National Cancer Data Base. We examined overall survival on 219,983 mastectomy patients diagnosed with unilateral AJCC Stage 1-III invasive breast cancer between 1998 and 2002 of which 14,994 (7 %) underwent CPM at the time of their index mastectomy. Median follow up time was 5 years. Neoadjuvant and locally advanced breast cancers were excluded. Approximately 4 % underwent CPM in 1998 compared to 9.4 % in 2002, an ~125 % increase. CPM patients were significantly younger than non-CPM patients, on managed care plans, and were treated at high volume centers. The unadjusted hazard ratio (HR) of death was 0.55 (95 % CI 0.52-0.57) for CPM compared to unilateral mastectomy. In a multivariable Cox model adjusting for age, race, stage, grade, histology, insurance, facility characteristics, use of adjuvant hormonal, chemotherapy, and radiotherapy, and year of diagnosis, the adjusted HR was 0.88 (95 % CI 0.83-0.93; p < 0.001) which translated into an absolute 5-year benefit of 2 %. There was a differential effect of CPM by stage and age: HR = 0.88 (95 % CI 0.82-0.94; p < 0.001) in women younger than 70 with stage I/II, and HR = 0.95 (95 % CI 0.88-1.04; p = 0.28) in women with stage III or older than age 69 which translated into an absolute 5-year benefit of 1.3 %. Utilization of hormonal therapy or chemotherapy had no effect on the HR. After adjusting for confounding, the overall survival benefit for CPM is minimal at best.
    PMID: 24218052 [PubMed - as supplied by publisher]
  • Variations in clinicopathologic characteristics of thyroid cancer among racial ethnic groups: analysis of a large public city hospital and the SEER database.

    American journal of surgery 2013 Nov

    Authors: Moo-Young TA,
    Abstract
    Clinicopathologic variables influence the treatment and prognosis of patients with thyroid cancer.
    A retrospective analysis of public hospital thyroid cancer database and the Surveillance, Epidemiology and End Results 17 database was conducted. Demographic, clinical, and pathologic data were compared across ethnic groups.
    Within the public hospital database, Hispanics versus non-Hispanic whites were younger and had more lymph node involvement (34% vs 17%, P < .001). Median tumor size was not statistically different across ethnic groups. Similar findings were demonstrated within the Surveillance, Epidemiology and End Results database. African Americans aged <45 years had the largest tumors but were least likely to have lymph node involvement. Asians had the most stage IV disease despite having no differences in tumor size, lymph node involvement, and capsular invasion.
    There is considerable variability in the clinical presentation of thyroid cancer across ethnic groups. Such disparities persist within an equal-access health care system. These findings suggest that factors beyond socioeconomics may contribute to such differences.
    PMID: 24157347 [PubMed - as supplied by publisher]
  • Predicting aggressive behavior in nonfunctioning pancreatic neuroendocrine tumors.

    Surgery 2013 Oct

    Authors: Cherenfant J,
    Abstract
    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 for PNETs from 1998 to 2011 in the databases of 4 institutions. Functioning PNETs were excluded. Multivariate regression Cox proportional models were constructed to identify clinical and pathologic factors associated with distant metastasis and survival.
    The study included 128 patients-57 females and 71 males. The age (mean ± standard deviation) was 55 ± 14 years. The body mass index was 28 ± 5 kg/m(2). Eighty-nine (70%) patients presented with symptoms, and 39 (30%) had tumors discovered incidentally. The tumor size was 3.3 ± 2 cm with 56 (44%) of the tumors measuring ≤2 cm. Seventy-three (57%) patients had grade 1 histology tumors, 37 (29%) had grade 2, and 18 (14%) had grade 3. Peripancreatic lymph node involvement was present in 31 patients (24%), absent in 75 (59%), and unknown in 22 (17%). Distant metastasis occurred in 18 patients (14%). There were 12 deaths, including 1 perioperative, 8 disease related, and 3 of unknown cause. With a median follow-up of 33 months, the overall 5-year survival was 75%. Multivariate Cox regression analysis identified age >55 (hazard ratio [HR], 5.89; 95% confidence interval [CI], 1.64-20.58), grade 3 histology (HR, 6.08; 95% CI, 1.32-30.2), and distant metastasis (HR, 8.79; 95% CI, 2.67-28.9) as risk factors associated with death (P < .05). Gender, race, body mass index, clinical symptoms, lymphovascular and perineural invasion, and tumor size were not related to metastasis or survival (P > .05). Three patients with tumors ≤2 cm developed distant metastasis resulting in 2 disease-related deaths.
    Age >55 years, grade 3 histology, and distant metastasis predict a greater risk of death from nonfunctioning PNETs. Resection or short-term surveillance should be considered regardless of tumor size.
    PMID: 24074416 [PubMed - as supplied by publisher]
  • Accurate staging with internal mammary chain sentinel node biopsy for breast cancer.

    Annals of surgical oncology 2014 Feb

    Authors: Gnerlich JL,
    Abstract
    Although internal mammary chain (IMC) metastases are an independent predictor of prognosis, collecting IMC sentinel nodes (SN) remains controversial. We sought to determine predictors for IMC nodal positivity and the role positive IMC-SNs have on changing staging and management.
    We reviewed a prospectively collected database (1997-2012) to identify patients who had IMC drainage detected on lymphoscintigraphy and underwent biopsy. Chi square tests and logistic regression models were used to determine trends and factors associated with IMC node positivity.
    A total of 122 patients with cTis-T2cN0M0 breast cancer underwent IMC-SN biopsy. Mean age of the cohort was 53 years, and mean tumor size was 2.0 cm. Identification of IMC nodes was successful in 100% of the cases. There were no complications. Sentinel nodes mapped to the IMC alone in 14 of 122 (11%) patients. Overall, 26% of patients were node positive, with 12 of 122 (10%) patients having a positive IMC-SN. In patients with a positive axilla, IMC-SN was positive in 33% of patients, whereas in patients with a negative axilla, IMC-SN was positive in 3% of cases (P < 0.001). The number of positive axillary nodes was the only independent predictor of IMC positivity (1-3 positive axillary nodes odds ratio 16.9, 95% CI 3.1-91.1; ≥4 positive axillary nodes odds ratio 45.0, 95% CI 4.0-500.7). IMC-SN positivity led to a more advanced nodal category in all patients and more accurate staging in 4 of 12 (33%) patients.
    IMC-SN biopsy is predictable and safe. Identification of IMC metastases though IMC-SN biopsy has the potential to alter the stage and adjuvant therapy of breast cancer patients.
    PMID: 24046119 [PubMed - as supplied by publisher]
  • Trends in thyroid surgery in Illinois.

    Surgery 2013 Nov

    Authors: Cherenfant J,
    Abstract
    Endocrine surgery is an evolving subspecialty in general surgery. To determine whether this subspecialty is having an effect on practice patterns of thyroid surgery, we reviewed all thyroidectomies performed in Illinois over an 11-year period.
    The Illinois COMPdata database from the Illinois Hospital Association was used to retrieve all the thyroid operations performed in the state of Illinois from 1999 to 2009. Univariate and multivariate logistic regression analyses were performed to assess the effects of surgeon and hospital type on practice patterns of thyroidectomies.
    In the early period (1999-2004), 5,824 operations were identified compared with 8,454 in the late period (2005-2009; P < .001). Total thyroidectomy represented 2,679 (46%) of the thyroid operations done in the early period compared with 4,976 (59%) in the late period (P < .001). Sixty-two percent of all the thyroid operations were done at community hospitals in the early period compared with 56% in the late period. Endocrine surgeons (ES) performed the greatest rate of thyroidectomies, 0.7 and 0.6/10(5) population, in both early and late periods, respectively.
    In Illinois, the volume of thyroid operations has increased significantly over the past 10 years with a shift toward total thyroidectomy. Although most thyroidectomies are still performed in community hospitals, this percentage has decreased. ES perform a minority of thyroid operations, but they have the greatest volume of thyroidectomies per surgeon. These findings may represent broader trends in thyroid surgery throughout the United States.
    PMID: 24008085 [PubMed - as supplied by publisher]
  • Accelerated partial-breast irradiation versus whole-breast irradiation for early-stage breast cancer patients undergoing breast conservation, 2003-2010: a report from the national cancer data base.

    Annals of surgical oncology 2013 Oct

    Authors: Czechura T,
    Abstract
    Previous studies have demonstrated an increase in the utilization of accelerated partial-breast irradiation via brachytherapy (APBI-b), but larger, more contemporary studies examining overall APBI use are lacking.
    A total of 575,438 nonneoadjuvant American Joint Committee on Cancer stage 0 to II breast conservation patients were selected from the National Cancer Data Base from 2003 to 2010 who underwent either whole-breast irradiation or APBI.
    Overall, 59,396 patients (10.3 %) underwent APBI. The use of APBI for the entire cohort increased from 3.4 % in 2003 to 12.8 % (p < 0.001) in 2008 and then decreased to 12.4 % in 2010. Three-dimensional conformal radiation increased from 0.8 to 2.2 %, intensity-modulated radiotherapy increased from 0.7 to 1.3 %, and brachytherapy (APBI-b) increased from 2.0 to 8.9 %. The most significant factors associated with APBI use were patient age and facility location. Patients 80-89 years old were 3.8 times more likely to undergo APBI compared to patients 30-39 years old (odds ratio [OR] 3.77, 95 % confidence interval [CI] 3.45-4.10, p < 0.001). Patients living in the West census region were 2.0 times more likely to undergo APBI compared to patients living in the Northeast (OR 2.0, 95 % CI 1.93-2.15, p < 0.001). Using the American Society of Radiation Oncology (ASTRO) guidelines, among patients with noninvasive cancer who received APBI, 95.6 % were categorized as "cautionary" and 4.4 % as "unsuitable." Of the invasive patients, 43.8 % were categorized as "suitable," 47.0 % as "cautionary," and 9.2 % as "unsuitable."
    The utilization of APBI has stabilized at approximately 12 % starting in 2008. The majority of APBI is delivered using APBI-b, with patient age being the most significant factor associated with APBI use.
    PMID: 23975298 [PubMed - as supplied by publisher]
  • Axillary surgery among estrogen receptor positive women 70 years of age or older with clinical stage I breast cancer, 2004-2010: a report from the national cancer data base.

    Annals of surgical oncology 2013 Oct

    Authors: Pesce C,
    Abstract
    Randomized trials have not demonstrated a survival benefit for axillary dissection in the elderly, but the use of axillary staging for women 70 years of age and older remains controversial.
    We utilized the National Cancer Data Base to study the use of axillary staging from 2004 to 2010 on 102,026 clinically node-negative and estrogen receptor-positive cases of pT1N0 tumors. Chi-square and logistic regression models were used to determine the trends and factors related to axillary staging.
    Axillary nodes were examined in 88.9 % of the total cohort, and the trend significantly increased from 87.7 % in 2004 to 89.2 % in 2010. A total of 77.2 % of patients underwent lumpectomy and 22.8 % mastectomy, with 87.0 % of lumpectomy patients undergoing axillary staging compared to 95.5 % of mastectomy patients. Predictors of axillary staging examined were age, comorbidity, income, histology, grade, facility type, facility location, and population density. The strongest independent predictor of axillary staging was age: 96.0 % of women aged 70-75 years underwent axillary staging, versus 92.3 % of women 75-80 years old, 83.2 % of women 80-85 years old, 66.5 % of women 86-90 years old, and 45.6 % of women >90 years old. Patients treated at academic/research facilities were 18.5 % less likely (odds ratio 0.81, 95 % confidence interval 0.76-0.87) than community cancer programs to undergo axillary staging. There was significant regional variation among U.S. Census regions: patients treated in the Midwest were 3.8 times more likely to undergo axillary staging than those treated in the Northeast.
    Despite data indicating decreased utility, axillary staging remains overutilized in women with advancing age.
    PMID: 23975297 [PubMed - as supplied by publisher]
  • Operative risks associated with contralateral prophylactic mastectomy: a single institution experience.

    Annals of surgical oncology 2013 Dec

    Authors: Miller ME,
    Abstract
    The purpose of this study was to determine if newly diagnosed breast cancer patients undergoing contralateral prophylactic mastectomy (CPM) experience more complications than patients undergoing unilateral mastectomy (UM).
    A total of 600 patients underwent either UM or CPM between January 2009 and March 2012 for unilateral breast cancer. Operative complications were classified as minor (aspirations, infection requiring antibiotics, partial flap and nipple necrosis, minor bleeding, delayed wound healing) or major (hematoma or seroma requiring operation, infection requiring rehospitalization, blood product transfusion, total flap or nipple loss, implant removal), mixed (both minor and major complications), or multiple. Chi-square and multivariate logistic regressions were used for the analysis.
    Of the 600 patients, 391 (65 %) underwent UM and 209 (35 %) underwent CPM. Across all complication groups, there were significantly more complications in the CPM group versus the UM group (41.6 vs. 28.6 %, p = 0.001). Major complications alone were significantly greater in the CPM versus the UM group (13.9 vs. 4.1 %, p < 0.001). When adjusting for age, body mass index, smoking and diabetes history, AJCC stage, reconstruction, previous radiation therapy, and adjuvant therapy, CPM patients were 1.5 times more likely to have any complication (odds ratio [OR] 1.53; 95 % CI 1.04-2.25, p = 0.029) and 2.7 times more likely to have a major complication compared with UM patients (OR 2.66; 95 % CI 1.37-5.19, p = 0.004).
    CPM patients have an increased risk of complications, especially major complications requiring rehospitalization or reoperation. These complications may influence patient and physician decisions to choose CPM.
    PMID: 23868655 [PubMed - as supplied by publisher]
  • Who should have or not have an axillary node dissection with breast cancer?

    Advances in surgery 2012

    Authors: Williams RT,
    Abstract
    There have been dramatic changes in the approach to the axilla in women with breast cancer over the last 100 years, reflecting the evolution in our understanding of the underlying tumor biology, reduced disease burden because of early detection, and advances in all breast cancer treatment modalities. The approach to the axilla needs to be individualized, much like the extent of surgery for the primary tumor. Axillary dissection remains an important intervention for patients with more locally advanced disease. However, in patients with early-stage breast cancer, in whom regional recurrence is extremely low, the added benefit of an ALND has yet to be confirmed.
    PMID: 22873029 [PubMed - as supplied by publisher]

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Dr. Winchester discusses the latest findings from the study published in the British Journal of Medicine.

Dr. Winchester discusses the latest findings from the study published in the British Journal of Medicine.

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