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, Spanish

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 847.503.4353 fax Get Directions This location is wheelchair accessible.
B

NorthShore Medical Group

1000 Central St.
Suite 800
Evanston, IL 60201
847.570.1700 847.503.4353 fax Get Directions This location is wheelchair accessible.
C

NorthShore Medical Group

2650 Ridge Ave.
Suite 1155
Evanston, IL 60201
847.570.1700 847.503.4353 fax Get Directions This location is wheelchair accessible.
D

NorthShore Medical Group

2050 Pfingsten Rd.
Suite 130
Glenview, IL 60026
847.570.1700 847.503.4353 fax Get Directions This location is wheelchair accessible.

Insurance

Commercial Plans
  • Aetna Choice POS
  • Aetna Elect Choice EPO and EPO
  • Aetna Health Network Options
  • Aetna HMO
  • Aetna Managed Choice
  • Aetna Managed Choice POS
  • Aetna Open Choice PPO
  • Aetna Open Choice PPO (Aetna HealthFund)
  • Aetna QPOS
  • Aetna Savings Plus
  • Aetna Select
  • Beechstreet PPO Network
  • Blue Cross Blue Shield - PPO Products
    Not Contracted Blue Cross Blue Shield Blue Choice PPO
  • Blue Cross Blue Shield Blue Advantage
  • Blue Cross Blue Shield HMOI
  • Cigna HMO
  • Cigna LocalPlus
  • Cigna Open Access Plus (OAP)
  • Cigna Open Access Plus with CareLink (OAPC)
  • Cigna POS
  • Cigna PPO
  • Cofinity PPO (an Aetna Company)
  • Coventry Health Care Elect Choice EPO
  • Coventry Health Care First Health PPO
  • Galaxy Health PPO Network
  • Great West PPO/POS
  • Healthcare's Finest Network (HFN)
  • Humana - All Commercial Plans (including Choice Care)
  • Humana - NorthShore Complete Care
  • Humana/ChoiceCare Network PPO
  • Medicare
  • Multiplan and PHCS PPO Network (Including PHCS Savility)
  • NorthShore Employee Network
  • Preferred Plan PPO
  • Three Rivers Provider PPO Network (TRPN)
  • Tricare
  • Unicare
  • United Healthcare - All Commercial Plans
    Not Contracted United Healthcare Core
    Not Contracted United Healthcare Navigate
Exchange Plans
  • Aetna Whole Health Chicago
  • Not Contracted Blue Cross Blue Shield - PPO Products
    Not Contracted Blue Cross Blue Shield Blue Choice PPO
  • Blue Cross Blue Shield Blue Precision HMO
  • Coventry (PPO)
  • Harken Health - an Affiliate of United Healthcare
    Verify physician participation and out of pocket expenses with Harken
  • Land of Lincoln Health Traditional PPO
  • Not Contracted United Healthcare Compass
Medicaid
  • Illinois Department of Public Aid (IDPA)
  • Illinicare ICP
  • Community Care Partners
Medicare Advantage Plans
  • Aetna Medicare (SM) Plan (HMO)
  • Aetna Medicare (SM) Plan (PPO)
  • Blue Cross Blue Shield Medicare Advantage PPO Plan
  • Cigna-HealthSpring Advantage HMO
  • Cigna-HealthSpring Premier HMO-POS
  • Cigna-HealthSpring Primary HMO
  • Humana Gold Plus HMO
  • Humana Gold Plus PFFS
  • HumanaChoice PPO
  • United Healthcare - All Medicare Plans
Medicare Medicaid Alignment Initiative (MMAI) Plans
  • Blue Cross Blue Shield Community
  • HealthSpring
  • Humana
  • Illinicare Health Plan
  • Meridian Complete

Publications

  • Perioperative chemotherapy is associated with a survival advantage in early stage adenocarcinoma of the pancreatic head.

    Surgery 2016 Jul 12

    Authors: Lutfi W, Talamonti MS, Kantor O, Wang CH, Liederbach E, Stocker SJ, Bentrem DJ, Roggin KK, Winchester DJ, Marsh R, Prinz RA, Baker MS
    Abstract
    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, 10.2% received neoadjuvant chemotherapy alone, and 4.9% received perioperative chemotherapy, both preoperative and postoperative chemotherapy. Neoadjuvant chemotherapy use (neoadjuvant chemotherapy alone and postoperative chemotherapy) increased from 12.0% in 2006 to 20.2% in 2012. Patients who received chemotherapy prior to the operation (neoadjuvant chemotherapy alone and postoperative chemotherapy) had greater rates of margin negative (80.2% vs 73.0%, P < .001) and node negative (58.2% vs 28.7%, P < .001) resections and shorter mean durations of stay (12.0 vs 11.1 days, P = .012) than those receiving either adjuvant chemotherapy or no chemotherapy at all. There were no differences in 30-day unplanned readmissions (P = .074) and 90-day mortality (P = .227). On Cox survival analysis, adjusted for clinical variables including age and comorbid disease, patients undergoing perioperative chemotherapy, adjuvant chemotherapy, and neoadjuvant chemotherapy alone demonstrated significantly improved overall survival relative to that of patients undergoing resection alone (all P < .001). Patients receiving postoperative chemotherapy demonstrated a significant overall survival advantage compared with those receiving adjuvant chemotherapy (hazard ratio 0.75; 95% confidence interval, 0.65-0.85). Neoadjuvant chemotherapy alone had a marginal overall survival benefit compared with adjuvant chemotherapy (hazard ratio 0.89; 95% confidence interval, 0.81-0.98).
    Early stage pancreatic cancer patients who receive postoperative chemotherapy have better overall survival than those receiving no chemotherapy, adjuvant chemotherapy, or neoadjuvant chemotherapy alone. Patterns of postoperative morbidity are similar regardless of the sequence of therapy. Neoadjuvant chemotherapy should be considered for patients presenting with early stage pancreatic cancer.
    PMID: 27422328 [PubMed - as supplied by publisher]
  • Patient satisfaction with nipple-sparing mastectomy: A prospective study of patient reported outcomes using the BREAST-Q.

    Journal of surgical oncology 2016 Jul 8

    Authors: Howard MA, Sisco M, Yao K, Winchester DJ, Barrera E, Warner J, Jaffe J, Hulick P, Kuchta K, Pusic AL, Sener SF
    Abstract
    The authors sought to study patient-reported outcomes following nipple-sparing mastectomy (NSM).
    From 2008 to 2011, the BREAST-Q was administered to women undergoing NSM surgery for cancer treatment or risk-reduction prior to surgery and at 2 years after completion of reconstruction. The change in score over time and the impact of surgical indication, complication occurrence, and laterality on scores were analyzed.
    The BREAST-Q was prospectively administered to 39 women undergoing NSM for cancer treatment (n = 17) or risk-reduction (RR) (n = 22). At 2 years after operation, median overall satisfaction with breasts was 75 (IQR = 67,100). There were significant postoperative increases in scores for overall satisfaction with breasts (+8, P = 0.021) and psychosocial well-being (+14, P = 0.003). Postoperatively, RR patients had significantly higher scores for psychosocial wellness, physical impact (chest), and overall satisfaction with outcome compared to cancer treatment patients (P < 0.05). Also, increase from preoperative to postoperative psychosocial wellness was higher in the RR compared to cancer treatment patients (+17 vs. +1, P = 0.043). Complication occurrence did not significantly impact postoperative scores.
    Following NSM for cancer treatment or RR, patients demonstrated high levels of satisfaction and quality of life as measured by BREAST-Q. Satisfaction level increased 2 years following operation. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.
    PMID: 27393183 [PubMed - as supplied by publisher]
  • Utilization of Axillary Surgery for Patients With Ductal Carcinoma In Situ: A Report From the National Cancer Data Base.

    Annals of surgical oncology 2016 Jun 22

    Authors: Miller ME, Kyrillos A, Yao K, Kantor O, Tseng J, Winchester DJ, Shulman LN
    Abstract
    This study evaluated the use of axillary surgery (AS), including sentinel lymph node biopsy (SLNB), for patients with ductal carcinoma in situ (DCIS) and the factors associated with its use. To determine whether utilization of SLNB is appropriate, predictors of SLNB performance were compared with factors predictive of tumor upstaging.
    The National Cancer Data Base was utilized to identify patients with American Joint Committee on Cancer (AJCC) clinical stage 0 breast cancer treated from 2004 to 2013. DCIS with microinvasion was excluded. Chi square tests and logistic regression were used to examine patient, tumor, and facility features associated with SLNB and tumor upstaging.
    Of the 218,945 total patients, 155,093 (70.8 %) underwent lumpectomy, and 63,852 (29.2 %) underwent mastectomy. SLNB was performed for 19.0 % of lumpectomy patients and 63.5 % of mastectomy patients. Multivariate analysis for 2012-2013 demonstrated that estrogen receptor (ER)-negative and grade 3 tumors were more likely to be treated with SLNB in both groups. Tumor size was significant only for the lumpectomy patients who underwent one operation. Further, 22.8 % of lumpectomy patients and 18.7 % of mastectomy patients who underwent AS were upstaged compared with 1.8 % of lumpectomy and 3.6 % of mastectomy patients who did not undergo AS. Tumor upstaging was predicted by ER-negative status (odds ratio [OR] 2.99; 95 % confidence interval [CI] 2.76-3.24) but not by higher grade or larger tumor size.
    Use of SLNB for DCIS is high with mastectomy, and nearly one fifth of the lumpectomy patients underwent SLNB. However, the performance of AS was strongly associated with the likelihood of upstaging in both groups, suggesting that surgical judgment plays an important role in this decision.
    PMID: 27334212 [PubMed - as supplied by publisher]
  • Response to commentary on: Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study.

    Surgery 2016 May 26

    Authors: Suman P, Wang CH, Abadin SS, Block R, Raghavan V, Moo-Young TA, Prinz RA, Winchester DJ
    Abstract
    Post-thyroidectomy radioiodine (RAI) therapy is indicated for papillary thyroid carcinoma (PTC) with high-risk features. There is a variability in the timing of RAI therapy with no consensus. We analyzed the impact of the timing of initial RAI therapy on overall survival (OS) in PTC.
    The National Cancer Data Base (NCDB) was queried from 2003-2006 for patients with PTC undergoing near/subtotal or total thyroidectomy, and RAI therapy. High-risk patients had tumors > 4 cm in size, lymph node involvement or grossly positive margins. Early RAI was ≤3 months whereas delayed was between 3-12 months after thyroidectomy. Kaplan-Meier (KM) and Cox survival analyses were performed after adjusting for patient and tumor-related variables. A propensity matched set of high-risk patients after eliminating bias in RAI timing was also analyzed.
    There were 9706 patients in the high-risk group. The median survival was 74.7 months. KM analysis showed a survival benefit for early RAI in high-risk patients (P .025). However, this difference disappeared (HR 1.26, 95% CI .98-1.62, P .07) on adjusted Cox multivariable analysis. Timing of RAI therapy failed to affect OS in propensity matched high-risk (HR 1.09, 95% CI .75-1.58, P .662) patients.
    The timing of post-thyroidectomy initial RAI therapy does not affect OS in patients with high-risk PTC.
    PMID: 27238355 [PubMed - as supplied by publisher]
  • The Learning Curve Is Surmountable: In Reply to Fong and colleagues.

    Journal of the American College of Surgeons 2016 Feb

    Authors: Kantor O, Pesce C, Liederbach E, Wang CH, Winchester DJ, Yao K
    Abstract
    There has been a trend toward minimizing surgery in elderly women with estrogen receptor-positive (ER+) breast cancer.
    Using the National Cancer Data Base, we selected 95,357 women ≥80 years with invasive, ER+ breast cancer. Chi-square test and logistic regression were used to analyze trends in surgery and hormone therapy.
    From 2004 to 2012, 90% of women were treated with surgery first and 10% were treated with primary nonoperative management. Of those undergoing nonoperative management, 72% received endocrine therapy and 27% had no treatment. The rate of primary nonoperative treatment doubled from 7% in 2004 to 14% in 2012. Multivariate logistic regression adjusted for patient, facility, and tumor factors identified more advanced clinical stage, older age, African-American race, and treatment at Academic facilities as independent predictors of receiving primary nonsurgical management.
    There has been an increase over time in primary nonoperative management of ER+ breast cancer in octogenarians.
    PMID: 26809388 [PubMed - as supplied by publisher]
  • A Graded Evaluation of Outcomes Following Pancreaticoduodenectomy with Major Vascular Resection in Pancreatic Cancer.

    Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 2016 Feb

    Authors: Kantor O, Talamonti MS, Stocker SJ, Wang CH, Winchester DJ, Bentrem DJ, Prinz RA, Baker MS
    Abstract
    Previous studies examining short- and long-term outcomes of pancreaticoduodenectomy with vascular resection for pancreatic adenocarcinoma have not graded perioperative complication severity. These studies may provide incomplete assessments of the efficacy of vascular resection. In the current study, we evaluated 36 patients who had pancreaticoduodenectomy with major vascular resection. These were matched 1:3 by tumor stage and age to patients who had pancreaticoduodenectomy without vascular resection. Charts were reviewed to identify all complications and 90-day readmissions. Complications were graded as either severe or minor adverse postoperative outcomes, taking into account the total length of stay. There were no statistical differences in patient demographics, comorbidities, or symptoms between the groups. Patients who had vascular resection had significantly increased rates of severe adverse postoperative outcomes, readmissions, lengths of hospital stay, as well as higher hospital costs. Hypoalbuminemia and major vascular resection were independent predictors of severe adverse postoperative outcomes. On multivariate Cox-regression survival analysis, patients who had vascular resection had decreased recurrence-free (12 vs. 17 months) and overall (17 vs. 29 months) survival. Major vascular resection was a predictor of mortality, may be an independent prognostic factor for survival, and may warrant incorporation into future staging systems.
    PMID: 26493974 [PubMed - as supplied by publisher]
  • Risk factors for central lymph node metastasis in papillary thyroid carcinoma: A National Cancer Data Base (NCDB) study.

    Surgery 2016 Jan

    Authors: Suman P, Wang CH, Abadin SS, Moo-Young TA, Prinz RA, Winchester DJ
    Abstract
    There is no consensus regarding prophylactic central lymph node dissection (pCLND) in patients with papillary thyroid carcinoma (PTC). Identification of risk factors for central lymph node metastasis (CLNM) in patients with PTC could assist surgeons in determining whether to perform selective pCLND.
    The National Cancer database was queried from 1998 to 2011 for patients with clinical staging T1-4cN0M0 PTC. All patients underwent near, sub-, or total thyroidectomy with or without pCLND. Univariate and multivariable logistic regressions were performed on the following clinical variables: age, sex, race and tumor size as risk factors for pathologic CLNM (pN1a).
    In 39,562 patients with T1-4cN0M0 PTC, 61% underwent pCLND. Patients with age >45 years, African American race, tumor size ≤ 1 cm, unifocal tumors, follicular variant PTC, no insurance, and treatment at community cancer facilities were less likely to have pCLND (P < .001). In the pCLND group, 15.6% of patients had CLNM. On adjusted multivariable logistic regression, age ≤ 45 years, Asian race, male sex, and larger tumors were statistically significantly associated with CLNM.
    Age ≤ 45 years, Asian race, male sex, and larger tumors are associated with the presence of CLNM, which allows for selective pCLND in PTC.
    PMID: 26435436 [PubMed - as supplied by publisher]
  • Survival Outcomes and Pathologic Features Among Breast Cancer Patients Who Have Developed a Contralateral Breast Cancer.

    Annals of surgical oncology 2015 Dec

    Authors: Liederbach E, Wang CH, Lutfi W, Kantor O, Pesce C
    Abstract
    Studies have shown that contralateral breast cancer (CBC) portends worse survival compared to unilateral breast cancer (UBC), but few studies have been conducted in the United States, and survival is usually examined from the time of CBC development.
    Utilizing the Surveillance, Epidemiology, and End Results database, we selected 83,001 newly diagnosed breast cancer patients from 1998 to 2005. The time interval between the initial cancer and CBC was used as a time-dependent variable in a Cox regression analysis to examine overall survival (OS) and disease-specific survival (DSS) between UBC and CBC.
    Overall, 2130 patients (2.6 %) developed a CBC, 47.2 % within 5 years and 52.8 % ≥ 5 years. Most stage I patients (61.9 %) developed a stage I CBC, and a majority of stage II patients (51.6 %) developed a stage I CBC (p < 0.001). There was a median follow-up of 8.7 years. After adjustment, patients who developed a CBC 4 years after their initial breast cancer had worse DSS compared to patients with UBC (hazard ratio 1.36, 95 % confidence interval 1.03-1.79). Those patients who developed their CBC 8 years after their initial breast cancer had improved DSS (hazard ratio 0.37, 95 % confidence interval 0.20-0.67). Similar trends were observed for OS. Similar trends for OS and DSS were observed for estrogen receptor-negative women and women <50 years old.
    Development of a CBC early is associated with worse survival, but CBC development later on is associated with improved survival. Future studies are needed that can assist physicians with how to predict whether a patient will develop a CBC early on.
    PMID: 26334294 [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.