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 - Employer Sponsored
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Aetna Choice POS II
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Aetna Health Network Only
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Aetna HMO
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Aetna Open Access Aetna Select
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Aetna Open Access Managed Choice
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Aetna Open Choice PPO
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Aetna Sub- Cofinity
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Aetna Sub- First Health
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Aetna Traditional Choice-Indemnity Plan
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Aetna Whole Health Chicago (All Metal Tiers)
Not Available In 2017
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Beechstreet PPO Network
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Blue Cross Blue Shield Blue Advantage HMO
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Blue Cross Blue Shield Blue Choice Options
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Blue Cross Blue Shield Blue Choice Preferred PPO Plans (All Metal Tiers)
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Blue Cross Blue Shield Blue Choice Select PPO
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Blue Cross Blue Shield Blue Choice Select Value Choice
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Blue Cross Blue Shield Blue Distinction Total Care Benefit Differentail
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Blue Cross Blue Shield Blue Options (All Metal Tiers)
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Blue Cross Blue Shield Blue PPO (All Metal Tiers)
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Blue Cross Blue Shield Blue Precision HMO Plans (All Metal Tiers)
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Blue Cross Blue Shield BlueCare Direct (All Metal Tiers)
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Blue Cross Blue Shield BlueEdge HSA and BlueEdge HCA
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Blue Cross Blue Shield HMOI
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Blue Cross Blue Shield PPO Value Choice
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Cigna Exclusive Provider Organization EPO
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Cigna Medical PPO
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Cigna Medical Open Access POS
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Cofinity PPO (an Aetna Company)
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Coventry Consumer Choices (C3)
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Coventry HMO
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Coventry POS
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Coventry PPO
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Galaxy Health Network
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Health Alliance HMO, PPO, POS, POS-C
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Health Link HMO
If Unicare Affiliate logo present on card
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Health Link PPO
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Health Link-Open Access I, II, III
If Unicare Affiliate logo present on card
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Healthcare's Finest Network- FHN 10 & 20
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Healthcare's Finest Network- FHN Platinum
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Healthcare's Finest Network- HFN Community Health Connect
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Healthcare's Finest Network- HFN Community Health Connect Elite
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Healthcare's Finest Network- HFN Community Health Connect Premiere
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Healthcare's Finest Network- HFN-ID
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Humana Advocate Centered EPO
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Humana Advocate Centered HMO
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Humana Choice POS
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Humana Classic Plan (Traditional Indemnity Plan)
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Humana Condell Custom PPO
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Humana Copay: PPO
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Humana COT National POS-Open Access
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Humana Edward- Elmhurst Value HMO
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Humana Edward-Elmhurst Advantage HSA/Choice PPO
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Humana Illinois Coordinated Care
Available In 2017
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Humana Level Funded Premium
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Humana NorthShore Complete Care
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Humana Self Funding: Administrative Services Only (ASO)
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Humana Self-Funding: Level Funded Premium (LFP)
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Humana Self-Funding: Stop Loss Insurance
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Humana Simplicity (HMO, POS, PPO)
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Humana Total Health (100 or more employees)
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Multiplan/ PHCS- Health EOS Network
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Multiplan/ PHCS- MultiPlan Complementary
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Multiplan/ PHCS- MultiPlan Limited Benefit Plan
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Multiplan/ PHCS- MultiPlan Practitioner Only
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Multiplan/ PHCS- MultiPlan Shared Savings
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Multiplan/ PHCS- PHCS Healthy Directions
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Multiplan/ PHCS- PHCS Practitioner Only
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Multiplan/ PHCS- PHCS Savility
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Multiplan/ PHCS- ValuePoint by MultiPlan
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NorthShore Employee Network
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Preferred Network Access
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Preferred Plan- HealthSmart Get Better
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Preferred Plan PPO
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Stratose- National Preferred Provider Network
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Three Rivers Provider PPO Network (TRPN)
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UniCare HMO
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UniCare HMO Performance Select
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Unicare PPO
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UniCare Travel Access
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United Healthcare Catalyst
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United Healthcare Heritage
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United Healthcare Multi-Choice
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United Healthcare Navigate and Navigate Plus
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United Healthcare Options Non-Differential PPO
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United Healthcare Options PPO
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Exchange Plans
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Aetna Whole Health Chicago (All Metal Tiers)
Not Available In 2017
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Aetna Whole Health Chicago Bronze Deductible Only HSA Eligible
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Ambetter Balance Care 10+ Vision+ Adult Dental
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Ambetter Balanced Care 1
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Ambetter Balanced Care 1+ Vision+ Adult Dental
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Ambetter Balanced Care 10
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Ambetter Balanced Care 2
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Ambetter Balanced Care 2+ Vision+ Adult Dental
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Ambetter Essential Care 1
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Ambetter Secure Care 1 w/ 3 Free PCP Visits
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Blue Cross Blue Shield Basic 103 Multi-State Plan
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Blue Cross Blue Shield Blue Choice Preferred PPO (Plan #'s 101-107; All Metal Tiers)
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Blue Cross Blue Shield Blue Choice Preferred Security PPO 100
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Blue Cross Blue Shield Blue Precision HMO (Plan #'s 101-103; All Metal Tiers)
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Blue Cross Blue Shield Blue Premier 101 Multi-State Plan
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Blue Cross Blue Shield BlueCare Direct with Advocate (Plan #'s 101-103; All Metal Tiers)
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Blue Cross Blue Shield Solution 102 Multi-State Plan
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Coventry $15 Copay; Silver & Gold
Not Available In 2017
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Coventry Bronze $ 20 Copay
Not Available In 2017
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Coventry Bronze $10 Copay Carelink St. John's
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Coventry Bronze $15 Copay Carelink St. John's
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Coventry Bronze Deductible Only HSA Eligible
Not Available In 2017
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Harken Health - an Affiliate of United Healthcare
Verify physician participation and out of pocket expenses with Harken
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Health Alliance HMO (All Metal Tiers)
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Health Alliance POS (All Metal Tiers)
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Health Alliance PPO (All Metal Tiers)
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Humana Chicago HMOx (All Metal Tiers)
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Land of Lincoln Health Traditional PPO
Plan Ending 9/30/16
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United Healthcare Compass (All Metal Tiers)
Not Available In 2017
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Medicaid
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Aetna Better Health FHP
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Aetna Better Health ICP
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Blue Cross Blue Shield Community ICP
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Cigna HealthSpring ICP
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Community Care Alliance- ICP
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Family Health Network- FHP
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Harmony/WellCare FHP Plan
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Humana ICP
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Illinicare Family Health Plan (FHP/ACA)
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Illinicare ICP
Primary Care- Current Patients Only
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Illinois Department of Public Aid (IDPA)
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Meridian FHP/ACA Expansion
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Meridian ICP
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Molina ICP
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Next Level ACA/FHP
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Medicare Advantage Plans
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Aetna Medicare (SM) Plan (HMO)
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Aetna Medicare (SM) Plan (PPO)
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Aetna Medicare Advantage Group Plans
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Aetna Medicare Connect Plus (PPO)/PPO Connect Plus
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Aetna Medicare Standard Plan (PPO)/PPO Standard Plan
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Aetna Medicare Value Plan (HMO)/HMO Value
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Aetna Medicare Value Plan (PPO)/PPO Value Plan
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Aetna Traditional Choice Plan
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Blue Cross Blue Shield Medicare Advantage Basic HMO
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Blue Cross Blue Shield Medicare Advantage Basic Plus HMO-POS
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Blue Cross Blue Shield Medicare Advantage Choice Plus PPO
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Blue Cross Blue Shield Medicare Advantage Choice Premier PPO
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Cigna-HealthSpring Advantage HMO
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Cigna-HealthSpring Premier HMO-POS
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Cigna-HealthSpring Primary HMO
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Cigna-HealthSpring TotalCare HMO-SNP
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Community Care Alliance Complete HMO-D-SNP
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Community Care Alliance HMO
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Harmony/WellCare Access (HMO-SNP)
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Harmony/WellCare Choice (HMO-POS)
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Harmony/WellCare Health Plan
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Harmony/WellCare RX (HMO)
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Harmony/WellCare Value (HMO-POS)
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Harmony/WellCare-Medicare HMO Plans
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Harmony/WellCare-Medicare Special Needs Plans
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Humana Choice PPO
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Humana Community HMO Diabetes and Heart (SNP Program)
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Humana Gold Plus HMO
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Humana Gold Plus PFFS
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Meridian Medicare Advantage
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Molina Medicare Advantage
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United Healthcare - AARP Medicare Complete
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United Healthcare AARP Medicare Complete Access
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United Healthcare- AARP Medicare Complete Plus (HMO-POS)
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United Healthcare Medicare Advantage Focus
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United Healthcare- Medicare Solutions/Medicare Advantage
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Medicare Medicaid Alignment Initiative (MMAI) Plans
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Aetna Better Health MMAI
PRIMARY CARE
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HOSPITALS
 
 
 
Blue Cross Blue Shield Community MLTSS/LTSS
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Blue Cross Blue Shield Community MMAI
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Cigna-HealthSpring MMAI
PRIMARY CARE
SPECIALTY CARE
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Humana MMAI
PRIMARY CARE
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Illinicare MLTSS/LTSS
PRIMARY CARE
SPECIALTY CARE
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Illinicare MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Meridian MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Molina MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Commercial - Individual Plans
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Aetna Bronze Deductible Only HSA Eligible Savings Plus OAMC PD
Not Available In 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Aetna Savings Plus OAMC PD (All Metal Tiers)
Not Available In 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Aetna Whole Health Chicago (All Metal Tiers)
Not available for 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Aetna Whole Health Chicago Bronze Deductible Only HSA Eligible
Not available for 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Ambetter Balanced Care 1
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 1+ Vision+ Dental
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 10
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 10+ Vision+ Dental
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 2
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Balanced Care 2+ Vision+ Dental
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Essential Care 1
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Ambetter Secure Care 1 w/ 3 Free PCP Visits
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Choice Preferred PPO (Plan #'s 101-107; All Metal Tiers)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Choice Preferred Security PPO 100
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Cross Blue Premier 101 Multi-State Plan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Cross Blue Shield Basic 103 Multi-State Plan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Precision HMO (Plan #'s 101-103; All Metal Tiers)
Verify PCP Participation
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Blue Cross Blue Shield Blue Precision Platinum HMO 104
Verify PCP Participation
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Publications

  • Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study.

    Annals of surgical oncology 2016 Sep 21

    Authors: Yao K, Belkora J, Bedrosian I, Rosenberg S, Sisco M, Barrera E, Kyrillios A, Tilburt J, Wang C, Rabbitt S, Pesce C, Simovic S, Winchester DJ, Sepucha K
    Abstract
    Studies have reported that breast cancer patients have limited understanding about the oncologic outcomes following contralateral prophylactic mastectomy (CPM). We hypothesized that an in-visit decision aid (DA) would be associated with higher patient knowledge about the anticipated short and long term outcomes of CPM.
    We piloted a DA which used the SCOPED: (Situation, Choices, Objectives, People, Evaluation and Decision) framework. Knowledge, dichotomized as "low" (≤3 correct) versus "high" (≥4 correct), was assessed immediately after the visit by a 5 item survey. There were 97 DA patients (response rate 62.2 %) and 114 usual care (UC) patients (response rate 71.3 %).
    Patient demographic factors were similar between the two groups. Twenty-one (21.7 %) patients in the DA group underwent CPM compared with 18 (15.8 %) in the UC group (p = 0.22). Mean and median knowledge levels were significantly higher in the DA group compared with the UC group for patients of all ages, tumor stage, race, family history, anxiety levels, worry about CBC, and surgery type. Eighty-six (78.9 %) of UC versus 35 (37.9 %) DA patients had low knowledge. Of patients who underwent CPM, 15 (83.3 %) in the UC cohort versus 5 (25.0 %) of DA patients had "low" knowledge.
    Knowledge was higher in the DA group. The UC group had approximately three times the number of patients of the DA group who were at risk for making a poorly informed decision to have CPM. Future studies should assess the impact of increased knowledge on overall CPM rates.
    PMID: 27654108 [PubMed - as supplied by publisher]
  • External radiation is associated with limited improvement in overall survival in resected margin-negative stage IIB pancreatic adenocarcinoma.

    Surgery 2016 Sep 7

    Authors: Kantor O, Talamonti MS, Lutfi W, Wang CH, Winchester DJ, Marsh R, Prinz RA, Baker MS
    Abstract
    The absolute benefit of adjuvant external beam radiation therapy after a margin-negative resection in early stage pancreatic cancer has not been determined.
    We queried the National Cancer Data Base for patients with pathologic stage I-II pancreatic adenocarcinoma who underwent operative resection between 2004 and 2012. Multivariate Cox regression adjusted for age, race, comorbidities, facility type, location and volume, type of pancreatectomy, and tumor grade was used to estimate stage-specific survival.
    A total of 15,966 patients with stage I-II pancreatic adenocarcinoma underwent upfront operative therapy (no neoadjuvant treatment) and had a margin-negative resection during the study period. A total of 835 (5.2%) patients were pathologic stage IA, 1,539 (9.5%) were stage IB, 3,378 (20.9%) were stage IIA, and 10,214 (63.1%) were stage IIB. Chemoradiation utilization increased with increasing stage (22.8% in stage IA vs 39.6% in stage IIB, P < .01). Chemoradiation was more common at low-volume centers (39.0% vs 31.7% at high-volume centers, P < .01) and with younger age (43.3% of patients <70 years old compared to 25.0% ≥70 years old, P < .01). Treatment at a high-volume center was associated with decreased mortality (hazard ratio 0.80-0.89) across all stages. Age ≥70 years old (hazard ratio 1.18-1.29, P < .01) and higher grade (hazard ratio 1.68-2.69, P < .01) were associated with higher risk of mortality at all stages. Chemoradiation was associated with a benefit in median overall survival over chemotherapy alone for stage IIB disease (21.8 months vs 19.5 months, P < .01). Chemoradiation was not associated with a significant benefit in median overall survival for stage IA, IB, or IIA disease (P > .30).
    Addition of radiation to adjuvant chemotherapy after margin-negative resection of pancreatic adenocarcinoma is associated with a limited survival benefit in patients with pathologic stage IIB disease and should be weighed against its associated risks in these patient groups.
    PMID: 27614417 [PubMed - as supplied by publisher]
  • Perioperative chemotherapy is associated with a survival advantage in early stage adenocarcinoma of the pancreatic head.

    Surgery 2016 Sep

    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 perioperative chemotherapy) increased from 12.0% in 2006 to 20.2% in 2012. Patients who received chemotherapy prior to the operation (neoadjuvant chemotherapy alone and perioperative 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 perioperative 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 perioperative 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 Sep

    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;114:416-422. © 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 Oct

    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
    Postthyroidectomy radioiodine (RAI) therapy is indicated for papillary thyroid carcinoma (PTC) with high-risk features. There is 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 to 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 and 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 9,706 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 (hazard ratio [HR] 1.26, 95% confidence interval [CI] 0.98-1.62, P = .07) on adjusted Cox multivariable analysis. Timing of RAI therapy failed to affect OS in propensity-matched high-risk patients (HR 1.09, 95% CI 0.75-1.58, P = .662).
    The timing of postthyroidectomy initial RAI therapy does not affect OS in patients with high-risk PTC.
    CI = confidence interval CLNM = cervical lymph node metastasis FVPTC = follicular variant papillary thyroid carcinoma HR = hazard ratio KM = Kaplan-Meier NCDB = National Cancer Data Base OS = overall survival PTC = papillary thyroid carcinoma RAI = radioactive iodine.
    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]

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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.