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

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

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.
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.

Insurance

For behavioral health services, please confirm participation with your insurance company or provider.

2017 Exchange Plans (Individuals)

 
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Ambetter Insured By Celtic
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Basic PPO A Multi-State Plan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Choice Preferred PPO (All Plans)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue FocusCare HMO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Precision HMO (All Plans)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Blue Cross Blue Shield Blue Premier PPO A Multi-State Plan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Solution PPO A Multi-State Plan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield BlueCare Direct with Advocate HMO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Cigna Connect HMO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Cigna Connect HSA
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 

Off Exchange Plans (Individuals)

 
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Aetna Bronze Deductible Only HSA Eligible Savings Plus OAMC PD
Not Available In 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Aetna Leap Everday Value Plan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Aetna Leap Everyday Carelink Centegra Health System
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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 Insured By Celtic
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Choice Preferred PPO (All Plans)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Blue Choice Preferred Security PPO 100
PRIMARY CARE
SPECIALTY CARE
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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 (all plans)
PRIMARY CARE
SPECIALTY CARE
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Blue Cross Blue Shield Blue Precision Platinum HMO 104
PRIMARY CARE
SPECIALTY CARE
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Blue Cross Blue Shield BlueCare Direct with Advocate
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Solution 102 Multi-State Plan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Coventry $15 Copay: Silver & Gold
Not Available In 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Coventry Bronze $10 Copay Carelink St. John's
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Coventry Bronze $15 Copay Carelink St. John's
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Coventry Bronze $20 Copay
Not Available In 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Coventry Bronze Deductible Only HSA Eligible
Not Available In 2017
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Harken Health - an Affiliate of United Healthcare
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Health Alliance HMO (All Metal Tiers)
PRIMARY CARE
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Health Alliance POS (All Metal Tiers)
PRIMARY CARE
SPECIALTY CARE
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Health Alliance PPO (All Metal Tiers)
PRIMARY CARE
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Humana Chicago HMOx (All Metal Tiers)
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Humana Illinois HMOx
PRIMARY CARE
SPECIALTY CARE
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United Health One Golden Rule
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United Healthcare Compass (All Plans)
Not Available In 2017
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Employer Sponsored Plans

 
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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 Managed Choice
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Aetna Network Options
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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 Savings Plus
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Aetna Select
PRIMARY CARE
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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)
For employers with 2-50 employees
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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 PPO (All Metal Tiers)
Participating in Tier 2, there may be higher out of pocket costs
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Blue Cross Blue Shield Blue Choice Preferred PPO (All Plans)
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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 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 BluePrint
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Blue Cross Blue Shield Community Participating Option
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Blue Cross Blue Shield HMOI
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Blue Cross Blue Shield PPO
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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 Great West Healthcare (GWH) Cigna Network
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Cigna HMO
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Cigna HMO Open Access
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Cigna HMO Open Access POS
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Cigna HMO POS
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Cigna Medical PPO
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Cigna Medical Indemnity
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Cigna Medical LocalPlus
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Cigna Medical LocalPlus In-Network
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Cigna Medical Network
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Cigna Medical Network POS
PRIMARY CARE
SPECIALTY CARE
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Cigna Medical Open Access Plus (OAP)
PRIMARY CARE
SPECIALTY CARE
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Cigna Medical Open Access Plus (OAP) In-Network
PRIMARY CARE
SPECIALTY CARE
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Cigna Medical Open Access POS
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Cofinity PPO (an Aetna Company)
PRIMARY CARE
SPECIALTY CARE
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Coventry Consumer Choices (C3)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Coventry HMO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Coventry POS
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Coventry PPO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Galaxy Health Network
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Harken Health
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Health Alliance HMO, PPO, POS, POS-C
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Health Link HMO
If Unicare Affiliate logo present on card
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Health Link PPO
If Unicare Affiliate logo present on card
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Health Link-Open Access I, II, III
If Unicare Affiliate logo present on card
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Healthcare's Finest Network- FHN 10 & 20
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Healthcare's Finest Network- FHN Platinum
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Healthcare's Finest Network- HFN Community Health Connect
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Healthcare's Finest Network- HFN Community Health Connect Elite
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Healthcare's Finest Network- HFN Community Health Connect Premiere
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Healthcare's Finest Network- HFN-ID
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Humana Advocate Centered EPO
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SPECIALTY CARE
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Humana Advocate Centered HMO
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Humana Choice POS
PRIMARY CARE
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Humana Classic Plan (Traditional Indemnity Plan)
PRIMARY CARE
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Humana Coinsurance: NPOS
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Humana Coinsurance: PPO
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Humana Coinsurance:HMO
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SPECIALTY CARE
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Humana Condell Custom PPO
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Humana Copay: HMO
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SPECIALTY CARE
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Humana Copay: NPOS
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SPECIALTY CARE
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Humana Copay: PPO
PRIMARY CARE
SPECIALTY CARE
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Humana COT National POS-Open Access
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SPECIALTY CARE
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Humana Edward- Elmhurst Value HMO
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Humana Edward-Elmhurst Advantage HSA/Choice PPO
PRIMARY CARE
SPECIALTY CARE
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Humana High-deductible plans (HDHP) HMO
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SPECIALTY CARE
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Humana High-deductible plans (HDHP) National point of service (NPOS)
PRIMARY CARE
SPECIALTY CARE
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Humana High-deductible plans (HDHP) PPO
PRIMARY CARE
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Humana Illinois Coordinated Care
Available In 2017
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SPECIALTY CARE
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Humana Level Funded Premium
PRIMARY CARE
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HOSPITALS
Humana NorthShore Complete Care
PRIMARY CARE
SPECIALTY CARE
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Humana Self Funding: Administrative Services Only (ASO)
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SPECIALTY CARE
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Humana Self-Funding: Level Funded Premium (LFP)
PRIMARY CARE
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HOSPITALS
Humana Self-Funding: Minimum Premium (MP)
PRIMARY CARE
SPECIALTY CARE
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Humana Self-Funding: Stop Loss Insurance
PRIMARY CARE
SPECIALTY CARE
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Humana Simplicity (HMO, POS, PPO)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Humana Total Health (100 or more employees)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Multiplan/ PHCS- Health EOS Network
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Multiplan/ PHCS- MultiPlan Complementary
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Multiplan/ PHCS- MultiPlan Limited Benefit Plan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Multiplan/ PHCS- MultiPlan Practitioner Only
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Multiplan/ PHCS- MultiPlan Shared Savings
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
Multiplan/ PHCS- PHCS Healthy Directions
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Multiplan/ PHCS- PHCS Practitioner Only
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Multiplan/ PHCS- PHCS Savility
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Multiplan/ PHCS- ValuePoint by MultiPlan
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
NorthShore Employee Network
PRIMARY CARE
SPECIALTY CARE
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Preferred Network Access
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Preferred Plan- HealthSmart Get Better
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Preferred Plan PPO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Stratose- National Preferred Provider Network
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
Three Rivers Provider PPO Network (TRPN)
PRIMARY CARE
SPECIALTY CARE
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UniCare HMO
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SPECIALTY CARE
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UniCare HMO Performance Select
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Unicare PPO
PRIMARY CARE
SPECIALTY CARE
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UniCare Travel Access
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United Health One Golden Rule
PRIMARY CARE
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United Healthcare Catalyst
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United Healthcare Charter
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United Healthcare Choice
PRIMARY CARE
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United Healthcare Choice Plus
PRIMARY CARE
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United Healthcare Core
PRIMARY CARE
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United Healthcare Heritage
PRIMARY CARE
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United Healthcare Multi-Choice
PRIMARY CARE
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United Healthcare Navigate and Navigate Plus
PRIMARY CARE
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United Healthcare Options Non-Differential PPO
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United Healthcare Options PPO
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United Healthcare Tiered Benefits
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Medicaid

 
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Aetna Better Health FHP
PRIMARY CARE
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Aetna Better Health ICP
PRIMARY CARE
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Blue Cross Blue Shield Community FHP
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Blue Cross Blue Shield Community ICP
PRIMARY CARE
SPECIALTY CARE
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Cigna HealthSpring ICP
PRIMARY CARE
SPECIALTY CARE
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Community Care Alliance- ICP
PRIMARY CARE
SPECIALTY CARE
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Family Health Network- FHP
PRIMARY CARE
SPECIALTY CARE
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Harmony/WellCare FHP Plan
PRIMARY CARE
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Humana ICP
PRIMARY CARE
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Illinicare Family Health Plan (FHP/ACA)
PRIMARY CARE
SPECIALTY CARE
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Illinicare ICP
Primary Care- Current Patients Only
PRIMARY CARE
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Illinois Department of Public Aid (IDPA)
PRIMARY CARE
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Meridian FHP/ACA Expansion
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Meridian ICP
PRIMARY CARE
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Molina ICP
PRIMARY CARE
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Next Level ACA/FHP
PRIMARY CARE
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Medicare Advantage Plans

 
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Aetna Medicare (SM) Plan (HMO)
PRIMARY CARE
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Aetna Medicare (SM) Plan (PPO)
PRIMARY CARE
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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
PRIMARY CARE
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Blue Cross Blue Shield Medicare Advantage Basic HMO
PRIMARY CARE
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Blue Cross Blue Shield Medicare Advantage Basic Plus HMO-POS
PRIMARY CARE
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Blue Cross Blue Shield Medicare Advantage Choice Plus PPO
PRIMARY CARE
SPECIALTY CARE
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Blue Cross Blue Shield Medicare Advantage Choice Premier PPO
PRIMARY CARE
SPECIALTY CARE
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Blue Cross Blue Shield Medicare Advantage Premier Plus HMO-POS
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Cigna-HealthSpring Advantage HMO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Cigna-HealthSpring Premier HMO-POS
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Cigna-HealthSpring Primary HMO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Cigna-HealthSpring TotalCare HMO-SNP
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Community Care Alliance Complete HMO-D-SNP
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Community Care Alliance HMO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Harmony/WellCare Access (HMO-SNP)
PRIMARY CARE
SPECIALTY CARE
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Harmony/WellCare Choice (HMO-POS)
PRIMARY CARE
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Harmony/WellCare Health Plan
PRIMARY CARE
SPECIALTY CARE
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Harmony/WellCare RX (HMO)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Harmony/WellCare Value (HMO-POS)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Harmony/WellCare-Medicare HMO Plans
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Harmony/WellCare-Medicare Special Needs Plans
PRIMARY CARE
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HOSPITALS
 
 
 
Humana Choice PPO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Humana Community HMO Diabetes and Heart (SNP Program)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Humana Gold Plus HMO
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Humana Gold Plus PFFS
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Meridian Medicare Advantage
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Molina Medicare Advantage
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
United Healthcare - AARP Medicare Complete
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
United Healthcare AARP Medicare Complete Access
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
United Healthcare- AARP Medicare Complete Plus (HMO-POS)
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
United Healthcare Medicare Advantage Focus
PRIMARY CARE
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United Healthcare- Medicare Solutions/Medicare Advantage
PRIMARY CARE
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Medicare Medicaid Alignment Initiative (MMAI) Plans

 
PRIMARY CARE
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HOSPITALS
Aetna Better Health MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Community MLTSS/LTSS
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Blue Cross Blue Shield Community MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Cigna-HealthSpring MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Humana MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Illinicare MLTSS/LTSS
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 
Illinicare MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Meridian MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Molina MMAI
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
 

Medicare Supplemental Plans

 
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
Medicare Supplemental Plans
These plans are secondary to Traditional Medicare; we accept all supplemental plans. Please confirm your coverage benefits with your supplemental carrier.
PRIMARY CARE
SPECIALTY CARE
HOSPITALS

Coverage For Active Military

 
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
TRICARE For Life
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
TRICARE Prime
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
TRICARE Prime Overseas
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
TRICARE Prime Remote
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
TRICARE Prime Remote Overseas
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
TRICARE Reserve Select
PRIMARY CARE
SPECIALTY CARE
HOSPITALS
 
 
TRICARE Retired Reserve
PRIMARY CARE
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Publications

  • Clinical accuracy of preoperative breast MRI for breast cancer.

    Journal of surgical oncology 2017 Apr 13

    Authors: Tseng J
    Abstract
    It is unclear if breast magnetic resonance imaging (MRI) is more accurate than mammography (MGM) and ultrasound (U/S) in aggregate for patients with invasive cancer.
    We compared concordance of combined tumor size and tumor foci between MRI and MGM and U/S combined to pathological tumor size and foci as the gold standard from 2009 to 2015. Tumor size was nonconcordant if it differed from the pathologic size by ≥33% and tumor foci was nonconcordant if >1 foci were seen. If one or both of the MGM or U/S was nonconcordant and the MRI was concordant, MRI provided greater accuracy.
    Of 471 patients with MGM, US, and MRI, MRI was more accurate for 32.9% of patients for tumor size and for 21.9% for tumor foci. Patients for whom MRI had greater accuracy were compared to those who did not for clinical and tumor factors. The only significant factor was calcifications on mammography. Tumor size, stage, molecular subtype, histology, grade, patient BMI, age, mammographic density, and use of hormone replacement therapy were not significantly different.
    Breast MRI provides greater accuracy for a third of patients undergoing preoperative MGM and U/S. Mammographic calcifications were associated with MRI clinical accuracy for patients with invasive cancer.
    PMID: 28409837 [PubMed - as supplied by publisher]
  • Erratum to: Impact of an In-visit Decision Aid on Patient Knowledge about Contralateral Prophylactic Mastectomy: A Pilot Study.

    Annals of surgical oncology 2017 Mar 27

    Authors: Kantor O, Pesce C
    Abstract
    In 2010, the ACOSOG Z0011 trial showed equivalent survival and recurrence between sentinel lymph node biopsy (SLNB) alone versus axillary lymph node dissection (ALND) for those with a tumor positive sentinel node (SN). We examined national trends in axillary surgery following neoadjuvant chemotherapy (NAC) for clinically node positive disease in the years prior to and after the Z0011 trial publication. 12,063 women with cT1-4N1M0 invasive breast cancer who underwent NAC from 2006 to 2013 and had 1-3 positive nodes on pathology were selected from the National Cancer Data Base. We defined SLNB as 1-4 nodes and ALND as ≥10 nodes examined. 2,704 women (22.4%) underwent SLNB alone and 9,359 (77.6%) underwent ALND. The rate of SLNB increased from 25.6% in 2006 to 33.3% in 2012 in patients that underwent lumpectomy (p < 0.01) and increased from 20.6% to 22.8% in patients that underwent mastectomy (p = 0.25). Patients treated at Community centers (30.4% versus 19.2% at Academic centers) and those with less positive nodes (32.2% for 1 positive node versus 10.1% for 3 positive nodes, p < 0.01) were more likely to have SLNB alone compared to ALND. On multivariate analysis, treatment with lumpectomy (OR 1.46, CI 1.28-1.67), lower number of positive nodes (OR 3.98, CI 3.29-4.82) and lobular subtype (OR 1.82, CI 1.42-2.34) were independent predictors of receiving SLNB alone after NAC. Approximately 22% of patients with cN1 breast cancer underwent SLNB alone for pN1 disease after NAC. Ongoing clinical trials will determine if recurrence and survival rates are equivalent between SLNB and ALND groups.
    PMID: 28349337 [PubMed - as supplied by publisher]
  • Breast Cancer-Major changes in the American Joint Committee on Cancer eighth edition cancer staging manual.

    CA: a cancer journal for clinicians 2017 Mar 14

    Authors: Giuliano AE, Connolly JL, Edge SB, Mittendorf EA, Rugo HS, Solin LJ, Weaver DL, Winchester DJ, Hortobagyi GN
    Abstract
    Answer questions and earn CME/CNE The revision of the eighth edition of the primary tumor, lymph node, and metastasis (TNM) classification of the American Joint Commission of Cancer (AJCC) for breast cancer was determined by a multidisciplinary team of breast cancer experts. The panel recognized the need to incorporate biologic factors, such as tumor grade, proliferation rate, estrogen and progesterone receptor expression, human epidermal growth factor 2 (HER2) expression, and gene expression prognostic panels into the staging system. AJCC levels of evidence and guidelines for all tumor types were followed as much as possible. The panel felt that, to maintain worldwide value, the tumor staging system should remain based on TNM anatomic factors. However, the recognition of the prognostic influence of grade, hormone receptor expression, and HER2 amplification mandated their inclusion into the staging system. The value of commercially available, gene-based assays was acknowledged and prognostic input added. Tumor biomarkers and low Oncotype DX recurrence scores can alter prognosis and stage. These updates are expected to provide additional precision and flexibility to the staging system and were based on the extent of published information and analysis of large, as yet unpublished databases. The eighth edition of the AJCC TNM staging system, thus, provides a flexible platform for prognostic classification based on traditional anatomic factors, which can be modified and enhanced using patient biomarkers and multifactorial prognostic panel data. The eighth edition remains the worldwide basis for breast cancer staging and will incorporate future online updates to remain timely and relevant. CA Cancer J Clin 2017. © 2017 American Cancer Society.
    PMID: 28294295 [PubMed - as supplied by publisher]
  • Preoperative adrenal biopsy does not affect overall survival in adrenocortical carcinoma.

    American journal of surgery 2017 Feb 01

    Authors: Suman P, Calcatera N, Wang CH, Moo-Young TA, Winchester DJ, Prinz RA
    Abstract
    The impact of preoperative biopsy on overall survival (OS) in adrenocortical carcinoma (ACC) is unclear. We analyzed the National Cancer Data Base (NCDB) for factors associated with preoperative adrenal biopsy and its effect on OS in ACC.
    The NCDB was queried from 2003 to 2012 for M0 ACC. Patients with or without preoperative biopsy were compared for factors associated with an increased rate of biopsy. Survival analysis was performed after adjusting for patient and tumor-related variables.
    There were 1782 patients with M0 ACC of whom 332 (19%) had a preoperative biopsy. Treatment outside academic cancer centers (OR 1.36, 95% CI 1.04-1.77, P = 0.023) and male gender (OR 1.45, 95% CI 1.11-1.88, P = 0.006) were associated with an increased rate of biopsy. In patients undergoing adrenalectomy with negative margins, biopsy failed to impact OS (log-rank P = 0.225, HR 1.20, 95% CI 0.84-1.72, P = 0.306).
    Preoperative adrenal biopsy continues to be performed for ACC with no added survival benefit. Adrenalectomy offers the best chance of survival in patients with ACC.
    PMID: 28233539 [PubMed - as supplied by publisher]
  • Evaluation of the Quality of Adjuvant Endocrine Therapy Delivery for Breast Cancer Care in the United States.

    JAMA oncology 2017 Feb 02

    Authors: Daly B, Olopade OI, Hou N, Yao K, Winchester DJ, Huo D
    Abstract
    Randomized trials in breast cancer have demonstrated the clinical benefits of adjuvant endocrine therapy (AET) in preventing recurrence and death. The examination of concordance with AET guidelines at a national level as a measure of quality of care is important.
    To investigate temporal trends and factors related to receipt of AET for breast cancer.
    This retrospective cohort study included 981 729 women with breast cancer in the National Cancer Database from January 1, 2004, to December 31, 2013. Women with stages I to III breast cancer who received all or part of their treatment at the reporting institution were included in the analysis.
    Temporal changes in AET receipt (estimating the annual percentage change) and AET practice patterns (using logistic regression) and the effect of AET guideline concordance on survival of women with hormone receptor-positive (HR+) breast cancer (using the multivariable Cox proportional hazards model).
    Of the 981 729 eligible patients (mean [SD] age, 60.8 [13.3] years), 818 435 had HR+ and 163 294 had HR-negative (HR-) cancer. Among the patients with HR+ cancer, receipt of AET increased over time, from 69.8% in 2004 to 82.4% in 2013. Among patients with HR- cancer, receipt decreased from 5.2% in 2004 to 3.4% in 2013. Hospital-level adherence (≥80% of patients with HR+ cancer received AET) increased from 40.2% in 2004 to 69.2% in 2013. Receipt of AET varied significantly by age (lower in patients ≥80 years), race (lower in African American and Hispanic participants), geographic location (lower in West South Central, Moutain, and Pacific census regions), and receptor status (lower in patients with estrogen receptor-negative and progesterone receptor-positive cancer). Surgery and radiotherapy were the factors most significantly associated with appropriate AET receipt (only 45.0% in patients who received lumpectomy without radiotherapy). Receipt of AET was associated with a 29% relative risk reduction in mortality. Based on this effectiveness estimate, if all patients with HR+ cancer received AET, approximately 14 630 lives would have been saved over 10 years.
    From 2004 to 2013, underuse and misuse of AET have decreased for patients with breast cancer, but optimal use has not been achieved, and significant variation in care remains. The involvement of surgery and radiotherapy were among the most significant factors associated with optimal use, which underscores the benefits of team-based care to support guideline-concordant therapy.
    PMID: 28152150 [PubMed - as supplied by publisher]
  • Neoadjuvant external beam radiation is associated with No benefit in overall survival for early stage pancreatic cancer.

    American journal of surgery 2017 Mar

    Authors: Lutfi W, Talamonti MS, Kantor O, Wang CH, Stocker SJ, Bentrem DJ, Roggin KK, Winchester DJ, Marsh R, Prinz RA, Baker MS
    Abstract
    Neoadjuvant protocols for early stage pancreatic adenocarcinoma (PDAC) frequently involve external beam radiation used in combination with systemic chemotherapy. The benefit of radiation in these protocols has not been determined.
    We examined patients with stage I and II PDAC within the National Cancer Data Base between 2006 and 2012. Propensity score matching was used to compare patients receiving neoadjuvant chemotherapy including radiation (NCRT) to those receiving neoadjuvant chemotherapy without radiation (NCT) prior to pancreaticoduodenectomy.
    Prior to matching, NCRT patients had higher rates of T3 tumors (P = 0.046) and vascular abutment (P < 0.001). Propensity score matching (1:1) yielded 397 patients per group. Patients treated with NCRT were more likely to have node negative resections (P < 0.001) but had increased rates of 90-day mortality (P = 0.015) and demonstrated a trend towards shorter overall survival (P = 0.0502) than those receiving NCT.
    In early stage PDAC, the addition of radiation to NCT is often utilized with more advanced disease and is associated with higher perioperative mortality and no long-term overall survival benefit.
    PMID: 28089341 [PubMed - as supplied by publisher]
  • Post-mastectomy radiation therapy and overall survival after neoadjuvant chemotherapy.

    Journal of surgical oncology 2017 Jan 13

    Authors: Kantor O, Pesce C, Singh P, Miller M, Tseng J, Wang CH, Winchester DJ, Yao K
    Abstract
    The role of postmastectomy radiation therapy (PMRT) after neoadjuvant chemotherapy (NAC) and mastectomy is unclear, especially in patients that have post-treatment tumor negative axillary nodes (ypN0).
    The National Cancer Data Base was used to identify women that had PMRT after NAC and mastectomy for clinically node positive (cN1-2) disease from 2004 to 2008. Median follow-up time was 69 months.
    8,321 patients were included for analysis, and 6140 (65.6%) had cN1 disease and 2181 (23.3%) had cN2 disease. On adjusted survival analysis, PMRT was associated with an overall survival (OS) benefit in both patients with cN1 (5-yr OS 75.8% vs. 71.9%, P < 0.01) and cN2 (5-yr OS 69.2% vs. 58.6%, P < 0.01) disease. In the subgroup of patients that were ypN0 after NAC, there was no significant survival difference (P > 0.11) for PMRT compared to those patients who were not ypN0, except for patients with hormone-receptor negative tumors, who had improved OS with PMRT (HR 0.65, P < 0.01).
    PMRT is associated with improved OS in patients with cN1 and cN2 disease after NAC and mastectomy. However, in the subgroup of patients that were ypN0 after NAC, PMRT improved OS for hormone-receptor negative patients but not hormone-receptor positive patients.
    PMID: 28083910 [PubMed - as supplied by publisher]
  • Laparoscopic pancreaticoduodenectomy for adenocarcinoma provides short-term oncologic outcomes and long-term overall survival rates similar to those for open pancreaticoduodenectomy.

    American journal of surgery 2017 Mar

    Authors: Kantor O, Talamonti MS, Sharpe S, Lutfi W, Winchester DJ, Roggin KK, Bentrem DJ, Prinz RA, Baker MS
    Abstract
    The long-term efficacy of laparoscopic pancreaticoduodenectomy (LPD) relative to open pancreaticoduodenectomy (OPD) for pancreatic adenocarcinoma has not been well studied.
    The National Cancer Data Base was used to compare patients undergoing LPD and OPD for stage I-II pancreatic adenocarcinoma between 2010 and 2013.
    828 (10%) patients underwent LPD and 7385 (90%) OPD. There were no differences in tumor or demographic characteristics between groups. On multivariable analysis adjusted for hospital volume, LPD was associated with a lower rate of readmission (p < 0.01) and trends toward shorter initial length of stay (p = 0.14) and time to adjuvant chemotherapy (p = 0.11). There were no differences between patients undergoing LPD and those undergoing OP in rates of margin negative resection, number of lymph nodes examined, perioperative mortality and median overall survival (20.7 vs 20.9 months, p = 0.68).
    For patients with localized pancreatic adenocarcinoma, LPD provides short-term oncologic and long-term overall survival outcomes identical to OPD and is associated with decreased rates of readmission and a trend towards accelerated recovery.
    PMID: 28049562 [PubMed - as supplied by publisher]
  • Timing of Adjuvant Radioactive Iodine Therapy Does Not Affect Overall Survival in Low- and Intermediate-Risk Papillary Thyroid Carcinoma.

    The American surgeon 2016 Sep

    Authors: Suman P, Wang CH, Moo-Young TA, Prinz RA, Winchester DJ
    Abstract
    There is no consensus regarding the timing of adjuvant radioactive iodine therapy (RAI) therapy in low- and intermediate-risk papillary thyroid carcinoma (PTC). We analyzed the impact of adjuvant RAI on overall survival (OS) in low- and intermediate-risk PTC. The National Cancer Data Base was queried from 2004 to 2011 for pN0M0 PTC patients having near/subtotal or total thyroidectomy and adjuvant RAI. Tumors ≤1 cm with negative margins were low risk while 1.1- to 4-cm tumors with negative margins or ≤1 cm with microscopic margins were termed intermediate risk. RAI in ≤3 months and between 3 and 12 months was termed as early and delayed, respectively. Survival analysis was performed after adjusting for patient and tumor-related variables. There were 7,306 low-risk and 16,609 intermediate-risk patients. Seventeen per cent low-risk and 15 per cent intermediate-risk patients had delayed RAI. Kaplan-Meier analysis did not show a difference in OS for early versus delayed RAI administration in low- (10-year OS 94.5% vs 94%, P = 0.627) or intermediate-risk (10-year OS 95.3% vs 95.9%, P = 0.944) patients. In adjusted survival analysis, RAI timing did not affect OS in all patients (hazard ratios = 0.98, 95% confidence interval = 0.71-1.34, P = 0.887). In conclusion, the timing of postthyroidectomy adjuvant RAI therapy does not affect OS in low- or intermediate-risk PTC.
    PMID: 27670568 [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.