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Katharine A. Yao, M.D.

Katharine A. Yao, M.D.

Katharine A. Yao, M.D.

Breast Surgery
  • Locations
    Locations
    A

    NorthShore Medical Group

    2650 Ridge Ave.
    Suite 1155
    Evanston, IL 60201
    847.570.1700 847.733.5298 fax Get Directions This location is wheelchair accessible.
    B

    NorthShore Medical Group

    2650 Ridge Ave.
    Kellogg Cancer Center
    Evanston, IL 60201
    847.570.1700 847.733.5298 fax Get Directions This location is wheelchair accessible.
  • Publications
    Publications
    • ASO Author Reflections: Axillary Surgery for Node-Positive Mastectomy Patients.

      Annals of surgical oncology 2018 Oct 16

      Authors: Gaines S, Yao K
      Abstract

      PMID: 30327969 [PubMed - as supplied by publisher]
    • ASO Author Reflections: Bilateral Mastectomy After Neoadjuvant Therapy: An Ever-Increasing Trend?

      Annals of surgical oncology 2018 Oct 16

      Authors: Kantor O, Yao K
      Abstract

      PMID: 30327968 [PubMed - as supplied by publisher]
    • The effect of contralateral prophylactic mastectomy on breast-related charges: A 5-year analysis.

      Journal of surgical oncology 2018 Jul

      Authors: Smith JR
      Abstract
      The purpose of this study was to determine charges following unilateral mastectomy (UM) and bilateral mastectomy (BM) for patients with unilateral breast cancer (UBC). We hypothesized that BM may be associated with fewer charges over time.
      A retrospective review was conducted of patients with UBC treated between 2006 and 2010 with UM and BM in a large healthcare system. Institutional billing data were investigated for 5 years postoperatively to calculate the immediate and subsequent charges of all inpatient and outpatient breast-related care associated with the initial diagnosis for a subset of patients identified using propensity score matching method.
      A subset of matched patients (n = 320) undergoing UM (n = 160) or BM (n = 160) were included in this analysis. At 1 year, there was a trend toward lower total charges following UM as compared with BM (median, $125 230 vs $138 467; P = .6075). However, during years 2 to 5, total charges were significantly higher following UM vs BM ($22 128 vs $13 478; P = .0116).
      While initially higher, overall charges for BM are lower than UM between 2 and 5 years out from surgery. Further study is necessary to determine if this trend is sustained over the long term. These data can inform patient decision making regarding mastectomy for their breast cancer.
      PMID: 30098307 [PubMed - as supplied by publisher]
    • Facility-level analysis of robot utilization across disciplines in the National Cancer Database.

      Journal of robotic surgery 2018 Jul 30

      Authors: Fantus RJ, Cohen A, Riedinger CB, Kuchta K, Wang CH, Yao K, Park S
      Abstract
      To evaluate trends in contemporary robotic surgery across multiple organ sites as they relate to robotic prostatectomy volume. We queried the National Cancer Database for patients who underwent surgery from 2010 to 2013 for prostate, kidney, bladder, corpus uteri, uterus, cervix, colon, sigmoid, rectum, lung and bronchus. The trend between volumes of robotic surgery for each organ site was analyzed using the Cochran-Armitage test. Multivariable models were then created to determine independent predictors of robotic surgery within each organ site by calculating the odds ratio with 95% CI. Among the 566,399 surgical cases analyzed, 35.1% were performed using robot assistance. Institutions whose robotic prostatectomy volume was in the top 75 percentile compared to the bottom 25 percentile performed a larger percentage of robotic surgery on the following sites: kidney 32.6 vs. 28.8%, bladder 23.6 vs. 18.6%, uterus 52.5 vs. 47.7%, cervix 43.5 vs. 39.2%, colon 3.2 vs. 2.9%, rectum 10.7 vs. 8.9%, and lung 7.3 vs. 6.8% (all p < 0.0001). It appears that increased trends toward robotic surgery in urology have lead to increased robotic utilization within other surgical fields. Future analysis in benign utilizations of robotic surgery as well as outcome data comparing robotic to open approaches are needed to better understand the ever-evolving nature of minimally invasive surgery within the United States.
      PMID: 30062641 [PubMed - as supplied by publisher]
    • Author's response.

      The breast journal 2018 Jul 26

      Authors: Tevis SE, James TA, Kuerer HM, Pusic AL, Yao KA, Merlino J, Dietz J
      Abstract
      Patient-reported outcomes (PROs) provide insight into how patients perceive health and treatment effects, how treatments impact outcomes, and are helpful in determining how disease and surgical interventions impact many aspects of a patients' life. Commonly utilized metrics include survival and disease control, degree of recovery and functional status, access to treatment, treatment-related complications, health-related quality of life, and long-term consequences of therapy. The key to value-based, patient-centered health care is systematically incorporating patient input into the measures that they consider to be the most important outcomes for a particular medical condition while minimizing costs of care. This manuscript reviews the development and validation of multiple available PROs in breast surgical oncology and reconstruction, their impact in improving patient-physician communication and treatment outcome, and potential for impacting reimbursement. The implementation of PROs can be complex and challenging and care must be taken to minimize the potential for survey fatigue by patients and the potential financial burden for implementation, maintenance, and analyses of collected data. Because there is an increased emphasis in providing high-value care for cancer patients, the widespread incorporation of transparent breast-specific PROs stratified by treatments received and disease stage will be essential in delivering exceptional quality care.
      PMID: 30051547 [PubMed - as supplied by publisher]
    • The Changing Paradigms for Breast Cancer Surgery: Performing Fewer and Less-Invasive Operations.

      Annals of surgical oncology 2018 Oct

      Authors: Ollila DW, Hwang ES, Brenin DR, Kuerer HM, Yao K, Feldman S
      Abstract
      Historically, through the conduct of prospective clinical trials, breast cancer surgeons have performed less radical breast and axillary surgeries with no survival decrement to our patients. Currently, other opportunities exist for the treating breast surgeon to do less. Possibilities include active surveillance for ductal carcinoma in situ, ablative therapy for small primary breast cancers, selective omission of a sentinel node biopsy, and selective elimination of breast surgery after neoadjuvant systemic therapy. Breast surgeons must be leaders in the development and testing of effective therapy with the least intervention possible.
      PMID: 29968033 [PubMed - as supplied by publisher]
    • 'Nudging' Surgeons and Patients to De-Escalation of Surgery for Breast Cancer.

      Annals of surgical oncology 2018 Oct

      Authors: Kantor O, Wang CH
      Abstract
      Adherence to quality measures has become an important indicator of cancer center performance for high-quality cancer care. We examined regional variation in performance for Commission on Cancer breast quality measures and its impact on overall survival (OS) for those measures that have been shown to impact OS.
      Six breast quality measures were analyzed using the National Cancer Data Base from 2014 to 2015, and a multivariable model was used to assess performance for each measure by region. Kaplan-Meier and Cox proportional hazard models were used to examine OS between high- and low-performing centers from 2007 to 2012.
      Overall, 305,391 women had surgery at 1322 institutions in nine US regions; 90.8% underwent needle biopsy (range 86.0-92.6% between regions, p < 0.01), 69.8% had breast-conserving surgery (BCS) for stage 0-II cancer (60.9-79.3%, p < 0.01), 85.2% aged < 70 years had radiation therapy (RT) after BCS (79.6-90.8%, p < 0.01), 78.3% of women with four or more positive nodes had post-mastectomy RT (70.9-84.5%, p < 0.01), 90.9% with hormone receptor (HR)-positive stage IB-III cancer had hormone therapy (83.7-95.1%, p < 0.01), and 89.4% aged < 70 years with HR-negative stage IB-III cancer had chemotherapy (87.6-91.4%, p < 0.01). Multivariate analyses adjusted for patient and facility factors found that region was the only consistent predictor of non-compliance across measures. With median 65-month follow-up, there was no difference in OS between high- and low-performing centers for the three measures that have been shown to impact OS.
      There is significant regional variation in performance on the breast quality measures but this variation did not impact OS. Targeted efforts in certain areas of the country may help improve performance on these measures.
      PMID: 29968025 [PubMed - as supplied by publisher]
    • Axillary Surgery for Early-Stage, Node-Positive Mastectomy Patients and the Use of Postmastectomy Chest Wall Radiation Therapy.

      Annals of surgical oncology 2018 Aug

      Authors: Gaines S, Suss N, Barrera E, Pesce C, Kuchta K, Winchester DJ, Yao K
      Abstract
      We examined axillary surgery in mastectomy patients with tumor-positive nodes and how the type of axillary surgery impacted use of postmastectomy chest wall radiation therapy (PMRT).
      Using the National Cancer Data Base, we selected patients with AJCC cT1/T2c N0 breast cancer with one to three tumor-positive lymph nodes treated between 2013 and 2014. Type of axillary surgery was analyzed using the FORDS scope of regional lymph node surgery variable. Multivariable logistic regression modeling was used to identify independent predictors associated with SNB alone and the use of PMRT.
      Of 8089 patients, 2482 (30.7%) underwent SNB alone, 1339 (16.6%) underwent axillary dissection (ALND) alone, and 4268 (52.7%) underwent SNB followed by ALND. Fifty-seven percent of patients with micrometastases underwent SNB alone compared with 22.6% of patients with macrometastases. Independent predictors of SNB alone for patients with micrometastases were African American race, number of nodes positive, and PMRT. For patients with macrometastases, age, facility type and location, and PMRT were independent predictors for SNB alone. Of 2449 patients who underwent SNB alone, 1538 (62.8%) had no PMRT, 261 (10.7%) had PMRT alone, and 650 (26.5%) had PMRT with regional nodal irradiation. Patients undergoing SNB alone were 1.70 times [96% confidence interval (CI) 1.45-2.00] more likely to undergo PMRT than upfront ALND and 1.51 times (96% CI 1.34-1.71) more likely than SNB followed by ALND.
      Surgeons are omitting completion ALND in a third of early-stage, node-positive mastectomy patients. SNB alone patients are more likely to undergo PMRT than patients undergoing ALND.
      PMID: 29626303 [PubMed - as supplied by publisher]
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