Apoorve Nayyar

Definition and Management of Positive Margins for Invasive Breast Cancer

Breast-conserving surgery (BCS) followed by radiation therapy is the current standard of care for early stage breast cancer. Successful BCS necessitates complete tumor resection with clear margins at the pathologic assessment of the specimen (no ink on tumor). The presence of positive margins warrants additional surgery to obtain negative final margins, which has significant physical, psychological, and financial implications for the patient. The challenge lies in developing accurate real-time intraoperative margin assessment techniques to minimize the presence of ink on tumor and the subsequent need for additional surgery.

Postoperative outcomes of esophagectomy for cancer in elderly patients

BACKGROUNDnThe number of elderly patients with esophageal cancer is expected to increase. We aimed to determine the postoperative outcomes of esophagectomy for esophageal cancer in elderly patients.nnnMATERIAL AND METHODSnA retrospective, population-based analysis was performed using the National inpatient sample for the period 2000-2014. Adult patients ≥18 years old (yo) diagnosed with esophageal cancer who underwent esophagectomy during their inpatient hospitalization were included. Patients were categorized into <70 yo and ≥70 yo. Multivariable linear and logistic regressions were used to assess the potential effect of age on postoperative complications, inpatient mortality, and hospital charges.nnnRESULTSnOverall, 5243 patients were included, with 3699 (70.6%) <70 yo and 1544 (29.5%) ≥70 yo. The yearly rate of esophagectomies among patients ≥70 yo did not significantly changed duringxa0the study period (28.4% in 2000 and 26.3% in 2014, Pxa0=xa00.76). Elderly patients were significantly more likely to have postoperative cardiac failure (odds ratio 1.59, 95% confidence interval [CI] 1.21, 2.09, Pxa0=xa00.0009) and inpatient mortality (odds ratio 1.84, 95% CI 1.39, 2.45, Pxa0<xa00.0001). Among the elderly patients, hospital charges were, on average,

Individualizing Local-Regional Therapy of Breast Cancer in the Elderly

16,320 greater (95% CI

Survival analysis of early-stage breast cancer patients undergoing axillary lymph node dissection and sentinel lymph node dissection

3110,

Are You on the Right Platform? A Conjoint Analysis of Social Media Preferences in Aesthetic Surgery Patients

29,530) than patients <70 yo (Pxa0=xa00.02). The predicted probability of mortality increased consistently across age (1.5% in 40 yo, 2.5% in 50 yo, 3.6% in 60 yo, 5.4% in 70 yo, and 7.0% in 80 yo).nnnCONCLUSIONSnElderly patients undergoing esophagectomy for cancer have a significantly higher risk of postoperative mortality and pose a higher financial burden on the health care system. Elderly patients with esophageal cancer should be carefully selected for surgery.

Management of Pulmonary Failure after Burn Injury: From VDR to ECMO

Purpose of ReviewThe treatment of breast cancer in the elderly population requires a tailored approach. We summarize the current best evidence for personalized local-regional therapy in breast cancer patients older than 70.Recent FindingsBreast cancer treatment in older adults incorporates the use of geriatric assessment tools to best evaluate functional status and treatment tolerability while accounting for the biologic profile of the disease. Surgical resection of the primary tumor with lymph node evaluation remains the cornerstone of local-regional control. Recent clinical trials demonstrate that surgery and radiation therapy may, however, be safely omitted in selected patients who are eligible for primary endocrine therapy. In patients with high-risk node-positive disease, DFS can be improved by systemic chemotherapy, but potential toxicity should be carefully considered in this population.SummaryPatient-specific evaluation of the risks of both under- and over-treatment of breast cancer in the older adult is essential for delivering optimal care in this population.

Temporal Trends in Immediate Postmastectomy Breast Reconstruction

BACKGROUNDnThe American College of Surgeons Oncology Group (ACOSOG) Z0011 trial demonstrated equivalent survival in early-stage breast cancer (BC) patients receiving either axillary lymph node dissection (ALND) or sentinel lymph node dissection (SLND) alone. However, institutional studies have called into question the generalization of these findings outside of a clinical trial.nnnMETHODSnEarly-stage BC patients diagnosed in 2013, that received lumpectomy with whole-breast irradiation, and underwent either ALND or SLND alone, in National Cancer Database were included. Weighted Kaplan-Meier curves were used to estimate 45-month survival, accounting for demographics, comorbidities, insurance type, cancer and neighborhood characteristics.nnnRESULTSn62,184 patients were included, of which 21,892 (35%) underwent ALND. Patients undergoing ALND, compared to SLND, appeared to have slightly lower survival (91.4% vs 95.1%); moreover, even after weighting, a small difference persisted (92.7% vs 94.7%, RR 0.98, 95% CI 0.97, 0.99).nnnCONCLUSIONSnSLND is a safe and effective alternative to ALND in BC patients with limited nodal involvement. This study provides additional evidence that the findings of ACOSOG Z0011 are applicable to the larger early-stage BC population.

Disparities in the Utilization of Post-Mastectomy Breast Reconstruction

BackgroundnSocial media has become an indispensable tool for patients to learn about aesthetic surgery. Currently, procedure-specific patient preferences for social media platforms and content are unknown.nnnObjectivesnTo evaluate social media preferences of patients seeking aesthetic surgery.nnnMethodsnWe utilized a choice-based conjoint analysis survey to analyze the preferences of patients seeking three common aesthetic procedures - breast augmentation (BA), facial rejuvenation (FR) and combined breast/abdominal surgery (BAB). Participants were asked to choose among social media platforms (Facebook, Twitter, Instagram, Snapchat, Pinterest, Tumblr, YouTube), information extent (basic, moderate, comprehensive), delivery mechanism (pre-recorded video, live-video, photographs, text description), messenger (surgeon, nurse/clinic staff, patient) and option for interactivity (Yes/No). The survey was administered using an Internet crowdsourcing service (Amazon Mechanical Turk©).nnnResultsnA total of 647 participants were recruited: 201 in BA, 255 in FR and 191 in BAB. Amongst attributes surveyed, participants in all three groups (BA, FR, BAB) valued social media platform as the most important (30.9%, 33.1%, 31.4%), followed by information extent (23.1%, 22.9%, 21.6%), delivery mechanism (18.9%, 17.4%, 18%), messenger (16%, 17%, 17.2%) and interactivity (11.1%, 9.8%, 11.8%). Within these attributes, Facebook ranked as the preferred platform, with comprehensive information extent, live-video as the delivery mechanism and surgeon as the messenger as most preferred.nnnConclusionnThe choice of social media platform is the most important factor for patients, with a preference for comprehensive information delivered by the surgeon via live-video on Facebook. Our study elucidates social media usage in common aesthetic populations, which can help improve aesthetic patient outreach.

Regional Variations in Use of Postmastectomy Breast Reconstruction for Breast Cancer Patients

This article highlights the challenges in managing pulmonary failure after burn injury. The authors review several different ventilator techniques, provide weaning parameters, and discuss complications.