Daniel J. Kagedan

Pasireotide for the Prevention of Pancreatic Fistula Following Pancreaticoduodenectomy: A Cost-effectiveness Analysis

Objective: To determine the cost-effectiveness of perioperative administration of pasireotide for reduction of pancreatic fistula (PF). Summary: PF is a major complication following pancreaticoduodenectomy (PD), associated with significant morbidity and healthcare-related costs. Pasireotide is a novel multireceptor ligand somatostatin analogue, which has been demonstrated to reduce the incidence of PF following pancreas resection; however, the drug cost is significant. This study sought to estimate the cost-effectiveness of routine administration of pasireotide to patients undergoing PD, compared with no intervention from the perspective of the hospital system. Methods: A decision-analytic model was developed to compare costs for perioperative administration of pasireotide versus no pasireotide. The model was populated using an institutional database containing all PDs performed 2002 to 2012 at a single institution, including data regarding clinically significant PF (International Study Group on Pancreatic Fistula Grade B or C) and hospital-related inpatient costs for 90 days following PD, converted to 2014

Combined pancreaticoduodenectomy and colon resection for locally advanced peri-ampullary tumours: analysis of peri-operative morbidity and mortality

USD. Relative risk of PF associated with pasireotide was estimated from the published literature. Deterministic and probabilistic sensitivity analyses were performed to test robustness of the model. Results: Mean institutional cost of index admissions was

Beyond the dollar: Influence of sociodemographic marginalization on surgical resection, adjuvant therapy, and survival in patients with pancreatic cancer.

67,417 and

The Impact of Increasing Hospital Volume on 90-Day Postoperative Outcomes Following Pancreaticoduodenectomy.

31,950 for patients with and without PF, respectively. Pasireotide was the dominant strategy, associated with savings of

Secondary gastric cancer malignancies following a breast cancer diagnosis: A population-based analysis

1685, and a mean reduction of 1.5 days length of stay. Univariate sensitivity analyses demonstrated cost-savings down to a PF rate of 5.6%, up to a relative risk of PF of 0.775, and up to a drug cost of

The association of adjuvant therapy with survival at the population level following pancreatic adenocarcinoma resection

2817. Probabilistic sensitivity analysis showed 79% of simulations were cost saving. Conclusions: Pasireotide appears to be a cost-saving treatment following PD across a wide variation of clinical and cost scenarios.

Early Recovery After Surgery Pathways for Pancreatectomy

BACKGROUND Combined pancreaticoduodenectomy (PD) and colonic resection may be necessary to achieve an R0 resection of peri-ampullary tumours. The aim of this study was to examine the morbidity and mortality associated with this procedure. METHODS A retrospective cohort study was performed comparing 607 patients who underwent a standard pancreaticoduodenectomy (S-PD) to 28 patients who had a concomitant colon resection and PD (PD-colon) over a 10-year period at an academic centre. RESULTS Patients in the PD-colon group were more likely to have received neoadjuvant chemotherapy ± radiation (3/28, 11% versus 14/607, 2%, P = 0.024). Operative time was also longer (530 versus 410 min, P < 0.001) and they were more likely to have had portal vein resections (9/28, 32% versus 76/607, 13%, P = 0.007). There was no difference in the intra-operative blood loss, length of stay, or overall complication rates. The PD-colon group had a higher rate of severe post-operative bleeding (4/28, 11% versus 8/607, 1%, P = 0.002). The post-operative mortality rates for the PD-colon and PD groups were 2/28 (7%) and 8/607 (1%), respectively (P = 0.068). CONCLUSIONS PD-colon has an acceptable risk of peri-operative morbidity compared with S-PD in well-selected patients.

Re: Secondary gastric cancer following a breast cancer diagnosis; beware of metastatic breast cancer

The single‐payer universal health care system in Ontario, Canada creates a setting with reduced socioeconomic barriers to treatment. Herein, the authors sought to elucidate the influence of sociodemographic marginalization on receipt of pancreatectomy, overall survival (OS), and receipt of adjuvant treatment among patients diagnosed with pancreatic cancer at the population level using an observational cohort study design.

L’effet néfaste des transfusions sur l’issue post-opératoire après gastrectomie pour cancer gastrique : une analyse de l’American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP)

BackgroundPerformance of pancreaticoduodenectomy (PD) in high-volume centers has been posited to improve postoperative morbidity and mortality, consistent with the volume-outcomes hypothesis. We sought to evaluate the impact of hospital volume on 90-day PD outcomes at hepatopancreatobiliary (HPB) centers within a regionalized system.MethodsA retrospective population-based observational cohort study was performed, using administrative records of patients undergoing PD between 2005 and 2013 in Ontario, Canada. Postoperative administrative codes were used to define complications. Patients’ 90-day postoperative outcomes were compared between center-volume categories using chi-square tests and multivariable regression. Volume cutoffs were defined using minimal regional standards (20PD/year), with assessment of the impact of further volume increases.ResultsOf 2660 patients, 2563 underwent PD at HPB centers. Of these, 38.9% underwent surgery at higher-volume centers (>40 PD/year), 36.9% at medium-volume centers (20–39 PD/year), and 24.1% at lower-volume centers (10–19 PD/year). Mortality (30- and 90-day) was lowest at higher-volume hospitals (1.5%, 2.7%, respectively) compared to medium-volume (3.9%, 6.3%) and lower-volume hospitals (2.9%, 5.2%) (p < 0.01). Patients treated at higher- and medium-volume centers had lower reoperation rates (10.3%, 10.7% vs. 16.7%, p = 0.0002) and less prolonged length of stay (23.2%, 22.0% vs. 31.6%, p < 0.0001) compared to lower-volume centers.ConclusionProgressive increases in hospital volume correspond to improved 90-day outcomes following PD.

Epiglottitis as a presentation of leukemia in an adolescent.

OBJECTIVE To quantify the population-risk of developing gastric cancer (GC) following breast cancer (BC). METHODS GC incidence following a ductal or lobular BC were separately compared to incidence in the general United States population using SEER data. RESULTS GC rates were similar to the general population for ductal BC. Women aged 35-75 with lobular BC had a significantly higher incidence of GC; women aged 40-44 had the highest risk. CONCLUSION The risk of secondary GC is high among young women diagnosed with lobular BC. More studies investigating the etiology and prevalence of familial GC syndromes at the population-level are needed.