Jan Franko

Cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion versus systemic chemotherapy alone for colorectal peritoneal carcinomatosis

Survival benefit of cytoreductive surgery combined with hyperthermic intraperitoneal chemoperfusion was demonstrated by a prospective randomized trial for colorectal peritoneal carcinomatosis. Because of a recent substantial improvement in chemotherapy, the authors analyzed treatment options of colorectal carcinomatosis in the current era.

Introduction of Minimally Invasive Esophagectomy in a Community Teaching Hospital

Background and Objectives: The safety of minimally invasive esophagectomy (MIE) outside of high-volume centers has not been studied. Therefore, we evaluated our experience with the introduction of MIE in the setting of a community teaching hospital. Methods: A retrospective cohort of all elective esophagectomy patients treated in a community hospital from 2008 through 2015 was evaluated (n = 57; open = 31 vs MIE = 26). Clavien-Dindo complication grades were recorded prospectively. Results: Mean age was 63 ± 11 years (range, 30–83), mean Charlson comorbidity index was 4.5 ± 1.7 and proportion of ASA score ≥3 was 87%. The groups did not differ in age, gender distribution, or comorbidity indices. There were 108 complications observed, including 2 deaths (3.5%, both coronary events). Postoperative complication rate was 77.1% and serious complication rate (grades 3 and 4) was 50.8% in the entire cohort. The rate of serious complications was similar (58% for open vs 42% for MIE group; 2-sided P = .089). MIE operations were longer (342 ± 109 vs 425 ± 74 minutes; P = .001). Length of stay trended toward not being significantly shorter among MIE cases (15 ± 13 vs 12 ± 12 days; P = .071). Logistic regression models including MIE status were not predictive of complications. Conclusions: Introduction of MIE esophagectomy in our community hospital was associated with prolonged operative time, but no detectable adverse outcomes. Length of stay was nonsignificantly shortened by the use of MIS esophagectomy.

Role of the Inferior Mesenteric Artery in Predicting Secondary Intervention for Type II Endoleak After Endovascular Aneurysm Repair

Objective: The objective of this study was to determine whether flow velocities measured on Doppler ultrasound after endovascular aneurysm repair can predict whether a type II endoleak can resolve without intervention. In addition, we assessed the relationship of flow velocities to sac growth and the need for an intervention. We hypothesized that hemodynamic properties suggesting low flow velocity would predict resolution of type II endoleaks. Methods: Patients with type II endoleaks after endovascular aneurysm repair identified on Doppler ultrasound between January 2014 and December 2017 were retrospectively analyzed. Twenty patients were found to have type II endoleaks, and they were split into two groups. Group 1 consisted of 10 patients with resolved endoleaks or shrinking sac size; group 2 consisted of 10 patients with increasing sac size or those who required intervention to seal the endoleak because of an increased sac size. An analysis of the velocities of the endoleak nidus was conducted. Results: Doppler ultrasound velocities were significantly lower in patients with resolved type II endoleaks and in those with shrinking aneurysm sac size compared with those requiring intervention or demonstrating an increase in aneurysm sac size (43.6 6 20.5 cm/s vs 147.30 6 103.45 cm/s; P < .01). Nine of 10 patients in group 2 underwent intervention with either translumbar embolization or transarterial embolization, with only 1 having complete resolution of the type II endoleak despite intervention. All patients in group 2 had at least one duplex ultrasound examination with endoleak nidus velocities >100 cm/s, whereas there was no patient in group 1 who had any duplex ultrasound examination with endoleak nidus velocities >100 cm/s. Average follow-up time was similar in both groups, with group 1 at 581 days and group 2 at 547 days postoperatively. Conclusions: Doppler ultrasound velocities of type II endoleaks can be used to predict whether type II endoleaks will spontaneously seal or lead to sac growth. Type II endoleaks on Doppler ultrasound with endoleak nidus flow velocities >100 cm/s remain persistent, even with attempted treatment.