Mehraneh D. Jafari

Surgical outcomes of hyperthermic intraperitoneal chemotherapy: analysis of the american college of surgeons national surgical quality improvement program.

IMPORTANCE Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery have been shown to benefit selected patients with peritoneal carcinomatosis. However, these procedures are associated with high morbidity and mortality. Available data investigating the outcomes of HIPEC are mostly limited to single-center studies. To date, there have been few large-scale studies investigating the postoperative outcomes of HIPEC. OBJECTIVE To determine the associated 30-day morbidity and mortality of cytoreductive surgery-HIPEC in the treatment of metastatic and primary peritoneal cancer in American College of Surgeons National Surgical Quality Improvement Program centers. DESIGN, SETTING, AND PARTICIPANTS A retrospective review of HIPEC cases performed for primary and metastatic peritoneal cancer diagnoses was conducted. The cytoreductive surgical procedures were sampled, and disease processes were identified. Patient demographics, intraoperative occurrences, and postoperative complications were reviewed from the American College of Surgeons National Surgical Quality Improvement Program from 2005-2011. MAIN OUTCOMES AND MEASURES Thirty-day mortality and morbidity. RESULTS Of the cancers identified among the 694 sampled cases, 14% of patients had appendiceal cancer, 11% had primary peritoneal cancer, and 8% had colorectal cancer. The American Society of Anesthesiologists classification was 3 for 70% of patients. The average operative time was 7.6 hours, with 15% of patients requiring intraoperative transfusions. Postoperative bleeding (17%), septic shock (16%), pulmonary complications (15%), and organ-space infections (9%) were the most prevalent postoperative complications. The average length of stay was 13 days, with a 30-day readmission rate of 11%. The rate of reoperation was 10%, with an overall mortality rate of 2%. CONCLUSIONS AND RELEVANCE American College of Surgeons National Surgical Quality Improvement Program hospitals performing HIPEC have acceptable rates of morbidity and mortality.

Colorectal Cancer Resections in the Aging US Population: A Trend Toward Decreasing Rates and Improved Outcomes

IMPORTANCE The incidence of colorectal cancer in elderly patients is likely to increase, but there is a lack of large nationwide data regarding the mortality and morbidity of colorectal cancer resections in the aging population. OBJECTIVE To examine the surgical trends and outcomes of colorectal cancer treatment in the elderly. DESIGN, SETTING, AND PARTICIPANTS A review of operative outcomes for colorectal cancer in the United States was conducted in a Nationwide Inpatient Sample from January 1, 2001, through December 31, 2010. Patients were stratified within age groups of 45 to 64, 65 to 69, 70 to 74, 75 to 79, 80 to 84, and 85 years and older. Postoperative complications and yearly trends were analyzed. A multivariate logistic regression was used to compare in-hospital mortality and morbidity between individual groups of patients 65 years and older and those aged 45 to 64 years while controlling for sex, comorbidities, procedure type, diagnosis, and hospital status. MAIN OUTCOMES AND MEASURES In-hospital mortality and morbidity. RESULTS Among the estimated 1,043,108 patients with colorectal cancer sampled, 63.8% of the operations were performed on those 65 years and older and 22.6% on patients 80 years and older. Patients 80 years and older were 1.7 times more likely to undergo urgent admission than those younger than 65 years. Patients younger than 65 years accounted for 46.0% of the laparoscopies performed in the elective setting compared with 14.1% for patients 80 years and older. Mortality during the 10 years decreased by a mean of 6.6%, with the most considerable decrease observed in the population 85 years and older (9.1%). Patients 80 years and older had an associated

Randomized Clinical Trial of Epidural Compared with Conventional Analgesia after Minimally Invasive Colorectal Surgery

9492 higher hospital charge and an increased 2½-day length of stay vs patients younger than 65 years. Compared with patients aged 45 to 64 years, higher risk-adjusted in-hospital mortality was observed in patients with advancing age: 65 to 69 years (odds ratio, 1.32; 95% CI, 1.18-1.49), 70 to 74 years (2.02; 1.82-2.24), 75 to 79 years (2.51; 2.28-2.76), 80 to 84 years (3.15; 2.86-3.46), and 85 years and older (4.72; 4.30-5.18) (P < .01). Compared with patients aged 45 to 64 years, higher risk-adjusted morbidity was noted in those with advancing age: 65 to 69 years (odds ratio, 1.25; 95% CI, 1.21-1.29), 70 to 74 years (1.40; 1.36-1.45), 75 to 79 years (1.54; 1.49-1.58), 80 to 84 years (1.68; 1.63-1.74), and 85 years and older (1.96; 1.89-2.03) (P < .01). CONCLUSIONS AND RELEVANCE Most operations for colorectal cancer are performed on the aging population, with an overall decrease in the number of cases performed. Despite the overall improved mortality seen during the past 10 years, the risk-adjusted mortality and morbidity of the elderly continue to be substantially higher than that for the younger population.

Association of Compensation From the Surgical and Medical Device Industry to Physicians and Self-declared Conflict of Interest

BACKGROUND The effectiveness of thoracic epidural analgesia (EA) vs conventional IV analgesia (IA) after minimally invasive surgery is still unproven. We designed a randomized controlled trial comparing EA with IA after minimally invasive colorectal surgery. STUDY DESIGN A total of 87 patients who underwent minimally invasive colorectal procedures at a single institution between 2011 and 2014 were enrolled. Eight patients were excluded and 38 were randomized to EA and 41 to IA. Pain was assessed with the Visual Analogue Scale and quality of life with the Overall Benefit of Analgesia Score daily until discharge. RESULTS Mean age was 57 ± 14 years, 43% of patients were female, and mean BMI was 28.6 ± 6 kg/m2. The 2 groups were similar in demographic characteristics and distribution of diagnoses and procedures. Epidural analgesia had a higher incidence of hypotensive systolic blood pressure (<90 mmHg) episodes (9 vs 2; p < 0.05) and a trend toward longer Foley catheter duration (3 ± 2 days vs 2 ± 4 days; p > 0.05). Epidural and IA had equivalent mean lengths of stay (4 ± 3 days vs 4 ± 3 days), daily Visual Analogue Scale scores (2.4 ± 2.0 vs 3.0 ± 2.0), and Overall Benefit of Analgesia Scores (3.2 ± 2.0 vs 3.2 ± 2.0), and similar time to start oral diet (2.8 ± 2 days vs 2.2 ± 1 days). Epidural analgesia patients used a higher total dose of narcotics (147.5 ± 192.0 mg vs 98.1 ± 112.0 mg; p > 0.05). Epidural and IV analgesia had equivalent total hospital charges (

Defining the Role of Minimally Invasive Proctectomy for Locally Advanced Rectal Adenocarcinoma

144,991 ±

Personalizing Therapy for Locally Advanced Rectal Cancer

67,636 vs

Patient Positioning, Instrumentation, and Trocar Placement

141,339 ±

Robotic-Assisted Extralevator Abdominoperineal Resection

75,579; p > 0.05). CONCLUSIONS This study indicates that EA has no added clinical benefit in patients undergoing minimally invasive colorectal surgery. A trend toward higher total narcotics use and complications with EA was demonstrated.

Su1605 Anastomotic Leak Following Anterior Resection for Rectal Cancer: Does the Presence of a Defunctioning Stoma Reduce the Burden of a Leak ?

Importance Surgical and medical device manufacturers have a cooperative relationship with clinicians. When evaluating published works, one should assess the integrity and academic credentials of the authors, who serve as putative experts. A relationship with a relevant manufacturer may increase the potential risk for bias in relevant studies. Objective To characterize the association of industrial payments by device manufacturers, self-declared conflict of interest (COI), and relevance of publications among physicians receiving the highest compensation. Design, Setting, and Participants This population-based bibliometric analysis identified 10 surgical and medical device manufacturing companies and the 10 physicians receiving the highest compensation from each company using the 2015 Open Payments Database (OPD) general payments data. For each of the 100 physicians, the total amount of general payments, number of payments, institution type, and academic rank were recorded. Royalty or license payments were excluded. A search of PubMed identified articles published by each physician from January 1 through December 31, 2016, and their associated COI declaration. Scopus was used to identify bibliometric data reported as the h index (number of papers by a researcher with at least h citations each). Main Outcomes and Measures Discrepancy between self-declared COI and industry payments. Results The 100 physicians included in the sample population (88% men) were paid a total of

The use of indocyanine green fluorescence to assess anastomotic perfusion during robotic assisted laparoscopic rectal surgery

12 446 969, with a median payment of