The Experts below are selected from a list of 627 Experts worldwide ranked by ideXlab platform
Timothy M. Pawlik - One of the best experts on this subject based on the ideXlab platform.
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National Assessment of Margin Status as a Quality Indicator after Pancreatic Cancer Surgery
Annals of Surgical Oncology, 2014Co-Authors: Ryan P. Merkow, Karl Y. Bilimoria, David J. Bentrem, Henry A. Pitt, David P. Winchester, Mitchell C. Posner, Timothy M. PawlikAbstract:Background Surgical Margin involvement is an important outcome after pancreatic cancer surgery; however, variation in pathologic review practices may limit its use as a quality indicator. Our objectives were to assess variation in hospital performance and the reliability of Margin involvement after pancreatic cancer surgery. Methods From the National Cancer Data Base, patients who underwent pancreatic resection for stage I to III adenocarcinoma were identified. Risk-adjusted surgical Margin involvement was evaluated using hierarchical regression methods, and variation in hospital performance and reliability was determined. Results From 1,002 hospitals, 14,889 patients underwent pancreatic resection for adenocarcinoma, and 3,573 (24.0 %) had an involved surgical Margin (R1 22.8 %; R2 1.2 %). The strongest predictors associated with Margin involvement were T stage [T3: odds ratio (OR) 2.08, 95 % confidence interval (CI) 1.68–2.59; T4: OR 7.26, 95 % CI 5.50–9.60; vs. T1] and tumor size (2–3.9 cm: OR 1.66, 95 % CI 1.39–1.98, ≥4 cm: OR 2.28, 95 % CI 1.90–2.74; vs.
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National Assessment of Margin status as a quality indicator after pancreatic cancer surgery.
Annals of surgical oncology, 2013Co-Authors: Ryan P. Merkow, Karl Y. Bilimoria, David J. Bentrem, Henry A. Pitt, David P. Winchester, Mitchell C. Posner, Timothy M. PawlikAbstract:Background Surgical Margin involvement is an important outcome after pancreatic cancer surgery; however, variation in pathologic review practices may limit its use as a quality indicator. Our objectives were to assess variation in hospital performance and the reliability of Margin involvement after pancreatic cancer surgery.
John R. Benson - One of the best experts on this subject based on the ideXlab platform.
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Novel techniques for intraoperative Assessment of Margin involvement.
Ecancermedicalscience, 2018Co-Authors: Dorin Dumitru, Michael Douek, John R. BensonAbstract:Breast conserving surgery (BCS) is now the standard of care for the majority of women with early stage breast cancer. There is a finite rate of ipsilateral breast tumour recurrence (IBTR) for breast conserving therapy (BCT) with annual rates of less than 1% for specialist breast practices. There has been recent consensus on the definition of an adequate resection Margin for both invasive and noninvasive breast cancer treated with BCS, although some variation in Margin policy persists with definitions of 'no tumour at ink', 1 and 2 mm Margin mandates. Despite the development of methods for intraoperative Assessment of Margins, up to 20% of patients require further surgery (cavity re-excision or completion mastectomy) to achieve clear surgical Margins. In the past decade, several novel technologies for intraoperative Margin Assessment have been explored with the aim of reducing rates of re-operation and its attendant patient anxiety, inconvenience and additional cost. Ongoing studies are addressing the safety, feasibility and cost-effectiveness of these novel technologies relative to methods in routine clinical usage.
Ryan P. Merkow - One of the best experts on this subject based on the ideXlab platform.
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National Assessment of Margin Status as a Quality Indicator after Pancreatic Cancer Surgery
Annals of Surgical Oncology, 2014Co-Authors: Ryan P. Merkow, Karl Y. Bilimoria, David J. Bentrem, Henry A. Pitt, David P. Winchester, Mitchell C. Posner, Timothy M. PawlikAbstract:Background Surgical Margin involvement is an important outcome after pancreatic cancer surgery; however, variation in pathologic review practices may limit its use as a quality indicator. Our objectives were to assess variation in hospital performance and the reliability of Margin involvement after pancreatic cancer surgery. Methods From the National Cancer Data Base, patients who underwent pancreatic resection for stage I to III adenocarcinoma were identified. Risk-adjusted surgical Margin involvement was evaluated using hierarchical regression methods, and variation in hospital performance and reliability was determined. Results From 1,002 hospitals, 14,889 patients underwent pancreatic resection for adenocarcinoma, and 3,573 (24.0 %) had an involved surgical Margin (R1 22.8 %; R2 1.2 %). The strongest predictors associated with Margin involvement were T stage [T3: odds ratio (OR) 2.08, 95 % confidence interval (CI) 1.68–2.59; T4: OR 7.26, 95 % CI 5.50–9.60; vs. T1] and tumor size (2–3.9 cm: OR 1.66, 95 % CI 1.39–1.98, ≥4 cm: OR 2.28, 95 % CI 1.90–2.74; vs.
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National Assessment of Margin status as a quality indicator after pancreatic cancer surgery.
Annals of surgical oncology, 2013Co-Authors: Ryan P. Merkow, Karl Y. Bilimoria, David J. Bentrem, Henry A. Pitt, David P. Winchester, Mitchell C. Posner, Timothy M. PawlikAbstract:Background Surgical Margin involvement is an important outcome after pancreatic cancer surgery; however, variation in pathologic review practices may limit its use as a quality indicator. Our objectives were to assess variation in hospital performance and the reliability of Margin involvement after pancreatic cancer surgery.
Michael Harris - One of the best experts on this subject based on the ideXlab platform.
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1099 ANALYSIS of RISK FACTORS FOR BIOCHEMICAL RECURRENCE FOLLOWING RADICAL PERINEAL PROSTATECTOMY IN A LARGE CONTEMPORARY SERIES: A DETAILED Assessment of Margin STATUS AND LOCATION
The Journal of Urology, 2011Co-Authors: Jesse D. Sammon, Quoc-dien Trinh, Shyam Sukumar, Wooju Jeong, Navneet Mander, Naveen Pokala, Emil Kheterpal, Michael HarrisAbstract:on biochemical failure (BCF), metastasis and survival were correlated, with a median follow-up of 99 months, Positive EPE and positive surgical Margin ( EPE Margin), 2. Positive EPE and negative surgical Margin ( EPE-Margin), 3. Negative EPE and positive surgical Margin (-EPE Margin), and 4. Negative EPE and negative surgical Margin (-EPE-Margin). RESULTS: Although both EPE (H.R.2.68, C.I. 1.23 & 5.82)and PSM (H.R.2.53, C.I. 1.25 & 5.13) were independent predictors of biochemical failure (BCF), only EPE was associated with metastasis and death from prostate cancer In addition, patients with EPE Margin or EPE-Margin had higher risks of BCF, metastasis and death from prostate cancer than patients with -EPE Margin or -EPE-Margin. Patients with a non-focal PSM 0.1 mm had a significantly higher risk of BCF compared with those with a focal PSM 0.1 mm (P value 0.028). CONCLUSIONS: Our study confirms the value of in depth pathologic analysis and reporting on radical prostatectomy specimens. The results support the concept of selective adjuvant radiotherapy in patients with EPE, based on focality and extent of EPE as well as extent of PSM, to minimize the likelihood of BCF.
Jesse D. Sammon - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for biochemical recurrence following radical perineal prostatectomy in a large contemporary series: a detailed Assessment of Margin extent and location.
Urologic oncology, 2012Co-Authors: Jesse D. Sammon, Quoc-dien Trinh, Shyam Sukumar, Praful Ravi, Ariella A. Friedman, Maxine Sun, Jan Schmitges, Claudio Jeldres, Wooju Jeong, Navneet ManderAbstract:Abstract Objectives The implications of positive surgical Margin (PSM) extent and location during radical perineal prostatectomy (RPP) have not been assessed in a contemporary series. We aimed to examine the incidence, location, and extent of PSM as well as their impact on biochemical recurrence (BCR) following RPP. Materials and methods A total of 794 patients underwent RPP by a single surgeon between June 1993 and August 2010. Covariates included age, pathologic T stage, pathologic Gleason sum, preoperative PSA, prostate volume, PSM extent, and location. Life table, Kaplan-Meier, and Cox regression analyses assessed predictors of BCR following RPP. Results PSM were recorded in 162 patients (20.4%); of these, 83 (51.2%) were focal (≤1 mm) whereas 79 (48.8%) were broad (>1 mm). Location of PSM was anterior 10.5%, posterior or lateral 14.8%, bladder neck 23.5%, apical 32.1%, and multifocal 19.1%. At a median follow-up of 54 months, the 5-year BCR-free probability was 90.8% in patients with negative Margins, 77.5% in patients with focal PSM, and 47.5% in patients with broad PSM. On multivariable analyses adjusted for age, pathologic T stage, pathologic Gleason sum, preoperative PSA, and prostate volume, broad PSM, (HR = 3.49, P P = 0.003), bladder neck (HR = 2.25, P = 0.01) and multifocal (HR = 3.55, P Conclusions In this study, we present oncologic outcomes following RPP in a large contemporary cohort of patients undergoing RPP. In adjusted analyses, broad and anterior PSM carried the highest risk of recurrence after RPP.
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1099 ANALYSIS of RISK FACTORS FOR BIOCHEMICAL RECURRENCE FOLLOWING RADICAL PERINEAL PROSTATECTOMY IN A LARGE CONTEMPORARY SERIES: A DETAILED Assessment of Margin STATUS AND LOCATION
The Journal of Urology, 2011Co-Authors: Jesse D. Sammon, Quoc-dien Trinh, Shyam Sukumar, Wooju Jeong, Navneet Mander, Naveen Pokala, Emil Kheterpal, Michael HarrisAbstract:on biochemical failure (BCF), metastasis and survival were correlated, with a median follow-up of 99 months, Positive EPE and positive surgical Margin ( EPE Margin), 2. Positive EPE and negative surgical Margin ( EPE-Margin), 3. Negative EPE and positive surgical Margin (-EPE Margin), and 4. Negative EPE and negative surgical Margin (-EPE-Margin). RESULTS: Although both EPE (H.R.2.68, C.I. 1.23 & 5.82)and PSM (H.R.2.53, C.I. 1.25 & 5.13) were independent predictors of biochemical failure (BCF), only EPE was associated with metastasis and death from prostate cancer In addition, patients with EPE Margin or EPE-Margin had higher risks of BCF, metastasis and death from prostate cancer than patients with -EPE Margin or -EPE-Margin. Patients with a non-focal PSM 0.1 mm had a significantly higher risk of BCF compared with those with a focal PSM 0.1 mm (P value 0.028). CONCLUSIONS: Our study confirms the value of in depth pathologic analysis and reporting on radical prostatectomy specimens. The results support the concept of selective adjuvant radiotherapy in patients with EPE, based on focality and extent of EPE as well as extent of PSM, to minimize the likelihood of BCF.
