The Experts below are selected from a list of 57720 Experts worldwide ranked by ideXlab platform
Yihsiang Huang - One of the best experts on this subject based on the ideXlab platform.
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surgical resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombosis a propensity score analysis
Annals of Surgical Oncology, 2014Co-Authors: Pohong Liu, Chiayang Hsu, Chengyuan Hsia, Yihsiang Huang, Yunhsuan LeeAbstract:The long-term survival in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) who received surgical resection (SR) or transarterial chemoembolization (TACE) remains unclear. We compared the efficacy of SR and TACE by using a propensity score analysis. A total of 247 and 181 HCC patients with PVTT undergoing SR and TACE, respectively, were evaluated. One hundred eight pairs of matched patients were selected from each Treatment arm by using a propensity score analysis. Of all patients, the estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 85 versus 60 %, 68 versus 42 %, and 61 versus 33 %, respectively (p < 0.001). Patients selected for SR were significantly younger and had better liver functional reserve, performance status, and smaller tumor burden. In the propensity model, the survival benefit of SR remained significant. The estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 84 versus 71 %, 69 versus 50 %, and 59 versus 35 %, respectively (p = 0.004). The two groups of patients in the propensity score analysis were similar in baseline characteristics. In the Cox proportional hazards model, patients receiving TACE had a 2.044-fold increased risk of mortality compared with patients receiving SR (95 % confidence interval: 1.284–3.252, p = 0.003). For either unselected patients or patients in the propensity model, SR provides significantly better long-term survival than TACE. SR should be considered as a Priority Treatment in this subgroup of HCC patients.
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comparison of surgical resection and transarterial chemoembolization for hepatocellular carcinoma beyond the milan criteria a propensity score analysis
Annals of Surgical Oncology, 2012Co-Authors: Chiayang Hsu, Chengyuan Hsia, Yihsiang Huang, Hanchieh Lin, Jihtung Pai, Chechuan LoongAbstract:Treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) is controversial. This study compared the long-term survival of patients beyond the Milan criteria who received surgical resection (SR) or transarterial chemoembolization (TACE). A total of 268 and 455 HCC patients beyond the Milan criteria undergoing SR and TACE, respectively, were retrospectively evaluated. After propensity score analysis to adjust for baseline differences, 146 pairs of matched patients were selected from each Treatment arm. Long-term survival was compared by the Kaplan–Meier method. Independent prognostic predictors were determined by the Cox proportional hazards model. Long-term survival was significantly better for the SR group by univariate survival analysis (P < .001). In the Cox model, SR was identified as an independent predictor of better prognosis (hazard ratio = 0.3, 95% confidence interval [95% CI]: 0.23–0.4; P < .001). Despite similar baseline characteristics in the propensity score model, patients who underwent SR had significantly better survival than patients who underwent TACE (P < .001). Patients receiving TACE had 2.56-fold increased risk of long-term mortality in the propensity model (95% CI: 1.73–3.78). The SR and TACE groups had comparable 30- and 90-day postTreatment mortality. The Cox model consistently disclosed the significant superiority of SR in terms of long-term survival in the propensity score model (P < .001). For HCC patients beyond the Milan criteria, SR is considered equally safe as TACE and provides better long-term survival. SR may be regarded as the Priority Treatment for these patients.
Chiayang Hsu - One of the best experts on this subject based on the ideXlab platform.
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surgical resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombosis a propensity score analysis
Annals of Surgical Oncology, 2014Co-Authors: Pohong Liu, Chiayang Hsu, Chengyuan Hsia, Yihsiang Huang, Yunhsuan LeeAbstract:The long-term survival in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) who received surgical resection (SR) or transarterial chemoembolization (TACE) remains unclear. We compared the efficacy of SR and TACE by using a propensity score analysis. A total of 247 and 181 HCC patients with PVTT undergoing SR and TACE, respectively, were evaluated. One hundred eight pairs of matched patients were selected from each Treatment arm by using a propensity score analysis. Of all patients, the estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 85 versus 60 %, 68 versus 42 %, and 61 versus 33 %, respectively (p < 0.001). Patients selected for SR were significantly younger and had better liver functional reserve, performance status, and smaller tumor burden. In the propensity model, the survival benefit of SR remained significant. The estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 84 versus 71 %, 69 versus 50 %, and 59 versus 35 %, respectively (p = 0.004). The two groups of patients in the propensity score analysis were similar in baseline characteristics. In the Cox proportional hazards model, patients receiving TACE had a 2.044-fold increased risk of mortality compared with patients receiving SR (95 % confidence interval: 1.284–3.252, p = 0.003). For either unselected patients or patients in the propensity model, SR provides significantly better long-term survival than TACE. SR should be considered as a Priority Treatment in this subgroup of HCC patients.
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comparison of surgical resection and transarterial chemoembolization for hepatocellular carcinoma beyond the milan criteria a propensity score analysis
Annals of Surgical Oncology, 2012Co-Authors: Chiayang Hsu, Chengyuan Hsia, Yihsiang Huang, Hanchieh Lin, Jihtung Pai, Chechuan LoongAbstract:Treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) is controversial. This study compared the long-term survival of patients beyond the Milan criteria who received surgical resection (SR) or transarterial chemoembolization (TACE). A total of 268 and 455 HCC patients beyond the Milan criteria undergoing SR and TACE, respectively, were retrospectively evaluated. After propensity score analysis to adjust for baseline differences, 146 pairs of matched patients were selected from each Treatment arm. Long-term survival was compared by the Kaplan–Meier method. Independent prognostic predictors were determined by the Cox proportional hazards model. Long-term survival was significantly better for the SR group by univariate survival analysis (P < .001). In the Cox model, SR was identified as an independent predictor of better prognosis (hazard ratio = 0.3, 95% confidence interval [95% CI]: 0.23–0.4; P < .001). Despite similar baseline characteristics in the propensity score model, patients who underwent SR had significantly better survival than patients who underwent TACE (P < .001). Patients receiving TACE had 2.56-fold increased risk of long-term mortality in the propensity model (95% CI: 1.73–3.78). The SR and TACE groups had comparable 30- and 90-day postTreatment mortality. The Cox model consistently disclosed the significant superiority of SR in terms of long-term survival in the propensity score model (P < .001). For HCC patients beyond the Milan criteria, SR is considered equally safe as TACE and provides better long-term survival. SR may be regarded as the Priority Treatment for these patients.
Chengyuan Hsia - One of the best experts on this subject based on the ideXlab platform.
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surgical resection versus transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombosis a propensity score analysis
Annals of Surgical Oncology, 2014Co-Authors: Pohong Liu, Chiayang Hsu, Chengyuan Hsia, Yihsiang Huang, Yunhsuan LeeAbstract:The long-term survival in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) who received surgical resection (SR) or transarterial chemoembolization (TACE) remains unclear. We compared the efficacy of SR and TACE by using a propensity score analysis. A total of 247 and 181 HCC patients with PVTT undergoing SR and TACE, respectively, were evaluated. One hundred eight pairs of matched patients were selected from each Treatment arm by using a propensity score analysis. Of all patients, the estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 85 versus 60 %, 68 versus 42 %, and 61 versus 33 %, respectively (p < 0.001). Patients selected for SR were significantly younger and had better liver functional reserve, performance status, and smaller tumor burden. In the propensity model, the survival benefit of SR remained significant. The estimated 1-, 3-, and 5-year survival rates of patients receiving SR and TACE were 84 versus 71 %, 69 versus 50 %, and 59 versus 35 %, respectively (p = 0.004). The two groups of patients in the propensity score analysis were similar in baseline characteristics. In the Cox proportional hazards model, patients receiving TACE had a 2.044-fold increased risk of mortality compared with patients receiving SR (95 % confidence interval: 1.284–3.252, p = 0.003). For either unselected patients or patients in the propensity model, SR provides significantly better long-term survival than TACE. SR should be considered as a Priority Treatment in this subgroup of HCC patients.
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comparison of surgical resection and transarterial chemoembolization for hepatocellular carcinoma beyond the milan criteria a propensity score analysis
Annals of Surgical Oncology, 2012Co-Authors: Chiayang Hsu, Chengyuan Hsia, Yihsiang Huang, Hanchieh Lin, Jihtung Pai, Chechuan LoongAbstract:Treatment for patients with intermediate-stage hepatocellular carcinoma (HCC) is controversial. This study compared the long-term survival of patients beyond the Milan criteria who received surgical resection (SR) or transarterial chemoembolization (TACE). A total of 268 and 455 HCC patients beyond the Milan criteria undergoing SR and TACE, respectively, were retrospectively evaluated. After propensity score analysis to adjust for baseline differences, 146 pairs of matched patients were selected from each Treatment arm. Long-term survival was compared by the Kaplan–Meier method. Independent prognostic predictors were determined by the Cox proportional hazards model. Long-term survival was significantly better for the SR group by univariate survival analysis (P < .001). In the Cox model, SR was identified as an independent predictor of better prognosis (hazard ratio = 0.3, 95% confidence interval [95% CI]: 0.23–0.4; P < .001). Despite similar baseline characteristics in the propensity score model, patients who underwent SR had significantly better survival than patients who underwent TACE (P < .001). Patients receiving TACE had 2.56-fold increased risk of long-term mortality in the propensity model (95% CI: 1.73–3.78). The SR and TACE groups had comparable 30- and 90-day postTreatment mortality. The Cox model consistently disclosed the significant superiority of SR in terms of long-term survival in the propensity score model (P < .001). For HCC patients beyond the Milan criteria, SR is considered equally safe as TACE and provides better long-term survival. SR may be regarded as the Priority Treatment for these patients.
M Carrick - One of the best experts on this subject based on the ideXlab platform.
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the effect of orthopaedic surgeons and interventional radiologists availability on the Priority Treatment sequence for hemodynamically unstable pelvic fractures a survey of us level i trauma centers
Journal of Orthopaedic Surgery and Research, 2019Co-Authors: Stephanie Jarvis, A Orlando, Benoit Blondeau, K Banton, C Reynolds, Gina M Berg, N Patel, Rick Meinig, M CarrickAbstract:Most guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, however their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; however, there is no data confirming this. This cross-sectional survey of 158 trauma medical directors at US Level I trauma centers collected the availability of orthopaedic surgeons and interventional radiologists, the number of orthopaedic trauma surgeons trained to manage pelvic fractures, and Priority Treatment sequence for hemodynamically unstable pelvic fractures. The study objective was to compare the availability of orthopaedic surgeons to interventional radiologists and describe how the availability of orthopaedic surgeons and interventional radiologists affects the Treatment sequence for hemodynamically unstable pelvic fractures. Fisher’s exact, chi-squared, and Kruskal-Wallis tests were used, alpha = 0.05. The response rate was 25% (40/158). Orthopaedic surgeons (86%) were on-site more often than interventional radiologists (54%), p = 0.003. Orthopaedic surgeons were faster to arrive 39% of the time, and interventional radiologists were faster to arrive 6% of the time. There was a higher proportion of participants who prioritized PP before angioembolization at centers with above the average number (> 3) of orthopaedic trauma surgeons trained to manage pelvic fractures, as among centers with equal to or below average, p = 0.02. Arrival times for orthopaedic surgeons did not significantly predict prioritization of angioembolization or PP. Our results provide evidence that orthopaedic surgeons typically are more available than interventional radiologists but contrary to anecdotal evidence most participants used angioembolization first. Familiarity with the availability of orthopaedic surgeons and interventional radiologists may contribute to individual trauma center’s Treatment sequence.
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Variability in pelvic packing practices for hemodynamically unstable pelvic fractures at US level 1 trauma centers
Patient Safety in Surgery, 2019Co-Authors: Benoit Blondeau, Stephanie Jarvis, A Orlando, K Banton, Gina M Berg, N Patel, Rick Meinig, Allen Tanner, M CarrickAbstract:Background Mortality from hemodynamically unstable pelvic fractures remains high. Guidelines offer varying care approaches including the use of pelvic packing (PP), which was recently adopted for potential control of bleeding for this condition. However, the implementation of PP is uncertain as the debate on the optimal resuscitation strategy, angioembolization or PP continues. The study was designed to assess current practices among level 1 trauma centers in the US in regard to PP Treatment for hemodynamically unstable pelvic fractures. Methods A cross-sectional survey was created to assess when to apply PP, application approach, and the respondent’s anecdotal perception on safety and effectiveness. Trauma Medical Directors at 158 US level 1 trauma centers were sent biweekly email invitations for 3 months. Participants were allowed to skip questions for any reason. The study hypothesis was that PP practices vary by US census bureau region, annual trauma admissions, and length of time in years since each trauma center received their respective level 1 trauma center designation. Results Twenty-five percent (40/158) of trauma medical directors participated and 75% (118/158) of the trauma medical directors did not participate. Of those who took the survey, 36/40 (90%) completed the survey and 4/40 (10%) partially completed the survey. Only 36 trauma medical directors responded on their perception of safety and effectiveness; 72% (26/36) of participants perceived PP as safe, whereas only a third (12/36) of participants perceived PP as effective. There were 25 trauma medical directors who provided the sequence of Treatment modalities utilized at their level 1 trauma center, 76% (19/25) of participants reported that PP is utilized as the third or fourth Priority. None of the participating level 1 trauma centers reported a preference towards utilization of PP as the first Priority Treatment. Half of the participants reported a preference towards applying PP only as a last resort to control hemorrhage. Northeastern and Western level 1 trauma centers were significantly more likely than Midwestern and Southern level 1 trauma centers to have reported application of PP to all hemodynamically unstable patients ( p = 0.05). Midwestern, Southern, and Western level 1 trauma centers were significantly more likely to have perceived PP as safe than Northeastern level 1 trauma centers ( p = 0.04). All low-volume and 38% high-volume level 1 trauma centers perceived PP to increase infection risks, ( p = 0.03). We observed no association between the length of time each trauma center was designated a level 1 trauma center, and all participant responses. Conclusion Controversy and varying anecdotal perception regarding safety and effectiveness of PP prevails among trauma medical directors at level 1 trauma centers in the US.
Benoit Blondeau - One of the best experts on this subject based on the ideXlab platform.
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the effect of orthopaedic surgeons and interventional radiologists availability on the Priority Treatment sequence for hemodynamically unstable pelvic fractures a survey of us level i trauma centers
Journal of Orthopaedic Surgery and Research, 2019Co-Authors: Stephanie Jarvis, A Orlando, Benoit Blondeau, K Banton, C Reynolds, Gina M Berg, N Patel, Rick Meinig, M CarrickAbstract:Most guidelines recommend both pelvic packing (PP) and angioembolization for hemodynamically unstable pelvic fractures, however their sequence varies. Some argue to use PP first because orthopaedic surgeons are more available than interventional radiologists; however, there is no data confirming this. This cross-sectional survey of 158 trauma medical directors at US Level I trauma centers collected the availability of orthopaedic surgeons and interventional radiologists, the number of orthopaedic trauma surgeons trained to manage pelvic fractures, and Priority Treatment sequence for hemodynamically unstable pelvic fractures. The study objective was to compare the availability of orthopaedic surgeons to interventional radiologists and describe how the availability of orthopaedic surgeons and interventional radiologists affects the Treatment sequence for hemodynamically unstable pelvic fractures. Fisher’s exact, chi-squared, and Kruskal-Wallis tests were used, alpha = 0.05. The response rate was 25% (40/158). Orthopaedic surgeons (86%) were on-site more often than interventional radiologists (54%), p = 0.003. Orthopaedic surgeons were faster to arrive 39% of the time, and interventional radiologists were faster to arrive 6% of the time. There was a higher proportion of participants who prioritized PP before angioembolization at centers with above the average number (> 3) of orthopaedic trauma surgeons trained to manage pelvic fractures, as among centers with equal to or below average, p = 0.02. Arrival times for orthopaedic surgeons did not significantly predict prioritization of angioembolization or PP. Our results provide evidence that orthopaedic surgeons typically are more available than interventional radiologists but contrary to anecdotal evidence most participants used angioembolization first. Familiarity with the availability of orthopaedic surgeons and interventional radiologists may contribute to individual trauma center’s Treatment sequence.
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Variability in pelvic packing practices for hemodynamically unstable pelvic fractures at US level 1 trauma centers
Patient Safety in Surgery, 2019Co-Authors: Benoit Blondeau, Stephanie Jarvis, A Orlando, K Banton, Gina M Berg, N Patel, Rick Meinig, Allen Tanner, M CarrickAbstract:Background Mortality from hemodynamically unstable pelvic fractures remains high. Guidelines offer varying care approaches including the use of pelvic packing (PP), which was recently adopted for potential control of bleeding for this condition. However, the implementation of PP is uncertain as the debate on the optimal resuscitation strategy, angioembolization or PP continues. The study was designed to assess current practices among level 1 trauma centers in the US in regard to PP Treatment for hemodynamically unstable pelvic fractures. Methods A cross-sectional survey was created to assess when to apply PP, application approach, and the respondent’s anecdotal perception on safety and effectiveness. Trauma Medical Directors at 158 US level 1 trauma centers were sent biweekly email invitations for 3 months. Participants were allowed to skip questions for any reason. The study hypothesis was that PP practices vary by US census bureau region, annual trauma admissions, and length of time in years since each trauma center received their respective level 1 trauma center designation. Results Twenty-five percent (40/158) of trauma medical directors participated and 75% (118/158) of the trauma medical directors did not participate. Of those who took the survey, 36/40 (90%) completed the survey and 4/40 (10%) partially completed the survey. Only 36 trauma medical directors responded on their perception of safety and effectiveness; 72% (26/36) of participants perceived PP as safe, whereas only a third (12/36) of participants perceived PP as effective. There were 25 trauma medical directors who provided the sequence of Treatment modalities utilized at their level 1 trauma center, 76% (19/25) of participants reported that PP is utilized as the third or fourth Priority. None of the participating level 1 trauma centers reported a preference towards utilization of PP as the first Priority Treatment. Half of the participants reported a preference towards applying PP only as a last resort to control hemorrhage. Northeastern and Western level 1 trauma centers were significantly more likely than Midwestern and Southern level 1 trauma centers to have reported application of PP to all hemodynamically unstable patients ( p = 0.05). Midwestern, Southern, and Western level 1 trauma centers were significantly more likely to have perceived PP as safe than Northeastern level 1 trauma centers ( p = 0.04). All low-volume and 38% high-volume level 1 trauma centers perceived PP to increase infection risks, ( p = 0.03). We observed no association between the length of time each trauma center was designated a level 1 trauma center, and all participant responses. Conclusion Controversy and varying anecdotal perception regarding safety and effectiveness of PP prevails among trauma medical directors at level 1 trauma centers in the US.