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Does preoperative jaundice increase the risk of postoperative complications after pancreaticoduodenectomy? Analysis of the American College of Surgeons NSQIP Database
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Scientific Poster Presentations: 2015 Clinical Congress
age groups. Ages <18 and >90 years each had VTE incidence 2%. The VTE event occurred prior to cancer diagnosis in 80% among >90 year old, 44% 18-50 year old, 37% 65-90 year old, 26% 5164 year old, and 20% <18 year old age groups. Of patients with VTE 8% had breast cancer and 17% had lung cancer, representing the most common malignancies. However the cancer-specific incidence of VTE was 4% in lung cancer and 2.6% in breast cancer, compared to liver and bile duct malignancy 19.6%, gallbladder malignancy 15.8% and pancreatic cancer 8.9%. CONCLUSIONS: Biliary and pancreatic cancers had the highest incidence of VTE, suggesting a biologic basis for hypercoagulability. VTE incidence increases with age, and often occurs prior to cancer diagnosis in the elderly. Prophylactic anticoagulation or VTE screening should be considered in geriatric cancer, especially with hepato-pancreaticobiliary malignancies. Does preoperative jaundice increase the risk of postoperative complications after pancreaticoduodenectomy? Analysis of the American College of Surgeons NSQIP Database Mohammed Al-Temimi, MD, Samir Johna, MD, MACM, FACS Kaiser Permenante, Fontana, CA INTRODUCTION: Obstructive jaundice is associated with abnormal body homeostasis, however, its effect on postoperative complications is not clear. The aim of this study is to assess the effect of preoperative jaundice on postoperative outcomes after pancreaticoduodenectomy (PD). METHODS: Patients who underwent PD and had preoperative bilirubin level were identified in the ACS NSQIP database (2005-2009). Jaundice was defined as bilirubin level > 5 mg/dl. The preoperative characteristics and postoperative outcomes (mortality, overall morbidity, major morbidity, wound infection, organ/ space infection, and sepsis) were compared between patients with and without jaundice using univariate and multivariate analysis. RESULTS: Jaundice was identified among 12% (n¼698) of the patients in the cohort (n¼5,770). Patients with jaundice were more likely to be older than 65 years old (53% vs 48%, p¼0.02), have dependent functional status (5.1% vs 2.6%, p<0.01), have weight loss (25% vs 19%) and albumin < 3.5 g/ dL (62% vs 28%). Major morbidity (29.2%) and mortality (2.1%) were not different between the two groups, however, sepsis (OR¼0.78, 95% CI 0.61-0.99) and organ/space infection (OR¼0.74, 95% CI 0.55-0.99) were lower among patients with jaundice in multivariate analysis. CONCLUSIONS: In our cohort, jaundice was associated with slightly lower risk of sepsis and organ/space infection. Our results might suggest that preoperative drainage is not associated with better postoperative outcomes.
J Am Coll Surg
Epidemiology and treatment outcome among patients with desmoplastic small round cell tumors Yen-Yi Juo, MD, Christian Meyer, MD, PhD, Katherine A Thornton, MD, Joseph M Herman, MD, Stephanie A Terezakis, MD, Nita Ahuja, MD, FACS George Washington University Medical Center, Washington, DC; Johns Hopkins University, Baltimore, MD INTRODUCTION: Since its definition in 1991, less than 200 cases of desmoplastic small round cell tumor (DSRCT) have been described, with the majority of these being case reports. Utilizing a population database, we attempt to analyze its disease epidemiology and treatment outcome in an objective manner. METHODS: A retrospective review was performed using data from Surveillance Epidemiology and End Results (SEER) database from 1991 to 2010. Demographics of DSRCT patients diagnosed during this period were described. Kaplan-Meier Survival Analysis was used to evaluate the impact of various demographic and treatment factors on treatment outcome. RESULTS: Among the 205 patients diagnosed during this period, 99 were males and 106 were females. The median age at diagnosis was 37 years old. DSRCT affected soft tissues across the body with similar predilection, including the lower limbs (16.6%), abdomen (15.6%), pelvis (15.1%), thorax (12.7%), upper limbs (8.3%), retroperitoneum (4.4%), vertebrae (3.9%), and other nonspecified area (15.1%). 126 patients eventually received surgery. 81 patients received external beam radiation. 57 patients received both radiation and surgery. No significant temporal trend could be found in surgical resection or radiotherapy. Median disease free survival was 21 months and median overall survival 26 months. Using Cox proportional hazards model, Kaplan-Meier Analysis showed surgical resection to be the only significant predictor of improved 3-year disease free survival. CONCLUSIONS: DSRCT is a rare soft tissue tumor mainly affecting young adults with similar involvement of soft tissue across the body. Despite overall poor prognosis, patients who received surgical resection appeared to experience improved disease free survival. Gene expression analysis enables repositioning of mithramycin for precision medicine inhibition of cancer stem cell signaling in thoracic malignancies David S Schrump, MD, FACS, Mary Zhang, Julie Hong, Vivek Shukla, PhD, R Taylor Ripley, MD, Scott M Atay, MD, Young Hong, MD, Cody J Peer, PhD, Tristan M Sissung, PhD, William D Figg, PharmD, MBA National Cancer Institute, CCR, Bethesda, MD INTRODUCTION: The chemotherapeutic agent, mithramycin, was discontinued in the 1970s due to hepatotoxicity. Recently, there has been renewed interest in this compound due to its ability to inhibit Sp1, a transcription factor that enhances proliferation and
Scientific Poster Presentations: 2015 Clinical Congress
age groups. Ages <18 and >90 years each had VTE incidence 2%. The VTE event occurred prior to cancer diagnosis in 80% among >90 year old, 44% 18-50 year old, 37% 65-90 year old, 26% 5164 year old, and 20% <18 year old age groups. Of patients with VTE 8% had breast cancer and 17% had lung cancer, representing the most common malignancies. However the cancer-specific incidence of VTE was 4% in lung cancer and 2.6% in breast cancer, compared to liver and bile duct malignancy 19.6%, gallbladder malignancy 15.8% and pancreatic cancer 8.9%. CONCLUSIONS: Biliary and pancreatic cancers had the highest incidence of VTE, suggesting a biologic basis for hypercoagulability. VTE incidence increases with age, and often occurs prior to cancer diagnosis in the elderly. Prophylactic anticoagulation or VTE screening should be considered in geriatric cancer, especially with hepato-pancreaticobiliary malignancies. Does preoperative jaundice increase the risk of postoperative complications after pancreaticoduodenectomy? Analysis of the American College of Surgeons NSQIP Database Mohammed Al-Temimi, MD, Samir Johna, MD, MACM, FACS Kaiser Permenante, Fontana, CA INTRODUCTION: Obstructive jaundice is associated with abnormal body homeostasis, however, its effect on postoperative complications is not clear. The aim of this study is to assess the effect of preoperative jaundice on postoperative outcomes after pancreaticoduodenectomy (PD). METHODS: Patients who underwent PD and had preoperative bilirubin level were identified in the ACS NSQIP database (2005-2009). Jaundice was defined as bilirubin level > 5 mg/dl. The preoperative characteristics and postoperative outcomes (mortality, overall morbidity, major morbidity, wound infection, organ/ space infection, and sepsis) were compared between patients with and without jaundice using univariate and multivariate analysis. RESULTS: Jaundice was identified among 12% (n¼698) of the patients in the cohort (n¼5,770). Patients with jaundice were more likely to be older than 65 years old (53% vs 48%, p¼0.02), have dependent functional status (5.1% vs 2.6%, p<0.01), have weight loss (25% vs 19%) and albumin < 3.5 g/ dL (62% vs 28%). Major morbidity (29.2%) and mortality (2.1%) were not different between the two groups, however, sepsis (OR¼0.78, 95% CI 0.61-0.99) and organ/space infection (OR¼0.74, 95% CI 0.55-0.99) were lower among patients with jaundice in multivariate analysis. CONCLUSIONS: In our cohort, jaundice was associated with slightly lower risk of sepsis and organ/space infection. Our results might suggest that preoperative drainage is not associated with better postoperative outcomes.
J Am Coll Surg
Epidemiology and treatment outcome among patients with desmoplastic small round cell tumors Yen-Yi Juo, MD, Christian Meyer, MD, PhD, Katherine A Thornton, MD, Joseph M Herman, MD, Stephanie A Terezakis, MD, Nita Ahuja, MD, FACS George Washington University Medical Center, Washington, DC; Johns Hopkins University, Baltimore, MD INTRODUCTION: Since its definition in 1991, less than 200 cases of desmoplastic small round cell tumor (DSRCT) have been described, with the majority of these being case reports. Utilizing a population database, we attempt to analyze its disease epidemiology and treatment outcome in an objective manner. METHODS: A retrospective review was performed using data from Surveillance Epidemiology and End Results (SEER) database from 1991 to 2010. Demographics of DSRCT patients diagnosed during this period were described. Kaplan-Meier Survival Analysis was used to evaluate the impact of various demographic and treatment factors on treatment outcome. RESULTS: Among the 205 patients diagnosed during this period, 99 were males and 106 were females. The median age at diagnosis was 37 years old. DSRCT affected soft tissues across the body with similar predilection, including the lower limbs (16.6%), abdomen (15.6%), pelvis (15.1%), thorax (12.7%), upper limbs (8.3%), retroperitoneum (4.4%), vertebrae (3.9%), and other nonspecified area (15.1%). 126 patients eventually received surgery. 81 patients received external beam radiation. 57 patients received both radiation and surgery. No significant temporal trend could be found in surgical resection or radiotherapy. Median disease free survival was 21 months and median overall survival 26 months. Using Cox proportional hazards model, Kaplan-Meier Analysis showed surgical resection to be the only significant predictor of improved 3-year disease free survival. CONCLUSIONS: DSRCT is a rare soft tissue tumor mainly affecting young adults with similar involvement of soft tissue across the body. Despite overall poor prognosis, patients who received surgical resection appeared to experience improved disease free survival. Gene expression analysis enables repositioning of mithramycin for precision medicine inhibition of cancer stem cell signaling in thoracic malignancies David S Schrump, MD, FACS, Mary Zhang, Julie Hong, Vivek Shukla, PhD, R Taylor Ripley, MD, Scott M Atay, MD, Young Hong, MD, Cody J Peer, PhD, Tristan M Sissung, PhD, William D Figg, PharmD, MBA National Cancer Institute, CCR, Bethesda, MD INTRODUCTION: The chemotherapeutic agent, mithramycin, was discontinued in the 1970s due to hepatotoxicity. Recently, there has been renewed interest in this compound due to its ability to inhibit Sp1, a transcription factor that enhances proliferation and