46 results on '"Liou, Douglas"'
Search Results
2. Comparison of failure to rescue in younger versus elderly patients following lung cancer resection
- Author
-
Wang, Yoyo, Kapula, Ntemena, Yang, Chi-Fu J., Manapat, Pooja, Elliott, Irmina A., Guenthart, Brandon A., Lui, Natalie S., Backhus, Leah M., Berry, Mark F., Shrager, Joseph B., and Liou, Douglas Z.
- Abstract
Failure to rescue (FTR), defined as in-hospital death following a major complication, has been increasingly studied in patients who undergo cardiothoracic surgery. This study tested the hypothesis that elderly patients undergoing lung cancer resection have greater rates of FTR compared with younger patients.
- Published
- 2023
- Full Text
- View/download PDF
3. Risk of developing subsequent primary lung cancer after receiving radiation for breast cancer
- Author
-
Wong, Lye-Yeng, Kapula, Ntemena, He, Hao, Guenthart, Brandon A., Vitzthum, Lucas K., Horst, Kathleen, Liou, Douglas Z., Backhus, Leah M., Lui, Natalie S., Berry, Mark F., Shrager, Joseph B., and Elliott, Irmina A.
- Abstract
Radiotherapy (RT) is integral to breast cancer treatment, especially in the current era that emphasizes breast conservation. The aim of our study was to determine the incidence of subsequent primary lung cancer after RT exposure for breast cancer over a time span of 3 decades to quantify this risk over time as modern oncologic treatment continues to evolve.
- Published
- 2023
- Full Text
- View/download PDF
4. p53 governs an AT1 differentiation programme in lung cancer suppression
- Author
-
Kaiser, Alyssa M., Gatto, Alberto, Hanson, Kathryn J., Zhao, Richard L., Raj, Nitin, Ozawa, Michael G., Seoane, José A., Bieging-Rolett, Kathryn T., Wang, Mengxiong, Li, Irene, Trope, Winston L., Liou, Douglas Z., Shrager, Joseph B., Plevritis, Sylvia K., Newman, Aaron M., Van Rechem, Capucine, and Attardi, Laura D.
- Abstract
Lung cancer is the leading cause of cancer deaths worldwide1. Mutations in the tumour suppressor gene TP53occur in 50% of lung adenocarcinomas (LUADs) and are linked to poor prognosis1–4, but how p53 suppresses LUAD development remains enigmatic. We show here that p53 suppresses LUAD by governing cell state, specifically by promoting alveolar type 1 (AT1) differentiation. Using mice that express oncogenic Krasand null, wild-type or hypermorphic Trp53alleles in alveolar type 2 (AT2) cells, we observed graded effects of p53 on LUAD initiation and progression. RNA sequencing and ATAC sequencing of LUAD cells uncovered a p53-induced AT1 differentiation programme during tumour suppression in vivo through direct DNA binding, chromatin remodelling and induction of genes characteristic of AT1 cells. Single-cell transcriptomics analyses revealed that during LUAD evolution, p53 promotes AT1 differentiation through action in a transitional cell state analogous to a transient intermediary seen during AT2-to-AT1 cell differentiation in alveolar injury repair. Notably, p53 inactivation results in the inappropriate persistence of these transitional cancer cells accompanied by upregulated growth signalling and divergence from lung lineage identity, characteristics associated with LUAD progression. Analysis of Trp53wild-type and Trp53-null mice showed that p53 also directs alveolar regeneration after injury by regulating AT2 cell self-renewal and promoting transitional cell differentiation into AT1 cells. Collectively, these findings illuminate mechanisms of p53-mediated LUAD suppression, in which p53 governs alveolar differentiation, and suggest that tumour suppression reflects a fundamental role of p53 in orchestrating tissue repair after injury.
- Published
- 2023
- Full Text
- View/download PDF
5. Half of Anastomotic Leaks After Esophagectomy Are Undetected on Initial Postoperative Esophagram.
- Author
-
Elliott, Irmina A., Berry, Mark F., Trope, Winston, Lui, Natalie S., Guenthart, Brandon A., Liou, Douglas Z., Whyte, Richard I., Backhus, Leah M., and Shrager, Joseph B.
- Abstract
The sensitivity of fluoroscopic esophagography with oral administration of contrast material to exclude anastomotic leak after esophagectomy is not well documented, and the consequences of missing a leak in this setting have not been previously described. We performed a retrospective cohort study of a prospectively maintained institutional database of patients undergoing esophagectomy with esophagogastric anastomosis from 2008 to 2020. Relevant details of leaks, management, and outcomes were obtained from the database and formal chart review. Statistical analysis was performed to compare patients with and without leaks and those with false-negative vs positive esophagrams. There were 384 patients who underwent esophagectomy with gastric reconstruction; the majority were Ivor-Lewis (82%), and 51% were wholly or partially minimally invasive. By use of a broad definition of leak, 55 patients (16.7%) developed an anastomotic leak. Of the 55 patients, 27 (49%) who ultimately were found to have a leak initially had a normal esophagram result (performed on average on postoperative day 6). Those with a normal initial esophagram result were more likely to have an uncontained leak (81% vs 29%; P <.01), to require unplanned readmission (70% vs 39%; P =.02), and to undergo reoperation (44% vs 11%; P <.01). Early postoperative esophagrams intended to evaluate anastomotic integrity have a low sensitivity of 51%, and leaks missed on the initial esophagram have greater clinical consequences than those identified on the initial esophagram. These findings suggest that a high index of suspicion must be maintained even after a normal esophagram result and call into question the common practice of using this test to triage patients for diet advancement. [Display omitted] [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
6. Induction Therapy Is Not Associated With Improved Survival in Large cT4 N0 Non-Small Cell Lung Cancers.
- Author
-
Sun, Beatrice J., Bhandari, Prasha, Jeffrey Yang, Chi-Fu, Berry, Mark F., Shrager, Joseph B., Backhus, Leah M., Lui, Natalie S., and Liou, Douglas Z.
- Published
- 2022
- Full Text
- View/download PDF
7. The Impact of Extended Delayed Surgery for Indolent Lung Cancer or Part-Solid Ground Glass Nodules.
- Author
-
Mayne, Nicholas R., Elser, Holly, Lin, Belle K., Raman, Vignesh, Liou, Douglas, Li, Xiao, D'Amico, Thomas A., and Jeffrey Yang, Chi-Fu
- Abstract
During the COVID-19 pandemic, patients with lung cancer may experience treatment delays. The objective of this study was to evaluate the impact of extended treatment delays on survival among patients with stage I typical bronchopulmonary carcinoid (BC), lepidic predominant adenocarcinoma (LPA) or invasive adenocarcinoma with a lepidic component (ADL). Using National Cancer Database data (2004-2015), multivariable Cox regression analysis with penalized smoothing splines was performed to examine the association between treatment delay and all-cause mortality for stage I BC, LPA, and ADL. Propensity score–matched analyses compared the overall survival of patients who received "early" vs "delayed" surgery (ie, 0-30 vs 90-120 days after diagnosis) across the different histologic subtypes. During the study period, patients with stage I BC (n = 4947), LPA (n = 5340), and ADL (n = 6816) underwent surgery. Cox regression analysis of these cohorts showed a gradual steady increase in the hazard ratio the longer treatment is delayed. However, in propensity score–matched analyses that created cohorts of patients who underwent early and delayed surgery that were well-balanced in patient characteristics, no significant differences in 5-year survival were found between early and delayed surgery for stage I BC (87% [95% CI:77%-93%] vs 89% [95% CI: 80%-94%]), stage I LPA (73% [95% CI: 64%-80%] vs 77% [95% CI: 68%-83%]), and stage I ADL (71% [95% CI: 64%-76%] vs 69% [95% CI: 60%-76%]). During the COVID-19 pandemic, for early-stage indolent lung tumors and part-solid ground glass lung nodules, a delay of surgery by 3-4 months after diagnosis can be considered. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
8. Early Discharge After Lobectomy for Lung Cancer Does Not Equate to Early Readmission.
- Author
-
Patel, Deven C., Leipzig, Matthew, Jeffrey Yang, Chi-Fu, Wang, Yoyo, Shrager, Joseph B., Backhus, Leah M., Lui, Natalie S., Liou, Douglas Z., and Berry, Mark F.
- Abstract
Enhanced recovery after surgery pathways in several specialties reduce length of stay, but accelerated discharge after thoracic surgery is not well characterized. This study tested the hypothesis that patients discharged on postoperative day 1 (POD1) after lobectomy for lung cancer have an increased risk of readmission. Patients who underwent a lobectomy for lung cancer between 2011 and 2019 in the American College of Surgeons National Surgical Quality Improvement Program database were identified. Readmission rates were compared between patients discharged on postoperative day 1 (POD 1) and patients discharged on POD 2 to 6. Early discharge and readmission predictors were evaluated using multivariable logistic regression analysis. Only 854 (3.8%) of 22,585 patients who met inclusion criteria were discharged on POD 1, although POD 1 discharge rates increased from 2.3% to 8.1% (P <.001) from 2011 to 2019, respectively. Median hospitalization for patients discharged on POD 2 to 6 was 4 days (interquartile range, 3 to 5 days). Patients' characteristics associated with a lower likelihood of POD 1 discharge were increasing age, smoking, or a history of dyspnea, whereas a minimally invasive approach was the strongest predictor of early discharge (adjusted odds ratio, 5.42; P <.001). Readmission rates were not significantly different for the POD 1 and POD 2 to 6 groups in univariate analysis (6.0% vs 7.0%; P =.269). Further, POD 1 discharge was not a risk factor for readmission in multivariable analysis (adjusted odds ratio, 1.10; P =.537). Select patients can be discharged on POD 1 after lobectomy for lung cancer without an increased readmission risk, a finding supporting this accelerated discharge target inclusion in lobectomy enhanced recovery after surgery protocols. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
9. Use of a Personalized Multimedia Education Platform Improves Preoperative Teaching for Lung Cancer Patients.
- Author
-
Benson, Jalen, Bhandari, Prasha, Lui, Natalie, Berry, Mark, Liou, Douglas Z., Shrager, Joseph, Ayers, Kelsey, and Backhus, Leah M.
- Abstract
We sought to develop and evaluate a personalized multimedia education (ME) tool for preoperative patient education to improve patient health knowledge, quality of life and satisfaction with care in thoracic surgery. The ME tool was developed and deployed in outpatient clinic during preoperative teaching for patients undergoing surgical resection for lung cancer for quality improvement. Patients were given an electronic survey prior to preoperative teaching and at initial postoperative visit to assess teaching effectiveness and care satisfaction. Sequential patients received either standard preoperative teaching or teaching using the ME tool. Pre- and postoperative survey responses were compared using independent sample paired t test and multivariable linear regression modeling for adjustment. The final ME tool was an iPad application that incorporated real-time annotations of 3-dimensional, interactive anatomic diagrams. The tool featured video tours of operations, and radiology image import for annotation by the surgeon. Forty-eight patients were included in this pilot study (standard education n = 26; ME, n = 22). ME patients had significantly higher satisfaction scores compared to SE patients with respect to length of education materials, clarity of content, supportiveness of content and willingness to recommend materials to others. There was no difference in length of clinic visit between groups. Both patient and provider input can be used to create an innovative electronic preoperative educational tool that prepares and empowers patients in shared decision-making before surgery. Improvements in health literacy and self-efficacy may be more difficult to achieve but remain important as multimedia teaching tools are further developed. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
10. A National Analysis of Treatment Patterns and Outcomes for Patients 80 Years or Older With Esophageal Cancer.
- Author
-
Yang, Chi-Fu Jeffrey, Wang, Yoyo, Raman, Vignesh, Patel, Deven, Lui, Natalie, Backhus, Leah, Shrager, Joseph, Berry, Mark F., and Liou, Douglas
- Abstract
The purpose of this study was to evaluate practice patterns and outcomes for patients 80 years or older with esophageal cancer using a nationwide cancer data base. Practice patterns for patients 80 years or older with stage I-IV esophageal cancer in the National Cancer Data Base from 2004 to 2014 were analyzed. Overall survival associated with different treatment strategies were evaluated using the Kaplan-Meier method and multivariable Cox proportional hazard models. In the study period, 40.5% and 46.2% of patients with stage I adenocarcinoma and squamous cell carcinoma, respectively, did not receive any treatment at all. Less than 11% (196/1,865) of patients with stage I-II disease underwent esophagectomy, even though surgery was associated with a better 5-year survival compared to no treatment (stage I: 47.3% [95% confidence interval [CI] 36.2-57.6%] vs 14.9% [95% CI: 11.2-19.1%]; stage II: 29.3% [95% CI 20.1-39.1%] vs 1.2% [95% CI: 0.1-5.5%]). Of the 1,596 (37.7%) patients with stage III disease who received curative-intent treatment (surgery or chemoradiation), the 5-year survival was significantly better than that of patients who received no treatment (11.9% [95% CI: 9.7-14.4% vs 4.3% [95% CI: 1.9-8.3%]). In this national analysis of patients 80 years and older with esophageal cancer, over 40% of patients with stage I disease did not receive treatment. Patients with stage I-III disease had better survival and risks and benefits of treatment for elderly patients should be discussed in a multidisciplinary setting. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
11. Paradoxical Motion on Sniff Test Predicts Greater Improvement Following Diaphragm Plication.
- Author
-
Patel, Deven C., Berry, Mark F., Bhandari, Prasha, Backhus, Leah M., Raees, Shehzaib, Trope, Winston, Nash, Abraham, Lui, Natalie S., Liou, Douglas Z., and Shrager, Joseph B.
- Abstract
Diaphragm plication (DP) improves pulmonary function and quality of life for those with diaphragm paralysis or dysfunction. It is unknown whether differing degrees of diaphragm dysfunction as measured by sniff testing affect results after plication. Patients who underwent minimally invasive DP from 2008 to 2019 were dichotomized based on sniff test results: paradoxical motion (PM) versus no paradoxical motion (NPM); the latter included normal, decreased, and no motion. Preoperative and postoperative pulmonary function testing (PFT) after DP was compared between groups. The impact of the diaphragm height index, a measure of diaphragm elevation, was also assessed. A total of 26 patients underwent preoperative sniff testing, DP, and postoperative PFT. Including all patients, DP resulted in a 17.8% ± 5.5% improvement in forced expiratory volume in 1 second (P <.001), a 14.4% ± 5.3% improvement in forced vital capacity (P <.001), and a 4.7% ± 4.6% improvement in the diffusing capacity of carbon monoxide (P =.539). There were greater improvements in the PM group (n = 16) compared with the NPM group (n = 10) for forced expiratory volume in 1 second (27.2% ± 6.0% versus 3.9% ± 6.2%; P =.017) and forced vital capacity (28.1% ± 5.3% versus –0.5% ± 3.3%; P =.001). There was no difference in the change in the diffusing capacity of carbon monoxide between groups. There were no differences between patients with PM and NPM in the postoperative course or complications. No value for diaphragm height index predicted improvement in PFT after DP. Patients with PM on sniff test have dramatically greater objective improvements in pulmonary function after plication compared with those without PM. Most patients without PM do not demonstrate improvement in standard PFT. Improvements in dyspnea require additional study. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
12. Estimating the Impact of Extended Delay to Surgery for Stage I Non-small-cell Lung Cancer on Survival.
- Author
-
Mayne, Nicholas R., Elser, Holly C., Darling, Alice J., Raman, Vignesh, Liou, Douglas Z., Colson, Yolonda L., D’Amico, Thomas A., and Chi-Fu Jeffrey Yang
- Abstract
Objective: The purpose of this study is to evaluate the impact of extended delay to surgery for stage I NSCLC. Summary of Background Data: During the COVID-19 pandemic, patients with NSCLC may experience delays in care, and some national guidelines recommend delays in surgery by >3 months for early NSCLC. Methods: Using data from the National Lung Screening Trial, a multi-center randomized trial, and the National Cancer Data Base, a multi-institutional oncology registry, the impact of “early” versus “delayed” surgery (surgery received 0–30 vs 90–120 days after diagnosis) for stage I lung adenocarcinoma and squamous cell carcinoma (SCC) was assessed using multivariable Cox regression analysis with penalized smoothing spline functions and propensity score-matched analyses. Results: In Cox regression analysis of the National Lung Screening Trial (n = 452) and National Cancer Data Base (n = 80,086) cohorts, an increase in the hazard ratio was seen the longer surgery was delayed. In propensity score-matched analysis, no significant differences in survival were found between early and delayed surgery for stage IA1 adenocarcinoma and IA1-IA3 SCC (all P > 0.13). For stage IA2-IB adenocarcinoma and IB SCC, delayed surgery was associated with worse survival (all P < 0.004). Conclusions: The mortality risk associated with an extended delay to surgery differs across patient subgroups, and difficult decisions to delay care during the COVID-19 pandemic should take substage and histologic subtype into consideration. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
13. Reconsidering the American Joint Committee on Cancer Eighth Edition TNM Staging Manual Classifications for T2b and T3 NSCLC
- Author
-
Kumar, Arvind, Kumar, Sanjeevani, Gilja, Shivee, Potter, Alexandra L., Raman, Vignesh, Muniappan, Ashok, Liou, Douglas Z., and Jeffrey Yang, Chi-Fu
- Abstract
The American Joint Committee on Cancer (AJCC) eighth edition TNM staging manual for NSCLC, derived from the International Association for the Study of Lung Cancer (IASLC) Staging Project, designates tumors with additional nodule(s) in the same lobe as T3. This study sought to externally validate the results of the IASLC, which showed a trend in improved survival for such tumors, but excluded treatment-based adjustment, by assessing whether these tumors have worse survival than T2b NSCLC.
- Published
- 2021
- Full Text
- View/download PDF
14. Stereotactic Body Radiotherapy Versus Delayed Surgery for Early-stage Non-small-cell Lung Cancer.
- Author
-
Mayne, Nicholas R., Lin, Belle K., Darling, Alice J., Raman, Vignesh, Patel, Deven C., Liou, Douglas Z., D'Amico, Thomas A., and Yang, Chi-Fu Jeffrey
- Abstract
Objective: To evaluate the overall survival of patients with operable stage IA non-small-cell lung cancer (NSCLC) who undergo "early" SBRT (within 0-30 days after diagnosis) versus "delayed" surgery (90-120 days after diagnosis). Summary of background data: During the COVID-19 pandemic, national guidelines have recommended patients with operable stage IA NSCLC to consider delaying surgery by at least 3 months or, alternatively, to undergo SBRT without delay. It is unknown which strategy is associated with better short- and long-term outcomes. Methods: Multivariable Cox proportional hazards modeling and propensity score-matched analysis was used to compare the overall survival of patients with stage IA NSCLC in the National Cancer Data Base from 2004 to 2015 who underwent "early" SBRT (0-30 days after diagnosis) versus that of patients who underwent "delayed" wedge resection (90-120 days after diagnosis). Results: During the study period, 570 (55%) patients underwent early SBRT and 475 (45%) underwent delayed wedge resection. In multivariable analysis, delayed resection was associated with improved survival [adjusted hazard ratio 0.61; (95% confidence interval (CI): 0.50-0.76)]. Propensity-score matching was used to create 2 groups of 279 patients each who received early SBRT or delayed resection that were well-matched with regard to baseline characteristics. The 5-year survival associated with delayed resection was 53% (95% CI: 45%-61%) which was better than the 5-year survival associated with early SBRT (31% [95% CI: 24%-37%]). Conclusion: In this national analysis, for patients with stage IA NSCLC, extended delay of surgery was associated with improved survival when compared to early treatment with SBRT. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
15. Estimating the Impact of Extended Delay to Surgery for Stage I Non-small-cell Lung Cancer on Survival
- Author
-
Mayne, Nicholas R., Elser, Holly C., Darling, Alice J., Raman, Vignesh, Liou, Douglas Z., Colson, Yolonda L., D’Amico, Thomas A., and Yang, Chi-Fu Jeffrey
- Abstract
Supplemental Digital Content is available in the text
- Published
- 2021
- Full Text
- View/download PDF
16. The Impact of Immunotherapy Use in Stage IIIA (T1-2N2) NSCLC: A Nationwide Analysis
- Author
-
Wong, Lye-Yeng, Liou, Douglas Z., Roy, Mohana, Elliott, Irmina A., Backhus, Leah M., Lui, Natalie S., Shrager, Joseph B., and Berry, Mark F.
- Abstract
Multiple clinical trials have revealed the benefit of immunotherapy (IO) for NSCLC, including unresectable stage III disease. Our aim was to investigate the impact of IO use on treatment and outcomes of potentially resectable stage IIIA NSCLC in a broader nationwide patient cohort.
- Published
- 2024
- Full Text
- View/download PDF
17. Greater ipsilateral rectus muscle atrophy after robotic thoracic surgery compared to open and Video-assisted thoracoscopic surgery approaches
- Author
-
Wang, Yoyo, Randle, Ryan J., Bhandari, Prasha, He, Hao, Trope, Winston L., Guenthart, Brandon A., Guo, Haiwei H., Liou, Douglas Z., Backhus, Leah M., Berry, Mark F., Shrager, Joseph B., and Lui, Natalie S.
- Abstract
Robotic thoracic surgery provides another minimally invasive approach in addition to video-assisted thoracoscopic surgery (VATS) that yields less pain and faster recovery compared to open surgery. However, robotic incisions are generally placed more inferiorly, which may increase the risk of intercostal nerve injury that affects the abdominal wall. We hypothesized that a robotic approach causes greater ipsilateral rectus muscle atrophy compared to open and VATS approaches.
- Published
- 2024
- Full Text
- View/download PDF
18. Management of Paraesophageal Hernias
- Author
-
Randle, Ryan J., Liou, Douglas Z., and Lui, Natalie S.
- Abstract
Paraesophageal hernias are classified according to the altered anatomic relationships between the gastroesophageal junction or stomach and the diaphragmatic hiatus. Herniation of these structures into the mediastinum may produce common complaints such as reflux, chest pain, and dysphagia. The elective repair of these hernias is well tolerated and significantly improves quality of life among patients with symptomatic disease. The hallmarks of a quality repair include the circumferential mobilization of the esophagus to generate 3 cm of tension-free intra-abdominal length and the performance of a fundoplication.
- Published
- 2024
- Full Text
- View/download PDF
19. Stereotactic Body Radiotherapy Versus Delayed Surgery for Early-stage Non-small-cell Lung Cancer
- Author
-
Mayne, Nicholas R., Lin, Belle K., Darling, Alice J., Raman, Vignesh, Patel, Deven C., Liou, Douglas Z., D’Amico, Thomas A., and Yang, Chi-Fu Jeffrey
- Abstract
Supplemental Digital Content is available in the text
- Published
- 2020
- Full Text
- View/download PDF
20. Commentary: A guide for what we know and what still needs to be learned.
- Author
-
Liou, Douglas Z.
- Published
- 2023
- Full Text
- View/download PDF
21. Safety and feasibility of minimally invasive lobectomy after neoadjuvant immunotherapy for non–small cell lung cancer.
- Author
-
Mathey-Andrews, Camille, McCarthy, Meghan, Potter, Alexandra L., Beqari, Jorind, Wightman, Sean C., Liou, Douglas, Raman, Vignesh, and Jeffrey Yang, Chi-Fu
- Abstract
The objective of this study was to evaluate the feasibility of minimally invasive surgery (MIS) and perioperative outcomes following neoadjuvant immunotherapy for resectable non–small cell lung cancer (NSCLC). Patients with stage I to III NSCLC treated with immunotherapy with or without chemotherapy or chemotherapy alone prior to lobectomy were identified in the National Cancer Database (2010-2018). The percentage of operations performed minimally invasively, conversion rates, and perioperative outcomes were evaluated using propensity-score matching. Propensity-score matching was also used to compare perioperative outcomes between patients who underwent an open lobectomy and those who underwent an MIS lobectomy after neoadjuvant immunotherapy. Of the 4229 patients identified, 218 (5%) received neoadjuvant immunotherapy and 4011 (95%) received neoadjuvant chemotherapy alone. There was no difference in the rate of MIS lobectomy among patients who received immunotherapy compared with those who received chemotherapy alone in propensity score–matched analysis (60.8% vs 51.6%; P =.11). There also were no significant differences in the rate of conversion from MIS to open lobectomy (14% vs 15%, P =.83; odds ratio, 1.1; 95% confidence interval, 0.51-2.24) or in nodal downstaging, margin positivity, 30-day readmission, and 30- and 90-day mortality between the 2 groups. In a subgroup analysis of only patients treated with neoadjuvant immunotherapy, there were no differences in pathologic or perioperative outcomes between patients who underwent open lobectomy and those who underwent MIS lobectomy. In this national analysis, neoadjuvant immunotherapy for resectable NSCLC was not associated with an increased likelihood of the need for thoracotomy, conversion from MIS to open lobectomy, or inferior perioperative outcomes. [Display omitted] [Display omitted] [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
22. Induction therapy for locally advanced distal esophageal adenocarcinoma: Is radiation Always necessary?
- Author
-
Liou, Douglas Z., Backhus, Leah M., Lui, Natalie S., Shrager, Joseph B., and Berry, Mark F.
- Abstract
Objective To compare outcomes between induction chemotherapy alone (ICA) and induction chemoradiation (ICR) in patients with locally advanced distal esophageal adenocarcinoma. Methods Patients in the National Cancer Database treated with ICA or ICR followed by esophagectomy between 2006 and 2012 for cT1-3N1M0 or T3N0M0 adenocarcinoma of the distal esophagus were compared using logistic regression, Kaplan-Meier analysis, and Cox proportional hazards methods. Results The study group included 4763 patients, of whom 4323 patients (90.8%) received ICR and 440 patients (9.2%) received ICA. There were no differences in age, sex, race, Charlson Comorbidity Index, treatment facility type, clinical T or N status between the 2 groups. Tumor size ≥5 cm (odds ratio, 1.46; P = .006) was the only factor that predicted ICR use. Higher rates of T downstaging (39.7% vs 33.4%; P = .012), N downstaging (32.0% vs 23.4%; P < .001), and complete pathologic response (13.1% vs 5.9%; P < .001) occurred in ICR patients. Positive margins were seen more often in ICA patients (9.6% vs 5.5%; P = .001), but there was no difference in 5-year survival (ICR 35.9% vs ICA 37.2%; P = .33), and ICR was not associated with survival in multivariable analysis (hazard ratio = 1.04; P = .61). Conclusions ICR for locally advanced distal esophageal adenocarcinoma is associated with a better local treatment effect, but not improved survival compared with ICA, which suggests that radiation can be used selectively in this clinical situation. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
23. Predictors of Failure to Rescue After Esophagectomy.
- Author
-
Liou, Douglas Z., Serna-Gallegos, Derek, Mirocha, James, Bairamian, Vahak, Alban, Rodrigo F., and Soukiasian, Harmik J.
- Abstract
Background Failure to rescue (FTR), defined as death after a major complication, is a metric increasingly being used to assess quality of care. Risk factors associated with FTR after esophagectomy have not been previously studied. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent esophagectomy with gastric conduit between 2010 and 2014. Patients with at least one major postoperative complication were grouped according to inhospital mortality (FTR group) and survival to discharge (SUR group). A stepwise logistic regression model was used to identify predictors of FTR. Results A total of 1,730 patients comprised the study group, with 102 (5.9%) in the FTR group and 1,628 (94.1%) in the SUR group. The FTR patients were older (69.0 versus 64.0 years, p < 0.0001) compared with the SUR patients. There were no differences in sex, body mass index, preoperative weight loss, smoking status, operation type, or surgeon specialty between the two groups. Age greater than 75 years (adjusted odds ratio 2.68, p < 0.0001), black race (adjusted odds ratio 2.75, p = 0.001), American Society of Anesthesiologists class 4 or 5 (adjusted odds ratio 1.82, p = 0.02), and the occurrence of pneumonia, respiratory failure, acute renal failure, sepsis, or acute myocardial infarction were predictive of FTR based on multivariable logistic regression. Conclusions Nearly 6% of patients who have a major complication after esophagectomy do not survive to discharge. Age greater than 75 years, black race, American Society of Anesthesiologists class 4 or 5, and complications related to major infection or organ failure predict FTR. Further research is necessary to investigate how these factors affect survival after complications in order to improve rescue efforts. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
24. Positron emission tomography/computed tomography differentiates resectable thymoma from anterior mediastinal lymphoma.
- Author
-
Byrd, Catherine T., Trope, Winston L., Bhandari, Prasha, Konsker, Harrison B., Moradi, Farshad, Lui, Natalie S., Liou, Douglas Z., Backhus, Leah M., Berry, Mark F., and Shrager, Joseph B.
- Abstract
Discrete anterior mediastinal masses most often represent thymoma or lymphoma. Lymphoma treatment is nonsurgical and requires biopsy. Noninvasive thymoma is ideally resected without biopsy, which may potentiate pleural metastases. This study sought to determine if clinical criteria or positron emission tomography/computed tomography could accurately differentiate the 2, guiding a direct surgery versus biopsy decision. A total of 48 subjects with resectable thymoma and 29 subjects with anterior mediastinal lymphoma treated from 2006 to 2019 were retrospectively examined. All had pretreatment positron emission tomography/computed tomography and appeared resectable (solitary, without clear invasion or metastasis). Reliability of clinical criteria (age and B symptoms) and positron emission tomography/computed tomography maximum standardized uptake value were assessed in differentiating thymoma and lymphoma using Wilcoxon rank-sum test, chi-square test, and logistic regression. Receiver operating characteristic analysis identified the maximum standardized uptake value threshold most associated with thymoma. There was no association between tumor type and age group (P =.183) between those with thymoma versus anterior mediastinal lymphoma. Patients with thymoma were less likely to report B symptoms (P <.001). The median maximum standardized uptake value of thymoma and lymphoma differed dramatically: 4.35 versus 18.00 (P <.001). Maximum standardized uptake value was independently associated with tumor type on multivariable regression. On receiver operating characteristic analysis, lower maximum standardized uptake value was associated with thymoma. Maximum standardized uptake value less than 12.85 was associated with thymoma with 100.00% sensitivity and 88.89% positive predictive value. Maximum standardized uptake value less than 7.50 demonstrated 100.00% positive predictive value for thymoma. Positron emission tomography/computed tomography maximum standardized uptake value of resectable anterior mediastinal masses may help guide a direct surgery versus biopsy decision. Tumors with maximum standardized uptake value less than 7.50 are likely thymoma and thus perhaps appropriately resected without biopsy. Tumors with maximum standardized uptake value greater than 7.50 should be biopsied to rule out lymphoma. Lymphoma is likely with maximum standardized uptake value greater than 12.85. This study identifies SUVmax values separating thymoma and anterior mediastinal lymphoma. PET/CT , Positron emission tomography/computed tomography; SUVmax , maximum standardized uptake value. [Display omitted] [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
25. Thoracic Surgery Considerations in Obese Patients
- Author
-
Liou, Douglas Z. and Berry, Mark F.
- Abstract
The obesity epidemic in the United States has increased greatly over the past several decades, and thoracic surgeons are likely to see obese patients routinely in their practices. Obesity has direct deleterious health effects such as metabolic disorder and cardiovascular disease, and is associated with many cancers. Obese patients who need thoracic surgery pose practical challenges to many of the routine elements in perioperative management. Preoperative assessment of obesity-related comorbid conditions and risk stratification for surgery, thorough intraoperative planning for anesthesia and surgery, and postoperative strategies to optimize pulmonary hygiene and mobility minimize the risk of adverse outcomes.
- Published
- 2018
- Full Text
- View/download PDF
26. Bicycle trauma and alcohol intoxication.
- Author
-
Harada, Megan Y., Gangi, Alexandra, Ko, Ara, Liou, Douglas Z., Barmparas, Galinos, Li, Tong, Hotz, Heidi, Stewart, Donovan, and Ley, Eric J.
- Subjects
CYCLING ,LONGITUDINAL method ,SAFETY hats ,TRAFFIC accidents ,HEAD injuries ,DISEASE incidence ,ALCOHOLIC intoxication - Abstract
Introduction: As bicycling has become more popular, admissions after bicycle trauma are on the rise. The impact of alcohol use on bicycle trauma has not been well studied. The aim of this study was to examine the effect of alcohol intoxication on injury burden following bicycle-related crashes.Methods: A retrospective review of trauma patients presenting to a Level I trauma center after bicycle-related crashes from January 2002 to December 2011 was conducted. Demographics, injury data, alcohol intoxication, helmet use, and clinical outcomes were reviewed. Blood alcohol level (BAL) was considered positive if >0.01 g/dL. Variables were compared between patients based on BAL: negative, 0.01-0.16 g/dL, and >0.16 g/dL.Results: During the 10 year study period, 563 patients met study criteria; mean age was 33.5 ± 16.5 years, 87% were male, and mortality was 1%. On average, bicycle crashes increased over the study period by 4.4 collisions per year. BAL was tested in 211 (38%) patients. Mean BAL was 0.24 g/dL, with 37% of these patients being intoxicated (BAL ≥ 0.010 g/dL). Intoxicated patients were significantly less likely to wear a helmet (4.7% vs. 22.2%, p = 0.002) and to be involved in motor vehicle crash (59.0% vs. 81.2%, p < 0.001). There was no difference noted in the injury burden including ISS ≥ 16 (14.3% vs. 19.5%, p = 0.335) and AIS Head ≥ 3 (17.9% vs. 21.8%, p = 0.502). When comparing patients according to their BAL, there was a decreasing risk of motor vehicle collision with increasing BAL (81.2% for undetected, 76.5% for BAL ≤ 0.16 g/dL and 54.1% for BAL >0.16 g/dL, p < 0.001). The risk for a severe head injury (AIS Head ≥ 3) was significantly lower in helmeted patients (8.4% vs. 15.8%, p = 0.035).Conclusions: The incidence of bicycle-related crashes is increasing and more than a third of patients tested for alcohol after bicycle-related crashes are found to be intoxicated. The injury burden in intoxicated patients, including head trauma, was not different compared to non-intoxicated patients. In addition, the risk for a collision with a motor vehicle was significantly lower. Nonetheless, these patients rarely utilize a helmet. The findings from this study can be used for the development and implementation of preventive strategies to minimize the injury burden associated with bicycle crashes and intoxicated cyclists. [ABSTRACT FROM AUTHOR]- Published
- 2015
- Full Text
- View/download PDF
27. The impact of neoadjuvant immunotherapy on perioperative outcomes and survival after esophagectomy for esophageal cancer
- Author
-
Wong, Lye-Yeng, Liou, Douglas Z., Backhus, Leah M., Lui, Natalie S., Shrager, Joseph B., and Berry, Mark F.
- Abstract
Immunotherapy for esophageal cancer is relatively novel but increasingly used. This study evaluated the early use of immunotherapy as an adjunct to neoadjuvant chemoradiotherapy before esophagectomy for locally advanced disease.
- Published
- 2023
- Full Text
- View/download PDF
28. Survival Difference in Patients with Malignant Pleural Effusions Treated with Pleural Catheter or Talc Pleurodesis
- Author
-
Liou, Douglas Z., Serna-Gallegos, Derek, Chan, Joshua L., Borgella, Jerald, Akhmerov, Shah, and Soukiasian, Harmik J.
- Abstract
Malignant pleural effusions (MPE) are commonly managed with either pleural catheter (PC) or talc pleurodesis (TP). The aim of this study was to compare survival in MPE patients treated with either PC or TP. A retrospective review of our cancer center database was performed. Patients with metastatic cancer and MPE were analyzed. Demographic and clinical data were tabulated and compared. A total of 238 patients with MPE treated by either PC or TP were included. Of these, 79 patients comprised the PC group and 159 the TP group. PC had a higher incidence of advanced disease (stage III or IV) at initial diagnosis compared with TP (70.9% vs57.2%, P= 0.05). TP had a longer postprocedure length of stay compared with PC (7.1 vs5.0 days, P= 0.02); however, overall length of stay was similar (9.7 vs11.1 days, P= 0.34). Read-missions were significantly lower in TP (11.9% vs22.8%, P= 0.04). Mean survival was higher in TP compared with PC (18.7 vs4.1 months, P <0.001). Patients with metastatic cancer and MPE treated with TP had significantly higher survival compared with PC. This is likely related to a greater disease burden in PC, as 70 per cent of patients in this group had stage III or IV disease on initial presentation.
- Published
- 2016
- Full Text
- View/download PDF
29. Commentary: Two decades of innovation, leadership, and overcoming challenges, but more lies ahead.
- Author
-
Liou, Douglas Z.
- Published
- 2021
- Full Text
- View/download PDF
30. Impact of positive fluid balance on critically ill surgical patients: A prospective observational study.
- Author
-
Barmparas, Galinos, Liou, Douglas, Lee, Debora, Fierro, Nicole, Bloom, Matthew, Ley, Eric, Salim, Ali, and Bukur, Marko
- Subjects
ACADEMIC medical centers ,REGULATION of body fluids ,CHI-squared test ,CONFIDENCE intervals ,CRITICALLY ill ,INFECTION ,INTENSIVE care units ,LONGITUDINAL method ,MORTALITY ,HEALTH outcome assessment ,PATIENTS ,POSTOPERATIVE care ,QUALITY assurance ,SURGERY ,T-test (Statistics) ,LOGISTIC regression analysis ,TREATMENT effectiveness ,DATA analysis software ,DESCRIPTIVE statistics - Published
- 2014
- Full Text
- View/download PDF
31. Prehospital hypertension is predictive of traumatic brain injury and is associated with higher mortality.
- Author
-
Barmparas, Galinos, Liou, Douglas Z., Lamb, Alexander W., Gangi, Alexandra, Chin, Mike, Ley, Eric J., Salim, Ali, and Bukur, Marko
- Published
- 2014
- Full Text
- View/download PDF
32. Influence of facility volume on long-term survival of patients undergoing esophagectomy for esophageal cancer.
- Author
-
Patel, Deven C., Jeffrey Yang, Chi-Fu, He, Hao, Liou, Douglas Z., Backhus, Leah M., Lui, Natalie S., Shrager, Joseph B., and Berry, Mark F.
- Abstract
This study investigated the influence of facility volume on long-term survival in patients with esophageal cancer treated with esophagectomy. Patients treated with esophagectomy for cT1 3N0 3M0 adenocarcinoma or squamous cell carcinoma of the mid-distal esophagus in the National Cancer Database between 2006 and 2013 were stratified by annual facility esophagectomy volume dichotomized as more/less than both 6 and 20. Patient characteristics associated with facility volume were evaluated using logistic regression, and the influence of facility volume on survival was evaluated with Kaplan-Meier curves, Cox proportional hazards methods, and propensity matched analysis. Of 11,739 patients who had esophagectomy at 1018 facilities where annual volume ranged from 1 to 47.6 cases, 4262 (36.3%) were treated at 44 facilities with annual esophagectomy volume > 6 and 1515 (12.9%) were treated at 7 facilities with annual volume > 20. Higher volume was associated with significantly better 5-year survival for both annual volume > 6 (47.6% vs 40.2%; P <.001) and annual volume > 20 (47.2% vs 42.3%; P <.001), which persisted in propensity matched analyses as well as Cox multivariable analysis (hazard ratio, 0.81; 95% confidence interval, 0.74-0.89; P <.001 for facility volume > 6 and hazard ratio, 0.78; 95% confidence interval, 0.65-0.95; P =.01 for facility volume > 20). In Cox multivariable analysis that considered facility volume as a continuous variable, higher volume continued to be associated with better survival (hazard ratio, 0.93 per 5 cases; 95% CI, 0.91-0.96; P <.001). Esophageal cancer patients treated with esophagectomy at higher volume facilities have significantly better long-term survival than patients treated at lower volume facilities. [Display omitted] [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
33. Work Hour Reduction: Still Room for Improvement
- Author
-
Liou, Douglas Z., Barmparas, Galinos, Harada, Megan, Chung, Rex, Melo, Nicolas, Ley, Eric J., Salim, Ali, and Bukur, Marko
- Abstract
The effect of resident duty hour restrictions continues to yield conflicting results on patient outcomes. Failure to rescue (FTR), or death after a major complication, has become a topic of increasing quality assessment. The aim of this study is to evaluate the effect of duty hour restrictions on in-hospital mortality, complication rates, and FTR in patients suffering traumatic injuries.
- Published
- 2016
- Full Text
- View/download PDF
34. Recovery of native renal function in patients with hepatorenal syndrome following combined liver and kidney transplant with Mercaptoacetyltriglycine-3 renogram: Developing a methodology
- Author
-
Aparici, Carina, Bains, Sukhkarn, Carlson, David, Qian, Jesse, Liou, Douglas, Wojciechowski, David, Werner, Jacob, Khan, Sana, Kroll, Cameron, Sandhu, Manreet, Nguyen, Nhan, and Hawkins, Randall
- Published
- 2016
- Full Text
- View/download PDF
35. To swab or not to swab? A prospective analysis of 341 SICU VRE screens.
- Author
-
Liou, Douglas Z., Barmparas, Galinos, Ley, Eric J., Salim, Ali, Tareen, Aasin, Casas, Tamara, Lee, Debora, and Bukur, Marko
- Published
- 2014
- Full Text
- View/download PDF
36. Prehospital hypertension is predictive of traumatic brain injury and is associated with higher mortality
- Author
-
Barmparas, Galinos, Liou, Douglas Z., Lamb, Alexander W., Gangi, Alexandra, Chin, Mike, Ley, Eric J., Salim, Ali, and Bukur, Marko
- Abstract
The purpose of the current study was to investigate the effect of early adrenergic hyperactivity as manifested by prehospital (emergency medical service EMS) hypertension on outcomes of traumatic brain injury (TBI) patients and to develop a prognostic model of the presence of TBI based on EMS and admission (emergency department ED) hypertension.
- Published
- 2014
- Full Text
- View/download PDF
37. Defining Early Trauma-induced Coagulopathy Using Thromboelastography
- Author
-
Liou, Douglas Z., Shafi, Hedyeh, Bloom, Matthew B., Chung, Rex, Ley, Eric J., Salim, Ali, Tcherniantchouk, Oxana, and Margulies, Daniel R.
- Abstract
Early trauma-induced coagulopathy (ETIC) is abnormal coagulation detected on presentation, but a clear description is lacking. We used thromboelastography (TEG) to characterize ETIC. Data were prospectively collected on high-acuity trauma activations at an urban Level I trauma center between July 2012 and May 2013. Patients with admission TEG before any blood transfusion were stratified by Injury Severity Score (ISS): mild (less than 16), moderate (16 to 24), severe (25 or greater). TEG parameters were compared between groups. ETIC was defined as any abnormality detected on TEG. Fifty-two patients were included; mean age was 49 years and mean time to the emergency department was 26 minutes. Mean ISS for the cohort was 17 with 28 patients in mild, eight in moderate, and 16 in severe. Glasgow Coma Score was lower and head Abbreviated Injury Scale was higher in severe (P< 0.001). Forty-three (83%) patients had an abnormal TEG. Shortened reaction (R) time was noted in 42 patients. There were no differences in any TEG parameters between the injury severity groups. Hyperfibrinolysis was detected in four (8%) patients. ETIC was present in over 80 per cent of high-acuity trauma activations irrespective of injury severity and characterized primarily by shortened R time, indicating ETIC is initially described by a hypercoagulable state as a result of thrombin generation.
- Published
- 2014
- Full Text
- View/download PDF
38. Insurance- and race-related disparities decrease in elderly trauma patients.
- Author
-
Singer, Matthew B., Liou, Douglas Z., Clond, Morgan A., Bukur, Marko, Mirocha, James, Margulies, Daniel R., Salim, Ali, and Ley, Eric J.
- Published
- 2013
- Full Text
- View/download PDF
39. To swab or not to swab A prospective analysis of 341 SICU VRE screens
- Author
-
Liou, Douglas Z., Barmparas, Galinos, Ley, Eric J., Salim, Ali, Tareen, Aasin, Casas, Tamara, Lee, Debora, and Bukur, Marko
- Abstract
Vancomycin-resistant Enterococcus(VRE) screening is routine practice in many intensive care units despite the question of its clinical significance. The value of VRE screening at predicting subsequent VRE or other hospital-acquired infection (HAI) is unknown. The purpose of this investigation was to examine the rate of subsequent VRE HAI in patients undergoing VRE screening.
- Published
- 2014
- Full Text
- View/download PDF
40. Breast-Conserving Therapy for Triple-Negative Breast Cancer
- Author
-
Gangi, Alexandra, Chung, Alice, Mirocha, James, Liou, Douglas Z., Leong, Trista, and Giuliano, Armando E.
- Abstract
IMPORTANCE The aggressive triple-negative phenotype of breast cancer (negative for estrogen and progesterone receptors and v-erb-b2 avian erythroblastic leukemia viral oncogene homolog 2 [ERBB2] [formerly human epidermal growth factor receptor 2 (HER2)]) is considered by some investigators to be a relative contraindication to breast-conserving therapy. OBJECTIVES To compare outcomes of breast-conserving therapy for patients with triple-negative breast cancer (TNBC) with those of patients with the luminal A, luminal B, and ERBB2 subtypes. DESIGN, SETTING, AND PARTICIPANTS Prospective database review at an academic tertiary medical center with a designated breast cancer center. We included 1851 consecutive patients ages 29 to 85 years with stages I to III invasive breast cancer who underwent breast-conserving therapy at a single institution from January 1, 2000, through May 30, 2012. Of these patients, 234 (12.6%) had TNBC; 1341 (72.4%), luminal A subtype; 212 (11.5%), luminal B subtype; and 64 (3.5%), ERBB2-enriched subtype. EXPOSURE Breast-conserving therapy. MAIN OUTCOMES AND MEASURES The primary outcome measure was local recurrence (LR). Secondary outcome measures included regional recurrence, distant recurrence, and overall survival. RESULTS Triple-negative breast cancer was associated with younger age at diagnosis (56 vs 60 years; P = .001), larger tumors (2.1 vs 1.8 cm; P < .001), more stage II vs I cancer (42.1% vs 33.6%; P = .005), and more G3 tumors (86.4% vs 28.4%; P < .001) compared with the non-TNBC subtypes. Multivariable analysis showed that TNBC did not have a significantly increased risk of LR compared with the luminal A (hazard ratio, 1.4 [95% CI, 0.6-3.3]; P = .43), luminal B (1.6 [0.5-5.2]; P = .43), and ERBB2 (1.1 [0.2-5.2]; P = .87) subtypes. Only tumor size was a significant predictor of LR (hazard ratio, 4.7 [95% CI, 1.6-14.3]; P = .006). Predictors of worse overall survival included tumor size, grade, and stage and TNBC subtype. CONCLUSIONS AND RELEVANCE Breast-conserving therapy for TNBC is not associated with increased LR compared with non-TNBC subtypes. However, the TNBC phenotype correlates with worse overall survival. Breast-conserving therapy is appropriate for patients with TNBC.
- Published
- 2014
- Full Text
- View/download PDF
41. Gender impacts mortality after traumatic brain injury in teenagers
- Author
-
Ley, Eric J., Short, Scott S., Liou, Douglas Z., Singer, Matthew B., Mirocha, James, Melo, Nicolas, Bukur, Marko, and Salim, Ali
- Abstract
Gender may influence outcomes following traumatic brain injury (TBI) although the mechanism is unknown. Animal TBI studies suggest that gender differences in endogenous hormone production may be the source. Limited retrospective clinical studies on gender present varied conclusions. Pediatric patients represent a unique population as pubescent children experience up-regulation of endogenous hormones that varies dramatically by gender. Younger children do not have these hormonal differences. The aim of this study was to compare pubescent and prepubescent females with males after isolated TBI to identify independent predictors of mortality.
- Published
- 2013
- Full Text
- View/download PDF
42. Surgical Management of Advanced Adrenocortical Carcinoma: A 21-year Population-based Analysis
- Author
-
Tran, Thuy B., Liou, Douglas, Menon, Vijay G., and Nissen, Nicholas N.
- Abstract
Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with a dismal prognosis. When diagnosed in advanced stages of the disease, the outcomes of surgical resection are not well understood. The objective of this study is to determine the impact of surgery in patients with advanced ACC. Using the Surveillance, Epidemiology and End Results database, we identified patients diagnosed with Stage III and IVACC between 1988 and 2009. A total of 320 patients with Stage III and IV disease were included in our analysis. In patients treated with surgical resection, the Stage III 1- and 5-year survival rates were 77 and 40 per cent, respectively, whereas the Stage IV 1- and 5-year survival rates were 54 and 27.6 per cent, respectively. Patients treated without surgery had poor survival at 1 year for both Stage III (13%) and Stage IV (16%) (P< 0.01 compared with the surgical groups). Lymph node dissection was performed in 26 per cent of the patients with advanced ACC and was associated with improved survival in univariate analysis of Stage IV patients. Overall, our results indicate that favorable survival outcomes can be achieved even in patients with Stage III and IV disease and surgery should be considered in patients with advanced ACC.
- Published
- 2013
- Full Text
- View/download PDF
43. Insurance-and race-related disparities decrease in elderly trauma patients
- Author
-
Singer, Matthew B., Liou, Douglas Z., Clond, Morgan A., Bukur, Marko, Mirocha, James, Margulies, Daniel R., Salim, Ali, and Ley, Eric J.
- Abstract
Little focus is on health care disparities in the elderly, a population largely covered by public insurance. We characterized insurance type and race in elderly trauma patients to determine if lack of insurance or minority status predict increased mortality.
- Published
- 2013
- Full Text
- View/download PDF
44. A national analysis of open versus minimally invasive thymectomy for stage I to III thymoma.
- Author
-
Yang, Chi-Fu Jeffrey, Hurd, Jacob, Shah, Shivani A., Liou, Douglas, Wang, Hanghang, Backhus, Leah M., Lui, Natalie S., D'Amico, Thomas A., Shrager, Joseph B., and Berry, Mark F.
- Abstract
The oncologic efficacy of minimally invasive thymectomy for thymoma is not well characterized. We compared short-term outcomes and overall survival between open and minimally invasive (video-assisted thoracoscopic and robotic) approaches using the National Cancer Data Base. Perioperative outcomes and survival of patients who underwent open versus minimally invasive thymectomy for clinical stage I to III thymoma from 2010 to 2014 in the National Cancer Data Base were evaluated using multivariable Cox proportional hazards modeling and propensity score–matched analysis. Predictors of minimally invasive use were evaluated using multivariable logistic regression. Outcomes of surgical approach were evaluated using an intent-to-treat analysis. Of the 1223 thymectomies that were evaluated, 317 (26%) were performed minimally invasively (141 video-assisted thoracoscopic and 176 robotic). The minimally invasive group had a shorter median length of stay when compared with the open group (3 [2-4] days vs 4 [3-6] days, P <.001). In a propensity score–matched analysis of 185 open and 185 minimally invasive (video-assisted thoracoscopic + robotic) thymectomy, the minimally invasive group continued to have a shorter median length of stay (3 vs 4 days, P <.01) but did not have significant differences in margin positivity (P =.84), 30-day readmission (P =.28), 30-day mortality (P =.60), and 5-year survival (89.4% vs 81.6%, P =.20) when compared with the open group. In this national analysis, minimally invasive thymectomy was associated with shorter length of stay and was not associated with increased margin positivity, perioperative mortality, 30-day readmission rate, or reduced overall survival when compared with open thymectomy. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
45. The influence of hormone replacement therapy on lung cancer incidence and mortality.
- Author
-
Titan, Ashley L., He, Hao, Lui, Natalie, Liou, Douglas, Berry, Mark, Shrager, Joseph B., and Backhus, Leah M.
- Abstract
Data regarding the effects of hormone replacement therapy (HRT) on non–small cell lung cancer (NSCLC) are mixed. We hypothesized HRT would have a protective benefit with reduced NSCLC incidence among women in a large, prospective cohort. We used data from the multicenter randomized Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (1993-2001). Participants were women aged 50 to 74 years followed prospectively for up to 13 years for cancer screening. The influence of HRT on the primary outcome of NSCLC incidence and secondary outcomes of all-cause and disease-specific mortality were assessed with Kaplan-Meier analysis and Cox proportional hazard models adjusting for covariates. In the overall cohort of 75,587 women, 1147 women developed NSCLC after a median follow-up of 11.5 years. HRT use was characterized as 49.4% current users, 17.0% former users, and 33.6% never users. Increased age, smoking, comorbidities, and family history were associated with increased risk of NSCLC. On multivariable analysis, current HRT use was associated with reduced risk of NSCLC compared with never users (hazard ratio, 0.80; 95% confidence interval, 0.70-0.93; P =.009). HRT or oral contraception use was not associated with significant differences in all-cause mortality or disease-specific mortality. These data represent among the largest prospective cohorts suggesting HRT use may have a protective effect on the development of NSCLC among women; the physiological basis of this effect merits further study; however, the results may influence discussion surrounding HRT use in women. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
46. Midodrine
- Author
-
Liou, Douglas Z., Warren, Heather, Maher, Dermot P., Soukiasian, Harmik J., Melo, Nicolas, Salim, Ali, and Ley, Eric J.
- Abstract
Thoracic duct injury is a rare but serious complication following surgery of the neck or chest that leads to uncontrolled chyle leak. Conventional management includes drainage, nutritional modification, or aggressive surgical interventions such as thoracic duct ligation, flap coverage, fibrin glue, or talc pleurodesis; few successful medical therapeutics are available. We report a case of a high-output chylothorax refractory to aggressive medical and surgical interventions. Chyle output decreased substantially after initiating midodrine, an α1-adrenergic agonist that causes vasoconstriction of the lymph system, reducing chyle flow. This case report suggests that midodrine may be a novel therapeutic for refractory chyle leaks.
- Published
- 2013
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.