21 results on '"Jarnagin W."'
Search Results
2. Port-Site Resection in the Surgical Management of Incidental Gallbladder Cancer: A Still Inconclusive Question: A Reply
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Maker, A. V. and Jarnagin, W. R.
- Published
- 2017
- Full Text
- View/download PDF
3. Perioperative complications influence recurrence and survival after resection of hepatic colorectal metastases
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Correa-Gallego, C., Gonen, M., Fischer, M., Grant, F., Kemeny, N. E., Arslan-Carlon, V., Kingham, T. P., DeMatteo, R. P., Fong, Y., Allen, P. J., D’Angelica, M. I., and Jarnagin, W. R.
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- 2013
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4. Malignant Progression in IPMN: A Cohort Analysis of Patients Initially Selected for Resection or Observation
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LaFemina, J., Katabi, N., Klimstra, D., Correa-Gallego, C., Gaujoux, S., Kingham, T. P., DeMatteo, R. P., Fong, Y., D’Angelica, M. I., Jarnagin, W. R., Do, R. K., Brennan, M. F., and Allen, Peter J.
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- 2013
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5. Downstaging in Pancreatic Cancer: A Matched Analysis of Patients Resected Following Systemic Treatment of Initially Locally Unresectable Disease
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Bickenbach, K. A., Gonen, M., Tang, Laura H., O’Reilly, Eileen, Goodman, Karyn, Brennan, M. F., D’Angelica, M. I., DeMatteo, R. P., Fong, Y., Jarnagin, W. R., and Allen, P. J.
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- 2012
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6. Prospective Study of Outcomes after Percutaneous Biliary Drainage for Malignant Biliary Obstruction
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Robson, P. C., Heffernan, N., Gonen, M., Thornton, R., Brody, L. A., Holmes, R., Brown, K. T., Covey, A. M., Fleischer, D., Getrajdman, G. I., Jarnagin, W., Sofocleous, C., Blumgart, L., and D’Angelica, M.
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- 2010
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7. The Role of Staging Laparoscopy in Hepatobiliary Malignancy: Prospective Analysis of 401 Cases
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D’Angelica, M., Fong, Y., Weber, S., Gonen, M., DeMatteo, R. P., Conlon, K., Blumgart, L. H., and Jarnagin, W. R.
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- 2003
- Full Text
- View/download PDF
8. Staging laparoscopy for potentially resectable noncolorectal, nonneuroendocrine liver metastases
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D’Angelica, M., Jarnagin, W., Dematteo, R., Conlon, K., Blumgart, L. H., and Fong, Y.
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- 2002
- Full Text
- View/download PDF
9. Malignant Progression in IPMN: A Cohort Analysis of Patients Initially Selected for Resection or Observation
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LaFemina, J., primary, Katabi, N., additional, Klimstra, D., additional, Correa-Gallego, C., additional, Gaujoux, S., additional, Kingham, T. P., additional, DeMatteo, R. P., additional, Fong, Y., additional, D’Angelica, M. I., additional, Jarnagin, W. R., additional, Do, R. K., additional, Brennan, M. F., additional, and Allen, Peter J., additional
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- 2012
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10. Downstaging in Pancreatic Cancer: A Matched Analysis of Patients Resected Following Systemic Treatment of Initially Locally Unresectable Disease
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Bickenbach, K. A., primary, Gonen, M., additional, Tang, Laura H., additional, O’Reilly, Eileen, additional, Goodman, Karyn, additional, Brennan, M. F., additional, D’Angelica, M. I., additional, DeMatteo, R. P., additional, Fong, Y., additional, Jarnagin, W. R., additional, and Allen, P. J., additional
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- 2011
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11. Surgery for Bismuth-Corlette Type 4 Perihilar Cholangiocarcinoma: Results from a Western Multicenter Collaborative Group
- Author
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Ruzzenente, Andrea, Bagante, Fabio, Olthof, Pim B, Aldrighetti, Luca, Alikhanov, Ruslan, Cescon, Matteo, Koerkamp, Bas Groot, Jarnagin, William R, Nadalin, Silvio, Pratschke, Johann, Schmelzle, Moritz, Sparrelid, Ernesto, Lang, Hauke, Iacono, Calogero, van Gulik, Thomas M, Guglielmi, Alfredo, Andreou A, Bartsch F, Benzing C, Buettner S, Campagnaro T, Capobianco I, Charco R, de Reuver P, de Savornin, Lohman E, Nijmegen, Dejong CHC, Efanov M, Erdmann JI, Franken LC, Giovinazzo G, Giglio MC, Gomez-Gavara C, Heid F, IJzermans JNM, Isaac J, Jansson H, Ligthart MAP, Maithel SK, Malago` M. Malik HZ, Muiesan P, Olde Damink SWM, Quinn LM, Ratti F, Ravaioli M, Rolinger J, Schadde E, Serenari M, Troisi R, van Laarhoven S, van Vugt JLA, Faculteit Medische Wetenschappen/UMCG, Surgery, Ruzzenente, Andrea, Bagante, Fabio, Olthof, Pim B, Aldrighetti, Luca, Alikhanov, Ruslan, Cescon, Matteo, Koerkamp, Bas Groot, Jarnagin, William R, Nadalin, Silvio, Pratschke, Johann, Schmelzle, Moritz, Sparrelid, Ernesto, Lang, Hauke, Iacono, Calogero, van Gulik, Thomas M, Guglielmi, Alfredo, Andreou, A, Bartsch, F, Benzing, C, Buettner, S, Campagnaro, T, Capobianco, I, Charco, R, de Reuver, P, De, Savornin, Lohman, E, Nijmegen, Dejong, Chc, Efanov, M, Erdmann, Ji, Franken, Lc, Giovinazzo, G, Giglio, Mc, Gomez-Gavara, C, Heid, F, Ijzermans, Jnm, Isaac, J, Jansson, H, Ligthart, Map, Maithel, Sk, Malago` M., Malik HZ, Muiesan, P, Olde Damink, Swm, Quinn, Lm, Ratti, F, Ravaioli, M, Rolinger, J, Schadde, E, Serenari, M, Troisi, R, van Laarhoven, S, van Vugt, Jla, Ruzzenente, A., Bagante, F., Olthof, P. B., Aldrighetti, L., Alikhanov, R., Cescon, M., Koerkamp, B. G., Jarnagin, W. R., Nadalin, S., Pratschke, J., Schmelzle, M., Sparrelid, E., Lang, H., Iacono, C., van Gulik, T. M., Guglielmi, A., Andreou, A., Bartsch, F., Benzing, C., Buettner, S., Campagnaro, T., Capobianco, I., Charco, R., de Reuver, P., de Savornin Lohman, E., Dejong, C. H. C., Efanov, M., Erdmann, J. I., Franken, L. C., Giovinazzo, G., Giglio, M. C., Gomez-Gavara, C., Heid, F., Ijzermans, J. N. M., Isaac, J., Jansson, H., Ligthart, M. A. P., Maithel, S. K., Malago, M., Malik, H. Z., Muiesan, P., Damink, S. W. M. O., Quinn, L. M., Ratti, F., Ravaioli, M., Rolinger, J., Schadde, E., Serenari, M., Troisi, R., van Laarhoven, S., van Vugt, J. L. A., CCA - Cancer Treatment and Quality of Life, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Perineural invasion ,Metastasis ,Cholangiocarcinoma ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,Surgical oncology ,Medicine ,Hepatectomy ,Humans ,Perihilar Cholangiocarcinoma ,Contraindication ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Surgery ,Oncology ,Bile Duct Neoplasms ,Cohort ,business ,Bismuth ,Klatskin Tumor - Abstract
Background Although Bismuth-Corlette (BC) type 4 perihilar cholangiocarcinoma (pCCA) is no longer considered a contraindication for curative surgery, few data are available from Western series to indicate the outcomes for these patients. This study aimed to compare the short- and long-term outcomes for patients with BC type 4 versus BC types 2 and 3 pCCA undergoing surgical resection using a multi-institutional international database. Methods Uni- and multivariable analyses of patients undergoing surgery at 20 Western centers for BC types 2 and 3 pCCA and BC type 4 pCCA. Results Among 1138 pCCA patients included in the study, 826 (73%) had BC type 2 or 3 disease and 312 (27%) had type 4 disease. The two groups demonstrated significant differences in terms of clinicopathologic characteristics (i.e., portal vein embolization, extended hepatectomy, and positive margin). The incidence of severe complications was 46% for the BC types 2 and 3 patients and 51% for the BC type 4 patients (p = 0.1). Moreover, the 90-day mortality was 13% for the BC types 2 and 3 patients and 12% for the BC type 4 patients (p = 0.57). Lymph-node metastasis (N1; hazard-ratio [HR], 1.62), positive margins (R1; HR, 1.36), perineural invasion (HR, 1.53), and poor grade of differentiation (HR, 1.25) were predictors of survival (all p ≤0.004), but BC type was not associated with prognosis. Among the N0 and R0 patients, the 5-year overall survival was 43% for the patients with BC types 2 and 3 pCCA and 41% for those with BC type 4 pCCA (p = 0.60). Conclusions In this analysis of a large Western multi-institutional cohort, resection was shown to be an acceptable curative treatment option for selected patients with BC type 4 pCCA although a more technically challenging surgical approach was required.
- Published
- 2020
12. Impact of Primary Tumor Laterality on Adjuvant Hepatic Artery Infusion Pump Chemotherapy in Resected Colon Cancer Liver Metastases: Analysis of 487 Patients.
- Author
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Gholami S, Stewart S, Kemeny N, Gönen M, Groot Koerkamp B, Cercek A, Kingham P, Balachandran V, Allen P, DeMatteo R, Wei A, Connell L, Drebin J, Jarnagin W, and D'Angelica M
- Subjects
- Chemotherapy, Adjuvant, Hepatectomy, Hepatic Artery, Humans, Infusions, Intra-Arterial, Prospective Studies, Survival Rate, Colonic Neoplasms drug therapy, Colorectal Neoplasms surgery, Liver Neoplasms drug therapy, Liver Neoplasms surgery
- Abstract
Background: Hepatic artery infusion (HAI) chemotherapy is associated with overall survival (OS) in patients with resected colon cancer liver metastases (CLM). The prognostic impact of primary tumor location in CLM following hepatic resection in patients receiving regional HAI is unknown. This study seeks to investigate the prognostic impact of HAI in relation to laterality in this patient population., Methods: Consecutive patients with resected CLM, with known primary tumor site treated with and without HAI, were reviewed from a prospective institutional database. Correlations between HAI, laterality, other clinicopathological factors, and survival were analyzed, and Cox proportional hazard regression was used to determine whether laterality was an independent prognostic factor., Results: From 1993 to 2012, 487 patients [182 with right colon cancer (RCC), 305 with left colon cancer (LCC)] were evaluated with a median follow-up of 6.5 years. Fifty-seven percent (n = 275) received adjuvant HAI. Patients with RCC had inferior 5-year OS compared with LCC (56% vs. 67%, P = 0.01). HAI was associated with improved 5-year OS in both RCC (68% vs. 45%; P < 0.01) and LCC (73% vs. 55%; P < 0.01). On multivariable analysis, HAI remained associated with improved OS (HR 0.52; 95% CI 0.39-0.70; P < 0.01) but primary tumor site did not (HR 0.83; 95% CI 0.63-1.11; P = 0.21). Additional significant prognostic factors on multivariable analysis included age, number of tumors, node-positive primary, positive margins, RAS mutation, two-stage hepatectomy, and extrahepatic disease. Cox proportional hazard regression determined no significant interaction between HAI and laterality on OS [parameter estimate (SEM), 0.12 (0.28); P = 0.67]., Conclusions: Our data show an association of adjuvant HAI and increased OS in patients who underwent curative hepatectomy, irrespective of primary tumor location. Laterality should therefore not impact decision-making when offering adjuvant HAI.
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- 2021
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13. Positive postoperative CEA is a strong predictor of recurrence for patients after resection for colorectal liver metastases.
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Araujo RL, Gönen M, Allen P, DeMatteo R, Kingham P, Jarnagin W, D'Angelica M, and Fong Y
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- Aged, Colorectal Neoplasms metabolism, Colorectal Neoplasms mortality, Colorectal Neoplasms surgery, Female, Follow-Up Studies, Hepatectomy, Humans, Liver Neoplasms metabolism, Liver Neoplasms mortality, Liver Neoplasms surgery, Male, Middle Aged, Neoplasm Recurrence, Local metabolism, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local surgery, Neoplasm Staging, Postoperative Period, Prognosis, Prospective Studies, Retrospective Studies, Survival Rate, Biomarkers, Tumor metabolism, Carcinoembryonic Antigen metabolism, Colorectal Neoplasms pathology, Liver Neoplasms pathology, Neoplasm Recurrence, Local diagnosis
- Abstract
Background: The role of carcinoembryonic antigen (CEA) in surveillance and follow-up of patients with colorectal cancer continues to be debated. The objective of this study was to assess the utility of postoperative CEA as a predictor of recurrence for patients with resected colorectal liver metastases (CLM)., Methods: Patients were identified from a prospectively maintained CLM database, and were studied retrospectively. Patients with extrahepatic disease or initially unresectable CLM were excluded. All patients in this study received adjuvant systemic chemotherapy after resection., Results: Between 1997 and 2007, a total of 318 consecutive patients were studied, with 168 patients (53 %) experiencing recurrence within 2 years. Various postoperative CEA cutoffs were tested as independent predictors of recurrence. A postoperative CEA ≥15 ng/ml obtained the highest hazard ratio (1.87; 95 % CI 1.09-3.2; p = 0.023) and was chosen to be included in the survival analysis in the multivariate model. A postoperative CEA ≥15 ng/ml had a specificity of 96 % and positive predictive value of 82 % for recurrence. On multivariate analysis, age ≥70 years, the presence of positive lymph node at primary tumor resection, disease-free interval ≤12 months, number of lesions >1, largest lesion ≥5 cm, presence of positive margins, and postoperative CEA ≥15 ng/ml were independent predictors of recurrence within 2 years., Conclusion: This study demonstrates a postoperative CEA ≥15 ng/ml to be a predictive test for recurrence.
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- 2015
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14. Comparison between perioperative and postoperative chemotherapy after potentially curative hepatic resection for metastatic colorectal cancer.
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Araujo R, Gonen M, Allen P, Blumgart L, DeMatteo R, Fong Y, Kemeny N, Jarnagin W, and D'Angelica M
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- Aged, Colorectal Neoplasms mortality, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Liver Neoplasms mortality, Liver Neoplasms secondary, Liver Neoplasms surgery, Male, Middle Aged, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Neoplasm Staging, Perioperative Period, Postoperative Period, Prognosis, Prospective Studies, Retrospective Studies, Survival Rate, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Colorectal Neoplasms drug therapy, Hepatectomy, Liver Neoplasms drug therapy, Neoplasm Recurrence, Local drug therapy
- Abstract
Background: Additional chemotherapy in patients with resectable colorectal liver metastases (CRLM) likely improves outcomes. Whether to administer chemotherapy as perioperative or adjuvant therapy remains controversial. We analyzed outcomes between these two treatment strategies., Methods: Patients were identified from a prospective CRLM database and studied retrospectively. Patients with extrahepatic disease or initially unresectable CRLM were excluded. Only patients receiving oxaliplatin- and/or irinotecan-containing chemotherapy regimens were included. Univariate and Cox regression models were developed for recurrence and death., Results: Between 1998 and 2007, 236 patients (57.4 %) in the adjuvant group and 175 patients (42.6 %) in the perioperative group were compared. The perioperative group was younger and had more tumors, shorter disease-free intervals, and higher clinical risk scores (CRS), but had smaller tumors. The overall survival was similar between the groups (perioperative 72.9 months vs. adjuvant 71.5 months; p = 0.48). When the comparison was adjusted for other clinicopathologic factors and CRS, the differences remained insignificant. On univariate analysis, there was a significant difference in recurrence-free survival between the groups (perioperative 17.2 months vs. adjuvant 27.4 months, p = 0.036). However, when the recurrence-free survival was adjusted for other clinicopathologic factors and the CRS, differences were not significant., Conclusions: The timing of additional chemotherapy for resectable CRLM is not associated with outcomes. Trials comparing adjuvant and perioperative chemotherapy would have to be powered for small differences in outcome.
- Published
- 2013
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15. Synchronous resection of primary and liver metastases for neuroendocrine tumors.
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Gaujoux S, Gonen M, Tang L, Klimstra D, Brennan MF, D'Angelica M, Dematteo R, Allen PJ, Jarnagin W, and Fong Y
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- Female, Follow-Up Studies, Humans, Liver Neoplasms mortality, Liver Neoplasms secondary, Male, Middle Aged, Neoplasm Recurrence, Local mortality, Neoplasm Recurrence, Local pathology, Neoplasm Staging, Neuroendocrine Tumors mortality, Neuroendocrine Tumors pathology, Prognosis, Prospective Studies, Survival Rate, Hepatectomy, Liver Neoplasms surgery, Neoplasm Recurrence, Local surgery, Neuroendocrine Tumors surgery
- Abstract
Background: Surgical approach is an accepted approach for metastatic neuroendocrine tumors (NET), but the safety and effectiveness of synchronous liver metastases resection with primary and/or locally recurrent NET is unclear., Methods: From 1992 to 2009, a total of 36 patients underwent synchronous resection of primary NET or local recurrence and liver metastases. Patients and tumor characteristics, surgical procedures, and postoperative and long-term outcome were reviewed., Results: Primary lesions were solitary in 28 patients (80 %), with a median size of 25 mm. Liver metastases were multiple in 32 cases (89 %), with a bilobar distribution in 29 patients (81 %) and a median size of 62 mm. Resections included gastroduodenal (n = 5), ileocolonic (n = 18), pancreatic resection (n = 13), and major hepatectomy (n = 15). Resections were R0, R1, and R2 in 13, 11, and 12 cases, respectively, and tumors were classified as G1 in 20 (56 %) and G2 in 15 (42 %). There was 1 postoperative death after a Whipple/right trisectionectomy, and postoperative complication occurred in 16 patients (44 %). With a median follow-up of 56 months, 31 patients (89 %) experienced recurrence, which was confined to the liver in 90 %. Reduction of disease to liver only allowed subsequent liver-directed therapy, such as arterial embolization or percutaneous ablation, in 25 patients (71 %). Five-year symptom-free survival and overall survival were 60 %, and 69 %, respectively., Conclusions: In highly selected patients, an initial surgical approach combining simultaneous resection of liver metastases and primary/recurrent tumors can be performed with low mortality. Most patients develop liver-confined recurrence, which is usually amenable to ablative therapies that offer ongoing disease and symptom control.
- Published
- 2012
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16. Impact of obesity and body fat distribution on survival after pancreaticoduodenectomy for pancreatic adenocarcinoma.
- Author
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Gaujoux S, Torres J, Olson S, Winston C, Gonen M, Brennan MF, Klimstra DS, D'Angelica M, DeMatteo R, Fong Y, House M, Jarnagin W, Kurtz RC, and Allen PJ
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- Adenocarcinoma complications, Aged, Blood Loss, Surgical, Body Mass Index, Disease-Free Survival, Female, Humans, Intra-Abdominal Fat, Kaplan-Meier Estimate, Male, Middle Aged, Operative Time, Pancreatic Neoplasms complications, Pancreaticoduodenectomy, Proportional Hazards Models, Statistics, Nonparametric, Survival Rate, Adenocarcinoma surgery, Body Fat Distribution, Obesity complications, Pancreatic Neoplasms surgery
- Abstract
Background: Epidemiologic studies have reported a positive correlation between body mass index (BMI) and pancreatic cancer risk, but clinical relevance of obesity and/or body fat distribution on tumor characteristics and cancer-related outcome remain controversial. We sought to assess the influence of obesity and body fat distribution on pathologic characteristics and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma., Methods: Demographic and biometric data were collected on 328 patients undergoing pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. In a subset of patients, pancreatic fatty infiltration and fibrosis were assessed pathologically, and visceral fat area (VFA) was evaluated. Influence of BMI and body fat distribution on tumor characteristics and survival were evaluated., Results: A significant positive correlation between BMI and VFA was observed, with a wide range of VFA value within each BMI class. According to BMI or VFA distribution, there were no significant differences in patient characteristics, intraoperative or perioperative outcome, or pathologic characteristics, with the exception of significantly higher blood loss in patients with an increased body weight or VFA. Unadjusted overall and disease-free survival between BMI class and VFA quartile were not significantly different., Conclusions: In this study, obesity and body fat distribution were not correlated with specific tumor characteristics or cancer-related outcome.
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- 2012
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17. T cell infiltrate predicts long-term survival following resection of colorectal cancer liver metastases.
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Katz SC, Pillarisetty V, Bamboat ZM, Shia J, Hedvat C, Gonen M, Jarnagin W, Fong Y, Blumgart L, D'Angelica M, and DeMatteo RP
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- Adult, Aged, Aged, 80 and over, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, Colorectal Neoplasms pathology, Colorectal Neoplasms surgery, Female, Humans, Immunoenzyme Techniques, Liver Neoplasms secondary, Liver Neoplasms surgery, Male, Middle Aged, Neoplasm Staging, Prognosis, Prospective Studies, Survival Rate, Time Factors, Colorectal Neoplasms immunology, Colorectal Neoplasms mortality, Liver Neoplasms immunology, Liver Neoplasms mortality, Lymphocytes, Tumor-Infiltrating immunology
- Abstract
Background: While tumor infiltrating lymphocytes (TIL) have been shown to independently predict survival in primary colorectal cancer, the prognostic implications of TIL in resectable colorectal cancer liver metastases (CRCLM) have not been previously defined. This study examines the correlation between TIL numbers and survival following hepatic resection., Methods: We studied patients who survived
or=10 years following CRCLM resection. Immunohistochemistry was performed on tissue microarrays (TMAs) to determine the number of T cells within CRCLM. Correlation between TIL frequency and or=10 year survival was determined while controlling for established prognostic factors., Results: Of 162 patients, 104 survived or=10 years. Independent correlates of 10-year survival following CRCLM resection included a high number of CD8 T cells, a low number of CD4 T cells, and a clinical risk score of - Published
- 2009
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18. Liver resection for metastatic colorectal cancer in patients with concurrent extrahepatic disease: results in 127 patients treated at a single center.
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Carpizo DR, Are C, Jarnagin W, Dematteo R, Fong Y, Gönen M, Blumgart L, and D'Angelica M
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- Adult, Aged, Colorectal Neoplasms pathology, Female, Humans, Liver Neoplasms secondary, Lung Neoplasms secondary, Lymphatic Metastasis, Male, Middle Aged, Neoplasm Invasiveness, Neoplasm Recurrence, Local pathology, Neoplasm Recurrence, Local surgery, Neoplasm Staging, Peritoneal Neoplasms secondary, Prognosis, Prospective Studies, Retrospective Studies, Survival Rate, Treatment Outcome, Colorectal Neoplasms surgery, Hepatectomy, Liver Neoplasms surgery, Lung Neoplasms surgery, Peritoneal Neoplasms surgery
- Abstract
Background: Surgical resection for patients with hepatic and extrahepatic (EHD) colorectal metastases is controversial. We analyzed our experience with hepatic resection in patients with concomitant EHD. The aims were to characterize survival, recurrence rates, and factors associated with outcome., Methods: From 1992 to 2007, 1,369 patients underwent resection of hepatic colorectal metastases, of whom 127 (9%) had concurrent resection of EHD. Survival and recurrence were compared between patients with and without EHD. Survival data were stratified by site of metastatic involvement. Variables potentially associated with survival were analyzed in univariate and multivariate analyses., Results: Median follow-up was 24 months (range 3-152 months). The 3- and 5-year survival for patients with concomitant EHD were 47% and 26%, respectively, compared with 67% and 49%, for those without EHD (P < 0.001). Among the patients with EHD, multivariate analysis identified higher clinical risk score, incomplete resection of all EHD, EHD detected intraoperatively, and having received neoadjuvant chemotherapy to be independently associated with a worse survival. Patients with portal lymph node metastases had worse survival than those with lung or ovarian metastases. Among patients who had a complete resection of all disease, 95% recurred., Conclusion: Concurrent resection of hepatic and EHD in well-selected patients is associated with a possibility of long-term survival. The presence of limited and resectable EHD should not be an absolute contraindication to resection. The site of EHD and the nearly universal recurrence rate must be taken into consideration.
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- 2009
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19. The role of staging laparoscopy in hepatobiliary malignancy: prospective analysis of 401 cases.
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D'Angelica M, Fong Y, Weber S, Gonen M, DeMatteo RP, Conlon K, Blumgart LH, and Jarnagin WR
- Subjects
- Aged, Analysis of Variance, Bile Duct Neoplasms surgery, Female, Humans, Laparotomy, Liver Neoplasms surgery, Logistic Models, Male, Middle Aged, Prospective Studies, Treatment Outcome, Bile Duct Neoplasms pathology, Laparoscopy, Liver Neoplasms pathology, Neoplasm Staging methods
- Abstract
Background: Patients with potentially resectable hepatobiliary malignancy are frequently found to have unresectable tumors at laparotomy. We prospectively evaluated staging laparoscopy in patients with resectable disease on preoperative imaging., Methods: Staging laparoscopy was performed on 410 patients with potentially resectable hepatobiliary malignancy. The preoperative likelihood of resectability was recorded. Data on preoperative imaging, operative findings, and hospital course were analyzed., Results: Laparoscopic inspection was complete in 291 (73%) patients. In total, 153 patients (38%) had unresectable disease, 84 of whom were identified laparoscopically, increasing resectability from 62% to 78%. On multivariate analysis, a complete examination, preoperative likelihood of resection, and primary diagnosis were significant predictors of identifying unresectable disease at laparoscopy. The highest yield was for biliary cancers, and the lowest was for metastatic colorectal cancer. In patients with unresectable disease identified at laparoscopy, the mean hospital stay was 3 days, and postoperative morbidity was 9%, compared with 8 days and 27%, respectively, in patients found to have unresectable disease at laparotomy., Conclusions: Laparoscopy spared one in five patients a laparotomy while reducing hospital stay and morbidity. Targeting laparoscopy to patients at high risk for unresectable disease requires consideration of disease-specific factors; however, the surgeons' preoperative impression of resectability is also important.
- Published
- 2003
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20. Staging laparoscopy for potentially resectable noncolorectal, nonneuroendocrine liver metastases.
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D'Angelica M, Jarnagin W, Dematteo R, Conlon K, Blumgart LH, and Fong Y
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- Adult, Aged, Analysis of Variance, Female, Humans, Liver Neoplasms surgery, Male, Middle Aged, Postoperative Complications, Ultrasonography, Interventional, Hepatectomy, Laparoscopy, Liver Neoplasms pathology, Liver Neoplasms secondary, Neoplasm Staging methods, Patient Selection
- Abstract
Background: Carefully selected patients with noncolorectal, nonneuroendocrine (NCNN) liver metastases may benefit from hepatic resection. The incidence of occult unresectable disease and the possible benefits of staging laparoscopy in these patients are not known., Methods: From December 1997 to July 2000, staging laparoscopy was performed in 30 consecutive patients with NCNN metastases before planned open exploration and resection. Demographics, extent of preoperative imaging, operative and postoperative findings, and factors associated with laparoscopic identification of unresectable disease were analyzed., Results: Twenty-four patients (80%) had a complete laparoscopic examination, and 23 had laparoscopic ultrasonography. All patients underwent preoperative computed tomography or magnetic resonance imaging, and 21 (70%) patients had 2 or more preoperative radiological studies. Overall, nine patients had unresectable disease, six of whom were identified by laparoscopy. Of the remaining 24 patients believed to have resectable disease at laparoscopy, 21 went on to a potentially curative procedure. Laparoscopy did not identify irresectability because of vascular involvement in three patients. Laparoscopy added a median of 30 minutes of operative time to those patients going on to laparotomy., Conclusions: Laparoscopy identified the majority of patients with occult unresectable disease, improved resectability, and should be routine in patients being considered for potentially curative hepatic resection.
- Published
- 2002
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21. Survival after resection of multiple hepatic colorectal metastases.
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Weber SM, Jarnagin WR, DeMatteo RP, Blumgart LH, and Fong Y
- Subjects
- Adult, Aged, Female, Humans, Liver Neoplasms secondary, Male, Middle Aged, New York City epidemiology, Prognosis, Prospective Studies, Severity of Illness Index, Survival Analysis, Colorectal Neoplasms pathology, Liver Neoplasms mortality, Liver Neoplasms surgery
- Abstract
Background: Hepatic resection is potentially curative in selected patients with colorectal metastases. It is a widely held practice that multiple colorectal hepatic metastases are not resected, although outcome after removal of four or more metastases is not well defined., Methods: Patients with four or more colorectal hepatic metastases who submitted to resection were identified from a prospective database. Number of metastases was determined by serial sectioning of the gross specimen at the time of resection. Demographic data, tumor characteristics, complications, and survival were analyzed., Results: From August 1985 to September 1998, 155 patients with four or more metastatic tumors (range 4-20) underwent potentially curative resection by extended hepatectomy (39%), lobectomy (42%), or multiple segmental resections (19%). Operative morbidity and mortality were 26% and 1%, respectively. Actuarial 5-year survival was 23% for the entire group (median = 32 months) and there were 12 actual 5-year survivors. On multivariate analysis, only number of hepatic tumors (P = .005) and the presence of a positive margin (P = .003) were independent predictors of poor survival., Conclusions: Hepatic resection in patients with four or more colorectal metastases can achieve long-term survival although the results are less favorable as the number of tumors increases. Number of hepatic metastases alone should not be used as a sole contraindication to resection, but it is clear that the majority of patients will not be cured after resection of multiple lesions.
- Published
- 2000
- Full Text
- View/download PDF
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