32 results on '"Berry, Mark"'
Search Results
2. Commentary: Re-consult surgery for patients with lung cancer? The role of resection after initial nonoperative therapy.
- Author
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Lin N and Berry MF
- Subjects
- Humans, Treatment Outcome, Clinical Decision-Making, Referral and Consultation, Lung Neoplasms surgery, Lung Neoplasms therapy, Lung Neoplasms pathology, Pneumonectomy adverse effects
- Abstract
Competing Interests: Conflict of Interest Statement The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.
- Published
- 2024
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3. Positron emission tomography/computed tomography differentiates resectable thymoma from anterior mediastinal lymphoma.
- Author
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Byrd CT, Trope WL, Bhandari P, Konsker HB, Moradi F, Lui NS, Liou DZ, Backhus LM, Berry MF, and Shrager JB
- Subjects
- Humans, Retrospective Studies, Reproducibility of Results, Positron Emission Tomography Computed Tomography, Positron-Emission Tomography methods, Fluorodeoxyglucose F18, Radiopharmaceuticals, Thymoma diagnostic imaging, Thymoma surgery, Thymoma pathology, Thymus Neoplasms diagnostic imaging, Thymus Neoplasms surgery, Thymus Neoplasms pathology, Mediastinal Neoplasms diagnostic imaging, Mediastinal Neoplasms surgery, Mediastinal Neoplasms pathology, Lymphoma diagnostic imaging, Lymphoma surgery
- Abstract
Objective: 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., Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
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4. Influence of facility volume on long-term survival of patients undergoing esophagectomy for esophageal cancer.
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Patel DC, Jeffrey Yang CF, He H, Liou DZ, Backhus LM, Lui NS, Shrager JB, and Berry MF
- Subjects
- Adenocarcinoma mortality, Adenocarcinoma surgery, Aged, Carcinoma, Squamous Cell mortality, Carcinoma, Squamous Cell surgery, Female, Humans, Male, Middle Aged, Multivariate Analysis, United States epidemiology, Esophageal Neoplasms mortality, Esophageal Neoplasms surgery, Esophagectomy statistics & numerical data, Hospitals, High-Volume
- Abstract
Objective: This study investigated the influence of facility volume on long-term survival in patients with esophageal cancer treated with esophagectomy., Methods: 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., Results: 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)., Conclusions: Esophageal cancer patients treated with esophagectomy at higher volume facilities have significantly better long-term survival than patients treated at lower volume facilities., (Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2022
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5. Reply: The importance of appropriate selection for segmentectomy.
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Jeffrey Yang CF and Berry MF
- Subjects
- Humans, Pneumonectomy, Thoracic Surgery, Video-Assisted, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms surgery
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- 2020
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6. A national analysis of open versus minimally invasive thymectomy for stage I to III thymoma.
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Yang CJ, Hurd J, Shah SA, Liou D, Wang H, Backhus LM, Lui NS, D'Amico TA, Shrager JB, and Berry MF
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- Adult, Aged, Databases, Factual, Female, Humans, Length of Stay, Male, Margins of Excision, Middle Aged, Neoplasm Staging, Patient Readmission, Retrospective Studies, Risk Assessment, Risk Factors, Thymectomy adverse effects, Thymectomy mortality, Thymoma mortality, Thymoma pathology, Thymus Neoplasms mortality, Thymus Neoplasms pathology, Time Factors, Treatment Outcome, United States, Robotic Surgical Procedures adverse effects, Robotic Surgical Procedures mortality, Thoracic Surgery, Video-Assisted adverse effects, Thoracic Surgery, Video-Assisted mortality, Thymectomy methods, Thymoma surgery, Thymus Neoplasms surgery
- Abstract
Objective: 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., Methods: 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., Results: 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., Conclusions: 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., (Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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7. Discussion.
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Berry MF
- Published
- 2020
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8. Commentary: Resection of clinical early-stage lung cancer with unexpected nodal disease-can less really be the same?
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Yang CJ and Berry MF
- Subjects
- Humans, Mastectomy, Segmental, Neoplasm Staging, Pneumonectomy, Carcinoma, Non-Small-Cell Lung, Lung Neoplasms
- Published
- 2020
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9. The influence of hormone replacement therapy on lung cancer incidence and mortality.
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Titan AL, He H, Lui N, Liou D, Berry M, Shrager JB, and Backhus LM
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- Aged, Carcinoma, Non-Small-Cell Lung pathology, Cohort Studies, Female, Humans, Incidence, Kaplan-Meier Estimate, Lung Neoplasms pathology, Middle Aged, Proportional Hazards Models, Survival Rate, Carcinoma, Non-Small-Cell Lung epidemiology, Carcinoma, Non-Small-Cell Lung therapy, Hormone Replacement Therapy, Lung Neoplasms epidemiology, Lung Neoplasms therapy
- Abstract
Objective: 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., Methods: 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., Results: 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., Conclusions: 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., (Published by Elsevier Inc.)
- Published
- 2020
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10. Discussion.
- Author
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Berry MF
- Subjects
- Humans, Propensity Score, Carcinoma, Non-Small-Cell Lung, Lung Neoplasms, Robotic Surgical Procedures, Robotics
- Published
- 2019
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11. The role of thoracoscopic pneumonectomy in the management of non-small cell lung cancer: A multicenter study.
- Author
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Yang CJ, Yendamuri S, Mayne NR, Battoo A, Wang H, Meyerhoff RR, Vandusen K, Hirji SA, Berry MF, McKenna RJ Jr, Demmy TL, and D'Amico TA
- Subjects
- Carcinoma, Non-Small-Cell Lung mortality, Female, Humans, Intention to Treat Analysis, Logistic Models, Lung Neoplasms mortality, Male, Middle Aged, Propensity Score, Proportional Hazards Models, Retrospective Studies, Survival Analysis, Thoracotomy methods, Thoracotomy mortality, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms surgery, Pneumonectomy methods, Pneumonectomy mortality, Thoracic Surgery, Video-Assisted methods, Thoracic Surgery, Video-Assisted mortality
- Abstract
Objective: The objective of this study was to evaluate the impact of the video-assisted thoracoscopic (VATS) approach on the outcomes of patients who underwent pneumonectomy., Methods: The effect of the surgical approach on perioperative complications and survival in patients who underwent pneumonectomy for nonmetastatic non-small cell lung cancer across 3 institutions (2000-2016) was assessed using multivariable logistic regression, Cox proportional hazards analysis, and propensity-score matching. Completion pneumonectomies were excluded from this study, and an "intent-to-treat" analysis was performed., Results: During the study period, 359 patients met inclusion criteria and underwent pneumonectomy for nonmetastatic non-small cell lung cancer; 124 (35%) underwent pneumonectomy via VATS and 235 (65%) via thoracotomy. Perioperative mortality (VATS, 7% [n = 9] vs open, 8% [n = 19]; P = .75) and morbidity (VATS, 28% [n = 35] vs open, 28% [n = 65]; P = .91) were similar between the groups, even after multivariable adjustment. VATS showed similar 5-year survival when compared with thoracotomy in unadjusted analysis (47% [95% confidence interval (CI), 36-56] vs 33% [95% CI, 27-40]; P = .19), even after multivariable adjustment (hazard ratio, 0.76 [95% CI, 0.50-1.18]; P = .23). In a propensity score-matched analysis that balanced patient characteristics, there were no significant differences found in overall survival between the 2 groups (P = .69)., Conclusions: Although the role of VATS pneumonectomy will likely become clearer as more surgeons report results, this multicenter study suggests that the VATS approach for pneumonectomy can be performed safely, with at least equivalent oncologic outcomes when compared with thoracotomy., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2019
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12. The impact of postoperative therapy on primary cardiac sarcoma.
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Wu Y, Million L, Moding EJ, Scott G, Berry M, and Ganjoo KN
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- Adult, Aged, Chemotherapy, Adjuvant, Disease Progression, Female, Heart Neoplasms diagnostic imaging, Heart Neoplasms mortality, Heart Neoplasms pathology, Humans, Male, Middle Aged, Neoplasm Staging, Progression-Free Survival, Radiotherapy, Adjuvant, Retrospective Studies, Risk Assessment, Risk Factors, Sarcoma diagnostic imaging, Sarcoma mortality, Sarcoma secondary, Time Factors, Tomography, X-Ray Computed, Young Adult, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures mortality, Chemoradiotherapy, Adjuvant adverse effects, Chemoradiotherapy, Adjuvant mortality, Heart Neoplasms surgery, Sarcoma surgery
- Abstract
Objective: Primary cardiac sarcomas (PCS) are extremely rare, portend a very poor prognosis, and have limited outcomes data to direct management. This study evaluated the impact of postoperative chemotherapy and/or radiotherapy on survival for PCS., Methods: A retrospective chart review was conducted of 12 patients diagnosed with and who underwent resection for PCS at a single institution between 2000 and 2016. Data were collected on patient/tumor characteristics and analyzed with respect to treatment and outcome using Kaplan-Meier methods., Results: Median age was 43 (range 21-73 years) with a 50:50 male-to-female ratio. The most common subtype was angiosarcoma (42%), and 25% presented with distant metastases (DMs). The initial treatment modality for all patients was surgery, with 58% having macroscopically positive (R2) margins. In total, 75% received postoperative chemotherapy and/or radiotherapy. Median progression-free survival (PFS) was 5.9 months, and median overall survival (OS) was 12.0 months. Achieving negative or microscopically positive margins (R0/R1) as compared with R2 resection significantly improved PFS (12.6 vs 2.7 months, P = .008) and OS (21.8 vs 7.2 months, P = .006). DM at presentation demonstrated a significantly shorter OS (7.0 vs 16.9 months, P = .04) and PFS (0.7 vs 7.9 months, P = .003) compared with localized disease. Patients given postoperative therapy had longer OS compared with surgery only, but this difference was not statistically significant (15.5 vs 2.6 months, P = .12)., Conclusions: Gross total surgical resection can significantly improve PFS and OS in PCS, but DM at diagnosis is an extremely poor prognostic sign. Postoperative therapy should be considered, although this study was likely underpowered to demonstrate a statistically significant benefit., (Copyright © 2018. Published by Elsevier Inc.)
- Published
- 2018
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13. All evidence points to the need for collaborative care.
- Author
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Yerokun BA, Berry MF, and Hartwig MG
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- Cooperative Behavior, Cost-Benefit Analysis, Humans, Carcinoma, Non-Small-Cell Lung, Lung Neoplasms
- Published
- 2018
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14. Induction therapy for locally advanced distal esophageal adenocarcinoma: Is radiation Always necessary?
- Author
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Liou DZ, Backhus LM, Lui NS, Shrager JB, and Berry MF
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- Aged, Esophagectomy, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Adenocarcinoma epidemiology, Adenocarcinoma mortality, Adenocarcinoma therapy, Chemoradiotherapy, Adjuvant mortality, Chemoradiotherapy, Adjuvant statistics & numerical data, Esophageal Neoplasms epidemiology, Esophageal Neoplasms mortality, Esophageal Neoplasms therapy, Induction Chemotherapy mortality, Induction Chemotherapy statistics & numerical data
- 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., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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15. Intraoperative costs of video-assisted thoracoscopic lobectomy can be dramatically reduced without compromising outcomes.
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Richardson MT, Backhus LM, Berry MF, Vail DG, Ayers KC, Benson JA, Bhandari P, Teymourtash M, and Shrager JB
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- Aged, Cost Savings, Cost-Benefit Analysis, Disposable Equipment economics, Equipment Reuse economics, Female, Humans, Lung Neoplasms pathology, Male, Middle Aged, Neoplasm Staging, Operative Time, Pneumonectomy instrumentation, Pneumonectomy methods, Retrospective Studies, Surgical Instruments economics, Thoracic Surgery, Video-Assisted instrumentation, Thoracic Surgery, Video-Assisted methods, Thoracotomy instrumentation, Thoracotomy methods, Time Factors, Treatment Outcome, Hospital Costs, Lung Neoplasms economics, Lung Neoplasms surgery, Outcome and Process Assessment, Health Care economics, Pneumonectomy economics, Thoracic Surgery, Video-Assisted economics, Thoracotomy economics
- Abstract
Objective: To determine whether surgeon selection of instrumentation and other supplies during video-assisted thoracoscopic lobectomy (VATSL) can safely reduce intraoperative costs., Methods: In this retrospective, cost-focused review of all video-assisted thoracoscopic surgery anatomic lung resections performed by 2 surgeons at a single institution between 2010 and 2014, we compared VATSL hospital costs and perioperative outcomes between the surgeons, as well as costs of VATSL compared with thoracotomy lobectomy (THORL)., Results: A total of 100 VATSLs were performed by surgeon A, and 70 were performed by surgeon B. The preoperative risk factors did not differ significantly between the 2 groups of surgeries. Mean VATSL total hospital costs per case were 24% percent greater for surgeon A compared with surgeon B (P = .0026). Intraoperative supply costs accounted for most of this cost difference and were 85% greater for surgeon A compared with surgeon B (P < .0001). The use of nonstapler supplies, including energy devices, sealants, and disposables, drove intraoperative costs, accounting for 55% of the difference in intraoperative supply costs between the surgeons. Operative time was 25% longer for surgeon A compared with surgeon B (P < .0001), but this accounted for only 11% of the difference in total cost. Surgeon A's overall VATSL costs per case were similar to those of THORLs (n = 100) performed over the same time period, whereas surgeon B's VATSL costs per case were 24% less than those of THORLs. On adjusted analysis, there was no difference in VATSL perioperative outcomes between the 2 surgeons., Conclusions: The costs of VATSL differ substantially among surgeons and are heavily influenced by the use of disposable equipment/devices. Surgeons can substantially reduce the costs of VATSL to far lower than those of THORL without compromising surgical outcomes through prudent use of costly instruments and technologies., (Copyright © 2017 The American Association for Thoracic Surgery. All rights reserved.)
- Published
- 2018
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16. Survival and risk factors for progression after resection of the dominant tumor in multifocal, lepidic-type pulmonary adenocarcinoma.
- Author
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Gao RW, Berry MF, Kunder CA, Khuong AA, Wakelee H, Neal JW, Backhus LM, and Shrager JB
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- Adenocarcinoma of Lung diagnostic imaging, Adenocarcinoma of Lung mortality, Adenocarcinoma of Lung pathology, Aged, Clinical Decision-Making, Disease Progression, Female, Humans, Lung Neoplasms diagnostic imaging, Lung Neoplasms mortality, Lung Neoplasms pathology, Male, Multiple Pulmonary Nodules diagnostic imaging, Multiple Pulmonary Nodules mortality, Multiple Pulmonary Nodules pathology, Neoplasm Staging, Neoplasm, Residual, Neoplasms, Multiple Primary diagnostic imaging, Neoplasms, Multiple Primary mortality, Neoplasms, Multiple Primary pathology, Patient Selection, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Tumor Burden, Adenocarcinoma of Lung surgery, Lung Neoplasms surgery, Multiple Pulmonary Nodules surgery, Neoplasms, Multiple Primary surgery, Pneumonectomy adverse effects, Pneumonectomy mortality
- Abstract
Background: It remains unclear whether a dominant lung adenocarcinoma that presents with multifocal ground glass opacities (GGOs) should be treated by local therapy. We sought to address survival in this setting and to identify risk factors for progression of unresected GGOs., Methods: Retrospective review of 70 patients who underwent resection of a pN0, lepidic adenocarcinoma, who harbored at least 1 additional GGO. Features associated with GGO progression were determined using logistic regression and survival was evaluated using the Kaplan-Meier method., Results: Subjects harbored 1 to 7 GGOs beyond their dominant tumor (DT). Mean follow-up was 4.1 ± 2.8 years. At least 1 GGO progressed after DT resection in 21 patients (30%). In 11 patients (15.7%), this progression prompted resection (n = 5) or stereotactic radiotherapy (n = 6) at mean 2.8 ± 2.3 years. Several measures of the overall tumor burden were associated with GGO progression (all P values < .03) and with progression prompting intervention (all P values < .01). In logistic regression, greater DT size (odds ratio, 1.07; 95% confidence interval, 1.01-1.14) and an initial GGO > 1 cm (odds ratio, 4.98; 95% confidence interval, 1.15-21.28) were the only factors independently associated with GGO progression. Survival was not negatively influenced by GGO progression (100% with vs 80.7% without; P = .1) or by progression-prompting intervention (P = .4)., Conclusions: At 4.1-year mean follow-up, 15.7% of patients with unresected GGOs after resection of a pN0 DT underwent subsequent intervention for a progressing GGO. Some features correlated with GGO growth, but neither growth, nor need for an intervention, negatively influenced survival. Thus, even those at highest risk for GGO progression should not be denied resection of a DT., (Published by Elsevier Inc.)
- Published
- 2017
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17. A national analysis of wedge resection versus stereotactic body radiation therapy for stage IA non-small cell lung cancer.
- Author
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Yerokun BA, Yang CJ, Gulack BC, Li X, Mulvihill MS, Gu L, Wang X, Harpole DH, D'Amico TA, Berry MF, and Hartwig MG
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- Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung pathology, Female, Humans, Kaplan-Meier Estimate, Lung surgery, Lung Neoplasms mortality, Lung Neoplasms pathology, Male, Middle Aged, Pneumonectomy, Propensity Score, Retrospective Studies, Survival Analysis, Carcinoma, Non-Small-Cell Lung radiotherapy, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms radiotherapy, Lung Neoplasms surgery, Radiosurgery methods
- Abstract
Objective: Lobectomy is considered optimal therapy for early-stage non-small cell lung cancer, but sublobar wedge resection and stereotactic body radiation therapy are alternative treatments. This study compared outcomes between wedge resection and stereotactic body radiotherapy., Methods: Overall survival of patients with cT1N0 and tumors ≤2 cm who underwent stereotactic body radiotherapy or wedge resection in the National Cancer Data Base from 2008 to 2011 was assessed via a Kaplan-Meier and propensity score-matched analysis. A center-level sensitivity analysis that used observed/expected mortality ratios was conducted to identify an association between center use of stereotactic body radiotherapy and mortality., Results: Of the 6295 patients included, 1778 (28.2%) underwent stereotactic body radiotherapy, and 4517 (71.8%) underwent wedge resection. Stereotactic body radiotherapy was associated with significantly reduced 5-year survival compared with wedge resection in both unmatched analysis (30.9% vs 55.2%, P < .001) and after adjustment for covariates (31.0% vs 49.9%, P < .001). Stereotactic body radiotherapy also was associated with worse overall survival than wedge resection after 2 subgroup analyses of propensity-matched patients (P < .05 for both). Centers that used stereotactic body radiotherapy more often as opposed to surgery for patients with cT1N0 patients with tumors <2 cm were more likely to have an observed/expected mortality ratio > 1 for 3-year mortality (P = .034)., Conclusions: In this national analysis, wedge resection was associated with better survival for stage IA non-small cell lung cancer than stereotactic body radiotherapy., (Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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18. Evidence for resection of sarcoma pulmonary metastases: More, but better?
- Author
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Berry MF
- Subjects
- Humans, Lung Neoplasms surgery, Metastasectomy, Sarcoma surgery, Soft Tissue Neoplasms
- Published
- 2017
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19. Video-assisted thoracoscopic diaphragm plication using a running suture technique is durable and effective.
- Author
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Demos DS, Berry MF, Backhus LM, and Shrager JB
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- Aged, Diaphragm diagnostic imaging, Diaphragm physiopathology, Female, Humans, Length of Stay, Male, Middle Aged, Postoperative Complications etiology, Recovery of Function, Respiratory Paralysis diagnostic imaging, Respiratory Paralysis physiopathology, Retrospective Studies, Risk Factors, Time Factors, Treatment Outcome, Diaphragm surgery, Respiratory Paralysis surgery, Suture Techniques, Thoracic Surgery, Video-Assisted adverse effects
- Abstract
Objective: Surgeons have hesitated to adopt minimally invasive diaphragm plication techniques because of technical limitations rendering the procedure cumbersome or leading to early failure or reduced efficacy. We sought to demonstrate efficacy and durability of our thoracoscopic plication technique using a single running suture., Methods: We retrospectively reviewed patients who underwent our technique for diaphragm plication since 2008. We used a single, buttressed, double-layered, to-and-fro running suture with additional plicating horizontal mattress sutures as needed., Results: Eighteen patients underwent thoracoscopic plication from 2008 to 2015. There were no operative mortalities and 2 unrelated late deaths. Median hospital stay was 3 days (range, 1-12). Atrial fibrillation occurred in 1 patient (5.5%), pneumonia occurred in 2 patients (11%), reintubation occurred in 1 patient (5.5%), and ileus occurred in 1 patient (5.5%). Of 14 patients with complete follow-up, median follow-up was 29.4 months (range, 3.4-84.7). Significant increases between preoperative and postoperative pulmonary function tests (% predicted values) were found for mean forced expiratory volume in 1 second (73.5% ± 3.5% to 88.8% ± 4.5%, P = .002) and mean forced vital capacity (70.6% ± 3.5% to 82.3% ± 3.5%, P = .002). Preoperative mean Baseline Dyspnea Index was 8.1 ± 0.7. Mean Transitional Dyspnea Index 6 months postoperatively was 7.1 ± 0.6 (moderate to major improvement). Transitional Dyspnea Index at last contact (median 29.4 months postoperatively) was 7.2 ± 0.6 (P = .38). Compared with previously published results, this is at least equivalent., Conclusions: Thoracoscopic diaphragm plication with a running suture is safe and achieves excellent early and long-term improvements. This addresses technical challenges of tying multiple interrupted sutures by video-assisted thoracoscopic surgery without any apparent compromise to efficacy or durability., (Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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20. Frozen section of N2 nodes is invaluable whenever unexpected suspicious operative findings are encountered.
- Author
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Yang CJ, D'Amico TA, and Berry MF
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- Humans, Lymph Nodes, Retrospective Studies, Frozen Sections, Lymphatic Metastasis
- Published
- 2016
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21. Long-term outcomes after lobectomy for non-small cell lung cancer when unsuspected pN2 disease is found: A National Cancer Data Base analysis.
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Yang CF, Kumar A, Gulack BC, Mulvihill MS, Hartwig MG, Wang X, D'Amico TA, and Berry MF
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- Aged, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung pathology, Cause of Death, Chemotherapy, Adjuvant, Cohort Studies, Databases, Factual, Disease-Free Survival, Female, Follow-Up Studies, Humans, Kaplan-Meier Estimate, Lung Neoplasms drug therapy, Lung Neoplasms pathology, Lymph Nodes surgery, Lymphatic Metastasis, Male, Mediastinum, Middle Aged, Neoplasm Invasiveness pathology, Neoplasm Staging, Perioperative Care methods, Pneumonectomy methods, Retrospective Studies, Statistics, Nonparametric, Survival Analysis, Time Factors, Treatment Outcome, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms mortality, Lung Neoplasms surgery, Lymph Nodes pathology
- Abstract
Objective: There are few studies evaluating whether to proceed with planned resection when a patient with non-small cell lung cancer (NSCLC) unexpectedly is found to have N2 disease at the time of thoracoscopy or thoracotomy. To help guide management of this clinical scenario, we evaluated outcomes for patients who were upstaged to pN2 after lobectomy without induction therapy using the National Cancer Data Base (NCDB)., Methods: Survival of NSCLC patients treated with lobectomy for clinically unsuspected mediastinal nodal disease (cT1-cT3 cN0-cN1, pN2 disease) from 1998-2006 in the NCDB was compared with "suspected" N2 disease patients (cT1-cT3 cN2) who were treated with chemotherapy with or without radiation followed by lobectomy, using matched analysis based on propensity scores., Results: Unsuspected pN2 disease was found in 4.4% of patients (2047 out of 46,691) who underwent lobectomy as primary therapy for cT1-cT3 cN0-cN1 NSCLC. The 5-year survival was 42%, 36%, 21%, and 28% for patients who underwent adjuvant chemotherapy (n = 385), chemoradiation (n = 504), radiation (n = 300), and no adjuvant therapy (n = 858), respectively. Five-year survival of the entire unsuspected pN2 cohort was worse than survival of 2302 patients who were treated with lobectomy after induction therapy for clinical N2 disease (30% vs 40%; P < .001), although no significant difference in 5-year survival was found in a matched-analysis of 655 patients from each group (37% vs 37%; P = .95)., Conclusions: This population-based analysis suggests that, in the setting of unsuspected pN2 NSCLC, proceeding with lobectomy does not appear to compromise outcomes if adjuvant chemotherapy with or without radiation therapy can be administered following surgery., (Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
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22. Risk calculators are useful but....
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Wang X and Berry MF
- Subjects
- Female, Humans, Male, Carcinoma, Non-Small-Cell Lung surgery, Decision Support Techniques, Lung surgery, Lung Neoplasms surgery, Pneumonectomy, Radiosurgery, Thoracic Surgery, Video-Assisted
- Published
- 2016
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23. Large clinical databases for the study of lung cancer: Making up for the failure of randomized trials.
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Yang CJ, Hartwig MG, D'Amico TA, and Berry MF
- Subjects
- Data Mining, Humans, Lung Neoplasms mortality, Lung Neoplasms pathology, Treatment Outcome, Databases, Factual, Evidence-Based Medicine, Lung Neoplasms therapy, Randomized Controlled Trials as Topic
- Published
- 2016
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24. Adding radiation to induction chemotherapy does not improve survival of patients with operable clinical N2 non-small cell lung cancer.
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Yang CF, Gulack BC, Gu L, Speicher PJ, Wang X, Harpole DH, Onaitis MW, D'Amico TA, Berry MF, and Hartwig MG
- Subjects
- Combined Modality Therapy, Female, Humans, Male, Middle Aged, Neoadjuvant Therapy, Neoplasm Staging, Pneumonectomy, Survival Rate, Treatment Outcome, Carcinoma, Non-Small-Cell Lung therapy, Chemoradiotherapy, Induction Chemotherapy, Lung Neoplasms therapy
- Abstract
Objective: Radiotherapy is commonly used in induction regimens for patients with non-small cell lung cancer with operable mediastinal nodal disease, although evidence has not shown a benefit over induction chemotherapy alone. We compared outcomes between induction chemotherapy and induction chemoradiation using the National Cancer Data Base., Methods: Induction radiation use and survival of patients who underwent lobectomy or pneumonectomy after induction chemotherapy for clinical T1-3N2M0 non-small cell lung cancer in the National Cancer Data Base from 2003 to 2006 were assessed using logistic regression, general linear regression, Kaplan-Meier, and Cox proportional hazard analysis., Results: Of 1362 patients who met study criteria, 834 (61%) underwent induction chemoradiation and 528 (39%) underwent induction chemotherapy. Lobectomy was performed in 82% of patients (n = 1111), and pneumonectomy was performed in 18% of patients (n = 251). Pneumonectomy was performed more often after induction chemoradiation than after induction chemotherapy (20% vs 16%, P = .04). Downstaging from N2 to N0/N1 was more common with induction chemoradiation compared with induction chemotherapy (58% vs 46%, P < .01), but 5-year survival of patients receiving induction chemoradiation and patients receiving induction chemotherapy was similar in unadjusted analysis (41% vs 41%, P = .41). In multivariable analysis, the addition of radiation to induction chemotherapy also was not associated with a survival benefit (hazard ratio, 1.03; 95% confidence interval, 0.89-1.18; P = .73)., Conclusions: Induction chemoradiation is used in the majority of patients with non-small cell lung cancer with N2 disease who undergo induction therapy before surgical resection, but it is not associated with improved survival compared with induction chemotherapy., (Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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25. Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons General Thoracic Database.
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Tong BC, Kosinski AS, Burfeind WR Jr, Onaitis MW, Berry MF, Harpole DH Jr, and D'Amico TA
- Subjects
- Aged, Databases, Factual, Female, Hospital Mortality, Humans, Logistic Models, Lung Neoplasms mortality, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Retrospective Studies, Risk Factors, Sex Factors, Societies, Medical, Time Factors, Treatment Outcome, Health Status Disparities, Lung Neoplasms surgery, Thoracic Surgical Procedures adverse effects, Thoracic Surgical Procedures mortality
- Abstract
Objectives: Women with lung cancer have superior long-term survival outcomes compared with men, independent of stage. The cause of this disparity is unknown. For patients undergoing lung cancer resection, these survival differences could be due, in part, to relatively better perioperative outcomes for women. This study was undertaken to determine differences in perioperative outcomes after lung cancer surgery on the basis of sex., Methods: The Society of Thoracic Surgeons' General Thoracic Database was queried for all patients undergoing resection of lung cancer between 2002 and 2010. Postoperative complications were analyzed with respect to sex. Univariable analysis was performed, followed by multivariable modeling to determine significant risk factors for postoperative morbidity and mortality., Results: A total of 34,188 patients (16,643 men and 17,545 women) were considered. Univariable analysis demonstrated statistically significant differences in postoperative complications favoring women in all categories of postoperative complications. Women also had lower in-hospital and 30-day mortality (odds ratio, 0.56; 95% confidence interval, 0.44-0.71; P < .001). Multivariable analysis demonstrated that several preoperative conditions independently predicted 30-day mortality: male sex, increasing age, lower diffusion capacity, renal insufficiency, preoperative radiation therapy, cancer stage, extent of resection, and thoracotomy as surgical approach. Coronary artery disease was an independent predictor of mortality in women but not in men. Thoracotomy as the surgical approach and preoperative radiation therapy were predictive of mortality for men but not for women. Postoperative prolonged air leak and empyema predicted mortality in men but not in women., Conclusions: Women have lower postoperative morbidity and mortality after lung cancer surgery. Some risk factors are sex-specific with regard to mortality. Further study is warranted to determine the cause of these differences and to determine their effect on survival., (Copyright © 2014 The American Association for Thoracic Surgery. All rights reserved.)
- Published
- 2014
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26. Differential prognostic significance of extralobar and intralobar nodal metastases in patients with surgically resected stage II non-small cell lung cancer.
- Author
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Haney JC, Hanna JM, Berry MF, Harpole DH, D'Amico TA, Tong BC, and Onaitis MW
- Subjects
- Aged, Carcinoma, Non-Small-Cell Lung mortality, Combined Modality Therapy, Humans, Lung Neoplasms mortality, Middle Aged, Neoplasm Staging, Prognosis, Retrospective Studies, Survival Rate, Carcinoma, Non-Small-Cell Lung secondary, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms pathology, Lung Neoplasms surgery, Pneumonectomy
- Abstract
Objectives: We sought to determine the prognostic significance of extralobar nodal metastases versus intralobar nodal metastases in patients with lung cancer and pathologic stage N1 disease., Methods: A retrospective review of a prospectively maintained lung resection database identified 230 patients with pathologic stage II, N1 non-small cell lung cancer from 1997 to 2011. The surgical pathology reports were reviewed to identify the involved N1 stations. The outcome variables included recurrence and death. Univariate and multivariate analyses were performed using the R statistical software package., Results: A total of 122 patients had extralobar nodal metastases (level 10 or 11); 108 patients were identified with intralobar nodal disease (levels 12-14). The median follow-up was 111 months. The baseline characteristics were similar in both groups. No significant differences were noted in the surgical approach, anatomic resections performed, or adjuvant therapy rates between the 2 groups. Overall, 80 patients developed recurrence during follow-up: 33 (30%) of 108 in the intralobar and 47 (38%) of 122 in the extralobar cohort. The median overall survival was 46.9 months for the intralobar cohort and 24.4 months for the extralobar cohort (P < .001). In a multivariate Cox proportional hazard model that included the presence of extralobar nodal disease, age, tumor size, tumor histologic type, and number of positive lymph nodes, extralobar nodal disease independently predicted both recurrence-free and overall survival (hazard ratio, 1.96; 95% confidence interval, 1.36-2.81; P = .001)., Conclusions: In patients who underwent surgical resection for stage II non-small cell lung cancer, the presence of extralobar nodal metastases at level 10 or 11 predicted significantly poorer outcomes than did nodal metastases at stations 12 to 14. This finding has prognostic importance and implications for adjuvant therapy and surveillance strategies for patients within the heterogeneous stage II (N1) category., (Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2014
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27. Impact of T status and N status on perioperative outcomes after thoracoscopic lobectomy for lung cancer.
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Villamizar NR, Darrabie M, Hanna J, Onaitis MW, Tong BC, D'Amico TA, and Berry MF
- Subjects
- Adult, Aged, Aged, 80 and over, Chi-Square Distribution, Female, Hospital Mortality, Humans, Logistic Models, Lung Neoplasms mortality, Lung Neoplasms pathology, Lymphatic Metastasis, Male, Middle Aged, Multivariate Analysis, Neoplasm Staging, North Carolina, Pneumonectomy adverse effects, Pneumonectomy mortality, Postoperative Complications mortality, Propensity Score, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, Tumor Burden, Young Adult, Lung Neoplasms surgery, Pneumonectomy methods, Thoracic Surgery, Video-Assisted adverse effects, Thoracic Surgery, Video-Assisted mortality
- Abstract
Objective: We sought to evaluate the effect of tumor size, location, and clinical nodal status on outcomes after thoracoscopic lobectomy for lung cancer., Methods: All patients who underwent attempted thoracoscopic lobectomy for lung cancer between June 1999 and October 2010 at a single institution were reviewed. A model for morbidity including published risk factors as well as tumor size, location, and clinical N status was developed by multivariable logistic regression., Results: During the study period, 916 thoracoscopic lobectomies met study criteria: 329 for peripheral, clinical N0 tumors ≤ 3 cm and 504 for tumors that were central, clinical node positive, or >3 cm. Tumor location could not be documented for 83 patients. Conversions to thoracotomy occurred in 36 patients (4%); patients with clinically node-positive disease had higher conversion rates (11 conversions in 153 clinical N1 to N3 patients [7.2%] vs 25 in 763 clinical N0 patients [3.3%, P = .03]. Overall operative mortality was 1.6% (14 patients) and morbidity was 32% (296 patients). Although patients with larger tumors (P = .006) and central tumors (P = .01) had increased complications by univariate analysis, tumor size >3 cm (P = .17) and central location (P = .5) did not predict significantly overall morbidity in multivariate analysis. Clinical node status did not predict increased complications by univariate or multivariate analysis. Significant predictors of morbidity in multivariable analysis were increasing age, decreasing forced expiratory volume in 1 second, prior chemotherapy, and congestive heart failure., Conclusions: Thoracoscopic lobectomy for lung cancers that are central, clinically node positive, or >3 cm does not confer increased morbidity compared with peripheral, clinical N0 cancers that are <3 cm., (Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2013
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28. Myocardial tissue elastic properties determined by atomic force microscopy after stromal cell-derived factor 1α angiogenic therapy for acute myocardial infarction in a murine model.
- Author
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Hiesinger W, Brukman MJ, McCormick RC, Fitzpatrick JR 3rd, Frederick JR, Yang EC, Muenzer JR, Marotta NA, Berry MF, Atluri P, and Woo YJ
- Subjects
- Animals, Biomechanical Phenomena, Disease Models, Animal, Elastic Modulus, Fibrosis, Heart Ventricles pathology, Heart Ventricles physiopathology, Male, Mice, Myocardial Infarction pathology, Myocardial Infarction physiopathology, Time Factors, Ventricular Remodeling drug effects, Angiogenesis Inducing Agents pharmacology, Chemokine CXCL12 pharmacology, Elasticity Imaging Techniques methods, Heart Ventricles drug effects, Microscopy, Atomic Force, Myocardial Infarction drug therapy, Myocardium pathology, Neovascularization, Physiologic drug effects
- Abstract
Objectives: Ventricular remodeling after myocardial infarction begins with massive extracellular matrix deposition and resultant fibrosis. This loss of functional tissue and stiffening of myocardial elastic and contractile elements starts the vicious cycle of mechanical inefficiency, adverse remodeling, and eventual heart failure. We hypothesized that stromal cell-derived factor 1α (SDF-1α) therapy to microrevascularize ischemic myocardium would rescue salvageable peri-infarct tissue and subsequently improve myocardial elasticity., Methods: Immediately after left anterior descending coronary artery ligation, mice were randomly assigned to receive peri-infarct injection of either saline solution or SDF-1α. After 6 weeks, animals were killed and samples were taken from the peri-infarct border zone and the infarct scar, as well as from the left ventricle of noninfarcted control mice. Determination of tissues' elastic moduli was carried out by mechanical testing in an atomic force microscope., Results: SDF-1α-treated peri-infarct tissue most closely approximated the elasticity of normal ventricle and was significantly more elastic than saline-treated peri-infarct myocardium (109 ± 22.9 kPa vs 295 ± 42.3 kPa; P < .0001). Myocardial scar, the strength of which depends on matrix deposition from vasculature at the peri-infarct edge, was stiffer in SDF-1α-treated animals than in controls (804 ± 102.2 kPa vs 144 ± 27.5 kPa; P < .0001)., Conclusions: Direct quantification of myocardial elastic properties demonstrates the ability of SDF-1α to re-engineer evolving myocardial infarct and peri-infarct tissues. By increasing elasticity of the ischemic and dysfunctional peri-infarct border zone and bolstering the weak, aneurysm-prone scar, SDF-1α therapy may confer a mechanical advantage to resist adverse remodeling after infarction., (Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.)
- Published
- 2012
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29. Persistent N2 disease after neoadjuvant chemotherapy for non-small-cell lung cancer.
- Author
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Higgins KA, Chino JP, Ready N, Onaitis MW, Berry MF, D'Amico TA, and Kelsey CR
- Subjects
- Adult, Aged, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung pathology, Chemotherapy, Adjuvant, Disease-Free Survival, Female, Humans, Kaplan-Meier Estimate, Lung Neoplasms mortality, Lung Neoplasms pathology, Male, Middle Aged, Neoadjuvant Therapy, North Carolina, Radiotherapy, Adjuvant, Retrospective Studies, Risk Assessment, Risk Factors, Survival Rate, Time Factors, Treatment Outcome, Carcinoma, Non-Small-Cell Lung drug therapy, Carcinoma, Non-Small-Cell Lung surgery, Lung Neoplasms drug therapy, Lung Neoplasms surgery, Neoplasm, Residual, Pulmonary Surgical Procedures adverse effects, Pulmonary Surgical Procedures mortality
- Abstract
Objectives: Patients achieving a mediastinal pathologic complete response with neoadjuvant chemotherapy have improved outcomes compared with patients with persistent N2 disease. How to best manage this latter group of patients is unknown, prompting a review of our institutional experience., Methods: All patients who initiated neoadjuvant therapy for non-small-cell lung cancer from 1995 to 2008 were evaluated. The patients were excluded if they had received preoperative radiotherapy, had had a mediastinal pathologic complete response, or had evidence of disease progression after neoadjuvant chemotherapy. The clinical endpoints were calculated using the Kaplan-Meier product-limit method and compared using a log-rank test., Results: A total of 28 patients were identified. The median follow-up period was 24 months. Several neoadjuvant chemotherapy regimens were used, most commonly carboplatin with vinorelbine (36%) or paclitaxel (32%). A partial response to chemotherapy was noted in 23 (82%) and stable disease was noted in 5 (18%) on postchemotherapy imaging. Resection was performed in 22 of 28 patients, consisting of lobectomy in 14, pneumonectomy in 2, and wedge/segmentectomy in 6 (21/22 R0, 1/22 R1). There were no postoperative deaths. Postoperative therapy (radiotherapy and/or additional chemotherapy) was administered to 12 patients (55%). The remaining 6 patients generally received definitive radiotherapy with or without additional chemotherapy. The overall and disease-free survival rate at 1, 3, and 5 years was 75%, 37%, and 37% and 50%, 23%, and 19%, respectively. The survival rate at 5 years was similar between patients undergoing resection (34%) and those receiving definitive radiotherapy with or without chemotherapy (40%; P = .73)., Conclusions: Disease-free and overall survival was sufficiently high to warrant aggressive local therapy (surgery or radiotherapy) in patients with persistent N2 disease after neoadjuvant chemotherapy., (Copyright © 2011. Published by Mosby, Inc.)
- Published
- 2011
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30. Stromal cell-derived factor and granulocyte-monocyte colony-stimulating factor form a combined neovasculogenic therapy for ischemic cardiomyopathy.
- Author
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Woo YJ, Grand TJ, Berry MF, Atluri P, Moise MA, Hsu VM, Cohen J, Fisher O, Burdick J, Taylor M, Zentko S, Liao G, Smith M, Kolakowski S, Jayasankar V, Gardner TJ, and Sweeney HL
- Subjects
- Animals, Cardiomyopathies etiology, Cardiomyopathies physiopathology, Chemokine CXCL12, Male, Models, Animal, Myocardial Ischemia complications, Rats, Ventricular Function drug effects, Ventricular Remodeling drug effects, Angiogenesis Inducing Agents pharmacology, Cardiomyopathies drug therapy, Chemokines, CXC pharmacology, Granulocyte-Macrophage Colony-Stimulating Factor pharmacology, Neovascularization, Physiologic drug effects
- Abstract
Objective: Ischemic heart failure is an increasingly prevalent global health concern with major morbidity and mortality. Currently, therapies are limited, and novel revascularization methods might have a role. This study examined enhancing endogenous myocardial revascularization by expanding bone marrow-derived endothelial progenitor cells with the marrow stimulant granulocyte-monocyte colony-stimulating factor and recruiting the endothelial progenitor cells with intramyocardial administration of the potent endothelial progenitor cell chemokine stromal cell-derived factor., Methods: Ischemic cardiomyopathy was induced in Lewis rats (n = 40) through left anterior descending coronary artery ligation. After 3 weeks, animals were randomized into 4 groups: saline control, granulocyte-monocyte colony-stimulating factor only (GM-CSF only), stromal cell-derived factor only (SDF only), and combined stromal cell-derived factor/granulocyte-monocyte colony-stimulating factor (SDF/GM-CSF) (n = 10 each). After another 3 weeks, hearts were analyzed for endothelial progenitor cell density by endothelial progenitor cell marker colocalization immunohistochemistry, vasculogenesis by von Willebrand immunohistochemistry, ventricular geometry by hematoxylin-and-eosin microscopy, and in vivo myocardial function with an intracavitary pressure-volume conductance microcatheter., Results: The saline control, GM-CSF only, and SDF only groups were equivalent. Compared with the saline control group, animals in the SDF/GM-CSF group exhibited increased endothelial progenitor cell density (21.7 +/- 3.2 vs 9.6 +/- 3.1 CD34 + /vascular endothelial growth factor receptor 2-positive cells per high-power field, P = .01). There was enhanced vascularity (44.1 +/- 5.5 versus 23.8 +/- 2.2 von Willebrand factor-positive vessels per high-power field, P = .007). SDF/GM-CSF group animals experienced less adverse ventricular remodeling, as manifested by less cavitary dilatation (9.8 +/- 0.1 mm vs 10.1 +/- 0.1 mm [control], P = .04) and increased border-zone wall thickness (1.78 +/- 0.19 vs 1.41 +/- 0.16 mm [control], P = .03). (SDF/GM-CSF group animals had improved cardiac function compared with animals in the saline control group (maximum pressure: 93.9 +/- 3.2 vs 71.7 +/- 3.1 mm Hg, P < .001; maximum dP/dt: 3513 +/- 303 vs 2602 +/- 201 mm Hg/s, P < .05; cardiac output: 21.3 +/- 2.7 vs 13.3 +/- 1.3 mL/min, P < .01; end-systolic pressure-volume relationship slope: 1.7 +/- 0.4 vs 0.5 +/- 0.2 mm Hg/microL, P < .01.), Conclusion: This novel revascularization strategy of bone marrow stimulation and intramyocardial delivery of the endothelial progenitor cell chemokine stromal cell-derived factor yielded significantly enhanced myocardial endothelial progenitor cell density, vasculogenesis, geometric preservation, and contractility in a model of ischemic cardiomyopathy.
- Published
- 2005
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31. Targeted overexpression of leukemia inhibitory factor to preserve myocardium in a rat model of postinfarction heart failure.
- Author
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Berry MF, Pirolli TJ, Jayasankar V, Morine KJ, Moise MA, Fisher O, Gardner TJ, Patterson PH, and Woo YJ
- Subjects
- Adenoviridae genetics, Animals, Gene Expression, Gene Transfer Techniques, Heart Rupture, Post-Infarction pathology, Heart Ventricles pathology, In Situ Nick-End Labeling, Leukemia Inhibitory Factor, Male, Myocytes, Cardiac metabolism, Rats, Ventricular Pressure, Heart Rupture, Post-Infarction metabolism, Heart Rupture, Post-Infarction therapy, Interleukin-6 metabolism, Myocardium metabolism
- Abstract
Objective: Myocardial infarction leads to cardiomyocyte loss. The cytokine leukemia inhibitory factor regulates the differentiation and growth of embryonic and adult heart tissue. This study examined the effects of gene transfer of leukemia inhibitory factor in infarcted rat hearts., Methods: Lewis rats underwent ligation of the left anterior descending coronary artery and direct injection of adenovirus encoding leukemia inhibitory factor (n = 10) or null transgene as control (n = 10) into the myocardium bordering the ischemic area. A sham operation group (n = 10) underwent thoracotomy without ligation. After 6 weeks, the following parameters were evaluated: cardiac function with a pressure-volume conductance catheter, left ventricular geometry and architecture by histologic methods; myocardial fibrosis by Masson trichrome staining, apoptosis by terminal deoxynucleotidal transferase-mediated deoxyuridine triphosphate nick-end labeling assay, and cardiomyocyte size by immunofluorescence., Results: Rats with overexpression of leukemia inhibitory factor had more preserved myocardium and less fibrosis in both the infarct and its border zone. The border zone in leukemia inhibitory factor-treated animals contained fewer apoptotic nuclei (1.6% +/- 0.1% vs 3.3% +/- 0.2%, P < .05) than that in control animals and demonstrated cardiomyocytes with larger cross-sectional areas (910 +/- 60 microm 2 vs 480 +/- 30 microm 2 , P < .05). Leukemia inhibitory factor-treated animals had increased left ventricular wall thickness (2.1 +/- 0.1 mm vs 1.8 +/- 0.1 mm, P < .05) and less dilation of the left ventricular cavity (237 +/- 22 microL vs 301 +/- 16 microL, P < .05). They also had improved cardiac function, as measured by maximum change in pressure over time (3950 +/- 360 mm Hg/s vs 2750 +/- 230 mm Hg/s, P < .05) and the slopes of the maximum change in pressure over time-end-diastolic volume relationship (68 +/- 5 mm Hg/[s . microL] vs 46 +/- 6 mm Hg/[s . microL], P < .05) and the preload recruitable stroke work relationship (89 +/- 10 mm Hg vs 44 +/- 4 mm Hg, P < .05)., Conclusions: Myocardial gene transfer of leukemia inhibitory factor preserved cardiac tissue, geometry, and function after myocardial infarction in rats.
- Published
- 2004
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32. Ethyl pyruvate preserves cardiac function and attenuates oxidative injury after prolonged myocardial ischemia.
- Author
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Woo YJ, Taylor MD, Cohen JE, Jayasankar V, Bish LT, Burdick J, Pirolli TJ, Berry MF, Hsu V, and Grand T
- Subjects
- Adenosine Triphosphate metabolism, Animals, Hemodynamics, Lipid Peroxidation, Male, Myocardial Reperfusion Injury metabolism, Myocardial Reperfusion Injury pathology, Myocardial Reperfusion Injury physiopathology, Myocardium metabolism, Myocardium pathology, Rats, Rats, Wistar, Cardiotonic Agents administration & dosage, Myocardial Reperfusion Injury prevention & control, Pyruvates administration & dosage
- Abstract
Objective: Myocardial injury and dysfunction following ischemia are mediated in part by reactive oxygen species. Pyruvate, a key glycolytic intermediary, is an effective free radical scavenger but unfortunately is limited by aqueous instability. The ester derivative, ethyl pyruvate, is stable in solution and should function as an antioxidant and energy precursor. This study sought to evaluate ethyl pyruvate as a myocardial protective agent in a rat model of ischemia-reperfusion injury., Methods: Rats underwent 30-minute ischemia and 30-minute reperfusion of the left anterior descending coronary artery territory. Immediately prior to both ischemia and reperfusion, animals received an intravenous bolus of either ethyl pyruvate (n = 26) or vehicle control (n = 26). Myocardial high-energy phosphate levels were determined by adenosine triphosphate assay, oxidative injury was measured by lipid peroxidation assay, infarct size was quantified by triphenyltetrazolium chloride staining, and cardiac function was assessed in vivo., Results: Ethyl pyruvate administration significantly increased myocardial adenosine triphosphate levels compared with control (87.6 +/- 29.2 nmol/g vs 10.0 +/- 2.4 nmol/g, P =.03). In ischemic myocardium, ethyl pyruvate reduced oxidative injury compared with control (63.8 +/- 3.3 nmol/g vs 89.5 +/- 3.0 nmol/g, P <.001). Ethyl pyruvate diminished infarct size as a percentage of area at risk (25.3% +/- 1.5% vs 33.6% +/- 2.1%, P =.005). Ethyl pyruvate improved myocardial function compared with control (maximum pressure: 86.6 +/- 2.9 mm Hg vs 73.5 +/- 2.5 mm Hg, P <.001; maximum rate of pressure rise: 3518 +/- 243 mm Hg/s vs 2703 +/- 175 mm Hg/s, P =.005; maximal rate of ventricular systolic volume ejection: 3097 +/- 479 microL/s vs 2120 +/- 287 microL/s, P =.04; ejection fraction: 41.9% +/- 3.8% vs 31.4% +/- 4.1%, P =.03; cardiac output: 26.7 +/- 0.9 mL/min vs 22.7 +/- 1.3 mL/min, P =.01; and end-systolic pressure-volume relationship slope: 1.09 +/- 0.22 vs 0.59 +/- 0.2, P =.02)., Conclusions: In this study of myocardial ischemia-reperfusion injury, ethyl pyruvate enhanced myocardial adenosine triphosphate levels, attenuated myocardial oxidative injury, decreased infarct size, and preserved cardiac function.
- Published
- 2004
- Full Text
- View/download PDF
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