Browsing by Author "Maithel, Shishir K."

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    A novel preoperative risk score to optimize patient selection for performing concomitant liver resection with cytoreductive surgery/HIPEC
    (Wiley, 2021) Lee, Rachel M.; Gamboa, Adriana C.; Turgeon, Michael K.; Zaidi, Mohammad Y.; Kimbrough, Charles; Leiting, Jennifer; Grotz, Travis; Lee, Andrew J.; Fournier, Keith; Powers, Benjamin; Dineen, Sean; Baumgartner, Joel M.; Veerapong, Jula; Mogal, Harveshp; Clarke, Callisia; Wilson, Gregory; Patel, Sameer; Hendrix, Ryan; Lambert, Laura; Pokrzywa, Courtney; Abbott, Daniel E.; LaRocca, Christopher J.; Raoof, Mustafa; Greer, Jonathan; Johnston, Fabian M.; Staley, Charles A.; Cloyd, Jordan M.; Maithel, Shishir K.; Russell, Maria C.; Surgery, School of Medicine
    Background: While parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), liver resection (LR) is increasingly performed with CRS/HIPEC. Methods: Patients from the US HIPEC Collaborative (2000-2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0-1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival (OS). Results: A total of 658 patients were included. About 83 (15%) underwent LR of colorectal (58%) or invasive appendiceal (42%) metastases. LR patients had more complications (81% vs. 60%; p = .001), greater number of complications (2.3 vs. 1.5; p < .001) per patient and required more reoperations (22% vs. 11%; p = .007) and readmissions (39% vs. 25%; p = .014) than non-LR patients. LR patients had decreased OS (2-year OS 62% vs. 79%, p < .001), even when accounting for peritoneal carcinomatosis index and histology type. Preoperative factors associated with decreased OS on multivariable analysis in LR patients included age < 60 years (HR, 3.61; 95% CI, 1.10-11.81), colorectal histology (HR, 3.84; 95% CI, 1.69-12.65), and multiple liver tumors (HR, 3.45; 95% CI, 1.21-9.85) (all p < .05). When assigning one point for each factor, there was an incremental decrease in 2-year survival as the risk score increased from 0 to 3 (0: 100%; 1: 91%; 2: 58%; 3: 0%). Conclusions: As CRS/HIPEC + LR has become more common, we created a simple risk score to stratify patients considered for CRS/HIPEC + LR. These data aid in striking the balance between an increased perioperative complication profile with the potential for improvement in OS.
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    Differences in preoperative frailty assessment of surgical candidates by sex, age, and race
    (Elsevier, 2024-05-11) Nicaise, Edouard H.; Palmateer, Gregory; Schmeusser, Benjamin N.; Futral, Cameron; Liu, Yuan; Goyal, Subir; Nabavizadeh, Reza; Kooby, David A.; Maithel, Shishir K.; Sweeney, John F.; Sarmiento, Juan M.; Ogan, Kenneth; Master, Viraj A.; Urology, School of Medicine
    Introduction: Surgical decision-making often relies on a surgeon's subjective assessment of a patient's frailty status to undergo surgery. Certain patient demographics can influence subjective judgment when compared to validated objective assessments. In this study, we explore the relationship between subjective and objective frailty assessments according to patient age, sex, and race. Methods: Patients were prospectively enrolled in urology, general surgery, and surgical oncology clinics. Using a visual analog scale (0-100), operating surgeons independently rated the patient's frailty status. Objective frailty was classified using the Fried Frailty Criteria ranging from 0 to 5. Multivariable proportional odds models were conducted to examine the potential association of factors with objective frailty, according to surgeon frailty rating. Subgroup analysis according to patient sex, race, and age was also performed. Results: Seven male surgeons assessed 203 patients preoperatively with a median age of 65. A majority of patients were male (61 %), white (67 %), and 60 % and 40 % underwent urologic and general surgery/surgical oncology procedures respectively. Increased subjective surgeon rating (OR 1.69; p < 0.001) was significantly associated with the presence of objective frailty. On subgroup analysis, a higher magnitude of such association was observed more in females (OR 1.86; p = 0.0007), non-white (OR 1.84; p = 0.0019), and older (>60, OR 1.75; p = 0.0001) patients, compared to male (OR 1.45; p = 0.0243), non-white (OR 1.48; p = 0.0109) and patients under 60 (OR 1.47; p = 0.0823). Conclusion: The surgeon's subjective assessment of frailty demonstrated tendencies to rate older, female, and non-white patients as frail; however, differences in patient sex, age, and race were not statistically significant.
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    Optimal Timing of Administration of Direct-Acting Antivirals for Patients with Hepatitis C-Associated Hepatocellular Carcinoma Undergoing Liver Transplantation
    (Wolters Kluwer, 2021-10) Turgeon, Michael K.; Shah, Shimul A.; Delman, Aaron M.; Tran, Benjamin V.; Agopian, Vatche G.; Wedd, Joel P.; Magliocca, Joseph F.; Kim, Ahyoung; Cameron, Andrew; Olyaei, Ali; Orloff, Susan L.; Anderson, Matthew P.; Kubal, Chandrashekhar A.; Cannon, Robert M.; Locke, Jayme E.; Simpson, Mary A.; Akoad, Mohamed E.; Wongjirad, Chelsey P.; Emamaullee, Juliet; Moro, Amika; Aucejo, Federico; Feizpour, Cyrus A.; Vagefi, Parsia A.; Nguyen, Mindie H.; Esquivel, Carlos O.; Dhanireddy, Kiran; Subramanian, Vijay; Chavarriaga, Alejandro; Kazimi, Marwan M.; Anderson, Maia S.; Sonnenday, Christopher J.; Kim, Steven C.; Foley, David P.; Abdouljoud, Marwan; Salgia, Reena J.; Moris, Dimitrios; Sudan, Debra L.; Ganesh, Swaytha R.; Humar, Abhinav; Doyle, Majella; Chapman, William C.; Maithel, Shishir K.; Surgery, School of Medicine
    Objective: To investigate the optimal timing of direct acting antiviral (DAA) administration in patients with hepatitis C-associated hepatocellular carcinoma (HCC) undergoing liver transplantation (LT). Summary of Background Data: In patients with hepatitis C (HCV) associated HCC undergoing LT, the optimal timing of direct-acting antivirals (DAA) administration to achieve sustained virologic response (SVR) and improved oncologic outcomes remains a topic of much debate. Methods: The United States HCC LT Consortium (2015–2019) was reviewed for patients with primary HCV-associated HCC who underwent LT and received DAA therapy at 20 institutions. Primary outcomes were SVR and HCC recurrence-free survival (RFS). Results: Of 857 patients, 725 were within Milan criteria. SVR was associated with improved 5-year RFS (92% vs 77%, P < 0.01). Patients who received DAAs pre-LT, 0–3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 92%, and 82%, and 5-year RFS of 93%, 94%, and 87%, respectively. Among 427 HCV treatment-naïve patients (no previous interferon therapy), patients who achieved SVR with DAAs had improved 5-year RFS (93% vs 76%, P < 0.01). Patients who received DAAs pre-LT, 0–3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 93%, and 78% (P < 0.01) and 5-year RFS of 93%, 100%, and 83% (P = 0.01). Conclusions: The optimal timing of DAA therapy appears to be 0 to 3 months after LT for HCV-associated HCC, given increased rates of SVR and improved RFS. Delayed administration after transplant should be avoided. A prospective randomized controlled trial is warranted to validate these results.