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  • ASO Visual Abstract: Impact of Delaying Surgery After Chemoradiation on Outcomes for Locally Advanced Esophageal Squamous Cell Carcinoma. Annals of surgical oncology Wong, L. Y., Liou, D. Z., Vitzthum, L. K., Backhus, L. M., Lui, N. S., Chang, D., Shrager, J. B., Berry, M. F. 2023

    View details for DOI 10.1245/s10434-023-13156-5

    View details for PubMedID 36759429

  • The Impact of Age and Need for Emergent Surgery in Paraesophageal Hernia Repair Outcomes. The Annals of thoracic surgery Wong, L. Y., Parsons, N., David, E. A., Burfeind, W., Berry, M. F. 2023

    Abstract

    Observation of paraesophageal hernias (PEH) may lead to emergent surgery for hernia-related complications. This study evaluated urgent/emergent repair outcomes to quantify the possible sequelae of failed conservative PEH management.The impact of operative status (Elective vs. Urgent/Emergent) on perioperative mortality or major morbidity for patients who underwent hiatal hernia repair for a paraesophageal hernia diagnosis from 2012-2021 in the Society of Thoracic Surgery General Thoracic Surgery Database was evaluated with multivariable logistic regression models.Overall, 2,082 (10.9%) of 19,122 PEH patients underwent Urgent/Emergent repair. Non-elective surgery patients were significantly older than elective surgery patients (median age 73 years [IQR 63-82] versus 66 [58-74]) and had a lower preoperative performance score (p<0.001). Non-elective surgeries were more likely to be done through the chest or via laparotomy rather than via laparoscopy (20% versus 11.4%, p<0.001) and were associated with longer hospitalizations (4 days vs 2, p<0.001), higher operative mortality (4.5% vs 0.6%, p<0.001), and higher major morbidity (27% versus 5.5%, p<0.001). Non-elective surgery was a significant independent predictor of major morbidity in multivariable analysis (odds ratio 2.06, p<0.001). Patients over the age of 80 had higher operative mortality (4.3% vs 0.6%, p<0.001) and major morbidity (19% vs 6.1%, p<0.001) than younger patients overall, and more often had non-elective surgery (26% vs 8.6%, p<0.001) CONCLUSIONS: The operative morbidity of PEH repair is significantly increased when surgery is non-elective, particularly for older patients. These results can inform the potential consequences of choosing watchful waiting versus elective PEH repair.

    View details for DOI 10.1016/j.athoracsur.2023.01.017

    View details for PubMedID 36702291

  • ASO Author Reflections: Timing of Surgery and Chemoradiation for Esophageal Squamous Cell Carcinoma. Annals of surgical oncology Wong, L., Berry, M. F. 2023

    View details for DOI 10.1245/s10434-022-13048-0

    View details for PubMedID 36607525

  • Impact of Delaying Surgery After Chemoradiation on Outcomes for Locally Advanced Esophageal Squamous Cell Carcinoma. Annals of surgical oncology Wong, L., Liou, D. Z., Vitzthum, L. K., Backhus, L. M., Lui, N. S., Chang, D., Shrager, J. B., Berry, M. F. 2022

    Abstract

    BACKGROUND: Performing selective esophagectomy for locally advanced squamous cell carcinoma may spare patients morbidity, but delayed surgery may infer higher risks. This study evaluated the impact of length of time between chemoradiation and esophagectomy on perioperative outcomes and long-term survival.METHODS: The impact of surgical timing, stratified by surgery performed < 180 and ≥ 180 days from starting radiation, on perioperative outcomes and survival in patients treated with chemoradiation and esophagectomy for cT1N + M0 and cT2-4, any N, M0 squamous cell carcinoma of the mid-distal esophagus in the National Cancer Database (2006-2016) was evaluated with logistic regression, Kaplan-Meier curves, Cox proportional-hazards methods, and propensity-matched analysis.RESULTS: Median time between starting radiation and esophagectomy in 1641 patients was 93 (IQR 81-114) days. Most patients (96.8%, n = 1589) had surgery within 180 days of starting radiation, while 52 patients (3.2%) had delayed surgery. Black race and clinical T stage were associated with delayed surgery. Rates of pathologic upstaging, downstaging, complete response, and positive margins were not significantly different between the groups. Patients with delayed surgery had increased major morbidity as measured by a composite of length of hospital stay, readmission, and 30-day mortality [42.3% (22/52) vs 22.3% (355/1589), p = 0.001]. However, delayed surgery was not associated with a significant difference in survival in both univariate [5-year survival 32.8% (95% CI 21.1-50.7) vs 47.3% (44.7-50.1), p = 0.19] and multivariable analysis [hazard ratio (HR) 1.23 (0.85-1.78), p = 0.26].CONCLUSIONS: Delaying surgery longer than 180 days after starting chemoradiation for esophageal squamous cell carcinoma is associated with worse perioperative outcomes but not long-term survival.

    View details for DOI 10.1245/s10434-022-12980-5

    View details for PubMedID 36572807