Rejoice F Ngongoni
Affiliate, Department Funds
Resident in Graduate Medical Education
All Publications
-
Association of Care Fragmentation and Hospital Cancer Designation with Survival in Gastroesophageal Junction Cancer: A State-Wide Study.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
2025: 101962
Abstract
BACKGROUND: Fragmentation of care (FC) is healthcare provided by different providers and/or facilities. FC has been associated with inferior outcomes, yet it improves access to specialized cancer care. We aim to identify the association of fragmented gastroesophageal junction cancer (GEJ) care with survival.METHODS: In this retrospective cohort study, adults diagnosed with primary GEJ cancer between January 1, 2007, and December 31, 2017, were identified in the California Cancer Registry (patient data) and merged with the California Healthcare Access and Information database (facility-level data for each patient encounter). FC was measured by quantity, defined as the number of facilities a patient visited within 1year post-diagnosis, and FC directionality, defined by how patients transitioned across different healthcare facilities (with/without cancer center designation). Multivariable time-varying Cox regression models were performed to determine the association of FC with survival which were expressed as hazard ratios (HR).RESULTS: A total of 6025 patients were identified. Of the 2919 (48.4%) patients who experienced FC, 1979 (67.8%) were seen at two facilities. Time-varying Cox regression for FC quantity showed that FC quantity was associated with higher mortality (2 facilities: HR:1.21, (1.12-1.31), p<0.001, 3 facilities: HR:1.47, (1.31-1.65), p<0.001, 4+ facilities: HR:2.34, (1.93-2.82), p<0.001). Compared to unfragmented designated care, upgrading from a non-designated to designated center had higher survival than unfragmented non-designated care (HR:1.40, (1.16-1.70), p=0.001 versus HR:1.48, (1.29-1.70), p<0.001).CONCLUSION: Fragmented GEJ cancer care is associated with decreased survival. However, upgrading care to a designated cancer facility could mitigate the deleterious association of fragmentation with decreased survival.
View details for DOI 10.1016/j.gassur.2025.101962
View details for PubMedID 39826826
-
Current landscape of minimally invasive pancreatectomy for neoplasms: A retrospective cohort study.
World journal of surgery
2024
Abstract
To evaluate recent minimally invasive pancreatectomy (MIP) trends for neoplastic disease and compare perioperative outcomes.Patients who underwent open (OS) or MIP (laparoscopic-LS or robotic-RS) pancreaticoduodenectomy (PD) or non-pancreati-coduodenectomy resections (non-PD) were identified from PINC AI Healthcare Database. Outcomes were compared using multivariable regressions.OS was the predominant approach for PD (87.8%); MIP was more common in non-PD (48.5%) than PD with a substantial RS uptake (11.7%-29.9%). In PDs, outcomes were similar except OS had a longer length of stay (LOS) and lower costs. In non-PDs, MIP patients were less likely to have prolonged LOS, intensive care unit admission, and overall complications than OS. Conversion to OS was lower in the RS approach than LS in PD and non-PD.MIP for non-PD has become the most common operative approach with improved outcomes; MIP-PD has flat adoption and similar outcomes to OS. Robotics facilitates MIP (PD and non-PD) completion through fewer conversions to open surgery (OS).
View details for DOI 10.1002/wjs.12408
View details for PubMedID 39578686
-
Resident-Applicant Buddy Program Increases Applicant Interest and Program Transparency.
Journal of surgical education
2024; 81 (11): 1792-1797
Abstract
Resident-Applicant Buddy Programs (RABPs) are a new initiative designed to improve resident recruitment. This study aims to evaluate the impact and perceived value of RABPs and to identify areas for improvement for future recruitment cycles.Anonymous online survey study of RABP participants with mixed-methods approach to evaluate participants' experience and perceived impact of the program. The survey queried demographics, Likert responses, and open-ended responses. Qualitative thematic analysis of open-ended responses was performed with inductive coding in an iterative fashion by 2 raters.This study was conducted at a general surgery residency program at a tertiary academic institution during 2022-2023 recruitment cycle.Of 125 RABP participants (n = 39 residents and n = 86 interviewed applicants), surveys from n = 45 participants (n = 19 residents, 66%; n = 26 applicants, 30%) were completed and analyzed.Applicants were predominantly female (65%) and first-generation physicians (69%). Buddy pairings were 65% gender concordant and 48% race/ethnicity concordant. Many applicants (60%) participated in RABPs at other institutions. Buddies connected for a mean (SD) of 52 (28) minutes. Majority of applicants agreed the program decreased stress/apprehension about interviewing (70%, 4.0 [1.1]), helped understand resident life at the program (91%, 4.3 [1.0]), and increased desire to match in the program (65%, 4.0 [1.1]). Residents agreed they enjoyed participation (89%, 4.5 [0.7]), the program should be continued (100%, 4.8 [0.4]), and desired to participate again (100%, 4.8 [0.4]). Thematic analysis revealed applicants valued the program as an approachable source of information, illumination of program culture, aid in interview preparation, and connection between applicant and program. Applicants appreciated the intentionality of the program to create a RABP.RABP decreased applicants' stress, improved understanding of resident life, and for the majority, increased desire to match at the program. Resident engagement and desire for ongoing participation in the RABP was high. Overall, RABPs can increase applicant interest and program transparency.
View details for DOI 10.1016/j.jsurg.2024.08.010
View details for PubMedID 39321695
-
The Potential Clinical Benefits of Direct Surgical Transgastric Pancreatic Necrosectomy for Patients With Infected Necrotizing Pancreatitis.
Pancreas
2024; 53 (7): e573-e578
Abstract
Surgical transgastric pancreatic necrosectomy (STGN) has the potential to overcome the shortcomings (ie, repeat interventions, prolonged hospitalization) of the step-up approach for infected necrotizing pancreatitis. We aimed to determine the outcomes of STGN for infected necrotizing pancreatitis.This observational cohort study included adult patients who underwent STGN for infected necrosis at two centers from 2008 to 2022. Patients with a procedure for pancreatic necrosis before STGN were excluded. Primary outcomes included mortality, length of hospital and intensive care unit (ICU) stay, new-onset organ failure, repeat interventions, pancreatic fistulas, readmissions, and time to episode closure.Forty-three patients underwent STGN at a median of 48 days (interquartile range [IQR] 32-70) after disease onset. Mortality rate was 7% (n = 3). After STGN, the median length of hospital was 8 days (IQR 6-17), 23 patients (53.5%) required ICU admission (2 days [IQR 1-7]), and new-onset organ failure occurred in 8 patients (18.6%). Three patients (7%) required a reintervention, 1 (2.3%) developed a pancreatic fistula, and 11 (25.6%) were readmitted. The median time to episode closure was 11 days (IQR 6-22).STGN allows for treatment of retrogastric infected necrosis in one procedure and with rapid episode resolution. With these advantages and few pancreatic fistulas, direct STGN challenges the step-up approach.
View details for DOI 10.1097/MPA.0000000000002334
View details for PubMedID 38986078
-
Postoperative outcomes and costs of laparoscopic versus robotic distal pancreatectomy: a propensity-matched analysis.
Surgical endoscopy
2024
Abstract
Minimally invasive distal pancreatectomy (MIDP) has established advantages over the open approach. The costs associated with robotic DP (RDP) versus laparoscopic DP (LDP) make the robotic approach controversial. We sought to compare outcomes and cost of LDP and RDP using propensity matching analysis at our institution.Patients undergoing LDP or RDP between 2000 and 2021 were retrospectively identified. Patients were optimally matched using age, gender, American Society of Anesthesiologists status, body mass index, and tumor size. Between-group differences were analyzed using the Wilcoxon signed-rank test for continuous data, and the McNemar's test for categorical data. Outcomes included operative duration, conversion to open surgery, postoperative length of stay, pancreatic fistula rate, pseudocyst requiring intervention, and costs.298 patients underwent MIDP, 180 (60%) were laparoscopic and 118 (40%) were robotic. All RDPs were matched 1:1 to a laparoscopic case with absolute standardized mean differences for all matching covariates below 0.10, except for tumor type (0.16). RDP had longer operative times (268 vs 178 min, p < 0.01), shorter length of stay (2 vs 4 days, p < 0.01), fewer biochemical pancreatic leaks (11.9% vs 34.7%, p < 0.01), and fewer interventional radiological drainage (0% vs 5.9%, p = 0.01). The number of pancreatic fistulas (11.9% vs 5.1%, p = 0.12), collections requiring antibiotics or intervention (11.9% vs 5.1%, p = 0.12), and conversion rates (3.4% vs 5.1%, p = 0.72) were comparable between the two groups. The total direct index admission costs for RDP were 1.01 times higher than for LDP for FY16-19 (p = 0.372), and 1.33 times higher for FY20-22 (p = 0.031).Although RDP required longer operative times than LDP, postoperative stays were shorter. The procedure cost of RDP was modestly more expensive than LDP, though this was partially offset by reduced hospital stay and reintervention rate.
View details for DOI 10.1007/s00464-024-10728-8
View details for PubMedID 38438677
View details for PubMedCentralID 1877036
-
Comparison of Spleen-Preservation Versus Splenectomy in Minimally Invasive Distal Pancreatectomy.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
2023
Abstract
Spleen-preservation during minimally invasive distal pancreatectomy (MIDP) can be technically challenging and remains controversial. Our primary aim was to compare MIDP and splenectomy with spleen-preserving MIDP. Secondarily, we compared two spleen-preserving techniques.Adults undergoing MIDP (2007-2021) were retrospectively included in this single-center study. Intraoperative and postoperative outcomes between spleen-preservation and splenectomy and between the two spleen-preserving techniques were compared using the Mann-Whitney U test for continuous data, and Fisher's exact test for categorical data.Of the 293 patients who underwent MIDP, preservation of the spleen was intended in 208 (71%) patients. Spleen-preservation was achieved in 174 patients (84%) via the Warshaw technique (130; 75%) or vessel-preservation (44; 25%). The spleen-preserving group had shorter length of stay (3 vs 4 days, p < 0.01), fewer conversions to open (1 vs 12, p < 0.01) and less blood loss (p < 0.01) compared to the splenectomy group. Operative (OR) times were comparable (229 vs 214 min, p = 0.67). Except for the operative time, which was longer for the Warshaw technique (245 vs 183 min, p = 0.01), no other differences between the two spleen-preserving techniques were found. At a median follow-up of 43 (IQR 18-79) months after spleen-preservation, only 2 (1.1%) patients had required splenectomy (1 partial splenectomy for infarct/abscess after Warshaw, 1 for variceal bleeding after vessel-preserving).Spleen-preservation is not associated with increased risk of blood loss, longer hospital stay, conversion, nor lengthy OR times. Late splenectomy is very rarely required. Given the immune consequences of splenectomy, spleen-preservation should be strongly considered in MIDP.
View details for DOI 10.1007/s11605-023-05809-3
View details for PubMedID 37653153
View details for PubMedCentralID 3912973
-
Going Virtual: Effect of Implementing Video Visits On Readmission Rates in Gi Surgical Oncology Patients
LIPPINCOTT WILLIAMS & WILKINS. 2023: S63-S64
View details for Web of Science ID 000989943300167
-
Comparison of Spleen-Preservation vs Splenectomy in Minimally Invasive Distal Pancreatectomy: A Propensity-Matched Analysis
LIPPINCOTT WILLIAMS & WILKINS. 2022: S52
View details for Web of Science ID 000867877000130
-
Surgery, Liver Directed Therapy and Peptide Receptor Radionuclide Therapy for Pancreatic Neuroendocrine Tumor Liver Metastases.
Cancers
2022; 14 (20)
Abstract
Pancreatic neuroendocrine tumors (PNETs) are described by the World Health Organization (WHO) classification by grade (1-3) and degree of differentiation. Grade 1 and 2; well differentiated PNETs are often characterized as relatively "indolent" tumors for which locoregional therapies have been shown to be effective for palliation of symptom control and prolongation of survival even in the setting of advanced disease. The treatment of liver metastases includes surgical and non-surgical modalities with varying degrees of invasiveness; efficacy; and risk. Most of these modalities have not been prospectively compared. This paper reviews literature that has been published on treatment of pancreatic neuroendocrine liver metastases using surgery; liver directed embolization and peptide receptor radionuclide therapy (PRRT). Surgery is associated with the longest survival in patients with resectable disease burden. Liver-directed (hepatic artery) therapies can sometimes convert patients with borderline disease into candidates for surgery. Among the three embolization modalities; the preponderance of data suggests chemoembolization offers superior radiographic response compared to bland embolization and radioembolization; but all have similar survival. PRRT was initially approved as salvage therapy in patients with advanced disease that was not amenable to resection or embolization; though the role of PRRT is evolving rapidly.
View details for DOI 10.3390/cancers14205103
View details for PubMedID 36291892