Surgery Commons^™

Aging- And Alcohol-Associated Spatial Transcriptomic Signature In Mouse Acute Pancreatitis Reveals Heterogeneity Of Inflammation And Potential Pathogenic Factors, Rachel R. Tindall, Yuntao Yang, Isabella Hernandez, Amy Qin, Jiajing Li, Yinjie Zhang, Thomas H. Gomez, Mamoun Younes, Qiang Shen, Jennifer M. Bailey-Lundberg, Zhongming Zhao, Daniel Kraushaar, Patricia Castro, Yanna Cao, W. Jim Zheng, Tien C. Ko

School of Medicine Faculty Publications

Abstract: The rapidly aging population is consuming more alcohol, leading to increased alcohol-associated acute pancreatitis (AAP) with high mortality. However, the mechanisms remain undefined, and currently there are no effective therapies available. This study aims to elucidate aging- and alcohol-associated spatial transcriptomic signature by establishing an aging AAP mouse model and applying Visium spatial transcriptomics for understanding of the mechanisms in the context of the pancreatic tissue. Upon alcohol diet feeding and caerulein treatment, aging mice (18 months) developed significantly more severe AAP with 5.0-fold increase of injury score and 2.4-fold increase of amylase compared to young mice (3 months). …

Efficacy Of Full Dose And Sandwich Neoadjuvant Chemotherapy In Breast Cancer: A Literature Review, I Gusti Ng Wibisana, Shandy V. Putra

The New Ropanasuri Journal of Surgery

Introduction. Breast cancer is the leading cause of death in productive-age women, and that needs to be addressed with systemic medication. There has been a big-scale success using adjuvant chemotherapy; however, the optimal method of chemotherapy administration has yet to be determined. Two methods have been introduced today: full dose and sandwich methods. In full dose, we administer chemotherapy before surgical intervention, whereas in the sandwich method, we administer chemotherapy before and after surgical intervention. In this literature review, we aim to observe the effectiveness of chemotherapy administration through both full-dose and sandwich methods.

Method. In the initial phase, 51 …

Clinical And Genomic Profile Of Primary Cranial Neurolymphomatosis, Emily B Wolf, Robin Imperial, Liuyan Jiang, Amit K Agarwal, Han W Tun

Faculty, Staff and Student Publications

Primary cranial neurolymphomatosis (PCNL) is a rare subtype of primary CNS lymphoma (PCNSL) in which infiltrative lymphomatous involvement is confined to cranial nerves. Here, we report a case of PCNL with successful genomic profiling. A 57-year-old male had a lengthy prediagnostic phase spanning approximately 30 months, characterized by multiple episodes of cranial neuropathies managed by steroids. At the time of diagnosis, the patient had right-sided cranial neuropathies involving cranial nerves (CN) V, VI, and VII. Pathological findings of the right cavernous lesion biopsy were consistent with large B-cell lymphoma-infiltrating nerve fibers. The clinical course was aggressive and refractory, characterized by …

Aso Author Reflections: Isolated Margin Positivity In Localized Pancreatic Ductal Adenocarcinoma And Operative Margin Revision, Lee M. Ocuin

Faculty Scholarship

No abstract provided.

To Revise Or Not Revise? Isolated Margin Positivity In Localized Pancreatic Ductal Adenocarcinoma, Victoria S. Wu, Henry J. Stitzel, John B. Ammori, Jeffrey Hardacre, Lee M. Ocuin

Faculty Scholarship

Background: The study determined the proportion of patients with pancreatic adenocarcinoma (PDAC) who had margin-positive disease and no other adverse pathologic findings (APF) using institutional and administrative datasets. Methods: Patients with clinical stage I or II PDAC in the National Cancer Database (NCDB 2010–2020) and those who underwent pancreatectomy at the authors’ institution (2010–2021) were identified. Isolated margin positivity (IMP) was defined as a positive surgical margin with no APF (negative nodes, no lymphovascular/perineural invasion). Results: The study included 225 patients from the authors’ institution and 23,598 patients from the NCDB. The margin-positive rates were 21.8% and 20.3%, and the …

Microvascular Reconstruction Of Midface Osteoradionecrosis, Larissa Sweeny, Neeraja Konuthula, Ryan Jackson, Mark K. Wax, Joseph M. Curry, Sara Yang, Dev Amin, Anne C. Kane, Steve B. Cannady, Kendall Tasche, Michael Dileo, Daniel Lander, Alexandra E. Kejner, Patrik Pipkorn

School of Medicine Faculty Publications

Background: Head and neck osteoradionecrosis (ORN) of the midface requiring free flap (FF) reconstruction is uncommon. This multi-institutional study was designed to review outcomes for this rare patient population. Methods: Retrospective multi-institutional review of FF reconstruction for midface ORN (2005–2022; n = 54). Results: The FF survival rate was 87% (n = 54). Patients were less likely to be tolerating a regular diet at 3 months postoperative if they had a preoperative history of prior head and surgery (80% vs. 95%; p = 0.02), a pathologic fracture (50% vs. 90%; p = 0.04), exposed bone intraorally (43% vs. 94%; p …

A Modified Switching Procedure From Temporary To Tunneled Central Venous Dialysis Catheters, Johannes Eberhard, Constantin Bedau, Andrew Genius Chapple, Julia Klein, Christoph Reissfelder, Anna Isabelle Kaelsch, Andreas Lutz Heinrich Gerken, Sebastian Zach, Kay Schwenke

School of Medicine Faculty Publications

Background: Tunneled central venous catheters are commonly used for dialysis in patients without a functional permanent vascular access. In an emergent setting, a non-tunneled, temporary central venous catheter is often placed for immediate dialysis. The most critical step in the catheter insertion is venipuncture, which is often a major cause for longer intervention times and procedure-related adverse events. To avoid this critical step when placing a more permanent tunneled catheter, an exchange over a previously placed temporary one can be considered. In this paper, we present a modified switching approach with a separate access site. Methods: In this retrospective analysis …

Lymphovenous Anastomosis For The External And Internal Types Of Head And Neck Lymphedema: A Case Series And Preliminary Clinical Results, Ying-Sheng Lin, Chia-Ju Liu, Chen-Han Chou

Faculty, Staff and Student Publications

BACKGROUND: Head and neck lymphedema (HNL), including external and internal types, could be a possible consequence for patients who have received neck dissection and radiotherapy for head and neck cancer. Initially, the common presentations are heaviness or tightness, followed by swelling in appearance, or difficulty speaking and swallowing in internal edema cases. Lymphovenous anastomosis (LVA) is an established approach to treat extremity lymphedema. We hereby present our preliminary experience in using LVA to treat HNL.

METHODS: Between March 2021 and January 2024, six patients with HNL were treated with LVA via a preauricular or submandibular incision of the obstructed side. …

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

Complete Pathologic Response To Gemcitabine And Oxaliplatin Chemotherapy After Prior Therapies In A Patient With Hepatocellular Carcinoma And Peritoneal Metastases Undergoing Cytoreductive Surgery And Hyperthermic Intraperitoneal Chemotherapy, Amry Majeed, Sneha Alaparthi, Dina Halegoua-De Marzio, Jaime Eberle-Singh, Wei Jiang, Pramila Rani Anne, Ashesh P. Shah, Wilbur B. Bowne, Daniel Lin

Jefferson Hospital Staff Papers and Presentations

Hepatocellular carcinoma (HCC) is often diagnosed at a late stage and frequently recurs despite curative intervention, leading to poor survival outcomes. Frontline systemic therapies include combination immunotherapy regimens and tyrosine kinase inhibitors. We report a case of a 38-year-old woman with chronic hepatitis B and C coinfection-associated non-cirrhotic HCC, which recurred in the peritoneum after initial resection of her primary tumor. Disease progression occurred on both atezolizumab/bevacizumab and lenvatinib, and she was subsequently treated with gemcitabine and oxaliplatin (GEMOX) chemotherapy and exhibited a profound clinical response on imaging with normalization of alpha fetoprotein (AFP) after several months. Following extensive multidisciplinary …

An Unexpected Finding During A Breast Excisional Biopsy: A Case Report, Emily Forester, Anjeanette Brown

Rowan-Virtua Research Day

Background: Pacemaker leads within the breast are rare. Although it is infrequent, there are some reports of implanted cardiac devices or wires migrating into breast tissue or through the chest wall. To the best of our knowledge, there are no current reports of pacemaker leads within the breast tissue of a patient with concurrent breast cancer. This case aims to detail the surgical management of this rare phenomenon.

Case Presentation: A pacemaker-dependent, female patient presented to the operating room for a left breast excisional biopsy. Intraoperatively, two epicardial leads were unexpectedly found within the center of the patient’s breast tissue. …

Resection And Reconstruction Of Ewing Sarcoma Of The Cuboid Utilizing Vascularized Fibular Autograft: A Case Report, Brandon Cunha, Alexandre Arkader

Rowan-Virtua Research Day

Ewing Sarcoma (EWS) rarely presents in the bones of the foot, and particularly in the cuboid, making it an exceedingly rare occurrence. We present the case of a 7-year-old female diagnosed with EWS of the right cuboid, detailing the management and outcomes of this rare presentation. The patient, now almost 5 years post-initial local control, exhibits restored foot function, a normalized gait, and no evidence of disease recurrence. This case underscores the potential for preserving lower extremity function and improving postoperative quality of life in rare presentations of EWS through innovative reconstruction strategies.

Comparative Analysis Of Health Outcomes In Gastric Cancer: Robotic Vs. Laparoscopic Gastrectomy, Maftuna Kurbonnazarova

Rowan-Virtua Research Day

Exploring the most effective surgical approach for gastrectomy is crucial for determining superior health outcomes in patients. This research compares robotic and laparoscopic techniques with the aim of pinpointing the optimal method, offering valuable insights for improved postoperative well-being.

Macrophage Polarization And Colorectal Cancer Immune Checkpoint Protein Expression., Anne Macleod

Electronic Theses and Dissertations

The majority of patients with colorectal cancer do not respond to treatment with immunotherapy. Immunotherapy requires the expression of cell surface immune checkpoint proteins (e.g. PDL1) to exert its effect. Most (>85%) of colorectal cancers do not express these proteins and this contributes in part to the poor prognosis and survival in patients with advanced disease. The patients in which immunotherapy is a potential treatment option, are a genetic subtype known as mismatch repair deficient, and have demonstrated an excellent response to anti-PD-1/PDL1 immunotherapy. A key feature of mismatch repair deficient (MMRd) cancers is their immune cell rich tumor …

Advantages Of Mechanical Anastomosis In Rectal Cancer Surgery, Paul Șiancu, Adrian Boicean, Denisa Tănăsescu, Dan Bratu, Ciprian Tănăsescu

Journal of Mind and Medical Sciences

Rectal oncological pathology represents an increased degree of difficulty in terms of surgical approach. Along with the development of minimally invasive surgery, technology has also increased the options for performing digestive anastomoses. A significant increase has been observed among mechanical anastomoses. The evolution of mechanical sutures through the use of the stapler has become a true symbol of technological advancement, as they have led to improvements and effective gains in quality and productivity in suture making. The aim of this paper is to highlight the advantages of the use of staplers in rectal surgery, with their help achieving a lower …

Correlation Between Molecular Prognostic Factors And Bevacizumab Therapeutic Resistance In Patients With Metastatic Colorectal Cancer; The Avamet Study, Adrian Paul Suceveanu, Dragos Serban, Andreea Daniela Caloian, Georgeta Camelia Cozaru, Anca Chisoi, Anca Antonela Nicolau, Ioan Sergiu Micu, Andra Iulia Suceveanu

Journal of Mind and Medical Sciences

Objectives. Colorectal cancer is responsible for more than two million cases diagnosed annually. Despite early diagnosis through screening programs and adequate treatment, 25% of cases are diagnosed with metastatic disease while up to 50% of patients diagnosed early progress to metastatic disease. Materials and Methods. The study of 40 patients aims to identify the role of placental growth factor and heparin-binding growth factor as prognostic tools for current treatments involving resistance to bevacizumab in metastatic colorectal cancer. Results. Our results suggested that overall survival was influenced by serum fibroblast growth factor 1 levels. A cut-off value of 260.71 pg/ml was …

Medical And Psychological Management Of Patients With A History Of Surgical Treatment For Pancreatic Diseases, Magdalena Țone, Daniel Cochior, Oana Denisa Balalau, Tomescu Dana Rodica, Cristian Balalau, Teodora Mocan, Aurelian Udristoiu, Gabriel Petre Gorecki

Journal of Mind and Medical Sciences

Background. Pancreatic cancer, known for its high mortality rate and late diagnosis, remains a significant health concern. Surgery offers a potential therapeutic remedy, but it is only valid in the early stage of detection. Increasing risk factors and an aging population are expected to raise the incidence of pancreatic cancer, further challenging healthcare systems. Methods. The general objective of this study was to analyze doctors' experiences regarding the health status of patients with benign pancreatic pathology who underwent surgery and were admitted to CF2 Clinical Hospital in Bucharest. The research involved a specialized questionnaire addressing various aspects of patient health, …

Surgery Of The Colon; The Impact Of Colostomy And Postoperative Complications On Patients' Quality Of Life, Vlad Denis Constantin, Adrian Silaghi, Dragos Epistatu, Daniela Gabriela Bălan, Florin Silviu Groseanu, Denisa Mihaela Nedelcu, Ioana Paunica

Journal of Mind and Medical Sciences

Introduction. This study aims to evaluate the impact of stoma formation on the quality of life of patients undergoing colonic surgery, considering both emergency and elective procedures. Several factors (demographic data, Charlson comorbidity score, type of surgical intervention, duration of hospitalization, postoperative outcomes and complications, etc.) were analyzed to understand their influence on patients' well-being. Materials and Methods. A retrospective analysis was performed on patients who underwent colorectal surgery that required stoma formation. A total of 270 patients were included in the study, with 69.25% undergoing emergency surgery and 30.74% undergoing elective procedures. Results. The Charlson comorbidity score was significantly …

Low Anterior Rectal Resection; The Impact Of Anastomotic Fistula On Incidence And Severity Of Low Anterior Resection Syndrome, Georgiana Cotofana-Graure, Cecil Mirea, Silviu Daniel Preda, Stefan Patrascu, Tiberiu Stefanita Tenea-Cojan, Adina Turcu-Stiolica, Alexandru Munteanu, Vlad Padureanu, Dragos Margaritescu, Sandu Ramboiu, Dan Cartu, Valeriu Surlin, Petru Radu

Journal of Mind and Medical Sciences

Objectives. Low anterior resection is a common surgical procedure for rectal cancer, but it is associated with a distressing complication known as Low Anterior Resection Syndrome (LARS). The incidence of LARS varies, with severe symptoms persisting in some patients even years after surgery. This study aimed to investigate the association between anastomotic leak and LARS severity in rectal cancer patients. Methods. A retrospective analysis was conducted on 100 rectal cancer patients who underwent LAR between 2017 and 2021. Patients were categorized based on LARS questionnaire responses into groups with anastomotic leakage and LARS, LARS alone, or no LARS. Various factors, …

Genetic And Serological Markers In Colorectal Cancer Surgery, Adrian Silaghi, Vlad Denis Constantin, Dragos Serban, Dragos Epistatu, Ioana Paunica, Daniela Gabriela Bălan, Laura Florentina Rebegea

Journal of Mind and Medical Sciences

Colon cancer is relatively asymptomatic in the early stages, the manifestations appearing and intensifying with the evolution of the disease, especially when associated with local and/or systemic complications. In such cases, surgical interventions are often emergency and involve more extensive operations (on metabolically and immune-stressed organisms), so that an early diagnosis (endoscopy, tumor markers, etc.) remains not only desirable but even a priority, especially in predisposed patients (genetic factors, lifestyle, etc.). As a consequence, the involvement of tumor markers in colon neoplasms has become more and more investigated in recent times. This review investigates the roles of serological and genetic …

Diabetic Patients And Postoperative Complications In Colorectal Surgery, Ioana Paunica, Adrian Silaghi, Daniela Gabriela Bălan, Bogdan Socea, Cristian Balalau, Florin Silviu Groseanu, George Alexandru Popescu, Dragos Epistatu, Vlad Denis Constantin

Journal of Mind and Medical Sciences

Diabetes mellitus is one of the most common comorbidities of patients undergoing surgery. Colorectal surgery is frequently associated with postoperative complications, and diabetic patients represent a population that presents a high risk of developing such complications. Understanding the interrelationships between neoplastic disease and diabetes, as well as the pathophysiological mechanisms underlying postoperative complications, are essential for effective therapeutic management. Genetic predispositions, alterations in the gut microbiota, inflammatory response, ischemic, thrombotic and infectious processes contribute significantly to the development of severe surgical complications, such as anastomotic fistulas. Postoperative ileus, characterized by gastrointestinal dysmotility, is common in diabetic patients due to neuropathic …

Aso Author Reflections: Outcomes Of Hepatic Artery-Based Therapies And Systemic Multiagent Chemotherapy In Unresectable Colorectal Liver Metastases: A Systematic Review And Meta-Analysis, Lee M. Ocuin

Faculty Scholarship

No abstract provided.

Evaluation Of Four Computed Tomography Reconstruction Algorithms Using A Coronary Artery Phantom, Shungo Sawamura, Shingo Kato, Yoshinori Funama, Seitaro Oda, Harumi Mochizuki, Sayuri Inagaki, Yuka Takeuchi, Tsubasa Morioka, Toshiharu Izumi, Yoichiro Ota, Hironori Kawagoe, Shihyao Cheng, Naoki Nakayama, Kazuki Fukui, Takashi Tsutsumi, Tae Iwasawa, Daisuke Utsunomiya

Faculty, Staff and Student Publications

BACKGROUND: Despite advancements in coronary computed tomography angiography (CTA), challenges in positive predictive value and specificity remain due to limited spatial resolution. The purpose of this experimental study was to investigate the effect of 2nd generation deep learning-based reconstruction (DLR) on the quantitative and qualitative image quality in coronary CTA.

METHODS: A vessel model with stepwise non-calcified plaque was scanned using 320-detector CT. Image reconstruction was performed using four techniques: hybrid iterative reconstruction (HIR), model-based iterative reconstruction (MBIR), DLR, and 2nd generation DLR. The luminal peak CT number, contrast-to-noise ratio (CNR), and edge rise slope (ERS) were quantitatively evaluated via …

Patient Experience Of Head And Neck Surgery With Free Flap Reconstruction., Lillian W. Dattilo, Trinity I. Russell, Chloe B. Warinner, Heather Starmer, Donald J. Annino, Laura A. Goguen, Rosh K. V. Sethi, Ravindra Uppaluri, Melina Windon, Regan W. Bergmark, Eleni M. Rettig

Markey Cancer Center Faculty Publications

IMPORTANCE: Major head and neck surgery with microvascular free tissue transfer reconstruction is complex, with considerable risk of morbidity. Little is known about patients' experiences, including decision-making prior to, and regret following, free flap surgery.

OBJECTIVE: To characterize patient experiences and decision regret of patients undergoing head and neck reconstructive free flap surgery.

DESIGN, SETTING, AND PARTICIPANTS: This mixed-methods cohort study comprising semistructured interviews was conducted June to August 2021 at a single tertiary academic cancer center. Participants underwent head and neck reconstructive surgery with microvascular free tissue transfer (flap) more than 3 months before recruitment (range, 3 months to …

Sphingosine-1-Phosphate Inhibition Increases Endoplasmic Reticulum Stress To Enhance Oxaliplatin Sensitivity In Pancreatic Cancer, Zachary Gao, Harinarayanan Janakiraman, Yang Xiao, Sung Wook Kang, Jiangling Dong, Jasmine Choi, Besim Ogretmen, Hyun-Sung Lee, Ernest Ramsay Camp

Faculty, Staff and Students Publications

BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer resistant to current therapies, including oxaliplatin (Oxa). Growing evidence supports the ability of cancers to harness sphingolipid metabolism for survival. Sphingosine-1-phosphate (S1P) is an anti-apoptotic, pro-survival mediator that can influence cellular functions such as endoplasmic reticulum (ER) stress. We hypothesize that PDAC drives dysregulated sphingolipid metabolism and that S1P inhibition can enhance ER stress to improve therapeutic response to Oxa in PDAC.

METHODS: RNA sequencing data of sphingolipid mediators from The Cancer Genome Atlas (TCGA) and Genotype-Tissue Expression Project (GTEx) datasets were analyzed. Murine and human PDAC cell lines were treated …

Randomized Controlled Trial Of The Cmr Immersive Virtual Reality (Ivr) Headset Training Compared To E-Learning For Operating Room Configuration Of The Cmr Versius Robot, Catherine L Eley, Varun Palaniappan, Abbie Carter, Opeyemi Sogaolu, James Horwood, Michael Davies, Jared Torkington, James Ansell

Faculty, Staff and Student Publications

Robotic surgery offers potential advantages over laparoscopic procedures, but the training for configuring robotic systems in the operating room remains underexplored. This study seeks to validate immersive virtual reality (IVR) headset training for setting up the CMR Versius in the operating room. This single-blinded randomized control trial randomised medical students with no prior robotic experience using an online randomiser. The intervention group received IVR headset training, and the control group, e-learning modules. Assessors were blinded to participant group. Primary endpoint was overall score (OS): Likert-scale 1-5: 1 reflecting independent performance, with increasing verbal prompts to a maximum score of 5, …

Outcomes Of Hepatic Artery-Based Therapies And Systemic Multiagent Chemotherapy In Unresectable Colorectal Liver Metastases: A Systematic Review And Meta-Analysis, Henry Stitzel, Victoria Wu, David Bajor, Sakti Chakrabarti, Madison Conces, Lauren Henke, Melissa Lumish, Amit Mahipal, Amr Mohamed, Jordan M. Winter, Jeffrey M. Hardacre, John B. Ammori, Jennifer E. Selfridge, Lee M. Ocuin

Faculty Scholarship

Background: Treatment of unresectable colorectal liver metastases (UCRLM) includes locoregional and systemic therapy. A comprehensive analysis capturing long-term outcomes of these treatment options has not been performed. Objective: A systematic review and meta-analysis was performed to calculate pooled outcomes of hepatic artery infusion with systemic chemotherapy (HAI-S), transarterial chemoembolization with systemic chemotherapy (TACE-S), transarterial radioembolization with systemic chemotherapy (TARE-S), doublet (FOLFOX, FOLFIRI), and triplet chemotherapy (FOLFOXIRI). Methods: Outcomes included overall survival (OS), progression-free survival (PFS), rate of conversion to resection (CTR), and response rate (RR). Results: A total of 32, 7, 9, and 14 publications were included in the HAI-S, …

The Utility Of Interventional Anesthesia, Kylie Daguio, Kiley Jackson, Samantha Boever, Andrew Chang, James Keane, Leonard B. Goldstein

SOMA Faculty Publications

no abstract

Response To The Letter To The Editor: Surgical Delay Of Thoracodorsal Artery Perforator Flaps For Bilateral Autologous Breast Reconstruction, Robert J. Allen, Mark A. Maier

School of Medicine Faculty Publications

No abstract provided.

Advancing Virtual At-Home Care For Community Health Center Patients Using Patient Self-Care Tools, Technology, And Education [Letter], Cheryl Modica, Joy H. Lewis, Curtis Bay

SOMA Faculty Publications

Abstract

Introduction

Health centers are community-based, patient directed primary care providers that offer accessible, high-quality primary care within medically underserved communities. Screening for cancer and managing complex chronic conditions such as diabetes, hypertension, obesity, and depression are vital services for the vulnerable populations seen by community health centers. Delivering care for complex chronic conditions and preventive services using virtual models that integrate self-care tools and technology is an important approach to increasing access for hard-to-reach patients served by health centers.

Objective

This study aimed to explore the use of a virtual care model, applied using a systems approach and patient-driven …