Surgery Commons^™

Bacillus Calmette-Guerin (Bcg) As An Intralesional Therapy For Cutaneous Metastatic Malignant Melanoma: A Literature Review, Farisa B. Dina, Ahmad Kurnia

The New Ropanasuri Journal of Surgery

Introduction. Malignant melanoma is the most lethal form of skin cancer and is the third most common cause of death of all malignancies in the world. Cutaneous metastatic lesions are the earliest and the most frequently encountered metastatic lesions in malignant melanoma. The use of Bacillus Calmette-Guerin (BCG) as an intradermal therapy agent has been long debated due to its effectiveness and adverse effects. This literature review aims to provide a comprehensive explanation regarding the use of intralesional BCG in establishing local control and preventing recurrence in cutaneous metastatic malignant melanoma.

Method. A literature search was conducted on various …

Infrarenal Abdominal Aortic Pseudoaneurysm With Suspected Behcet Disease: A Unique Case Report, Harsya D. Gunardi, Danny Pratama, Andrio W. Prabowo, Nanang W. Hidayat, M Aprizal Putera, Grady Krisandi

The New Ropanasuri Journal of Surgery

Introduction. Abdominal aortic pseudoaneurysm caused by autoimmune vasculitis is a rare complication. Clinical presentation of patients is often late with life–threatening complications.

Case Illustration: A 62–year–old male patient with infrarenal abdominal aortic pseudoaneurysm presenting with a 2–week worsening severe abdominal and lumbar pain with a history of uncontrolled hypertension and a history of oral ulcer. He was successfully treated with tube grafting through open surgical repair.

Conclusion: The pseudoaneurysm was successfully removed and replaced with a polyester tube graft with no perioperative complications and was discharged 5 days later

C-Reactive Protein As An Early Predictor Of Anastomosis Leakage After Colorectal Surgery: A Literature Review, Lucky Permana, Ridho A. Syaiful

The New Ropanasuri Journal of Surgery

Introduction. Anastomosis leakage is a defect in the intestinal wall at the anastomosis site after surgery. This condition is a serious complication causing increased morbidity and mortality. CRP is commonly used as an acute postoperative indicator after abdominal surgery. The use of CRP as an early predictor of anastomosis leakage after colorectal surgery is supported by several studies showing its good diagnostic value. However, using CRP as a biomarker is not standard at Cipto Mangunkusumo National Hospital. Therefore, this literature review aims to support the evidence for CRP in the early detection of anastomosis leakage after colorectal surgery.

Method. …

The Role Of Active Surveillance Of Papillary Thyroid Microcarcinoma: A Literature Review, Prasojo Prasojo, I Gusti Ngurah Gunawan Gunawan Wibisana

The New Ropanasuri Journal of Surgery

Introduction: Thyroid cancer is one of the most common cancers in the world, with incidence 144,7: 100.000 population. The incidence has risen up to 211% within the last 30 years, and one–third of thyroid cancer is papillary thyroid microcarcinoma. There are still controversies regarding whether immediate surgery or active surveillance is the better option for treating this condition. This review aims to evaluate the safety and efficacy of active papillary thyroid microcarcinoma surveillance.

Methods: Cochrane, PubMed, EBSCOHost, and ProQuest were searched for relevant studies of active surveillance of papillary thyroid microcarcinoma.

Results: Six publications were selected after a literature search …

Transformation Of Accreditation Of Higher Education In Health In Indonesia: Qualitative Assessment, Yefta Moenadjat, Insan Sosiawan A. Tunru, Sutrisno Soemardjo

The New Ropanasuri Journal of Surgery

Accreditation of higher education in health in Indonesia shifts to the qualitative assessment driven to ensure quality improvement. The method replaces the former quantitative assessment method that has been applied since 2012; it will be effective in January 2025. The driving factors and rationale of transformation are outlined in this article. The rationale of the qualitative assessment that applies principle–based accreditation and the quantitative assessment that applies rule–based accreditation is reviewed here. Information on the accreditation procedure and the goal is presented, aiming for institutions to prepare for this new version of accreditation.

Surgical Treatment For Hepatocellular Carcinoma With Right Atrium Tumor Thrombus: A Literature Review, Mohammad Z. Hazmi, Ridho A. Syaiful

The New Ropanasuri Journal of Surgery

Introduction. The prognosis of patients with hepatocellular carcinoma (HCC) with right atrial tumor thrombus (RATT) is poor, with a mortality rate of 60 to 90%. Along with the development of multimodality management and surgical techniques in cases of HCC, surgery is still an option for curative purposes. This study aims to review the indications, appropriate surgical techniques, and postoperative survival outcomes in HCC with RATT.

Methods. This literature review conducted using online databases, including Cochrane Library, PubMed, ScienceDirect, EBSCOhost, and ProQuest.

Results. Six case reports and four retrospective studies were reviewed. Surgery for HCC with RATT has one, three, and …

A Review Of Managing Catastrophes In Robotic-Assisted Thoracic Surgery, Shamele Battan-Wraith, Kevin Wang, Ahmed Elkamel, Kameron Durante, Hope Conrad, Kayla Iannarelli, Olugbenga Okusanya, Praveen Sridhar, Stephanie G. Worrell

Department of Surgery Faculty Papers

Lung cancer is the most commonly diagnosed cancer worldwide in 2022, with over 2.5 million new cases, or 1 in 8 of all cancers diagnosed worldwide. Lung cancer is the leading cause of cancer related mortality in the United States, with non-small cell lung cancer (NSCLC) being the most prevalent type. For early-stage NSCLC, lung resection with anatomic lobectomy remains the standard of care. Robot-assisted lobectomy is gaining popularity over video-assisted thoracoscopic surgery (VATS) and open thoracotomy due to improved visualization, ergonomics, and instrumentation. Despite these advancements, intraoperative complications and a steep learning curve present significant barriers to the widespread …

Comparing Functional Outcomes Between 3d Printed Acetabular Cups And Traditional Prosthetic Implants In Hip Arthroplasty: A Systematic Review And Meta Analysis, Ryan St. John, Seth Spicer, Mo Hadaya, Hanna Brancaccio, Seungkyu Park, Sean Mcmillan

Rowan-Virtua School of Osteopathic Medicine Departmental Research

OBJECTIVE: The primary research aim was to determine if the use of traditional or 3D printed prosthesis resulted in better functional outcome scores in hip arthroplasty.

METHODS: A systematic review and meta-analysis was conducted utilizing the PRISMA 2020 guidelines. Six databases (PubMed, Embase, Scopus, WebOfScience, and Cochrane Library, Google Scholar) were searched yielding 1117 article titles and abstracts. Rayyan.ai was used to detect duplicates (n = 246) and for manual screening for inclusion and exclusion criteria. Included were controlled studies of any publication time that assessed Harris Hip Score (HHS) at baseline and twelve months. Six papers were sought for …

Influence Of Antibody–Drug Conjugate Cleavability, Drug-To-Antibody Ratio, And Free Payload Concentration On Systemic Toxicities: A Systematic Review And Meta-Analysis, Shou Ching Tang, Carrie Wynn, Tran Le, Martin Mccandless, Yunxi Zhang, Ritesh Patel, Nita Maihle, William Hillegass

School of Medicine Faculty Publications

While in theory antibody drug conjugates (ADCs) deliver high-dose chemotherapy directly to target cells, numerous side effects are observed in clinical practice. We sought to determine the effect of linker design (cleavable versus non-cleavable), drug-to-antibody ratio (DAR), and free payload concentration on systemic toxicity. Two systematic reviews were performed via PubMed search of clinical trials published between January 1998—July 2022. Eligible studies: (1) clinical trial for cancer therapy in adults, (2) ≥ 1 study arm included a single-agent ADC, (3) ADC used was commercially available/FDA-approved. Data was extracted and pooled using generalized linear mixed effects logistic models. 40 clinical trials …

Pancreaticoduodenectomy In Trauma Patients With Grade Iv-V Duodenal Or Pancreatic Injuries: A Post Hoc Analysis Of An East Multicenter Trial, Rachel Leah Choron, Charoo Piplani, Julia Kuzinar, Amanda L. Teichman, Christopher Bargoud, Jason D. Sciarretta, Randi N. Smith, Dustin Hanos, Iman N. Afif, Jessica H. Beard, Navpreet Kaur Dhillon, Ashling Zhang, Mira Ghneim, Rebekah Devasahayam, Oliver Gunter, Alison A. Smith, Brandi Sun, Chloe S. Cao, Jessica K. Reynolds, Lauren A. Hilt, Daniel N. Holena, Grace Chang, Meghan Jonikas, Karla Echeverria-Rosario, Nathaniel S. Fung, Aaron Anderson, Caitlin A. Fitzgerald, Ryan Peter Dumas, Jeremy H. Levin, Christine T. Trankiem, Jaehee Yoon, Jacqueline Blank, Joshua P. Hazelton, Christopher J. Mclaughlin, Rami Al-Aref, Jordan Michael Kirsch, Daniel S. Howard, Dane R. Scantling, Kate Dellonte, Michael A. Vella, Brent Hopkins, Chloe Shell, Pascal Udekwu, Evan G. Wong, Bellal Joseph, Howard Lieberman, Walter A. Ramsey, Collin H. Stewart, Claudia Alvarez, John D. Berne, Jeffry Nahmias, Ivan Puente, Joe Patton, Ilya Rakitin, Lindsey Perea, Odessa Pulido, Hashim Ahmed, Jane Keating, Lisa M Kodadek, Jason Wade, Henry Reynold, Martin Schreiber, Andrew Benjamin, Abid Khan, Laura K. Mann, Caleb Mentzer, Vasileios Mousafeiris, Francesk Mulita, Shari Reid-Gruner, Erica Sais, Christopher W. Foote, Carlos H. Palacio, Dias Argandykov, Haytham Kaafarani, Michelle T. Bover Manderski, Lilamarie Moko, Mayur Narayan, Mark Seamon

SKMC Student Presentations and Publications

INTRODUCTION: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries.

METHODS: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD.

RESULTS: The sample (n=95) was young (26 years), male (82%), …

Patient-Reported Outcome Measures For Mohs Reconstruction: A Systematic Review, Neha Garg, Shreya Mandloi, Natalia Queenan, Jay Trivedi, Adam Mccann, Vivian Xu, Dev Amin, Howard Krein, Ryan Heffelfinger

Jefferson Hospital Staff Papers and Presentations

OBJECTIVE: Mohs micrographic surgery (MMS) and subsequent reconstructive procedures for the treatment of facial nonmelanoma skin cancers (NMSCs) significantly impact quality of life (QoL). A validated patient-reported outcome measure (PROM) for patients who undergo Mohs reconstruction is not yet established. This study aims to systematically assess the quality of existing PROMs to determine their effectiveness in capturing the challenges faced after Mohs reconstruction for facial NMSC.

DATA SOURCES: A systematic review following established Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines was performed. Medline, PubMed, Scopus, and Cochrane databases were searched using keywords relevant to MMS, NMSC, facial reconstruction, …

Aspiration Of Left Atrial Masses Using The Large-Bore Manual Aspiration System: The Aspirate La Procedure, Shaurya Srivastava, Hussam Al Hennawi, Ahmad Abulshamat, Appa Bandi, Mohammed Qintar

Abington Jefferson Health Papers

Transcatheter mass extraction of left-sided cardiac masses has gained popularity in recent years, with scarce data on effectiveness, safety, and types of devices used. Mostly, left-sided aspirations use mechanical and continuous-flow–mediated devices (the AngioVac [AngioDynamics] and Penumbra systems [Penumbra]). To our knowledge, the use of manual aspiration devices has not been reported yet. Here, we report the first case series on the use of the AlphaVac (AngioDynamics) (a large-bore manual aspiration device) system for left-sided intracardiac masses.

Deceased Donor Renal Allograft Utility In Adult Single And Multi-Organ Transplantation In The United States, Peter J. Altshuler, Adam S. Bodzin, Kenneth A. Andreoni, Pooja Singh, Anju Yadav, Jaime M. Glorioso, Ashesh P. Shah, Carlo B. Ramirez, Warren R. Maley, Adam M. Frank

Department of Surgery Faculty Papers

BACKGROUND: Deceased donor multiorgan transplants utilizing kidneys (MOTs) can improve outcomes for multiorgan recipients but reduces kidneys for chronic renal failure patients.

METHODS: We reviewed the Organ Procurement and Transplantation Network database from 2015 through 2019, for adult deceased donor kidney transplants. Recipients were classified as kidney transplant alone (KTA) (n = 62,252) or MOTs pancreas-kidney, simultaneous pancreas-kidney (n = 3,976), liver-kidney, simultaneous liver-kidney (n = 3,212), heart-kidney, simultaneous heart-kidney (n = 808), and "other"-kidney, simultaneous "other" kidney (n = 73).

RESULTS: Liver, heart, and lung-alone transplants were at least 7 times more frequent than their MOT correlate, whereas the …

Decoding Ras Mutations In Thyroid Cancer: A Meta-Analysis Unveils Specific Links To Distant Metastasis And Increased Mortality, Isabel Riccio, Alexandra Laforteza, Madeleine B. Landau, Mohammad H. Hussein, Joshua Linhuber, Jonathan Staav, Peter P. Issa, Eman A. Toraih, Emad Kandil

School of Medicine Faculty Publications

Background/objectives: RAS mutations are common in thyroid cancer, but their impact on clinical outcomes remains controversial. This study aimed to evaluate the prevalence of RAS mutations in thyroid cancer and their association with various clinical and pathological features. Methods: We conducted a systematic review and meta-analysis of studies reporting on RAS mutations in thyroid cancer. Both one-arm and pairwise meta-analyses were performed to compare outcomes between RAS-mutated (RAS+) and wild-type (RAS-) thyroid cancers. Results: Our analysis included 2552 thyroid cancer patients from 17 studies. The overall prevalence of RAS mutations was 35.4 % (95 % CI: 22.7 %–50.7 %). NRAS …

The Revised Cdc Chronic Pain Guidelines And Payer Opioid Analgesic Policies In Michigan, Victoria Tutag Lehr, Cynthia L. Arfken

Michigan Journal of Public Health

Abstract

The 2016 publication of A Guideline for Prescribing Opioids for Chronic Pain by the Centers for Disease Control and Prevention motivated commercial and Medicaid payers to restrict their opioid prescribing policies including the imposition of hard limits on opioid daily dosages and duration. One result of these policies was an increase in abrupt opioid discontinuation and rapid tapering events for patients receiving long-term opioid therapy. Responding to this misapplication of the 2016 guideline, the 2022 revised guidelines emphasized individualized opioid therapy and exclusion of certain chronic diseases. However, it is not known if the payers changed their policies to …

Endovascular Repair Of Graft-To-Graft Ascending Aortic Pseudoaneurysm, Joshua R. Chen, Vishal N. Shah, Mitchell Hirsch, Thomas Jefferson University, Gaurang Joshi, Konstadinos A. Plestis, Babak Abai

Department of Surgery Faculty Papers

No abstract provided.

Venous Thromboembolism Prophylaxis In Orthopedic Surgery: A Narrative Review, Jacob Lahti, Sarah Gallitto, Thomas C. Varkey

Annual Research Symposium

This poster highlights current and updated guidelines for chemical and mechanical prophylaxis for venous thromboembolism in patients undergoing major and minor orthopedic surgery. Existing and new potential therapies were reviewed, as well as an analysis into the lack of high-quality risk-prediction score calculators to improve personalization of prophylaxis regimens. Alongside a summary of existing and potential new prophylaxis protocols, a call to action to improve validity of said risk score calculators so as to improve patient outcomes and personalized medicine is made.

Comparative Efficacy, Safety, And Oncological Outcomes Of Percutaneous Thermal And Chemical Ablation Modalities For Recurrent Metastatic Cervical Lymphadenopathy From Thyroid Cancer, Eman A. Toraih, Siva Paladugu, Rami M. Elshazli, Mohammad M. Hussein, Hassan Malik, Humza Pirzadah, Ahmed Abdelmaksoud, Salem I. Noureldine, Emad Kandil

School of Medicine Faculty Publications

Background: Thermal and chemical ablation techniques may consolidate recurrent metastatic cervical lymph nodes as alternatives to repeat neck dissection in thyroid cancer patients. This meta-analysis aims to compare the efficacy and safety across modalities. Methods: Four databases were searched for studies on radiofrequency (RFA), microwave (MWA), laser (LA), and ethanol ablation (EA) treating metastatic cervical nodes from thyroid cancer. The outcomes analyzed included treatment response, oncologic control, and complications. Random effects meta-analytical pooling was conducted. Results: There were 25 studies (n = 1061 nodes) examining the four ablation methods. Patients showed comparable baseline characteristics and initial lymph node sizes ranging …

Colonic Derotation Revisited: The "Deloyers Procedure" For Long-Segment Hirschsprung Disease., Ismael Elhalaby, Irene Isabel P. Lim, Elizaveta Bokova, Ifeanyi K Egbuchulem, Rebecca M. Rentea

Manuscripts, Articles, Book Chapters and Other Papers

Long-segment Hirschsprung disease (HSCR) presents significant challenges in surgical management, often requiring extensive bowel mobilization and creative techniques to achieve tension-free anastomosis. Colonic derotation offers a viable solution for preserving bowel length and maintaining the ileocecal valve, which is crucial for postoperative bowel function. The procedure involves extensive colonic mobilization and strategic vascular divisions of the right and middle colic vessels while preserving the ileocolic and marginal arteries, followed by a 180° counterclockwise rotation of the colon around the ileocolic vascular axis. Critical aspects include ensuring proper bowel orientation post-derotation, the careful assessment of potential compression points, and the preservation …

Unraveling The Link Between Language Barriers And Cancer Risk, Eman A. Toraih, Mohammad H. Hussein, Manal S. Malik, Alaa N. Malik, Emad Kandil, Manal S. Fawzy

School of Medicine Faculty Publications

Purpose: Clear patient communication with the physician is an integral aspect of cancer treatment and successful health outcomes. Previous research has shown improved cancer screening in cases of patient navigator assistance to limited English proficient patients, but no research has analyzed the relationship between language isolation and cancer incidence rates in the United States. Methods: Using state-level data from the United States Census Bureau and the National Cancer Institute, we analyzed the correlations between language isolation and age-adjusted incidence rates across 19 different invasive cancers. Results: A complex relationship between language isolation and cancer incidence rates was found. States such …