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Papers by Donald McCain
Journal of Clinical Oncology, 2004
3776 Background: Evaluation of 38 patients with colorectal liver metastases(164 lesions) from 11/... more 3776 Background: Evaluation of 38 patients with colorectal liver metastases(164 lesions) from 11/2000 to12/2003 treated with systemic chemotherapy and laparoscopic radiofrequency ablation. METHODS All patients were treated with standardized systemic regimens of 5-FU, irinotecan and oxaliplatinum with laparoscopic radiofrequency ablation. RESULTS Median follow up was 16 months (range 3-36 months) with a 78.6% survival at 16 months. Survival by Kaplan-Meier actuarial survival analyis was 84.7% at 1 year and 52.3% at two yearswith improved disease free survival seen in patients with lesions <5cm in size and < 5 in number. CONCLUSIONS Laparoscopic radiofrequency ablation was safe and effective when combined with systemic chemotherapy in treating colorectal liver metastases with patients being able to maintain their chemotherapy treatment schedules. Patients with low volume disease had the highest survival benefit. No significant financial relationships to disclose.
The American Journal of Surgery
Journal of Pakistan Association of Dermatologists, Mar 18, 2021
Annals of Surgical Case Reports, Mar 1, 2021
PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text ... more PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Massive malignant solitary fibrous tumor arising from the bladder serosa: a case report
Background Hepatocellular carcinoma is a primary liver malignancy often caused by viral hepatitis... more Background Hepatocellular carcinoma is a primary liver malignancy often caused by viral hepatitis infection due to chronic inflammation and persistent cytokine release. Although rare, patients may present with large, pedunculated hepatocellular neoplasms that extend into the intra-abdominal space. Here, we present a case report on a 66-year-old male who was found to have such a mass that required careful pre-operative planning to complete a challenging, yet worthwhile, surgical intervention with R0 resection. Case Presentation A 66-year-old Caucasian male with a history of Hepatitis C presented with 4-5 months of abdominal pain, distention and weight loss. Imaging revealed a large heterogenous mass attached to the left lobe of the liver, with compression of the stomach, transverse colon and abdominal wall. Biopsy revealed hepatocellular carcinoma with extensive necrosis and ultimately the patient required surgical intervention, which required resection of omentum, partial gastrectomy, hepatectomy and extensive dissection of the mass to separate the tumor from the remaining intraabdominal structures and the retroperitoneum. Conclusion Peduncular hepatocellular carcinomas vary in presentation and difficulty of resection. The prognosis and probability of successful surgical intervention depends on the level of differentiation, early staging, size of the neoplasm and invasion into surrounding structures. In this case, R0 resection
Journal of Clinical Oncology, 2015
e14512 Background: Hispanics (H) are the largest and fastest growing ethnic group in the US. With... more e14512 Background: Hispanics (H) are the largest and fastest growing ethnic group in the US. With most of the studies focusing in African Americans and Non-Hispanics whites (NHW), defining the characteristics of colorectal cancer (CRC) in the Hispanic population has been a challenge. The aim of our study was to compare the clinico-pathological characteristics and survival among H and NHW with CRC. Methods: We reviewed the records of all patients (pts) diagnosed with CRC at our institution from 1993 to 2013. A total of 2146 pts were studied. Demographics, tumor characteristics, and survival were analyzed. Kaplan-Meier and Cox regression were used for survival and multivariate analysis. Results: There were 318 H and 1828 NHW. Median age at diagnosis was 63 years in H and 70 years in NHW. A significant difference was found in the stage IV pts, with a median age of 60 years for H and 71 years for NHW. Adenocarcinoma was the most common histologic subtype for both groups. At diagnosis, 96 (30%) of H had stage ...
Journal of Clinical Oncology, 2015
e14542 Background: Surgical resection remains a mainstay of treatment for localized colorectal ca... more e14542 Background: Surgical resection remains a mainstay of treatment for localized colorectal cancer (CRC). However, up to 35% of patients (pts) develop recurrence with a significant decrease in overall survival. The aim of this study was to evaluate clinical characteristics and specific predictors of recurrence for stage I/II CRC. Methods: We performed a retrospective analysis of 2310 pts diagnosed with stage I/II CRC at our institution between 1990 and 2013, with a minimum follow up of 24 months. Tumor characteristics and recurrence data were studied. Cox regression was used for statistical analysis. Results: Of the 2310 pts, recurrence was identified in 276 (12%) pts, of which 88 (32%) pts had early recurrence ( < 1year). Median time of recurrence was 625 days. 210 (76%) pts had local recurrence while 66 (24%) pts had distal recurrence, with liver being the main site of distant metastasis. Males had a higher recurrence rate than females (16% vs. 7%, p < 0.0001). When comparing recurrence pts (R) with ...
Journal of Clinical Oncology, 2014
1613 Background: Gastric cancer is a leading cause of cancer death worldwide and has significant ... more 1613 Background: Gastric cancer is a leading cause of cancer death worldwide and has significant geographical, ethnic, and socioeconomic differences in distribution. The aim of this study was to compare clinicopathological characteristics and survival between Hispanics and non-Hispanic whites with gastric cancer. Methods: We reviewed the records of all patients diagnosed with gastric cancer between January 1999 and March 2013 at the JTCC. A total of 638 patients were studied. Demographics, histology, anatomic site, recurrence and survival rate among both Hispanics and non-Hispanic whites were analyzed. Chi-square test was used to estimate differences in categorical data; Kaplan-Meier and Wilcoxon methods were used for the survival analysis. Results: There were 101 Hispanics (H) and 537 non-Hispanic whites (NHW). The mean age at diagnosis was 63 years (21-88) in H and 69 years (39-95) in NHW. A significant difference in age at diagnosis was found in the Stage IV subgroup, with a mean of 54 years for H and ...
Journal of Bacteriology, 1987
Spontaneous switching of the rotation sense of the flagellar motor of the archaebacterium Halobac... more Spontaneous switching of the rotation sense of the flagellar motor of the archaebacterium Halobacterium halobium and modulation of the switch by attractant and repellent photostimuli were analyzed by using a computerized cell-tracking system with 67-ms resolution coupled to electronic shutters. The data fit a three-state model of the switch, in which a Poisson process governs the transition from state N (nonreversing) to state R (reversing). After a reversal, the switch returns to state N, passing through an intermediate state I (inactive), which produces a ca. 2-s period of low reversal frequency before the state N Poisson rate is restored. The stochastic nature of the H. halobium switch reveals a close similarity to Escherichia coli flagellar motor properties as elucidated previously. Sensory modulation of the switch by both photoattractant and photorepellent signals can be interpreted in terms of modulation of the single forward rate constant of the N to R transition. Insight int...
Journal of Clinical Oncology, 2015
538 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the U.S. ... more 538 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the U.S. Early recognition of CRC in young patients (pts) is a challenge, and clinicopathologic features at the time of presentation are not well described. The aim of this study was to compare clinico-pathological characteristics and survival between early onset CRC (Age <50) and late onset CRC (Age ≥50). Methods: We reviewed the records of all patients diagnosed with CRC at our institution from 1999 to 2013. Total of 3,066 pts were studied. Demographics, tumor characteristics, and survival rate were analyzed. Patients with polyposis syndromes or genetic predisposition for CRC were excluded. Kaplan-Meier and Cox regression were used for the statistical analysis. Results: Of 3,066 pts, 425 pts (14%) under the age of 50 were identified (28-49). Hispanics (13% vs 8%, p<0.01) and African Americans (7% vs. 4%, p<0.009) were more prevalent in the early onset subgroup (EO) when compared to the...
Journal of Clinical Oncology, 2014
650 Background: Radiation in patients with rectal cancer is an important adjuvant therapy. It can... more 650 Background: Radiation in patients with rectal cancer is an important adjuvant therapy. It can be given either pre-operative or post-operative phase or both. However the optimum timing of the radiation in terms of pre-operative or post-op phase remains a question of debate in octogenarian patients as there is lack of enough evidence. Methods: In this study we aim to find the optimum time of radiation therapy in octogenarians with rectal cancer undergoing surgical resection. Octogenarians with rectal cancer were selected from surveillance, Epidemiology and End Results (SEER) database collected between 1998 and 2009. The data set contained 4,026 patients with rectal cancer who underwent surgical resection and radiation therapy. They were divided into 3 groups. 1,586 (39%) patients had radiation before the surgery. 66 (2%) patients had radiation before and after the surgery, also called the combination group. 2,347(59%) patients had radiation after the surgery. Taking in the conside...
Journal of Clinical Oncology, 2014
171 Background: Surgical resection of gastric GIST (Gastro-Intestinal Stromal Tumor) in octogenar... more 171 Background: Surgical resection of gastric GIST (Gastro-Intestinal Stromal Tumor) in octogenarians is a morbid procedure. There is limited data in literature about the survival of octogenarians after resection of gastric GIST. In this study we focused on the outcome in terms of survival in octogenarians with resectable gastric GIST. Methods: Our study demonstrates that octagenarians as a whole do not experience a survival benefit from surgical resection for HCC. Subgroup analysis, however, may ultimately identify benefit in specific disease stages or patients with fewer comorbidities. Results: The mean survival in the patient group undergoing surgery was 31.30 months and the mean survival in the patients opting for non-surgical management was 33.89 months. The survival benefit in avoiding surgery in this population was 2.59 months with a p-value of <0.0001 and a confidence interval of 1.35 to 3.83 months. Conclusions: The mean survival in the patient group undergoing surgery w...
CRSLS: MIS Case Reports from SLS, 2014
Introduction: Despite evolving experience with laparoscopic resections of gastric gastrointestina... more Introduction: Despite evolving experience with laparoscopic resections of gastric gastrointestinal stromal tumors (GISTs), there are few data describing robotic resections. Here we describe the robotic removal of a gastric GIST using laparoscopic ultrasonography for tumor localization. Case Description: The patient is a 46-year-old African-American man with a biopsy-proven 3.5 ϫ 3.5-cm GIST along the greater curvature of the stomach, and with no evidence of metastatic disease on preoperative computed tomographic staging. Three robotic ports (12-mm umbilical, 8-mm left lower quadrant, and 8-mm subxiphoid) were combined with a 12-mm right lower quadrant assist port and a right midabdomen 8-mm port for the laparoscopic liver retractor. Mass localization was facilitated by intraoperative ultrasonography and dissection performed with bipolar electrocautery via dissecting forceps. Resection was performed using a stapled technique and the specimen removed via the assist port. Total operative time was 104 minutes and estimated blood loss was 25 mL. There was no significant morbidity. Length of stay was 3 days, and the patient returned to work within 1 week. The retrieved specimen was CD117-and DOG1-positive with 2 to 3 mitoses/hpf. At 1-year follow-up, there was no evidence of disease. Discussion: This case report describes a novel and efficient technique for the robotic removal of a gastric GIST. This resection can be safely performed with the aid of intraoperative ultrasonography instead of gastroscopy or gastrotomy for identification of resection margins.
The Annals of Thoracic Surgery, Mar 1, 2014
cavity and deliver enteral nutrient from a distal point nasally (Fig 3B). The treatment was effec... more cavity and deliver enteral nutrient from a distal point nasally (Fig 3B). The treatment was effective, and the patient recovered smoothly. In conclusion, we encountered a very rare case of anastomotic leakage followed by lung fistula after esophagectomy, managed successfully with a WED tube. We consider that the WED tube was very effective for the treatment of this patient because it facilitated decompression of the gastric conduit and administration of sufficient parenteral nutrition.
Journal of the American College of Surgeons, 2015
RESULTS: There were 948 OVHRs, 400 LWM, and 548 MWM. The MWM patients tended to be more complex t... more RESULTS: There were 948 OVHRs, 400 LWM, and 548 MWM. The MWM patients tended to be more complex than LWM patients, with longer operative times, larger defects requiring larger meshes and more component separations, more frequent panniculectomy, and longer inpatient stay (Table, p 0.05)(Table).QOLscores were no different at 1, 6, or 12 months (p>0.05).
Clinics and Practice, 2015
A 72-year-old female presented with dyspepsia for 2 years and an incidental mass in the head of t... more A 72-year-old female presented with dyspepsia for 2 years and an incidental mass in the head of the pancreas on abdominal computed tomography (CT) scan. Patient had multiple negative endoscopic ultrasound guided biopsies. She was followed up for 3 years with serial imaging until an abdominal CT scan showed an increase in size of the pancreatic mass. Physical examination was unremarkable. Laboratory tests including tumor markers were normal. Given the enlarging size of the mass and its impingement on the portal vein, the consensus was to proceed with surgery. Histology revealed a 3.5 cm mass showing a spindle cell neoplasm with mild atypia. The lesion was well defined and nerve tissue was noted at the periphery. On immuno-stains, the spindle cells were positive for S-100 protein and negative for pan-cytokeratin, CD-34, CD- 117, smooth muscle actin and Melan A, consistent with the diagnosis of a pancreatic schwannoma.
Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology
Gastriccancer is a leading cause of cancer death worldwide and has significant ethnic and socioec... more Gastriccancer is a leading cause of cancer death worldwide and has significant ethnic and socioeconomic differences in distribution. The aim of this study was to compare clinicopathologic characteristics and survival between Hispanics (H) and non-Hispanic whites (NHW) with gastric cancer. We reviewed the records of all patients diagnosed with gastric cancer between 1999 and 2013 at our institution. A total of 638 patients were studied. Demographics, tumor characteristics and survival rate were analyzed. Kaplan-Meier was used for survival analysis. There were 101 H and 537 NHW. The median age at diagnosis was 63 years in H and 69 years in NHW. At diagnosis, 48 (48%) of H patients had stage IV disease compared with 195 (36%) of NHW (P<0.03). H were more likely to have distal cancers and poorly differentiated tumors compared to NHW (44% vs. 15%, P<0.0001; 70% vs. 50%, P<0.0002, respectively). There was a significant difference in median overall survival between the two groups,...
Journal of Clinical Oncology, 2004
3776 Background: Evaluation of 38 patients with colorectal liver metastases(164 lesions) from 11/... more 3776 Background: Evaluation of 38 patients with colorectal liver metastases(164 lesions) from 11/2000 to12/2003 treated with systemic chemotherapy and laparoscopic radiofrequency ablation. METHODS All patients were treated with standardized systemic regimens of 5-FU, irinotecan and oxaliplatinum with laparoscopic radiofrequency ablation. RESULTS Median follow up was 16 months (range 3-36 months) with a 78.6% survival at 16 months. Survival by Kaplan-Meier actuarial survival analyis was 84.7% at 1 year and 52.3% at two yearswith improved disease free survival seen in patients with lesions <5cm in size and < 5 in number. CONCLUSIONS Laparoscopic radiofrequency ablation was safe and effective when combined with systemic chemotherapy in treating colorectal liver metastases with patients being able to maintain their chemotherapy treatment schedules. Patients with low volume disease had the highest survival benefit. No significant financial relationships to disclose.
The American Journal of Surgery
Journal of Pakistan Association of Dermatologists, Mar 18, 2021
Annals of Surgical Case Reports, Mar 1, 2021
PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text ... more PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Massive malignant solitary fibrous tumor arising from the bladder serosa: a case report
Background Hepatocellular carcinoma is a primary liver malignancy often caused by viral hepatitis... more Background Hepatocellular carcinoma is a primary liver malignancy often caused by viral hepatitis infection due to chronic inflammation and persistent cytokine release. Although rare, patients may present with large, pedunculated hepatocellular neoplasms that extend into the intra-abdominal space. Here, we present a case report on a 66-year-old male who was found to have such a mass that required careful pre-operative planning to complete a challenging, yet worthwhile, surgical intervention with R0 resection. Case Presentation A 66-year-old Caucasian male with a history of Hepatitis C presented with 4-5 months of abdominal pain, distention and weight loss. Imaging revealed a large heterogenous mass attached to the left lobe of the liver, with compression of the stomach, transverse colon and abdominal wall. Biopsy revealed hepatocellular carcinoma with extensive necrosis and ultimately the patient required surgical intervention, which required resection of omentum, partial gastrectomy, hepatectomy and extensive dissection of the mass to separate the tumor from the remaining intraabdominal structures and the retroperitoneum. Conclusion Peduncular hepatocellular carcinomas vary in presentation and difficulty of resection. The prognosis and probability of successful surgical intervention depends on the level of differentiation, early staging, size of the neoplasm and invasion into surrounding structures. In this case, R0 resection
Journal of Clinical Oncology, 2015
e14512 Background: Hispanics (H) are the largest and fastest growing ethnic group in the US. With... more e14512 Background: Hispanics (H) are the largest and fastest growing ethnic group in the US. With most of the studies focusing in African Americans and Non-Hispanics whites (NHW), defining the characteristics of colorectal cancer (CRC) in the Hispanic population has been a challenge. The aim of our study was to compare the clinico-pathological characteristics and survival among H and NHW with CRC. Methods: We reviewed the records of all patients (pts) diagnosed with CRC at our institution from 1993 to 2013. A total of 2146 pts were studied. Demographics, tumor characteristics, and survival were analyzed. Kaplan-Meier and Cox regression were used for survival and multivariate analysis. Results: There were 318 H and 1828 NHW. Median age at diagnosis was 63 years in H and 70 years in NHW. A significant difference was found in the stage IV pts, with a median age of 60 years for H and 71 years for NHW. Adenocarcinoma was the most common histologic subtype for both groups. At diagnosis, 96 (30%) of H had stage ...
Journal of Clinical Oncology, 2015
e14542 Background: Surgical resection remains a mainstay of treatment for localized colorectal ca... more e14542 Background: Surgical resection remains a mainstay of treatment for localized colorectal cancer (CRC). However, up to 35% of patients (pts) develop recurrence with a significant decrease in overall survival. The aim of this study was to evaluate clinical characteristics and specific predictors of recurrence for stage I/II CRC. Methods: We performed a retrospective analysis of 2310 pts diagnosed with stage I/II CRC at our institution between 1990 and 2013, with a minimum follow up of 24 months. Tumor characteristics and recurrence data were studied. Cox regression was used for statistical analysis. Results: Of the 2310 pts, recurrence was identified in 276 (12%) pts, of which 88 (32%) pts had early recurrence ( < 1year). Median time of recurrence was 625 days. 210 (76%) pts had local recurrence while 66 (24%) pts had distal recurrence, with liver being the main site of distant metastasis. Males had a higher recurrence rate than females (16% vs. 7%, p < 0.0001). When comparing recurrence pts (R) with ...
Journal of Clinical Oncology, 2014
1613 Background: Gastric cancer is a leading cause of cancer death worldwide and has significant ... more 1613 Background: Gastric cancer is a leading cause of cancer death worldwide and has significant geographical, ethnic, and socioeconomic differences in distribution. The aim of this study was to compare clinicopathological characteristics and survival between Hispanics and non-Hispanic whites with gastric cancer. Methods: We reviewed the records of all patients diagnosed with gastric cancer between January 1999 and March 2013 at the JTCC. A total of 638 patients were studied. Demographics, histology, anatomic site, recurrence and survival rate among both Hispanics and non-Hispanic whites were analyzed. Chi-square test was used to estimate differences in categorical data; Kaplan-Meier and Wilcoxon methods were used for the survival analysis. Results: There were 101 Hispanics (H) and 537 non-Hispanic whites (NHW). The mean age at diagnosis was 63 years (21-88) in H and 69 years (39-95) in NHW. A significant difference in age at diagnosis was found in the Stage IV subgroup, with a mean of 54 years for H and ...
Journal of Bacteriology, 1987
Spontaneous switching of the rotation sense of the flagellar motor of the archaebacterium Halobac... more Spontaneous switching of the rotation sense of the flagellar motor of the archaebacterium Halobacterium halobium and modulation of the switch by attractant and repellent photostimuli were analyzed by using a computerized cell-tracking system with 67-ms resolution coupled to electronic shutters. The data fit a three-state model of the switch, in which a Poisson process governs the transition from state N (nonreversing) to state R (reversing). After a reversal, the switch returns to state N, passing through an intermediate state I (inactive), which produces a ca. 2-s period of low reversal frequency before the state N Poisson rate is restored. The stochastic nature of the H. halobium switch reveals a close similarity to Escherichia coli flagellar motor properties as elucidated previously. Sensory modulation of the switch by both photoattractant and photorepellent signals can be interpreted in terms of modulation of the single forward rate constant of the N to R transition. Insight int...
Journal of Clinical Oncology, 2015
538 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the U.S. ... more 538 Background: Colorectal cancer (CRC) is the second leading cause of cancer deaths in the U.S. Early recognition of CRC in young patients (pts) is a challenge, and clinicopathologic features at the time of presentation are not well described. The aim of this study was to compare clinico-pathological characteristics and survival between early onset CRC (Age <50) and late onset CRC (Age ≥50). Methods: We reviewed the records of all patients diagnosed with CRC at our institution from 1999 to 2013. Total of 3,066 pts were studied. Demographics, tumor characteristics, and survival rate were analyzed. Patients with polyposis syndromes or genetic predisposition for CRC were excluded. Kaplan-Meier and Cox regression were used for the statistical analysis. Results: Of 3,066 pts, 425 pts (14%) under the age of 50 were identified (28-49). Hispanics (13% vs 8%, p<0.01) and African Americans (7% vs. 4%, p<0.009) were more prevalent in the early onset subgroup (EO) when compared to the...
Journal of Clinical Oncology, 2014
650 Background: Radiation in patients with rectal cancer is an important adjuvant therapy. It can... more 650 Background: Radiation in patients with rectal cancer is an important adjuvant therapy. It can be given either pre-operative or post-operative phase or both. However the optimum timing of the radiation in terms of pre-operative or post-op phase remains a question of debate in octogenarian patients as there is lack of enough evidence. Methods: In this study we aim to find the optimum time of radiation therapy in octogenarians with rectal cancer undergoing surgical resection. Octogenarians with rectal cancer were selected from surveillance, Epidemiology and End Results (SEER) database collected between 1998 and 2009. The data set contained 4,026 patients with rectal cancer who underwent surgical resection and radiation therapy. They were divided into 3 groups. 1,586 (39%) patients had radiation before the surgery. 66 (2%) patients had radiation before and after the surgery, also called the combination group. 2,347(59%) patients had radiation after the surgery. Taking in the conside...
Journal of Clinical Oncology, 2014
171 Background: Surgical resection of gastric GIST (Gastro-Intestinal Stromal Tumor) in octogenar... more 171 Background: Surgical resection of gastric GIST (Gastro-Intestinal Stromal Tumor) in octogenarians is a morbid procedure. There is limited data in literature about the survival of octogenarians after resection of gastric GIST. In this study we focused on the outcome in terms of survival in octogenarians with resectable gastric GIST. Methods: Our study demonstrates that octagenarians as a whole do not experience a survival benefit from surgical resection for HCC. Subgroup analysis, however, may ultimately identify benefit in specific disease stages or patients with fewer comorbidities. Results: The mean survival in the patient group undergoing surgery was 31.30 months and the mean survival in the patients opting for non-surgical management was 33.89 months. The survival benefit in avoiding surgery in this population was 2.59 months with a p-value of <0.0001 and a confidence interval of 1.35 to 3.83 months. Conclusions: The mean survival in the patient group undergoing surgery w...
CRSLS: MIS Case Reports from SLS, 2014
Introduction: Despite evolving experience with laparoscopic resections of gastric gastrointestina... more Introduction: Despite evolving experience with laparoscopic resections of gastric gastrointestinal stromal tumors (GISTs), there are few data describing robotic resections. Here we describe the robotic removal of a gastric GIST using laparoscopic ultrasonography for tumor localization. Case Description: The patient is a 46-year-old African-American man with a biopsy-proven 3.5 ϫ 3.5-cm GIST along the greater curvature of the stomach, and with no evidence of metastatic disease on preoperative computed tomographic staging. Three robotic ports (12-mm umbilical, 8-mm left lower quadrant, and 8-mm subxiphoid) were combined with a 12-mm right lower quadrant assist port and a right midabdomen 8-mm port for the laparoscopic liver retractor. Mass localization was facilitated by intraoperative ultrasonography and dissection performed with bipolar electrocautery via dissecting forceps. Resection was performed using a stapled technique and the specimen removed via the assist port. Total operative time was 104 minutes and estimated blood loss was 25 mL. There was no significant morbidity. Length of stay was 3 days, and the patient returned to work within 1 week. The retrieved specimen was CD117-and DOG1-positive with 2 to 3 mitoses/hpf. At 1-year follow-up, there was no evidence of disease. Discussion: This case report describes a novel and efficient technique for the robotic removal of a gastric GIST. This resection can be safely performed with the aid of intraoperative ultrasonography instead of gastroscopy or gastrotomy for identification of resection margins.
The Annals of Thoracic Surgery, Mar 1, 2014
cavity and deliver enteral nutrient from a distal point nasally (Fig 3B). The treatment was effec... more cavity and deliver enteral nutrient from a distal point nasally (Fig 3B). The treatment was effective, and the patient recovered smoothly. In conclusion, we encountered a very rare case of anastomotic leakage followed by lung fistula after esophagectomy, managed successfully with a WED tube. We consider that the WED tube was very effective for the treatment of this patient because it facilitated decompression of the gastric conduit and administration of sufficient parenteral nutrition.
Journal of the American College of Surgeons, 2015
RESULTS: There were 948 OVHRs, 400 LWM, and 548 MWM. The MWM patients tended to be more complex t... more RESULTS: There were 948 OVHRs, 400 LWM, and 548 MWM. The MWM patients tended to be more complex than LWM patients, with longer operative times, larger defects requiring larger meshes and more component separations, more frequent panniculectomy, and longer inpatient stay (Table, p 0.05)(Table).QOLscores were no different at 1, 6, or 12 months (p>0.05).
Clinics and Practice, 2015
A 72-year-old female presented with dyspepsia for 2 years and an incidental mass in the head of t... more A 72-year-old female presented with dyspepsia for 2 years and an incidental mass in the head of the pancreas on abdominal computed tomography (CT) scan. Patient had multiple negative endoscopic ultrasound guided biopsies. She was followed up for 3 years with serial imaging until an abdominal CT scan showed an increase in size of the pancreatic mass. Physical examination was unremarkable. Laboratory tests including tumor markers were normal. Given the enlarging size of the mass and its impingement on the portal vein, the consensus was to proceed with surgery. Histology revealed a 3.5 cm mass showing a spindle cell neoplasm with mild atypia. The lesion was well defined and nerve tissue was noted at the periphery. On immuno-stains, the spindle cells were positive for S-100 protein and negative for pan-cytokeratin, CD-34, CD- 117, smooth muscle actin and Melan A, consistent with the diagnosis of a pancreatic schwannoma.
Annals of gastroenterology : quarterly publication of the Hellenic Society of Gastroenterology
Gastriccancer is a leading cause of cancer death worldwide and has significant ethnic and socioec... more Gastriccancer is a leading cause of cancer death worldwide and has significant ethnic and socioeconomic differences in distribution. The aim of this study was to compare clinicopathologic characteristics and survival between Hispanics (H) and non-Hispanic whites (NHW) with gastric cancer. We reviewed the records of all patients diagnosed with gastric cancer between 1999 and 2013 at our institution. A total of 638 patients were studied. Demographics, tumor characteristics and survival rate were analyzed. Kaplan-Meier was used for survival analysis. There were 101 H and 537 NHW. The median age at diagnosis was 63 years in H and 69 years in NHW. At diagnosis, 48 (48%) of H patients had stage IV disease compared with 195 (36%) of NHW (P<0.03). H were more likely to have distal cancers and poorly differentiated tumors compared to NHW (44% vs. 15%, P<0.0001; 70% vs. 50%, P<0.0002, respectively). There was a significant difference in median overall survival between the two groups,...