Richard Schulick

ObjectivesThe effect of a patient’s Social Vulnerability Index (SVI) on complication rates after esophagectomy remains unstudied. The purpose of this study was to determine how social vulnerability influences morbidity following esophagectomy.MethodsThis was a retrospective review of a prospectively collected esophagectomy database at one academic institution, 2016 to 2022. Patients were grouped into low-SVI (<75%ile) and high-SVI (>75%ile) cohorts. The primary outcome was overall postoperative complication rate; secondary outcomes were rates of individual complications. Perioperative patient variables and postoperative complication rates were compared between the 2 groups. Multivariable logistic regression was used to control for covariates.ResultsOf 149 patients identified who underwent esophagectomy, 27 (18.1%) were in the high-SVI group. Patients with high SVI were more likely to be of …

ASO Visual Abstract: Adjuvant Chemotherapy with or Without Radiotherapy for Resected Pancreatic Cancer Following Multiagent Neoadjuvant Chemotherapy ASO Visual Abstract: Adjuvant Chemotherapy with or Without Radiotherapy for Resected Pancreatic Cancer Following Multiagent Neoadjuvant Chemotherapy Ann Surg Oncol. 2024 Apr 26. doi: 10.1245/s10434-024-15335-4. Online ahead of print. Authors Oskar Franklin 1 2 , Toshitaka Sugawara 1 3 , Richard Blake Ross 4 , Salvador Rodriguez Franco 1 , Kathryn Colborn 5 6 , Sana Karam 4 , Richard D Schulick 7 8 , Marco Del Chiaro 9 10 Affiliations 1 Division of Surgical Oncology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA. 2 Department of Diagnostics and Intervention, Surgery, Umeå University, Umeå, Sweden. 3 Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical …

ObjectiveThe purpose of this study was to determine if an association between Social Vulnerability Index (SVI) and risk-adjusted complications exists in a broad spectrum of surgical patients.Summary background dataGrowing evidence supports the impact of social circumstances on surgical outcomes. SVI is a neighborhood-based measure accounting for sociodemographic factors putting communities at risk.MethodsThis was a multi-hospital, retrospective cohort study including a sample of patients within one healthcare system (2012–2017). Patient addresses were geocoded to determine census tract of residence and estimate SVI. Patients were grouped into low SVI (score<75) and high SVI (score≥75) cohorts. Perioperative variables and postoperative outcomes were tracked and compared using local ACS-NSQIP data. Multivariable logistic regression was performed to generate risk-adjusted odds ratios of …

BackgroundHistorically, pancreaticoduodenectomy (PD) has been performed via a laparotomy, but increasingly, laparoscopic and robotic platforms are being employed for PD. Laparoscopic PD has a steep surgeon specific learning curve and programmatic elements that must be optimized. These factors may limit a surgeon who is proficient at laparoscopic PD to develop a program at another institution. We hypothesize that the learning curve for a surgeon transferring a program to a second institution is shorter than the initial laparoscopic PD learning curve for the same surgeon.MethodsA retrospective review of patients who underwent laparoscopic PD for any indication at the first institution (FI) from 2012 to 2017 and the second institution (SI) from 2018 to 2021 was conducted. Standard statistical analysis was performed. The learning curve was identified using one-sided CUSUM analysis of operative times.Result …

Objective:The REDISCOVER consensus conference aimed at developing and validate guidelines on the perioperative care of patients with borderline resectable (BR-) and locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC).Summary Background Data:Coupled with improvements in chemotherapy and radiation, the contemporary approach to pancreatic surgery supports resection of BR-PDAC and, to a lesser extent, LA-PDAC. Guidelines outlining the selection and perioperative care for these patients are lacking.Methods:The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used to develop the REDISCOVER guidelines and create recommendations. The Delphi approach was used to reach consensus (agreement≥ 80%) among experts. Recommendations were approved after a debate and vote among international experts in pancreatic surgery and pancreatic cancer …

The downstream effects on healthcare delivery during the initial wave of the COVID‐19 pandemic remain unclear. The purpose of this study was to determine how the healthcare environment surrounding the pandemic affected the oncologic care of patients diagnosed with esophageal cancer. This was a retrospective cohort study evaluating patients in the National Cancer Database (2019–2020). Patients with esophageal cancer diagnoses were divided into pre‐pandemic (2019) and pandemic (2020) groups. Patient demographics, cancer‐related variables, and treatment modalities were compared. Among 26,231 esophageal cancer patients, 14,024 patients (53.5%) were in the pre‐pandemic cohort and 12,207 (46.5%) were in the pandemic cohort. After controlling for demographics, patients diagnosed during the pandemic were more likely to have poorly differentiated tumors (odds ratio [OR] 1.24, 95 …

Background: For head and neck pancreatic cancer it is difficult to differentiate whether vascular involvement is a true biologic predictor of survival due to technical issues. Splenic artery (SpA) and vein (SpV) are the same-grade branches of the celiac axis and portal vein as the hepatic artery and superior mesenteric vein and therefore a good model to study the link between radiologic involvement and survival. The NCCN definitions of borderline, BR, and locally advanced pancreatic cancer, LAPC, were applied to SpA/SpV in body and tail pancreatic cancer (btPC) and correlated with survival.Materials and Methods: The imaging of patients operated for resectable (R) btPC between January 2008-October 2018 in three high-volume centers was retrospectively reviewed.“btBR” was defined as SpV> 180 or≤ 180+ contour irregularity/thrombosis and/or SpA contact> 180.“btLAPC” was defined as SpA contact> 180 …

C-type lectins, distinguished by a C-type lectin binding domain (CTLD), are an evolutionarily conserved superfamily of glycoproteins that are implicated in a broad range of physiologic processes. The group XIV subfamily of CTLDs are comprised of CD93, CD248/endosialin, CLEC14a, and thrombomodulin/CD141, and have important roles in creating and maintaining blood vessels, organizing extracellular matrix, and balancing pro-and anti-coagulative processes. As such, dysregulation in the expression and downstream signaling pathways of these proteins often lead to clinically relevant pathology. Recently, group XIV CTLDs have been shown to play significant roles in cancer progression, namely tumor angiogenesis and metastatic dissemination. Interest in therapeutically targeting tumor vasculature is increasing and the search for novel angiogenic targets is ongoing. Group XIV CTLDs have emerged as key …

Objective:The objective of this study was to assess the association of survival with neoadjuvant chemotherapy (NAC) in resectable pancreatic adenocarcinoma (PDAC).Background:The early control of potential micrometastases and patient selection using NAC has been advocated for patients with PDAC. However, the role of NAC for resectable PDAC remains unclear.Methods:Patients with clinical T1 and T2 PDAC were identified in the National Cancer Database from 2010 to 2017. Kaplan–Meier estimates, and Cox regression models were used to compare survival. To address immortal time bias, landmark analysis was performed. Interactions between preoperative factors and NAC were investigated in subgroup analyses. A propensity score analysis was performed to compare survival between multiagent NAC and upfront surgery.Results:In total, 4041 patients were treated with upfront surgery and 1,175 patients …

ObjectiveGrowing evidence supports the impact of sociodemographics on cancer outcomes. The objective of this study was to examine the Social Vulnerability Index (SVI) and its association with oncologic presentation and subsequent treatments across 8 major cancers.MethodsThis was a retrospective-cohort study using one institution’s contribution to the National Cancer Database (2011–2021). Patients were grouped into low SVI (<75th percentile) and high SVI (≥75th percentile) cohorts. Un-adjusted comparison between groups was performed followed by multivariable regression to control for the effect of demographic characteristics on oncologic presentation, and for demographic and oncologic characteristics on subsequent treatments. A subgroup analysis was performed comparing cancers that have national screening protocols versus those without.ResultsOf 12,712 cases, 2842 (22.4%) were in the high …

Background: Limited evidence is available on the safety of pancreatectomy for patients with celiac artery stenosis (CAS).Methods: Patients who underwent pancreaticoduodenectomy or total pancreatectomy between 2011 and 2021 at the University of Colorado Cancer Center were analyzed. Preoperative enhanced computed tomography was reviewed for the assessment of CAS. Stenosis rate was calculated using the sagittal plane and cases with> 30% stenosis were defined as having CAS. We compared the clinical outcomes between patients with and without CAS.Results: Out of 759 patients included in this study, 45 (5.9%) had CAS (< 50% stenosis, n= 8; 50%–70% stenosis, n= 28;≥ 70% stenosis, n= 9). The incidence of major complications (Clavien-Dindo grade 3 or more) was similar between patients with and without CAS (22.2% versus 20.0%, p= 0.722). However, patients with CAS had higher rates of …

BackgroundA significantly lower rate of non–small cell lung cancer (NSCLC) screening, greater healthcare avoidance, and changes to oncologic recommendations were some consequences of the Coronavirus disease 2019 (COVID-19) pandemic affecting the medical environment. We sought to determine how the healthcare environment during the COVID-19 pandemic affected the oncologic treatment of patients diagnosed with non–small cell lung cancer (NSCLC).MethodsThis was a retrospective cohort study evaluating patients with NSCLC in the National Cancer Database (2019-2020). Patients were divided into prepandemic (2019) and pandemic (2020) cohorts, and patient, oncologic, and treatment variables were compared. Multivariable logistic regression was performed to control for the impact of demographic characteristics on oncologic variables and the impact of oncologic variables on treatment …

BackgroundMany states have legalized medical cannabis with various reported therapeutic benefits. However, there is little data assessing the effects of cannabis on surgical outcomes. We sought to compare post-operative pancreatic resection complications between cannabis users and non-users.MethodsThis is a single-center, retrospective review of patients who underwent Whipple or distal pancreatectomy from 1/2017-12/2020. The primary outcome was any in-hospital complication, using Clavien-Dindo. Multivariable regression analysis was performed.ResultsThere were 486 patients who underwent Whipple (n=346, 71.2%) or distal pancreatectomy (n=140, 28.8%). Overall, 21.4% (n=104) reported cannabis use, of whom 80.8% were current users. Cannabis users were younger (60 vs. 66 years, p < 0.001), and more likely to have smoked tobacco (p=0.04), but otherwise had similar demographics as non …

Locally advanced pancreatic cancer (LAPC), which progresses locally and surrounds major vessels, has historically been deemed unresectable. Surgery alone failed to provide curative resection and improve overall survival. With the advancements in treatment, reports have shown favorable results in LAPC after undergoing successful chemotherapy therapy or chemoradiation therapy followed by surgical resection, so-called “conversion surgery”, at experienced high-volume centers. However, recognizing significant regional and institutional disparities in the management of LAPC, an international consensus meeting on conversion surgery for LAPC was held during the Joint Congress of the 26th Meeting of the International Association of Pancreatology (IAP) and the 53rd Annual Meeting of Japan Pancreas Society (JPS) in Kyoto in July 2022. During the meeting, presenters reported the current best …

Simple Summary This study aimed to compare the characteristics, management, and overall survival of pancreatic ductal adenocarcinoma (PDAC) vs. invasive intraductal papillary mucinous neoplasm (IPMN) using the National Cancer Database in the US. This study included 101,190 patients, with 100,834 having PDAC and 356 having IPMN. The results showed that PDAC was more aggressive than IPMN, with a lower proportion of patients undergoing surgery but a higher proportion receiving chemotherapy or radiation. The median overall survival for PDAC was 8.3 months and for IPMN it was 33.4 months. Surgery was found to improve overall survival, and efforts should focus on facilitating surgical treatment for better outcomes. Abstract Background: Current evidence on overall survival (OS) between invasive pancreatic ductal adenocarcinoma (PDAC) and intraductal papillary mucinous neoplasm (IPMN) is limited to single-center reports. We aimed to compare the characteristics, management, and OS of invasive PDAC vs. IPMN using a national United States (US) database. Methods: Invasive PDAC or IPMN adult (≥18 years) patients were identified in the National Cancer Database (2004–2016). OS was assessed with the Kaplan–Meier method and the stratified log-rank test. Results: We included 101,190 patients (100,834 PDAC, 356 IPMN). A higher proportion of PDAC vs. IPMN patients had clinical N1 (36.8% vs. 15.7%, p < 0.001) and M1 disease (41.2% vs. 5.9%, p < 0.001). A lower proportion of PDAC patients underwent surgery (25.5% vs. 80.3%, p < 0.001), but a higher proportion received …

Background: Patients who undergo a liver resection are at moderate-to-high risk for postoperative venous thromboembolism (VTE). This is especially true for those who undergo a major hepatectomy. However, VTE prophylaxis is often withheld in these patients due to concerns about postoperative bleeding. This study was designed to evaluate the incidence of VTE after a major hepatectomy as well as to identify possible perioperative risk factors.Methods: This study is a retrospective review of prospectively collected data on all patients who underwent a major hepatectomy between 2010 and 2022 in a single institution. Patient demographics, perioperative characteristics, thromboprophylaxis use, complications, and clinical outcomes were assessed. Diagnosis of VTE based on clinical criteria was assessed for up to one year from the surgical procedure.Results: A total of 374 patients were included. The overall …

Significantly lower rates of NSCLC screening, healthcare avoidance, and changes to oncologic recommendations were some consequences of the medical environment during the COVID-19 pandemic. We sought to determine how the healthcare environment during the COVID-19 pandemic affected the oncologic treatment of patients diagnosed with non-small cell lung cancer (NSCLC). This was a retrospective cohort study evaluating patients with NSCLC in the National Cancer Database (2019-2020). Patients were divided into pre-pandemic (2019) and pandemic (2020) cohorts. Patient, oncologic, and treatment variables were compared. Multivariable logistic regression was performed to control for the impact of demographic characteristics on oncologic variables and the impact of oncologic variables on treatment variables. There were 250,791 patients included: 114,533 patients (45.7%) were in the pandemic cohort. There were 15% fewer new NSCLC diagnoses during the pandemic. Patients diagnosed during the pandemic had more advanced clinical TNM stage on presentation (p< 0.0001) and were more likely to have tumors in overlapping lobes or in a main bronchus (p= 0.0002). They were less likely to receive cancer treatment (p< 0.0001), to undergo primary resection (p< 0.0001), and more likely to receive adjuvant systemic therapy (p= 0.004), and a combination of palliative treatment regimens (p< 0.0001). After risk-adjustment, these differences remained statistically significant (p-values< 0.05). The COVID-19 pandemic was associated with increased clinical stage at presentation for patients with NSCLC, which impacted subsequent …

BackgroundTumors of mixed neuroendocrine and nonneuroendocrine histology are classified as collision, combined, or amphicrine and can occur in most organs, including the hepato-pancreato-biliary tract. Given the rarity of mixed adenoneuroendocrine carcinoma (MANEC) of the ampulla of Vater, the patient characteristics, management, and outcomes remain unclear. We sought to systematically review the worldwide literature on ampullary MANECs.MethodsEligible studies were identified through a systematic search of the MEDLINE (via PubMed), Scopus, and Cochrane Library databases (end-of-search-date: January 5th, 2022), according to the PRISMA 2020 statement.ResultsA total of 39 studies reporting on 56 patients with ampullary MANEC were included. The median age was 63.0 (interquartile range [IQR]: 51.0–69.0) years and 55.6% were male (n = 25/45). Most had combined tumors (64.4%; n = 29/45 …

BACKGROUND:The role of curative-intent resection and perioperative chemotherapy for nonmetastatic pancreatic neuroendocrine carcinoma (PanNEC) remains unclear due to their biological aggressiveness and rarity. This study aimed to evaluate the association of resection and perioperative chemotherapy with overall survival for nonmetastatic PanNEC.STUDY DESIGN:Patients with localized (cT1–3, M0), small-and large-cell PanNEC were identified in the National Cancer Database from 2004 to 2017. The changing trends in terms of the annual proportions of resection and adjuvant chemotherapy were assessed. The survival of patients who received resection and those who received adjuvant chemotherapy were investigated using Kaplan–Meier estimates and Cox regression models.RESULTS:In total, 199 patients with localized small-and large-cell PanNEC were identified; 50.3% of those were resected, and …

722Background: While neoadjuvant chemotherapy is increasingly being using in pancreatic cancer treatment, it is unclear whether it is beneficial in treatment of body and tail tumors. Randomized controlled trials are lacking and previous observational studies have not demonstrated any benefit. We aimed to assess survival associations, trends over time and patient selection associations for multiagent neoadjuvant chemotherapy treated pancreatic cancer of the body and tail using data from the National Cancer Database (NCDB). Methods: We queried the NCDB for pancreatic adenocarcinoma in the body or tail diagnosed between 2010 – 2018 that received multiagent neoadjuvant chemotherapy and/or a distal pancreatectomy. Patients with clinical M1, clinical T4 and surgery other than partial pancreatectomy were excluded. Survival was compared with Kaplan-Meier estimates and multivariable Cox Proportional …