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Article ; Online: PRO-Angoff method for remote standard setting: establishing clinical thresholds for the upper digestive disease tool.

Lee, Minji K / Abou Chaar, Mohamad K / Blackmon, Shanda H / Yost, Kathleen J

Journal of patient-reported outcomes

2024 Volume 8, Issue 1, Page(s) 30

Abstract: Background: The Upper Digestive Disease (UDD) Tool™ is used to monitor symptom frequency, intensity, and interference across nine symptom domains and includes two Patient-Reported Outcome Measurement Information System (PROMIS) domains assessing ... ...

Abstract	Background: The Upper Digestive Disease (UDD) Tool™ is used to monitor symptom frequency, intensity, and interference across nine symptom domains and includes two Patient-Reported Outcome Measurement Information System (PROMIS) domains assessing physical and mental health. This study aimed to establish cut scores for updated symptom domains through standard setting exercises and evaluate the effectiveness and acceptability of virtual standard setting. Methods: The extended Angoff method was employed to determine cut scores. Subject matter experts refined performance descriptions for symptom control categories and achieved consensus. Domains were categorized into good, moderate, and poor symptom control. Two cut scores were established, differentiating good vs. moderate and moderate vs. poor. Panelists estimated average scores for 100 borderline patients per item. Cut scores were computed based on the sum of the average ratings for individual questions, converted to 0-100 scale. Results: Performance descriptions were refined. Panelists discussed that interpretation of the scores should take into account the timing of symptoms after surgery and patient populations, and the importance of items asking symptom frequency, severity, and interference with daily life. The good/moderate cut scores ranged from 21.3 to 35.0 (mean 28.6, SD 3.6) across domains, and moderate/poor ranged from 47.5 to 71.3 (mean 54.5, SD 7.0). Conclusions: Panelists were confident in the virtual standard setting process, expecting valid cut scores. Future studies can further validate the cut scores using patient perspectives and collect patient and physician preferences for displaying contextual items on patient- and physician-facing dashboard.
MeSH term(s)	Humans ; Patient Reported Outcome Measures ; Physical Examination ; Mental Health
Language	English
Publishing date	2024-03-12
Publishing country	Germany
Document type	Journal Article
ISSN	2509-8020
ISSN (online)	2509-8020
DOI	10.1186/s41687-024-00707-x
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Article ; Online: Clarifying the UDD Tool's Role in Post-Esophagectomy Care.

Abou Chaar, Mohamad K / Lee, Minji K / Yost, Kathleen J / Blackmon, Shanda H

The Annals of thoracic surgery

2023

Language	English
Publishing date	2023-12-21
Publishing country	Netherlands
Document type	Letter
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2023.12.001
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Article ; Online: Chest wall and diaphragm reconstruction; a technique not well established in literature - case report.

Abdel Jalil, Riad / Abou Chaar, Mohamad K / Al-Qudah, Obada / Kakish, Hanna / Elfar, Salam

Journal of cardiothoracic surgery

2021 Volume 16, Issue 1, Page(s) 196

Abstract: Introduction: Regardless of its rarity, and indolent clinical course, chest wall tumor places high morbidity and burden on patients especially when invasion to a neighboring structure is found. Once detected, surgery is the cornerstone for treatment of ... ...

Abstract	Introduction: Regardless of its rarity, and indolent clinical course, chest wall tumor places high morbidity and burden on patients especially when invasion to a neighboring structure is found. Once detected, surgery is the cornerstone for treatment of such etiology combined with chemo-radiotherapy. In order to maintain intact respiratory function, chest wall reconstruction must be performed whenever resection is done. Herein, we present a case of chest wall tumor that necessitated three ribs and part of hemidiaphragm resection and reconstruction with optimal post-operative results. Case presentation: A 27-year-old male patient who had chest wall and diaphragm reconstruction for a chest wall Ewing sarcoma, using a single patch of expanded polytetrafluoroethylene (ePTFE) mesh with diaphragm implanted into the middle of the mesh. There were no immediate nor post-operative complications. The patient received post-operative radiotherapy with good functional and cosmetic results. Conclusion: We present a novel and safe technique for combined chest wall and diaphragmatic resection following excision of an invading tumor while ensuring cosmesis and functionality of the ribcage as well as the diaphragm.
MeSH term(s)	Adult ; Diaphragm/surgery ; Humans ; Male ; Polytetrafluoroethylene ; Radiotherapy, Adjuvant ; Plastic Surgery Procedures/methods ; Ribs/surgery ; Sarcoma, Ewing/radiotherapy ; Sarcoma, Ewing/surgery ; Surgical Mesh ; Thoracic Neoplasms/radiotherapy ; Thoracic Neoplasms/surgery ; Thoracic Wall/surgery
Chemical Substances	Polytetrafluoroethylene (9002-84-0)
Language	English
Publishing date	2021-07-09
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-021-01577-w
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Article: Novel Double Central Ray Amputation of the Third and Fourth Digits: Case Report and Literature Review.

Abou Chaar, Mohamad K / Jaber, Omar I / Asha, Wafa / Abdel Al, Samer

Case reports in oncology

2020 Volume 13, Issue 1, Page(s) 91–99

Abstract: Whenever partial hand amputations for soft tissue sarcomas are attempted, special consideration should be given to achieve a balance between complete resection associated with negative margins and preservation of functionality to the patient so that the ... ...

Abstract	Whenever partial hand amputations for soft tissue sarcomas are attempted, special consideration should be given to achieve a balance between complete resection associated with negative margins and preservation of functionality to the patient so that the hand can support the contralateral intact hand for bimanual activities. This difficult decision is even more challenging within the limited anatomical confines of the hand. Based on our literature review, this is the first case of double central 3rd and 4th ray amputation, as far as we know with good hand function, evaluated by the Musculoskeletal Tumor Rating Scale.
Language	English
Publishing date	2020-02-06
Publishing country	Switzerland
Document type	Case Reports
ZDB-ID	2458961-5
ISSN	1662-6575
ISSN	1662-6575
DOI	10.1159/000504934
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Article ; Online: Maintaining quality of life after major lung resection for carcinoid tumor.

Abdel Jalil, Riad / Abdallah, Farah A / Obeid, Zeinab / Abou Chaar, Mohamad K / Harb, Ahmad Khaled / Shannies, Tariq Bassam / El-Edwan, Ahed / Haddad, Hussam / Ghraibeh, Azza / Abu-Shanab, Ahmad

Journal of cardiothoracic surgery

2023 Volume 18, Issue 1, Page(s) 330

Abstract: Background: Pulmonary carcinoid is a rare diagnosis with surgery remaining the standard treatment of choice. However, resection may impact patients' daily activities due to decreased lung volume reserve and postoperative pain. Our study aims to compare ... ...

Abstract	Background: Pulmonary carcinoid is a rare diagnosis with surgery remaining the standard treatment of choice. However, resection may impact patients' daily activities due to decreased lung volume reserve and postoperative pain. Our study aims to compare the impact of different types of surgical resection on the post-operative quality of life with the application of a strict peri-operative pulmonary care program. Methods: Patients who underwent surgery for bronchopulmonary carcinoid tumors in a tertiary cancer center between August, 2017 and March, 2020 were identified and demographic data was collected. Patients were contacted via phone for the qualitative and quantitative assessment of pain and quality of life, utilizing the Arabic version of Short-form McGill Pain Questionnaire and Activity of Daily Living (ADL) instrument respectively. Lung reserve was assessed before and after surgery. Statistical analysis used Chi-Square for categorical variables and ANOVA for continuous variables. Results: A total of 16 patients underwent different type of resection. The majority were male (n = 10; 63%) with a mean age of 44 years (19-81). Most common clinical stage was stage I (n = 12, 75%) with typical carcinoid features recorded in more than half of the cases (n = 11, 69%). Almost all patients underwent surgical excision (n = 15, 94%) with negative resection margin and no major post-operative complications. Bilobectomy was the most frequent procedure (n = 6, 40%) and video-assisted thoracoscopic surgery (VATS) was utilized in 8 patients (50%). Expected changes were recorded in pre- and postoperative pulmonary function test with an average drop of 10 in FEV1 and 14 mL/min/mmHg in DLCO. The majority of patients (n = 15, 94%) were totally independent doing daily activities. Mild intermittent pain was found in 7 patients (44%) who scored an average intensity of 1.6 out of 10. Conclusions: Excellent long-term outcomes can be achieved following surgical resection of pulmonary carcinoid tumors with little to no effect on patients' lung function and quality of life in regard to performance status and post-operative pain when a good peri-operative pulmonary, physical rehabilitation, and pain management programs are adopted and strictly implemented.
MeSH term(s)	Humans ; Male ; Female ; Adult ; Quality of Life ; Lung Neoplasms/pathology ; Lung/pathology ; Carcinoid Tumor/surgery ; Carcinoid Tumor/complications ; Pneumonectomy/methods ; Pain, Postoperative/etiology ; Thoracic Surgery, Video-Assisted/methods
Language	English
Publishing date	2023-11-14
Publishing country	England
Document type	Journal Article
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-023-02435-7
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Article ; Online: Locally advanced thymoma; does neoadjuvant chemotherapy make a difference?

Abdel Jalil, Riad / Abdallah, Farah A / Obeid, Zeinab / Harb, Ahmad Khaled / Abou Chaar, Mohamad K / Shannies, Tariq Bassem / El-Edwan, Ahed / Haddad, Hussam / Ghraibeh, Azza / Abu-Shanab, Ahmad

Journal of cardiothoracic surgery

2023 Volume 18, Issue 1, Page(s) 245

Abstract: Background: Regardless of its rare occurrence, Thymoma remains the most frequently encountered primary tumor of the anterior mediastinum comprising about 50% of all masses in the region. Surgical resection, via thymectomy, remains the mainstay treatment ...

Abstract	Background: Regardless of its rare occurrence, Thymoma remains the most frequently encountered primary tumor of the anterior mediastinum comprising about 50% of all masses in the region. Surgical resection, via thymectomy, remains the mainstay treatment modality. In locally advanced and borderline resectable tumors, neoadjuvant chemotherapy (NACT) may be utilized to increase the chance of R0 resection, raising the question of its efficacy and safety. Methods: Demographic and clinical data from patients who presented to a tertiary cancer center between January 2015-October 2021 with a diagnosis of thymoma and underwent curative surgical resection was collected. Computed tomography scan was used to delineate clinical staging, tumor size and to detect post-therapeutic variations in tumor burden. The response evaluation criteria in solid tumors (RECIST) was used to classify the effect of NACT on tumor burden. The pathological response was determined by measuring the percentage of necrotic tissue. Results: A total of 23 patients were diagnosed with thymoma. Most patients were male with a mean age 46 (± 15) years at diagnosis. The most common clinical stage was stage II with 5 patients (22%). A total of 12 patients had NACT as compared to 11 patients who had upfront surgery. The mean change in tumor volume was 165 cm Conclusions: The exact role of induction chemotherapy in locally advanced thymoma patients remains controversial. NACT effect after utilizing radiological and pathological assessment tools was not found to significantly improve oncological outcomes compared to upfront surgery in locally advanced disease, with minimal radiologic and pathologic effect. To further demonstrate the impact of induction chemotherapy, we recommend multicentric collaborative studies.
MeSH term(s)	Humans ; Male ; Middle Aged ; Female ; Thymoma/drug therapy ; Thymoma/surgery ; Neoadjuvant Therapy ; Thymus Neoplasms/drug therapy ; Thymus Neoplasms/surgery ; Mediastinum ; Necrosis
Language	English
Publishing date	2023-08-18
Publishing country	England
Document type	Journal Article
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-023-02357-4
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Article ; Online: Determinants of Long-term Survival Decades After Esophagectomy for Esophageal Cancer.

Abou Chaar, Mohamad K / Godin, Anny / Harmsen, William S / Wzientek, Camryn / Saddoughi, Sahar A / Hallemeier, Christopher L / Cassivi, Stephen D / Nichols, Francis C / Reisenauer, Janani S / Shen, K Robert / Tapias, Luis F / Wigle, Dennis A / Blackmon, Shanda H

The Annals of thoracic surgery

2023 Volume 116, Issue 5, Page(s) 1036–1044

Abstract: Background: Long-term survival in esophagectomy patients with esophageal cancer is low due to tumor-related characteristics, with few reports of modifiable variables influencing outcome. We identified determinants of overall survival, time to recurrence, ...

Abstract	Background: Long-term survival in esophagectomy patients with esophageal cancer is low due to tumor-related characteristics, with few reports of modifiable variables influencing outcome. We identified determinants of overall survival, time to recurrence, and disease-free survival in this patient cohort. Methods: Adult patients who underwent esophagectomy for primary esophageal cancer from January 5, 2000, through December 30, 2010, at our institution were identified. Univariate Cox models and multivariable logistic regression analyses were used to identify associations between modifiable and unmodifiable patient and clinical variables and outcome of survival for the total cohort and a subgroup with locally advanced disease. Results: We identified 870 patients with esophageal cancer who underwent esophagectomy. The median follow-up time was 15 years, and the 15-year overall survival rate was 25.2%, survival free of recurrence was 57.96%, and disease-free survival was 24.21%. Decreased overall survival was associated with the following unmodifiable variables: older age, male sex, active smoking status, history of coronary artery disease, advanced clinical stage, and tumor location. Decreased overall survival was associated with the following modifiable variables: use of neoadjuvant therapy, advanced pathologic stage, resection margin positivity, surgical reintervention, and blood transfusion requirement. The overall survival probability 6 years after esophagectomy was 0.920 (95% CI, 0.895-0.947), and time-to-recurrence probability was 0.988 (95% CI, 0.976-1.000), with a total of 17 recurrences and 201 deaths. Conclusions: Once patients survive 5 years, recurrence is rare. Long-term survival can be achieved in high-volume centers adhering to National Comprehensive Cancer Network guidelines using multidisciplinary care teams that is double what has been previously reported in the literature from national databases.
Language	English
Publishing date	2023-06-22
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2023.05.033
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Zs.A 252: Show issues

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Jg. 1995 - 2021: Lesesall (1.OG)
ab Jg. 2022: Lesesaal (EG)

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Article ; Online: Esophagectomy Enhanced Recovery After Surgery Initiative Results in Improved Outcomes.

Sims, Charles R / Abou Chaar, Mohamad K / Kerfeld, Mitchell H / Cassivi, Stephen D / Hofer, Ryan E / Nichols, Francis C / Reisenauer, Janani / Saddoughi, Sahar S / Shen, K Robert / Stewart, Thomas M / Tapias, Luis F / Wigle, Dennis A / Blackmon, Shanda H

The Annals of thoracic surgery

2023 Volume 117, Issue 4, Page(s) 847–857

Abstract: Background: Esophagectomy for esophageal cancer is a procedure with high morbidity and mortality. This study developed a Multidisciplinary Esophagectomy Enhanced Recovery Initiative (MERIT) pathway and analyzed implementation outcomes in a single ... ...

Abstract	Background: Esophagectomy for esophageal cancer is a procedure with high morbidity and mortality. This study developed a Multidisciplinary Esophagectomy Enhanced Recovery Initiative (MERIT) pathway and analyzed implementation outcomes in a single institution. Methods: The MERIT pathway was developed as a practice optimization and quality improvement initiative. Patients were studied from November 1, 2021 to June 20, 2022 and were compared with historical control subjects. The Wilcoxon rank sum test and the Fisher exact test were used for statistical analysis. Results: The study compared 238 historical patients (January 17, 2017 to December 30, 2020) with 58 consecutive MERIT patients. There were no significant differences between patient characteristics in the 2 groups. In the MERIT group, 49 (85%) of the patients were male, and their mean age was 65 years (range, 59-71 years). Most cases were performed for esophageal cancer after neoadjuvant therapy. Length of stay improved by 27% from 11 to 8 days (P = .27). There was a 12% (P = .05) atrial arrhythmia rate reduction, as well as a 9% (P = .01) decrease in postoperative ileus. Overall complications were reduced from 54% to 35% (-19%; P = .01). Conclusions: This study successfully developed and implemented an enhanced recovery after surgery pathway for esophagectomy. In the first year, study investigators were able to reduce overall complications, specifically atrial arrhythmias, and postoperative ileus.
MeSH term(s)	Humans ; Male ; Aged ; Female ; Esophagectomy/methods ; Enhanced Recovery After Surgery ; Treatment Outcome ; Esophageal Neoplasms ; Postoperative Complications/etiology ; Arrhythmias, Cardiac/complications ; Ileus/complications ; Ileus/surgery ; Length of Stay ; Retrospective Studies
Language	English
Publishing date	2023-12-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2023.10.032
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Zs.A 252: Show issues

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ab Jg. 2022: Lesesaal (EG)

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Article: Atypical perigraft seroma masquerading as a forearm tumor in a dialysis patient.

Abdel Al, Samer / Abou Chaar, Mohamad K / Asha, Wafa / Ellati, Riyad T / Abdeljalil, Riad / Bitar, Ayman / Al-Qawasmi, Muhamad / Hajir, Maysoun / Elfarr, Salam

Qatar medical journal

2022 Volume 2022, Issue 3, Page(s) 20

Abstract: Background: An extremely rare manifestation of perigraft seroma (PGS), in which a dense, semisolid jelly-like mass had formed around the shunt instead of the standard fluid-like form of the usual seroma, leading to misdiagnosis with other entities, such ...

Abstract	Background: An extremely rare manifestation of perigraft seroma (PGS), in which a dense, semisolid jelly-like mass had formed around the shunt instead of the standard fluid-like form of the usual seroma, leading to misdiagnosis with other entities, such as tumors around the synthetic arterio-venous shunt (AVS) was presented. Case report: A 64-year-old male with multiple myeloma post autologous bone marrow transplant with a renal impairment, presented with a rare form of PGS, which was noticed 2 months after placing a synthetic AVS vascular graft. The mass increased in size, and multiple attempts for excision failed due to recurrence, which led to tumor misdiagnosis. The mass reoccurrence stopped completely only after the radical shunt removal. Conclusion: This case report revealed a rare form of PGS, in which the seroma was represented as a firm, semisolid jelly-like mass rather than the typical fluid type transudate seroma. Despite its rarity, it was associated with a high recurrence rate because unlike the standard perishunt seroma, this semisolid jelly-like material could neither be aspirated, nor could it be resected en-bloc, leading to shunting dysfunction. Its management included advanced imaging and a high probability of shunt removal or replacement.
Language	English
Publishing date	2022-06-04
Publishing country	Qatar
Document type	Journal Article
ZDB-ID	3031075-1
ISSN	2227-0426 ; 0253-8253
ISSN (online)	2227-0426
ISSN	0253-8253
DOI	10.5339/qmj.2022.20
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Article ; Online: Early surgical and oncological outcomes during adoption of a single port VATS lung resection in a tertiary cancer center: a retrospective analysis.

Abdel Jalil, Riad / Abou Chaar, Mohamad K / Al-Qudah, Obada / Al-Edwan, Ahed / Almajali, Omar / Ababneh, Hazim / U'wais, Ahmad / Al-Ghazawi, Munir / Al-Najjar, Hani / Abu-Shanab, Ahmad

Journal of cardiothoracic surgery

2022 Volume 17, Issue 1, Page(s) 26

Abstract: Background: Video-assisted thoracoscopic surgery (VATS) is a safe and effective surgical approach for pulmonary resection. VATS can be accomplished with only a single incision, resulting in less postoperative pain and paresthesia, better cosmetic ... ...

Abstract	Background: Video-assisted thoracoscopic surgery (VATS) is a safe and effective surgical approach for pulmonary resection. VATS can be accomplished with only a single incision, resulting in less postoperative pain and paresthesia, better cosmetic results, and greater patient satisfaction. Single-port VATS (spVATS) has become increasingly common for lung resection. We assess the early surgical and oncological outcomes after adopting this new technique at our tertiary cancer center as the first institution to do so in the country. Method: Medical records for 257 patients in a tertiary cancer center, with a diagnosis of non-small cell lung cancer, pulmonary metastasis, or other chest-confined pathology, were accessed to obtain perioperative outcomes, pathologic results, post-operative follow-up data, and early surgical and oncological outcomes. All patients underwent spVATS for limited or major lung resection. Simple descriptive analysis was utilized. Results: spVATS was either performed with curative intent (79.8%, N = 205), or as a diagnostic procedure (20.2%, N = 52). Resection types were subcategorized for curative intent group as limited (73.6%, N = 151), lobectomy (16.6%, N = 34), and complex (9.7%, N = 20). Resection with a negative margin (R0) rate was 100% for the primary lung cancer (PLC) patients and 97% for the pulmonary metastasectomy (PM) group. The complication rate was 5%. Three-year disease-free survival was 87% and 68.5% for PLC and PM group, respectively. The 3-year overall-survival was 91.3% for the PLC and 82.8% for PM. Operation duration showed a downtrend over the study period in each curative subcategory with a borderline difference in the limited resection (P value = 0.05). Conclusion: All the spVATS procedures were successfully performed without perioperative severe complications or mortality, regardless of complexity. R0 resection was excellent. Middle- and long-term efficacies of spVATS for lung cancer require further follow-up. With proper training, appropriate indication and meticulous application, adopting spVATS is safe and feasible technique that does not compromise surgical and oncological outcomes.
MeSH term(s)	Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/surgery ; Humans ; Lung/pathology ; Lung Neoplasms/pathology ; Pneumonectomy/methods ; Retrospective Studies ; Thoracic Surgery, Video-Assisted/methods
Language	English
Publishing date	2022-03-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-022-01777-y
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