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Article ; Online: Ileostomy After Intestinal Transplantation: The First in Depth Report on Techniques, Complications, and Outcomes.

Dumronggittigule, Wethit / Venick, Robert S / Dubray, B John / Cheng, Elaine C / Duffy, John P / Marcus, Elizabeth A / Busuttil, Ronald W / Farmer, Douglas G

Transplantation

2019 Volume 104, Issue 3, Page(s) 652–658

Abstract: Background: Temporary ileostomy during intestinal transplantation (ITx) is the standard technique for allograft monitoring. A detailed analysis of the ITx ileostomy has never been reported.: Methods: A retrospective review of a single-center ITx ... ...

Abstract	Background: Temporary ileostomy during intestinal transplantation (ITx) is the standard technique for allograft monitoring. A detailed analysis of the ITx ileostomy has never been reported. Methods: A retrospective review of a single-center ITx database was performed. The analysis was divided into ileostomy formation and takedown episodes. Results: One hundred thirty-five grafts underwent ileostomy formation, and 79 underwent ileostomy takedown. Median age at ITx was 7.7 years and weight was 23 kg. Allograft types were intestine (22%), liver/intestine (55%), multivisceral (16%), and modified multivisceral (7%). Sixty-four percent had 1-stage ITx, whereas 36% required 2-staged ITx. Final ileostomy types were end (20%), loop (10%), distal blowhole (59%), and proximal blowhole (11%). Ileostomy formation: Thirty-one grafts had complications (23%), including prolapse (26%), ischemia (16%), and parastomal hernia (19%). Twelve required surgical revision. There were no significant differences in graft type, ileostomy type, survival, and ileostomy takedown rate between grafts with and without complications. Colon inclusive grafts had higher complication rates (P = 0.002). Ileostomy takedown: Ileostomy takedown occurred at a median of 422 days post-ITx. Twenty-five complications occurred after 22 takedowns (28%), including small bowel obstruction (27%) and abscess (18%). Fifteen grafts required surgical correction. Recipients with complications had longer hospital stay (17 versus 9 d; P = 0.001) than those without complications. Graft type, ileostomy type, and survival were not different. Conclusions: The first of its kind analysis of the surgical ileostomy after ITx reveals that most recipients can undergo successful ileostomy formation/takedown, complication rates are significant but within an acceptable range, and complications do not affect survival. This study demonstrates that the routine use of transplant ostomies remains an acceptable practice after ITx. However, true analysis of risk and benefit will require a randomized control trial.
MeSH term(s)	Adolescent ; Adult ; Allografts/physiopathology ; Child ; Child, Preschool ; Female ; Humans ; Ileostomy/adverse effects ; Ileostomy/methods ; Infant ; Intestinal Diseases/mortality ; Intestinal Diseases/physiopathology ; Intestinal Diseases/surgery ; Intestines/physiopathology ; Intestines/transplantation ; Male ; Middle Aged ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/physiopathology ; Retrospective Studies ; Survival Analysis ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2019-07-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	208424-7
ISSN	1534-6080 ; 0041-1337
ISSN (online)	1534-6080
ISSN	0041-1337
DOI	10.1097/TP.0000000000002879
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Article: Pancreatic neoplasms.

Duffy, John P / Reber, Howard A

Current opinion in gastroenterology

2005 Volume 19, Issue 5, Page(s) 458–466

Abstract: Purpose of review: This review describes significant basic science and clinical advances in the field of pancreatic neoplasms.: Recent findings: Some of the genetic and molecular bases for the aggressive behavior of pancreatic cancer have been ... ...

Abstract	Purpose of review: This review describes significant basic science and clinical advances in the field of pancreatic neoplasms. Recent findings: Some of the genetic and molecular bases for the aggressive behavior of pancreatic cancer have been uncovered, and new targets for therapy have been identified. Various techniques for diagnosis and staging of this disease-endoscopic ultrasound, laparoscopy-continue to undergo evaluation. Surgical results show slightly improved long-term survival, and perioperative mortality rates remain low. The concept that locally invasive pancreatic cancer can be effectively downstaged and later resected has been called into question. Regional chemotherapy has shown promise, especially when combined with immunotherapy. Intraductal papillary mucinous tumors continue to be commonly encountered and their development and clinical course intensely studied. Acinar cell carcinomas are rare pancreatic neoplasms associated with postresection survival longer than ductal adenocarcinoma but shorter than endocrine carcinoma. Neoplasms metastatic to the pancreas can be resected safely and with improved survival compared with nonsurgical therapies. Summary: The treatment of pancreatic neoplasms remains a major challenge for physicians and surgeons. Future progress requires sound scientific inquiry and continued clinical diligence.
Language	English
Publishing date	2005-02-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	632571-3
ISSN	1531-7056 ; 0267-1379
ISSN (online)	1531-7056
ISSN	0267-1379
DOI	10.1097/00001574-200309000-00004
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Article: Surgical resection of hepatocellular carcinoma.

Duffy, John P / Hiatt, Jonathan R / Busuttil, Ronald W

Cancer journal (Sudbury, Mass.)

2008 Volume 14, Issue 2, Page(s) 100–110

Abstract: The incidence of hepatocellular carcinoma (HCC) is increasing in the United States, primarily due to hepatitis C-related liver disease. Nearly 85%-90% of patients with HCC have underlying chronic liver disease or cirrhosis. Advanced tumor burden or ... ...

Abstract	The incidence of hepatocellular carcinoma (HCC) is increasing in the United States, primarily due to hepatitis C-related liver disease. Nearly 85%-90% of patients with HCC have underlying chronic liver disease or cirrhosis. Advanced tumor burden or prohibitive hepatic dysfunction precludes operative resection in most patients with HCC. Surgical resection is a treatment option with curative intent in patients with HCC not associated with cirrhosis or in patients with well-compensated liver disease. Tumor extent and hepatic function must be assessed preoperatively to avoid postresection hepatic failure, an often fatal condition that may require urgent liver transplantation. Appropriately selected candidates for liver resection have 5-year postoperative survival rates of 40%-70%, but recurrence rates approach 70%, especially in patients with cirrhosis. For this reason, the best resection for patients with HCC and cirrhosis is orthotopic liver transplantation, which has 5-year posttransplant survival rates of 65%-80% in well-selected candidates.
MeSH term(s)	Algorithms ; Carcinoma, Hepatocellular/diagnosis ; Carcinoma, Hepatocellular/surgery ; Combined Modality Therapy ; Humans ; Liver Cirrhosis/complications ; Liver Neoplasms/diagnosis ; Liver Neoplasms/surgery ; Neoplasm Staging ; Postoperative Complications ; Preoperative Care ; Survival Analysis
Language	English
Publishing date	2008-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2018400-1
ISSN	1528-9117 ; 1081-4442
ISSN	1528-9117 ; 1081-4442
DOI	10.1097/PPO.0b013e31816a5c1f
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Article: Surgical treatment of chronic pancreatitis.

Duffy, John P / Reber, Howard A

Journal of hepato-biliary-pancreatic surgery

2002 Volume 9, Issue 6, Page(s) 659–668

Abstract: Debilitating abdominal or back pain remains the most common indication for surgery in patients with chronic pancreatitis. The surgical approach to chronic pancreatitis should be individualized based on pancreatic and ductal anatomy, pain characteristics, ...

Abstract	Debilitating abdominal or back pain remains the most common indication for surgery in patients with chronic pancreatitis. The surgical approach to chronic pancreatitis should be individualized based on pancreatic and ductal anatomy, pain characteristics, baseline exocrine and endocrine function, and medical co-morbidity. No single approach is ideal for all patients with chronic pancreatitis. Pancreatic ductal drainage with pancreaticojejunostomy targets patients with a dilated pancreatic duct and produces good early postoperative pain relief; however, 30%-50% of patients experience recurrent symptoms at 5 years. Resection for chronic pancreatitis should be considered (1) when the main pancreatic duct is not dilated, (2) when the pancreatic head is enlarged, (3) when there is suspicion of a malignancy, or (4) when previous pancreaticojejunostomy has failed. Re-sectional strategies include pancreaticoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum-preserving pancreatic head resection (Beger procedure), or local resection of the pancreatic head with longitudinal pancreaticojejunostomy (Frey procedure). Superior results are obtained when the pancreatic head is resected, either completely (pancreaticoduodenectomy) or partially (Beger or Frey procedure). Although pylorus-preserving pancreaticoduodenectomy remains the gold standard resection procedure, there is evidence that newer operations, such as the Beger resection, may be as effective in regard to pain relief and better in respect to nutritional repletion and preservation of endocrine and exocrine function.
MeSH term(s)	Chronic Disease ; Drainage ; Gastric Emptying ; Humans ; Nutritional Status ; Pancreaticoduodenectomy ; Pancreaticojejunostomy ; Pancreatitis/surgery ; Quality of Life
Language	English
Publishing date	2002
Publishing country	Japan
Document type	Journal Article
ZDB-ID	1181222-9
ISSN	1436-0691 ; 0944-1166
ISSN (online)	1436-0691
ISSN	0944-1166
DOI	10.1007/s005340200091
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Article: A quarter century of liver transplantation at UCLA.

Duffy, John P / Farmer, Douglas G / Busuttil, Ronald W

Clinical transplants

2007 , Page(s) 165–170

Abstract: Orthotopic liver transplant (OLT) has become the best and most durable treatment for end stage liver disease (ESLD) of any etiology. The UCLA program, established in 1984, has accumulated one of the world's most extensive experiences with this procedure. ...

Abstract	Orthotopic liver transplant (OLT) has become the best and most durable treatment for end stage liver disease (ESLD) of any etiology. The UCLA program, established in 1984, has accumulated one of the world's most extensive experiences with this procedure. The UCLA experience has been built on the classical techniques of Starzl, yet has forged innovations such as split liver transplantation and use of extended criteria donor organs. The UCLA program also reports one of the largest experiences in pediatric liver transplantation and has demonstrated that recipient renal function is a main predictor of post-transplant survival. UCLA has offered further evidence that criteria for liver transplantation for hepatocellular carcinoma (HCC) should be expanded. As the 21st Century progresses, the Dumont-UCLA Liver Transplant program will continue its efforts to improve outcomes for all patients with endstage liver disease.
MeSH term(s)	Humans ; Kidney Transplantation/mortality ; Kidney Transplantation/statistics & numerical data ; Liver Failure/mortality ; Liver Failure/surgery ; Liver Transplantation/mortality ; Liver Transplantation/statistics & numerical data ; Los Angeles/epidemiology ; Survival Rate ; Tissue Donors/statistics & numerical data ; Tissue Donors/supply & distribution
Language	English
Publishing date	2007
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	607631-2
ISSN	0890-9016
ISSN	0890-9016
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Article ; Online: The impact of the 'hub and spoke' model of care for lung cancer and equitable access to surgery.

Khakwani, Aamir / Rich, Anna L / Powell, Helen A / Tata, Laila J / Stanley, Rosamund A / Baldwin, David R / Duffy, John P / Hubbard, Richard B

Thorax

2015 Volume 70, Issue 2, Page(s) 146–151

Abstract: Objectives: To determine the influence of where a patient is first seen (either surgical or non-surgical centre) and patient features on having surgery for non-small cell lung cancer (NSCLC).: Design: Cross-sectional study from individual patients, ... ...

Abstract	Objectives: To determine the influence of where a patient is first seen (either surgical or non-surgical centre) and patient features on having surgery for non-small cell lung cancer (NSCLC). Design: Cross-sectional study from individual patients, between 1January 2008 and 31March 2012. Setting: Linked National Lung Cancer Audit and Hospital Episode Statistics datasets. Participants: 95,818 English patients with a diagnosis of NSCLC, of whom 12,759 (13%) underwent surgical resection. Main outcome measure: Odds of having surgery based on the empirical catchment population of the 30 thoracic surgical centres in England and whether the patient is first seen in a surgical centre or a non-surgical centre. Results: Patients were more likely to be operated on if they were first seen at a surgical centre (OR 1.37; 95% CI 1.29 to 1.45). This was most marked for surgical centres with the largest catchment populations. In these surgical centres with large catchment populations, the resection rate for local patients was 18% and for patients first seen in a non-surgical centre within catchment was 12%. Conclusions: Surgical centres that serve the largest catchment populations have high resection rates for patients first seen in their own centre but, in contrast, low resection rates for patients first seen at the surrounding centres they serve. Our findings demonstrate the importance of going further than relating resection rates to hospital volume or surgeon number, and show that there is a pressing need to design lung cancer services which enable all patients, including those first seen at non-surgical centres, to have equal access to lung cancer surgery.
MeSH term(s)	Age Factors ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/pathology ; Carcinoma, Non-Small-Cell Lung/surgery ; Catchment Area (Health)/statistics & numerical data ; Cross-Sectional Studies ; England ; Female ; Health Services Accessibility/organization & administration ; Health Services Accessibility/statistics & numerical data ; Hospitals, Special/statistics & numerical data ; Humans ; Lung Neoplasms/pathology ; Lung Neoplasms/surgery ; Male ; Middle Aged ; Models, Organizational ; Patient Acuity ; Pneumonectomy/statistics & numerical data ; Sex Factors ; Thoracic Surgery
Language	English
Publishing date	2015-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	204353-1
ISSN	1468-3296 ; 0040-6376
ISSN (online)	1468-3296
ISSN	0040-6376
DOI	10.1136/thoraxjnl-2014-205841
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Article ; Online: Age and neo-adjuvant chemotherapy increase the risk of atrial fibrillation following oesophagectomy.

Rao, Vinay P / Addae-Boateng, Emmanuel / Barua, Anupama / Martin-Ucar, Antonio E / Duffy, John P

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2012 Volume 42, Issue 3, Page(s) 438–443

Abstract: Objectives: Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic ... ...

Abstract	Objectives: Atrial tachyarrhythmias occur in up to 25% of patients after major thoracic surgery. We examined risk factors for new-onset atrial fibrillation (AF) following oesophagectomy in an attempt to guide prophylactic use of anti-arrhythmic strategies. Methods: Data were extracted from a database of patients who underwent oesophagectomy between 1991 and 2009. Patients with pre-operative arrhythmias were excluded leaving 997 patients for further analysis. Univariate and multivariate logistic regression analyses were performed to identify factors predicting AF, and receiver operating characteristic curves were generated from a model using these predictors. Statistical significance was reflected in a P-value of <0.05. Results: Patients who developed AF (n = 209; 20.96%) were older (median age 70.54 years vs. 66.9 years; P < 0.01) and included 141 males (67.4%) (P = 0.11). Patients with AF were noted to have a higher in-hospital mortality rate (n = 17; 8.1% vs. n = 34; 4.8%) (P = 0.04) and a longer stay in hospital (14 days vs. 12 days; P < 0.01). Multivariate analysis identified advanced age and neo-adjuvant chemotherapy to be independent predictors of the risk of developing AF. Assessment of discriminative ability of a predictive model revealed a c-statistic of just 0.62. Conclusions: Despite the identification of age and neo-adjuvant chemotherapy as predictors of AF, the moderate discriminative ability of predictive modelling does not support the use of prophylactic anti-arrhythmic drugs. However, the high incidence of AF after major thoracic surgery makes it necessary to understand its underlying mechanisms better before prophylactic strategies are considered.
MeSH term(s)	Age Factors ; Aged ; Analysis of Variance ; Antineoplastic Agents/adverse effects ; Antineoplastic Agents/therapeutic use ; Atrial Fibrillation/etiology ; Atrial Fibrillation/mortality ; Atrial Fibrillation/physiopathology ; Databases, Factual ; Esophageal Neoplasms/drug therapy ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery ; Esophagectomy/adverse effects ; Esophagectomy/methods ; Female ; Follow-Up Studies ; Hospital Mortality/trends ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Neoadjuvant Therapy/adverse effects ; Neoadjuvant Therapy/methods ; Neoplasm Staging ; Postoperative Complications/epidemiology ; Postoperative Complications/physiopathology ; Predictive Value of Tests ; Preoperative Care/methods ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Survival Rate ; Treatment Outcome ; United Kingdom
Chemical Substances	Antineoplastic Agents
Language	English
Publishing date	2012-09
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1093/ejcts/ezs085
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Article: Pancreatic surgery.

Duffy, John P / Delano, Matthew J / Reber, Howard A

Current opinion in gastroenterology

2006 Volume 18, Issue 5, Page(s) 568–573

Abstract: Over the past year considerable progress has been made in the field of pancreatic surgery. Innovative diagnostic techniques continue to improve the preoperative staging of pancreatic cancer. For patients with cancer and biliary obstruction, preoperative ... ...

Abstract	Over the past year considerable progress has been made in the field of pancreatic surgery. Innovative diagnostic techniques continue to improve the preoperative staging of pancreatic cancer. For patients with cancer and biliary obstruction, preoperative biliary stenting appears to increase the incidence of wound infection after pancreatoduodenectomy but has no effect on other perioperative complications. New information about the molecular biology of pancreatic cancer may begin to influence the surgical approach to the disease. More cases of intraductal papillary mucinous neoplasms are being diagnosed and studied. The impact of adjuvant chemotherapy and chemoradiation on survival has been more clearly defined in a large, randomized trial. In patients with sterile acute necrotizing pancreatitis, conservative nonsurgical management has continued to produce favorable results. For chronic pancreatitis, surgery appears to diminish both chronic pain and recurrent episodes of acute pain.
Language	English
Publishing date	2006-09-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	632571-3
ISSN	1531-7056 ; 0267-1379
ISSN (online)	1531-7056
ISSN	0267-1379
DOI	10.1097/00001574-200209000-00008
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Article ; Online: Early outcomes of surgery for oesophageal cancer in a thoracic regional unit. Can we maintain training without compromising results?

Handagala, Sumana D M / Addae-Boateng, Emmanuel / Beggs, David / Duffy, John P / Martin-Ucar, Antonio E

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

2011 Volume 41, Issue 1, Page(s) 31–4; discussion 34–5

Abstract: Objectives: Meaningful exposure to oesophageal cancer surgery during general thoracic surgical training is restricted to few centres in the United Kingdom. Our Regional Tertiary Unit remains a rare 'large-volume' oesophagectomy centre. We aimed to ... ...

Abstract	Objectives: Meaningful exposure to oesophageal cancer surgery during general thoracic surgical training is restricted to few centres in the United Kingdom. Our Regional Tertiary Unit remains a rare 'large-volume' oesophagectomy centre. We aimed to determine the proportion of patients operated by trainees and their perioperative outcomes. Methods: From January 2004 to September 2009, 323 patients (229 male and 94 female, median age of 69 (range 40-92) years) underwent oesophagectomy for carcinoma in our Thoracic Surgical Unit. Data were complete and obtained from a prospective departmental database. The preoperative characteristics, operative data and postoperative results were compared between the 120 patients (37%) operated by a trainee (group T) and the remainder 203 patients operated by a consultant (group C). Results: The overall incidence of mortality, anastomotic leak and chylothorax were 6.5%, 5.3% and 2.2%, respectively. There were no differences in terms of age, gender, tumour location, tumour staging, preoperative spirometry or use of neoadjuvant chemotherapy between the two groups. There was no significant difference between the consultant group and the trainee group in the following key outcome measures: postoperative mortality (8% vs 4%), incidence of respiratory complications (30% vs 25%), hospital stay (14 days vs 13 days) and number of lymph nodes excised (median of 16 vs 14). Conclusions: Training in oesophageal cancer surgery can be provided in a large-volume thoracic surgical unit. It does not seem to compromise outcomes or use of resources.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Clinical Competence ; Consultants ; Education, Medical, Graduate/methods ; Education, Medical, Graduate/standards ; England ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/surgery ; Esophagectomy/adverse effects ; Esophagectomy/education ; Esophagectomy/standards ; Esophagectomy/statistics & numerical data ; Female ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Neoplasm Staging ; Regional Medical Programs/standards ; Surgery Department, Hospital/statistics & numerical data ; Thoracic Surgery/education ; Treatment Outcome
Language	English
Publishing date	2011-05-31
Publishing country	Germany
Document type	Journal Article
ZDB-ID	639293-3
ISSN	1873-734X ; 1010-7940 ; 1567-4258
ISSN (online)	1873-734X
ISSN	1010-7940 ; 1567-4258
DOI	10.1016/j.ejcts.2011.04.003
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Article ; Online: Utility of an immune cell function assay to differentiate rejection from infectious enteritis in pediatric intestinal transplant recipients.

Wozniak, Laura J / Venick, Robert S / Gordon Burroughs, Sherilyn / Ngo, Khiet D / Duffy, John P / Farmer, Douglas G

Clinical transplantation

2014 Volume 28, Issue 2, Page(s) 229–235

Abstract: The Cylex Immune Cell Function Assay measures cell-mediated immunity based on ATP production by stimulated CD4 + cells. We hypothesized that this test would discriminate acute cellular rejection (ACR) from infectious enteritis (IE) in pediatric ... ...

Abstract	The Cylex Immune Cell Function Assay measures cell-mediated immunity based on ATP production by stimulated CD4 + cells. We hypothesized that this test would discriminate acute cellular rejection (ACR) from infectious enteritis (IE) in pediatric intestinal transplant (ITx) recipients with allograft dysfunction. We retrospectively analyzed 224 Cylex assays drawn in 47 children who received 53 ITx. Samples were classified as stable, ACR, or IE based on clinical status. ATP values were analyzed using Kruskal-Wallis and t-tests. Overall, there was a statistically significant difference in ATP values based on clinical status (p = 0.03); however, overlap was observed between groups. The median ATP value during ACR was significantly greater than during stable periods (p = 0.02). No difference was seen in IE vs. stability (p = 0.8). The difference in median ATP value in ACR vs. IE approached significance (p = 0.1). Relative to previous levels, ACR episodes were associated with a median ATP increase of 101 ng/mL and IE episodes with a decrease of 3 ng/mL (p = 0.3). These data indicate that the Cylex assay has limited utility in differentiating ACR from IE, largely due to interpatient variability. Following longitudinal intrapatient trends may be an adjunctive tool in discriminating IE from ACR and guiding immunosuppression adjustments in select patients.
MeSH term(s)	Adenosine Triphosphate/blood ; CD4-Positive T-Lymphocytes/immunology ; Child ; Diagnosis, Differential ; Enteritis/diagnosis ; Enteritis/microbiology ; Female ; Follow-Up Studies ; Graft Rejection/diagnosis ; Graft Rejection/immunology ; Humans ; Immunity, Cellular/physiology ; Immunoassay/methods ; Intestines/transplantation ; Jejunal Diseases/complications ; Jejunal Diseases/microbiology ; Jejunal Diseases/surgery ; Male ; Prognosis ; Prospective Studies ; Retrospective Studies
Chemical Substances	Adenosine Triphosphate (8L70Q75FXE)
Language	English
Publishing date	2014-02
Publishing country	Denmark
Document type	Journal Article
ZDB-ID	639001-8
ISSN	1399-0012 ; 0902-0063
ISSN (online)	1399-0012
ISSN	0902-0063
DOI	10.1111/ctr.12303
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