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Article: Gastrectomy for Distal Gastric Cancer: Transitioning from an Open to a Minimally Invasive Surgical Practice. A Single Surgeon Experience.

Solomon, Daniel / Greemland, Itzhak / Menasherov, Nikolai / Bard, Vyacheslav

The Israel Medical Association journal : IMAJ

2023 Volume 25, Issue 2, Page(s) 110–116

Abstract: Background: Surgical resection is the only curative option for gastric carcinoma (GC). Minimally invasive techniques are gaining popularity.: Objectives: To present a single-surgeon's experience in transitioning from an open to a minimally invasive ... ...

Abstract	Background: Surgical resection is the only curative option for gastric carcinoma (GC). Minimally invasive techniques are gaining popularity. Objectives: To present a single-surgeon's experience in transitioning from an open to a minimally invasive approach, focusing on surgical and oncological outcomes. Methods: We conducted a retrospective analysis including distal gastrectomy patients 2012-2020 operated by a single surgeon. Two cohorts were compared: open (ODG) and laparoscopic distal gastrectomy (LDG). Results: Overall, 173 patients were referred for gastrectomy during the study years. We excluded 80 patients because they presented with non-GC tumors, underwent proximal or total gastrectomy, or underwent palliative surgery. Neoadjuvant treatment was administered to 62 patients (33.3%). Billroth 1 was the preferred method of reconstruction (n=77, 82.8%), followed by Roux-en-Y (n=12, 13%). Fifty-one patients (54.8%) underwent LDG, 42 (45.2%) underwent ODG. The LDG group had significantly shorter lengths of stay (6 days, interquartile range [IQR] 1-3 5-8 vs. 5 days, IQR 1-3 4-6, P = 0.001, respectively), earlier return to oral feeding (1 day, IQR 1-3 1-3 vs. 2 days, IQR 1-3 1-3.2, P < 0.001), and earlier removal of drains (4 days, IQR 1-3 3-5.2 vs. 5 days, IQR 1-3 3.5-6.7, P < 0.001). Overall lymph node yield was 30 (IQR 1-3 24-39) and was similar among groups (P = 0.647). Conclusions: Laparoscopic techniques for resection of distal GC are feasible and safe, leading to good perioperative outcomes and adequate lymph node yield.
MeSH term(s)	Humans ; Stomach Neoplasms/surgery ; Retrospective Studies ; Lymph Nodes/pathology ; Surgeons ; Gastrectomy/methods ; Laparoscopy/methods ; Treatment Outcome ; Postoperative Complications/surgery
Language	English
Publishing date	2023-02-25
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article: Cardiac Tamponade: A Rare and Insidious Surgical Complication of Hiatal Hernia Repair.

Apel, Roy / Bard, Slava / Naimark, Ari / Menasherov, Nikolai / Wasserberg, Nir / Wiesel, Ory

The Israel Medical Association journal : IMAJ

2024 Volume 26, Issue 4, Page(s) 251–253

MeSH term(s)	Humans ; Cardiac Tamponade/diagnosis ; Cardiac Tamponade/etiology ; Cardiac Tamponade/surgery ; Herniorrhaphy/adverse effects ; Neurosurgical Procedures
Language	English
Publishing date	2024-03-31
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Article ; Online: Thoracic Duct Visualization in Esophageal Resection - a Pilot Trial.

Berger, Yael / Bard, Vyacheslav / Abbas, Muhammad / Solomon, Daniel / Menasherov, Nikolai / Kashtan, Hanoch

European surgical research. Europaische chirurgische Forschung. Recherches chirurgicales europeennes

2024

Abstract: Introduction: Inadvertent thoracic duct injury is common during esophagectomy and may result in postoperative chylothorax. This study's objective is to investigate utility of patent-blue injection as a modality for intraoperative thoracic duct ... ...

Abstract	Introduction: Inadvertent thoracic duct injury is common during esophagectomy and may result in postoperative chylothorax. This study's objective is to investigate utility of patent-blue injection as a modality for intraoperative thoracic duct visualization. Methods: A prospective, single-arm, interventional study of patients undergoing minimally invasive esophagectomy was performed. Patients were injected with patent-blue dye into both groins prior to thoracic stage of surgery and assessed for duct visualization. Control group was formed by propensity score matching using retrospectively collected data regarding patients who underwent esophagectomy. Results: A total of 25 patients were included in analysis, compared to a control of 50 patients after matching. Thoracic duct was visualized in 60% of patients in the study group (15/25 patients). Significant differences were found between study and control groups(p<0.05) with regards to median operative time (422 vs. 285 minutes, respectively), overall complications (16% vs. 34%, respectively) and median postoperative length of stay (13.5 vs. 10 days, respectively). There was a difference in rate of chyle leak between study and control groups, however this was not significant (0% vs. 12%, respectively, p=0.17). Conclusion: Patent-blue injection represents a simple method for thoracic duct visualization during minimally invasive esophagectomy which may improve surgical outcomes.
Language	English
Publishing date	2024-04-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	205700-1
ISSN	1421-9921 ; 0014-312X
ISSN (online)	1421-9921
ISSN	0014-312X
DOI	10.1159/000538691
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Zs.A 745: Show issues

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Article ; Online: Implementing the first program of minimally invasive esophagectomy for cancer in Israel: shifting the paradigm in a high-volume center - a cohort study.

Solomon, Daniel / Sarfaty, Elad / Menasherov, Nikolai / Bard, Vyacheslav / Bueno, Raphael / Kashtan, Hanoch

International journal of surgery (London, England)

2023 Volume 109, Issue 11, Page(s) 3467–3475

Abstract: Background: Esophagectomy is associated with significant perioperative morbidity. Limited data are available on the process of implementation of minimally invasive techniques in esophagectomy and related outcomes. The authors sought to describe ... ...

Abstract	Background: Esophagectomy is associated with significant perioperative morbidity. Limited data are available on the process of implementation of minimally invasive techniques in esophagectomy and related outcomes. The authors sought to describe implementation processes and outcomes following the implementation of the first minimally invasive esophagectomy (MIE) program at a high-volume center in Israel under the mentorship of American early adopters. Methods: Patients who underwent esophagectomy for esophageal carcinoma 2011-2022 were included. Early and late cohorts were created for learning curve analysis. Secondary analysis included patients who underwent open esophagectomy 1997-2011. Results: Overall, 300 patients underwent MIE: three-field MIE (3F-MIE) was performed in 242 (80.7%) patients, two-field MIE (2F-MIE) in 58 (19.3%) patients. Following program implementation in 2012, the number of MIE performed increased during the first 3 years ( n =33, 86.8% in 2015). Among 3F-MIE patients, a higher number of retrieved lymph nodes was reported during later cases (median, IQR1-3 17, 12-23 vs. 12, 8-12, P <0.001) while surgeries required a longer time (median, IQR1-3 300 min, 261-355 vs. 262.5, 239-300, P <0.001). Among 2F-MIE patients, the late cohort had lower rates of prolonged ICU admissions than earlier counterparts ( n =2, 6.9% vs. n =9, 31%, P =0.041), overall and severe 30-day complications ( n =12, 41.4% vs. n =23, 79.3%, P <0.001 and n =7, 24.1% vs. n =23, 79.3%, P =0.003). Conclusions: MIE was safely implemented. Nodal yield was higher among MIE patients than open esophagectomy. During the study years, open approach was gradually abandoned in favor of 3F-MIE procedures, while 2F-MIE increased over the course of the last years.
MeSH term(s)	Humans ; Cohort Studies ; Esophagectomy/methods ; Israel/epidemiology ; Treatment Outcome ; Retrospective Studies ; Esophageal Neoplasms/surgery ; Esophageal Neoplasms/complications ; Minimally Invasive Surgical Procedures/adverse effects ; Minimally Invasive Surgical Procedures/methods ; Postoperative Complications/etiology
Language	English
Publishing date	2023-11-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1097/JS9.0000000000000646
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Zs.A 6502: Show issues

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Article ; Online: Predicting Factors for a Favorable Pathologic Response to Neoadjuvant Therapy in Esophageal Cancer.

Wiesel, Ory / Zlotnik, Oran / Morgenstern, Sarah / Tsur, Maya / Menasherov, Nikolai / Feferman, Yael / Ben-Aharon, Irit / Kashtan, Hanoch

American journal of clinical oncology

2022 Volume 45, Issue 12, Page(s) 514–518

Abstract: Background: Favorable pathologic response(FPR) is a significant predictor for improved survival following Neoadjuvant therapy(NAT) in esophageal and gastroesophageal cancer(GEJ). Preoperative prediction of FPR could modify treatment plans. No reliable ... ...

Abstract	Background: Favorable pathologic response(FPR) is a significant predictor for improved survival following Neoadjuvant therapy(NAT) in esophageal and gastroesophageal cancer(GEJ). Preoperative prediction of FPR could modify treatment plans. No reliable method for predicting FPR exists. We sought to identify preoperative predicting factors for FPR. Materials and methods: Retrospective analysis of patients with esophageal and GEJ cancer who underwent esophagectomy following (NAT). Univariate and multivariate analysis was used to identify preoperative predicting factors for FPR. A comparison of Tumor Regression Grade(TRG) was used to assess treatment response on overall survival(OS). Results: Out of 121 patients, 82(67.8%) had neoadjuvant chemoradiation. FPR was observed in 60(49.6%). Female sex, Radiation therapy(RT), squamous cell carcinoma(SCC), lack of signet ring feature, and FDG avidity posttreatment were associated with FPR on univariate analysis. RT and SCC were associated with FPR (OR=3.9 and 4.0, respectively) on multivariate analysis. OS was lower among patients who did not achieve FPR to NAT(P=0.027). Conclusions: FPR is a predictor of improved OS. SCC and radiation therapy-based protocol were identified as major prediction factors of FPR in patients with esophageal and GEJ cancers.
MeSH term(s)	Female ; Humans ; Esophageal Neoplasms/pathology ; Neoadjuvant Therapy/methods ; Retrospective Studies ; Survival Rate ; Male
Language	English
Publishing date	2022-11-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	604536-4
ISSN	1537-453X ; 0277-3732
ISSN (online)	1537-453X
ISSN	0277-3732
DOI	10.1097/COC.0000000000000954
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Zs.A 1557: Show issues

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Article ; Online: Signet Ring Cell Features are Associated with Poor Response to Neoadjuvant Treatment and Dismal Survival in Patients with High-Grade Esophageal Adenocarcinoma.

Solomon, Daniel / Abbas, Muhammad / Feferman, Yael / Haddad, Riad / Perl, Gali / Kundel, Yulia / Morgenstern, Sara / Menasherov, Nikolai / Kashtan, Hanoch

Annals of surgical oncology

2021 Volume 28, Issue 9, Page(s) 4929–4940

Abstract: Background: While the prognosis of patients with locoregional esophageal adenocarcinoma (EAC) has improved in the neoadjuvant treatment (NAT) era, high-grade histology (G3) is still associated with a limited treatment response. We sought to investigate ... ...

Abstract	Background: While the prognosis of patients with locoregional esophageal adenocarcinoma (EAC) has improved in the neoadjuvant treatment (NAT) era, high-grade histology (G3) is still associated with a limited treatment response. We sought to investigate oncologic outcomes in patients after esophagectomy for G3 EAC and to identify predictors of poor survival among these patients. Methods: Patients with EAC who underwent resection with curative intent in 2011-2018 were divided by histologic grade (G3, G1/2) and compared for overall survival (OS). Cox regression was performed to analyze the response to NAT and the predictive role of signet ring cell (SRC) features. Results: The cohort included 163 patients, 94 (57.7%) with G3 histology. NAT was administered to 69 (73.4%) patients. Following resection, OS in the G3 EAC group was 30 months (95% confidence interval [CI] 23.9-36.1). On univariate analysis, G3 disease (p = 0.050) and SRC features (p = 0.019) predicted low OS. Median survival in the G3 EAC group was worse in patients with SRC histology (18 months, 95% CI 8.6-27.4) than those without (30 months, 95% CI 23.8-36.1; p = 0.041). No patients with SRC histology were alive at 5 years of follow-up. Among all patients administered NAT, 88.2% of those with SRC showed minimal or no pathologic response and only 27.8% were downstaged. Conclusions: High-grade histology was found in most patients with EAC and predicted poor survival and treatment response. SRC features in patients with G3 disease were associated with lower OS. The benefit of NAT for G3 EAC in patients with SRC histology appears limited.
MeSH term(s)	Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Carcinoma, Signet Ring Cell/pathology ; Carcinoma, Signet Ring Cell/surgery ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/therapy ; Humans ; Neoadjuvant Therapy ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Survival Rate
Language	English
Publishing date	2021-03-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-021-09644-1
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Zs.A 4042: Show issues

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Article: Abdominal Surgery in Patients with a Ventricular Assist Device: A Single Center Experience in Israel.

Zilbermints, Veacheslav / Israeli, Oren / Ben Abraham, Binyamin / Ben-Gal, Tuvia / Rubchevsky, Victor / Aravot, Dan / Kashtan, Hanoch / Menasherov, Nikolai / Aranovich, David

The Israel Medical Association journal : IMAJ

2020 Volume 22, Issue 6, Page(s) 369–373

Abstract: Background: Left ventricular assist devices (LVADs) are used more commonly in patients with advanced-stage heart failure. Some of these patients may require elective or urgent abdominal surgical procedures.: Objectives: To determine the outcomes of ... ...

Abstract	Background: Left ventricular assist devices (LVADs) are used more commonly in patients with advanced-stage heart failure. Some of these patients may require elective or urgent abdominal surgical procedures. Objectives: To determine the outcomes of the management of LVAD-supported patients who underwent elective and urgent abdominal surgical procedures in our institution. Methods: A retrospective review was conducted on 93 patients who underwent LVAD implantation between August 2008 and January 2017. All abdominal surgeries in these patients were studied, and their impact on postoperative morbidity and mortality Ten patients underwent abdominal surgical procedures. Of these procedures, five were emergent and five were elective. The elective cases included one bariatric surgery for morbid obesity, one hiatal hernia repair, two cholecystectomies, and one small bowel resection for a carcinoid tumor. The emergency cases included suspected ischemic colitis, right colectomy for bleeding adenocarcinoma, laparotomy due to intraabdominal bleeding, open cholecystectomy for gangrenous cholecystitis, and laparotomy for sternal and abdominal wall infection. All patients undergoing elective procedures survived. Of the five patients who underwent emergency surgery, three died (60%, P = 0.16) and one presented with major morbidity. One of the two survivors required reintervention. In total, 12 interventions were performed on this group of patientswas evaluated. Results: Ten patients underwent abdominal surgical procedures. Of these procedures, five were emergent and five were elective. The elective cases included one bariatric surgery for morbid obesity, one hiatal hernia repair, two cholecystectomies, and one small bowel resection for a carcinoid tumor. The emergency cases included suspected ischemic colitis, right colectomy for bleeding adenocarcinoma, laparotomy due to intraabdominal bleeding, open cholecystectomy for gangrenous cholecystitis, and laparotomy for sternal and abdominal wall infection. All patients undergoing elective procedures survived. Of the five patients who underwent emergency surgery, three died (60%, P = 0.16) and one presented with major morbidity. One of the two survivors required reintervention. In total, 12 interventions were performed on this group of patients. Conclusions: It is safe to perform elective abdominal procedures for LVAD-supported patients. The prognosis of these patients undergoing emergency surgery is poor and has high mortality and morbidity rates.
MeSH term(s)	Abdomen/surgery ; Aged ; Female ; Heart Failure/surgery ; Heart-Assist Devices ; Humans ; Israel ; Male ; Middle Aged ; Retrospective Studies
Language	English
Publishing date	2020-06-17
Publishing country	Israel
Document type	Journal Article
ZDB-ID	2008291-5
ISSN	1565-1088 ; 0021-2180
ISSN	1565-1088 ; 0021-2180
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Zs.A 5470: Show issues

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Article ; Online: Gastrointestinal Stromal Tumor of Stomach: A Gentle Enemy of the Surgeon. Our Experience in Confronting the Disease.

Bard, Vyacheslav / Menasherov, Nikolai / Morgenstern, Sara / Haddad, Riad / Kashtan, Hanoch

Surgical laparoscopy, endoscopy & percutaneous techniques

2016 Volume 26, Issue 5, Page(s) 406–409

Abstract: Background: Surgical resection is considered to be the best treatment for gastrointestinal stromal tumor (GIST), the most common mesenchymal tumor of the gastrointestinal tract. Tumor size, mitotic rate, and anatomic locations are directly related to ... ...

Abstract	Background: Surgical resection is considered to be the best treatment for gastrointestinal stromal tumor (GIST), the most common mesenchymal tumor of the gastrointestinal tract. Tumor size, mitotic rate, and anatomic locations are directly related to the potential malignancy, surgical approach, oncological treatment, and recurrence rate. Materials and methods: This was a retrospective study of 40 patients who underwent surgical resection of histologically or immunohistochemistry-proven GIST of the stomach at the Rabin and Kaplan Medical Center between 2004 and 2013. Tumor size, location, margin status, pathologic characteristics, surgical approach, surgical outcome, and long-term follow-up were analyzed from hospital records. Results: The most common presentation was upper gastrointestinal bleeding (40%), although 30% of cases were asymptomatic. A laparoscopic approach was the preferred technique whenever feasible; 85% of tumors were localized in the proximal stomach, with a median size of 5.6 cm. Most of the resected tumors revealed a low mitotic rate and thus had low-moderate risks of malignancy. All tumors were completely resected with free surgical margins. The median follow-up period was 40 months with 93% disease-free survival. Conclusions: Gastric GIST is a snake in the grass and its diagnosis is often incidental to endoscopy and computed tomographic scan. The most important technical point is to avoid tumor rupture during removal.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Female ; Gastrointestinal Hemorrhage/etiology ; Gastrointestinal Hemorrhage/surgery ; Gastrointestinal Stromal Tumors/pathology ; Gastrointestinal Stromal Tumors/surgery ; Gastroscopy/statistics & numerical data ; Humans ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Retrospective Studies ; Stomach Neoplasms/pathology ; Stomach Neoplasms/surgery ; Treatment Outcome
Language	English
Publishing date	2016-10
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	1475108-2
ISSN	1534-4908 ; 1530-4515 ; 1051-7200
ISSN (online)	1534-4908
ISSN	1530-4515 ; 1051-7200
DOI	10.1097/SLE.0000000000000317
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Zs.A 3200: Show issues

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Article ; Online: The addition of cetuximab to preoperative chemoradiotherapy for locally advanced esophageal squamous cell carcinoma is associated with high rate of long term survival: Mature results from a prospective phase Ib/II trial.

Brenner, Baruch / Purim, Ofer / Gordon, Noa / Goshen-Lago, Tal / Idelevich, Efraim / Kashtan, Hanoch / Menasherov, Nikolai / Fenig, Eyal / Sulkes, Aaron / Kundel, Yulia

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2019 Volume 134, Page(s) 74–80

Abstract: Aim: This phase IB/II study evaluated the safety and efficacy of the addition of cetuximab to standard preoperative chemoradiotherapy (CRT) in locally advanced esophageal cancer (LAEC).: Methods: Patients (pts) with resectable LAEC (T: Results: 64 ...

Abstract	Aim: This phase IB/II study evaluated the safety and efficacy of the addition of cetuximab to standard preoperative chemoradiotherapy (CRT) in locally advanced esophageal cancer (LAEC). Methods: Patients (pts) with resectable LAEC (T Results: 64 pts were treated and 60 completed CRT. Median age was 65 years and 66% were males. Adenocarcinoma/squamous ratio was 61%/39%. Tumors were advanced: 95% T Conclusions: This study suggests that the addition of cetuximab to standard preoperative CRT is feasible. R0, pCR and local control rates are encouraging. Pts with squamous cell tumors benefited more from the addition of cetuximab.
MeSH term(s)	Adult ; Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Cetuximab/therapeutic use ; Chemoradiotherapy/methods ; Esophageal Neoplasms/mortality ; Esophageal Neoplasms/therapy ; Esophageal Squamous Cell Carcinoma/mortality ; Esophageal Squamous Cell Carcinoma/therapy ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Survival Rate
Chemical Substances	Cetuximab (PQX0D8J21J)
Language	English
Publishing date	2019-02-04
Publishing country	Ireland
Document type	Clinical Trial, Phase I ; Clinical Trial, Phase II ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2019.01.013
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Article: Esophageal Cancer in Israel has Unique Clinico-Pathological Features: A Retrospective Study.

Sarfaty, Michal / Lankry, Esty / Moore, Assaf / Kurman, Noga / Purim, Ofer / Kundel, Yulia / Ben-Aharon, Irit / Perl, Gali / Ulitsky, Olga / Gordon, Noa / Sulkes, Aaron / Menasherov, Nikolai / Kashtan, Hanoch / Brenner, Baruch

Journal of Cancer

2017 Volume 8, Issue 13, Page(s) 2417–2423

Abstract: Introduction: ...

Abstract	Introduction:
Language	English
Publishing date	2017-07-22
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2573318-7
ISSN	1837-9664
ISSN	1837-9664
DOI	10.7150/jca.19210
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