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Article ; Online: Evidence-Based Guidelines for Branch-Duct Intraductal Papillary Mucinous Neoplasm Management: Still a Lot of Room to Grow.

Conroy, Patricia C / Nakakura, Eric

2021 Volume 156, Issue 7, Page(s) 661–662

MeSH term(s)	Carcinoma, Pancreatic Ductal/surgery ; Humans ; Pancreatic Neoplasms/surgery
Language	English
Publishing date	2021-05-13
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2021.1814
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Article ; Online: Robotic-assisted endoluminal gastric leiomyoma resection: a novel surgical technique for benign gastroesophageal junction tumors.

Yin, Han / Ganjouei, Amir Ashraf / Wang, Jaeyun Jane / Romero-Hernandez, Fernanda / Nakakura, Eric / Alseidi, Adnan / Adam, Mohamed A

Chinese clinical oncology

2024 Volume 13, Issue 1, Page(s) 6

Abstract: Gastric leiomyomas are rare, benign smooth muscle tumors that arise from the muscularis propria and can be found in any part of the stomach. The American College of Gastroenterologists recommends resection only for symptomatic leiomyomas, which can often ...

Abstract	Gastric leiomyomas are rare, benign smooth muscle tumors that arise from the muscularis propria and can be found in any part of the stomach. The American College of Gastroenterologists recommends resection only for symptomatic leiomyomas, which can often present with bleeding, abdominal pain, or dyspepsia. Notably, symptomatic leiomyomas that arise at the gastroesophageal (GE) junction, especially those that are large, pose unique challenges. Specifically, total gastrectomy with esophagojejunostomy is often necessary, which can be associated with a compromised quality of life and possible complications such as anastomotic stricture or reflux esophagitis. In this context, we present the case of a young, male patient with a large symptomatic leiomyoma at the GE junction who was offered a robotic-assisted endoluminal leiomyoma resection. By placing endoluminal trocars and utilizing the Da Vinci® robot, we were able to carefully excise the tumor without perforating the stomach or causing GE junction stenosis. This allowed the patient to preserve his stomach and avoid a high-risk anastomosis. Another notable highlight of the case included the use of the endoscope as both a bougie and a source of insufflation. The patient had an uncomplicated postoperative course and a rapid recovery, highlighting the feasibility of this approach for patients with benign GE junction tumors.
MeSH term(s)	Humans ; Male ; Robotic Surgical Procedures ; Quality of Life ; Stomach Neoplasms/surgery ; Stomach Neoplasms/pathology ; Esophagogastric Junction/surgery ; Esophagogastric Junction/pathology ; Gastrectomy/methods ; Leiomyoma/surgery ; Laparoscopy/methods ; Retrospective Studies
Language	English
Publishing date	2024-02-01
Publishing country	China
Document type	Case Reports ; Journal Article
ZDB-ID	2828547-5
ISSN	2304-3873 ; 2304-3873
ISSN (online)	2304-3873
ISSN	2304-3873
DOI	10.21037/cco-23-112
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Article ; Online: Improved survival of patients receiving immunotherapy and chemotherapy following curative-intent resection of colorectal liver metastases.

Pollini, Tommaso / Tran, Thuy / Wong, Paul / Adam, Mohamed A / Alseidi, Adnan / Corvera, Carlos / Hirose, Kenzo / Nakakura, Eric / Warren, Robert / Maker, Vijay K / Maker, Ajay V

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2024 Volume 28, Issue 3, Page(s) 246–251

Abstract: Background: Despite significant advancements in the treatment of patients with colorectal liver metastases (CRLMs), only a minority will experience long-term survival. This study aimed to determine the effect of chemotherapy (CT) and immunotherapy (IT) ... ...

Abstract	Background: Despite significant advancements in the treatment of patients with colorectal liver metastases (CRLMs), only a minority will experience long-term survival. This study aimed to determine the effect of chemotherapy (CT) and immunotherapy (IT) compared with that of CT alone on patient survival after surgical resection. Methods: Patients undergoing curative-intent liver resection followed by adjuvant systemic therapy for stage IV colon cancer were identified using the National Cancer Database. Patients were stratified into type of therapy (CT alone vs CT + IT) and microsatellite status. Propensity score-weighted analysis was performed through 1:1 matching based on the nearest neighbor method. Results: Of 9943 patients who underwent resection of CRLMs, 7971 (80%) received systemic adjuvant therapy. Of 7971 patients, 1432 (18%) received a combination of CT and IT. Microsatellite status was not associated with overall survival (OS). Adjuvant CT + IT was associated with increased 3-year OS compared with that of CT alone in both the unmatched cohort (55% vs 48%, respectively; P < .001) and matched cohort (52% vs 48%, respectively; P = .050). On multivariate analysis, older age, positive resection margins, and KRAS mutation were independent predictors of poor survival, whereas the administration of adjuvant CT + IT was an independent predictor of improved survival. Conclusion: IT combined with CT was associated with improved survival compared with that of CT alone after curative-intent resection of CRLMs, regardless of microsatellite instability status. Clinical trials to determine optimal patient selection, IT regimen, and long-term efficacy to improve outcomes of patients with CRLMs are warranted.
MeSH term(s)	Humans ; Immunotherapy ; Liver Neoplasms/therapy ; Chemotherapy, Adjuvant ; Hepatectomy ; Colonic Neoplasms/therapy
Language	English
Publishing date	2024-01-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1016/j.gassur.2023.12.026
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Article ; Online: Whole genome sequencing reveals the independent clonal origin of multifocal ileal neuroendocrine tumors.

Mäkinen, Netta / Zhou, Meng / Zhang, Zhouwei / Kasai, Yosuke / Perez, Elizabeth / Kim, Grace E / Thirlwell, Chrissie / Nakakura, Eric / Meyerson, Matthew

Genome medicine

2022 Volume 14, Issue 1, Page(s) 82

Abstract: Background: Small intestinal neuroendocrine tumors (SI-NETs) are the most common neoplasms of the small bowel. The majority of tumors are located in the distal ileum with a high incidence of multiple synchronous primary tumors. Even though up to 50% of ... ...

Abstract	Background: Small intestinal neuroendocrine tumors (SI-NETs) are the most common neoplasms of the small bowel. The majority of tumors are located in the distal ileum with a high incidence of multiple synchronous primary tumors. Even though up to 50% of SI-NET patients are diagnosed with multifocal disease, the mechanisms underlying multiple synchronous lesions remain elusive. Methods: We performed whole genome sequencing of 75 de-identified synchronous primary tumors, 15 metastases, and corresponding normal samples from 13 patients with multifocal ileal NETs to identify recurrent somatic genomic alterations, frequently affected signaling pathways, and shared mutation signatures among multifocal SI-NETs. Additionally, we carried out chromosome mapping of the most recurrent copy-number alterations identified to determine which parental allele had been affected in each tumor and assessed the clonal relationships of the tumors within each patient. Results: Absence of shared somatic variation between the synchronous primary tumors within each patient was observed, indicating that these tumors develop independently. Although recurrent copy-number alterations were identified, additional chromosome mapping revealed that tumors from the same patient can gain or lose different parental alleles. In addition to the previously reported CDKN1B loss-of-function mutations, we observed potential loss-of-function gene alterations in TNRC6B, a candidate tumor suppressor gene in a small subset of ileal NETs. Furthermore, we show that multiple metastases in the same patient can originate from either one or several primary tumors. Conclusions: Our study demonstrates major genomic diversity among multifocal ileal NETs, highlighting the need to identify and remove all primary tumors, which have the potential to metastasize, and the need for optimized targeted treatments.
MeSH term(s)	Humans ; Intestinal Neoplasms/genetics ; Intestinal Neoplasms/pathology ; Mutation ; Neuroendocrine Tumors/genetics ; Pancreatic Neoplasms ; RNA-Binding Proteins/genetics ; Stomach Neoplasms ; Whole Genome Sequencing
Chemical Substances	RNA-Binding Proteins ; TNRC6B protein, human
Language	English
Publishing date	2022-08-03
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2484394-5
ISSN	1756-994X ; 1756-994X
ISSN (online)	1756-994X
ISSN	1756-994X
DOI	10.1186/s13073-022-01083-1
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Article ; Online: Metastatic colorectal adenocarcinoma tumor purity assessment from whole exome sequencing data.

Tbeileh, Noura / Timmerman, Luika / Mattis, Aras N / Toriguchi, Kan / Kasai, Yosuke / Corvera, Carlos / Nakakura, Eric / Hirose, Kenzo / Donner, David B / Warren, Robert S / Karelehto, Eveliina

PloS one

2023 Volume 18, Issue 4, Page(s) e0271354

Abstract: Tumors rich in stroma are associated with advanced stage and poor prognosis in colorectal adenocarcinoma (CRC). Abundance of stromal cells also has implications for genomic analysis of patient tumors as it may prevent detection of somatic mutations. As ... ...

Abstract	Tumors rich in stroma are associated with advanced stage and poor prognosis in colorectal adenocarcinoma (CRC). Abundance of stromal cells also has implications for genomic analysis of patient tumors as it may prevent detection of somatic mutations. As part of our efforts to interrogate stroma-cancer cell interactions and to identify actionable therapeutic targets in metastatic CRC, we aimed to determine the proportion of stroma embedded in hepatic CRC metastases by performing computational tumor purity analysis based on whole exome sequencing data (WES). Unlike previous studies focusing on histopathologically prescreened samples, we used an unbiased in-house collection of tumor specimens. WES from CRC liver metastasis samples were utilized to evaluate stromal content and to assess the performance of three in silico tumor purity tools, ABSOLUTE, Sequenza and PureCN. Matching tumor derived organoids were analyzed as a high purity control as they are enriched in cancer cells. Computational purity estimates were compared to those from a histopathological assessment conducted by a board-certified pathologist. According to all computational methods, metastatic specimens had a median tumor purity of 30% whereas the organoids were enriched for cancer cells with a median purity estimate of 94%. In line with this, variant allele frequencies (VAFs) of oncogenes and tumor suppressor genes were undetectable or low in most patient tumors, but higher in matching organoid cultures. Positive correlation was observed between VAFs and in silico tumor purity estimates. Sequenza and PureCN produced concordant results whereas ABSOLUTE yielded lower purity estimates for all samples. Our data shows that unbiased sample selection combined with molecular, computational, and histopathological tumor purity assessment is critical to determine the level of stroma embedded in metastatic colorectal adenocarcinoma.
MeSH term(s)	Humans ; Exome Sequencing ; Mutation ; Exome/genetics ; Colorectal Neoplasms/genetics ; Colorectal Neoplasms/pathology ; Adenocarcinoma/genetics ; Liver Neoplasms/genetics
Language	English
Publishing date	2023-04-06
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0271354
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Article ; Online: National Practice Patterns in Malignant Peritoneal Mesothelioma: Updates in Management and Survival.

Calthorpe, Lucia / Romero-Hernandez, Fernanda / Casey, Megan / Nunez, Miguel / Conroy, Patricia C / Hirose, Kenzo / Kim, Alex / Kirkwood, Kimberly / Maker, Ajay V / Corvera, Carlos / Nakakura, Eric / Alseidi, Adnan / Adam, Mohamed Abdelgadir

Annals of surgical oncology

2023 Volume 30, Issue 8, Page(s) 5119–5129

Abstract: Background: Malignant peritoneal mesothelioma (MPM) is a rare malignancy with a historically poor prognosis. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an effective therapy for patients with ... ...

Abstract	Background: Malignant peritoneal mesothelioma (MPM) is a rare malignancy with a historically poor prognosis. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has emerged as an effective therapy for patients with peritoneal malignancies. A contemporary analysis of trends in management of and survival from MPM is warranted. Methods: Patients with MPM were identified from the National Cancer Database (2004-2018). Patients were categorized by treatment (CRS-HIPEC, CRS-chemotherapy, CRS only, chemotherapy only, no treatment), and joinpoint regression was employed to compute the annual percent change (APC) in treatment over time. Multivariable Cox proportional hazards models were used to analyze factors associated with survival. Results: Of 2683 patients with MPM, 19.1% underwent CRS-HIPEC, and 21.1% received no treatment. Joinpoint regression revealed a statistically significant increase in the proportion of patients undergoing CRS-HIPEC over time (APC 3.21, p = 0.01), and a concurrent decrease in the proportion of patients who underwent no treatment (APC - 2.21, p = 0.02). Median overall survival was 19.5 months. Factors independently associated with survival included CRS-HIPEC, CRS, histology, sex, age, race, Charlson Comorbidity Index, insurance, and hospital type. Although there was a strong association between year of diagnosis and survival on univariate analysis (2016-2018 HR 0.67, p < 0.001), this association was attenuated after adjustment for treatment. Conclusions: CRS-HIPEC is increasingly employed as a treatment for MPM. In parallel, there has been a decrease in patients receiving no treatment with an increase in overall survival. These findings suggest that patients with MPM may be receiving more appropriate therapy; however, a substantial proportion of patients may remain undertreated.
MeSH term(s)	Humans ; Mesothelioma/pathology ; Peritoneal Neoplasms/pathology ; Lung Neoplasms/pathology ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Prognosis ; Hyperthermia, Induced ; Mesothelioma, Malignant ; Combined Modality Therapy ; Cytoreduction Surgical Procedures ; Survival Rate ; Retrospective Studies
Language	English
Publishing date	2023-05-04
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/s10434-023-13528-x
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Article ; Online: A Machine Learning Approach to Predict Postoperative Pancreatic Fistula After Pancreaticoduodenectomy Using Only Preoperatively Known Data.

Ashraf Ganjouei, Amir / Romero-Hernandez, Fernanda / Wang, Jaeyun Jane / Casey, Megan / Frye, Willow / Hoffman, Daniel / Hirose, Kenzo / Nakakura, Eric / Corvera, Carlos / Maker, Ajay V / Kirkwood, Kimberly S / Alseidi, Adnan / Adam, Mohamed A

Annals of surgical oncology

2023 Volume 30, Issue 12, Page(s) 7738–7747

Abstract: Background: Clinically-relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) is a major postoperative complication and the primary determinant of surgical outcomes. However, the majority of current risk calculators ... ...

Abstract	Background: Clinically-relevant postoperative pancreatic fistula (CR-POPF) following pancreaticoduodenectomy (PD) is a major postoperative complication and the primary determinant of surgical outcomes. However, the majority of current risk calculators utilize intraoperative and postoperative variables, limiting their utility in the preoperative setting. Therefore, we aimed to develop a user-friendly risk calculator to predict CR-POPF following PD using state-of-the-art machine learning (ML) algorithms and only preoperatively known variables. Methods: Adult patients undergoing elective PD for non-metastatic pancreatic cancer were identified from the ACS-NSQIP targeted pancreatectomy dataset (2014-2019). The primary endpoint was development of CR-POPF (grade B or C). Secondary endpoints included discharge to facility, 30-day mortality, and a composite of overall and significant complications. Four models (logistic regression, neural network, random forest, and XGBoost) were trained, validated and a user-friendly risk calculator was then developed. Results: Of the 8666 patients who underwent elective PD, 13% (n = 1160) developed CR-POPF. XGBoost was the best performing model (AUC = 0.72), and the top five preoperative variables associated with CR-POPF were non-adenocarcinoma histology, lack of neoadjuvant chemotherapy, pancreatic duct size less than 3 mm, higher BMI, and higher preoperative serum creatinine. Model performance for 30-day mortality, discharge to a facility, and overall and significant complications ranged from AUC 0.62-0.78. Conclusions: In this study, we developed and validated an ML model using only preoperatively known variables to predict CR-POPF following PD. The risk calculator can be used in the preoperative setting to inform clinical decision-making and patient counseling.
Language	English
Publishing date	2023-08-07
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/s10434-023-14041-x
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Article ; Online: Hypertension Requiring Medication Use: a Silent Predictor of Poor Outcomes After Pancreaticoduodenectomy.

Lin, Jackie J / Conroy, Patricia C / Romero-Hernandez, Fernanda / Yilma, Mignote / Feng, Jean / Hirose, Kenzo / Nakakura, Eric / Maker, Ajay V / Corvera, Carlos / Kirkwood, Kimberly / Alseidi, Adnan / Adam, Mohamed A

Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract

2023 Volume 27, Issue 2, Page(s) 328–336

Abstract: Background: Although hypertension requiring medication (HTNm) is a well-known cardiovascular comorbidity, its association with postoperative outcomes is understudied. This study aimed to evaluate whether preoperative HTNm is independently associated ... ...

Abstract	Background: Although hypertension requiring medication (HTNm) is a well-known cardiovascular comorbidity, its association with postoperative outcomes is understudied. This study aimed to evaluate whether preoperative HTNm is independently associated with specific complications after pancreaticoduodenectomy. Study design: Adults undergoing elective pancreaticoduodenectomy were included from the 2014-2019 NSQIP-targeted pancreatectomy dataset. Multivariable regression models compared outcomes between patients with and without HTNm. Endpoints included significant complications, any complication, unplanned readmissions, length of stay (LOS), clinically relevant postoperative pancreatic fistula (CR-POPF), and cardiovascular and renal complications. A subgroup analysis excluded patients with diabetes, heart failure, chronic obstructive pulmonary disease, estimated glomerular filtration rate from serum creatinine (eGFRCr) < 60 ml/min per 1.73 m Results: Among 14,806 patients, 52% had HTNm. HTNm was more common among older male patients with obesity, diabetes, congestive heart failure, chronic obstructive pulmonary disease, functional dependency, hard pancreatic glands, and cancer. After adjusting for demographics, preoperative comorbidities, and laboratory values, HTNm was independently associated with higher odds of significant complications (aOR 1.12, p = 0.020), any complication (aOR 1.11, p = 0.030), cardiovascular (aOR 1.78, p = 0.002) and renal (aOR 1.60, p = 0.020) complications, and unplanned readmissions (aOR 1.14, p = 0.040). In a subgroup analysis of patients without major preoperative comorbidity, HTNm remained associated with higher odds of significant complications (aOR 1.14, p = 0.030) and cardiovascular complications (aOR 1.76, p = 0.033). Conclusions: HTNm is independently associated with cardiovascular and renal complications after pancreaticoduodenectomy and may need to be considered in preoperative risk stratification. Future studies are necessary to explore associations among underlying hypertension, specific antihypertensive medications, and postoperative outcomes to investigate potential risk mitigation strategies.
MeSH term(s)	Adult ; Humans ; Male ; Pancreaticoduodenectomy/adverse effects ; Pancreatectomy/adverse effects ; Obesity/complications ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Pancreatic Fistula/etiology ; Pulmonary Disease, Chronic Obstructive/complications ; Hypertension/complications ; Hypertension/epidemiology ; Retrospective Studies ; Risk Factors
Language	English
Publishing date	2023-01-09
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2012365-6
ISSN	1873-4626 ; 1934-3213 ; 1091-255X
ISSN (online)	1873-4626 ; 1934-3213
ISSN	1091-255X
DOI	10.1007/s11605-022-05577-6
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Article ; Online: Expert Consensus Practice Recommendations of the North American Neuroendocrine Tumor Society for the management of high grade gastroenteropancreatic and gynecologic neuroendocrine neoplasms.

Eads, Jennifer R / Halfdanarson, Thorvardur R / Asmis, Tim / Bellizzi, Andrew M / Bergsland, Emily K / Dasari, Arvind / El-Haddad, Ghassan / Frumovitz, Michael / Meyer, Joshua / Mittra, Erik / Myrehaug, Sten / Nakakura, Eric / Raj, Nitya / Soares, Heloisa P / Untch, Brian / Vijayvergia, Namrata / Chan, Jennifer A

Endocrine-related cancer

2023 Volume 30, Issue 8

Abstract: High-grade neuroendocrine neoplasms are a rare disease entity and account for approximately 10% of all neuroendocrine neoplasms. Because of their rarity, there is an overall lack of prospectively collected data available to advise practitioners as to how ...

Abstract	High-grade neuroendocrine neoplasms are a rare disease entity and account for approximately 10% of all neuroendocrine neoplasms. Because of their rarity, there is an overall lack of prospectively collected data available to advise practitioners as to how best to manage these patients. As a result, best practices are largely based on expert opinion. Recently, a distinction was made between well-differentiated high-grade (G3) neuroendocrine tumors and poorly differentiated neuroendocrine carcinomas, and with this, pathologic details, appropriate imaging practices and treatment have become more complex. In an effort to provide practitioners with the best guidance for the management of patients with high-grade neuroendocrine neoplasms of the gastrointestinal tract, pancreas, and gynecologic system, the North American Neuroendocrine Tumor Society convened a panel of experts to develop a set of recommendations and a treatment algorithm that may be used by practitioners for the care of these patients. Here, we provide consensus recommendations from the panel on pathology, imaging practices, management of localized disease, management of metastatic disease and surveillance and draw key distinctions as to the approach that should be utilized in patients with well-differentiated G3 neuroendocrine tumors vs poorly differentiated neuroendocrine carcinomas.
MeSH term(s)	Humans ; Female ; Neuroendocrine Tumors/diagnosis ; Neuroendocrine Tumors/therapy ; Neuroendocrine Tumors/pathology ; Consensus ; Neoplasm Grading ; Carcinoma, Neuroendocrine/diagnosis ; Carcinoma, Neuroendocrine/therapy ; Carcinoma, Neuroendocrine/pathology ; North America ; Pancreatic Neoplasms/diagnosis ; Pancreatic Neoplasms/therapy ; Pancreatic Neoplasms/pathology
Language	English
Publishing date	2023-07-11
Publishing country	England
Document type	Journal Article
ZDB-ID	1218450-0
ISSN	1479-6821 ; 1351-0088
ISSN (online)	1479-6821
ISSN	1351-0088
DOI	10.1530/ERC-22-0206
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Article: Minimally Invasive Distal Pancreatectomy Techniques: A Contemporary Analysis Exploring Trends, Similarities, and Differences to Open Surgery.

Romero-Hernandez, Fernanda / Mohamedaly, Sarah / Miller, Phoebe / Rodriguez, Natalie / Calthorpe, Lucia / Conroy, Patricia C / Ganjouei, Amir Ashraf / Hirose, Kenzo / Maker, Ajay V / Nakakura, Eric / Corvera, Carlos / Kirkwood, Kimberly S / Alseidi, Adnan / Adam, Mohamed A

Cancers

2022 Volume 14, Issue 22

Abstract: Limited contemporary data has compared similarities and differences between total laparoscopic (LDP), hand-assisted (HALDP), and open distal pancreatectomy (ODP). This study aimed to examine similarities and differences in outcomes between these three ... ...

Abstract	Limited contemporary data has compared similarities and differences between total laparoscopic (LDP), hand-assisted (HALDP), and open distal pancreatectomy (ODP). This study aimed to examine similarities and differences in outcomes between these three approaches in a contemporary cohort. Methods: Patients undergoing elective LDP, HALDP, and ODP in the NSQIP dataset (2014−2019) were included. Descriptive statistics and multivariate regression analyses were employed to compare postoperative outcomes. Results: Among 5636 patients, 33.9% underwent LDP, 13.1% HALDP, and 52.9% ODP. Compared with the LDP approach, surgical site infections were more frequent in HALDP and ODP approaches (1.2% vs. 2.6% vs. 2.8%, respectively, p < 0.01). After adjustment, the LDP approach was associated with a significantly lower likelihood of surgical site infection (OR 0.25, p = 0.03) when compared to ODP. There was no difference in the likelihood of surgical site infection when HALDP was compared to ODP (OR 0.59, p = 0.40). Unadjusted operative times were similar between approaches (LDP = 192 min, HALDP = 193 min, ODP = 191 min, p = 0.59). After adjustment, the LDP approach had a longer operative time (+10.3 min, p = 0.04) compared to ODP. There was no difference in the adjusted operative time between HALDP and ODP approaches (+5.4 min, p = 0.80). Conclusions: Compared to ODP, LDP was associated with improved surgical site infection rates and slightly longer operative times. There was no difference in surgical site infection rates between ODP and HALDP. Surgeon comfort and experience should decide the operative approach, but it is important to discuss the differences between these approaches with patients.
Language	English
Publishing date	2022-11-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14225625
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