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Article ; Online: Commentary: At the intersection of biology and anatomy: Segmentectomy.

Whitlock, Richard S / Burt, Bryan M

JTCVS open

2022 Volume 10, Page(s) 368–369

Language	English
Publishing date	2022-04-18
Publishing country	Netherlands
Document type	Editorial
ISSN	2666-2736
ISSN (online)	2666-2736
DOI	10.1016/j.xjon.2022.04.013
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Article ; Online: Variation in Resident Operative Autonomy at Veterans Affairs Hospitals.

Portuondo, Jorge I / Whitlock, Richard S / Mehl, Steven C / Massarweh, Nader N

JAMA surgery

2022 Volume 158, Issue 3, Page(s) 321–323

MeSH term(s)	Humans ; United States ; Veterans ; Retrospective Studies ; Risk Assessment ; Hospitals ; Hospitals, Veterans ; United States Department of Veterans Affairs
Language	English
Publishing date	2022-12-28
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2022.4791
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Article ; Online: Dispersion of National Institute of Health Funding to Departments of Surgery Is Contracting.

Brlecic, Paige E / Whitlock, Richard S / Zhang, Qianzi / LeMaire, Scott A / Rosengart, Todd K

The Journal of surgical research

2023 Volume 289, Page(s) 8–15

Abstract: Introduction: NIH funding to departments of surgery reported as benchmark Blue Ridge Institute for Medical Research (BRIMR) rankings are unclear.: Methods: We analyzed inflation-adjusted BRIMR-reported NIH funding to departments of surgery and ... ...

Abstract	Introduction: NIH funding to departments of surgery reported as benchmark Blue Ridge Institute for Medical Research (BRIMR) rankings are unclear. Methods: We analyzed inflation-adjusted BRIMR-reported NIH funding to departments of surgery and medicine between 2011 and 2021. Results: NIH funding to departments of surgery and medicine both increased 40% from 2011 to 2021 ($325 million to $454 million; $3.8 billion to $5.3 billion, P < 0.001 for both). The number of BRIMR-ranked departments of surgery decreased 14% during this period while departments of medicine increased 5% (88 to 76 versus 111 to 116; P < 0.001). There was a greater increase in the total number of medicine PIs versus surgery PIs during this period (4377 to 5224 versus 557 to 649; P < 0.001). These trends translated to further concentration of NIH-funded PIs in medicine versus surgery departments (45 PIs/program versus 8.5 PIs/program; P < 0.001). NIH funding and PIs/program in 2021 were respectively 32 and 20 times greater for the top versus lowest 15 BRIMR-ranked surgery departments ($244 million versus $7.5 million [P < 0.01]; 20.5 versus 1.3 [P < 0.001]). Twelve (80%) of the top 15 surgery departments maintained this ranking over the 10-year study period. Conclusions: Although NIH funding to departments of surgery and medicine is growing at a similar rate, departments of medicine and top-funded surgery departments have greater funding and concentration of PIs/program versus surgery departments overall and lowest-funded surgery departments. Strategies used by top-performing departments to obtain and maintain funding may assist less well-funded departments in obtaining extramural research funding, thus broadening the access of surgeon-scientists to perform NIH-supported research.
MeSH term(s)	Humans ; Schools, Medical ; Medicine ; Surgeons ; Hospital Departments ; Biomedical Research
Language	English
Publishing date	2023-04-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.03.023
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Article ; Online: Review: perspectives on renal and visceral protection during thoracoabdominal aortic aneurysm repair.

Whitlock, Richard S / Coselli, Joseph S

Indian journal of thoracic and cardiovascular surgery : official organ, Association of Thoracic and Cardiovascular Surgeons of India

2018 Volume 35, Issue Suppl 2, Page(s) 179–185

Abstract: Open repair of a thoracoabdominal aortic aneurysm (TAAA) is an extensive operation and associated with significant perioperative morbidities and mortality, in large part due to distal aortic ischemia secondary to aortic cross-clamping that is ... ...

Abstract	Open repair of a thoracoabdominal aortic aneurysm (TAAA) is an extensive operation and associated with significant perioperative morbidities and mortality, in large part due to distal aortic ischemia secondary to aortic cross-clamping that is necessitated during repair. Distal aortic ischemia may manifest as complications of the kidneys and viscera. Postoperative renal complications range from temporarily elevated levels of creatinine resulting from impaired kidney function to acute renal failure necessitating dialysis that may persist after hospital discharge. Continued advances in the management and adjuncts associated with TAAA repair since the groundbreaking era of E.S. Crawford have led to improved postoperative outcomes following surgery, but the dramatic improvements seen in reducing rates of spinal cord deficits, mesenteric ischemia and other serious postoperative complications have not been seen in contemporary rates of postoperative renal failure. We provide an overview of the various surgical techniques and adjuncts as they relate to the management of visceral and renal ischemia.
Language	English
Publishing date	2018-12-14
Publishing country	India
Document type	Journal Article ; Review
ZDB-ID	2164386-6
ISSN	0973-7723 ; 0970-9134
ISSN (online)	0973-7723
ISSN	0970-9134
DOI	10.1007/s12055-018-0757-5
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Article: Surgical Management of Hepatoblastoma and Recent Advances.

Yang, Tianyou / Whitlock, Richard S / Vasudevan, Sanjeev A

Cancers

2019 Volume 11, Issue 12

Abstract: Hepatoblastoma is the most common childhood liver malignancy. The management of hepatoblastoma requires multidisciplinary efforts. The five-year overall survival is approximately 80% in developed countries. Surgery remains the mainstay of treatment for ... ...

Abstract	Hepatoblastoma is the most common childhood liver malignancy. The management of hepatoblastoma requires multidisciplinary efforts. The five-year overall survival is approximately 80% in developed countries. Surgery remains the mainstay of treatment for hepatoblastoma, and meticulous techniques must be employed to ensure safe and effective local control surgeries. Additionally, there have been several advances from both pediatric and adult literature in the way liver tumor surgery is performed. In this review, we highlight important aspects of liver surgery for hepatoblastoma, the management of metastatic disease, and the most current technical advances in performing these procedures in a safe and effective manner.
Language	English
Publishing date	2019-12-04
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers11121944
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Article: Animal Modeling of Pediatric Liver Cancer.

Whitlock, Richard S / Yang, Tianyou / Vasudevan, Sanjeev A / Woodfield, Sarah E

Cancers

2020 Volume 12, Issue 2

Abstract: Hepatoblastoma (HB) is the most common pediatric liver malignancy. Management of HB requires multidisciplinary efforts. The 5-year overall survival of this disease is about 80% in developed countries. Despite advances in the care of these patients, ... ...

Abstract	Hepatoblastoma (HB) is the most common pediatric liver malignancy. Management of HB requires multidisciplinary efforts. The 5-year overall survival of this disease is about 80% in developed countries. Despite advances in the care of these patients, survival in recurrent or treatment-refractory disease is lower than 50%. This is due to more complex tumor biology, including hepatocellular carcinoma (HCC)-like mutations and expression of aggressive gene signatures leading to chemoresistance, vascular invasion, and metastatic spread. The current treatment protocols for pediatric liver cancer do not incorporate targeted therapies, and the ability to test these therapies is limited due to the inaccessibility of cell lines and mouse models. In this review, we discuss the current status of preclinical animal modeling in pediatric liver cancer, primarily HB. Although HB is a rare cancer, the research community has worked together to develop a range of interesting and relevant mouse models for diverse preclinical studies.
Language	English
Publishing date	2020-01-22
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers12020273
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Article ; Online: Pleurectomy and decortication are associated with better survival for bicavitary cytoreductive surgery for mesothelioma compared with extrapleural pneumonectomy.

Ripley, R Taylor / Holmes, Hudson M / Whitlock, Richard S / Groth, Shawn S / Medina, Cristian G / Choi, Eugene A / Burt, Bryan M / Sugarbaker, Paul H

The Journal of thoracic and cardiovascular surgery

2022 Volume 165, Issue 5, Page(s) 1722–1730

Abstract: Objectives: Mesothelioma is a nearly uniformly fatal tumor. Multimodality therapy including cytoreductive surgery and chemotherapy is associated with long-term survival in some patients. Cytoreductive surgery for thoracic disease includes a lung-sparing ...

Abstract	Objectives: Mesothelioma is a nearly uniformly fatal tumor. Multimodality therapy including cytoreductive surgery and chemotherapy is associated with long-term survival in some patients. Cytoreductive surgery for thoracic disease includes a lung-sparing operation called an "extended pleurectomy/decortication" or a lung-sacrificing surgery called an "extrapleural pneumonectomy." The benefit of cytoreductive surgery for bicavitary disease (chest and abdomen) is poorly understood. Our objective was to evaluate the long-term survivals for patients undergoing cytoreductive surgery for bicavitary disease and to determine whether any prognostic factors were associated with outcome. Methods: We reviewed our Institutional Review Board-approved, institutional, International Association for the Study of Lung Cancer Mesothelioma Staging Project database. Inclusion criteria were all patients who underwent cytoreductive surgery for bicavitary disease. Overall survival was calculated by Kaplan-Meier methodology. All International Association for the Study of Lung Cancer database elements were evaluated by univariable analysis. Results: From February 2014 to August 2021, 440 patients with mesothelioma were evaluated. Fourteen patients (3%) underwent cytoreductive surgery of both chest and abdomen as a planned 2-stage operation. Most patients (13/14; 93%) underwent chest surgery before abdomen surgery. For the entire cohort, the median overall survival was 33.6 months with a 5-year survival of 20%. Extended pleurectomy/decortication was associated with a better outcome compared with extrapleural pneumonectomy, with median overall survivals of 58.2 versus 13.5 months, respectively. Conclusions: For a highly selected group of patients with bicavitary mesothelioma, long-term survival can be achieved with an aggressive, staged surgical approach. The patients who undergo extended pleurectomy/decortication with preservation of the lung appear to have more favorable outcomes compared with patients undergoing extrapleural pneumonectomy.
MeSH term(s)	Humans ; Pneumonectomy/adverse effects ; Pneumonectomy/methods ; Cytoreduction Surgical Procedures/adverse effects ; Pleural Neoplasms ; Treatment Outcome ; Retrospective Studies ; Mesothelioma, Malignant ; Mesothelioma ; Lung Neoplasms/surgery
Language	English
Publishing date	2022-12-14
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2022.11.035
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Article ; Online: No Association of Sirolimus with Wound Complications in Children With Vascular Anomalies.

Mehl, Steven C / Whitlock, Richard S / Ortega, Rachel M / Creden, Sam / Iacobas, Ionela / Maricevich, Renata S / Rosenberg, Tara L / Rialon, Kristy L

Journal of pediatric surgery

2022 Volume 58, Issue 8, Page(s) 1555–1559

Abstract: Introduction: Sirolimus has demonstrated effectiveness as a treatment option for several types of vascular anomalies; however, it has a potential side effect of delayed surgical wound healing. The purpose of this study was to evaluate the association of ...

Abstract	Introduction: Sirolimus has demonstrated effectiveness as a treatment option for several types of vascular anomalies; however, it has a potential side effect of delayed surgical wound healing. The purpose of this study was to evaluate the association of sirolimus with postoperative complications in the pediatric vascular anomaly population. Methods: A retrospective cohort study was performed for children with a vascular anomaly who underwent excision or debulking of the anomaly from 2015 to 2020. Patient demographics, vascular anomaly characteristics, operative variables, sirolimus dosing information, and perioperative outcomes were collected. Univariate analysis was performed to compare outcomes based on the administration of sirolimus. Results: Forty-seven patients with vascular anomalies underwent 57 surgical procedures (36 without perioperative sirolimus, 21 with perioperative sirolimus). The median age at the time of surgery was seven years (IQR 1.7-14.0). The most common anomalies were lymphatic and venolymphatic malformations. Of the patients administered perioperative sirolimus, the median preoperative and postoperative sirolimus levels were comparable (preoperative 6.9 ng/mL (IQR 4.9-10.1), postoperative 6.5 ng/mL (IQR 4.7-9.4)). The rate of postoperative complications (sirolimus 19%, without sirolimus 11%; p = 0.45) and wound complications (sirolimus 14%, without sirolimus 6%; p = 0.26) were comparable between the cohorts. Conclusion: Our results suggest sirolimus may not significantly increase perioperative complication rates in pediatric patients undergoing resection of their vascular anomaly. Level of evidence: Level III.
MeSH term(s)	Child ; Humans ; Infant ; Child, Preschool ; Adolescent ; Sirolimus/adverse effects ; Retrospective Studies ; Treatment Outcome ; Vascular Malformations/complications ; Vascular Malformations/drug therapy ; Vascular Malformations/surgery ; Postoperative Complications/etiology ; Postoperative Complications/chemically induced
Chemical Substances	Sirolimus (W36ZG6FT64)
Language	English
Publishing date	2022-11-24
Publishing country	United States
Document type	Journal Article
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2022.11.009
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Article ; Online: Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategy.

Espinoza, Andres F / Patel, Kalyani R / Shetty, Priya B / Whitlock, Richard S / Sumazin, Pavel / Yu, Xinjian / Sarabia, Stephen F / Urbicain, Martin / Heczey, Andras / Masand, Prakash / Woodfield, Sarah E / López-Terrada, Dolores H / Vasudevan, Sanjeev A

Cancer medicine

2023 Volume 12, Issue 23, Page(s) 21270–21278

Abstract: Objective: Hepatoblastoma (HB) is the most common primary hepatic malignancy in childhood. Relapse occurs in more than 50% of high-risk patients with a high mortality due to ineffective salvage therapies. The purpose of this study is to identify risk ... ...

Abstract	Objective: Hepatoblastoma (HB) is the most common primary hepatic malignancy in childhood. Relapse occurs in more than 50% of high-risk patients with a high mortality due to ineffective salvage therapies. The purpose of this study is to identify risk factors for relapsed HB and predictors of survival in a single tertiary referral center. Methods: A retrospective chart review showed 129 surgically treated HB patients from October 2004 to July 2020. Of the cohort, 22 patients presented with relapsed HB. Relapse was defined as re-appearance of malignancy after 4 weeks of normalized AFP and disappearance of all tumors on imaging. Results: Patients with relapsed HB had a 5-year overall survival (OS) of 45.4% compared to 93.1% in those without relapse (p = 0.001). When comparing PRETEXT IV, microvascular invasion, metastatic disease, and age on multivariate logistic regression, only PRETEXT IV was an independent risk factor for relapsed HB with an OR of 2.39 (95% CI: 1.16-4.96; p = 0.019). Mixed epithelial and mesenchymal HB (12/19, 63.2%) was the most common histology of primary tumors while pure epithelial HB (13/15, 86.6%) was the most common relapsed histology. Combination of surgical and medical therapy for relapsed disease was predictive of survival with an HR of 16.3 (95% CI: 1.783-149.091; p = 0.013) compared to only chemotherapy. Conclusions: This study demonstrates that PRETEXT IV staging is an independent predictor of relapsed disease. The most common relapsed histology was epithelial, suggesting a potential selection or resistance of this component. Surgical resection is a critical component of multimodal therapy for relapsed HB.
MeSH term(s)	Humans ; Infant ; Hepatoblastoma/surgery ; Hepatoblastoma/pathology ; Retrospective Studies ; Prognosis ; Liver Neoplasms/pathology ; Recurrence ; Treatment Outcome
Language	English
Publishing date	2023-11-14
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2659751-2
ISSN	2045-7634 ; 2045-7634
ISSN (online)	2045-7634
ISSN	2045-7634
DOI	10.1002/cam4.6705
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Article ; Online: Sclerosing Encapsulating Peritonitis in a Pediatric Patient Treated With Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy.

Whitlock, Richard S / Malik, Tahir / Smith, Valeria / Mahajan, Priya / Hayes-Jordan, Andrea / Vasudevan, Sanjeev A

Journal of pediatric hematology/oncology

2020 Volume 43, Issue 5, Page(s) e685–e688

Abstract: Background: Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition characterized by small bowel encapsulation by a thick fibrocollagenous membrane. Patients with SEP often present with nonspecific symptoms, such as abdominal ...

Abstract	Background: Sclerosing encapsulating peritonitis (SEP) is a rare chronic inflammatory condition characterized by small bowel encapsulation by a thick fibrocollagenous membrane. Patients with SEP often present with nonspecific symptoms, such as abdominal pain and distension, however some patients may present with symptoms suggestive of intestinal obstruction. Secondary SEP has been reported in patients undergoing peritoneal dialysis and has been recently described in adults following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Observations: We report a clinical case of a 13-year-old female who presented with worsening abdominal pain and distension and persistent emesis who was found to have SEP 13 months following CRS and HIPEC for management of desmoplastic small round cell tumor and subsequently required operative intervention. Conclusion: Although there have been published reports of adult patients experiencing cases of SEP following CRS/HIPEC, this is the first published case of secondary SEP occurring in a pediatric oncology patient.
MeSH term(s)	Adolescent ; Cytoreduction Surgical Procedures/adverse effects ; Desmoplastic Small Round Cell Tumor/pathology ; Desmoplastic Small Round Cell Tumor/therapy ; Female ; Humans ; Hyperthermic Intraperitoneal Chemotherapy/adverse effects ; Peritoneal Neoplasms/pathology ; Peritoneal Neoplasms/therapy ; Peritonitis/etiology ; Peritonitis/pathology
Language	English
Publishing date	2020-08-26
Publishing country	United States
Document type	Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1231152-2
ISSN	1536-3678 ; 1077-4114 ; 0192-8562
ISSN (online)	1536-3678
ISSN	1077-4114 ; 0192-8562
DOI	10.1097/MPH.0000000000001899
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