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Bordeianou, Liliana

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Bordeianou

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Liliana

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Bordeianou, Liliana
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Now showing 1 - 7 of 7
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    Obesity, Outcomes and Quality of Care: BMI Increases the Risk of Wound-Related Complications in Colon Cancer Surgery
    (Elsevier BV, 2013) Amri, Ramzi; Bordeianou, Liliana; Sylla, Patricia; Berger, David
    BACKGROUND: Obese patients may face higher complication rates during surgical treatment of colon cancer. The aim of this study was to measure this effect at a high-volume tertiary care center. METHODS: All patients with colon cancer treated surgically at a single center from 2004 through 2011 were reviewed. Multivariate regression assessed relationships of complications and stay outcomes with body mass index (BMI) controlling for age, gender, comorbidity score, surgical approach, and history of smoking. RESULTS: In 1,048 included patients, BMI was a predictor of several complications in both laparoscopic and open procedures. For every increase of BMI by one World Health Organization category, the odds ratios were 1.61 (P < .001) for wound infection and 1.54 (P < .001) for slow healing. Additionally, right colectomies had an odds ratio of 3.23 (P = .017) for wound dehiscence. No further associations with BMI were found. CONCLUSIONS: BMI was incrementally associated with wound-related complications, illustrating how the proliferation of obesity relates to a growing risk for surgical complications. As the surgical community strives to improve the quality of care, patient-controllable factors will play an increasingly important role in cost containment and quality improvement.
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    A pilot study of natural orifice transanal endoscopic total mesorectal excision with laparoscopic assistance for rectal cancer
    (Springer Nature, 2013) Sylla, Patricia; Bordeianou, Liliana; Berger, David; Han, Kyung S.; Lauwers, Gregory Y.; Sahani, Dushyant; Sbeih, Mohammed A.; Lacy, Antonio M.; Rattner, David
    Background: The objective of this pilot study was to evaluate the feasibility and safety of natural orifice endoscopic transanal total mesorectal excision (TME) with laparoscopic assistance in a cohort study of five patients with stage I and IIA rectal cancer. Methods: Five eligible patients with node-negative rectal cancer located 4–12 cm from the anal verge were enrolled in an IRB-approved pilot study. All patients underwent transanal endoscopic TME with laparoscopic assistance, hand-sewn coloanal anastomosis, and a diverting loop ileostomy. Primary and secondary end points included adequacy of the mesorectal excision and 30-day postoperative complications, respectively. Results: Between November 2011 and May 2012, three males and two females underwent transanal endoscopic TME with laparoscopic assistance. Patient mean age and BMI were 48.6 ± 9.8 years and 25.7 ± 2.3 kg/m2, respectively. Tumors were located an average of 5.7 ± 2.4 cm from the anal verge and preoperatively staged as T1N0M0 (2), T2N0M0 (1), and T3N0M0 (2). Mean operative time was 274.6 ± 85.4 min with no intraoperative complications. Partial intersphincteric resection was performed in conjunction with transanal endoscopic TME in three patients. Pathologic examination of TME specimens demonstrated complete mesorectal excision in all cases with negative proximal, distal, and radial margins. Mean length of hospital stay was 5.2 ± 2.6 days and three minor complications occurred, including one ileus and two cases of transient urinary dysfunction. At a mean early follow-up of 5.4 ± 2.3 months, all patients remain disease-free. Conclusions: In this pilot study of five patients with rectal cancer, transanal endoscopic TME with laparoscopic assistance is feasible and safe, and is a promising alternative to open and laparoscopic TME. Evaluation of long-term functional and oncologic outcomes of this approach is needed before widespread adoption can be recommended.
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    The effect of neoadjuvant chemoradiation therapy on the prognostic value of lymph nodes after rectal cancer surgery
    (Elsevier BV, 2010) Klos, Coen L.; Shellito, Paul; Rattner, David; Hodin, Richard; Cusack, James; Bordeianou, Liliana; Sylla, Patricia; Hong, Theodore; Blaszkowsky, Lawrence; Ryan, Davis P.; Lauwers, Gregory Y.; Chang, Yuchiao; Berger, David
    Background: Neoadjuvant therapy may affect the prognostic impact of total lymph node harvests and lymph node positivity after surgery for rectal cancer. Methods: We performed a retrospective review of 390 consecutive patients with histologically confirmed rectal cancer. Postoperative follow-up evaluation and survival were confirmed via medical record review. The impacts of lymph node positivity and total lymph node harvest on survival and recurrence are reflected as proportional hazard ratios (HRs). Results: A total of 221 patients underwent neoadjuvant therapy, of whom 75 had positive nodes. Node-positive patients showed a significantly shorter survival time (HR, 2.89; P = .002) and time to local recurrence (HR, 6.36; P = .031) compared with patients without positive nodes. Survival and recurrence were not significantly different between patients with a total harvest of fewer than 12 nodes and patients with a higher lymph node harvest. Conclusions: After neoadjuvant treatment and total mesorectal excision, lymph node positivity is associated with significantly shorter survival and time to local recurrence in rectal cancer patients, whereas absolute total lymph node harvests likely have little impact on prognosis.
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    Impact of Screening Colonoscopy on Outcomes in Colon Cancer Surgery
    (American Medical Association (AMA), 2013) Amri, Ramzi; Bordeianou, Liliana; Sylla, Patricia; Berger, David
    Importance: Screening colonoscopy seemingly decreases colorectal cancer rates in the United States. In addition to removing benign lesions and preventing progression to malignancy, screening colonoscopy theoretically identifies asymptomatic patients with early-stage disease, potentially leading to higher survival rates. Objectives: To assess the effect of screening colonoscopy on outcomes of colon cancer surgery by reviewing differences in staging, disease-free interval, risk of recurrence, and survival and to identify whether diagnosis through screening improves long-term outcomes in- dependent of staging. Design: Retrospective review of prospectively maintained, institutional review board-approved database. Setting: Tertiary care center with high patient volume. Patients: All patients who underwent colon cancer surgery at Massachusetts General Hospital from January 1, 2004, through December 31, 2011. Intervention: Colon cancer surgery. Main Outcomes and Measures: Postoperative staging, death, and recurrence, measured as incidence and time to event. Results: A total of 1071 patients were included, with 217 diagnosed through screening. Patients not diagnosed through screening were at risk for a more invasive tumor (≥T3: relative risk [RR]=1.96; P<0.001), nodal disease (RR=1.92; P<0.001), and metastatic disease on presentation (RR=3.37; P<0.001). In follow-up, these patients had higher death rates (RR=3.02; P<0.001) and recurrence rates (RR=2.19; P=0.004) as well as shorter survival (P<0.001) and disease-free intervals (P<0.001). Cox and logistic regression controlling for staging and base- line characteristics revealed that death rate (P=0.02) and survival duration (P=0.01) were better stage for stage with diagnosis through screening. Death and metastasis rates also remained significantly lower in tumors without nodal or metastatic spread (all P<0.001). Conclusions and Relevance: Patients with colon cancer identified on screening colonoscopy not only have lower-stage disease on presentation but also have better outcomes independent of their staging. Compliance to screening colonoscopy guidelines can play an important role in prolonging longevity, improving quality of life, and reducing health care costs through early detection of colon cancer.
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    Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes.
    (Elsevier, 2015) Amri, Ramzi; Bordeianou, Liliana; Sylla, Patricia; Berger, David
    Background: Emergency presentation with colon cancer is intuitively related to advanced disease. We measured its effect on outcomes of surgically treated colon cancer. Methods: A retrospective cohort of 1,071 surgical colon cancer patients (2004 to 2011), with 102 emergency cases requiring surgery within the index admission, was analyzed. Results: Emergency patients required longer surgeries (median 141 vs 124 minutes; P = .04), longer median admissions (8% vs 5%; P < .001), more readmissions (12.7% vs 7.1%; P = .040), and perioperative mortality (7.8% vs .8%; P < .001). Surgical pathology displayed higher rates of node-positive disease (56.6% vs 38.6%; P < .001), extramural vascular invasion (39.6% vs 29.1%; P = .021), and metastatic disease (19.6% vs 8%; P < .001). Consequently, adjusting for staging, emergency presentations had considerably higher mortality (odds ratio = 2.07; P = .003) and shorter disease-free survival (hazard ratio = 1.39; P = .042). Conclusions: Emergency presentation is a stage-independent poor prognostic factor associated with aggressive tumor biology, resulting in longer surgeries and admissions, frequent readmissions, worsening outcomes, and increasing healthcare costs.
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    The conundrum of the young colon cancer patient
    (Elsevier BV, 2015) Amri, Ramzi; Bordeianou, Liliana; Berger, David
    BACKGROUND:Colonoscopy has had a major impact on the incidence and survival of colon cancer for patients who are screened, usually beginning at the age of 50. Meanwhile, the incidence rate of colon cancer is actually increasing in the patients younger than 50 while no routine screening is implemented for this age group. METHODS:All patients surgically treated for colon cancer (2004-2011) without preexisting high-risk characteristics (hereditary nonpolyposis colorectal cancer, inflammatory bowel disease) were included (n = 1,015). Age-related disparities in baseline disease and outcomes were reviewed. RESULTS:Patients younger than 50 years of age (n = 108; 10.6%) had the greatest baseline rates of metastatic (20.4% vs 8.0%; P < .001), node-positive disease (54.6% vs 39.4%; P = .002), and greater rates of extramural vascular invasion (38.9 vs 29.4%; P = .043). Cancer-related mortality also was greatest in this group (28.7 vs 18.4%; P = .011). Multivariable Cox regression shows that patients younger than 50 are still at significantly greater risk of mortality after adjustment for effects of age, baseline AJCC staging, smoking, and comorbidity (hazard ratio: 1.57, 95% confidence interval 1.01-2.45; P = .049). DISCUSSION: Patients younger than 50 present with the most advanced and aggressive disease, giving them the worst stage-independent prognosis of all age groups. Potential causes include age-related differences in tumor biology and underdetection by current screening efforts. This raises the question of how to address the conundrum of the young colon cancer patient, who often is the proverbial needle in a haystack of young patients, with nonspecific gastrointestinal symptoms but who would benefit considerably from early detection.
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    Variations in Metastasis Site by Primary Location in Colon Cancer
    (Springer Science + Business Media, 2015) Amri, Ramzi; Bordeianou, Liliana; Sylla, Patricia; Berger, David
    Objective: The purpose of this paper is to determine whether sites of distant recurrence are associated with specific locations of primary disease in colon cancer. Methods: A cohort including all patients (n = 947) undergoing a segmental colonic resection for colon cancer at our center (2004–2011) comparing site-specific metastatic presentation and recurrence rates, as well as their respective multivariable American Joint Committee on Cancer (AJCC) stage-adjusted hazard ratios (mHR). Results: Right-sided colectomies (n = 557) had a lower overall metastasis rate (24.8 % vs. 31.8 %; P = 0.017; mHR = 1.24 [95% CI: 0.96–1.60]; P = 0.011) due to significantly lower pulmonary metastasis in follow-up (2.7 % vs. 9 %; P < 0.001; mHR = 0.32 [95% CI: 0.17–0.58]; P = 0.001) and lower overall liver metastasis rate (15.6 vs. 22.1 %; P = 0.012; mHR = 0.74 [95% CI: 0.55–0.99];P = 0.050). Left colectomies (n = 127) had higher rates of liver metastasis during follow-up (9.4 % vs. 4.8 %; P = 0.029; mHR = 1.64 [95% CI: 0.86–3.15]; P = 0.134). Sigmoid resections (n = 238) had higher baseline rates of liver metastasis (17.1 % vs. 11.3 %; P = 0.015) and higher cumulative rates of lung (12.2 % vs. 5.4 %; P < 0.001; mHR = 2.26 [95 % CI: 1.41–3.63]; P = 0.001) and brain metastases (2.3 % vs. 0.6 %; P = 0.033; mHR = 4.03 [95% CI: 1.14–14.3]; P = 0.031). Other sites of metastasis, including the (retro) peritoneum, omentum, ovary, and bone, did not yield significant differences. Conclusions: Important variations in site-specific rates of metastatic disease exist within major resection regions of colon cancer. These variations may be important to consider when evaluating options for adjuvant treatment and surveillance after resection of the primary disease.