Browsing by Author "Sotiropoulos, G"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
- Recurrence After Operative Management of Intrahepatic CholangiocarcinomaPublication . Hyder, O; Hatzaras, I; Sotiropoulos, G; Paul, A; Alexandrescu, S; Marques, H; Pulitano, C; Barroso, E; Clary, B; Aldrighetti, L; Ferrone, C; Zhu, A; Bauer, T; Walters, D; Groeschl, R; Gamblin, C; Marsh, J; Nguyen, K; Turley, R; Popescu, I; Hubert, C; Meyer, S; Choti, M; Gigot, JF; Mentha, G; Pawlik, TINTRODUCTION: Data on recurrence after operation for intrahepatic cholangiocarcinoma (ICC) are limited. We sought to investigate rates and patterns of recurrence in patients after operative intervention for ICC. METHODS: We identified 301 patients who underwent operation for ICC between 1990 and 2011 from an international, multi-institutional database. Clinicopathologic data, recurrence patterns, and recurrence-free survival (RFS) were analyzed. RESULTS: During the median follow up duration of 31 months (range 1-208), 53.5% developed a recurrence. Median RFS was 20.2 months and 5-year actuarial disease-free survival, 32.1%. The most common site for initial recurrence after operation of ICC was intrahepatic (n = 98; 60.9%), followed by simultaneous intra- and extrahepatic disease (n = 30; 18.6%); 33 (21.0%) patients developed extrahepatic recurrence only as the first site of recurrence. Macrovascular invasion (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.34-3.21; P < .001), nodal metastasis (HR, 1.55; 95% CI, 1.01-2.45; P = .04), unknown nodal status (HR, 1.57; 95% CI, 1.10-2.25; P = .04), and tumor size ≥5 cm (HR, 1.84; 95% CI, 1.28-2.65; P < .001) were independently associated with increased risk of recurrence. Patients were assigned a clinical score from 0 to 3 according to the presence of these risk factors. The 5-year RFS for patients with scores of 0, 1, 2, and 3 was 61.8%, 36.2%, 19.5%, and 9.6%, respectively. CONCLUSION: Recurrence after operative intervention for ICC was common. Disease recurred both at intra- and extrahepatic sites with roughly the same frequency. Factors such as lymph node metastasis, tumor size, and vascular invasion predict highest risk of recurrence.
- Toward a Consensus on Centralization in SurgeryPublication . Vonlanthen, R; Lodge, P; Barkun, J; Farges, O; Rogiers, X; Soreide, K; Kehlet, H; Reynolds, J; Käser, S; Naredi, P; Borel-Rinkes, I; Biondo, S; Pinto Marques, H; Gnant, M; Nafteux, P; Ryska, M; Bechstein, W; Martel, G; Dimick, J; Krawczyk, M; Oláh, A; Pinna, A; Popescu, I; Puolakkainen, P; Sotiropoulos, G; Tukiainen, E; Petrowsky, H; Clavien, PAObjectives: To critically assess centralization policies for highly specialized surgeries in Europe and North America and propose recommendations. Background/methods: Most countries are increasingly forced to maintain quality medicine at a reasonable cost. An all-inclusive perspective, including health care providers, payers, society as a whole and patients, has ubiquitously failed, arguably for different reasons in environments. This special article follows 3 aims: first, analyze health care policies for centralization in different countries, second, analyze how centralization strategies affect patient outcome and other aspects such as medical education and cost, and third, propose recommendations for centralization, which could apply across continents. Results: Conflicting interests have led many countries to compromise for a health care system based on factors beyond best patient-oriented care. Centralization has been a common strategy, but modalities vary greatly among countries with no consensus on the minimal requirement for the number of procedures per center or per surgeon. Most national policies are either partially or not implemented. Data overwhelmingly indicate that concentration of complex care or procedures in specialized centers have positive impacts on quality of care and cost. Countries requiring lower threshold numbers for centralization, however, may cause inappropriate expansion of indications, as hospitals struggle to fulfill the criteria. Centralization requires adjustments in training and credentialing of general and specialized surgeons, and patient education. Conclusion/recommendations: There is an obvious need in most areas for effective centralization. Unrestrained, purely "market driven" approaches are deleterious to patients and society. Centralization should not be based solely on minimal number of procedures, but rather on the multidisciplinary treatment of complex diseases including well-trained specialists available around the clock. Audited prospective database with monitoring of quality of care and cost are mandatory.