Research

Kidner T, Morton DL, Lee DJ, Hoban M, Foshag LJ, Turner RR, Faries MB.

Combined intralesional Bacille Calmette-Guerin (BCG) and Topical Imiquimod for intransit Melanoma. J Immunother, In Press.

 

Kidner T, Amersi F, Silberman AW. A Novel Surgical Approach for the Treatment of Severe Alkaline Reflux after Total Gastrectomy and Roux-en-Y Reconstruction. The American Surgeon, In Press

 

Kidner T, Ozao-Choy J, Yoon J, Bilchick A. Should Quality Measures for Lymph

Node Dissection in Colon Cancer be Extrapolated to Early Stage Node Negative

Rectal Cancer? The American Journal of Surgery, In Press

 

Kidner T, Yoon J, Faries M, Morton D. Preoperative Imaging of Pulmonary

Metastases in Patients with Melanoma: Implications for Minimally Invasive

Techniques. Arch Surg 147:871-874, 2012

 

            HYPOTHESIS Preoperative imaging underestimates the number of pulmonary melanoma metastases. Although thoracoscopic resection is less invasive than resection via thoracotomy, it does not allow manual palpation of the lung to identify any metastases not visible on the preoperative scan or at the time of resection. DESIGN Retrospective review of a prospectively maintained database. SETTING Tertiary referral center. PATIENTS A total of 170 patients who underwent preoperative computed tomography of the chest, followed within 30 days by thoracotomy for resection of pulmonary metastatic melanoma. MAIN OUTCOME MEASURES Number of pathology-confirmed pulmonary metastases detected by preoperative chest computed tomography vs intraoperative manual palpation. RESULTS The mean age of the patients was 49.5 years at initial diagnosis of melanoma and 57.1 years at diagnosis of pulmonary metastases; 69% of patients were male. A total of 334 pulmonary metastases were resected; the mean lesion size was 2.0 cm (range, 0.1-14.0 cm). In 49 of 190 pulmonary resections (26%), manual palpation of the subpleural parenchyma revealed lesions not identified during preoperative imaging. The rate of 5-year overall survival was 33%. CONCLUSIONS Preoperative imaging underestimates the number of pulmonary lesions in patients with metastatic melanoma. Because incomplete resection of metastatic disease is associated with worse outcomes, we recommend caution when considering a minimally invasive approach for the resection of pulmonary metastatic melanoma.

 

 

 

Kidner T, Yoon J, Morton D. Epitrochlear Sentinel Lymph Nodes in Melanoma:

Interval or Independent? The American Surgeon. Am Surg 78:702-705, 2012

 

Most primary melanomas on the distal upper extremity metastasize to a sentinel lymph node (SLN) in the axillary basin, but occasionally a primary melanoma will drain to the epitrochlear basin. The relationship between tumor-draining axillary and epitrochlear SLNs is unclear. We hypothesize that the epitrochlear SLN functions in an interval manner with the axillary lymph node basin. We queried our melanoma database to identify patients who underwent SLN biopsy for a distal upper-extremity melanoma. Patient demographics, tumor characteristics, patterns of nodal drainage, and incidence of SLN metastasis were analyzed. Of 255 patients identified, 38 (14.9%) had an epitrochlear SLN. Mean Breslow thickness was 2.26 mm. All patients with epitrochlear drainage had concurrent axillary drainage and underwent axillary and epitrochlear SLN biopsies. Of these 38 patients, two (5.2%) had epitrochlear and axillary SLN metastasis, four (10.5%) had epitrochlear metastasis only, four (10.5%) had axillary metastasis only, and the remaining 28 (73.7%) had tumor-free SLNs. The invariable association of epitrochlear and axillary drainage in this study suggests that epitrochlear nodes function in an interval role with the axillary lymph node basin. Therefore we recommend that all patients with a positive epitrochlear SLN undergo completion axillary dissection.

 

 

 

Chung A, Huynh K, Kidner T, Mirzadeghan P, Sim M, Giuliano AE. Comparison of Outcomes of Breast Conservative Therapy in Multifocal or Multicentric and Unifocal Invasive Breast Cancer. Journal of the American College of Surgeons. J Am Coll Surg 215:137-146, 2012

 

            BACKGROUND: There is controversy about whether breast conserving therapy (BCT) should be contraindicated in multifocal (MF) breast cancer. Few studies have reported on the oncologic safety of BCT in MF breast cancer.

STUDY DESIGN: We reviewed a prospective database of 1,169 women with invasive breast cancer who were treated with segmentectomy and whole breast irradiation from 1991 through 2009 and followed at our institution. Multifocal breast cancer was defined as 2 or more distinct tumors excised with a single incision or segmentectomy. We compared 2 groups, MF and unifocal breast cancer patients, with respect to demographics, tumor characteristics, adjuvant systemic therapy, local recurrence (LR), disease-free survival (DFS), and overall survival (OS).

RESULTS: One hundred sixty-four patients with MF and 999 with unifocal invasive breast cancer were treated with BCT. Median follow-up was 112 months. Compared with the unifocal group, patients in the MF group had higher 10-year LR (0.6% vs 6.1%, p < 0.001) and lower 10-year DFS (97.7% vs 89.3%, p < 0.001) and OS (98.4% vs 85.8%, p < 0.001). On multivariable analysis, multifocality was independently significantly associated with local recurrence-free survival (LRFS), DFS, and OS.

CONCLUSIONS: Our data suggest that BCT in MF breast cancer is oncologically safe but may result in a slightly inferior outcome compared with BCT in unifocal breast cancer.

 

 

 

Milanchi S, Nasseri Y, Kidner T, Fleshner P. Wound Infection after Ileostomy

Closure can be Eliminated by Circumferential Subcuticular Wound Approximation. Disease of Colon & Rectum 52:469-474, 2009

 

            PURPOSE: Wound infections after ileostomy closure are common with primary closure of the skin. Although this risk can be reduced by secondary closure, cosmetic outcomes are less than desirable. In an effort to balance these issues, we have used circumferential subcuticular wound approximation to decrease wound size. This study compares outcomes of primary closure vs. circumferential subcuticular wound approximation after ileostomy closure.

METHODS: Forty-nine consecutive patients undergoing ileostomy closure over an 18-month period were reviewed. During the first half of this study, all ileostomy sites underwent primary closure, while during the second half all ileostomy sites underwent circumferential subcuticular wound approximation. Short-term outcomes were tabulated including wound infection. Long-term outcomes were assessed using a novel six-point patient satisfaction scale.

RESULTS: Primary closure was performed in 25 patients and circumferential subcuticular wound approximation performed in 24 patients. No wound infections occurred in the circumferential subcuticular wound approximation group, compared to 40 percent wound infection rate observed in the primary closure group (P = 0.002). The mean patient satisfaction score was higher in the circumferential subcuticular wound approximation group (18.4) vs. the primary closure group (15.9; P > 0.05).

CONCLUSIONS: Circumferential subcuticular wound approximation was associated with a significantly lower incidence of wound infection after ileostomy closure compared to primary closure. A trend was present toward better cosmetic results for circumferential subcuticular wound approximation than primary closure.

 

 

Kidner T, Dai M, Adusumilli P, Fong Y. Advances in Experimental and Translational Research in the Treatment of Hepatocellular Carcinoma. Surgical Oncology Clinics of North America 17:2, 377-389, 2008

 

            Hepatocellular cancer (HCC) is the fifth-leading cause of cancer and the third-leading cause of cancer related deaths world-wide. Current treatment options are limited, as HCC has been shown to be a highly resistant type of cancer to most current treatment modalities. Novel approaches are being explored in the fields of gene therapy, viral oncolytics, radioembolization, and several new biologic therapies. This article summarizes these recent clinical findings and discusses what role they will have in the future treatment of HCC.