Bio

Bio


Dr. Carolyn Seib is a board-certified general surgeon with subspecialty training in endocrine surgery and advanced training in biostatistics and clinical research. Dr. Seib completed her undergraduate education at Princeton University, graduating summa cum laude in 2004. She received her M.D. at the New York University School of Medicine and then came to San Francisco to complete her residency in General Surgery at UCSF. Dr. Seib received a Masters of Advanced Study (MAS) in Clinical Research from UCSF during her training. After finishing her residency, Dr. Seib completed a fellowship in Endocrine Surgery at UCSF, during which she cared for patients with complex disorders of the thyroid, parathyroid, and adrenal glands. She worked as a Clinical Instructor in the Department of Surgery at UCSF until February 2019. In April 2019, Dr. Seib joined the faculty at Stanford University as an Assistant Professor in the Division of General Surgery.

Dr. Seib’s independent research program focuses on the management of endocrine disorders in older adults. In August 2018, she was awarded an R03 grant, funded by the National Institute on Aging, to study long-term outcomes in older adults with primary hypeparathyroidism treated with medical and surgical therapy. She has 18 peer-reviewed journal publications in high impact journals and her research on the surgical management of older adults has received national attention, including being featured in the New York Times.

Clinical Focus


  • General Surgery
  • Endocrine Surgery

Academic Appointments


Professional Education


  • Board Certification: General Surgery, American Board of Surgery (2017)
  • Fellowship:UCSF Endocrine Surgery Fellowship (2017) CA
  • Residency:UCSF General Surgery Residency (2016) CA
  • Medical Education:New York University School of Medicine (2009) NY

Publications

All Publications


  • Invasive Procedures to Improve Function in Frail Older Adults Do Outcomes Justify the Intervention? JAMA INTERNAL MEDICINE Seib, C. D., Finlayson, E. 2019; 179 (3): 391–93
  • Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations JAMA SURGERY Seib, C. D., Rochefort, H., Chomsky-Higgins, K., Gosnell, J. E., Suh, I., Shen, W. T., Duh, Q., Finlayson, E. 2018; 153 (2): 160–68

    Abstract

    Frailty is a measure of decreased physiological reserve that is associated with morbidity and mortality in major elective and emergency general surgery operations, independent of chronological age. To date, the association of frailty with outcomes in ambulatory general surgery has not been established.To determine the association between frailty and perioperative morbidity in patients undergoing ambulatory general surgery operations.A retrospective cohort study was conducted of 140 828 patients older than 40 years of age from the 2007-2010 American College of Surgeons National Surgical Quality Improvement Program Participant Use File who underwent ambulatory and 23-hour-stay hernia, breast, thyroid, or parathyroid surgery. Data analysis was performed from August 18, 2016, to June 21, 2017.The association between the National Surgical Quality Improvement Program modified frailty index and perioperative morbidity was determined via multivariable logistic regression with random-effects modeling to control for clustering within Current Procedural Terminology codes.A total of 140 828 patients (80 147 women and 60 681 men; mean [SD] age, 59.3 [12.0] years) underwent ambulatory hernia (n = 71 455), breast (n = 51 267), thyroid, or parathyroid surgery (n = 18 106). Of these patients, 2457 (1.7%) experienced any type of perioperative complication and 971 (0.7%) experienced serious perioperative complications. An increasing modified frailty index was associated with a stepwise increase in the incidence of complications. In multivariable analysis adjusting for age, sex, race/ethnicity, anesthesia type, tobacco use, renal failure, corticosteroid use, and clustering by Current Procedural Terminology codes, an intermediate modified frailty index score (0.18-0.35, corresponding to 2-3 frailty traits) was associated with statistically significant odds ratios of 1.70 (95% CI, 1.54-1.88; P < .001) for any complication and 2.00 (95% CI, 1.72-2.34; P < .001) for serious complications. A high modified frailty index score (≥0.36, corresponding to ≥4 frailty traits) was associated with statistically significant odds ratios of 3.35 (95% CI, 2.52-4.46; P < .001) for any complication and 3.95 (95% CI, 2.65-5.87; P < .001) for serious complications. Anesthesia with local and monitored anesthesia care was the only modifiable covariate associated with decreased odds of serious 30-day complications, with an adjusted odds ratio of 0.66 (95% CI, 0.53-0.81; P < .001).Frailty is associated with increased perioperative morbidity in common ambulatory general surgery operations, independent of age, type of anesthesia, and other comorbidities. Surgeons should consider frailty rather than chronological age when counseling and selecting patients for elective ambulatory surgery.

    View details for DOI 10.1001/jamasurg.2017.4007

    View details for Web of Science ID 000425676000017

    View details for PubMedID 29049457

    View details for PubMedCentralID PMC5838594

  • Trends in Adrenal Surgery-The Changing Nature of Tumors and Patients JOURNAL OF SURGICAL RESEARCH Chen, Y., Chomsky-Higgins, K., Nwaogu, I., Gosnell, J. E., Seib, C., Shen, W. T., Suh, I., Duh, Q. 2019; 236: 129–33

    Abstract

    The volume of adrenal surgery is increasing. There has been a concern that the widespread use of axial imaging and minimally invasive approaches has led to changing indications for adrenalectomy. We reviewed trends in adrenal surgery at a single academic institution.This was a retrospective analysis of all patients who underwent adrenal surgery between 1993 and 2018 by the endocrine surgery service. Patient demographics, diagnosis, operative details, and perioperative complications were evaluated. Trend analysis was performed across ordered year groups (<2000, 2000-2004, 2005-2009, 2010-2014, and 2015-2018).We identified 732 patients who underwent 751 adrenal operations. Fifty-seven percent of the patients were women, and the median age was 51 y (range: 5-88). There was an increase in the number of procedures performed (P < 0.01, trend analysis). Over time, there was a higher proportion of patients with hypertension (54.7% [<2000] versus 73.6% [>2015], P < 0.01), diabetes (4.7% versus 22.1%, P = 0.01), and classified as American Society of Anesthesiology class 3/4 (15.7% versus 45.7%, P < 0.01). More patients had their adrenal lesion found incidentally (19.4% versus 39.3%, P < 0.01), and there was a larger proportion of pheochromocytomas (25% versus 36.4%, P < 0.01) and fewer nonfunctioning adenomas (7.4% versus 4.3%, P = 0.03). Median tumor size decreased from 3.5 cm to 2.9 cm (P = 0.03). Complication rates increased over time (8.3% versus 15%, P < 0.01), but the overall 30-d mortality remained low (0.3%).Adrenal surgery is being performed more commonly with an increasing number of incidentalomas and pheochromocytomas. Our patients have higher comorbidities with increase in complication rates over time, although perioperative mortality remains low. This highlights the importance of a thorough preoperative evaluation to identify suitable patients who may benefit from adrenalectomy.

    View details for DOI 10.1016/j.jss.2018.11.031

    View details for Web of Science ID 000458498300019

    View details for PubMedID 30694747

  • Treatment of Primary Aldosteronism Reduces the Probability of Obstructive Sleep Apnea JOURNAL OF SURGICAL RESEARCH Wang, E., Chomsky-Higgins, K., Chen, Y., Nwaogu, I., Seib, C. D., Shen, W. T., Duh, Q., Suh, I. 2019; 236: 37–43

    Abstract

    Aldosterone excess is hypothesized to worsen obstructive sleep apnea (OSA) symptoms by promoting peripharyngeal edema. However, the extent to which primary aldosteronism (PA), hypertension, and body mass index (BMI) influence OSA pathogenesis remains unclear.We conducted a cross-sectional study of PA patients from our endocrine database to retrospectively evaluate OSA probability before and after adrenalectomy or medical management of PA. A control group of patients undergoing adrenalectomy for nonfunctioning benign adrenal masses was also evaluated. We categorized patients as high or low OSA probability after evaluation with the Berlin Questionnaire, a validated 10-question survey that explores sleep, fatigue, hypertension, and BMI.We interviewed 91 patients (83 PA patients and eight control patients). Median follow-up time was 2.6 y. The proportion of high OSA probability in all PA patients decreased from 64% to 35% after treatment for PA (mean Berlin score 1.64 versus 1.35, P < 0.001). This decline correlated with improvements in hypertension (P < 0.001) and fatigue symptoms (P = 0.03). Both surgical (n = 48; 1.69 versus 1.33, P < 0.001) and medical (n = 35; 1.57 versus 1.37, P = 0.03) treatment groups demonstrated reduced OSA probability. BMI remained unchanged after PA treatment (29.1 versus 28.6, P = nonsignificant), and the impact of treatment on OSA probability was independent of BMI. The control surgical group showed no change in OSA probability after adrenalectomy (1.25 versus 1.25, P = nonsignificant).Both surgical and medical treatments of PA reduce sleep apnea probability independent of BMI and are associated with improvements in hypertension and fatigue. Improved screening for PA could reduce OSA burden.

    View details for DOI 10.1016/j.jss.2018.10.040

    View details for Web of Science ID 000458498300006

    View details for PubMedID 30694777

  • Risk Factors Associated With Perioperative Complications and Prolonged Length of Stay After Laparoscopic Adrenalectomy JAMA SURGERY Chen, Y., Scholten, A., Chomsky-Higgins, K., Nwaogu, I., Gosnell, J. E., Seib, C., Shen, W. T., Suh, I., Duh, Q. 2018; 153 (11): 1036–41

    Abstract

    Laparoscopic adrenalectomy is the gold standard for most adrenal disorders and its frequency in the United States is increasing. While national and administrative databases can adjust for patient factors, comorbidities, and institutional variations, granular disease-specific data that may significantly influence the incidence of perioperative complications and length of stay (LOS) are lacking.To investigate factors associated with perioperative complications and LOS after laparoscopic adrenalectomy.This cohort study was carried out at a single academic medical center, with all patients who underwent laparoscopic adrenalectomy between 1993 and 2017 by the endocrine surgery department. Multivariable linear and logistic regression were used to obtain adjusted odds ratios (ORs).The primary outcome was perioperative complications with a Dindo-Clavien grade of 2 or more. The secondary outcome was prolonged length of stay, defined as a stay longer than the 75th percentile of the overall cohort.We identified 640 patients who underwent 653 laparoscopic adrenalectomies, of whom 370 (56.7%) were female. The median age was 51 (range, 5-88) years. A total of 76 complications with a Dindo-Clavien grade of 2 or more occurred in 55 patients (8.4%), with postoperative mortality in 2 patients (0.3%). The median hospital length of stay was 1 day (range, 0-32 days). Factors independently associated with increased complications were American Society of Anesthesiologists class 3 or 4 (OR, 2.78 [95% CI, 1.39-5.55]; P < .01), diabetes (OR, 2.39 [95% CI, 1.14-5.01]; P = .02), conversion to hand-assisted or open surgery (OR, 5.32 [95% CI, 1.84-15.41]; P < .01), a diagnosis of pheochromocytoma (OR, 4.31 [95% CI, 1.43-13.05]; P = .01), and a tumor size of 6 cm or greater (OR, 2.47 [95% CI, 1.05-5.78]; P = .04). Prolonged length of stay was associated with age 65 years or older (OR, 2.44 [95% CI, 1.31-4.57]; P = .01), an American Society of Anesthesiologists class 3 or 4 (OR, 3.48 [95% CI, 1.88-6.41]; P < .01), any procedural conversion (OR, 63.28 [95% CI, 12.53-319.59]; P < .01), and a tumor size of 4 cm or larger (4-6 cm: OR, 2.38 [95% CI, 1.21-4.67]; P = .01; ≥6 cm: OR, 2.46 [95% CI, 1.12-5.40]; P = .03).Laparoscopic adrenalectomy remains safe for most adrenal disorders. Patient comorbidities, adrenal pathology, and tumor size are associated with the risk of complications and length of stay and should all be considered in selecting and preparing patients for surgery.

    View details for DOI 10.1001/jamasurg.2018.2648

    View details for Web of Science ID 000450718300018

    View details for PubMedID 30090934

    View details for PubMedCentralID PMC6584328

  • Postoperative Pain and Opioid Use after Thyroid and Parathyroid Surgery: A Novel, Prospective Short Messaging Service-Based Survey Chen, Y., Nwaogu, I., Chomsky-Higgins, K. H., Seib, C. D., Gosnell, J. E., Shen, W. T., Duh, Q., Suh, I. ELSEVIER SCIENCE INC. 2018: E121
  • Parathyroid Cryopreservation: Clinical Applications in the Era of Synthetic Parathyroid Hormone Nwaogu, I., Sedaghati, M., Sukpanich, R., Chomsky-Higgins, K. H., Chen, Y., Seib, C. D., Suh, I., Shen, W. T., Gosnell, J. E., Duh, Q. ELSEVIER SCIENCE INC. 2018: E120
  • Patient Frailty Should Be Used to Individualize Treatment Decisions in Primary Hyperparathyroidism WORLD JOURNAL OF SURGERY Seib, C. D., Chomsky-Higgins, K., Gosnell, J. E., Shen, W. T., Suh, I., Duh, Q., Finlayson, E. 2018; 42 (10): 3215–22

    Abstract

    Primary hyperparathyroidism (PHPT) is a common endocrine disorder that predominantly affects patients >60 and is increasing in prevalence. Identifying risk factors for poor outcomes after parathyroidectomy in older adults will help tailor operative decision making. The impact of frailty on surgical outcomes in parathyroidectomy has not been established.We performed a retrospective review of patients ≥40 years who underwent parathyroidectomy in the 2005-2010 ACS NSQIP. Frailty was assessed using the modified frailty index (mFI). Multivariable regression was used to determine the association of frailty with 30-day complications, length of stay (LOS), and reoperation.We identified 13,123 patients ≥40 who underwent parathyroidectomy for PHPT. The majority of patients were not frail, with 80% with a low NSQIP mFI score (0-1 frailty traits), 19% with an intermediate mFI score (2-3), and 0.9% with a high mFI score (≥4). Overall 30-day complications were rare, occurring in 141 (1.1%) patients. Increasing frailty was associated with an increased risk of complications with adjusted odds ratios (ORs) of 1.76 (95% CI 1.20-2.59; p = 0.004) for intermediate and 8.43 (95% CI 4.33-16.41; p < 0.001) for high mFI score. Patient age was independently associated with an increased risk of complications only when ≥75, as was African-American race. Anesthesia with local, monitored anesthesia care, or regional block was the only factor associated with decreased odds of complications. A high NSQIP mFI was also associated with a significant 4.77-day adjusted increase in LOS (95% CI 4.28-5.25; p < 0.001) and increased odds of reoperation (OR 4.20, 95% CI 1.64-10.74; p = 0.003).Patient frailty is associated with increased complications, reoperation and prolonged LOS in patients undergoing parathyroidectomy for PHPT. The risks of surgical management should be weighed against potential benefits in frail patients with PHPT to individualize treatment decisions in this vulnerable population.

    View details for DOI 10.1007/s00268-018-4629-3

    View details for Web of Science ID 000443995400021

    View details for PubMedID 29696330

  • Association of Patient Frailty With Increased Risk of Complications After Adrenalectomy JAMA SURGERY Anderson, J. E., Seib, C. D., Campbell, M. J. 2018; 153 (10): 966–67

    View details for DOI 10.1001/jamasurg.2018.1749

    View details for Web of Science ID 000447639600028

    View details for PubMedID 29971357

    View details for PubMedCentralID PMC6233782

  • Hidden in Plain Sight: Transoral and Submental Thyroidectomy as a Compelling Alternative to "Scarless" Thyroidectomy JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Chen, Y., Chomsky-Higgins, K., Nwaogu, I., Seib, C. D., Gosnell, J. E., Shen, W. T., Duh, Q., Suh, I. 2018; 28 (11): 1374–77

    Abstract

    Minimally invasive and remote access thyroid surgery has been evolving with the transoral endoscopic thyroidectomy vestibular approach (TOETVA) emerging as a true "scarless" thyroidectomy. In this study, we describe a hybrid transoral and submental thyroidectomy (TOaST) technique for thyroid lobectomy.A TOaST right thyroid lobectomy was performed for a 4 cm cytologically benign right thyroid nodule. Initial incision was made in the submental region with two additional 5 mm lateral ports inserted transorally. Right thyroid lobectomy proceeded via standard TOETVA with intact specimen extraction via the submental incision.The patient was discharged home on postoperative day 1. Final pathology showed a 4.2 cm follicular adenoma. Cosmetic results and patient satisfaction were excellent.This is the first reported case of a hybrid TOaST technique. It aims to maintain the principles and advantages of TOETVA while addressing its limitations related to large tumor extraction, mental nerve injury, and chin sensory changes. The shorter distance of dissection required may reduce postoperative pain. This approach may expand the indications for transoral thyroidectomy while maintaining excellent cosmetic outcomes.

    View details for DOI 10.1089/lap.2018.0146

    View details for Web of Science ID 000431590600001

    View details for PubMedID 29733263

  • Less is more: cost-effectiveness analysis of surveillance strategies for small, nonfunctional, radiographically benign adrenal incidentalomas Chomsky-Higgins, K., Seib, C., Rochefort, H., Gosnell, J., Shen, W. T., Kahn, J. G., Duh, Q., Suh, I. MOSBY-ELSEVIER. 2018: 197–203

    Abstract

    Guidelines for management of small adrenal incidentalomas are mutually inconsistent. No cost-effectiveness analysis has been performed to evaluate rigorously the relative merits of these strategies.We constructed a decision-analytic model to evaluate surveillance strategies for <4cm, nonfunctional, benign-appearing adrenal incidentalomas. We evaluated 4 surveillance strategies: none, one-time, annual for 2 years, and annual for 5 years. Threshold and sensitivity analyses assessed robustness of the model. Costs were represented in 2016 US dollars and health outcomes in quality-adjusted life-years.No surveillance has an expected net cost of $262 and 26.22 quality-adjusted life-years. One-time surveillance costs $158 more and adds 0.2 quality-adjusted life-years for an incremental cost-effectiveness ratio of $778/quality-adjusted life-years. The strategies involving more surveillance were dominated by the no surveillance and one-time surveillance strategies less effective and more expensive. Above a 0.7% prevalence of adrenocortical carcinoma, one-time surveillance was the most effective strategy. The results were robust to all sensitivity analyses of disease prevalence, sensitivity, and specificity of diagnostic assays and imaging as well as health state utility.For patients with a < 4cm, nonfunctional, benign-appearing mass, one-time follow-up evaluation involving a noncontrast computed tomography and biochemical evaluation is cost-effective. Strategies requiring more surveillance accrue more cost without incremental benefit.

    View details for DOI 10.1016/j.surg.2017.07.030

    View details for Web of Science ID 000419265300063

    View details for PubMedID 29129360

  • The Underestimated Risk of Cancer in Patients with Multinodular Goiters After a Benign Fine Needle Aspiration WORLD JOURNAL OF SURGERY Campbell, M. J., Seib, C. D., Candell, L., Gosnell, J. E., Quan-Yang Duh, Clark, O. H., Shen, W. T. 2015; 39 (3): 695–700

    Abstract

    Ultrasound-guided fine needle aspiration (FNA) is an excellent tool for evaluating patients with solitary thyroid nodules, with a false-negative malignancy rate of <3%. The utility of FNA in patients with a cervical multinodular goiter (MNG) is unknown, because biopsy and surveillance of thyroids with numerous nodules may be impractical.To evaluate the incidence and risk factors for unsuspected thyroid cancer on final pathology in patients with a non-functional, cervical MNG who had a benign preoperative FNA and underwent thyroidectomy.Retrospective review of patients with non-functional, cervical MNG at a high-volume tertiary referral center between 2005 and 2012.Incidence of thyroid cancer on surgical pathology.Of the 134 patients included in the study, 31 (23.1%) were found to have thyroid cancer on final pathology. Twenty-one (15.7%) patients had a microscopic papillary cancer (<1 cm) and 10 (7.5%) patients had other forms of thyroid cancer [five follicular, four papillary (>1 cm), and one patient with a papillary and follicular cancer]. On univariate analysis, male gender had a near-significant association with non-micropapillary thyroid cancer (p = 0.06). On multivariate analysis, male gender (OR = 10.2, 95% CI 1.35-76.8) and FNA cytology not reviewed at our institution (OR = 6.0, 95% CI 1.2-30) were independently associated with non-micropapillary thyroid cancer.The incidence of thyroid cancer in patients with MNG and benign FNA is significant. Men and patients in whom the FNA cytology is not reviewed by an experienced cytopathologist may be at an increased risk for an undetected thyroid cancer.

    View details for DOI 10.1007/s00268-014-2854-y

    View details for Web of Science ID 000351230900022

    View details for PubMedID 25446471

  • Differences Between Bilateral Adrenal Incidentalomas and Unilateral Lesions. JAMA surgery Pasternak, J. D., Seib, C. D., Seiser, N., Tyrell, J. B., Liu, C., Cisco, R. M., Gosnell, J. E., Shen, W. T., Suh, I., Duh, Q. Y. 2015; 150 (10): 974–78

    Abstract

    Adrenal incidentalomas are found in 1% to 5% of abdominal cross-sectional imaging studies. Although the workup and management of unilateral lesions are well established, limited information exists for bilateral incidentalomas.To compare the natural history of patients having bilateral incidentalomas with those having unilateral incidentalomas.Retrospective analysis of a prospective database of consecutive patients referred to an academic multidisciplinary adrenal conference. The setting was a tertiary care university hospital among a cohort of 500 patients with adrenal lesions between July 1, 2009, and July 1, 2014.Prevalence, age, imaging characteristics, biochemical workup, any intervention, and final diagnosis.Twenty-three patients with bilateral incidentalomas and 112 patients with unilateral incidentalomas were identified. The mean age at diagnosis of bilateral lesions was 58.7 years. The mean lesion size was 2.4 cm on the right side and 2.8 cm on the left side. Bilateral incidentalomas were associated with a significantly higher prevalence of subclinical Cushing syndrome (21.7% [5 of 23] vs 6.2% [7 of 112]) (P = .009) and a significantly lower prevalence of pheochromocytoma (4.3% [1 of 23] vs 19.6% [22 of 112]) (P = .003) compared with unilateral lesions, while rates of hyperaldosteronism were similar in both groups (4.3% [1 of 23] vs 5.4% [6 of 112]) (P > .99). Only one patient with bilateral incidentalomas underwent unilateral resection. The mean follow-up was 4 years (range, 1.2-13.0 years). There were no occult adrenocortical carcinomas.Bilateral incidentalomas are more likely to be associated with subclinical Cushing syndrome and less likely to be pheochromocytomas. Although patients with bilateral incidentalomas undergo a workup similar to that in patients with unilateral lesions, differences in their natural history warrant a greater index of suspicion for subclinical Cushing syndrome.

    View details for DOI 10.1001/jamasurg.2015.1683

    View details for PubMedID 26200882

  • Utility of serum thyroglobulin measurements after prophylactic thyroidectomy in patients with hereditary medullary thyroid cancer SURGERY Seib, C. D., Harari, A., Conte, F. A., Duh, Q., Clark, O. H., Gosnell, J. E. 2014; 156 (2): 394–98

    Abstract

    Prophylactic thyroidectomy can be curative for patients with hereditary medullary thyroid cancer (MTC) caused by RET proto-oncogene mutations. Calcitonin is a sensitive tumor marker used to follow patients. We suggest that thyroglobulin (Tg) levels should also be monitored postoperatively in these patients.We reviewed patients with RET mutations who underwent prophylactic thyroidectomy between 1981 and 2011 at an academic endocrine surgery center. Patients were excluded if they had no postoperative Tg levels recorded.Of the 22 patients who underwent prophylactic thyroidectomy, 14 were included in the final analysis. The average age at thyroidectomy was 9.8 years (range, 4-29). Tg levels were detectable 1.5 months to 31 years postoperatively in 11 patients (79%), all of whom were <15 years old at thyroidectomy. Median thyroid-stimulating hormone (TSH) was 2.5 mIU/L and 13.4 mIU/L in patients with undetectable and detectable Tg, respectively. Of those with detectable Tg, 5 had cervical ultrasonographic examination: Two showed no residual tissue in the thyroid bed, and 3 showed remnant thyroid tissue.Tg levels can identify patients with remnant thyroid tissue after prophylactic thyroidectomy. Ultrasonography can determine whether thyroid tissue remains posterolaterally that is at risk of MTC recurrence. Maintaining normal TSH may prevent growth of remaining thyroid follicular cells.

    View details for DOI 10.1016/j.surg.2014.03.037

    View details for Web of Science ID 000339463700024

    View details for PubMedID 24882762

    View details for PubMedCentralID PMC4099273

  • Adrenalectomy Outcomes Are Superior with the Participation of Residents and Fellows JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS Seib, C. D., Greenblatt, D. Y., Campbell, M. J., Shen, W. T., Gosnell, J. E., Clark, O. H., Duh, Q. 2014; 219 (1): 53–60

    Abstract

    Adrenalectomy is a complex procedure performed in many settings, with and without residents and fellows. Patients often ask, "Will trainees be participating in my operation?" and seek reassurance that their care will not be adversely affected. The purpose of this study was to determine the association between trainee participation and adrenalectomy perioperative outcomes.We performed a cohort study of patients who underwent adrenalectomy from the 2005 to 2011 American College of Surgeons NSQIP database. Trainee participation was classified as none, resident, or fellow, based on postgraduate year of the assisting surgeon. Associations between trainee participation and outcomes were determined via multivariate linear and logistic regression.Of 3,694 adrenalectomies, 732 (19.8%) were performed by an attending surgeon with no trainee, 2,315 (62.7%) involved a resident, and 647 (17.5%) involved a fellow. The participation of fellows was associated with fewer serious complications (7.9% with no trainee, 6.0% with residents, and 2.8% with fellows; p < 0.001). In a multivariate model, the odds of serious 30-day morbidity were lower when attending surgeons operated with residents (odds ratio = 0.63; 95% CI, 0.45-0.89). Fellow participation was associated with significantly lower odds of overall (odds ratio = 0.51; 95% CI, 0.32-0.82) and serious (odds ratio = 0.31; 95% CI, 0.17-0.57) morbidity. There was no significant association between trainee participation and 30-day mortality.In this analysis of multi-institutional data, the participation of residents and fellows was associated with decreased odds of perioperative adrenalectomy complications. Attending surgeons performing adrenalectomies with trainee assistance should reassure patients of the equivalent or superior care they are receiving.

    View details for DOI 10.1016/j.jamcollsurg.2014.02.020

    View details for Web of Science ID 000339320300010

    View details for PubMedID 24702888

    View details for PubMedCentralID PMC4065814

  • Vandetanib and the management of advanced medullary thyroid cancer CURRENT OPINION IN ONCOLOGY Campbell, M. J., Seib, C. D., Gosnell, J. 2013; 25 (1): 39–43

    Abstract

    Vandetanib is a small molecule tyrosine kinase inhibitor that has been recently approved as an 'orphan drug' for the treatment of patients with unresectable, locally advanced, or metastatic medullary thyroid cancer (MTC).MTC is a neuroendocrine malignancy frequently associated with mutations to the RET proto-oncogene. Vandetanib selectively targets RET, vascular endothelial growth factor receptor-2, and epidermal growth factor receptor dependent signaling. Vandetanib has been shown to improve progression-free survival in patients with advanced MTC. In general, vandetanib is well tolerated, but QTc prolongation remains a potential concern demanding careful patient selection and monitoring.Vandetanib has emerged as one of the more promising small molecule tyrosinse kinase inhibitors, providing durable rates of disease stabilization, with an acceptable adverse event profile in patients with advanced MTC.

    View details for DOI 10.1097/CCO.0b013e32835a42b9

    View details for Web of Science ID 000311975000007

    View details for PubMedID 23202050