Bio

Clinical Focus


  • Cancer > GI Oncology
  • Cancer, Colon
  • Colon and Rectal Surgery Specialty
  • General Surgery
  • Colorectal Surgery

Academic Appointments


Professional Education


  • Medical Education:Columbia University College of Physicians and Surgeons (2006) NY
  • Residency:Stanford Hospital and Clinics - Dept of Surgery (2011) CA
  • Fellowship:Cleveland Clinic Foundation (2012) OH
  • Internship:Stanford Hospital and Clinics - Dept of Surgery (2007) CA
  • Board Certification: General Surgery, American Board of Surgery (2006)
  • Board Certification, American Board of Surgery, General Surgery
  • Fellowship, Cleveland Clinic, OH, Colon and Rectal Surgery
  • Residency, Stanford Hospital and Clinics, General Surgery
  • MD, Columbia University, Medicine
  • BA, Harvard University, Government

Publications

Journal Articles


  • Colorectal cancer diagnostics: biomarkers, cell-free DNA, circulating tumor cells and defining heterogeneous populations by single-cell analysis. Expert review of molecular diagnostics Kin, C., Kidess, E., Poultsides, G. A., Visser, B. C., Jeffrey, S. S. 2013; 13 (6): 581-599

    Abstract

    Reliable biomarkers are needed to guide treatment of colorectal cancer, as well as for surveillance to detect recurrence and monitor therapeutic response. In this review, the authors discuss the use of various biomarkers in addition to serum carcinoembryonic antigen, the current surveillance method for metastatic recurrence after resection. The clinical relevance of mutations including microsatellite instability, KRAS, BRAF and SMAD4 is addressed. The role of circulating tumor cells and cell-free DNA with regards to their implementation into clinical use is discussed, as well as how single-cell analysis may fit into a monitoring program. The detection and characterization of circulating tumor cells and cell-free DNA in colorectal cancer patients will not only improve the understanding of the development of metastasis, but may also supplant the use of other biomarkers.

    View details for DOI 10.1586/14737159.2013.811896

    View details for PubMedID 23895128

  • Predictors of postoperative urinary retention after colorectal surgery. Diseases of the colon & rectum Kin, C., Rhoads, K. F., Jalali, M., Shelton, A. A., Welton, M. L. 2013; 56 (6): 738-746

    Abstract

    : National quality initiatives have mandated the earlier removal of urinary catheters after surgery to decrease urinary tract infection rates. A potential unintended consequence is an increased postoperative urinary retention rate.: The aim of this study was to determine the incidence and risk factors for postoperative urinary retention after colorectal surgery.: This was a prospective observational study.: A colorectal unit within a single institution was the setting for this study.: Adults undergoing elective colorectal operations were included.: Urinary catheters were removed on postoperative day 1 for patients undergoing abdominal operations, and on day 3 for patients undergoing pelvic operations. Postvoid residual and retention volumes were measured.: The primary outcomes measured were urinary retention and urinary tract infection.: The overall urinary retention rate was 22.4% (22.8% in the abdominal group, 21.9% in the pelvic group) and was associated with longer operative time and increased perioperative fluid administration. Mean operative time for those with retention was 2.8 hours and, for those without retention, the mean operative time 2.2 hours (abdominal group 2 hours vs 1.4 hours, pelvic group 3.9 hours vs 3.1 hours, p ? 0.02). Patients with retention received a mean of 2.7L during the operation, whereas patients without retention received 1.8L (abdominal group 1.9L vs 1.4L, pelvic group 3.6L vs 2.2L, p < 0.01). In the abdominal group, patients with and without retention also received different fluid volumes on postoperative days 1 (2.2L vs 1.7L, p = 0.004) and 2 (1.6L vs 1L, p = 0.05). Laparoscopic abdominal group had a 40% retention rate in comparison with 12% in the open abdominal group (p = 0.004). Age, sex, preoperative radiation therapy, preoperative prostatism, preoperative diagnosis, and level of anastomosis were not associated with retention. The urinary tract infection rate was 4.9%.: The lack of documentation of preoperative urinary function was a limitation of this study.: The practice of earlier urinary catheter removal must be balanced with operative time and fluid volume to avoid high urinary retention rates. Also important is increased vigilance for the early detection of retention.

    View details for DOI 10.1097/DCR.0b013e318280aad5

    View details for PubMedID 23652748

  • Accidental Puncture or Laceration in Colorectal Surgery: A Quality Indicator or a Complexity Measure? DISEASES OF THE COLON & RECTUM Kin, C., Snyder, K., Kiran, R. P., Remzi, F. H., Vogel, J. D. 2013; 56 (2): 219-225

    Abstract

    Accidental puncture or laceration during a surgical procedure is a patient safety indicator that is publicly reported and will factor into the Centers for Medicare and Medicaid's pay-for-performance plan. Accidental puncture or laceration includes serosal tear, enterotomy, and injury to the ureter, bladder, spleen, or blood vessels.This study aimed to identify risk factors and assess surgical outcomes related to accidental puncture or laceration.This is a retrospective study.This study was conducted in a single-hospital department of colorectal surgery.Inpatients undergoing colorectal surgery in which an accidental puncture or laceration did or did not occur were selected.The primary outcomes measured were surgical complications, length of stay, and readmission.Of 2897 operations, 269 had accidental puncture or laceration (9.2%) including serosal tear (47%), enterotomy (38%), and extraintestinal injuries (15%). Accidental puncture or laceration cases had more diagnoses of enterocutaneous fistula (11% vs 2%, p < 0.001), reoperative cases (91% vs 61%, p < 0.001), open surgery (96% vs 77%, p < 0.001), longer operative times (186 vs 146 minutes, p = 0.001), and increased length of stay (10 vs 7 days, p = 0.002). Patients with serosal tears had entirely similar outcomes to those without an injury, whereas patients with enterotomies had increased operative times and length of stay, and patients with extraintestinal injuries had higher rates of reoperation and sepsis (p < 0.05 for all).This study was limited by the loss of sensitivity due to grouping extraintestinal injuries.Accidental puncture or laceration is more likely to occur in complex colorectal operations. The clinical consequences range from none to significant depending on the specific type of injury. To make accidental puncture or laceration a more meaningful quality indicator, we advocate that groups who use the measure eliminate the injuries that have no bearing on surgical outcome and that risk adjustment for operative complexity is performed.

    View details for DOI 10.1097/DCR.0b013e3182765c43

    View details for Web of Science ID 000313550100015

    View details for PubMedID 23303151

  • Assessment of the Clinical Usefulness of Imaging Modalities in Identifying Postoperative Upper Gastrointestinal Tract Leaks Requiring Reoperation SURGICAL LAPAROSCOPY ENDOSCOPY & PERCUTANEOUS TECHNIQUES Khoury, W., Kin, C., Ben Yehuda, A., Weinbroum, A. A. 2012; 22 (4): 328-332

    Abstract

    To assess the usefulness of imaging modalities in the diagnosis and determination of whether postoperative upper gastrointestinal tract leak (UGITL) requires operative intervention.: Patients with suspected UGITL who underwent reoperation ? 30 days after the primary operation with intraoperative confirmation of leaks were identified. Data of those patients who had undergone computerized tomography (CT) or upper gastrointestinal contrast study (UGIS) before reoperation were reviewed. The usefulness and impact of imaging studies obtained before reoperation were evaluated.Thirty patients with confirmed UGITL were identified, 24 of whom had undergone imaging studies before reoperation. Fourteen CTs (63.7%) and 4 UGIS (67%) were positive or highly indicative of UGITL. The interval between the primary operation and the reoperation and the morbidity rates after the reoperation were similar between patients with and those without imaging studies before the reoperation (5.6 ± 4.8 vs. 6.8 ± 4.2 d, P=0.55; 91.6% vs. 100%, P=0.29, respectively). False-negative imaging results caused postponement of reoperation by ? 24 hours in 4 patients whose outcome was similar to those with true-positive results.CTs and UGIS are supportive tools when deciding whether to reoperate for postoperative UGITL. However, a negative imaging study for UGITL does not exclude it definitively, and therefore should not replace clinical evaluations.

    View details for DOI 10.1097/SLE.0b013e3182517e3a

    View details for Web of Science ID 000307671400030

    View details for PubMedID 22874681

  • The impact of hepatic portoenterostomy on liver transplantation for the treatment of biliary atresia: Early failure adversely affects outcome PEDIATRIC TRANSPLANTATION Alexopoulos, S. P., Merrill, M., Kin, C., Matsuoka, L., Dorey, F., Concepcion, W., Esquivel, C., Bonham, A. 2012; 16 (4): 373-378

    Abstract

    The most common indication for pediatric LTx is biliary atresia with failed HPE, yet the effect of previous HPE on the outcome after LTx has not been well characterized. We retrospectively reviewed a single-center experience with 134 consecutive pediatric liver transplants for the treatment of biliary atresia from 1 May 1995 to 28 April 2008. Of 134 patients, 22 underwent LTx without prior HPE (NPE), while 112 patients underwent HPE first. HPE patients were grouped into EF, defined as need for LTx within the first year of life, and LF, defined as need for LTx beyond the first year of life. NPE and EF groups differed significantly from the LF group in age, weight, PELD, and ICU status (p < 0.05) with NPE having the highest PELD and ICU status. Patients who underwent salvage LTx after EF following HPE had a significantly higher incidence of post-operative bacteremia and septicemia (p < 0.05), and subsequently lower survival rates. One-year patient survival and graft survival were as follows: NPE 100%, EF 81%, and LF 96% (p < 0.05); and NPE 96%, EF 79%, and LF 96% (p < 0.05). Further investigation into the optimal treatment of biliary atresia should focus on identifying patients at high risk of EF who may benefit from proceeding directly to LTx given the increased risk of post-LTx bacteremia, sepsis, and death after failed HPE.

    View details for DOI 10.1111/j.1399-3046.2012.01677.x

    View details for Web of Science ID 000303998800021

    View details for PubMedID 22463739

  • Utility of liver allograft biopsy obtained at procurement LIVER TRANSPLANTATION Lo, I. J., Lelkowitch, J. H., Feirt, N., Alkofer, B., Kin, C., Samstein, B., Guarrera, J. V., Renz, J. F. 2008; 14 (5): 639-646

    Abstract

    Extended-donor criteria (EDC) liver allografts potentiate the role of procurement biopsy in organ utilization. To expedite allocation, histologic evaluation is routinely performed upon frozen-section (FS) specimens by local pathologists. This descriptive study compares FS reports by local pathologists with permanent-section (PS) evaluation by dedicated hepatopathologists, identifies histologic characteristics underrepresented by FS evaluation, and evaluates the efficacy of a biopsy decision analysis based on organ visualization. Fifty-two liver transplants using EDC allografts evaluated by FS with PS were studied. Pathologic worksheets created by an organ procurement organization were applied in 34 FS. PS analysis included 7 staining procedures for 8 histologic criteria. PS from 56 additional allografts determined not to require donor biopsy were also analyzed. A high correlation was observed between FS and PS. Underestimation of steatosis by FS was associated with allograft dysfunction. Surgical assessment of cholestasis, congestion, and steatosis was accurate whereas inflammation, necrosis, and fibrosis were underestimated in allografts suffering parenchymal injury. In conclusion, the correlation between FS and PS is high, and significant discrepancies are rare. Biopsy is not a prerequisite for EDC utilization but is suggested in hepatitis C, hypernatremia, donation after cardiac death, or multiple EDC indications. Implementation of a universal FS worksheet could standardize histologic reporting and facilitate data collection, allocation, and research.

    View details for DOI 10.1002/lt.21419

    View details for Web of Science ID 000255581800010

    View details for PubMedID 18324657

  • Extended-donor criteria liver allografts SEMINARS IN LIVER DISEASE Alkofer, B., Samstein, B., Guarrera, J. V., Kin, C., Jan, D., Bellemare, S., Kinkhabwala, M., Brown, R., Emond, J. C., Renz, J. F. 2006; 26 (3): 221-233

    Abstract

    Extended-donor criteria liver allografts do not meet traditional criteria for transplantation. Although these organs offer immediate expansion of the donor pool, transplantation of extended-donor criteria liver allografts increases potential short- and long-term risk to the recipient. This risk may manifest as impaired allograft function or donor-transmitted disease. Guidelines defining this category of donor, level of acceptable risk, principles of consent, and post-transplantation surveillance have not been defined. This article reviews the utilization, ethical considerations, and outcomes of extended-donor criteria liver allografts.

    View details for DOI 10.1055/s-2006-947292

    View details for Web of Science ID 000239388500004

    View details for PubMedID 16850371

  • Utilization of extended donor criteria liver allografts maximizes donor use and patient access to liver transplantation ANNALS OF SURGERY Renz, J. F., Kin, C., Kinkhabwala, M., Jan, D., Varadarajan, R., Goldstein, M., Brown, R., Emond, J. C. 2005; 242 (4): 556-565

    Abstract

    The objective of this study was to evaluate the effect of systematic utilization of extended donor criteria liver allografts (EDC), including living donor allografts (LDLT), on patient access to liver transplantation (LTX).Utilization of liver allografts that do not meet traditional donor criteria (EDC) offer immediate expansion of the donor pool. EDC are typically allocated by transplant center rather than regional wait-list priority (RA). This single-institution series compares outcomes of EDC and RA allocation to determine the impact of EDC utilization on donor use and patient access to LTX.The authors conducted a retrospective analysis of 99 EDC recipients (49 deceased donor, 50 LDLT) and 116 RA recipients from April 2001 through April 2004. Deceased-donor EDC included: age >65 years, donation after cardiac death, positive viral serology (hepatitis C, hepatitis B core antibody, human T-cell lymphotrophic), split-liver, hypernatremia, prior carcinoma, steatosis, and behavioral high-risk donors. Outcome variables included patient and graft survival, hospitalization, initial graft function, and complication categorized as: biliary, vascular, wound, and other.EDC recipients were more frequently diagnosed with hepatitis C virus or hepatocellular carcinoma and had a lower model for end-stage liver disease (MELD) score at LTX (P < 0.01). Wait-time, technical complications, and hospitalization were comparable. Log-rank analysis of Kaplan-Meier survival estimates demonstrated no difference in patient or graft survival; however, deaths among deceased-donor EDC recipients were frequently the result of patient comorbidities, whereas LDLT and RA deaths resulted from graft failure (P < 0.01). EDC increased patient access to LTX by 77% and reduced pre-LTX mortality by over 50% compared with regional data (P < 0.01).Systematic EDC utilization maximizes donor use, increases access to LTX, and significantly reduces wait-list mortality by providing satisfactory outcomes to select recipients.

    View details for DOI 10.1097/01.sla.0000183973.49899.b1

    View details for Web of Science ID 000232357200011

    View details for PubMedID 16192816

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