Doctor of Medicine, Wayne State University School of Medicine (2016)
Bachelor of Science, University of Michigan (2012)
Brendan Visser, Postdoctoral Faculty Sponsor
Laparoscopic fenestration has largely replaced open fenestration of liver cysts. However, most hepatectomies for polycystic liver disease (PCLD) are performed open. Outcomes data on laparoscopic hepatectomy for PCLD are lacking.Patients who underwent surgery for PCLD at a single institution between 2010 and 2019 were reviewed and grouped by operative approach. Pre- and post-operative volumes were calculated for patients who underwent resection. Primary outcomes were: volume reduction, re-admission and postoperative complications.Twenty-six patients were treated for PCLD: 13 laparoscopic fenestration, nine laparoscopic hepatectomy, three open hepatectomy and one liver transplantation. Median length of stay for patients after laparoscopic resection was 3 days (IQR 2-3). The only complication was post-operative atrial fibrillation in one patient. There were no readmissions. Overall volume reduction was 51% (range 22-69) for all resections, 32% (range 22-46) after open resection and 56% (range 39-69) after laparoscopic resection.Volume reduction achieved through laparoscopic approach exceeded open volume reduction at this institution and is comparable to volume reduction in previously published open resection series. Adequate volume reduction can be accomplished by laparoscopic means with acceptable postoperative morbidity.
View details for DOI 10.1016/j.hpb.2020.04.010
View details for PubMedID 32451237
It is unclear whether placement of operative enteral access (OEA) during pancreaticoduodenectomy (PD) correlates with decreased morbidity.A retrospective chart review of patients undergoing PD with and without OEA placement between January 2016 and May 2018 was undertaken. Outcomes included length of stay (LOS), 30- and 90-day readmission, initiation of total parenteral nutrition (TPN), postoperative pancreatic fistula (POPF), delayed gastric emptying (DGE), and surgical site infection (SSI).69 patients were evaluated; there was a trend toward decreased LOS for patients without OEA (9 vs. 7.5 days, p?=?0.07). There were no significant differences in initiation of TPN (9.1% vs 19.4%, p?=?0.311), POPF (21.2% vs 11.1%, p?=?0.999), DGE (24.2% vs 22.2%, p?=?0.999), organ/space SSI (12.1% vs 8.3%, p?=?0.702).OEA placement at the time of PD is not necessarily associated with improved perioperative morbidity and outcomes, suggesting that OEA may not be necessary and should be considered on a case by case basis.It is unclear whether placement of operative enteral access (OEA) during pancreaticoduodenectomy (PD) correlates with decreased morbidity. A retrospective review of patients undergoing PD with and without OEA placement between January 2016 and May 2018 was performed, demonstrating that there were no overall significant differences in postoperative complications and outcomes.
View details for DOI 10.1016/j.amjsurg.2018.11.024
View details for Web of Science ID 000458798900017
View details for PubMedID 30538033
Biliary stricture is a common cause of morbidity after liver transplantation (LT). This study aimed to determine the risk factors for post-transplant biliary anastomotic strictures (BAS), focusing on perioperative platelet counts. We enrolled 771 consecutive recipients who underwent ABO-identical/compatible deceased donor LT with duct-to-duct biliary reconstruction from January 2000 to June 2012. BAS was identified in 142 cases. The median time for stricture development was 176 days. Preoperative and postoperative platelet counts within 5 days after LT were significantly lower in patients with BAS than those without BAS. Using cutoff values acquired by the receiver operating characteristic curve analysis, persistent postoperative thrombocytopenia was defined as platelet counts <41 × 1000/?l and <53 × 1000/?l on postoperative day (POD) 3 and POD 5, respectively. Multivariate analysis indicated persistent postoperative thrombocytopenia (OR = 2.38) was the only independent risk factor for BAS. No significant associations were observed in terms of donor and surgical factors. Multivariate analysis demonstrated estimated blood loss (OR = 1.01, per 100 ml) was an independent contributing factor for persistent postoperative thrombocytopenia. We demonstrated low platelet count was associated with progression of post-transplant BAS. Minimizing intraoperative blood loss potentially contributes to maintain post-transplant platelet count, which may reduce incidence of BAS.
View details for DOI 10.1111/tri.12996
View details for Web of Science ID 000411521700009
View details for PubMedID 28605573
The positive impact of platelets has been recently implicated in liver transplantation (LT). The aim of this study was to determine the risk factors for graft loss and mortality after LT, focusing on perioperative platelet counts.We reviewed all deceased donor LT from 2000 to 2012 and enrolled 975 consecutive recipients. The risk factors for graft loss and mortality were analyzed by multivariate analysis, using Cox's regression model.Using cutoff values acquired by receiver operating characteristics curve analysis, multivariate analyses determined that viral hepatitis C (hazard ratio [HR]=1.32), donor age >40 (HR=1.33), higher peak serum alanine aminotransferase (HR=1.01), reoperation within 30 days (HR=1.51), and platelet count <72 500/?L on postoperative day (POD) 5 (HR=1.30) were independent risk factors for graft loss. Viral hepatitis C (HR=1.33), reoperation within 30 days (HR=1.35), and platelet count <72 500/?L on POD 5 (HR=1.38) were independent risk factors for mortality.A low platelet count on POD 5 was associated with graft loss and mortality after LT. Platelet count <72 500/?L on POD 5 can be a predictor of poor graft and overall survival. Maintaining higher postoperative platelet counts could potentially improve graft and overall survival rates.
View details for DOI 10.1111/ctr.12891
View details for Web of Science ID 000395382200005
View details for PubMedID 27992667
Radiotherapy is a treatment choice for local control of breast cancer, particularly after the removal of tumor tissues by surgery. However, intrinsic radioresistance of cancer cells limits therapeutic efficacy. Here, we determined in breast cancer cells the potential radiosensitizing activity of SM-164, a small molecule compound, that mimics the activity of SMAC, a mitochondrial protein released during apoptosis to activate caspases by inhibiting cellular inhibitor of apoptosis proteins, cIAP-1, and XIAP. We found that SM-164 at nanomolar concentrations promoted degradation of cIAP-1, disrupted the inhibitory binding of XIAP to active caspase-9, and sensitized breast cancer cells to radiation with a sensitization enhancement ratio (SER) of 1.7-1.8. In one line of breast cancer cells resistant to SM-164 as a single agent, SM-164 radiosensitization was mediated by intrinsic apoptosis pathway through activation of caspases-9 and -3. In a line of breast cancer cells sensitive to SM-164 as a single agent, SM-164 radiosensitization was mediated by both extrinsic and intrinsic apoptosis pathways through activation of caspases-9, -8, and -3. Consistently, blockage of caspase activation, through siRNA knockdown or treatment with a pan-caspase inhibitor z-VAD-fmk, inhibited apoptosis and abrogated SM-164 radiosensitization. Our study demonstrates that IAPs are valid radiosensitizing targets in breast cancer cells and SM-164 could be further developed as a novel class of radiosensitizers for the treatment of radioresistant breast cancer.
View details for DOI 10.1007/s10549-011-1752-3
View details for Web of Science ID 000303509200018
View details for PubMedID 21901386