Publications by authors named "Stephen M Sentovich"

7 Publications

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Update: Telehealth in Colon and Rectal Surgery.

Dis Colon Rectum 2021 Jun;64(6):642-644

Division of Colorectal Surgery, Department of Surgery, City of Hope National Medical Center, Duarte, California.

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http://dx.doi.org/10.1097/DCR.0000000000002019DOI Listing
June 2021

Health-related quality of life and oncologic outcomes after surgery in older adults with colorectal cancer.

Support Care Cancer 2020 Jun 15;28(6):2857-2865. Epub 2019 Nov 15.

Department of Surgery, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA, 91104, USA.

Purpose: Data regarding changes in functional status and health-related quality of life (HRQOL) before and after surgery are lacking. We identified colorectal cancer patients from the SEER-Medicare Health Outcomes Survey (MHOS) linked database to evaluate the association between HRQOL and survival.

Methods: HRQOL survey data captured physical/mental health, activities of daily living (ADLs), and medical comorbidities. Patients who underwent surgery with HRQOL surveys prior to cancer diagnosis and ≥ 1 year after diagnosis were selected. Patient, disease, and HRQOL measures were analyzed in regard to overall survival (OS), disease-specific survival (DSS), and non-DSS.

Results: Of 590 patients included, 55% were female, 75% were Caucasian, and 83% had colonic primary. Disease extent was localized for 52%, regional for 41%, and distant for 7%. Median OS was 83 months. Decreased OS was independently associated with age ≥ 75 (HR 1.7, p < 0.0001), male sex (HR 1.4, p = 0.011), advanced disease (regional-HR 2.0, p < 0.0001; distant-HR 7.0, p < 0.0001), and decreased mental HRQOL (HR 1.4, p = 0.005). Decreased DSS was independently associated with advanced disease (regional-HR 4.1, p < 0.0001; distant-HR 16.5, p < 0.0001) and rectal primary (HR 1.6, p = 0.047). Decreased non-DSS was independently associated with age ≥ 75 (HR 2.2, p < 0.0001), male sex (HR 1.4, p = 0.03), decreased mental HRQOL (HR 1.4, p = 0.02), and increased comorbidities (HR 1.4, p = 0.04).

Conclusions: The potential overall survival benefit of oncologic surgery is diminished by declines in physical and mental health. Early identification of older surgical patients at risk for functional and HRQOL declines may improve survival following colorectal cancer surgery.
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http://dx.doi.org/10.1007/s00520-019-05087-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7700837PMC
June 2020

What Every Colorectal Surgeon Should Know About: CMS Survey of Global Period Surgical Services.

Dis Colon Rectum 2018 Apr;61(4):419-420

For the Healthcare Economics Committee of The American Society of Colon and Rectal Surgeons.

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http://dx.doi.org/10.1097/DCR.0000000000001075DOI Listing
April 2018

Accuracy of computed tomography in nodal staging of colon cancer patients.

World J Gastrointest Surg 2015 Jul;7(7):116-22

Audrey H Choi, Hans F Schoellhammer, Won Cho, Michelle Ko, Amanda Arrington, Christopher R Oxner, Stephen M Sentovich, Julio Garcia-Aguilar, Joseph Kim, Department of Surgery, City of Hope National Medical Center, Duarte, CA 91010, United States.

Aim: To predict node-positive disease in colon cancer using computed tomography (CT).

Methods: American Joint Committee on Cancer stage I-III colon cancer patients who underwent curavtive-intent colectomy between 2007-2010 were identified at a single comprehensive cancer center. All patients had preoperative CT scans with original radiology reports from referring institutions. CT images underwent blinded secondary review by a surgeon and a dedicated abdominal radiologist at our institution to identify pericolonic lymph nodes (LNs). Comparison of outside CT reports to our independent imaging review was performed in order to highlight differences in detection in actual clinical practice. CT reviews were compared with final pathology. Results of the outside radiologist review, secondary radiologist review, and surgeon review were compared with the final pathologic exam to determine sensitivity, specificity, positive and negative predictive values, false positive and negative rates, and accuracy of each review. Exclusion criteria included evidence of metastatic disease on CT, rectal or appendiceal involvement, or absence of accompanying imaging from referring institutions.

Results: From 2007 to 2010, 64 stageI-III colon cancer patients met the eligibility criteria of our study. The mean age of the cohort was 68 years, and 26 (41%) patients were male and 38 (59%) patients were female. On final pathology, 26 of 64 (40.6%) patients had node-positive (LN+) disease and 38 of 64 (59.4%) patients had node-negative (LN-) disease. Outside radiologic review demonstrated sensitivity of 54% (14 of 26 patients) and specificity of 66% (25 of 38 patients) in predicting LN+ disease, whereas secondary radiologist review demonstrated 88% (23 of 26) sensitivity and 58% (22 of 38) specificity. On surgeon review, sensitivity was 69% (18 of 26) with 66% specificity (25 of 38). Secondary radiology review demonstrated the highest accuracy (70%) and the lowest false negative rate (12%), compared to the surgeon review at 67% accuracy and 31% false negative rate and the outside radiology review at 61% accuracy and 46% false negative rate.

Conclusion: CT LN staging of colon cancer has moderate accuracy, with administration of NCT based on CT potentially resulting in overtreatment. Active search for LN+ may improve sensitivity at the cost of specificity.
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http://dx.doi.org/10.4240/wjgs.v7.i7.116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513434PMC
July 2015

Retraction: Lymph node retrieval and assessment after colorectal cancer resection: are pathologists doing an adequate job?

Dis Colon Rectum 2009 May;52(5):1020

Department of Surgery, Boston University School of Medicine, Boston, Massachussetts, USA.

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http://dx.doi.org/10.1007/DCR.0b013e3181a8ff92DOI Listing
May 2009

Successful sphincter-sparing surgery for all anal fistulas.

Dis Colon Rectum 2007 Oct;50(10):1535-9

Department of Surgery, Boston University School of Medicine, One Boston Medical Center Place, Boston, Massachusetts 02118, USA.

Purpose: This study was designed to evaluate the success of a sphincter-sparing treatment algorithm for patients with anal fistulas.

Methods: All patients with anal fistulas presenting to a single surgeon from 1999 to 2004 were retrospectively reviewed. Patients were treated according to a sphincter-sparing algorithm that utilized three operative approaches: subcutaneous fistulotomy, seton placement followed by fibrin glue, and/or seton placement followed by rectal advancement flap. Data analyzed included: age, gender, type of fistula, operative intervention, treatment success, and functional results.

Results: A total of 137 patients with anal fistulas were evaluated (age range, 23-74 years). Fistula etiology was cryptoglandular in 116 (85 percent), inflammatory bowel disease in 9 (7 percent), HIV in 3 (2 percent), and miscellaneous in 9 (7 percent). A subcutaneous fistulotomy was possible in 38 patients (28 percent), and all of these patients healed. The remaining 99 patients (72 percent) with transsphincteric fistulas underwent staged procedures: 89 patients (65 percent) underwent seton placement followed by fibrin glue closure (55 healed, 62 percent success rate), 9 patients had seton placement followed by flap (9 healed, 100 percent success rate), and 1 patient had seton placement alone. Of the 34 patients with fibrin glue failure, retreatment with glue was successful in 8 of 14 (57 percent success rate). The remaining 20 patients who declined glue retreatment and the 6 patients who failed glue retreatment underwent flap (26 healed, 100 percent success rate). All fistulas healed with an average of two operations per patient, and fecal continence was maintained in all patients.

Conclusions: By using staged operative procedures without any division of anal sphincter muscle, all fistulas healed with excellent functional results. A sphincter-sparing approach can successfully treat all anal fistulas.
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http://dx.doi.org/10.1007/s10350-007-9002-9DOI Listing
October 2007

Fibrin glue for anal fistulas: long-term results.

Dis Colon Rectum 2003 Apr;46(4):498-502

Section of Colon and Rectal Surgery, Department of Surgery, Boston University School of Medicine, Boston, MA, USA.

Purpose: The aim of this study was to evaluate the long-term success and complication rate of fibrin-glue treatment of anal fistulas.

Methods: Patients with an anal fistula presenting to a single surgeon over a three-year period were enrolled in this study. At their first operation, all 48 patients (26-72 years old) underwent anoscopy, biopsy, destruction of the internal gland, and placement of a draining seton. Approximately two months later after preoperative bowel preparation, the seton was removed, the internal opening closed with a single suture, and fibrin glue instilled by way of the external opening to seal the fistula tract. Patients were followed closely to document the results of treatment and any complications. Long-term follow-up was done by telephone interview.

Results: Cause of the anal fistula was cryptoglandular in 36 (75 percent) patients, Crohn's disease in 5 (10 percent), and miscellaneous in 7 (15 percent). Median follow-up was 22 months (range, 6-46 months). After a single treatment with fibrin glue, 29 (60 percent) fistulas closed. Retreatment with fibrin glue brought the successful number of fistula tracts closed to 33 (69 percent). The 15 (29 percent) patients who failed either one or two treatments with fibrin glue were successfully treated with either fistulotomy or advancement flap. Bowel function and fecal incontinence were not altered by the fibrin-glue treatment. In one patient who failed fibrin glue, the fibrin-glue treatment may have created a more complicated fistula tract. Late recurrences (>6 months) occurred in three (6 percent) patients, two of whom were successfully retreated with fibrin glue.

Conclusions: Fibrin-glue treatment of anal fistulas is successful in up to 69 percent of patients if initial failures are retreated. This sphincter-saving technique is associated with minimal complications and no functional detriment. Late recurrences are unusual.
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http://dx.doi.org/10.1007/s10350-004-6589-yDOI Listing
April 2003