Improving Surgical Outcomes

Improving Surgical Outcomes

Our group prospectively records patient information into a large institutionally supported database for research purposes. We use these data to study the influence of clinical decision-making on patient outcome. Our goal is to constantly improve clinical management of cancer patients using a data-driven approach. These data inform clinical trial design and identify extant gaps in our understanding of disease.

We capture all liver resection data, including cholecystectomies and hepatic arterial infusion pump placements and removals. We also capture all pancreas data including clinical and pathologic staging and chemotherapy treatments. At the present time, we have liver resection data on almost 27,000 patients and pancreas data on nearly 9,000 patients. As a cancer center, we are uniquely poised to record some of the largest datasets of rare cancers.

We also record all post-operative morbidity and mortality data using the Surgical Secondary Events (SSE) grading system that was developed at MSK. Our surgeons agree upon these grades at bi-weekly meetings to monitor the clinical course of patients following surgery.

We often share these data with other groups to compare patient outcomes across regions and institutions. As an example, we provided data from the pancreas database to improve the American Joint Committee on Cancer grading of intraductal papillary mucinous neoplasms: an impactful change that affected the grading of these neoplasms throughout the country.

We are actively improving these data to include all patients with liver, pancreas, and biliary cancers treated at MSK (only surgery patients are currently captured). Our collaborators across the institution will have access to these data including medical oncologists, radiologists, pathologists, gastroenterologists, and epidemiologists. The end goal is to create one large database that captures treatment parameters for all patients receiving treatment at MSK, and linking clinical and pathologic data in order to provide more comprehensive study (and ultimately care) to this patient population.

We have published hundreds of peer-reviewed papers from these data. This is a list of our most cited works:

 

  1. Tomlinson JS, Jarnagin WR, DeMatteo RP, Fong Y, Kornprat P, Gonen M, et al. Actual 10-year survival after resection of colorectal liver metastases defines cure. J Clin Oncol. 2007;25(29):4575–80.
  2. Jarnagin WR, Weber S, Tickoo SK, Koea JB, Obiekwe S, Fong Y, et al. Combined hepatocellular and cholangiocarcinoma: demographic, clinical, and prognostic factors. Cancer. 2002;94(7):2040–6.
  3. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, et al. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236(4):397-406-7.
  4. Jarnagin WR, Fong Y, DeMatteo RP, Gonen M, Burke EC, Bodniewicz BJ, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg. 2001/09/27. 2001;234(4):507–9.
  5. Burke EC, Jarnagin WR, Hochwald SN, Pisters PW, Fong Y, Blumgart LH. Hilar Cholangiocarcinoma: patterns of spread, the importance of hepatic resection for curative operation, and a presurgical clinical staging system. Ann Surg. 1998/09/22. 1998;228(3):385–94.
  6. Endo I, Gonen M, Yopp AC, Dalal KM, Zhou Q, Klimstra D, et al. Intrahepatic Cholangiocarcinoma: Rising Frequency, Improved Survival, and Determinants of Outcome After Resection. Ann Surg. 2008;248(1):84–96.
  7. Allen PJ, D’Angelica M, Gonen M, Jaques DP, Coit DG, Jarnagin WR, et al. A Selective Approach to the Resection of Cystic Lesions of the Pancreas: Results from 539 Consecutive Patients. Ann Surg. 2006;124(4):237–47.
  8. Jarnagin WR, Ruo L, Little SA, Klimstra D, D’Angelica M, DeMatteo RP, et al. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer. 2003;98(8):1689–700.
  9. House MG, Ito H, Gonen M, Fong Y, Allen PJ, DeMatteo RP, et al. Survival after hepatic resection for metastatic colorectal cancer: trends in outcomes for 1,600 patients during two decades at a single institution. J Am Coll Surg. 2010;210(5):744-752-755.
  10. Winter JM, Brennan MF, Tang LH, D’Angelica MI, DeMatteo RP, Fong Y, et al. Survival after Resection of Pancreatic Adenocarcinoma: Results from a Single Institution over Three Decades. Annals of Surgical Oncology. 2012. p. 169–75.
  11. Gold JS, Kornprat P, Jarnagin WR, Go M, Dematteo RP, Blumgart LH. Increased Use of Parenchymal-Sparing Surgery for Bilateral Liver Metastases From Colorectal Cancer Is Associated With Improved Mortality Without Change in Oncologic. 2008;247(1):109–17.
  12. Yoon SS, Charny CK, Fong Y, Jarnagin WR, Schwartz LH, Blumgart LH, et al. Diagnosis, management, and outcomes of 115 patients with hepatic hemangioma. J Am Coll Surg. 2003;197(3):392–402.
  13. Sadot E, Groot Koerkamp B, Leal JN, Shia J, Gonen M, Allen PJ, et al. Resection Margin and Survival in 2368 Patients Undergoing Hepatic Resection for Metastatic Colorectal Cancer: Surgical Technique or Biologic Surrogate? Ann Surg. 2015;262(3):476–85.