Author
Madhan Kumar Kuppusamy
Bio: Madhan Kumar Kuppusamy is an academic researcher from Virginia Mason Medical Center. The author has contributed to research in topics: Esophagectomy & Retrospective cohort study. The author has an hindex of 9, co-authored 19 publications receiving 693 citations.
Papers
More filters
••
Virginia Mason Medical Center1, University of Birmingham2, University of São Paulo3, University of Michigan4, Toronto General Hospital5, St Thomas' Hospital6, Aix-Marseille University7, University of Amsterdam8, University of Texas MD Anderson Cancer Center9, Keio University10, Queen Mary University of London11, Harvard University12, Katholieke Universiteit Leuven13, Tata Memorial Hospital14, University Hospitals Birmingham NHS Foundation Trust15, Trinity College, Dublin16, University of Cologne17, University of Queensland18, Erasmus University Rotterdam19
TL;DR: Standardized methods provide contemporary international benchmarks for reporting outcomes after esophagectomy, using a standardized dataset with specific definitions to prospectively collect international data to provide a benchmark for complications and outcomes associated with esphagectomy.
Abstract: Objective:Utilizing a standardized dataset with specific definitions to prospectively collect international data to provide a benchmark for complications and outcomes associated with esophagectomy.Summary of Background Data:Outcome reporting in oncologic surgery has suffered from the lack of a stand
453 citations
••
Virginia Mason Medical Center1, The Royal Marsden NHS Foundation Trust2, University of Verona3, McGill University Health Centre4, Queen Mary University of London5, Karolinska Institutet6, Virginia Commonwealth University7, University of Queensland8, University Hospital of Lausanne9, Örebro University10
TL;DR: The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.
Abstract: Enhanced recovery after surgery (ERAS) programs provide a format for multidisciplinary care and has been shown to predictably improve short term outcomes associated with surgical procedures. Esophagectomy has historically been associated with significant levels of morbidity and mortality and as a result routine application and audit of ERAS guidelines specifically designed for esophageal resection has significant potential to improve outcomes associated with this complex procedure. A team of international experts in the surgical management of esophageal cancer was assembled and the existing literature was identified and reviewed prior to the production of the guidelines. Well established procedure specific components of ERAS were reviewed and updated with changes relevant to esophagectomy. Procedure specific, operative and technical sections were produced utilizing the best current level of evidence. All sections were rated regarding the level of evidence and overall recommendation according to the evaluation (GRADE) system. Thirty-nine sections were ultimately produced and assessed for quality of evidence and recommendations. Some sections were completely new to ERAS programs due to the fact that esophagectomy is the first guideline with a thoracic component to the procedure. The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.
294 citations
••
TL;DR: Results from this series indicate that referral to a tertiary care center is as important as treatment within 24 hours, and an experienced surgical management team using a diversified approach, including selective application of nonoperative techniques, can expect to shorten LOS and limit complications and mortality.
Abstract: Background Management of acute esophageal perforation continues to evolve. We hypothesized that treatment of these patients at a tertiary referral center is more important than beginning treatment within 24 hours, and that the evolving application of nonsurgical treatment techniques by surgeons would produce improved outcomes. Study Design Demographics and outcomes of patients treated for esophageal perforation from 1989 to 2009 were recorded in an Institutional Review Board–approved database. Retrospective outcomes assessment was done for 5 separate time spans, including timing and type of treatment, length of stay (LOS), complications, and mortality. Results Eighty-one consecutive patients presented with acute esophageal perforation. Their mean age was 64 years, and 55 patients (68%) had American Society of Anesthesiologists levels 3 to 5; 59% of the study population was referred from other hospitals; 48 patients (59%) were managed operatively, 33 (41%) nonoperatively, and 10 patients with hybrid approaches involving a combination of surgical and interventional techniques; 57 patients (70%) were treated 24 hours after perforation. LOS was lower in the early-treatment group; however, there was no difference in complications or mortality. Nonoperative therapy increased from 0% to 75% over time. Nonsurgical therapy was more common in referred cases (48% vs 30%) and in the >24 hours treatment group (46% vs 38%). Over the period of study, there were decreases in complications (50% to 33%) and LOS (18.5 to 8.5 days). Mortality for the entire series involved 3 patients (4%): 2 operative and 1 nonoperative. Conclusions Results from our series indicate that referral to a tertiary care center is as important as treatment within 24 hours. An experienced surgical management team using a diversified approach, including selective application of nonoperative techniques, can expect to shorten LOS and limit complications and mortality.
57 citations
••
TL;DR: Positive circumferential resection margins are prognostically important and the CAP criteria provide a more clinically meaningful assessment and universal adoption of the CAP system can improve interpretation of international clinical trials and allow more accurate comparisons of outcomes.
Abstract: Objective To assess the clinical significance of circumferential resection margins according to current criteria of the College of American Pathologists (CAP) and the Royal College of Pathology (RCP) in esophageal and esophagogastric cancer. Design Prospective study. Setting Single-surgeon database. Patients One hundred thirty-five patients (mean age, 64 years) with T3 tumors who underwent esophageal resection for cancer between 1991 and 2006. Main Outcome Measure Resection margins criteria and survival. Results Three hundred seventy-four consecutive patients were prospectively identified from an institutional review board–approved database between 1991 and 2006. All patients with T3 tumors (n = 135) had their original pathologic slides reassessed by a single gastrointestinal pathologist. Operative mortality was 0.7% and mean follow-up was 3.1 years. Follow-up was complete in 81% of patients. Positive margins were identified in 16 cases in the CAP group vs 83 cases in the RCP group. Five-year Kaplan-Meier survival curves in the CAP group demonstrated a significant ( P P = .20). In comparisons of negative vs positive margins, respectively, median survival in the CAP group (29.8 months [95% confidence interval (CI), 22.7-36.9] vs 8.33 months [95% CI, 4.4-12.3]) was significantly different from the RCP group (28.47 months [95% CI, 19.7-37.2] vs 22.23 months [95% CI, 13.6-30.8]). At 60-month follow-up, the positive predictive value with respect to survival was 100% in the CAP group vs 81% in the RCP group. Univariate and multivariate analyses identified R1 margins in the CAP group and lymph node ratio as being directly linked to survival. Conclusions Positive circumferential resection margins are prognostically important and the CAP criteria provide a more clinically meaningful assessment. Universal adoption of the CAP system can improve interpretation of international clinical trials and allow more accurate comparisons of outcomes.
55 citations
••
University of Amsterdam1, Netherlands Cancer Institute2, VU University Amsterdam3, Catharina Ziekenhuis4, University Medical Center Utrecht5, Erasmus University Rotterdam6, Karolinska Institutet7, Katholieke Universiteit Leuven8, Humanitas University9, University of Milan10, University of Verona11, University of Bologna12, Royal Victoria Infirmary13, The Royal Marsden NHS Foundation Trust14, University of Oxford15, Norfolk and Norwich University Hospital16, Imperial College London17, Connolly Hospital Blanchardstown18, Trinity College, Dublin19, Showa University20, Chiba University21, Niigata University22, Fudan University23, University of Hong Kong24, University of Texas MD Anderson Cancer Center25, Virginia Mason Medical Center26, Mayo Clinic27, University of Toronto28, University of Mainz29
TL;DR: The TIGER study will provide a roadmap of the location of lymph node metastases in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph nodes metastases, pre-operative diagnostics, neo-adjuvant therapy and survival.
Abstract: An important parameter for survival in patients with esophageal carcinoma is lymph node status. The distribution of lymph node metastases depends on tumor characteristics such as tumor location, histology, invasion depth, and on neoadjuvant treatment. The exact distribution is unknown. Neoadjuvant treatment and surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy has not been reached. The aim of this study is to determine the distribution of lymph node metastases in patients with resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed. This can be the foundation for a uniform worldwide staging system and establishment of the optimal surgical strategy for esophageal cancer patients. The TIGER study is an international observational cohort study with 50 participating centers. Patients with a resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed in participating centers will be included. All lymph node stations will be excised and separately individually analyzed by pathological examination. The aim is to include 5000 patients. The primary endpoint is the distribution of lymph node metastases in esophageal and esophago-gastric junction carcinoma specimens following transthoracic esophagectomy with at least 2-field lymphadenectomy in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and (disease free) survival. The TIGER study will provide a roadmap of the location of lymph node metastases in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and survival. Patient-tailored treatment can be developed based on these results, such as the optimal radiation field and extent of lymphadenectomy based on the primary tumor characteristics. NCT03222895
, date of registration: July 19th, 2017.
51 citations
Cited by
More filters
••
University of Duisburg-Essen1, Bosch2, University of Tübingen3, University Hospital Heidelberg4, Ruhr University Bochum5, Dresden University of Technology6, Goethe University Frankfurt7, Charité8, Massachusetts Institute of Technology9, Ludwig Maximilian University of Munich10, University of Mainz11, Greifswald University Hospital12, Praxis13, Rolf C. Hagen Group14
TL;DR: In this article, the safety and efficacy of the docetaxel-based triplet FLOT (fluorouracil plus leucovorin, oxaliplatin, and doceteaxel) as a perioperative therapy for patients with locally advanced, resectable tumours was reported.
1,218 citations
••
Virginia Mason Medical Center1, University of Birmingham2, University of São Paulo3, University of Michigan4, Toronto General Hospital5, Newcastle University6, University of Cologne7, Allegheny Health Network8, Keio University9, University of Pennsylvania10, University of Hong Kong11, Katholieke Universiteit Leuven12, University of Oxford13, Pompeu Fabra University14, University of Rochester15, Tata Memorial Hospital16, Trinity College, Dublin17, University of Queensland18, Erasmus University Rotterdam19
TL;DR: The proposed system for defining and recording perioperative complications associated with esophagectomy provides an infrastructure to standardize international data collection and facilitate future comparative studies and quality improvement projects.
Abstract: Introduction: Perioperative complications influence long- and short-term outcomes after esophagectomy. The absence of a standardized system for defining and recording complications and quality measures after esophageal resection has meant that there is wide variation in evaluating their impact on these outcomes. Methods: The Esophageal Complications Consensus Group comprised 21 high-volume esophageal surgeons from 14 countries, supported by all the major thoracic and upper gastrointestinal professional societies. Delphi surveys and group meetings were used to achieve a consensus on standardized methods for defining complications and quality measures that could be collected in institutional databases and national audits. Results: A standardized list of complications was created to provide a template for recording individual complications associated with esophagectomy. Where possible, these were linked to preexisting international definitions. A Delphi survey facilitated production of specific definitions for anastomotic leak, conduit necrosis, chyle leak, and recurrent nerve palsy. An additional Delphi survey documented consensus regarding critical quality parameters recommended for routine inclusion in databases. These quality parameters were documentation on mortality, comorbidities, completeness of data collection, blood transfusion, grading of complication severity, changes in level of care, discharge location, and readmission rates. Conclusions: The proposed system for defining and recording perioperative complications associated with esophagectomy provides an infrastructure to standardize international data collection and facilitate future comparative studies and quality improvement projects.
733 citations
••
TL;DR: Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy.
Abstract: Esophageal cancer is a serious malignancy with regards to mortality and prognosis. It is a growing health concern that is expected to increase in incidence over the next 10 years. Squamous cell carcinoma is the most common histological type of esophageal cancer worldwide, with a higher incidence in developing nations. With the increased prevalence of gastroesophageal reflux disease and obesity in developed nations, the incidence of esophageal adenocarcinoma has dramatically increased in the past 40 years. Esophageal cancer is staged according to the widely accepted TNM system. Staging plays an integral part in guiding stage specific treatment protocols and has a great impact on overall survival. Common imaging modalities used in staging include computed tomography, endoscopic ultrasound and positron emission tomography scans. Current treatment options include multimodality therapy mainstays of current treatment include surgery, radiation and chemotherapy. Tumor markers of esophageal cancer are an advancing area of research that could potentially lead to earlier diagnosis as well as playing a part in assessing tumor response to therapy.
622 citations
11 Apr 2019
TL;DR: In locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma, perioperative FLOT improved overall survival compared withperioperative ECF/ECX, and the number of toxic deaths was increased.
345 citations
••
Virginia Mason Medical Center1, The Royal Marsden NHS Foundation Trust2, University of Verona3, McGill University Health Centre4, Queen Mary University of London5, Karolinska Institutet6, Virginia Commonwealth University7, University of Queensland8, University Hospital of Lausanne9, Örebro University10
TL;DR: The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.
Abstract: Enhanced recovery after surgery (ERAS) programs provide a format for multidisciplinary care and has been shown to predictably improve short term outcomes associated with surgical procedures. Esophagectomy has historically been associated with significant levels of morbidity and mortality and as a result routine application and audit of ERAS guidelines specifically designed for esophageal resection has significant potential to improve outcomes associated with this complex procedure. A team of international experts in the surgical management of esophageal cancer was assembled and the existing literature was identified and reviewed prior to the production of the guidelines. Well established procedure specific components of ERAS were reviewed and updated with changes relevant to esophagectomy. Procedure specific, operative and technical sections were produced utilizing the best current level of evidence. All sections were rated regarding the level of evidence and overall recommendation according to the evaluation (GRADE) system. Thirty-nine sections were ultimately produced and assessed for quality of evidence and recommendations. Some sections were completely new to ERAS programs due to the fact that esophagectomy is the first guideline with a thoracic component to the procedure. The current ERAS society guidelines should be reviewed and applied in all centers looking to improve outcomes and quality associated with esophageal resection.
294 citations