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Articles by D. M Nagorney
Total Records ( 2 ) for D. M Nagorney
  S. D Holubar , J. K Wang , B. G Wolff , D. M Nagorney , E. J Dozois , R. R Cima , M. M O'Byrne , R Qin and D. W. Larson

Objective  To determine the optimal surgical management of splenic injury encountered during colectomy.

Design  Retrospective review from 1992 to 2007.

Setting  Mayo Clinic in Rochester, Minnesota, a tertiary care center.

Patients  A cohort of patients who sustained splenic injury during colectomy from 1992 to 2007.

Main Outcome Measures  Overall 30-day major morbidity and mortality and overall 5-year survival.

Results  Of 13 897 colectomies, we identified 59 splenic injuries (0.42%). Of these, 33 (56%) were in men; there was a median age of 68 years (range, 30-93 years) and a median body mass index of 25.5 (range, 15-54). Thirty-seven injuries (63%) occurred during elective surgery, 6 (10%) occurred without splenic flexure mobilization, and 5 (8.4%) occurred during minimally invasive surgery. Injury was successfully managed by primary repair in 10 (17%), splenorrhaphy in 4 (7%), and splenectomy in 45 cases (76%). Four injuries (7%) were unrecognized and resulted in reoperation and splenectomy. Multiple attempts at splenic salvage were performed in 30 (51%); of these, 21 (70%) required splenectomy. More than 2 attempts at salvage was associated with splenectomy (P = .03). The 30-day major morbidity and mortality rates were 34% and 17%, respectively. Sepsis was the most common complication, with no confirmed episodes of postsplenectomy sepsis. Median survival after splenic injury was 7.25 years. There was no significant association between the surgical management of splenic injuries and short- or long-term outcomes.

Conclusions  Splenic injury is an infrequent but morbid complication. Splenic salvage is frequently unsuccessful; our data suggest that surgeons should not be reluctant to perform splenectomy when initial repair attempts fail.

  J Fatima , T Schnelldorfer , J Barton , C. M Wood , H. J Wiste , T. C Smyrk , L Zhang , M. G Sarr , D. M Nagorney and M. B. Farnell

Objective  To assess the effect of R0 resection margin status and R0 en bloc resection in pancreatoduodenectomy outcomes.

Design  Retrospective medical record review.

Setting  Mayo Clinic, Rochester, Minnesota.

Patients  Patients who underwent pancreatoduodenectomy for pancreatic adenocarcinoma at our institution between January 1, 1981, and December 31, 2007, were identified and their medical records were reviewed.

Main Outcome Measure  Median survival times.

Results  A total of 617 patients underwent pancreatoduodenectomy. Median survival times after R0 en bloc resection (n = 411), R0 non–en bloc resection (n = 57), R1 resection (n = 127), and R2 resection (n = 22) were 19, 18, 15, and 10 months, respectively (P < .001). A positive resection margin was associated with death (P = .01). No difference in survival time was found between patients undergoing R0 en bloc and R0 resections after reexcision of an initial positive margin (hazard ratio, 1.19; 95% confidence interval, 0.87-1.64; P = .28).

Conclusions  R0 resection remains an important prognostic factor. Achieving R0 status by initial en bloc resection or reexcision results in similar long-term survival.

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