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Articles by R Dematteo
Total Records ( 4 ) for R Dematteo
  N Kemeny , M Capanu , M D'Angelica , W Jarnagin , D Haviland , R Dematteo and Y. Fong
 

Background: The purpose of the study was to determine the maximum tolerated dose of systemic oxaliplatin (oxal), 5-fluorouracil (5-FU) and leucovorin (LV) that could be administered with hepatic arterial infusion (HAI) of floxuridine (FUDR) and dexamethasone (Dex) in the adjuvant setting after hepatic resection.

Methods: Thirty-five patients with resected liver metastases were entered into a phase I trial using HAI FUDR/Dex with escalating doses of oxal and 5-FU.

Results: The initial dose of HAI FUDR was fixed at 0.12 mg/kg x pump volume divided by pump flow rate plus Dex infused over the first 2 weeks of a 5-week cycle. Systemic chemotherapy was delivered on days 15 and 29 with the doses of oxal escalated from 85 to 100 mg/m2 and the 5-FU 48-h continuous infusion doses from 1000 to 2000 mg/m2. The LV dose was fixed at 400 mg/m2. Dose-limiting toxic effects were diarrhea, 8.5%, and elevated bilirubin, 8.5%. With a median follow-up of 43 months, the 4-year survival and progression-free survival were 88% and 50%, respectively.

Conclusions: Adjuvant therapy after liver resection with HAI FUDR/Dex plus systemic oxal at 85 mg/m2 and 5-FU by continuous infusion at 2000 g/m2 with LV at 400 mg/m2 is feasible and appears effective. Randomized studies comparing this regimen to systemic FOLFOX are suggested.

  D Correa , L Schwartz , W. R Jarnagin , S Tuorto , R DeMatteo , M D'Angelica , P Allen , K Brown and Y. Fong
 

Objective  To determine the time course of liver hypertrophy after portal vein embolization (PVE).

Design  In a cohort study, computed tomography volumetrics were calculated for livers during a 1-year period after PVE.

Setting  Tertiary liver cancer treatment center.

Patients  Ten patients who were subjected to PVE and were found subsequently to not be candidates for liver resection.

Intervention  Right PVE.

Main Outcome Measures  Left and right liver volumes.

Results  The left liver continued growing for the entire first year after PVE, while the right liver continued to atrophy. The total volume remained remarkably constant.

Conclusion  Early PVE during administration of a course of neoadjuvant therapy would be beneficial for enhanced growth of the liver before liver resection.

  K Morris , S Tuorto , M Gonen , L Schwartz , R DeMatteo , M D'Angelica , W. R Jarnagin and Y. Fong
 

Objective  To assess the effect of increasing body mass index, intra-abdominal fat, and outer abdominal fat on outcome in patients undergoing major hepatectomy.

Design  Cohort study.

Setting  Memorial Sloan-Kettering Cancer Center.

Participants  We studied patients aged 19 to 86 years undergoing major hepatic resection between June 18, 1996, and November 6, 2001. Complications were extracted from a prospective database at a tertiary cancer center.

Intervention  A total of 349 patients were grouped according to body mass index for analysis. Preoperative abdominal computed tomographic scans were examined and measurements of perinephric fat (as a surrogate for intra-abdominal fat) and outer abdominal fat taken at uniform anatomical locations.

Main Outcome Measures  We compared 30-day mortality and morbidity figures, length of stay, and operating times.

Results  Body mass index had an influence on operative time (P = .02) but no significant effect on mortality, frequency of any complications, frequency of severe complications, or length of stay (P = .80, P = .89, P = .16, and P = .81, respectively). Outer abdominal fat had no significant effect on any of the 5 outcome measures. Perinephric fat measurements had a significant effect on most outcome measures (P = .004 for mortality, P = .003 for frequence of complications, P < .001 for frequence of severe complications, and P = .001 for length of stay).

Conclusions  Outer appearances of obesity do not correlate with poor outcomes for major upper abdominal operations. A simple measurement of perinephric fat, as a surrogate for intra-abdominal fat, on preoperative imaging gives a more useful risk assessment for patients undergoing major upper abdominal operations.

 
 
 
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