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Articles by S Gallinger
Total Records ( 2 ) for S Gallinger
  A. K Sahajpal , S. C Chow , E Dixon , P. D Greig , S Gallinger and A. C. Wei
 

Objectives  To report on a large experience with laparoscopic cholecystectomy–associated bile duct injuries (LC-BDIs) and examine factors influencing outcomes.

Design  A retrospective medical record review. Univariate statistical analysis was used to identify risk factors for postoperative complications.

Setting  Two university-affiliated hospitals.

Patients  Sixty-nine patients who underwent surgical repair of LC-BDI between January 1, 1992, and December 31, 2007.

Main Outcome Measures  Outcomes following repair of LC-BDI, relationship between timing of LC-BDI repair and outcomes, complications, and long-term results following LC-BDI repair.

Results  Thirteen immediate repairs (0-72 hours post-LC), 34 intermediate repairs (72 hours-6 weeks), and 22 late repairs (>6 weeks) were performed. The LC-BDIs were Strasberg type A in 1 patient (1%), D in 2 patients (3%), E1 in 22 patients (32%), E2 in 16 patients (23%), E3 in 22 patients (32%), E4 in 4 patients (6%), and E5 in 2 patients (3%). Forty-one hepaticojejunostomies (59%), 24 choledochojejunostomies (35%), 3 right hepatic hepatectomies with biliary reconstruction (4%), and 1 primary common bile duct repair (1%) were performed. The overall morbidity rate was 30% (21 patients). The mortality rate was 1% (1 patient). Twelve patients (17%) developed short-term postoperative complications. There were no factors found to be associated with early postoperative morbidity. The most common long-term complication was biliary stricture, which occurred in 10 patients (14%). Patients whose BDIs were repaired in the intermediate period were more likely to develop biliary stricture than patients with repairs performed in the immediate or late periods (P = .03).

Conclusions  Our results suggest that the timing of LC-BDI repair is an important determinant of long-term outcome. Repairs in the intermediate period were significantly associated with biliary stricture. Thus, repairs should be undertaken either in the immediate (0-72 hours) or delayed (>6 weeks) periods after LC.

  P. T Campbell , E. T Jacobs , C. M Ulrich , J. C Figueiredo , J. N Poynter , J. R McLaughlin , R. W Haile , E. J Jacobs , P. A Newcomb , J. D Potter , L Le Marchand , R. C Green , P Parfrey , H. B Younghusband , M Cotterchio , S Gallinger , M. A Jenkins , J. L Hopper , J. A Baron , S. N Thibodeau , N. M Lindor , P. J Limburg , M. E Martinez and for the Colon Cancer Family Registry
  Background

Being overweight or obese is an established risk factor for colorectal cancer, more so for men than for women. Approximately 10%–20% of colorectal tumors display microsatellite instability (MSI), defined as the expansion or contraction of small repeated sequences in the DNA of tumor tissue relative to nearby normal tissue. We evaluated associations between overweight or obesity and colorectal cancer risk, overall and by tumor MSI status.

Methods

The study included 1794 case subjects with incident colorectal cancer who were identified through population-based cancer registries and 2684 of their unaffected sex-matched siblings as control subjects. Recent body mass index (BMI), BMI at age 20 years, and adult weight change were derived from self-reports of height and weight. Tumor MSI status, assessed at as many as 10 markers, was obtained for 69.7% of the case subjects and classified as microsatellite (MS)-stable (0% of markers unstable; n = 913), MSI-low (>0% but <30% of markers unstable; n = 149), or MSI-high (≥30% of markers unstable; n = 188). Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). All statistical tests were two-sided.

Results

Recent BMI, modeled in 5 kg/m2 increments, was positively associated with risk of colorectal cancer for men and women combined (OR = 1.24; 95% CI = 1.15 to 1.34), for women only (OR = 1.20; 95% CI = 1.10 to 1.32), and for men only (OR = 1.30; 95% CI = 1.15 to 1.47). There was no interaction with sex (P = .22). Recent BMI, per 5 kg/m2, was positively associated with the risk of MS-stable (OR = 1.38; 95% CI = 1.24 to 1.54) and MSI-low (OR = 1.33; 95% CI = 1.04 to 1.72) colorectal tumors, but not with the risk of MSI-high tumors (OR = 1.05; 95% CI = 0.84 to 1.31).

Conclusion

The increased risk of colorectal cancer associated with a high BMI might be largely restricted to tumors that display the more common MS-stable phenotype, suggesting further that colorectal cancer etiology differs by tumor MSI status.

 
 
 
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