James D Luketich

University of Pittsburgh, Pittsburgh, Pennsylvania, United States

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Publications (470)1997.59 Total impact

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    ABSTRACT: Background A suggested benefit of sublobar resection for stage I non-small cell lung cancer (NSCLC) compared to lobectomy is a relative preservation of pulmonary function. Very little objective data exist, however, supporting this supposition. We sought to evaluate the relative impact of both anatomic segmental and lobar resection on pulmonary function in patients with resected clinical stage I NSCLC. Methods The records of 159 disease-free patients who underwent anatomic segmentectomy (n = 89) and lobectomy (n = 70) for the treatment of stage I NSCLC with pre- and postoperative pulmonary function tests performed between 6 to 36 months after resection were retrospectively reviewed. Changes in forced expiratory volume in one second (FEV1) and diffusion capacity of carbon monoxide (DLCO) were analyzed based upon the number of anatomic pulmonary segments removed: 1–2 segments (n = 77) or 3–5 segments (n = 82). Results Preoperative pulmonary function was worse in the lesser resection cohort (1–2 segments) compared to the greater resection group (3–5 segments) (FEV1(%predicted): 79% vs. 85%, p = 0.038; DLCO(%predicted): 63% vs. 73%, p = 0.010). A greater decline in FEV1 was noted in patients undergoing resection of 3–5 segments (FEV1 (observed): 0.1 L vs. 0.3 L, p = 0.003; and FEV1 (% predicted): 4.3% vs. 8.2%, p = 0.055). Changes in DLCO followed this same trend (DLCO(observed): 1.3 vs. 2.4 mL/min/mmHg, p = 0.015; and DLCO(% predicted): 3.6% vs. 5.9%, p = 0.280). Conclusions Parenchymal-sparing resections resulted in better preservation of pulmonary function at a median of one year, suggesting a long-term functional benefit with small anatomic segmental resections (1–2 segments). Prospective studies to evaluate measurable functional changes, as well as quality of life, between segmentectomy and lobectomy with a larger patient cohort appear justified.
    Journal of Cardiothoracic Surgery 12/2015; 10(1). DOI:10.1186/s13019-015-0253-6 · 1.03 Impact Factor
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    ABSTRACT: Background: Thoracic esophageal diverticula are uncommon, and controversies exist regarding their management. The objective of this study was to evaluate the outcomes of a relatively large cohort of patients with thoracic esophageal diverticula treated with minimally invasive surgical techniques. Methods: We conducted a retrospective review of patients who underwent minimally invasive surgical treatment for symptomatic esophageal diverticula during a 15-year period. The primary end point was 30-day mortality. In addition, we evaluated the morbidity, improvement in dysphagia (score: 1, best to 5, worst), and quality of life (Gastroesophageal Reflux Disease-Health-Related Quality of Life score: 0, best to 50, most symptoms). Results: Fifty-seven patients underwent minimally invasive surgical treatment of symptomatic thoracic esophageal diverticula. The most common symptom was dysphagia (45 of 57; 79%). A motility disorder or distal mechanical obstruction was identified in 49 patients (86%). Approaches used included video-assisted thoracoscopic surgery (n = 33), laparoscopy (n = 18), and combined video-assisted thoracoscopic surgery and laparoscopy (n = 6). The most common procedure performed was diverticulectomy and myotomy (47 of 57 patients; 82.5%). The 30-day mortality was 0%. There were 4 patients (7%) with postoperative leaks requiring reoperation. During follow-up, the median dysphagia score improved from 3 to 1 (p < 0.001). The median Gastroesophageal Reflux Disease-Health-Related Quality of Life score after surgery was 5 (excellent). Conclusions: A minimally invasive surgical approach for the management of thoracic esophageal diverticula is safe and effective during intermediate-term follow-up when performed by surgeons experienced in esophageal surgery and minimally invasive techniques. Further follow-up is required to assess the durability of these results. The optimal approach and procedures performed should be determined on an individualized basis after a thorough investigation.
    The Annals of thoracic surgery 09/2015; DOI:10.1016/j.athoracsur.2015.04.122 · 3.85 Impact Factor
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    ABSTRACT: Background: A significant number of patients have recurrent or persistent lung cancer despite complete resection or treatment with definitive chemoradiation. Stereotactic radiosurgery (SRS)/stereotactic body radiation therapy is emerging as an important modality for the treatment of early-stage lung neoplasm; SRS may also offer an alternative treatment option for patients with recurrent lung disease. We evaluated outcomes after treatment with SRS for recurrent lung neoplasm in a large series of patients. Methods: Selected patients with limited recurrent, persistent, or progressive disease after one or more prior treatments for lung cancer were offered SRS. Thoracic surgeons evaluated all patients, placed fiducials when needed, and planned treatment in close collaboration with radiation oncologists and medical physicists. In our early experience, a single fraction of 20 Gy radiation was prescribed and was subsequently increased to 45 to 60 Gy in three to five fractions. The primary endpoint evaluated was overall survival. Results: We treated 100 patients with recurrent lung cancer (median age 72 years) with SRS. The postprocedure 30-day mortality rate was 0%; median follow-up was 51 months (range, 5 to 123). The median overall survival for the entire group was 23 months (95% confidence interval: 19 to 41). The probability of 2-year and 5-year overall survival was 49% (95% confidence interval: 40% to 60%) and 31% (95% confidence interval: 23% to 43%), respectively. Conclusions: Our experience indicates that SRS is safe, and offers an alternative modality for selected patients with recurrent oligometastatic or persistent lung cancer. Thoracic surgeons should actively participate in SRS and continue to evaluate the efficacy of this treatment strategy.
    The Annals of thoracic surgery 09/2015; DOI:10.1016/j.athoracsur.2015.04.113 · 3.85 Impact Factor
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    ABSTRACT: Objectives: Accurate cancer localization and negative resection margins are necessary for successful segmentectomy. In this study, we evaluate a newly developed software package that permits automated segmentation of the pulmonary parenchyma, allowing 3-dimensional assessment of tumor size, location, and estimates of surgical margins. Methods: A pilot study using a newly developed 3-dimensional computed tomography analytic software package was performed to retrospectively evaluate preoperative computed tomography images of patients who underwent segmentectomy (n = 36) or lobectomy (n = 15) for stage 1 non-small cell lung cancer. The software accomplishes an automated reconstruction of anatomic pulmonary segments of the lung based on bronchial arborization. Estimates of anticipated surgical margins and pulmonary segmental volume were made on the basis of 3-dimensional reconstruction. Results: Autosegmentation was achieved in 72.7% (32/44) of preoperative computed tomography images with slice thicknesses of 3 mm or less. Reasons for segmentation failure included local severe emphysema or pneumonitis, and lower computed tomography resolution. Tumor segmental localization was achieved in all autosegmented studies. The 3-dimensional computed tomography analysis provided a positive predictive value of 87% in predicting a marginal clearance greater than 1 cm and a 75% positive predictive value in predicting a margin to tumor diameter ratio greater than 1 in relation to the surgical pathology assessment. Conclusions: This preoperative 3-dimensional computed tomography analysis of segmental anatomy can confirm the tumor location within an anatomic segment and aid in predicting surgical margins. This 3-dimensional computed tomography information may assist in the preoperative assessment regarding the suitability of segmentectomy for peripheral lung cancers.
    The Journal of thoracic and cardiovascular surgery 08/2015; 150(3):523-8. DOI:10.1016/j.jtcvs.2015.06.051 · 4.17 Impact Factor
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    ABSTRACT: Outcomes data for high-risk donors (HRD) for transplantation are limited. We sought to elucidate the outcomes of lung transplant (LTx) recipients who received HRDs. We retrospectively reviewed the United Network for Organ Sharing (UNOS) registry from January 2005 to June 2013 to identify patients undergoing LTx. The Student t test and χ(2) test were used to identify differences in outcomes. A Cox proportional hazard model was developed to identify independent predictors of outcomes for HRD recipients. We identified 12,737 patients who underwent LTx. A total of 999 (7.8%) recipients received allografts from HRDs. Recipients in both the HRD and the non-HRD (NHRD) groups were similar. The HRDs had significantly higher rates of negative social behaviors and were likely to be thin young males who had died traumatically. Survival analysis demonstrated no survival benefit for patients receiving allografts from NHRDs (p = 0.63). Interestingly, HRDs did not have significantly higher viral loads, including hepatitis C virus (HCV) antibody, hepatitis B core antibody (HBcV), or hepatitis B surface antigen. When controlling for age, sex, and lung allocation score of the recipient, HRD status was not significantly detrimental to survival. Recipients receiving allografts from HRDs had at least equivalent survival to NHRD recipients. Our study supports the use of high-risk donation given limited resources. Centers interested in using these donors should educate prospective recipients willing to consider this option. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    The Annals of thoracic surgery 08/2015; DOI:10.1016/j.athoracsur.2015.05.065 · 3.85 Impact Factor
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    ABSTRACT: Staging for esophagogastric adenocarcinoma lacked sufficient prognostic accuracy and was revised. We compared survival prognostication between American Joint Committee on Cancer (AJCC) 6th and 7th editions. We abstracted data for 836 patients who underwent minimally invasive esophagectomy for esophagogastric adenocarcinoma (n = 256 neoadjuvant). Monotonicity and strength of survival trends, by stage, were assessed (log-rank test of trend chi-square statistic) and compared using permutation testing. Overall survival (Cox regression) and model fit (Akaike Information Criterion) were determined. A greater log-rank test of trend statistic indicated stronger survival trends by stage in AJCC 7th (152.872 vs 167.623; permutation test P < .001) edition. Greater Cox likelihood chi-square value (162.957 vs 173.951) and lower Akaike Information Criterion (4,831.011 vs 4,820.016) indicated better model fit. Superior performance was also shown after neoadjuvant therapy. AJCC 7th edition staging for esophagogastric adenocarcinoma provides superior prognostic stratification after minimally invasive esophagectomy, overall and after neoadjuvant therapy compared with AJCC 6th edition. Copyright © 2015 Elsevier Inc. All rights reserved.
    American journal of surgery 06/2015; DOI:10.1016/j.amjsurg.2015.05.010 · 2.29 Impact Factor
  • K. Noda · S. Haam · J. D’Cunha · J.D. Luketich · C.A. Bermudez · N. Shigemura
    The Journal of Heart and Lung Transplantation 04/2015; 34(4):S266-S267. DOI:10.1016/j.healun.2015.01.745 · 6.65 Impact Factor
  • K. Noda · S. Haam · J. D’Cunha · J.D. Luketich · C.A. Bermudez · N. Shigemura
    The Journal of Heart and Lung Transplantation 04/2015; 34(4):S149. DOI:10.1016/j.healun.2015.01.400 · 6.65 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-1139. DOI:10.1016/S0016-5085(15)33884-1 · 16.72 Impact Factor
  • The Journal of Heart and Lung Transplantation 04/2015; 34(4):S249. DOI:10.1016/j.healun.2015.01.690 · 6.65 Impact Factor
  • Gastroenterology 04/2015; 148(4):S-134. DOI:10.1016/S0016-5085(15)30463-7 · 16.72 Impact Factor
  • K. Noda · S. Haam · J. D’Cunha · J.D. Luketich · C.A. Bermudez · N. Shigemura
    The Journal of Heart and Lung Transplantation 04/2015; 34(4):S268. DOI:10.1016/j.healun.2015.01.749 · 6.65 Impact Factor
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    ABSTRACT: The lungs are dually perfused by the pulmonary artery and the bronchial arteries. This study aimed to test the feasibility of dual-perfusion techniques with the bronchial artery circulation and pulmonary artery circulation synchronously perfused using ex vivo lung perfusion (EVLP) and evaluate the effects of dual-perfusion on posttransplant lung graft function. Using rat heart-lung blocks, we developed a dual-perfusion EVLP circuit (dual-EVLP), and compared cellular metabolism, expression of inflammatory mediators, and posttransplant graft function in lung allografts maintained with dual-EVLP, standard-EVLP, or cold static preservation. The microvasculature in lung grafts after transplant was objectively evaluated using microcomputed tomography angiography. Lung grafts subjected to dual-EVLP exhibited significantly better lung graft function with reduced proinflammatory profiles and more mitochondrial biogenesis, leading to better posttransplant function and compliance, as compared with standard-EVLP or static cold preservation. Interestingly, lung grafts maintained on dual-EVLP exhibited remarkably increased microvasculature and perfusion as compared with lungs maintained on standard-EVLP. Our results suggest that lung grafts can be perfused and preserved using dual-perfusion EVLP techniques that contribute to better graft function by reducing proinflammatory profiles and activating mitochondrial respiration. Dual-EVLP also yields better posttransplant graft function through increased microvasculature and better perfusion of the lung grafts after transplantation. © Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
    American Journal of Transplantation 03/2015; 15(5). DOI:10.1111/ajt.13109 · 5.68 Impact Factor
  • Ryan A Macke · Tyler Foxwell · James D Luketich · Katie S Nason
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    ABSTRACT: Development of a tracheopharyngeal fistula after pharyngeal perforation is an uncommon occurrence. As a result, published guidance for management of this rare type of aerodigestive tract fistula is limited. We describe the workup and management of a traumatic tracheopharyngeal fistula caused by foreign body impaction. A conservative, endoscopic treatment strategy with broad-spectrum antibiotics, transnasal drainage, and covered tracheal stent placement was used. The stent was removed after 4 weeks, and complete closure of the fistula tract was confirmed by endoscopy and contrast esophagram. Although tracheopharyngeal fistulae are rare and operative treatment can be complex, this case demonstrates that conservative management with antibiotics, drainage, and endoscopic stenting can be successful in select patients. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    The Annals of Thoracic Surgery 02/2015; 99(2):e31-e35. DOI:10.1016/j.athoracsur.2014.11.016 · 3.85 Impact Factor
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    ABSTRACT: Previously regarded as a rare neoplasm, the incidence of esophageal adenocarcinoma has risen rapidly in recent decades. It is often discovered late in the disease process and has a dismal prognosis. Current prognostic markers including clinical, radiographic, and histopathologic findings have limited utility and do not consider the biology of this deadly disease. Genome-wide analyses have identified SMAD4 inactivation in a subset of tumors. Although Smad4 has been extensively studied in other gastrointestinal malignancies, its role in esophageal adenocarcinoma remains to be defined. Herein, we show, in a large cohort of esophageal adenocarcinomas, Smad4 loss by immunohistochemistry in 21 of 205 (10%) tumors and that Smad4 loss correlated with increased postoperative recurrence (P=0.040). Further, patients whose tumors lacked Smad4 had shorter time to recurrence (TTR) (P=0.007) and poor overall survival (OS) (P=0.011). The median TTR and OS of patients with Smad4-negative tumors was 13 and 16 months, respectively, as compared with 23 and 22 months, respectively, among patients with Smad4-positive tumors. In multivariate analyses, Smad4 loss was a prognostic factor for both TTR and OS, independent of histologic grade, lymphovascular invasion, perineural invasion, tumor stage, and lymph node status. Considering Smad4 loss correlated with postoperative locoregional and/or distant metastases, Smad4 was also assessed in a separate cohort of 5 locoregional recurrences and 43 metastatic esophageal adenocarcinomas. In contrast to primary tumors, a higher prevalence of Smad4 loss was observed in metastatic disease (44% vs. 10%). In summary, loss of Smad4 protein expression is an independent prognostic factor for TTR and OS that correlates with increased propensity for disease recurrence and poor survival in patients with esophageal adenocarcinoma after surgical resection.
    American Journal of Surgical Pathology 01/2015; 39(4). DOI:10.1097/PAS.0000000000000356 · 5.15 Impact Factor
  • Arjun Pennathur · William E Gooding · Katie S Nason · James D Luketich
    Annals of Surgery 01/2015; DOI:10.1097/SLA.0000000000000864 · 8.33 Impact Factor
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    ABSTRACT: The primary aim of this trial was to assess the feasibility of minimally invasive esophagectomy (MIE) in a multi-institutional setting. Esophagectomy is an important, potentially curative treatment for localized esophageal cancer, but is a complex operation. MIE may decrease the morbidity and mortality of resection, and single-institution studies have demonstrated successful outcomes with MIE. We conducted a multicenter, phase II, prospective, cooperative group study (coordinated by the Eastern Cooperative Oncology Group) to evaluate the feasibility of MIE. Patients with biopsy-proven high-grade dysplasia or esophageal cancer were enrolled at 17 credentialed sites. Protocol surgery consisted of either 3-stage MIE or Ivor Lewis MIE. The primary end point was 30-day mortality. Secondary end points included adverse events, duration of hospital-stay, and 3-year outcomes. Protocol surgery was completed in 95 of the 104 patients eligible for the primary analysis (91.3%). The 30-day mortality in eligible patients who underwent MIE was 2.1%; perioperative mortality in all registered patients eligible for primary analysis was 2.9%. Median intensive care unit and hospital stay were 2 and 9 days, respectively. Grade 3 or higher adverse events included anastomotic leak (8.6%), acute respiratory distress syndrome (5.7%), pneumonitis (3.8%), and atrial fibrillation (2.9%). At a median follow-up of 35.8 months, the estimated 3-year overall survival was 58.4% (95% confidence interval: 47.7%-67.6%). Locoregional recurrence occurred in only 7 patients (6.7%). This prospective multicenter study demonstrated that MIE is feasible and safe with low perioperative morbidity and mortality and good oncological results. This approach can be adopted by other centers with appropriate expertise in open esophagectomy and minimally invasive surgery.
    Annals of surgery 01/2015; 261(4). DOI:10.1097/SLA.0000000000000993 · 8.33 Impact Factor
  • Journal of Thoracic and Cardiovascular Surgery 12/2014; 149(4). DOI:10.1016/j.jtcvs.2014.12.029 · 4.17 Impact Factor
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    ABSTRACT: Undifferentiated carcinoma of the esophagus is a rare histologic variant of esophageal carcinoma. Using criteria based on studies of undifferentiated carcinomas arising at other sites, we have collected 16 cases of resected esophageal undifferentiated carcinomas. Patients ranged in age from 39 to 84 years (mean, 65.5 years) and were predominantly male (94%). The tumors were characterized by an expansile growth pattern of neoplastic cells organized in solid sheets and without significant glandular, squamous, or neuroendocrine differentiation. The neoplastic cells had a syncytial-like appearance, little intervening stroma, and patchy tumor necrosis. In a subset of cases, the tumor cells adopted a sarcomatoid (n = 2), rhabdoid (n = 1), or minor component (<5%) of glandular morphology (n = 3). In 1 case, reactive osteoclast-like giant cells were found interspersed among the neoplastic cells. Lymphovascular invasion, perineural invasion, and lymph node metastases were identified in 88%, 56%, and 81% of cases, respectively. In 12 (75%) specimens, the background esophageal mucosa was notable for Barrett esophagus. Consistent with the epithelial nature of these neoplasms, cytokeratin positivity was identified in all cases. In addition, SALL4 expression was present in 8 (67%) of 12 cases. Follow-up information was available for 15 (94%) of 16 patients, all of whom were deceased. Survival after surgery ranged from 1 to 50 months (mean, 11.9 months). Before death, 67% patients had documented locoregional recurrence and/or distant organ metastases. In summary, esophageal undifferentiated carcinomas are aggressive neoplasms and associated with a high incidence of recurrence and/or metastases and a dismal prognosis. Copyright © 2014 Elsevier Inc. All rights reserved.
    Human pathology 12/2014; 46(3). DOI:10.1016/j.humpath.2014.11.021 · 2.77 Impact Factor
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    ABSTRACT: Intractable gastroesophageal reflux disease (GERD) after antireflux operations presents a challenge-particularly in obese patients and patients with esophageal dysmotility-and increases the complexity of the redo operation. This study evaluated the results of Roux-en-Y near esophagojejunostomy (RNYNEJ) in the management of recurrent GERD after antireflux operations. We conducted a retrospective review of overweight patients with intractable GERD who underwent RNYNEJ for failed antireflux operations. We evaluated perioperative outcomes, dysphagia (ranging from 1 = no dysphagia to 5 = unable to swallow saliva), and quality of life (QOL) (assessed using the GERD health-related quality-of-life instrument (HRQOL). Over a 12-year period, 105 patients with body mass index (BMI) greater than 25 underwent RNYNEJ for failed antireflux operations. Most were obese (BMI > 30; 82 patients [78%]); esophageal dysmotility was demonstrated in more than one-third of patients. Forty-eight (46%) patients had multiple antireflux operations before RNYNEJ, and 27 patients had undergone a previous Collis gastroplasty. There was no perioperative mortality. Major complications, including anastomotic leak requiring surgical intervention (n = 3 [2.9%]), were noted in 25 patients (24%).The median length of stay was 6 days. During follow-up (mean, 23.39 months), median BMI decreased from 35 to 27.6 (p < 0.0001), and the mean dysphagia score decreased from 2.9 to 1.5 (p < 0.0001). The median GERD HRQOL score, assessed in a subset of patients, was 9 (classified as excellent). RNYNEJ for persistent GERD after antireflux operations in appropriately selected patients can be performed safely with good results in experienced centers. RNYNEJ should be considered an important option for the treatment of intractable recurrent symptoms after antireflux operations, particularly in obese patients. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
    The Annals of Thoracic Surgery 12/2014; 98(6):1905-13. DOI:10.1016/j.athoracsur.2014.07.004 · 3.85 Impact Factor

Publication Stats

11k Citations
1,997.59 Total Impact Points


  • 1996–2015
    • University of Pittsburgh
      • • Department of Cardiothoracic Surgery
      • • Department of Thoracic and Foregut Surgery
      • • Division of Trauma and General Surgery
      • • Department of Surgery
      • • Department of Radiology
      Pittsburgh, Pennsylvania, United States
  • 2014
    • University of Queensland
      Brisbane, Queensland, Australia
  • 2013
    • UPMC
      Pittsburgh, Pennsylvania, United States
  • 2011
    • Oregon Health and Science University
      Portland, Oregon, United States
  • 2008
    • University of Texas MD Anderson Cancer Center
      • Division of Radiation Oncology
      Houston, Texas, United States
  • 2007
    • Shadyside Hospital
      Pittsburgh, Pennsylvania, United States
    • Mount Sinai School of Medicine
      • Department of Pathology
      Manhattan, New York, United States
    • Boston University
      Boston, Massachusetts, United States
    • Childrens Hospital of Pittsburgh
      Pittsburgh, Pennsylvania, United States
  • 2006
    • Medical University of South Carolina
      • Department of Surgery
      Charleston, SC, United States
  • 2005
    • Nevada cancer institute
      Las Vegas, Nevada, United States
  • 2004–2005
    • University of California, Irvine
      • Department of Surgery
      Irvine, CA, United States
    • Allegheny General Hospital
      Pittsburgh, Pennsylvania, United States
  • 2001
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
  • 2000
    • California State University, Sacramento
      Sacramento, California, United States
    • Pennsylvania State University
      • Department of Biology
      University Park, Maryland, United States
  • 1990–1998
    • Hospital of the University of Pennsylvania
      • Department of Surgery
      Filadelfia, Pennsylvania, United States
  • 1993–1997
    • Memorial Sloan-Kettering Cancer Center
      • Department of Surgery
      New York, New York, United States