Emad Kandil

Tulane University, New Orleans, Louisiana, United States

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Publications (208)450.14 Total impact

  • Salem I Noureldine · Emad Kandil · Ralph P. Tufano ·
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    ABSTRACT: Primary thyroid lymphoma (PTL) is an uncommon tumor, accounting for 1–5 % of all thyroid malignancies. The clinical and pathologic spectrum of this thyroid lymphoproliferative disorder is diverse and must be differentiated from benign lymphocytic thyroiditis and thyroid cancer. Patients with chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) have a 67-to 80-fold increased risk of developing PTL. The most common clinical presentation includes a rapidly enlarging neck mass; however, patients may also present with symptoms of hoarseness, dysphagia, and dyspnea. This abrupt clinical presentation also raises the possibility of a soft tissue abscess or infection of the neck, hemorrhage into a benign thyroid nodule, subacute thyroiditis, anaplastic thyroid carcinoma, or metastatic cancer. Therefore, immediate diagnostic discrimination is needed due to the significant differences in therapy. The histopathologic interpretation requires an adequate tissue sample and proper cytopathologic interpretation. The recent delineation of the pathological entities of extranodal lymphomas has brought about a better understanding of the biologic behavior and clinical course of these tumors, and this has helped in defining treatment plans. Because PTL is typically responsive to both radiation and chemotherapy, the role of surgery is limited. The combination chemotherapy regimen usually consists of cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP). Rituximab is used as first-line therapy both in MALT and in DLBCL patients in combination with CHOP (R-CHOP regimen) and other anthracycline-based or anthracycline-free chemotherapy regimens. The survival rates range from 13 to 92 % at 5 years.
    Thyroid Cancer, Edited by David S. Cooper, Cosimo Durante, 11/2016: pages 403-410; Springer., ISBN: 978-3-319-22401-5
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    ABSTRACT: Importance: Incidence of thyroidectomies is continuing to increase. Identifying factors associated with favorable outcomes can lead to cost savings. Objective: To assess the association of surgeon volume with clinical outcomes and costs of thyroidectomy. Design, setting, and participants: Cross-sectional analysis performed in October of 2014 of adult (≥18 years) inpatients in US community hospitals using the Nationwide Inpatient Sample for the years 2003 through 2009. Exposures: Thyroidectomy. Main outcomes and measures: Complications, length of stay, and cost following thyroidectomy in relation to surgeon volume. Surgeon volumes were stratified into low (1-3 thyroidectomies per year), intermediate (4-29 thyroidectomies per year), and high (≥30 thyroidectomies per year). Results: A total of 77 863 patients were included. Procedures performed by low-volume surgeons were associated with a higher risk of postoperative complications compared with high-volume surgeons (15.8% vs 7.7%; OR, 1.55 [95% CI, 1.19-2.03]; P = .001). Mean (SD) hospital cost was significantly associated with surgeon volume (high volume, $6662.69 [$409.31]; intermediate volume, $6912.41 [$137.20]; low volume, $10 396.21 [$345.17]; P < .001). During the study period, if all operations performed by low-volume surgeons had been selectively referred to intermediate- or high-volume surgeons, savings of 11.2% or 12.2%, respectively, would have been incurred. On the basis of the cost growth rate, greater savings are forecasted for high-volume surgeons. With a conservative assumption of 150 000 thyroidectomies per year in the United States, referral of all patients to intermediate- or high-volume surgeons would produce savings of $2.08 billion or $3.11 billion, respectively, over a span of 14 years. Conclusions and relevance: A surgeon's expertise (measured by surgical volume of procedures per year) is associated with favorable clinical as well as financial outcomes. Our model estimates that considerable cost savings are attainable if higher-volume surgeons perform thyroid procedures in the United States.
    JAMA Otolaryngology - Head and Neck Surgery 11/2015; DOI:10.1001/jamaoto.2015.2503 · 1.79 Impact Factor
  • Adam Hauch · Zaid Al-Qurayshi · Emad Kandil ·
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    ABSTRACT: Background: Disparities following different operations exist. We seek to measure the effects of race/ethnicity and socioeconomic status on outcomes following adrenal surgery. Methods: Cross-sectional analysis of adrenal operations identified in the Nationwide Inpatient Sample (NIS) from 2003 to 2009. Results: A total of 7,537 procedures were included. Operations by high-volume surgeons had shorter length of stay (LOS) (3.4 days vs. 5.2 days, P < 0.001) and fewer complications (11.6% vs. 16.7%, P < 0.001). Hispanics were more likely to be operated on by low-volume surgeons [OR: 2.17, 95%CI: (1.33, 3.55)]. There were significant differences in LOS and cost among races/ethnicities, income categories, and insurance types (P < 0.05). Hispanics had longer LOS compared to Whites (P = 0.002) and their management was associated with a higher cost ($20,754.00 ± 1,478.40). Patients with either Medicaid [OR: 1.70, 95%CI: (1.30, 2.22)] or Medicare [OR: 1.86, 95%CI: (1.36, 2.54)] were more likely to have a LOS >5 days. Conclusions: Racial and socioeconomic disparities exist; however, they are not solely related to access. A complex interplay between various racial, cultural, and socioeconomic factors likely influence outcomes in adrenal surgery. J. Surg. Oncol. © 2015 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 11/2015; DOI:10.1002/jso.24082 · 3.24 Impact Factor
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    ABSTRACT: Background. Robotic surgery has been recently used as a novel tool for remote access thyroid surgery. We performed a meta-analysis of the current literature to examine the safety and oncological efficacy of robotic surgery compared to endoscopic and conventional approaches for different thyroid procedures. Methods. A systematic search of the online data bases was done using the following (MeSH) terms “robotic surgery,” “robotic thyroidectomy,” “robot-assisted thyroidectomy,” and “robot-assisted thyroid surgery.” Outcomes measured included total operative time, length of hospital stay, postoperative thyroglobulin levels, and postoperative complications. Statistical differences were analyzed between groups through the standard means and/or relative risk by using STATA analytical software. Results. In this study, 144 articles were identified; of which 18 of them met our inclusion criteria, totaling 4878 patients. Robotic approach was associated with longer total operative time (mean difference of 43.5 minutes) when compared to the conventional cervical approach (95% CI = 20.9-66.2; P < .001). Robotic approach was also found to have a similar risk of total postoperative complications when compared to the conventional and endoscopic approaches. Conclusion.Robotic thyroid surgery is as safe, feasible and provides similar perioperative complications and oncological outcomes when compared to both, conventional cervical and endoscopic approaches. However, robotic thyroid surgery is associated with longer operative time when compared to the conventional open approach
    Surgical Innovation 11/2015; DOI:10.1177/1553350615613451 · 1.46 Impact Factor
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    Emad Kandil · Ahmad Saeed · Joseph Buell ·

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    ABSTRACT: The patient was referred for management of a left adrenal incidentaloma. Preoperative CT scan and MRI showed focal calcification. Here we are presenting this video demonstrating robotic-assisted laparoscopic adrenalectomy for left adrenal mass.
    10/2015; 4(5):447-8. DOI:10.3978/j.issn.2227-684X.2015.05.05

  • Journal of the American College of Surgeons 10/2015; 221(4):S90. DOI:10.1016/j.jamcollsurg.2015.07.205 · 5.12 Impact Factor

  • Journal of the American College of Surgeons 10/2015; 221(4):e97. DOI:10.1016/j.jamcollsurg.2015.08.155 · 5.12 Impact Factor
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    Emad Kandil · Ahmad Saeed · Joseph Buell ·
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    ABSTRACT: Liver is the commonest site for metastasis in patients with neuroendocrine tumors (NETs); it occurs in 45-95% of patients. Available treatment options include surgical resection, liver transplantation, chemotherapy and biotherapy. Surgery is the gold standard for curative therapy. Typically, a multidisciplinary approach is a cornerstone for decision making while dealing with this aggressive disease. This review will focus on the performance and safety of open, laparoscopic, and liver transplant surgical approaches in NETs patients with liver metastases.
    10/2015; 4(5). DOI:10.3978/j.issn.2227-684X.2015.04.10
  • Zaid Al-Qurayshi · Emad Kandil ·

    Journal of the American College of Surgeons 10/2015; 221(4):e11. DOI:10.1016/j.jamcollsurg.2015.08.323 · 5.12 Impact Factor
  • Ahmed Deniwar · Emad Kandil · Gregory Randolph ·
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    ABSTRACT: Recurrent laryngeal nerve (RLN) injury is one of the most common complications of thyroid surgery. RLN injury can cause vocal cord paralysis, affecting the patient's voice and the quality of life. Injury of the external branch of the superior laryngeal nerve (EBSLN) can cause cricothyroid muscle denervation affecting high vocal tones. Thus, securing the laryngeal nerves in these surgeries is of utmost importance. Visual identification of the nerves has long been the standard method for this precaution. Intraoperative neuromonitoring (IONM) has been introduced as a novel technology to improve the protection of the laryngeal nerves and reduce the rate of RLN injury. The aim of this article is to provide a brief description of the technique and review the literature to illustrate the value of IONM. IONM can provide early identification of anatomical variations and unusual nerve routes, which carry a higher risk of injury if not detected. IONM helps in prognosticating postoperative nerve function. Moreover, by detecting nerve injury intraoperatively, it aids in staging bilateral surgeries to avoid bilateral vocal cord paralysis and tracheostomy. The article will discuss the value of continuous IONM (C-IOMN) that may prevent nerve injury by detecting EMG waveform changes indicating impending nerve injury. Herein, we are also discussing anatomy of laryngeal nerves and aspects of its injury.
    10/2015; 4(5):368-75. DOI:10.3978/j.issn.2227-684X.2015.04.04

  • Journal of the American College of Surgeons 10/2015; 221(4):e78. DOI:10.1016/j.jamcollsurg.2015.08.102 · 5.12 Impact Factor
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    ABSTRACT: Current advancement in robotic surgery has provided a safe, precise, 3-dimensional (3D) magnified dissection for parathyroid surgery without the need for CO2 insufflation, and with a better cosmetic outcome due to an invisible scar in the axillary or retroauricular region. Preoperative imaging studies that assist in the localization of lesions have been key elements in patients' selection for targeted parathyroid surgery.
    10/2015; 4(5):420-8. DOI:10.3978/j.issn.2227-684X.2015.04.09

  • Journal of the American College of Surgeons 10/2015; 221(4):S94. DOI:10.1016/j.jamcollsurg.2015.07.216 · 5.12 Impact Factor
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    ABSTRACT: Objectives/HypothesisSurgeon experience has been recognized in several clinical fields as a significant element of superior management outcomes. In this study, we seek to assess the association between surgeon volume and patients' community health status with the outcomes of thyroid and parathyroid surgery indicated for primary malignancies.Study DesignA cross-sectional study utilizing the State Inpatient Databases, 2010–2011, for Florida, New York, and Washington was merged with the County Health Rankings database.Methods International Classification of Diseases, Ninth Revision codes were used to identify adult (≥18 years) patients who underwent thyroidectomy or parathyroidectomy indicated for primary malignancies.ResultsA total of 6,347 records were included. Compared to high-volume surgeons, patients treated by low-volume surgeons were more likely to develop postoperative complications in the 1-month period after the operation (odds ratio: 4.34, 95% confidence interval: 3.31-5.70, P < .001). Furthermore, both low- and intermediate-volume surgeons were associated with a longer hospital stay (>2 days) and a higher risk of admission to the intensive care unit (P < .01 each). Cost of health services was significantly in the highest quartile (>$10,254.66) for patients treated by low-volume surgeons (P < .001). Patients who lived in communities of poor health measures had a higher risk of postoperative complications (16.3% vs. 11.8%, P = .030) independent of the clinical presentation and management type. Patients living in high health-risk communities and those of black and Hispanic backgrounds were more likely to be treated by low-volume surgeons (P < .001 each).Conclusions The surgeon's volume and the patient's living conditions are crucial and independent factors in multiple aspects of endocrine cancer management.Level of Evidence4 Laryngoscope, 2015
    The Laryngoscope 09/2015; DOI:10.1002/lary.25606 · 2.14 Impact Factor
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    ABSTRACT: Lithium treatment has been associated with hyperparathyroidism (HPT). However, there are conflicting data regarding the rate of single- (SGD) versus multiple-gland disease (MGD) as well as the optimum surgical approach in these cases. Published data were identified through systematic electronic literature searches. Studies that fulfilled the preset inclusion criteria were analyzed (n = 12). These studies documented 210 lithium-associated HPT (LAH) cases. Of these, 103 (49%) were due to SGD and 107 (51%) due to MGD. The unadjusted odds ratio of having multiple LAH compared to sporadic HPT was 3.44 (95% confidence interval 2.5907-4.5633; p < 0.0001). The sensitivity of preoperative sestamibi and sonography for SGD was 66-100 and 75-82%, respectively. The sensitivity for MGD was 9-67% for both. Intraoperative parathyroid hormone monitoring was utilized in 6 studies. Three studies recommended minimally invasive parathyroidectomy (MIP), while the other 3 recommended bilateral exploration. LAH is a relatively frequent condition among patients on lithium, and calcium monitoring should be performed initially and longitudinally. Almost half of the LAH cases are due to SGD. MIP should be the optimum surgical approach. © 2015 S. Karger AG, Basel.
    ORL 08/2015; 77(5):273-280. DOI:10.1159/000431230 · 0.88 Impact Factor
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    ABSTRACT: Secondary thyroid cancer is believed to lead to a more aggressive clinical course than primary thyroid cancer. We aim to examine the difference between primary and secondary thyroid cancer in terms of patient characteristics and perioperative outcomes at the national level. A cross-sectional study utilizing the Nationwide Inpatient Sample database for 2003-2010 was merged with County Health Rankings Data. International Classification of Diseases, Ninth Revision (ICD-9) codes were used to identify adult patients with thyroid cancer. A total of 21,581 discharge records were included. Overall, 16,625 (77.0 %) patients had primary cancer, while the rest (23.0 %) had secondary cancer. Younger (<45 years) and older (>65 years) patients, males, and those of White or Hispanic background were more likely to have secondary cancers (p < 0.05 each). The prevalence of secondary cancer was higher in communities of low health risk (24.0 % vs. 21.1 %; p < 0.024). Secondary cancer was more likely to be managed by total thyroidectomy (odds ratio [OR] 2.40, 95 % CI 2.12-2.73) and to require additional radical neck dissection (OR 12.51, 95 % CI 10.98-14.25). Patients with secondary thyroid cancers were at higher risk of postoperative complications (p < 0.01 each). The cost of secondary cancer management was significantly higher than primary cancer (US$12,449.00 ± 302.07 vs. US$7848.12 ± 149.05; p < 0.001). However, compared with intermediate-volume surgeons, the complication risk was lower for high-volume (OR 0.47, 95 % CI 0.24-0.92; p = 0.026). Secondary thyroid cancer is associated with a higher risk of perioperative complications and higher cost and distinct demographic profile. Patients managed by higher-volume surgeons were less likely to experience disadvantageous outcomes.
    Annals of Surgical Oncology 08/2015; DOI:10.1245/s10434-015-4800-0 · 3.93 Impact Factor
  • Hossam Eldin Mohamed · Emad Kandil ·
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    ABSTRACT: Remote access approaches for thyroid surgery using surgical incisions placed outside the neck, including the axillary, chest and the retro-auricular region have gained interest due to the social stigmatization of young females with a visible neck scar. These novel approaches have been reported to be safe and feasible approaches for thyroid surgery in a select group of patients. Herein, we will discuss different aspects of the current robotic approaches. J. Surg. Oncol. 2015;9999:XX-XX. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 08/2015; 112(3). DOI:10.1002/jso.23955 · 3.24 Impact Factor
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    ABSTRACT: The pre-operative diagnosis of thyroid tumors is determined by gold standard fine needle aspiration (FNA) biopsy. This has been widely accepted and offers the most cost-effective approach for evaluation of thyroid nodules. However, its diagnostic accuracy can pose a challenging scenario to surgeons. These diagnostic difficulties may subject patients to unnecessary thyroidectomies for benign thyroid nodules. Thus, additional molecular tests are needed to improve the sensitivity and specificity of FNA. The role of molecular markers is being proposed to predict the type and risk of malignancy to abate the need for diagnostic thyroidectomies. This review discusses their utility and validity in pre-operative diagnosis of thyroid nodules and how these markers can enhance the accuracy of FNA cytology.
    Future Oncology 08/2015; 11(16). DOI:10.2217/fon.15.135. · 2.48 Impact Factor
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    ABSTRACT: Comprehensive neck ultrasound (US) examination has become an essential component of preoperative workup for patients with thyroid cancer. Regional cervical lymph nodes may be involved in cases of Hashimoto's thyroiditis (HT). This study seeks to examine the sonographic pattern of lymph nodes in patients with HT. This is a retrospective study looking at patients with confirmed diagnoses of HT on final surgical pathology who underwent preoperative comprehensive neck US. We compared preoperative ultrasound for patients with HT to euthyroid patients with goiter. Data collected included number, size and ultrasonographic features of cervical lymph nodes. We included a total of 417 patients: 202 patients with HT in the study group, and 215 patients with goiter and euthyroid status in the control group. Patients with HT had a higher number of total cervical lymph nodes than the control group (2.00±2.35 vs. 0.76±1.36 mm; P<0.0001), most notably in cervical levels III and IV (P<0.05 for both). HT seems to be associated with an ultrasonographic pattern of increased number of enlarged cervical lymph nodes, particularly in levels III, and IV.
    08/2015; 4(4):301-6. DOI:10.3978/j.issn.2227-684X.2015.05.11

Publication Stats

1k Citations
450.14 Total Impact Points


  • 2009-2015
    • Tulane University
      • • Department of Surgery
      • • Section of Nephrology & Hypertension
      New Orleans, Louisiana, United States
    • Johns Hopkins University
      • Department of Surgery
      Baltimore, MD, United States
  • 2014
    • University of Chicago
      Chicago, Illinois, United States
  • 2013
    • Scott & White
      TPL, Texas, United States
    • University of New Orleans
      New Orleans, Louisiana, United States
  • 2011
    • Louisiana State University Health Sciences Center New Orleans
      New Orleans, Louisiana, United States
  • 2008-2010
    • Johns Hopkins Medicine
      • Department of Surgery
      Baltimore, Maryland, United States
  • 2006-2008
    • State University of New York Downstate Medical Center
      • Department of Surgery
      Brooklyn, New York, United States
  • 2003
    • Weill Cornell Medical College
      New York, New York, United States
    • Albert Einstein College of Medicine
      New York, New York, United States