Emad Kandil

Tulane University, New Orleans, Louisiana, United States

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Publications (221)475.38 Total impact

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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.
    No preview · Chapter · Nov 2016
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    ABSTRACT: Accidental injury of a nearby structure during surgical operations carries a risk of serious morbidity and mortality. Furthermore it represents a medico-legal liability. Herein, we aim to examine the national distribution, cost and trend of accidental intraoperative injuries.
    No preview · Article · Jan 2016 · Journal of the American College of Surgeons

  • No preview · Article · Jan 2016 · Surgery
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    ABSTRACT: Background: Tumor size is recognized as an important predictor of malignancy in many types of cancers. However, there is no clear line of characterization when it comes to the association between thyroid nodule size and malignancy risk prediction; and the current data remains inconsistent across different studies. The aim of our study is to examine the association between nodule size and malignancy using meta-analysis of the current literature. Methods: Data sources were gathered through systemic search of PubMed, Embase and other scientific databases for articles published between January 1, 1996 and June 1, 2013. A reference group with nodule sizes <3 cm was set as a control group. Two other nodule size categories were established and these included nodules from 3-5.9 cm and nodules ≥6 cm in size. Primary outcome was a histologically proven malignancy per nodule size category. The effect sizes of clinicopathologic parameters, which are the quantitative measures of association strength between two variables, were calculated by the means of odds ratios (OR). The effect sizes were then combined using a random-effects model. Results: Seven studies met our inclusion criteria with 10,817 thyroid nodules evaluated. Malignancy was identified in 2,206 (20.4%) nodules. After adjusting for patient age and gender, nodules that measured 3- 5.9 cm had a 26% greater malignancy risk compared to those measuring <3 cm [OR, 1.26; 95% confidence interval (CI): 1.13-1.39]. However, nodules 6 cm or larger had a 16% lower risk of malignancy compared to those measuring <3 cm (OR, 0.84; 95% CI: 0.73-0.98). Conclusions: Thyroid nodule size predicts cancer risk. However, a threshold effect of thyroid nodule size 6 cm or greater is significantly associated with a more benign disease
    Full-text · Article · Dec 2015

  • No preview · Article · Dec 2015 · JAMA Otolaryngology - Head and Neck Surgery
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    ABSTRACT: Importance Evaluation of preoperative and postoperative vocal fold function is important in patients undergoing thyroid or parathyroid surgical procedures. Transcutaneous laryngeal ultrasonography (TLUSG) has been proposed as a promising noninvasive technique and alternative to flexible fiberoptic laryngoscopy.Objective To determine whether TLUSG can be an alternative to flexible laryngoscopy in evaluating vocal fold function.Design, Setting, and Participants A prospective study was performed from March 1, 2013, to July 31, 2014. Patients who were scheduled to undergo thyroid or parathyroid surgery by a single surgeon at a North American, university-based tertiary care center and who agreed to undergo preoperative and postoperative TLUSG and flexible fiberoptic laryngoscopy were enrolled. Patients were divided into 2 groups: nonoverweight (body mass index [calculated as weight in kilograms divided by height in meters squared] <25) and overweight or obese (body mass index ≥25). Follow-up was completed on February 28, 2015, and data were analyzed from March 1, 2013, to February 28, 2015.Interventions Preoperative and postoperative TLUSG and flexible fiber optic laryngoscopic assessments of vocal fold function.Main Outcomes and Measures The findings of TLUSG and flexible fiber optic laryngoscopy were compared for all patients and each body mass index group to assess the accuracy of TLUSG in assessing vocal fold function.Results A total of 250 patients (500 vocal folds) underwent evaluation, of whom 208 (83.2%) were women and with a mean (SD) age of 52.7 (14.3) years. On flexible fiberoptic laryngoscopy findings, 13 patients had preoperative vocal fold paralysis (VFP), and 14 postoperative new incidents of VFP were identified. Only 7 (53.9%) of the preoperative cases of VFP and 15 (55.6%) of the postoperative cases of VFP were identified by TLUSG. The sensitivity, specificity, and accuracy of preoperative TLUSG were 53.8%, 50.5%, and 50.6%, respectively; for postoperative TLUSG, 55.6%, 38.7%, and 39.6%, respectively. In the nonoverweight group, the preoperative TLUSG sensitivity, specificity, and accuracy were 100%, 70.0%, and 70.5%, respectively; in the overweight-obese group, 45.4%, 43.4%, and 43.5%, respectively (odds ratio, 3.16; 95% CI, 2.06-4.84; P < .001). Postoperative visualization of the vocal folds was more challenging, with a sensitivity, specificity, and accuracy of 83.3%, 55.6%, and 56.8%, respectively, in the nonoverweight group, and 47.6%, 32.6%, and 33.4%, respectively, in the overweight-obese group (odds ratio, 2.62; 95% CI, 1.75-3.94; P < .001).Conclusions and Relevance When evaluation of vocal fold function is indicated in patients undergoing thyroid and parathyroid surgery, TLUSG should not be considered as an alternative to the current practice of flexible fiberoptic laryngoscopy. Adequate ultrasonographic visualization of the vocal folds and arytenoids is challenging, especially in overweight and obese patients and in the postoperative setting.
    No preview · Article · Dec 2015 · JAMA Otolaryngology - Head and Neck Surgery
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    ABSTRACT: Melanoma is characterized by dysregulated intracellular signalling pathways including an impairment of the cell death machinery, ultimately resulting in melanoma resistance, survival and progression. This explains the tumour's extraordinary resistance to the standard treatment. Imiquimod is a topical immune response modifier (imidazoquinoline) with both antiviral and antitumour activities. The mechanism by which imiquimod triggers the apoptosis of melanoma cells has now been carefully elucidated. Imiquimod-induced apoptosis is associated with the activation of apoptosis signalling regulating kinase1/c-Jun-N-terminal kinase/p38 pathways and the induction of endoplasmic stress characterized by the activation of the protein kinase RNA-like endoplasmic reticulum kinase signalling pathway, increase in intracellular Ca(2+) release, degradation of calpain and subsequent cleavage of caspase-4. Moreover, imiquimod triggers the activation of NF-κB and the expression of the inhibitor of apoptosis proteins (IAPs) such as, X-linked IAP (XIAP) together with the accumulation of reactive oxygen species (ROS). Also, imiquimod triggers mitochondrial dysregulation characterized by the loss of mitochondrial membrane potential (Δψm), the increase in cytochrome c release, and cleavage of caspase-9, caspase-3 and poly(ADP-ribose) polymerase (PARP). Inhibitors of specific pathways, permit the elucidation of possible mechanisms of imiquimod-induced apoptosis. They demonstrate that inhibition of NF-kB by the inhibitor of nuclear factor kappa-B kinase (IKK) inhibitor Bay 11-782 or knockdown of XIAP induces melanoma apoptosis in cells exposed to imiquimod. These findings support the use of either IKK inhibitors or IAP antagonists as adjuvant therapies to improve the effectiveness topical imiquimod in the treatment of melanoma.
    Full-text · Article · Nov 2015 · Journal of Cellular and Molecular Medicine
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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.
    No preview · Article · Nov 2015 · JAMA Otolaryngology - Head and Neck Surgery
  • 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.
    No preview · Article · Nov 2015 · Journal of Surgical Oncology
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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
    No preview · Article · Nov 2015 · Surgical Innovation
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    Emad Kandil · Ahmad Saeed · Joseph Buell

    Full-text · Dataset · Oct 2015
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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.
    No preview · Article · Oct 2015

  • No preview · Article · Oct 2015 · Journal of the American College of Surgeons

  • No preview · Article · Oct 2015 · Journal of the American College of Surgeons
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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.
    Full-text · Article · Oct 2015
  • Zaid Al-Qurayshi · Emad Kandil

    No preview · Article · Oct 2015 · Journal of the American College of Surgeons
  • 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.
    No preview · Article · Oct 2015

  • No preview · Article · Oct 2015 · Journal of the American College of Surgeons

  • No preview · Article · Oct 2015 · Journal of the American College of Surgeons
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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.
    No preview · Article · Oct 2015

Publication Stats

1k Citations
475.38 Total Impact Points

Institutions

  • 2009-2016
    • Tulane University
      • Department of Surgery
      New Orleans, Louisiana, 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