Randall Scheri

Positions:

Associate Professor of Surgery

Surgical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1996

University of Virginia

Grants:

Lymphadenectomy & Complete Lymph Node Dissection vs Lymphadenecty

Administered By
Surgical Oncology
Role
Principal Investigator
Start Date
End Date

Publications:

Severe Hypocalcemia After Thyroidectomy: An Analysis of 7366 Patients.

OBJECTIVE: The aim of the study was to determine severe hypocalcemia rate following thyroidectomy and factors associated with its occurrence. BACKGROUND: Hypocalcemia is the most common complication after thyroidectomy. Severe post-thyroidectomy hypocalcemia can be life-threatening; data on this specific complication are scarce. METHODS: Patients who underwent thyroidectomy in the American College of Surgeons-National Surgical Quality Improvement Program thyroidectomy-targeted database (2016-2017) were abstracted. A severe hypocalcemic event was defined as hypocalcemia requiring intravenous calcium, emergent clinic/hospital visit, or a readmission for hypocalcemia. Multivariable regression was used to identify factors independently associated with occurrence of severe hypocalcemia. RESULTS: Severe hypocalcemia occurred in 5.8% (n = 428) of 7366 thyroidectomy patients, with 83.2% necessitating intravenous calcium treatment. Rate of severe hypocalcemia varied by diagnosis and procedure (0.5% for subtotal thyroidectomy to 12.5% for thyroidectomy involving neck dissections). Overall, 38.3% of severe hypocalcemic events occurred after discharge; in this subset, 59.1% experienced severe hypocalcemia despite being discharged with calcium and vitamin D. Severe hypocalcemia patients had higher rates of recurrent laryngeal nerve injury (13.4% vs 6.6%), unplanned reoperations (4.4% vs 1.3%), and longer hospital stay (30.4% vs 6.2% ≥3 days (all P < 0.01). After multivariate adjustment, severe hypocalcemia was associated with multiple factors including Graves disease [odds ratio (OR) = 2.06], lateral neck dissections (OR: 3.10), and unexpected reoperations (OR = 3.55); all P values less than 0.01. CONCLUSIONS: Severe hypocalcemia and suboptimal hypocalcemia management after thyroidectomy are common. Patients who experienced severe hypocalcemia had higher rates of nerve injury and unexpected reoperations, indicating surgical complexity and provider inexperience. More biochemical surveillance particularly a parathyroid hormone-based protocol, fine-tuned supplementation, and selective referral could reduce occurrence of this morbid complication.
Authors
Kazaure, HS; Zambeli-Ljepovic, A; Oyekunle, T; Roman, SA; Sosa, JA; Stang, MT; Scheri, RP
MLA Citation
Kazaure, Hadiza S., et al. “Severe Hypocalcemia After Thyroidectomy: An Analysis of 7366 Patients..” Ann Surg, Dec. 2019. Pubmed, doi:10.1097/SLA.0000000000003725.
URI
https://scholars.duke.edu/individual/pub1423667
PMID
31804395
Source
pubmed
Published In
Ann Surg
Published Date
DOI
10.1097/SLA.0000000000003725

Low Risk Thyroid Cancer in Older Adults: More Extensive Surgery Comes with Increased Cost of Surveillance

Authors
Zambeli-Ljepovic, A; Wang, F; Dinan, MA; Hyslop, T; Stang, MT; Roman, SA; Sosa, JA; Scheri, RP
MLA Citation
Zambeli-Ljepovic, Alan, et al. “Low Risk Thyroid Cancer in Older Adults: More Extensive Surgery Comes with Increased Cost of Surveillance.” Journal of the American College of Surgeons, vol. 229, no. 4, ELSEVIER SCIENCE INC, 2019, pp. S78–S78.
URI
https://scholars.duke.edu/individual/pub1418725
Source
wos
Published In
Journal of the American College of Surgeons
Volume
229
Published Date
Start Page
S78
End Page
S78

Patient selection and outcomes of laparoscopic transabdominal versus posterior retroperitoneal adrenalectomy among surgeons in the Collaborative Endocrine Surgery Quality Improvement Program (CESQIP).

BACKGROUND: Laparoscopic adrenalectomy can be performed using a transabdominal or posterior retroperitoneal approach. Choosing the optimal approach can be challenging. METHODS: Using data from the Collaborative Endocrine Surgery Quality Improvement Program (2014-2018), baseline patient characteristics and outcomes were compared with bivariate methods; univariate and multivariate analyses were used to estimate the association between operative approach and complication risk. RESULTS: Among 833 patients, 35.3% underwent posterior retroperitoneal. Median age was 54 years. Patients undergoing posterior retroperitoneal had lesser rates of body mass index >40 (9.2% vs 17.4%, P = .001), smaller nodules (median 2.4 vs 3.2 cm, P < .001), and more commonly right-sided nodules (46.6% vs 36.9%, P = .02). Posterior retroperitoneal was associated with a lesser rate of conversion to an open procedure (0.7% vs 4.1%, P = .004), less complications (3.1% vs 8.7%, P = .002), and shorter hospital stay (≤48 h: 92.2% vs 76.6%, P < .001), but a greater rate of capsular disruption (12.6% vs 7.6%, P = .02). For posterior retroperitoneal cases with capsular disruption, median nodule size was 2.2 cm, and 16.2% were metastatic tumors. After multivariate adjustment, posterior retroperitoneal was 2.2 times as likely to result in capsular disruption as transabdominal (95% confidence interval, 1.04-4.79, P = .04). CONCLUSION: This study revealed a greater rate for capsular disruption during posterior retroperitoneal even for small tumors. Our findings from the Collaborative Endocrine Surgery Quality Improvement Program (2014-2018) suggests that posterior retroperitoneal should be used selectively, especially when a malignancy is suspected.
Authors
Marrero, AP; Kazaure, HS; Thomas, SM; Stang, MT; Scheri, RP
MLA Citation
URI
https://scholars.duke.edu/individual/pub1411902
PMID
31543324
Source
pubmed
Published In
Surgery
Volume
167
Published Date
Start Page
250
End Page
256
DOI
10.1016/j.surg.2019.03.034

Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study.

Animal models suggest postoperative cognitive dysfunction may be caused by brain monocyte influx. To study this in humans, we developed a flow cytometry panel to profile cerebrospinal fluid (CSF) samples collected before and after major noncardiac surgery in 5 patients ≥60 years of age who developed postoperative cognitive dysfunction and 5 matched controls who did not. We detected 12,654 ± 4895 cells/10 mL of CSF sample (mean ± SD). Patients who developed postoperative cognitive dysfunction showed an increased CSF monocyte/lymphocyte ratio and monocyte chemoattractant protein 1 receptor downregulation on CSF monocytes 24 hours after surgery. These pilot data demonstrate that CSF flow cytometry can be used to study mechanisms of postoperative neurocognitive dysfunction.
Authors
Berger, M; Murdoch, DM; Staats, JS; Chan, C; Thomas, JP; Garrigues, GE; Browndyke, JN; Cooter, M; Quinones, QJ; Mathew, JP; Weinhold, KJ; Amundsen, CL; Bengali, S; Brigman, BE; Bullock, WM; Carter, J; Chapman, J; Cheong Yee Ching, V; Cohen, HJ; Colin, B; D'Amico, TA; Devinney, MJ; DeOrio, JK; Ellet, T; Esclamado, RM; Ferrandino, MN; Gadsden, J; Guercio, J; Habib, A; Harpole, DH; Hartwig, MG; Iboaya, E; Inman, BA; Khan, A; Lagoo-Deenadayalan, S; Lee, PS; Lee, WT; Lemm, J; Levinson, H; Mantyh, C; McDonagh, DL; Migaly, J; Mithani, SK; Moretti, E; Moul, JW; Newman, MF; Ni, K; Ohlendorf, B; Perez, A; Peterson, AC; Ponussamy, V; Preminger, GM; Robertson, CN; Roman, SA; Runyon, S; Sandler, A; Scheri, RP; Smith, SK; Talbot, L; Thacker, JKM; Tong, BC; Tu, A; Vaslef, SN; Waldron, N; Wang, X; Whitson, H; Wickenheisser, V; Young, C; MADCO-PC Study Team,; Markers of Alzheimer’s Disease and neuroCognitive Outcomes after Perioperative Care (MADCO-PC),
MLA Citation
Berger, Miles, et al. “Flow Cytometry Characterization of Cerebrospinal Fluid Monocytes in Patients With Postoperative Cognitive Dysfunction: A Pilot Study..” Anesth Analg, vol. 129, no. 5, Nov. 2019, pp. e150–54. Pubmed, doi:10.1213/ANE.0000000000004179.
URI
https://scholars.duke.edu/individual/pub1385799
PMID
31085945
Source
pubmed
Published In
Anesth Analg
Volume
129
Published Date
Start Page
e150
End Page
e154
DOI
10.1213/ANE.0000000000004179

Adequacy of Lymph Node Yield for Papillary Thyroid Cancer: An Analysis of 23,131 Patients.

BACKGROUND: Threshold numbers for defining adequacy of lymph node (LN) yield have been determined for evaluation of occult nodal disease during papillary thyroid cancer (PTC) surgery. This study assesses the prevalence of adequate LN yield and estimates its association with patient clinicopathologic characteristics. MATERIALS AND METHODS: Adult patients with cN1 pT1b or pT2 and cN0 or cN1 pT3 M0 PTC ≥1 cm who received surgery with ≥1 LN resected were identified from the National Cancer Database, 2004-2015. Adequate yield was defined as removing ≥6, 9, and 18 LNs for pT1b, pT2, and pT3 stages, respectively, based on recently published literature. Univariable and multivariable logistic regression were used to determine factors associated with adequate yield. RESULTS: A total of 23,131 patients were included; 7544 (32.6%) had adequate LN yield. Rate of adequate yield increased from 19.9% to 36.6% over time. After adjustment, patients at academic facilities were more likely to have adequate yield than those at community centers [OR 1.94 (95% CI 1.55-2.41), P < 0.001]. Patients with more advanced tumors were less likely to have adequate yield (pT1b: 75.9% versus pT2: 64.5% versus pT3: 24.6% adequate LN yield, P < 0.001). Patients with adequate LN yield were 0.89 times likely to receive radioactive iodine compared with those with inadequate yield [OR 0.98 (95% CI 0.81-0.98), P = 0.02]. CONCLUSIONS: The rate of adequate LN yield has increased over time, but only a minority of lymphadenectomies performed for PTC can be defined as adequate. Disparities still exist based on patient and facility characteristics; patients with more advanced tumors appear less likely to have adequate LN yield.
Authors
Ji, KSY; Oyekunle, TO; Thomas, SM; Scheri, R; Stang, M; Roman, SA; Sosa, JA
MLA Citation
Ji, Keven S. Y., et al. “Adequacy of Lymph Node Yield for Papillary Thyroid Cancer: An Analysis of 23,131 Patients..” J Surg Res, vol. 244, Dec. 2019, pp. 566–73. Pubmed, doi:10.1016/j.jss.2019.06.027.
URI
https://scholars.duke.edu/individual/pub1402537
PMID
31352235
Source
pubmed
Published In
J Surg Res
Volume
244
Published Date
Start Page
566
End Page
573
DOI
10.1016/j.jss.2019.06.027