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:

Phase III Multicenter Randomized Trial of Sentinel Lymphadenectomy and Complete Lymph Node Dissection vs. Sentinel Lymphadenectomy Alone in Cutaneous Melanoma Patients with Molecular or Histopathological Evidence of Metastases in the Sentinel Node

Administered By
Surgical Oncology
Awarded By
John Wayne Cancer Institute
Role
Principal Investigator
Start Date
End Date

Publications:

Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.

BACKGROUND: Postoperative cognitive dysfunction (POCD), a syndrome of cognitive deficits occurring 1-12 months after surgery primarily in older patients, is associated with poor postoperative outcomes. POCD is hypothesized to result from neuroinflammation; however, the pathways involved remain unclear. Unbiased proteomic analyses have been used to identify neuroinflammatory pathways in multiple neurologic diseases and syndromes but have not yet been applied to POCD. OBJECTIVE: To utilize unbiased mass spectrometry-based proteomics to identify potential neuroinflammatory pathways underlying POCD. METHODS: Unbiased LC-MS/MS proteomics was performed on immunodepleted cerebrospinal fluid (CSF) samples obtained before, 24 hours after, and 6 weeks after major non-cardiac surgery in older adults who did (n = 8) or did not develop POCD (n = 6). Linear mixed models were used to select peptides and proteins with intensity differences for pathway analysis. RESULTS: Mass spectrometry quantified 8,258 peptides from 1,222 proteins in > 50%of patient samples at all three time points. Twelve peptides from 11 proteins showed differences in expression over time between patients with versus withoutPOCD (q < 0.05), including proteins previously implicated in neurodegenerative disease pathophysiology. Additionally, 283 peptides from 182 proteins were identified with trend-level differences (q < 0.25) in expression over time between these groups. Among these, pathway analysis revealed that 50 were from 17 proteins mapping to complement and coagulation pathways (q = 2.44*10-13). CONCLUSION: These data demonstrate the feasibility of performing unbiased mass spectrometry on perioperative CSF samples to identify pathways associated with POCD. Additionally, they provide hypothesis-generating evidence for CSF complement and coagulation pathway changes in patients with POCD.
Authors
VanDusen, KW; Li, Y-J; Cai, V; Hall, A; Hiles, S; Thompson, JW; Moseley, MA; Cooter, M; Acker, L; Levy, JH; Ghadimi, K; Quiñones, QJ; Devinney, MJ; Chung, S; Terrando, N; Moretti, EW; Browndyke, JN; Mathew, JP; Berger, M; MADCO-PC Investigators,
MLA Citation
VanDusen, Keith W., et al. “Cerebrospinal Fluid Proteome Changes in Older Non-Cardiac Surgical Patients with Postoperative Cognitive Dysfunction.J Alzheimers Dis, vol. 80, no. 3, 2021, pp. 1281–97. Pubmed, doi:10.3233/JAD-201544.
URI
https://scholars.duke.edu/individual/pub1475476
PMID
33682719
Source
pubmed
Published In
J Alzheimers Dis
Volume
80
Published Date
Start Page
1281
End Page
1297
DOI
10.3233/JAD-201544

Postoperative Surveillance in Older Adults With T1N0M0 Low-risk Papillary Thyroid Cancer.

BACKGROUND: The frequency and cost of postoperative surveillance for older adults (>65 y) with T1N0M0 low-risk papillary thyroid cancer (PTC) have not been well studied. METHODS: Using the SEER-Medicare (2006-2013) database, frequency and cost of surveillance concordant with American Thyroid Association (ATA) guidelines (defined as an office visit, ≥1 thyroglobulin measurement, and ultrasound 6- to 24-month postoperatively) were analyzed for the overall cohort of single-surgery T1N0M0 low-risk PTC, stratified by lobectomy versus total thyroidectomy. RESULTS: Majority of 2097 patients in the study were white (86.7%) and female (77.5%). Median age and tumor size were 72 y (interquartile range 68-76) and 0.6 cm (interquartile range 0.3-1.1 cm), respectively; 72.9% of patients underwent total thyroidectomy. Approximately 77.5% of patients had a postoperative surveillance visit; however, only 15.9% of patients received ATA-concordant surveillance. Patients who underwent total thyroidectomy as compared with lobectomy were more likely to undergo surveillance testing, thyroglobulin (61.7% versus 24.8%) and ultrasound (37.5% versus 29.2%) (all P < 0.01), and receive ATA-concordant surveillance (18.5% versus 9.0%, P < 0.001). Total surveillance cost during the study period was $621,099. Diagnostic radioactive iodine, ablation, and advanced imaging (such as positron emission tomography scans) accounted for 55.5% of costs ($344,692), whereas ATA-concordant care accounted for 44.5% of costs. After multivariate adjustment, patients who underwent total thyroidectomy as compared with lobectomy were twice as likely to receive ATA-concordant surveillance (adjusted odds ratio 2.0, 95% confidence interval: 1.5-2.8, P < 0.001). CONCLUSIONS: Majority of older adults with T1N0M0 low-risk PTC do not receive ATA-concordant surveillance; discordant care was costly. Total thyroidectomy was the strongest predictor of receiving ATA-concordant care.
Authors
Pradhan, MC; Kazaure, HS; Wang, F; Zambeli-Ljepovic, A; Perkins, JM; Stang, MT; Scheri, RP
MLA Citation
Pradhan, Molly C., et al. “Postoperative Surveillance in Older Adults With T1N0M0 Low-risk Papillary Thyroid Cancer.J Surg Res, vol. 264, Mar. 2021, pp. 37–44. Pubmed, doi:10.1016/j.jss.2021.01.049.
URI
https://scholars.duke.edu/individual/pub1477594
PMID
33765509
Source
pubmed
Published In
J Surg Res
Volume
264
Published Date
Start Page
37
End Page
44
DOI
10.1016/j.jss.2021.01.049

Immunomodulatory lipid mediator profiling of cerebrospinal fluid following surgery in older adults.

Arachidonic acid (AA), docosahexaenoic acid (DHA), and eicosapentaenoic acid (EPA) derived lipids play key roles in initiating and resolving inflammation. Neuro-inflammation is thought to play a causal role in perioperative neurocognitive disorders, yet the role of these lipids in the human central nervous system in such disorders is unclear. Here we used liquid chromatography-mass spectrometry to quantify AA, DHA, and EPA derived lipid levels in non-centrifuged cerebrospinal fluid (CSF), centrifuged CSF pellets, and centrifuged CSF supernatants of older adults obtained before, 24 h and 6 weeks after surgery. GAGE analysis was used to determine AA, DHA and EPA metabolite pathway changes over time. Lipid mediators derived from AA, DHA and EPA were detected in all sample types. Postoperative lipid mediator changes were not significant in non-centrifuged CSF (p > 0.05 for all three pathways). The AA metabolite pathway showed significant changes in centrifuged CSF pellets and supernatants from before to 24 h after surgery (p = 0.0000247, p = 0.0155 respectively), from before to 6 weeks after surgery (p = 0.0000497, p = 0.0155, respectively), and from 24 h to 6 weeks after surgery (p = 0.0000499, p = 0.00363, respectively). These findings indicate that AA, DHA, and EPA derived lipids are detectable in human CSF, and the AA metabolite pathway shows postoperative changes in centrifuged CSF pellets and supernatants.
Authors
Terrando, N; Park, JJ; Devinney, M; Chan, C; Cooter, M; Avasarala, P; Mathew, JP; Quinones, QJ; Maddipati, KR; Berger, M; MADCO-PC Study Team,
MLA Citation
Terrando, Niccolò, et al. “Immunomodulatory lipid mediator profiling of cerebrospinal fluid following surgery in older adults.Sci Rep, vol. 11, no. 1, Feb. 2021, p. 3047. Pubmed, doi:10.1038/s41598-021-82606-5.
URI
https://scholars.duke.edu/individual/pub1473574
PMID
33542362
Source
pubmed
Published In
Scientific Reports
Volume
11
Published Date
Start Page
3047
DOI
10.1038/s41598-021-82606-5

Response to: Comment on "Severe Hypocalcemia After Thyroidectomy: An Analysis of 7366 Patients".

Authors
Kazaure, HS; Oyekunle, T; Scheri, RP
MLA Citation
Kazaure, Hadiza S., et al. “Response to: Comment on "Severe Hypocalcemia After Thyroidectomy: An Analysis of 7366 Patients".Ann Surg, Jan. 2021. Pubmed, doi:10.1097/SLA.0000000000004777.
URI
https://scholars.duke.edu/individual/pub1472730
PMID
33491987
Source
pubmed
Published In
Ann Surg
Published Date
DOI
10.1097/SLA.0000000000004777

Recurrent Laryngeal Nerve Injury After Thyroid Surgery: An Analysis of 11,370 Patients.

BACKGROUND: Recurrent laryngeal nerve (RLN) injury is a well-known, potentially serious complication of thyroid surgery. We investigated factors associated with RLN injury during thyroid surgery using a multi-institutional data set. MATERIALS AND METHODS: Patients who underwent either lobectomy or total thyroidectomy were abstracted from the American College of Surgeons National Surgical Quality Improvement Program thyroidectomy-specific database (2016-2017). Baseline and operative factors associated with RLN injury ≤30 d of surgery were analyzed using bivariate and multivariate methods. Secondary complications of interest included unplanned reintubation and hypocalcemia. RESULTS: RLN injury occurred in 6.0% (n = 677) of the 11,370 patients included in the study. The RLN injury rate varied significantly based on the primary indication for surgery, from 4.3% in patients undergoing surgery for a single nodule to 9.0% in patients undergoing surgery for differentiated cancer (P < 0.01). RLN injury occurred more often in thyroidectomies than lobectomies (6.9% versus 4.3%, P < 0.01) and in surgeries without intraoperative nerve monitoring (6.5% versus 5.6%, P = 0.01). After multivariate adjustment, RLN injury was independently associated with age ≥65 y [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.3-2.0], total thyroidectomy (OR = 1.4, 95% CI 1.1-1.6), and diagnosis of thyroid malignancy (OR = 2.1, 95% CI = 1.6-2.7) (all P < 0.001) but not intraoperative RLN monitoring (OR = 0.9, 95% CI = 0.7-1.0, P = 0.06). CONCLUSIONS: In this large multi-institutional study, RLN injury ≤30 d of surgery occurred in nearly 6% of thyroid surgeries. This comprehensive analysis of RLN injury can be used to guide informed consent discussions and aid surgeons in identifying candidates who may be at higher risk for injury.
Authors
Gunn, A; Oyekunle, T; Stang, M; Kazaure, H; Scheri, R
MLA Citation
Gunn, Alexander, et al. “Recurrent Laryngeal Nerve Injury After Thyroid Surgery: An Analysis of 11,370 Patients.J Surg Res, vol. 255, Nov. 2020, pp. 42–49. Pubmed, doi:10.1016/j.jss.2020.05.017.
URI
https://scholars.duke.edu/individual/pub1448019
PMID
32540579
Source
pubmed
Published In
J Surg Res
Volume
255
Published Date
Start Page
42
End Page
49
DOI
10.1016/j.jss.2020.05.017