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Robert Steffner, MD

  • Robert John Steffner

No one plans on having cancer. With that in mind, I try to appreciate the anxiety that patients and their families may feel when they are referred to a cancer surgeon. It is my hope that I can provide good news and reassurance. If I cannot, my focus is to lead patients and their families through the treatment process, with an emphasis on providing clear, straightforward communication.

From my perspective, patients are the center of the medical universe. I want to help them through this difficult time, and I want to use all the unique resources available at Stanford to achieve the best outcome for them. Stanford is truly a special place where teams of physicians work together to overcome the most challenging problems in medicine and surgery.

Specialties

Orthopaedic Surgery

Work and Education

Professional Education

Wayne State University School of Medicine, Detroit, MI, 6/14/2006

Internship

University of Chicago Hospitals, Chicago, IL, 6/23/2007

Residency

University of Chicago Hospitals, Chicago, IL, 6/30/2011

Fellowship

University of California Davis Medical Center, Sacramento, CA, 7/31/2012

University of Chicago Hospitals, Chicago, IL, 7/31/2013

Board Certifications

Orthopaedic Surgery, American Board of Orthopaedic Surgery

Services

Orthopedics

Conditions Treated

Bone and Soft Tissue Tumors

All Publications

Patient Perceptions Correlate Weakly With Observed Patient Involvement in Decision-making in Orthopaedic Surgery. Clinical orthopaedics and related research Mertz, K., Eppler, S., Yao, J., Amanatullah, D. F., Chou, L., Wood, K. B., Safran, M., Steffner, R., Gardner, M., Kamal, R. 2018

Abstract

BACKGROUND: Shared decision-making between patients and physicians involves educating the patient, providing options, eliciting patient preferences, and reaching agreement on a decision. There are different ways to measure shared decision-making, including patient involvement, but there is no consensus on the best approach. In other fields, there have been varying relationships between patient-perceived involvement and observed patient involvement in shared decision-making. The relationship between observed and patient-perceived patient involvement in decision-making has not been studied in orthopaedic surgery.QUESTIONS/PURPOSES: (1) Does patient-perceived involvement correlate with observed measurements of patient involvement in decision-making in orthopaedic surgery? (2) Are patient demographics associated with perceived and observed measurements of patient involvement in decision-making?METHODS: We performed a prospective, observational study to compare observed and perceived patient involvement in new patient consultations for eight orthopaedic surgeons in subspecialties including hand/upper extremity, total joint arthroplasty, spine, sports, trauma, foot and ankle, and tumor. We enrolled 117 English-literate patients 18 years or older over an enrollment period of 2 months. A member of the research team assessed observed patient involvement during a consultation with the Observing Patient Involvement in Decision-Making (OPTION) instrument (scaled 1-100 with higher scores representing greater involvement). After the consultation, we asked patients to complete a questionnaire with demographic information including age, sex, race, education, income, marital status, employment status, and injury type. Patients also completed the Perceived Involvement in Care Scale (PICS), which measures patient-perceived involvement (scaled 1-13 with higher scores representing greater involvement). Both instruments are validated in multiple studies in various specialties and the physicians were blinded to the instruments used. We assessed the correlation between observed and patient-perceived involvement as well as tested the association between patient demographics and patient involvement scores.RESULTS: There was weak correlation between observed involvement (OPTION) and patient-perceived involvement (PICS) (r = 0.37, p < 0.01) in decision-making (mean OPTION, 28.7, SD 7.7; mean PICS, 8.43, SD 2.3). We found a low degree of observed patient involvement despite a moderate to high degree of perceived involvement. No patient demographic factor had a significant association with patient involvement.CONCLUSIONS: Further work is needed to identify the best method for evaluating patient involvement in decision-making in the setting of discordance between observed and patient-perceived measurements. Knowing whether it is necessary for (1) actual observable patient involvement to occur; or (2) a patient to simply believe they are involved in their care can inform physicians on the best way to improve shared decision-making in their practice.LEVEL OF EVIDENCE: Level II, therapeutic study.

View details for DOI 10.1097/CORR.0000000000000365

View details for PubMedID 29965894

Staging of Bone and Soft-tissue Sarcomas. The Journal of the American Academy of Orthopaedic Surgeons Steffner, R. J., Jang, E. S. 2018

Abstract

The purpose of staging in orthopaedic oncology is to provide a framework for classifying tumors based on their risk of local recurrence and distant metastasis to guide treatment decisions. Two separate systems are commonly used to categorize bone and soft-tissue sarcomas. The Musculoskeletal Tumor Society system for bone sarcomas and the Enneking system for soft-tissue sarcomas are the original staging systems developed by orthopaedic surgeons. The American Joint Committee on Cancer staging systems for bone and soft-tissue sarcomas are periodically updated based on new data, and they are currently on their eighth edition.

View details for DOI 10.5435/JAAOS-D-17-00055

View details for PubMedID 29781819

LYMPHOMA OF BONE JBJS REVIEWS Steffner, R. J., Jang, E. S., Danford, N. C. 2018; 6 (1): e1

View details for DOI 10.2106/JBJS.RVW.17.00006

View details for Web of Science ID 000428127600001

View details for PubMedID 29298179

Conservative management of desmoid tumors is safe and effective. journal of surgical research Park, J. S., Nakache, Y., Katz, J., Boutin, R. D., Steffner, R. J., Monjazeb, A. M., Canter, R. J. 2016; 205 (1): 115-120

Abstract

Surgical resection of desmoid tumors has traditionally been the mainstay of therapy, but this is a potentially morbid approach with high rates of recurrence. Given increasing reports of active surveillance in this disease, we sought to evaluate our experience with conservative management hypothesizing this would be an effective strategy.Using a prospectively maintained database of sarcoma patients from 2008 to 2015, we identified 47 patients with a diagnosis of desmoid tumor from all anatomic sites. Data points were abstracted on clinical and pathologic factors, disease stability or progression, and follow-up time. Main outcome measurements were tumor recurrence after surgical resection versus tumor progression with conservative management.In our cohort, 20 patients were managed with surveillance, 24 patients with surgery, and three patients with other approaches. Clinical and tumor characteristics between treatment groups were not significantly different. With a median follow-up of 35.7mo, there was one complete regression, five partial regressions, and 13 stable diseases among the surveillance group. Only one patient under observation progressed, crossing over to surgical resection. Among 24 patients managed with surgery, 13 patients developed local recurrence. Kaplan-Meier analysis revealed a statistically superior progression-free survival in the surveillance group (P=0.001).This retrospective analysis adds to the growing body of evidence that observation of desmoid tumors is safe and effective with high rates of stable disease. These data further support an initial conservative approach to desmoid tumors that may spare patients the morbidity and risk of recurrence that accompanies potentially extensive operations.

View details for DOI 10.1016/j.jss.2016.06.028

View details for PubMedID 27621007

Emerging Concepts in Upper Extremity Trauma Humeral Shaft Fractures ORTHOPEDIC CLINICS OF NORTH AMERICA Steffner, R. J., Lee, M. A. 2013; 44 (1): 21-?

Abstract

Fractures of the humeral shaft are common in low-energy and high-energy trauma, and optimal clinical management remains controversial. Nonsurgical management has been supported as the preferred treatment based on high union rates and minimal functional deficit due to a rich vascular supply from overlying muscle and the wide motion available at the glenohumeral joint. Recent studies of nonoperative management have challenged surgeons' understanding of these fractures and the perception of favorable outcomes. Current considerations support expanded operative indications with traditional open-plate fixation and with the use of minimally invasive techniques, implants, and a reconsideration of intramedullary nailing.

View details for DOI 10.1016/j.ocl.2012.08.005

View details for Web of Science ID 000313135100004

View details for PubMedID 23174323

Case series of sural island flaps used for soft-tissue defects of the distal-third lower extremity JOURNAL OF WOUND CARE Steffner, R. J., Spiguel, A., Ranieri, J., Suk, M., Yoo, B. J. 2012; 21 (10): 469-475

Abstract

To establish the sural island fasciocutaneous flap as an initial consideration for distal third lower-extremity soft tissue coverage and to provide non-plastic surgeons with a procedure they can perform on their own.Literature on reverse sural island fasciocutaneous flaps was reviewed and summarised. We then assessed our care series of sural island flaps from 2008-2011 and looked to provide our operative technique and patient outcomes.Nine patients, aged 12-70 years old, with greater than 1 year follow-up, were reviewed. Five patients had diabetes, peripheral vascular disease, or smoked tobacco. All patients healed their soft tissue coverage with minimal complication and were able to accommodate normal footwear.Reverse sural island flaps are resilient flaps that should be considered as an alternative to free muscle transfer, for distal third lower extremity coverage.There were no external sources of funding for this study. The authors have no conflicts of interest to declare.

View details for Web of Science ID 000309466600002

View details for PubMedID 23103480

Humeral shaft fractures. Current reviews in musculoskeletal medicine Spiguel, A. R., Steffner, R. J. 2012; 5 (3): 177-183

Abstract

Management of humeral shaft fractures has historically been largely conservative. A significant body of literature, dating back to the 1970s, has shown that functional bracing may achieve greater than 90% union rates and acceptable functional outcomes. More recently, however, with the advent of new surgical techniques and implant options, less tolerance for acceptable deformity and functional deficits, and less patience with conservative management, many treating orthopaedic surgeons are increasingly likely to consider surgical intervention. This article reviews the current recommendations for treatment of humeral shaft fractures, including both nonoperative and operative intervention. It also discusses the current thinking and operative trends in humeral shaft fracture fixation.

View details for DOI 10.1007/s12178-012-9125-z

View details for PubMedID 22566083

Surgical Intervention of Nonvertebral Osseous Metastasis CANCER CONTROL Attar, S., Steffner, R. J., Avedian, R., Hussain, W. M. 2012; 19 (2): 113-121

Abstract

Nonvertebral osseous metastases can result in pain and disability. The goals of surgical intervention are to reduce pain and to improve function if nonsurgical treatment fails. The indications for proceeding with surgical intervention depend on anatomic location, amount of local destruction, extent of skeletal and visceral disease and, most important, the patient's performance status and life expectancy.This article reviews the evaluation and treatment of metastatic nonvertebral osseous lesions from the perspective of the orthopedic surgeon, based mainly on an assessment of the surgical literature.This article summarizes the approaches to preoperative evaluation, patient selection, and medical optimization. Guidelines for estimating osseous stability and fracture risk are discussed, and surgical implants and their relation to postoperative outcomes are examined. This review also describes less invasive ablative procedures currently available.The surgical management of nonvertebral osseous metastases involves multidisciplinary collaboration. The surgical construct must be a stable, reliable, and durable intervention that is individually tailored and matched to a patient's prognosis and performance status.

View details for Web of Science ID 000307969100005

View details for PubMedID 22487973

Factors associated with recurrence of primary aneurysmal bone cysts: is argon beam coagulation an effective adjuvant treatment? journal of bone and joint surgery. American volume Steffner, R. J., Liao, C., Stacy, G., Atanda, A., Attar, S., Avedian, R., Peabody, T. D. 2011; 93 (21): e1221-9

Abstract

Our goal was to assess the effectiveness and safety of argon beam coagulation as an adjuvant treatment for primary aneurysmal bone cysts, to reevaluate the adjuvant effectiveness of the use of a high-speed burr alone, and, secondarily, to identify predictors of aneurysmal bone cyst recurrence.We retrospectively reviewed the records of ninety-six patients with primary aneurysmal bone cysts who were managed at our institution from January 1, 1983, to December 31, 2008. Forty patients were managed with curettage, a high-speed burr, and argon beam coagulation; thirty-four were managed with curettage and a high-speed burr without argon beam coagulation; and the remaining twenty-two were managed with curettage with argon beam coagulation alone, curettage with no adjuvant treatment, or resection of the entire lesion. Demographic, clinical, and radiographic data were viewed comparatively for possible predictors of recurrence. Kaplan-Meier survival analysis with a log-rank test was performed to measure association and effectiveness.The median age at the time of diagnosis was fifteen years (range, one to sixty-two years). The median duration of follow-up was 29.5 months (range, zero to 300 months). The overall rate of recurrence of aneurysmal bone cyst after surgical treatment was 11.5%. The rate of recurrence was 20.6% after curettage and high-speed-burr treatment alone and 7.5% after curettage and high-speed-burr treatment plus argon beam coagulation. The five-year Kaplan-Meier survival estimate was 92% for patients managed with curettage and adjuvant treatment with a high-speed burr and argon beam coagulation, compared with 73% for patients managed with curettage and a high-speed burr only (p = 0.060).Surgical treatment of aneurysmal bone cyst with curettage and adjuvant argon beam coagulation is effective. Postoperative fracture appears to be a common complication of this treatment and needs to be studied further. Treatment with curettage and high-speed burr alone may not reduce recurrence.

View details for DOI 10.2106/JBJS.J.01067

View details for PubMedID 22048101

Aneurysmal Bone Cyst Steffner, R. J., Avedian, R., Peabody, T. American Academy of Orthopaedic Surgeons. Orthopaedic Knowledge Online (OKO).. 2009

Abstract

Steffner R, Avedian R, Peabody T. Aneurysmal Bone Cyst. American Academy of Orthopaedic Surgeons. Orthopaedic Knowledge Online (OKO). 2009: http://www5.aaos.org/oko/description.cfm?topic=ONC013. Accessed May 21, 2009

Ascorbic acid recycling by cultured beta cells: Effects of increased glucose metabolism FREE RADICAL BIOLOGY AND MEDICINE Steffner, R. J., Wu, L., Powers, A., May, A. M. 2004; 37 (10): 1612-1621

Abstract

Ascorbic acid is necessary for optimal insulin secretion from pancreatic islets. We evaluated ascorbate recycling and whether it is impaired by increased glucose metabolism in the rat beta-cell line INS-1. INS-1 cells, engineered with the potential for overexpression of glucokinase under the control of a tetracycline-inducible gene expression system, took up and reduced dehydroascorbic acid to ascorbate in a concentration-dependent manner that was optimal in the presence of physiologic D-glucose concentrations. Ascorbate uptake did not affect intracellular GSH concentrations. Whereas depletion of GSH in culture to levels about 25% of normal also did not affect the ability of the cells to reduce dehydroascorbic acid, more severe acute GSH depletion to less than 10% of normal levels did impair dehydroascorbic acid reduction. Culture of inducible cells in 11.8 mM D-glucose and doxycycline for 48 h enhanced glucokinase activity, increased glucose utilization, abolished D-glucose-dependent insulin secretion, and increased generation of reactive oxygen species. The latter may have contributed to subsequent decreases in the ability of the cells both to maintain intracellular ascorbate and to recycle it from dehydroascorbic acid. Cultured beta cells have a high capacity to recycle ascorbate, but this is sensitive to oxidant stress generated by increased glucose metabolism due to culture in high glucose concentrations and increased glucokinase expression. Impaired ascorbate recycling as a result of increased glucose metabolism may have implications for the role of ascorbate in insulin secretion in diabetes mellitus and may partially explain glucose toxicity in beta cells.

View details for DOI 10.1016/j.freeradbiomed.2004.07.032

View details for Web of Science ID 000224792100010

View details for PubMedID 15477012

Oxidative stress is a mediator of glucose toxicity in insulin-secreting pancreatic islet cell lines JOURNAL OF BIOLOGICAL CHEMISTRY Wu, L., Nicholson, W., Knobel, S. M., Steffner, R. J., May, J. M., Piston, D. W., Powers, A. C. 2004; 279 (13): 12126-12134

Abstract

Pancreatic beta cells secrete insulin in response to changes in the extracellular glucose. However, prolonged exposure to elevated glucose exerts toxic effects on beta cells and results in beta cell dysfunction and ultimately beta cell death (glucose toxicity). To investigate the mechanism of how increased extracellular glucose is toxic to beta cells, we used two model systems where glucose metabolism was increased in beta cell lines by enhancing glucokinase (GK) activity and exposing cells to physiologically relevant increases in extracellular glucose (3.3-20 mm). Exposure of cells with enhanced GK activity to 20 mm glucose accelerated glycolysis, but reduced cellular NAD(P)H and ATP, caused accumulation of intracellular reactive oxygen species (ROS) and oxidative damage to mitochondria and DNA, and promoted apoptotic cell death. These changes required both enhanced GK activity and exposure to elevated extracellular glucose. A ROS scavenger partially prevented the toxic effects of increased glucose metabolism. These results indicate that increased glucose metabolism in beta cells generates oxidative stress and impairs cell function and survival; this may be a mechanism of glucose toxicity in beta cells. The level of beta cell GK may also be critical in this process.

View details for DOI 10.1074/jbc.M307097200

View details for Web of Science ID 000220334900018

View details for PubMedID 14688272