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354. 893 LAPAROSCOPIC ASSISTED ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY FOLLOWING GASTRIC BYPASS: A 12-YEAR ASSESSMENT OF OUTCOMES AND LEARNING CURVE AT A HIGH VOLUME PANCREATOBILIARY CENTER

Author

Masri, Samer S. Al, primary, Zenati, Mazen S., additional, Papachristou, Georgios, additional, Slivka, Adam, additional, Chennat, Jennifer, additional, Rabinovitz, Mordechai, additional, Khalid, Asif, additional, Gelrud, Andres, additional, Nasr, John Y., additional, Sarkaria, Savreet, additional, Das, Rohit, additional, Lee, Kenneth, additional, Schraut, Wolfgang H., additional, Hughes, Steven J., additional, Moser, A.J., additional, Paniccia, Alessandro, additional, Hogg, Melissa E., additional, Zeh, Herbert J., additional, and Zureikat, Amer H., additional

Published
2020
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355. 374 A SYSTEMATIC EVALUATION OF CELL LINEAGE AMONG NONFUNCTIONAL PANCREATIC NEUROENDOCRINE TUMORS (PANNETS) AND THEIR RELATIONSHIP TO GENOMIC ALTERATIONS ASSOCIATED WITH METASTATIC DISEASE AND POOR PATIENT SURVIVAL

Author

Aijazi, Muaz, primary, Singhi, Aatur, additional, Nalesnik, Michael A., additional, O'Sullivan, Roderick, additional, Roy, Somak, additional, Lee, Kenneth, additional, Bahary, Nathan, additional, Brand, Randall, additional, Chennat, Jennifer, additional, Kenneth, Fasanella, additional, McGrath, Kevin, additional, Nikiforova, Marina N., additional, Slivka, Adam, additional, Hogg, Melissa E., additional, Zeh, Herbert J., additional, and Zureikat, Amer H., additional

Published
2020
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360. Predictors of Disease Progression or Performance Status Decline in Patients Undergoing Neoadjuvant Therapy for Localized Pancreatic Head Adenocarcinoma

Author

Paniccia, Alessandro, primary, Gleisner, Ana L., additional, Zenati, Mazen S., additional, Al Abbas, Amr I., additional, Jung, Jae Pil, additional, Bahary, Nathan, additional, Lee, Kenneth K. W., additional, Bartlett, David, additional, Hogg, Melissa E., additional, Zeh, Herbert J., additional, and Zureikat, Amer H., additional

Published
2020
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363. Outcomes and efficacy of neoadjuvant chemoradiation versus chemotherapy in localized pancreatic cancer.

Author

Chopra, Asmita, primary, Hodges, Jacob C., additional, Olson, Adam, additional, Burton, Steven A., additional, Lee, Kenneth K., additional, Bahary, Nathan, additional, Singhi, Aatur D., additional, Boone, Brian A., additional, Lotze, Michael T., additional, Hogg, Melissa E., additional, Zeh, Herbert, additional, and Zureikat, Amer H., additional

Published
2020
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364. Association of SMAD4 loss with response to neoadjuvant chemotherapy with the autophagy inhibitor hydroxychloroquine in patients with pancreatic adenocarcinoma.

Author

Fei, Naomi, primary, Wen, Sijin, additional, Rao, Pavan, additional, Ramanathan, Rajesh, additional, Hogg, Melissa E., additional, Zureikat, Amer H., additional, Lotze, Michael T., additional, Bahary, Nathan, additional, Singhi, Aatur D., additional, Zeh, Herbert, additional, and Boone, Brian A., additional

Published
2020
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365. Recurrent Rearrangements in PRKACA and PRKACB in Intraductal Oncocytic Papillary Neoplasms of the Pancreas and Bile Duct

Author

Singhi, Aatur D., primary, Wood, Laura D., additional, Parks, Emma, additional, Torbenson, Michael S., additional, Felsenstein, Matthäus, additional, Hruban, Ralph H., additional, Nikiforova, Marina N., additional, Wald, Abigail I., additional, Kaya, Cihan, additional, Nikiforov, Yuri E., additional, Favazza, Laura, additional, He, Jin, additional, McGrath, Kevin, additional, Fasanella, Kenneth E., additional, Brand, Randall E., additional, Lennon, Anne Marie, additional, Furlan, Alessandro, additional, Dasyam, Anil K., additional, Zureikat, Amer H., additional, Zeh, Herbert J., additional, Lee, Kenneth, additional, Bartlett, David L., additional, and Slivka, Adam, additional

Published
2020
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366. Assessment of Response to Neoadjuvant Therapy Using CT Texture Analysis in Patients With Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinoma

Author

Borhani, Amir A., primary, Dewan, Rohit, additional, Furlan, Alessandro, additional, Seiser, Natalie, additional, Zureikat, Amer H., additional, Singhi, Aatur D., additional, Boone, Brian, additional, Bahary, Nathan, additional, Hogg, Melissa E., additional, Lotze, Michael, additional, III, Herbert J. Zeh, additional, and Tublin, Mitchell E., additional

Published
2020
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368. The Miami International Evidence-based Guidelines on Minimally Invasive Pancreas Resection

Author

Asbun, Horacio J., primary, Moekotte, Alma L., additional, Vissers, Frederique L., additional, Kunzler, Filipe, additional, Cipriani, Federica, additional, Alseidi, Adnan, additional, D’Angelica, Michael I., additional, Balduzzi, Alberto, additional, Bassi, Claudio, additional, Björnsson, Bergthor, additional, Boggi, Ugo, additional, Callery, Mark P., additional, Del Chiaro, Marco, additional, Coimbra, Felipe J., additional, Conrad, Claudius, additional, Cook, Andrew, additional, Coppola, Alessandro, additional, Dervenis, Christos, additional, Dokmak, Safi, additional, Edil, Barish H., additional, Edwin, Bjørn, additional, Giulianotti, Pier C., additional, Han, Ho-Seong, additional, Hansen, Paul D., additional, van der Heijde, Nicky, additional, van Hilst, Jony, additional, Hester, Caitlin A., additional, Hogg, Melissa E., additional, Jarufe, Nicolas, additional, Jeyarajah, D. Rohan, additional, Keck, Tobias, additional, Kim, Song Cheol, additional, Khatkov, Igor E., additional, Kokudo, Norihiro, additional, Kooby, David A., additional, Korrel, Maarten, additional, de Leon, Francisco J., additional, Lluis, Nuria, additional, Lof, Sanne, additional, Machado, Marcel A., additional, Demartines, Nicolas, additional, Martinie, John B., additional, Merchant, Nipun B., additional, Molenaar, I. Quintus, additional, Moravek, Cassadie, additional, Mou, Yi-Ping, additional, Nakamura, Masafumi, additional, Nealon, William H., additional, Palanivelu, Chinnusamy, additional, Pessaux, Patrick, additional, Pitt, Henry A., additional, Polanco, Patricio M., additional, Primrose, John N., additional, Rawashdeh, Arab, additional, Sanford, Dominic E., additional, Senthilnathan, Palanisamy, additional, Shrikhande, Shailesh V., additional, Stauffer, John A., additional, Takaori, Kyoichi, additional, Talamonti, Mark S., additional, Tang, Chung N., additional, Vollmer, Charles M., additional, Wakabayashi, Go, additional, Walsh, R. Matthew, additional, Wang, Shin-E, additional, Zinner, Michael J., additional, Wolfgang, Christopher L., additional, Zureikat, Amer H., additional, Zwart, Maurice J., additional, Conlon, Kevin C., additional, Kendrick, Michael L., additional, Zeh, Herbert J., additional, Hilal, Mohammad Abu, additional, and Besselink, Marc G., additional

Published
2020
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370. 500 Minimally Invasive Robotic Pancreatoduodenectomies

Author

Zureikat, Amer H., primary, Beane, Joal D., additional, Zenati, Mazen S., additional, Al Abbas, Amr I., additional, Boone, Brian A., additional, Moser, A. James, additional, Bartlett, David L., additional, Hogg, Melissa E., additional, and Zeh, Herbert J., additional

Published
2019
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373. Laparoscopic-assisted ERCP following RYGB: a 12-year assessment of outcomes and learning curve at a high-volume pancreatobiliary center.

Author

AlMasri, Samer, Zenati, Mazen S., Papachristou, Georgios I., Slivka, Adam, Sanders, Michael, Chennat, Jennifer, Rabinowitz, Mordechai, Khalid, Asif, Gelrud, Andres, Nasr, John, Sarkaria, Savreet, Das, Rohit, Lee, Kenneth K., Schraut, Wolfgang, Hughes, Steve J., Moser, A. James, Paniccia, Alessandro, Hogg, Melissa E., Zeh III, Herbert J., and Zureikat, Amer H.

Subjects
EDUCATIONAL outcomes, ENDOSCOPIC retrograde cholangiopancreatography, SURGICAL site infections, SURGERY, GALLBLADDER, GASTRIC bypass, URETHRA stricture
Abstract

Introduction: Treatment of pancreaticobiliary pathology following Roux-en-Y gastric bypass (RYGB) poses significant technical challenges. Laparoscopic-assisted endoscopic retrograde cholangiopancreatography (LA-ERCP) can overcome those anatomical hurdles, allowing access to the papilla. Our aims were to analyze our 12-year institutional outcomes and determine the learning curve for LA-ERCP. Methods: A retrospective review of cases between 2007 and 2019 at a high-volume pancreatobiliary unit was performed. Logistic regression was used to identify predictors of specific outcomes. To identify the learning curve, CUSUM analyses and innovative methods for standardizing the surgeon's timelines were performed. Results: 131 patients underwent LA-ERCP (median age 60, 81% females) by 17 surgeons and 10 gastroenterologists. Cannulation of the papilla was achieved in all cases. Indications were choledocholithiasis (78%), Sphincter of Oddi dysfunction/Papillary stenosis (18%), management of bile leak (2%) and stenting/biopsy of malignant strictures (2%). Median total, surgical and ERCP times were 180, 128 and 48 min, respectively, and 47% underwent concomitant cholecystectomy. Surgical site infection developed in 9.2% and post-ERCP pancreatitis in 3.8%. Logistic regression revealed multiple abdominal operations and magnitude of BMI decrease (between RYGB and LA-ERCP) to be predictive of conversion to open approach. CUSUM analysis of operative time demonstrated a learning curve at case 27 for the surgical team and case 9 for the gastroenterology team. On binary cut analysis, 3–5 cases per surgeon were needed to optimize operative metrics. Conclusion: LA-ERCP is associated with high success rates and low adverse events. We identify outcome benchmarks and a learning curve for new adopters of this increasingly performed procedure. [ABSTRACT FROM AUTHOR]

Published
2022
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374. The Role of Adjuvant Chemotherapy Following Right Hemicolectomy for Non-metastatic Mucinous and Nonmucinous Appendiceal Adenocarcinoma.

Author

AlMasri, Samer S., Paniccia, Alessandro, Hammad, Abdulrahman Y., Pai, Reetesh K., Bahary, Nathan, Zureikat, Amer H., Medich, David S., Celebrezze, James P., Choudry, Haroon A., and Nassour, Ibrahim

Subjects
RIGHT hemicolectomy, ADJUVANT chemotherapy, APPENDIX (Anatomy), ADENOCARCINOMA, LYMPHATIC metastasis
Abstract

Background: Appendiceal adenocarcinoma (AA) represents a heterogenous group of neoplasms with distinct histologic features. The role and efficacy of adjuvant chemotherapy (AC) in non-metastatic disease remain controversial. The aim of this study was to ascertain the role of AC in non-metastatic AA in a national cohort of patients. Methods: The National Cancer Database (NCDB) was queried to identify patients diagnosed with stage I–III mucinous and nonmucinous AA who underwent right hemicolectomy between 2006 and 2016. Kaplan-Meier and Cox regression analyses were used to evaluate the impact of AC on overall survival (OS) stratified by each pathologic stage. Results: A total of 1433 mucinous and 1954 nonmucinous AA were identified; 578 (40%) and 722 (40%) received AC respectively. In both AC groups, there was a higher proportion of T4 disease, lymph node metastasis, pathologic stage III, and poorly/undifferentiated grade (all P<0.05). On unadjusted analysis, there was no significant association between AC and OS for stage I–III mucinous AA. For nonmucinous AA, AC significantly improved OS only for stage II and III disease. On adjusted analysis, AC was independently associated with an improved OS for stage III nonmucinous AA (HR: 0.61, 95%CI 0.45–0.84, P=0.002), while for mucinous AA, AC was associated with worse outcomes for stage I/II disease (HR: 1.4, 95%CI 1.02–1.91, P=0.038) and had no significant association with OS for stage III disease. Conclusion: This current analysis of a national cohort of patients suggests a beneficial role for AC in stage III nonmucinous AA and demonstrates no identifiable benefit for stage I–III mucinous AA. [ABSTRACT FROM AUTHOR]

Published
2022
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375. Optimal Pancreatic Surgery: Are We Making Progress in North America?

Author

Beane, Joal D., Borrebach, Jeffrey D., Zureikat, Amer H., Kilbane, E. Molly, Thompson, Vanessa M., and Pitt, Henry A.

Abstract

Objective: Our aims were to assess North American trends in the management of patients undergoing pancreatoduodenectomy (PD) and distal pancreatectomy (DP), and to quantify the delivery of optimal pancreatic surgery. Background: Morbidity after pancreatectomy remains unacceptably high. Recent literature suggests that composite measures may more accurately define surgical quality. Methods: The 2013 to 2017 American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried to identify patients undergoing PD (N = 16,222) and DP (N = 7946). Patient, process, procedure, and 30-day postoperative outcome variables were analyzed over time. Optimal pancreatic surgery was defined as the absence of postoperative mortality, serious morbidity, percutaneous drainage, and reoperation while achieving a length of stay equal to or less than the 75th percentile (12 days for PD and 7 days for DP) with no readmissions. Risk-adjusted time-trend analyses were performed using logistic regression, and the threshold for statistical significance was P≤0.05. Results: The use of minimally invasive PD did not change over time, but robotic PD increased (2.5 to 4.2%; P < 0.001) and laparoscopic PD decreased (5.8% to 4.3%; P < 0.02). Operative times decreased (P < 0.05) and fewer transfusions were administered (P < 0.001). The percentage of patients with a drain fluid amylase checked on postoperative day 1 increased (P < 0.001), and a greater percentage of surgical drains were removed by postoperative day 3 (P < 0.001). Overall morbidity (P < 0.02), mortality (P < 0.05), and postoperative length of stay (P=0.002) decreased. Finally, the rate of optimal pancreatic surgery increased for PD (53.7% to 56.9%; P < 0.01) and DP (53.3% to 58.5%; P < 0.001), and alspo for patients with pancreatic cancer (P < 0.01). Conclusions: From 2013 to 2017, pre, intra, and perioperative pancreatectomy processes have evolved, and multiple postoperative outcomes have improved. Thus, in 4 years, optimal pancreatic surgery in North America has increased by 3% to 5%. [ABSTRACT FROM AUTHOR]

Published
2021
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377. Outcomes of Neoadjuvant Chemotherapy Versus Chemoradiation in Localized Pancreatic Cancer: A Case–Control Matched Analysis.

Author

Chopra, Asmita, Hodges, Jacob C., Olson, Adam, Burton, Steve, Ellsworth, Susannah G., Bahary, Nathan, Singhi, Aatur D., Boone, Brian A., Beane, Joal D., Bartlett, David, Lee, Kenneth K., Hogg, Melissa E., Lotze, Michael T., Paniccia, Alessandro, Zeh, Herbert, and Zureikat, Amer H.

Abstract

Background: Neoadjuvant therapy is increasingly used for patients with pancreatic ductal adenocarcinoma (PDAC). It is unknown whether neoadjuvant chemoradiotherapy is more effective than chemotherapy (NCRT vs. NAC). We aim to compare pathological and survival outcomes of NCRT and NAC in patients with PDAC. Patients and Methods: Single-center analysis of PDAC patients treated with NCRT or NAC followed by resection between December 2008 and December 2018 was performed. Average treatment effect (ATE) was estimated after case–control matching using Mahalanobis distance nearest-neighbor matching. Inverse probability weighted estimates (IPWE)-based ATE was estimated for disease-free survival (DFS) and overall survival (OS). Results: Among the 418 patients (mean age 66.8 years, 51% female) included in the study, 327 received NAC and 91 received NCRT. NCRT patients had higher rates of locally advanced disease, number of neoadjuvant chemotherapy cycles, more chemotherapy regimen crossover (gemcitabine and 5-FU based), and were more likely to undergo open surgical procedures and/or vascular resection (all p < 0.05). After matched analysis, NCRT was associated with a significant reduction in lymph node positive disease [ATE = (−)0.24, p = 0.007] and lymphovascular invasion [ATE = (−)0.20, p = 0.02]. While NCRT was associated with significantly improved DFS by 9.5 months (p = 0.006), it did not affect OS by IPWE-based ATE after adjusting for adjuvant therapy (ATE = 5.5 months; p = 0.32). Conclusion: Compared with NAC alone, NCRT is associated with improved pathologic surrogates and disease-free survival, but not overall survival in patients with PDAC. [ABSTRACT FROM AUTHOR]

Published
2021
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378. Development of a Novel Pancreatoduodenectomy-Specific Risk Calculator: an Analysis of 10,000 Patients.

Author

Al Abbas, Amr I., Borrebach, Jeffrey D., Pitt, Henry A., Bellon, Johanna, Hogg, Melissa E., Zeh III, Herbert J., and Zureikat, Amer H.

Subjects
RISK assessment, PANCREATIC duct, PANCREATIC fistula, LOGISTIC regression analysis, PANCREATICODUODENECTOMY, REGRESSION analysis, PANCREATECTOMY
Abstract

Background: Pancreatoduodenectomy (PD) is often performed in frail patients and is associated with significant morbidity. The five-factor modified frailty index (mFI-5) has been utilized to predict adverse postoperative outcomes, but has not been tested in PD. We aimed to develop risk tools to generate and predict 30-day outcomes after PD and compare their performance with the mFI-5. Risk tools were then used to generate a PD-specific calculator. Methods: Elective PDs from the 2014–2016 ACS NSQIP® Procedure Targeted Pancreatectomy PUFs were identified. Multivariable logistic regression models were constructed to predict postoperative mortality, any complication, serious complication, clinically relevant postoperative pancreatic fistula (CR-POPF), and discharge not-to-home. Predictive accuracy was evaluated through repeated stratified tenfold cross-validation and compared to the mFI-5. Results: Nine thousand eight hundred sixty-seven PDs were captured. Nine risk factors were retained: sex, age, BMI, DM, HTN, ASA classification, pancreatic duct size, gland texture, and adenocarcinoma. Cross-validated C-indices ranged from 0.49 to 0.61 for the mFI-5 and 0.63 to 0.75 for our risk models. The best-performing model was for discharge not-to-home (C = 0.75), and the model delivering the largest increase in predictive accuracy was for CR-POPF (CmFI-5/Model = 0.49/0.70). A user-friendly risk calculator was created predicting the five outcomes of interest. Conclusion: We have created a PD-specific risk calculator that outperforms the mFI-5. This calculator may serve as a useful adjunct in shared decision-making for patients and surgeons. [ABSTRACT FROM AUTHOR]

Published
2021
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379. Optimal Pancreatic Surgery

Author

Beane, Joal D., primary, Borrebach, Jeffrey D., additional, Zureikat, Amer H., additional, Kilbane, E. Molly, additional, Thompson, Vanessa M., additional, and Pitt, Henry A., additional

Published
2019
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385. Role of Adjuvant Multimodality Therapy After Curative-Intent Resection of Ampullary Carcinoma

Author

Ecker, Brett L., primary, Vollmer, Charles M., additional, Behrman, Stephen W., additional, Allegrini, Valentina, additional, Aversa, John, additional, Ball, Chad G., additional, Barrows, Courtney E., additional, Berger, Adam C., additional, Cagigas, Martha N., additional, Christein, John D., additional, Dixon, Elijah, additional, Fisher, William E., additional, Freedman-Weiss, Mollie, additional, Guzman-Pruneda, Francisco, additional, Hollis, Robert H., additional, House, Michael G., additional, Kent, Tara S., additional, Kowalsky, Stacy J., additional, Malleo, Giuseppe, additional, Salem, Ronald R., additional, Salvia, Roberto, additional, Schmidt, Carl R., additional, Seykora, Thomas F., additional, Zheng, Richard, additional, Zureikat, Amer H., additional, and Dickson, Paxton V., additional

Published
2019
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389. Real-Time Targeted Genome Profile Analysis of Pancreatic Ductal Adenocarcinomas Identifies Genetic Alterations That Might Be Targeted With Existing Drugs or Used as Biomarkers

Author

Singhi, Aatur D., primary, George, Ben, additional, Greenbowe, Joel R., additional, Chung, Jon, additional, Suh, James, additional, Maitra, Anirban, additional, Klempner, Samuel J., additional, Hendifar, Andrew, additional, Milind, Javle M., additional, Golan, Talia, additional, Brand, Randall E., additional, Zureikat, Amer H., additional, Roy, Somak, additional, Schrock, Alexa B., additional, Miller, Vincent A., additional, Ross, Jeffrey S., additional, Ali, Siraj M., additional, and Bahary, Nathan, additional

Published
2019
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396. Integrating next-generation sequencing to endoscopic retrograde cholangiopancreatography (ERCP)-obtained biliary specimens improves the detection and management of patients with malignant bile duct strictures

Author

Singhi, Aatur D, primary, Nikiforova, Marina N, additional, Chennat, Jennifer, additional, Papachristou, Georgios I, additional, Khalid, Asif, additional, Rabinovitz, Mordechai, additional, Das, Rohit, additional, Sarkaria, Savreet, additional, Ayasso, M Samir, additional, Wald, Abigail I, additional, Monaco, Sara E, additional, Nalesnik, Michael, additional, Ohori, N Paul, additional, Geller, David, additional, Tsung, Allan, additional, Zureikat, Amer H, additional, Zeh, Herbert, additional, Marsh, J Wallis, additional, Hogg, Melissa, additional, Lee, Kenneth, additional, Bartlett, David L, additional, Pingpank, James F, additional, Humar, Abhinav, additional, Bahary, Nathan, additional, Dasyam, Anil K, additional, Brand, Randall, additional, Fasanella, Kenneth E, additional, McGrath, Kevin, additional, and Slivka, Adam, additional

Published
2019
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398. Enhanced Neutrophil Extracellular Trap Formation in Acute Pancreatitis Contributes to Disease Severity and Is Reduced by Chloroquine

Author

Murthy, Pranav, primary, Singhi, Aatur D., additional, Ross, Mark A., additional, Loughran, Patricia, additional, Paragomi, Pedram, additional, Papachristou, Georgios I., additional, Whitcomb, David C., additional, Zureikat, Amer H., additional, Lotze, Michael T., additional, Zeh III, Herbert J., additional, and Boone, Brian A., additional

Published
2019
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400. Risk Factors and Mitigation Strategies for Pancreatic Fistula After Distal Pancreatectomy

Author

Ecker, Brett L., primary, McMillan, Matthew T., additional, Allegrini, Valentina, additional, Bassi, Claudio, additional, Beane, Joal D., additional, Beckman, Ross M., additional, Behrman, Stephen W., additional, Dickson, Euan J., additional, Callery, Mark P., additional, Christein, John D., additional, Drebin, Jeffrey A., additional, Hollis, Robert H., additional, House, Michael G., additional, Jamieson, Nigel B., additional, Javed, Ammar A., additional, Kent, Tara S., additional, Kluger, Michael D., additional, Kowalsky, Stacy J., additional, Maggino, Laura, additional, Malleo, Giuseppe, additional, Valero, Vicente, additional, Velu, Lavanniya K. P., additional, Watkins, Amarra A., additional, Wolfgang, Christopher L., additional, Zureikat, Amer H., additional, and Vollmer, Charles M., additional

Published
2019
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