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1. A proliferative subtype of colorectal liver metastases exhibits hypersensitivity to cytotoxic chemotherapy

Author

Liam F. Spurr, Carlos A. Martinez, Rohan R. Katipally, Soumya C. Iyer, Sian A. Pugh, John A. Bridgewater, John N. Primrose, Enric Domingo, Timothy S. Maughan, Michael I. D’Angelica, Mark Talamonti, Mitchell C. Posner, Philip P. Connell, Ralph R. Weichselbaum, and Sean P. Pitroda

Subjects
Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Personalized treatment approaches for patients with limited liver metastases from colorectal cancer are critically needed. By leveraging three large, independent cohorts of patients with colorectal liver metastases (n = 336), we found that a proliferative subtype associated with elevated CIN70 scores is linked to immune exclusion, increased metastatic proclivity, and inferior overall survival in colorectal liver metastases; however, high CIN70 scores generate a therapeutic vulnerability to DNA-damaging therapies leading to improved treatment responses. We propose CIN70 as a candidate biomarker to personalize systemic treatment options for patients with metastatic colorectal cancer. These findings are potentially broadly applicable to other human cancers.

Published
2022
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2. Integrated molecular subtyping defines a curable oligometastatic state in colorectal liver metastasis

Author

Sean P. Pitroda, Nikolai N. Khodarev, Lei Huang, Abhineet Uppal, Sean C. Wightman, Sabha Ganai, Nora Joseph, Jason Pitt, Miguel Brown, Martin Forde, Kathy Mangold, Lai Xue, Christopher Weber, Jeremy P. Segal, Sabah Kadri, Melinda E. Stack, Sajid Khan, Philip Paty, Karen Kaul, Jorge Andrade, Kevin P. White, Mark Talamonti, Mitchell C. Posner, Samuel Hellman, and Ralph R. Weichselbaum

Subjects
Science
Abstract

The oligometastasis hypothesis suggests certain metastases are limited in extent and curable with focal therapies. Here they identify three integrated molecular subtypes of colorectal cancer liver metastasis, which complement clinical risk stratification to distinguish the subset of oligometastatic patients.

Published
2018
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3. Author Correction: Integrated molecular subtyping defines a curable oligometastatic state in colorectal liver metastasis

Author

Sean P. Pitroda, Nikolai N. Khodarev, Lei Huang, Abhineet Uppal, Sean C. Wightman, Sabha Ganai, Nora Joseph, Jason Pitt, Miguel Brown, Martin Forde, Kathy Mangold, Lai Xue, Christopher Weber, Jeremy P. Segal, Sabah Kadri, Melinda E. Stack, Sajid Khan, Philip Paty, Karen Kaul, Jorge Andrade, Kevin P. White, Mark Talamonti, Mitchell C. Posner, Samuel Hellman, and Ralph R. Weichselbaum

Subjects
Science
Abstract

In the originally published version of this Article, the affiliation details for Kevin P. White inadvertently omitted ‘Tempus Labs, Chicago, IL, 60654, USA’. This has now been corrected in both the PDF and HTML versions of the Article.

Published
2018
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5. A core set of quality performance indicators for HPB procedures: a global consensus for hepatectomy, pancreatectomy, and complex biliary surgery

Author

Braden Woodhouse, Savio G. Barreto, Kjetil Soreide, Gregor A. Stavrou, Catherine Teh, Henry Pitt, Marcello Di Martino, Paulo Herman, Victor Lopez-Lopez, Frederik Berrevoet, Mark Talamonti, Mikhail Mikhnevich, Igor Khatkov, Laurence Webber, Ayrat Kaldarov, John Windsor, Omero P. Costa Filho, and Jonathan Koea

Subjects
Hepatology, Gastroenterology
Published
2023

6. Chromosomal instability mediates immune exclusion and response to cytotoxic chemotherapy in colorectal liver metastases

Author

John N. Primrose, Soumya C Iyer, Mark Talamonti, Mitchell C. Posner, Michael I. D’Angelica, Ralph R. Weichselbaum, Liam F. Spurr, Carlos A. Martinez, Enric Domingo, Sean P. Pitroda, Sian Alexandra Pugh, Philip P. Connell, Tim Maughan, and John Bridgewater

Subjects
Tumor microenvironment, Bladder cancer, business.industry, Colorectal cancer, medicine.medical_treatment, Aneuploidy, medicine.disease, Radiation therapy, Pathogenesis, Immune system, Chromosome instability, Cancer research, medicine, business
Abstract

The genomic drivers of immune exclusion in colorectal cancer liver metastases (CRCLM) remain poorly understood. Chromosomal instability (CIN), resulting in aneuploidy and genomic rearrangements, is the central pathway of mismatch repair-proficient colorectal cancer pathogenesis; however, it is unknown whether CIN impacts the outcomes of patients with limited spread of CRCLM treated with curative intent cytotoxic chemotherapy and surgery. Herein, we examined the relationship between CIN and the molecular subtypes of CRCLM, immune signaling, treatment sensitivity, and patient outcomes in three independent CRCLM patient cohorts. We established that a previously developed 70-gene CIN signature (CIN70) is a reliable measure of CIN, encompassing features of both aneuploidy and cellular proliferation. We demonstrated that tumors with the canonical subtype of CRCLM exhibit elevated levels of CIN and aneuploidy. Genomically unstable tumors were associated with an immune-depleted tumor microenvironment, and patients with genomically unstable tumors were at increased risk for disease progression in adverse metastatic sites, resulting in poor progression-free and overall survival. However, high-CIN tumors were particularly susceptible to DNA-damaging chemotherapies, including topoisomerase inhibitors, as well as radiation therapy. Treatment with genotoxic agents depleted CIN-rich cell populations, which resulted in a concomitant increase in intratumoral CD8+ T-cells in patients with primary rectal, breast, and bladder cancer. Taken together, we propose a mechanistic explanation for why cytotoxic chemotherapy can augment anti-tumor immunity and improve outcomes in patients with genomically unstable cancers.

Published
2021

7. Minimally invasive pancreatic resections: cost and value perspectives

Author

Kevin C. Conlon, Thijs de Rooij, Jony van Hilst, Mohammad Abu Hidal, Julie Fleshman, Mark Talamonti, Tsafrir Vanounou, Richard Garfinkle, Vic Velanovich, David Kooby, Charles M. Vollmer, Horacio J. Asbun, Jeffrey Barkun, Marc G.H. Besselink, Ugo Boggi, Kevin C.P. Conlon, Ho-Seong Han, Paul D. Hansen, Michael L. Kendrick, David A. Kooby, Andre L. Montagnini, C. Palanivelu, Bård I. Røsok, Shailesh V. Shrikhande, Go Wakabayashi, Herbert Zeh, CCA - Cancer Treatment and Quality of Life, Other departments, and AGEM - Amsterdam Gastroenterology Endocrinology Metabolism

Subjects
medicine.medical_specialty, Hepatology, Cost–benefit analysis, business.industry, medicine.medical_treatment, General surgery, Gastroenterology, MEDLINE, 030230 surgery, Societal level, Malignant disease, 03 medical and health sciences, 0302 clinical medicine, Quality of life, 030220 oncology & carcinogenesis, Pancreatectomy, medicine, business, Value (mathematics), Healthcare system
Abstract

Background The number of minimally invasive pancreatic resections (MIPR) performed for benign or malignant disease, have increased in recent years. However, there is limited information regarding cost/value implications. Methods An international conference evaluating MIPR was held during the 12th Bi-Annual International Hepato-Pancreato-Biliary Association (IHPBA) World Congress in Sao Paulo, Brazil, on April 20th, 2016. This manuscript summarizes the presentations that reviewed current topics in cost and value as they pertain to MIPR. Results Compared to the open approach, MIPR's are associated with higher operative costs but lower postoperative costs. However, measurements of patient value (defined as improvement in both quantity and quality of life) and financial value (using incremental cost-effectiveness ratio) are required to determine the true value at societal level. Conclusion Challenges remain as to how the potential benefits, both to the patient and the healthcare system as a whole, are measured. Research comparing MIPR versus other techniques for pancreatectomy will require appropriate and valid measurement tools, some of which are yet to be refined. Nonetheless, the experience to date would support the continued development of MIPR by experienced surgeons in high-volume pancreatic centers, married with appropriate review and recalibration.

Published
2017

9. Contributors

Author

Jalil Afnan, Jeffrey A. Alexander, Lauren F. Alexander, Surabhi Bajpai, Mark E. Baker, Stephen R. Baker, Aparna Balachandran, Dennis M. Balfe, Emil J. Balthazar, Stuart A. Barnard, Ahmed Ba-Ssalamah, Genevieve L. Bennett, Senta Berggruen, Jonathan W. Berlin, George S. Bissett, Roi M. Bittane, Michael A. Blake, Peyman Borghei, Kevin P. Boyd, Warren M. Brandwein, David H. Bruining, James L. Buck, Carina L. Butler, Selim R. Butros, Laura R. Carucci, Wei-Chou Chang, Raj R. Chinnappan, Byung Ihn Choi, Peter L. Cooperberg, Abraham H. Dachman, Alexander Ding, Carolyn K. Donaldson, Ronald L. Eisenberg, Sukru Mehmet Erturk, Thomas A. Farrell, Kate A. Feinstein, Sandra K. Fernbach, Hector Ferral, Florian J. Fintelmann, Elliot K. Fishman, Joel G. Fletcher, Kathryn J. Fowler, Aletta A. Frazier, Ann S. Fulcher, Helena Gabriel, Ana Maria Gaca, Kirema Garcia-Reyes, Gabriela Gayer, Gary G. Ghahremani, Seth N. Glick, Margaret D. Gore, Richard M. Gore, Sofia Gourtsoyianni, Nicholas C. Gourtsoyiannis, Jared R. Green, Gianfranco Gualdi, Rajan T. Gupta, Ravi Guttikonda, Robert A. Halvorsen, Nancy A. Hammond, Mukesh G. Harisinghani, Sandeep S. Hedgire, Frederick L. Hoff, Caroline L. Hollingsworth, Karen M. Horton, Steven Y. Huang, James E. Huprich, Aleksandar M. Ivanovic, Jill E. Jacobs, Bruce R. Javors, Bronwyn Jones, Naveen Kalra, Avinash Kambadakone, Mariam M. Kappil, Ana L. Keppke, David H. Kim, Stanley Taeson Kim, Douglas R. Kitchin, Michael L. Kochman, Dow-Mu Koh, J. Satheesh Krishna, Naveen Kulkarni, John C. Lappas, Igor Laufer, Fred T. Lee, Jr, Jeong Min Lee, Marc S. Levine, Angela D. Levy, Jennifer E. Lim-Dunham, Mark D. Little, Russell N. Low, Dean D.T. Maglinte, Abdullah Mahmutoglu, Maria A. Manning, Charles S. Marn, Gabriele Masselli, Shaunagh McDermott, Alec J. Megibow, Uday K. Mehta, Vincent M. Mellnick, Christine O. Menias, Joseph Meranda, James M. Messmer, Arthur B. Meyers, Morton A. Meyers, Frank H. Miller, Tara Morgan, Koenraad J. Mortele, Peter R. Mueller, Brian P. Mullan, Vamsi Narra, Albert A. Nemcek, Jr, Geraldine Mogavero Newmark, Jennifer L. Nicholas, Paul Nikolaidis, David J. Ott, Joseph Owen, Orhan S. Ozkan, Nickolas Papanikolaou, Mikin V. Patel, Pritesh Patel, Erik K. Paulson, Christine M. Peterson, Perry J. Pickhardt, Aliya Qayyum, David N. Rabin, Siva P. Raman, Peter M. Rodgers, Pablo R. Ros, Stephen E. Rubesin, Tara Sagebiel, Dushyant V. Sahani, Sanjay Saini, Martha Cotsen Saker, Riad Salem, Kumar Sandrasegaran, Rupan Sanyal, Christopher D. Scheirey, Francis J. Scholz, Adeel R. Seyal, Martin J. Shelly, Linda C. Sherbahn, Ali Shirkhoda, Ana Catarina Silva, Paul M. Silverman, Stuart G. Silverman, Robert I. Silvers, Ajay K. Singh, Jovitas Skucas, Gail S. Smith, Sat Somers, Anthony W. Stanson, Allison L. Summers, Richard A. Szucs, Mark Talamonti, Andrew J. Taylor, Darshit J. Thakrar, Kiran H. Thakrar, Yee Liang Thian, Ruedi F. Thoeni, Stephen Thomas, William Moreau Thompson, Temel Tirkes, Mary Ann Turner, Jennifer W. Uyeda, Fauzia Q. Vandermeer, Robert L. Vogelzang, Patrick M. Vos, Natasha Wehrli, Daniel R. Wenzke, Ellen L. Wolf, Jade J. Wong-You-Cheong, Cecil G. Wood, Michael A. Woods, Vahid Yaghmai, and Benjamin M. Yeh

Published
2015

10. Pancreatic Trauma and Surgery

Author

Paul Nikolaidis, Joseph Meranda, Frank H. Miller, Allison L. Summers, Helena Gabriel, Mark Talamonti, and Richard M. Gore

Published
2015

12. Phase II trial of chemoembolization for the treatment of metastatic colorectal carcinoma to the liver and review of the literature

Author

Robert L. Vogelzang, Claudia Tellez, Mark Talamonti, Al B. Benson, John Shaw, Michael A. Braun, Michael T. Lyster, and Albert A. Nemcek

Subjects
Cancer Research, medicine.medical_specialty, Chemotherapy, biology, business.industry, medicine.medical_treatment, Cancer, medicine.disease, Gastroenterology, Surgery, Metastasis, Regimen, Lethargy, Carcinoembryonic antigen, Oncology, Internal medicine, medicine, Carcinoma, biology.protein, Embolization, business
Abstract

BACKGROUND Hepatic artery chemoembolization represents an alternative treatment for patients whose neoplastic lesions are not amenable or have become refractory to other treatment modalities. This project was designed to test the feasibility of regional chemoembolization for patients with colorectal carcinoma metastasis to the liver who had experienced failure with one or more systemic treatments. METHODS Thirty patients who met the study entry criteria underwent one to three hepatic artery chemoembolizations. The chemoembolization regimen consisted of an injection of a bovine collagen material with cisplatin (10 mg/mL), doxorubicin (3 mg/mL), and mitomycin C (3 mg/mL). Repeat treatments were performed at 6- to 8-week intervals. RESULTS Radiologic responses, as measured by a decrease in lesion density of at least 75% of the lesion or a 25% decrease in the size of the lesion, occurred in 63% of the cases. A decrease of at least 25% of the baseline carcinoembryonic antigen level occurred in 95% of the cases. All responses were transient. Median survival for all 30 patients was 8.6 months after the initiation of chemoembolization and 29 months after the initial diagnosis of metastasis to the liver. Common toxicities included a "postembolization syndrome," which consisted of fever > 101 °F (83%), pain in the right upper quadrant (100%), nausea, and vomiting. Lethargy was a common occurrence (in 60+% of cases) and lasted up to 6 weeks. Hematologic toxicities included leukocytosis, anemia, and thrombocytopenia. CONCLUSIONS Chemoembolization is a feasible treatment modality for patients with colorectal carcinoma metastasis to the liver who have experienced failure with other systemic treatments. It results in high response rates with transient mild-to-moderate toxicity. Responses are measured in months, however, and all patients have eventual progression of disease. Patients who are able to undergo three or more chemoembolization procedures may receive the most clinical benefit. Cancer 1998;82:1250-9. © 1998 American Cancer Society.

Published
1998

13. Contributors

Author

Samuel Nathan Adler, Stephen R. Baker, Aparna Balachandran, Dennis M. Balfe, Emil J. Balthazar, Stuart A. Barnard, Clive Bartram, Genevieve L. Bennett, Jonathan W. Berlin, George S. Bissett, Peyman Borghei, James L. Buck, Carina L. Butler, Marc A. Camacho, Dina F. Caroline, Caroline W.T. Carrico, Richard I. Chen, Byung Ihn Choi, Howard B. Chrisman, Peter I. Cooperberg, Abraham H. Dachman, Susan Delaney, Gerald D. Dodd, Ronald L. Eisenberg, Sukru Mehmet Erturk, Sandra K. Fernbach, Julia R. Fielding, Elliot K. Fishman, Frans-Thomas Fork, Martin C. Freund, Ann S. Fulcher, Emma E. Furth, Helena Gabriel, Ana Maria, Gabriela Gayer, Gary G. Ghahremani, Seth N. Glick, Margaret D. Gore, Richard M. Gore, Nicholas C. Gourtsoyiannis, David Hahn, Robert A. Halvorsen, Nancy A. Hammond, Marjorie Hertz, Frederick L. Hoff, Caroline L. Hollingsworth, Karen M. Horton, Jill E. Jacobs, Werner R. Jaschke, Bruce R. Javors, Bronwyn Jones, Mannudeep K. Kalra, Ana L. Keppke, Stanley Taeson Kim, Michael L. Kochman, John C. Lapps, Thomas C. Lauenstein, Igor Laufer, Jeong Min Lee, Kang Hoon Lee, Marc S. Levine, Russell N. Low, Michael Macari, Robert L. MacCarty, Dean D.T. Maglinte, Charles S. Marn, Gabriele Masselli, Alan H. Maurer, Joseph Patrick Mazzie, Alec J. Megibow, Uday K. Mehta, James M. Messmer, Morton A. Meyers, Frank H. Miller, Koenraad J. Mortele, Karen A. Mourtzikos, Saravanan Namasivayam, Vamsi R. Narra, Rendon C. Nelson, Albert A. Nemcek, Geraldine Mogavero Newmark, Paul Nikolaidis, David J. Ott, Nickolas Papanikolaou, Erik K. Paulson, F. Scott Pereles, Christine M. Peterson, Vikram A. Rao, Richard D. Redvanly, Pablo R. Ros, Stephen E. Rubesin, Sanjay Saini, Riad Salem, Kumaresan Sandrasegaran, Kent T. Sato, Christopher D. Scheirey, Francis J. Scholz, Ali Shirkhoda, Paul M. Silverman, Stuart G. Silverman, Jovitas Skucas, William C. Small, Claire H. Smith, Robert H. Smith, Sat Somers, Allison L. Summers, Rajeev Suri, Richard A. Szucs, Mark Talamonti, Andrew J. Taylor, Ruedi F. Thoeni, William Moreau Thompson, Ranista Tongdee, Mitchell E. Tublin, Mary Ann Turner, Sean M. Tutton, Robert L. Vogelzang, Patrick M. Vos, Daphna Weinstein, Noel N. Williams, Stephanie R. Wilson, Ellen L. Wolf, Vahid Yaghmai, Silaja Yitta, and Rivka Zissin

Published
2010

14. Surgical management of gastric cancer

Author

Marshall S. Baker, Mark Talamonti S., and Malcolm M. Bilimoria

Subjects
Endoscopic ultrasound, Oncology, medicine.medical_specialty, Chemotherapy, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Carcinoid tumors, Cancer, medicine.disease, Internal medicine, medicine, Gastrectomy, Lymphadenectomy, business, Neoadjuvant therapy, Epirubicin, medicine.drug
Published
2009

15. Contributors

Author

STEPHEN E. RUBESIN, SAMUEL NATHAN ADLER, STEPHEN R. BAKER, APARNA BALACHANDRAN, DENNIS M. BALFE, EMIL J. BALTHAZAR, STUART A. BARNARD, CLIVE BARTRAM, GENEVIEVE L. BENNETT, JONATHAN W. BERLIN, GEORGE S. BISSETT, PEYMAN BORGHEI, JAMES L. BUCK, CARINA L. BUTLER, MARC A. CAMACHO, DINA F. CAROLINE, CAROLINE W.T. CARRICO, RICHARD I. CHEN, BYUNG IHN CHOI, HOWARD B. CHRISMAN, PETER L. COOPERBERG, ABRAHAM H. DACHMAN, SUSAN DELANEY, GERALD D. DODD, RONALD L. EISENBERG, SUKRU MEHMET ERTURK, SANDRA K. FERNBACH, JULIA R. FIELDING, ELLIOT K. FISHMAN, FRANS-THOMAS FORK, MARTIN C. FREUND, ANN S. FULCHER, EMMA E. FURTH, HELENA GABRIEL, ANA MARIA GACA, GABRIELA GAYER, GARY G. GHAHREMANI, SETH N. GLICK, MARGARET D. GORE, RICHARD M. GORE, NICHOLAS C. GOURTSOYIANNIS, DAVID HAHN, ROBERT A. HALVORSEN, NANCY A. HAMMOND, MARJORIE HERTZ, FREDERICK L. HOFF, CAROLINE L. HOLLINGSWORTH, KAREN M. HORTON, JILL E. JACOBS, WERNER R. JASCHKE, BRUCE R. JAVORS, BRONWYN JONES, MANNUDEEP K. KALRA, ANA L. KEPPKE, STANLEY TAESON KIM, MICHAEL L. KOCHMAN, JOHN C. LAPPAS, THOMAS C. LAUENSTEIN, IGOR LAUFER, JEONG MIN LEE, KANG HOON LEE, MARC S. LEVINE, RUSSELL N. LOW, MICHAEL MACARI, ROBERT L. MACCARTY, DEAN D.T. MAGLINTE, CHARLES S. MARN, GABRIELE MASSELLI, ALAN H. MAURER, JOSEPH PATRICK MAZZIE, ALEC J. MEGIBOW, UDAY K. MEHTA, JAMES M. MESSMER, MORTON A. MEYERS, FRANK H. MILLER, KOENRAAD J. MORTELE, KAREN A. MOURTZIKOS, SARAVANAN NAMASIVAYAM, VAMSI R. NARRA, RENDON C. NELSON, ALBERT A. NEMCEK, GERALDINE MOGAVERO NEWMARK, PAUL NIKOLAIDIS, DAVID J. OTT, NICKOLAS PAPANIKOLAOU, ERIK K. PAULSON, F. SCOTT PERELES, CHRISTINE M. PETERSON, VIKRAM A. RAO, RICHARD D. REDVANLY, PABLO R. ROS, SANJAY SAINI, RIAD SALEM, KUMARESAN SANDRASEGARAN, KENT T. SATO, CHRISTOPHER D. SCHEIREY, FRANCIS J. SCHOLZ, ALI SHIRKHODA, PAUL M. SILVERMAN, STUART G. SILVERMAN, JOVITAS SKUCAS, WILLIAM C. SMALL, CLAIRE H. SMITH, ROBERT H. SMITH, SAT SOMERS, ALLISON L. SUMMERS, RAJEEV SURI, RICHARD A. SZUCS, MARK TALAMONTI, ANDREW J. TAYLOR, RUEDI F. THOENI, WILLIAM MOREAU THOMPSON, RANISTA TONGDEE, MITCHELL E. TUBLIN, MARY ANN TURNER, SEAN M. TUTTON, ROBERT L. VOGELZANG, PATRICK M. VOS, DAPHNA WEINSTEIN, NOEL N. WILLIAMS, STEPHANIE R. WILSON, ELLEN L. WOLF, VAHID YAGHMAI, SILAJA YITTA, and RIVKA ZISSIN

Published
2008

16. Pancreatic Trauma and Surgery

Author

Paul Nikolaidis, Frank H. Miller, Allison L. Summers, Helena Gabriel, Mark Talamonti, and Richard M. Gore

Published
2008

17. Pancreatic adenocarcinoma. Clinical Practice Guidelines in Oncology

Author

Margaret, Tempero, J Pablo, Arnoletti, Edgar, Ben-Josef, Pankaj, Bhargava, Ephraim S, Casper, Paula, Kim, Mokenge P, Malafa, Eric K, Nakakura, Stephen, Shibata, Mark, Talamonti, Hanlin, Wang, and Christopher, Willett

Subjects
Antimetabolites, Antineoplastic, Cholestasis, Gastric Outlet Obstruction, Portal Vein, Palliative Care, Disease Management, Adenocarcinoma, Deoxycytidine, Gemcitabine, Pancreatic Neoplasms, Pancreatectomy, Treatment Outcome, Chemotherapy, Adjuvant, Drainage, Humans, Lymph Node Excision, Antigens, Tumor-Associated, Carbohydrate, Radiotherapy, Adjuvant, Algorithms, Neoplasm Staging
Published
2007

19. Demographic and prognostic factors in ampullary adenocarcinoma: A retrospective review of 74 sequential cases undergoing multidisciplinary management between 1997 and 2009

Author

Robert de Wilton Marsh, Romy Pandey, David J. Bentrem, Marshall Baker, Xian Ding, Susan Stocker, Eric Brown, and Mark Talamonti

Subjects
Cancer Research, Oncology
Abstract

e14642 Background: Ampullary adenocarcinoma represents 1% of GI cancers but accounts for almost 30% of Whipple operations at major centers. Prognosis falls between that of pancreatic and duodenal cancer, but demographic and prognostic factors are not well delineated. Methods: Retrospective review, with patient consent, of an IRB approved common surgical database at two academic institutions. This includes all cases operated on for ampullary adenocarcinoma between 1997 and 2009. Demographics and factors with potential relevance for prognosis by literature review were examined via Kaplan Meier and/or Cox models. Results: 74 cases were identified: 50 had conventional and 22 pylorus preserving Whipple procedures with 2 unresectable cases. Demographics: 38 males, 36 females; 64 Caucasian, 6 African American and 4 others; age 23-83, median 63.08 years. Tumor characteristics: Tis -1, T1-10, T2-22, T3-27, T4-12, Unknown-2; N0-35, N1-38, Unknown-1; pre-existing adenomas in 37 (50%). Tumor markers: CEA 2/34 and CA 19-9 16/37 tested were abnormal. Adjuvant therapy given (chemo and/or chemoRT): 33/74. Status: 34 patients alive and 41 deceased with a median follow-up of 22 months. Factors associated with poor outcome: Perineural invasion (PNI) p = 0.02; Pre-existing adenoma p = 0.001; Weight loss of 10 lbs or more p = 0.01; RBC transfusion in the OR p = 0.001. Factors not statistically prognostic: T stage, lymph nodal status, lymphovascular invasion, jaundice, CEA or CA 19-9 values and absence of adjuvant therapy. Pancreaticobiliary versus intestinal subtype was assessed by H and E staining but one third of cases were indeterminate, and while these appeared to have a worse prognosis, IHC will be performed for accurate classification and determination of significance. Conclusions: This dataset describes the demographics of patients treated for ampullary adenocarcinoma over 12 years and identifies PNI, weight loss, pre-existing adenoma and transfusion in the OR as adverse factors. These prognostic factors (and potentially histologic subtype) should be considered in patient care and future study design.

Published
2012

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