Carrie Luu

Interests

No activities entered.

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Galouzis, N., Khawam, M., Alexander, E. V., Khreiss, M. R., Luu, C., Mesropyan, L., Riall, T. S., Kwass, W. K., & Dull, R. O. (2024). Pilot Study to Optimize Goal-directed Hemodynamic Management During Pancreatectomy. The Journal of surgical research, 300, 173-182.
  More info

  Intraoperative goal-directed hemodynamic therapy (GDHT) is a cornerstone of enhanced recovery protocols. We hypothesized that use of an advanced noninvasive intraoperative hemodynamic monitoring system to guide GDHT may decrease intraoperative hypotension (IOH) and improve perfusion during pancreatic resection.
• Galouzis, N., Khawam, M., Alexander, E. V., Yallourakis, M. D., Mesropyan, L., Luu, C., Khreiss, M. R., & Riall, T. S. (2024). Decision regret and satisfaction with shared decision-making in pancreatic surgery. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 101870.
  More info

  Pancreatic surgery often does not provide long-term survival in patients with cancer or consistently improve symptoms in benign disease. This study aimed to assess decision regret and satisfaction with the decision-making process among patients who underwent pancreatectomy.
• Luu, C. (2024). When Benchmarks Fail Us: A Case Study in Cytoreductive Surgery. Annals of Surgical Oncology.
• Dougherty, K., Zhang, Z., Montenegro, G., Hinyard, L., Xu, E., Hsueh, E., & Luu, C. (2023). Impact of Hospital Volume on Utilization of Minimally Invasive Surgery for Gastric Cancer. The American surgeon, 89(11), 4569-4577.
  More info

  Minimally invasive surgery (MIS) for gastric cancer is increasingly performed. The purpose of this study is to evaluate trends in utilization of laparoscopic and robotic techniques compared to open surgery as well as utilization based on hospital volume.
• Diggs, L. P., Aversa, J. G., Wiemken, T. L., Martin, S. P., Drake, J. A., Ruff, S. M., Wach, M. M., Brown, Z. J., Blakely, A. M., Davis, J. L., Luu, C., & Hernandez, J. M. (2021). Patient Comorbidities Drive High Mortality Rates Associated with Major Liver Resections Irrespective of Hospital Volume. The American surgeon, 87(7), 1163-1170.
  More info

  Major hepatectomies are utilized to manage primary hepatic malignancies. Reports from high-volume centers (HVCs) with minimal perioperative mortality focus on multiple aspects of perioperative care, although patient-specific factors remain unelucidated. We identified patient factors associated with outcomes and examined whether these contribute to survival differences.
• Huang, B., Mooser, A., Carpenter, D., Montenegro, G., & Luu, C. (2021). A Rare Case of Pancreatic Endometriosis Masquerading as Pancreatic Mucinous Neoplasm. Case reports in surgery, 2021, 5570290.
  More info

  Endometriosis is a relatively common condition among women, and pancreatic endometriosis has been reported on rare occasions. Such pancreatic lesions are difficult to diagnose and distinguish from other cystic lesions of the pancreas preoperatively. This report describes a case of pancreatic endometriosis in a 51-year-old female patient. Imaging demonstrated an enlarging cyst with findings concerning for a mucinous neoplasm. The patient underwent robotic distal pancreatectomy and splenectomy. Histopathology revealed an endometriotic cyst. Pancreatic endometriosis can be difficult to distinguish from other lesions of the pancreas. Surgical resection should be undertaken in cases where malignancy is suspected.
• Tian, Y., Luu, C., Carpenter, D. H., & Montenegro, G. (2021). A Unique Presentation of Metastatic Gallbladder Carcinoma. Case reports in surgery, 2021, 6455540.
  More info

  Gallbladder carcinoma can be challenging to diagnose and treat and usually leads to poor outcome, due to its aggressive nature and the nonspecific clinical presentation at early stage. We describe an interesting case of a 60-year-old female who presented with stage 3 appendiceal carcinoma after appendectomy was performed outside hospital. Further imaging workup demonstrated enlarged ovarian cysts and porcelain gallbladder. Upon exploration, she was found to have carcinomatosis and we proceeded with cytoreductive surgery (CRS) and hyperthermic intraperitoneal therapy (HIPEC). Final pathology demonstrated carcinoma from gallbladder primary.
• Aversa, J. G., Diggs, L. P., Hagerty, B. L., Dominguez, D. A., Wiemken, T., Luu, C., & Hernandez, J. M. (2020). Trends of Clinician Adherence to Evidence-Based Recommendations for Multidisciplinary Oncology Care for Patients With Esophageal Cancer. JAMA oncology, 6(8), 1290-1292.
  More info

  This cohort study examines national rates of neoadjuvant dual-agent chemotherapy and radiation followed by surgery in patients with locally advanced esophageal carcinoma after a randomized clinical trial demonstrated a survival advantage.
• Ayabe, R. I., Wach, M. M., Ruff, S. M., Diggs, L. P., Martin, S. P., Wiemken, T., Hinyard, L., Davis, J. L., Luu, C., & Hernandez, J. M. (2020). Gallbladder squamous cell carcinoma: An analysis of 1084 cases from the National Cancer Database. Journal of surgical oncology, 122(4), 716-722.
  More info

  Gallbladder squamous cell carcinoma (SCC) is an uncommon malignancy whose rarity has made it particularly challenging to study. We utilized a national database to shed light on the clinicopathologic characteristics, management patterns, and survival associated with these tumors.
• Hagerty, B. L., Aversa, J., Diggs, L. P., Dominguez, D. A., Ayabe, R. I., Blakely, A. M., Davis, J. L., Luu, C., & Hernandez, J. M. (2020). Characterization of alveolar soft part sarcoma using a large national database. Surgery, 168(5), 825-830.
  More info

  Alveolar soft part sarcoma is a rare, histologic subtype of soft tissue sarcoma that remains poorly defined. We aimed to describe patient characteristics and treatment patterns and to examine factors associated with survival for patients with alveolar soft part sarcoma.
• Ayabe, R. I., Wach, M., Ruff, S., Martin, S., Diggs, L., Wiemken, T., Hinyard, L., Davis, J. L., Luu, C., & Hernandez, J. M. (2019). Primary Gallbladder Neuroendocrine Tumors: Insights into a Rare Histology Using a Large National Database. Annals of surgical oncology, 26(11), 3577-3585.
  More info

  Primary gallbladder neuroendocrine tumors (NETs) are rare, poorly understood cancers infrequently encountered at even the largest of tertiary referral centers. We therefore sought to identify a large cohort of patients with gallbladder NETs using a national database, with the aim of defining treatment modalities employed and survival associated with these uncommon malignancies.
• Luu, C., Thapa, R., Rose, T., Woo, K., Jeong, D., Thomas, K., Chen, D. T., Friedman, M., Malafa, M. P., & Hodul, P. J. (2018). Identification of nonalcoholic fatty liver disease following pancreatectomy for noninvasive intraductal papillary mucinous neoplasm. International journal of surgery (London, England), 58, 46-49.
  More info

  Nonalcoholic fatty liver disease (NAFLD) following pancreatectomy is a potential cause of long term morbidity in patients undergoing pancreatic resection with curative intent. Prior studies have reported an incidence of NAFLD up to 30% following pancreatectomy but the investigated cohorts were typically a mix of benign and malignant disease. Here we examined the incidence of NAFLD in a homogenous cohort of patients following pancreatectomy for benign intraductal papillary mucinous neoplasm (IPMN).
• Luu, C., Amaral, M., Klapman, J., Harris, C., Almhanna, K., Hoffe, S., Frakes, J., Pimiento, J. M., & Fontaine, J. P. (2017). Endoscopic ultrasound staging for early esophageal cancer: Are we denying patients neoadjuvant chemo-radiation?. World journal of gastroenterology, 23(46), 8193-8199.
  More info

  To evaluate the accuracy of endoscopic ultrasound (EUS) in early esophageal cancer (EC) performed in a high-volume tertiary cancer center.
• Luu, C., Thapa, R., Woo, K., Coppola, D., Almhanna, K., Pimiento, J. M., Chen, D. T., Marquez, D. D., & Hodul, P. J. (2017). Does histology really influence gastric cancer prognosis?. Journal of gastrointestinal oncology, 8(6), 1026-1036.
  More info

  Gastric cancer (GC) is associated with poor survival despite curative-intent surgical resection and systemic therapy. Our objective is to examine the impact of histology on prognosis as well as the impact of linitis plastica (LP) on survival.
• Lee, S., Heinrich, E. L., Lu, J., Lee, W., Choi, A. H., Luu, C., Chung, V., Fakih, M., & Kim, J. (2016). Epidermal Growth Factor Receptor Signaling to the Mitogen Activated Protein Kinase Pathway Bypasses Ras in Pancreatic Cancer Cells. Pancreas, 45(2), 286-92.
  More info

  Epidermal growth factor (EGF) receptor (EGFR/HER1) is overexpressed in human pancreatic cancers. However, anti-EGFR therapy does not exhibit significant therapeutic activity with oncogenic K-ras mutation. We sought to assess the signaling relationship between EGFR and mutant K-ras, which is commonly detected in pancreatic cancer.
• Luu, C., Khushalani, N. I., & Zager, J. S. (2016). Intralesional and systemic immunotherapy for metastatic melanoma. Expert opinion on biological therapy, 16(12), 1491-1499.
  More info

  Immunotherapy has revolutionized the treatment of metastatic melanoma and dramatically improved patient outcomes. Ipilimumab, an inhibitor of cytotoxic T-lymphocyte antigen-4 (CTLA-4), was the first immunotherapeutic agent to demonstrate improved survival in advanced melanoma. More recently, other immune checkpoint inhibitors, including the programmed death-1 (PD-1) inhibitors pembrolizumab and nivolumab, have demonstrated efficacy in locally advanced unresectable and metastatic melanoma. In addition to systemically delivered immunotherapies, intralesional therapies such as talimogene laherparepvec (TVEC) play an important role in the treatment of locoregionally advanced and metastatic melanoma. Areas covered: This review provides an overview of the mechanisms behind immune checkpoint inhibitors. Clinical evidence of their efficacy is presented and discussion of new patterns of response and associated immune related adverse events associated with immunotherapy are provided. Expert opinion: Treatment options for locally advanced and metastatic melanoma are expanding with new developments in immunotherapy and immune checkpoint inhibitors. The utility of these novel therapies in the adjuvant setting is currently being explored. The ideal treatment of metastatic melanoma continues to be multimodal, combining systemic treatments, intralesional and regional therapies, surgery and radiotherapy to achieve optimal outcomes.
• Kim, J., Ko, M. E., Nelson, R. A., Arrington, A., Luu, C., Falor, A. E., Nissen, N. N., Colquhoun, S., Hurria, A., & Singh, G. (2014). Increasing age and survival after orthotopic liver transplantation for patients with hepatocellular cancer. Journal of the American College of Surgeons, 218(3), 431-8.
  More info

  Orthotopic liver transplantation (OLT) is the gold standard treatment for patients with early hepatocellular carcinoma (HCC). There are concerns about the efficacy of OLT for HCC in older patients, who we hypothesized might have poorer outcomes. Therefore, we sought to examine advanced age and its impact on OLT outcomes.
• Luu, C., Arrington, A. K., Falor, A., Kim, J., Lee, B., Nelson, R., Singh, G., & Kim, J. (2014). Impact of gastric cancer resection on body mass index. The American surgeon, 80(10), 1022-5.
  More info

  Major gastric resection alters digestive function and may lead to profound weight loss. The objective of our study was to evaluate trends in body weight loss after curative gastrectomy for malignancy. A review of patients who underwent gastrectomy from 1999 to 2012 at two institutions was conducted. Patient demographics and treatment were assessed. Student's t test and analysis of variance were used to compare groups. Of 168 patients, two patients (1.2%) were Stage 0, 73 (43.5%) Stage I, 46 (27.4%) Stage II, 45 (26.8%) Stage III, and two (1.2%) stage unknown. Fifty-eight patients (34.5%) underwent total gastrectomy with Roux-en-Y esophagojejunostomy and 110 patients (65.5%) underwent subtotal gastrectomy. The average per cent decreases in body mass index (BMI) postgastrectomy at one month, six months, 12 months, and 24 months were 7.6, 11.7, 11.5, and 11.1 per cent, respectively (P = 0.003). The decreases in BMI were the same for all time periods whether patients had subtotal or total gastrectomy. Weight loss after gastric cancer resection is an important measure of quality of life. By understanding patterns of weight change after gastrectomy, we can better counsel and prepare our patients for the long-term effects of gastric cancer surgery.
• Arrington, A. K., Nelson, R. A., Falor, A., Luu, C., Wiatrek, R. L., Fakih, M., Singh, G., & Kim, J. (2013). Impact of medical and surgical intervention on survival in patients with cholangiocarcinoma. World journal of gastrointestinal surgery, 5(6), 178-86.
  More info

  To examine surgical and medical outcomes for patients with cholangiocarcinoma using a population-based cancer registry.
• Arrington, A. K., Nelson, R., Patel, S. S., Luu, C., Ko, M., Garcia-Aguilar, J., & Kim, J. (2013). Timing of chemotherapy and survival in patients with resectable gastric adenocarcinoma. World journal of gastrointestinal surgery, 5(12), 321-8.
  More info

  To evaluate the timing of chemotherapy in gastric cancer by comparing survival outcomes in treatment groups.
• Falor, A., Arrington, A. K., Luu, C., Schoellhammer, H. F., Ko, M., Chow, W., D'Apuzzo, M., Park, J., & Kim, J. (2013). Massive intra-abdominal imatinib-resistant gastrointestinal stromal tumor in a 21-year-old male. Case reports in medicine, 2013, 373981.
  More info

  Gastrointestinal stromal tumors (GISTs) in adolescence are far less common than adult GISTs and have varied GIST genotypes that present diagnostic and therapeutic challenges. Here, we discuss a 21-year-old male with diagnosis of unresectable, imatinib-resistant GIST. At initial evaluation, a neoadjuvant treatment approach was recommended. As such, the patient received imatinib over the course of one year. Unfortunately, the GIST increased in size, and a subsequent attempt at surgical resection was aborted fearing infiltration of major vascular structures. The patient was then referred to our institution, at which time imatinib therapy was discontinued. Surgical intervention was again considered and the patient underwent successful resection of massive intra-abdominal GIST with total gastrectomy and Roux-en-Y esophagojejunostomy. Since pediatric GISTs are typically resistant to imatinib, we performed genotype analysis of the operative specimen that revealed KIT mutations associated with imatinib sensitivity and resistance. Given the sequencing data and operative findings, the patient was started postoperatively on sunitinib. This case illustrates the importance of understanding both adult and pediatric GISTs when implementing appropriate treatment regimens. Since the genotype of GISTs dictates phenotypic behavior, mutational analysis is an important component of care especially for adolescents whose disease may mirror the pediatric or adult population.
• Heinrich, E. L., Arrington, A. K., Ko, M. E., Luu, C., Lee, W., Lu, J., & Kim, J. (2013). Paracrine Activation of Chemokine Receptor CCR9 Enhances The Invasiveness of Pancreatic Cancer Cells. Cancer microenvironment : official journal of the International Cancer Microenvironment Society, 6(3), 241-5.
  More info

  Chemokine receptors mediate cancer progression and metastasis. We have previously examined chemokine receptor CCR9 expression in pancreatic cancer. Here, our objective was to evaluate pancreatic stellate cells (PSCs) as a source of CCL25, the CCR9 ligand, and as an activator of CCL25-CCR9 signaling in pancreatic cancer cells. CCL25 and CCR9 expression levels in human pancreatic cancer tissues and normal human pancreas were assessed by immunohistochemsitry. In vitro secretion of CCL25 in PSCs and PANC-1 cells was verified by enzyme-linked immunosorbent assay. Pancreatic cancer cell invasion was measured using a modified Boyden chamber assay with CCL25, PSC secreted proteins, and PANC-1 secreted proteins as the chemoattractant. There was immunostaining for CCR9 expression in human pancreatic tumor tissues, but not in normal pancreatic tissue. CCL25 expression was absent in the normal pancreatic tissue sample, but was observed in cancer cells and in the stromal cells surrounding the tumor. In vitro, both PANC-1 cells and PSCs secreted CCL25. In an invasion assay, exposure to CCL25, PSC- and PANC-1-conditioned media significantly increased the invasiveness of PANC-1 cells. Inclusion of a CCR9-neutralizing antibody in the invasion assay blocked the increase in invading cells elicited by the chemoattractants. Our studies show that pancreatic cancer invasiveness is enhanced by autocrine and paracrine stimulation of CCR9. PSCs in the tumor microenvironment appear to contribute to paracrine activation of CCR9. Investigations into CCR9 as a potential therapeutic target in pancreatic cancer must consider cancer cell autocrine signaling and also paracrine signaling from interactions in the tumor microenvironment.
• Luu, C., Arrington, A. K., Schoellhammer, H. F., Singh, G., & Kim, J. (2013). Targeted therapies in colorectal cancer: surgical considerations. Journal of gastrointestinal oncology, 4(3), 328-36.
  More info

  Colorectal cancer (CRC) is a leading worldwide health concern that is responsible for thousands of deaths each year. The primary source of mortality for patients with CRC is the development and subsequent progression of metastatic disease. The most common site for distant metastatic disease is the liver. Although patients with metastatic disease to the liver have several effective treatment options, the only one for cure remains surgical resection of the liver metastases. Historically, most patients with liver metastases have had unresectable disease, and only a small percentage of patients have undergone complete curative resection. However, improved systemic therapies have led to an evolution in strategies to treat metastatic CRC to the liver. Under most conditions the management of these patients remains complex; and as chemotherapy options and new targeted therapies continue to improve outcomes, it is clear that a multidisciplinary approach must be the foundation on which advanced surgical and medical techniques are employed. Here, in this review, we highlight the role of targeted therapies in the surgical management of patients with metastatic CRC to the liver.
• Luu, C., Goldstein, L., Goldner, B., Schoellhammer, H. F., & Chen, S. L. (2013). Trends in radiotherapy after breast-conserving surgery in elderly patients with early-stage breast cancer. Annals of surgical oncology, 20(10), 3266-73.
  More info

  The benefit of adjuvant radiotherapy (RT) in elderly breast cancer patients is debatable. The purpose of this study was to evaluate trends in RT rates after breast-conserving surgery.
• Luu, C., Heinrich, E. L., Duldulao, M., Arrington, A. K., Fakih, M., Garcia-Aguilar, J., & Kim, J. (2013). TP53 and let-7a micro-RNA regulate K-Ras activity in HCT116 colorectal cancer cells. PloS one, 8(8), e70604.
  More info

  Recent reports have indicated that KRAS and TP53 mutations predict response to therapy in colorectal cancer. However, little is known about the relationship between these two common genetic alterations. Micro-RNAs (miRNAs), a class of noncoding RNA implicated in cellular processes, have been increasingly linked to KRAS and TP53. We hypothesized that lethal-7a (let-7a) miRNA regulates KRAS through TP53. To investigate the relationship between KRAS, TP53, and let-7a, we used HCT116 KRAS(mut) human colorectal cancer cells with four different genotypic modifications in TP53 (TP53(-/-), TP53(+/-), TP53(mut/+), and TP53(mut/-) ). Using these cells we observed that K-Ras activity was higher in cells with mutant or knocked out TP53 alleles, suggesting that wild-type TP53 may suppress K-Ras activity. Let-7a was present in HCT116 KRAS(mut) cells, though there was no correlation between let-7a level and TP53 genotype status. To explore how let-7a may regulate K-Ras in the different TP53 genotype cells we used let-7a inhibitor and demonstrated increased K-Ras activity across all TP53, thus corroborating prior reports that let-7a regulates K-Ras. To assess potential clinical implications of this regulatory network, we examined the influence of TP53 genotype and let-7a inhibition on colon cancer cell survival following chemoradiation therapy (CRT). We observed that cells with complete loss of wild-type TP53 alleles ((-/-) or (-/mut)) were resistant to CRT following treatment with 5-fluorouracil and radiation. Further increase in K-Ras activity with let-7a inhibition did not impact survival in these cells. In contrast, cells with single or double wild-type TP53 alleles were moderately responsive to CRT and exhibited resistance when let-7a was inhibited. In summary, our results show a complex regulatory system involving TP53, KRAS, and let-7a. Our results may provide clues to understand and target these interactions in colorectal cancer.
• Luu, C., Lee, B., & Stabile, B. E. (2013). Choledochoduodenostomy as the biliary-enteric bypass of choice for benign and malignant distal common bile duct strictures. The American surgeon, 79(10), 1054-7.
  More info

  Choledochoduodenostomy (including hepaticoduodenostomy) for common bile duct (CBD) strictures has been underused because of concerns regarding postoperative duodenal fistula and cholangitis attending the so-called "sump syndrome." An institutional retrospective review of 55 consecutive choledochoduodenostomy procedures for CBD strictures from 1995 to 2011 was performed to examine its suitability as the biliary-enteric bypass procedure of choice. There were 30 male (55%) and 25 female (45%) patients with a mean age of 49 years (range, 13 to 73 years). Thirty-seven (67%) patients had benign CBD strictures and 18 (33%) had unresectable periampullary adenocarcinomas. Forty-nine (89%) underwent choledochoduodenostomy and six (11%) underwent hepaticoduodenostomy. There were no 30-day postoperative deaths, anastomotic leaks, or intra-abdominal abscesses. Five patients (9%) sustained Clavien Grade III or IV complications. Over a mean long-term follow-up of 29 months (range, 1 to 162 months), there was one anastomotic stricture successfully managed by endoscopic dilation and temporary stenting. Liver function tests in all other patients returned to and remained within normal limits. We conclude that choledochoduodenostomy is the preferred biliary-enteric bypass for both benign and malignant distal CBD strictures because of its ease, safety, and durability. Persistent fears of duodenal fistula and the "sump syndrome" are not warranted by the empiric data and should be abandoned.
• Reynolds, T. S., Luu, C., & Chauvapun, J. (2012). Tissue loss secondary to extrinsic compression of common iliac artery from uterine leiomyoma: a case report and review of the literature. Vascular and endovascular surgery, 46(1), 80-4.
  More info

  Uterine leiomyomas are commonly reported to cause deep venous thrombosis and rarely arterial compression.
• Seyedin, S., Luu, C., Stabile, B. E., & Lee, B. (2012). Effect of socioeconomic status on surgery for pancreatic adenocarcinoma. The American surgeon, 78(10), 1128-31.
  More info

  Survival for pancreatic cancer remains poor. Surgical resection remains the only chance for cure. The intent of this study was to investigate the role of socioeconomic status (SES) on resection rates for pancreatic adenocarcinoma. The National Cancer Institute's Surveillance, Epidemiology, and End results database was used to identify patients with pancreatic adenocarcinoma. Disease was deemed resectable or unresectable based on the extent of disease code. Median family income was used as a SES variable to compare patients who underwent resection with those who did not. Median family income was organized into three categories based on definitions from the national census: less than $34,680 (low income), $34,680 to $48,650 (middle), and greater than $48,650 (high income). A total of 5,908 patients with potentially resectable disease were included. A total of 3,331 patients did not have a surgical resection despite having resectable disease. Subgroup analysis of income status revealed that patients with a low or middle income were less likely to have a resection when compared with those with high income (33.0 vs 39.9 vs 45.8%, P=0.0001). Multivariate analysis revealed that low and middle SES and race were significant predictors of resection. Ongoing study of access to health care may help define the means to eliminate the disparities in the care of patients with pancreatic adenocarcinoma.