Lusine Mesropyan

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Journals/Publications

• Alexander, E. V., Galouzis, N., Wozniak, C., Fotinos, M., Mitchel, O., Mesropyan, L., Luu, C., Khreiss, M. R., & Riall, T. S. (2025). Association of Advanced Practice Providers Integration With Postoperative Outcomes in Pancreatic Surgery. Journal of Surgical Research, 311. doi:10.1016/j.jss.2025.04.043
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  Introduction: Complications after pancreatic surgery occur in 30%-50% of patients, with readmission rates reported up to 30%-40%. We integrated an Advanced Practice Provider (APP) into our pancreatic surgery team to identify postoperative issues early and improve continuity of care. We implemented an APP led structured follow-up protocol to explore if this was associated with readmission rates, length of stay (LOS), mortality, and failure-to-rescue (FTR) rates in patients undergoing pancreatic surgery. Methods: This single-institution, retrospective study included patients who underwent pancreatic resection from 2019 to 2024, categorized into pre-APP (January 2019–September 2022) and post-APP (January 2023–February 2024) groups. The goal was for the APP to evaluate all patients within 72 h of discharge. Outcomes included readmission rates, LOS, mortality, and FTR rates. Results: A total of 290 patients were included, with 191 in the pre-APP group and 99 in the post-APP group. The average age of the total cohort was 65.5 ± 13.4 ys with 57.2% undergoing a pancreaticoduodenectomy. Between groups, the post-APP group had lower Charlson-Comorbidity Index scores (3.8 ± 2.2 versus 4.6 ± 2.0, P < 0.01), surgery was more likely a minimally invasive approach (11.1% versus 4.7%, P = 0.04), and was more likely indicated for benign pathology compared to the pre-APP group (40.4% versus 19.9%, P < 0.01). In the post-APP group, 48.5% of patients were seen within 72 h, and when compared to the pre-APP group, patients had shorter index hospitalization LOS (6.9 versus 8.6 ds, P = 0.01), earlier first postoperative visits (4.9 versus 10.1 ds, P < 0.01), and the time to readmission after discharge was shorter (8.1 ± 5.8 versus 11.3 ± 5.7, P = 0.05). Although not significantly different, both 30-d mortality (1.0% versus 4.2%, P = 0.17) and FTR rates (1.6% versus 5.8%, P = 0.28) were lower in the post-APP group. Conclusions: Integration of an APP with a structured follow-up protocol was associated with earlier identification of complications, shorter LOS, and lower mortality.
• Alexander, E. V., Galouzis, N., Wozniak, C., Fotinos, M., Mitchel, O., Mesropyan, L., Luu, C., Khreiss, M. R., & Riall, T. S. (2025). Association of Advanced Practice Providers Integration With Postoperative Outcomes in Pancreatic Surgery. The Journal of surgical research, 311, 232-240.
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  Complications after pancreatic surgery occur in 30%-50% of patients, with readmission rates reported up to 30%-40%. We integrated an Advanced Practice Provider (APP) into our pancreatic surgery team to identify postoperative issues early and improve continuity of care. We implemented an APP led structured follow-up protocol to explore if this was associated with readmission rates, length of stay (LOS), mortality, and failure-to-rescue (FTR) rates in patients undergoing pancreatic surgery.
• Galouzis, N., Khawam, M., Alexander, E. V., Mesropyan, L., Luu, C., Khreiss, M. R., & Riall, T. S. (2025). Quality of life and social health in patients after pancreatic surgery. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract, 29(3), 101969.
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  Clinicians lack robust data on quality of life (QOL) and social functioning after pancreatectomy limiting their ability guide patient decision making aligned with patients' goals of care.
• Galouzis, N., Khawam, M., Alexander, E. V., Yallourakis, M. D., Mesropyan, L., Luu, C., Khreiss, M. R., & Riall, T. S. (2025). Decision regret and satisfaction with shared decision-making in pancreatic surgery. Journal of Gastrointestinal Surgery, 29(Issue 1). doi:10.1016/j.gassur.2024.10.025
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  Background: 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. Methods: This study administered the Brehaut Decision Regret Scale (DRS), 9-Item Shared Decision-Making Questionnaire (SDM-Q-9), and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) to all patients who underwent elective pancreatectomies from 2021 to 2023. Decision regret was defined as a DRS of >25. In addition, this study evaluated SDM-Q-9 responses in patients with and without regret. Results: A total of 143 patients were included in this study, of whom 71 patients (49.6%) completed the distributed surveys. Demographics, pathology, and major complication rates were similar between responders and nonresponders. The indications for surgery were malignancy (67.6%) and benign disease (32.4%). Decision regret after pancreatic surgery was reported in 18.3% of patients. Patients who experienced regret were younger (50.8 ± 18.7 years [younger group] vs 62.0 ± 14.9 years [older group]; P = .03), more likely to have benign disease (39.1% [benign disease] vs 8.3% [malignant disease]; P < .01), underwent a distal pancreatectomy (34.5% [distal pancreatectomy] vs 7.7% [pancreaticoduodenectomy]; P = .02), or experienced a major complication (36.8% [major complication] vs 11.5% [no major complication]; P = .03). Patients with regret had lower global health (57.1 ± 20.1 [patients with regret] vs 76.2 ± 22.2 [patients without regret]; P < .01) and social function scores (61.5 ± 31.5 [patients with regret] vs 77.6 ± 22.0 [patients without regret]; P = .03) on the EORTC QLQ-C30. Patients with regret were less satisfied with the shared decision-making process. Conclusion: Strong decision regret was reported in 18% of patients who underwent pancreatectomy. Younger age, distal pancreatectomy, benign indications, and major postoperative complications were associated with regret. Data from the SDM-9 highlight areas for potential improvement to help patients make decisions aligned with their goals of care.
• 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.
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  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.
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  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.
• Mesropyan, L. (2023). Sensitivity, Specificity of Vessel Involvement in Pancreatic Head Adenocarcinoma by Imaging Modality per Treatment Effect. International Journal of Surgery and Surgical Techniques.. doi:10.23880/ijsst-16000194
• Siddiqi, S., & Mesropyan, L. (2022). Perivascular epithelioid cell tumour-mimicking retroperitoneal leiomyosarcoma. BMJ case reports, 15(8).
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  A young man in his 40s was evaluated in the emergency department for abdominal and right flank pain. A CT scan of the abdomen and pelvis showed a solid, well-circumscribed lesion measuring 7.1×8.1×5.4 cm, which was arising from the retroperitoneum and extending from the third portion of the duodenum towards the right kidney. A percutaneous core biopsy was obtained, demonstrating an atypical smooth muscle neoplasm suggestive of a low-grade leiomyosarcoma. The patient underwent surgery for an en-block resection of the mass and the final pathology confirmed a perivascular epithelioid cell neoplasm without significant pleomorphism, mitosis or necrosis. Our case adds to the small number of perivascular epithelioid cell tumour cases reported in the literature and we present it in order to increase our understanding of this tumour and to assist in its appropriate diagnosis and management.
• Mesropyan, L., Urias, D., Cho, R., & Stark, O. (2019). Traumatic Blunt Rupture of Pulmonary Artery. The American surgeon, 85(9), e449-e451.
• Urias, D., Silvis, J., Mesropyan, L., Oberlander, E., Simunich, T., & Tretter, J. (2017). Retrievable inferior vena cava filters in geriatric trauma: Is there an age bias?. Injury, 48(1), 148-152.
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  Trauma patients are at increased risk for developing venous thromboembolic (VTE) disease. The EAST (Eastern Association for the Surgery of Trauma) practice management guidelines identified risk factors for VTE, as well as indications for prophylactic inferior vena cava filters (IVCF). In a 2009 study, our institution found a 26% retrieval rate for IVCF. Lack of retrieval was most consistently due to lack of follow-up. Our study is a follow-up analysis for retrieval rate of IVCF, since the formation of a geriatric trauma service. We anticipated that geriatric trauma patients would have a lower rate of IVCF retrieval compared to the general trauma patient.
• Han, D., Ybanez, M. D., Johnson, H. S., McDonald, J. N., Mesropyan, L., Sancheti, H., Martin, G., Martin, A., Lim, A. M., Dara, L., Cadenas, E., Tsukamoto, H., & Kaplowitz, N. (2012). Dynamic adaptation of liver mitochondria to chronic alcohol feeding in mice: biogenesis, remodeling, and functional alterations. The Journal of biological chemistry, 287(50), 42165-79.
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  Liver mitochondria undergo dynamic alterations following chronic alcohol feeding to mice. Intragastric alcohol feeding to mice resulted in 1) increased state III respiration (109% compared with control) in isolated liver mitochondria, probably due to increased levels of complexes I, IV, and V being incorporated into the respiratory chain; 2) increased mitochondrial NAD(+) and NADH levels (∼2-fold), with no change in the redox status; 3) alteration in mitochondrial morphology, with increased numbers of elongated mitochondria; and 4) enhanced mitochondrial biogenesis in the liver, which corresponded with an up-regulation of PGC-1α (peroxisome proliferator-activated receptor γ coactivator-1α). Oral alcohol feeding to mice, which is associated with less liver injury and steatosis, slightly enhanced respiration in isolated liver mitochondria (30.8% compared with control), lower than the striking increase caused by intragastric alcohol feeding. Mitochondrial respiration increased with both oral and intragastric alcohol feeding despite extensive N-acetylation of mitochondrial proteins. The alcohol-induced mitochondrial alterations are probably an adaptive response to enhance alcohol metabolism in the liver. Isolated liver mitochondria from alcohol-treated mice had a greater rate of acetaldehyde metabolism and respiration when treated with acetaldehyde than control. Aldehyde dehydrogenase-2 levels were unaltered in response to alcohol, suggesting that the greater acetaldehyde metabolism by isolated mitochondria from alcohol-treated mice was due to increased mitochondrial respiration that regenerated NAD(+), the rate-limiting substrate in alcohol/acetaldehyde metabolism. Overall, our work suggests that mitochondrial plasticity in the liver may be an important adaptive response to the metabolic stress caused by alcohol intake and could potentially play a role in many other vital functions performed by the liver.

Presentations

• Mesropyan, L. (2025).

  Locally Advanced Pancreatic Cancer

  . 2nd Annual HPB Symposium, University of Arizona.
• Mesropyan, L. (2025).

  Management of the Incidentally Identified Gallbladder Cancer

  . Arizona Chapter ACS Annual Meeting.

Reviews

• Naser, Z. J., & Mesropyan, L. (2023. Peri-Hilar Cystic Lymphangioma Mimicking a Biliary Cystic Lesion Causing Biliary Obstruction: A Case Report and Literature Review(pp e939421).
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  BACKGROUND Lymphangiomas are rare and benign malformations of the lymphatic system. The presentation of intra-abdominal lymphangiomas, especially from within the hepatoduodenal ligament, is rare in the adult population. In this report, we examine a lymphangioma within the hepatoduodenal ligament resulting in biliary obstruction. CASE REPORT A 62-year-old man with surgical history of cholecystectomy presented to the hepatobiliary clinic for a peri-hilar cystic lesion identified on surveillance magnetic resonance imaging (MRI). The patient's MRI revealed a 5.5-cm cystic lesion at the peri-hilar region, likely arising from the biliary tree, which had been increasing in size and causing biliary dilatation. The patient underwent an endoscopic ultrasound, showing a 4.3×2.2 cm cystic structure likley arising from the cystic duct stump with internal septation. An endoscopic retrograde cholangiopancreatography (ERCP) was performed and demonstrated no communication between the biliary tree and the cystic lesion. Given the uncertain etiology of the lesion and its obstructive nature, the patient was moved to the operating room for a complete excision. A well-encapsulated cystic lesion was identified between the cystic duct and the common hepatic duct, which did not communicate with the biliary tree. Pathology confirmed the diagnosis of lymphangioma with features of vascular channel proliferation in the background of fibrotic stroma and lymphoid aggregates. The vascular channel proliferation demonstrated positive immunohistochemical staining for D2-40. At 3-year follow-up, there was no evidence of post-resection recurrence. CONCLUSIONS This case represents an acquired lymphangioma occurring as a sequela of cholecystectomy, likely caused by interruption of the lymphatic drainage system secondary to surgical manipulation.